Early detection of Parkinson’s via AI (and a surprising medium); Ed Marx on the digital transformation (or not) of health systems and COVID treatment at home

Somewhat off our normal beat….but of interest.

Ardigen and The BioCollective are collaborating on early detection research for Parkinson’s Disease, based on a microbiome-based biomarker. Ardigen has developed an Artificial Intelligence (AI) Microbiome Translational Platform. The BioCollective has a bank of metagenomic and patient metadata generated from an unexpected source: Parkinson’s patients’ stool samples. Release

The BioCollective is headed by Martha Carlin, who came from well outside of healthcare and pulled together a research group to address her husband’s diagnosis. A visit to this website is worth an examination on how these samples are collected for microbiome extraction. An interesting twist is the marketing of a probiotic mix developed using their BioFlux metabolic model for ‘gut health’.

Ed Marx, the former CIO of the Cleveland Clinic, has written a new book, ‘Healthcare Digital Transformation: How Consumerism, Technology, and the Pandemic are Accelerating the Future’. It’s billed as a wake-up call for healthcare systems and hospitals under challenge by Big Retail, Big Pharma, and Big Tech. This Editor met Mr. Marx when he premiered his entertaining memoir, ‘Extraordinary Tales from a Rather Ordinary Guy’, a few years ago. On treatment for COVID patients, except for the very sickest, he advocates it being done from home. From the release: “When the pandemic hit, a lot of progressive organizations would send most of their Covid patients home with monitoring equipment hooked up to phones unless they needed a ventilator. It’s a lot cheaper than staying in the hospital.”

News roundup: Amazon Pharmacy–retail, GoodRx threat, 81% of healthcare workers have remote IT issues, Epicor installs in Australia care homes, GrandCare for developmentally disabled adults

Rounding up lots of dogies here!

Amazon, to no one’s surprise, has formally entered the US pharmacy business with Amazon Pharmacy which can fill prescriptions for most common medications. There is a whole process of course to sign up (at right), and a separate program for Amazon Prime customers with discounts on Amazon Pharmacy with two-day delivery, PillPack, and at 50,000 pharmacies in 45 states. The Prime program is administered by Inside Rx, a subsidiary of Evernorth/Cigna.

Mr. Market downgraded pharmacy retailers CVS and Walgreens Boots stocks, again unsurprisingly. It isn’t just brick ‘n’ mortars feeling the heat; heavily advertised drug price comparison platform (lumped into ‘digital health’) and recent IPO winner GoodRx took a 20 percent hit as Amazon Prime also discounts, comparable to GoodRx Gold. The GoodRx network is about 70,000 pharmacies, including the largest retailers. Fierce Healthcare. Big hat tip to Jailendra Singh at Credit Suisse Equity Research for these analyses on Amazon Pharmacy and GoodRx.

81 percent of healthcare workers experience issues with systems and technology used in external care, out visiting and caring for patients, according to a ‘State of Mobility in Healthcare’ multi-national study (email signup required) by business mobility development company SOTI. 64 percent of UK healthcare workers (63 percent overall) are ripping out what is left of their hair due to IT/technology glitches leading to system failures within a normal working week. Only a quarter of respondents said that their systems were able to cope with COVID-19. Based on the Healthcare IT News EMEA edition article, UK respondents apparently reported a higher level of IT problems affecting their work. The bright spot is that 68 percent of UK healthcare workers/55 percent overall agree that investment in new or better technology could help save lives. The study had respondents in the US, Canada, UK, Germany, Sweden, France, and Australia.

Speaking of software, Epicor, a US-based software company, is providing to two Australian care home groups their Community Care workflow and information platform: Finncare, which is associated with services to the Finnish and Scandinavian communities, and MannaCare in the Victoria area. Healthcare IT News Australia

One of the Ur-companies (2005!) in the senior health monitoring sector, GrandCare Systems, announced that they are working with LADD, a Cincinnati Ohio-based non-profit that supports adults with developmental disabilities. LADD’s project, the Heidt Smart Living Home, will incorporate GrandCare’s communication, cognitive assists, telehealth, and social engagement tools, as well as innovations in accessibility, lighting, and sensory control, for residents. Release Hat tip to CEO Laura Mitchell via LinkedIn.

News roundup: Pfizer’s COVID-19 vaccine on horizon, CVS’ new CEO, Vodafone UK 5G health survey, Centene acquires Apixio AI, Doro’s 24/7 Response

As infection rates continue to rise, Pfizer’s and German partner BioNTech SE’s COVID-19 vaccine was the top of the news this undecided post-US election week. It was found to be “more than 90 percent effective in preventing COVID-19 in participants without evidence of prior SARS-CoV-2 infection in the first interim efficacy analysis” of the Phase 3 clinical study. They exceeded their evaluable case count (total was 94). Protection was achieved 28 days after the initiation of the 2-dose vaccination. Pfizer release. Chain and independent pharmacies have already signed on for distribution at no cost to patients, covering about 60 percent of pharmacies through the US, Puerto Rico, and the USVI. It’s expected that FDA approval will be by end of year with availability early next year. HHS release. Work on 10 other vaccines goes on. The NHS is lining up for distribution with Health Secretary Matt Hancock promising that they’ll be ready from December as coronavirus diagnoses and deaths climb up from summer levels. BBC News

CVS’ CEO Larry Merlo announces 1 Feb 2021 retirement, Aetna head Karen Lynch to take the helm. Ms. Lynch will also join the board of directors. Mr. Merlo will depart after the shareholder meeting and serve as a strategic adviser until 31 May, which is typical of CEO phased departures. He leaves CVS in excellent shape having conducted during his 10-year tenure the acquisition of Aetna in 2018 and the growth of CVS to almost 10,000 store locations, initiating 1,500 HealthHUBs, and over $199 bn in earnings through Q3 this year. Ms. Lynch joined Aetna in 2012 from Magellan Health Services, a specialty/behavioral managed health company, and Cigna. She hit a home run with vitalizing Aetna’s Medicare Advantage business to 2.5 million members from under 1 million in 2013 and became Aetna’s president in 2015. Mark Bertolini, Aetna’s CEO during the merger in 2018 (but not Federally approved till September 2019), lost his spot on the board in an apparent spat/downsizing last February.  FierceHealthcare, Healthcare Dive, Fortune

Vodafone UK’s new survey on 5G and Internet of Things (IoT) devices in UK health and social care has been issued. A key finding is the comfort level of some telehealth consults well past 50 percent, and over 60 percent in the 18-34 and 35-54 age groups. There is 60-70+ agreement with Government investment in digital technology to ‘future proof the UK healthcare sector’ and to pay for care homes’ high-quality broadband and mobile. More in Vodafone’s study here.

Healthcare payer Centene Corporation is acquiring healthcare analytics company Apixio. Apixio’s AI platform analyzes large amounts of unstructured patient data in physician notes and medical charts. It then creates algorithms to extract high-quality insights to support payers’ and providers’ administrative activities. Acquisition cost is not disclosed and close is expected by end of year. It will be an ‘operationally independent entity’ in an Enterprise group, but complement other in-house technologies such as Interpreta. A bit of catch up here as larger plans Anthem, UnitedHealth/Optum, and Humana all have either substantial in-house AI analytics or have contracted with outside vendors (e.g. Microsoft) for this capability. Release. (Disclosure: This Editor was formerly with Centene, via their WellCare Health Plans acquisition)

Doro Mobile UK and Ireland is introducing ‘Response by Doro’, a touch button service to summon help if needed. The alert button is on the back of the phone versus on the screen, which differs it from most mobile systems. The standard level connects to family and friends, with the Response Premium level connecting to a 24/7 service. For BT Mobile and EE mobile customers with a Doro mobile phone, their first month’s access to Response Premium is free. Release (PDF)

Shock news: a very muted HIMSS 2021 set for 9-13 August, Las Vegas

Yes, Virginia, there will be a HIMSS21, of sorts, we think. The news of a HIMSS21 in Las Vegas next August (when it will be 110° in the shade) is like the forecast of rain for this parched-of-business convention city and the parched-of-contact health tech community. The basics, mostly from the FAQ:

  • Registration will open in January (date TBD). If you paid your registration for the canceled 2020 conference, your registration will automatically be carried over to the 2021 conference, with details to come. If you cannot attend, no refunds.
  • Programming, exhibits, and events will be held at the Venetian-Sands Expo Center, Caesars Forum Conference Center, and Wynn 
  • The program and topics are sketched in (see the website dropdowns).
  • Proposals for the education track are closed, but open till mid-January for the optional events.  

Exhibitor registrations and paid badges will be carried over (unless you don’t plan on exhibiting, then again, no refunds). For whatever reason, the exhibit floor will be worthy of a Woman’s Christian Temperance Union (WCTU) convention in Des Moines, based on the published rules:

  • NO SOLICITING OUTSIDE THE CONFINES OF YOUR BOOTH (replicating their capitals, including hotels–what fun is this?)
  • All demos and promo activities must be performed five feet set into your booth space. It’ll get cozy for the small, poor exhibitors in a 10 x 10! In fact, straying outside your booth for anything is apparently prohibited.
  • No megaphones, loudspeakers, or what is quaintly called ‘sideshow’ tactics, for instance, clowns, whistles, or high school marching bands in the aisle. Noise must be less than 75db. If there are speakers, they must face into the booth–and better be small.
  • Tchotchkes must have logos on them, so no running out for brand-name candy needed to fuel a looong floor day
  • You have to stay in your booth during exhibit AND non-exhibit hours. (I guess this means no food, event attendance, bathroom breaks–or scoping out/chatting up the competition, a key activity at any trade show.) And don’t wear lights or signage of any type on your clothes.
  • Speaking of clothes, they’re NOT optional–tops and bottoms required. At all times. Even though it’s HIMSS. And Las Vegas.
  • No cameras or video equipment on the floor. (I guess this means you can’t shoot reference pictures, booths you like, or cute videos to share on your blog, Twitter feed, and LinkedIn. Sounds like a closed shop for HIMSS Media.)
  • Exhibitors must use the official booker (onPeak), or you can lose your badges and booth. No economizing! Rough on the small, poor companies.
  • “Event Participants are expected to behave responsibly and to treat each other – and treat the community – with respect, kindness, and compassion.” If you don’t, you lose Exhibitor Points. (No comment!)

This Editor wonders that with all these restrictions and the mid-summer timing, how many exhibitors will simply walk away from HIMSS21 and its high expense? Or wait till March 2022 in Orlando? After all, 2020 booth expense was in last year’s budget and written off. Is going to HIMSS worth it to you?  Hat tip to HISTalk.

Discovering ways to non-invasively early detect COVID-19 from heart rate, sleep, or a cough sound, even among the asymptomatic

Heart rate, sleep quality, daily movement–cough sound frequency? Several studies in the US and UK are attempting to turn up ways to early diagnose mildly symptomatic, asymptomatic, or even pre-symptomatic COVID-19 cases, without the PCR swab or a blood test.

The more obvious of the two comes out of the Scripps Research Translational Institute. The DETECT study started in March (!) with 30,500 participants sending in data in the first six weeks of the study on heart rate, sleep quality, and daily movement. This information was then matched with self-reported symptoms and diagnostic tests taken if any. In this way, new infections and outbreaks could be detected at an earlier stage.  The study is attempting to confirm if changes in those metrics in an individual’s pattern can identify those even at a pre-symptomatic or asymptomatic stage. 3,811 reported symptoms, 54 reported testing positive, and 279 negative for COVID-19. The numbers seem small, but the analysis carries out that the combination of sensor and symptom data performed better in discriminating between positive and negative individuals than symptom reporting alone. The symptom data were taken from Fitbits and any device connected through Apple HealthKit or Google Fit data aggregators, then reported on the research app MyDataHelps. FierceBiotech, Nature Medicine (study)

Also using vital signs, back in August, Fitbit released early data on a 100,000+ study where changes in heart rate and breathing could detect about half of diagnosed cases at least one day to a week before diagnosis. Symptomatic cases were 1,100 in this sample. Heart rate and breathing were detected to become more frequent in the symptomatic, with the variability in time between each heartbeat dropping, resulting in a more steady pulse. The preferred tracking was at night during rest. However, there was a 30 percent false positive rate on the algorithm used, which is extremely high. FierceBiotech Related to this work, Fitbit was selected at the end of October by the US Army Medical Research and Development Command (USAMRDC) to receive nearly $2.5 million from the US Department of Defense through a Medical Technology Enterprise Consortium (MTEC) award to advance a wearable diagnostic capability for the early detection of a COVID-19 infection. Fitbit will be working with Northwell Health’s Feinstein Institutes for Medical Research to validate their early detection algorithm. Business Wire

And what about that ‘Covid Cough’? MIT is researching that this cough is different than other coughs, like from cold or allergy. Their research found that there’s a difference in the sound of an asymptomatic individual’s cough–and that sound frequency difference could not be heard by human ears. (Dog ears perhaps?) MIT researchers created “the largest audio COVID-19 cough balanced dataset reported to date with 5,320 subjects” out of 70,000 cough samples. The algorithm performed well. “When validated with subjects diagnosed using an official test, the model achieves COVID-19 sensitivity of 98.5% with a specificity of 94.2% (AUC: 0.97). For asymptomatic subjects it achieves sensitivity of 100% with a specificity of 83.2%.” This sure sounds like an AI screening tool that is inexpensive and convenient to use with multiple populations even daily. IEEE-EMB  BBC News reports that similar studies are taking place at Cambridge University, Carnegie Mellon University, and UK health start-up Novoic. The Cambridge study used a combination of breath and cough sounds and had an 80 percent success rate in identifying positive coronavirus cases from their base of 30,000 recordings.

All of these will be useful, but still need to be validated–and that takes time, for which this Editor thinks is short as this virus, like others, will eventually 1) mutate out or 2) be effectively treated as we do with normal flus. But down the road, these will serve as a template for new ways for early screening or even diagnosis of other respiratory diseases.

Bexley, Wandsworth Councils onboarding remote monitoring, video calls with COVID-19 the spur (UK)

With Round 2 of the pandemic hitting the UK (and rising rates in EU and also parts of the US), it’s timely that borough councils have already stepped up their efforts to extend home monitoring and connectivity to the most vulnerable older adults and disabled. Here’s a short roundup:

  1. The London Borough of Bexley has been working with Docobo to install their DOC@HOME technology to connect residents with their GP to manage their health and well being at home. DOC@HOME connects with the patient via tablet (Android) tablet, computer, Docobo TV, or smartphone to their clinical teams to enroll, set up, and manage their patients using Docobo’s reporting platform. This version of DOC@HOME used two types of question sets: to set up a doctor consult requested by the resident or staff member and to conduct monthly wellness checks. The pilot was completed with one care home with these results (2019 vs 2018 same period): 71 percent fewer visits by GPs to the care home, and 36 percent fewer visits by residents to A&E. Bexley is now rolling out to 20 care homes using an NHS Digital pathfinder grant. Later plans will be rollout to individual homes.
  2. The Bexley Council is also piloting another Docobo product, ARTEMUS, a risk stratification platform, with the Bexley Clinical Commissioning Group (CCG) to create an analytics and decision support platform to support a more holistic approach to health and wellbeing at the individual level. Risk stratification at its most essential level uses data to classify residents or patients at their level of health risk (multiple chronic conditions) with the objective of mitigating long-term escalations in care needs and emergencies and integrate support, particularly to integrate support for those with dementia. 1 and 2 from NHS AI Lab Hat tip to Adrian Flowerday of Docobo for his LinkedIn post.
  3. Wandsworth Council is working with Alcove to provide the Carephone tablet to their residents who receive a care or support package. The Carephone enables them to make video calls with family, friends, care workers, and other approved service providers. Wandsworth Council article.

Further information on Tunstall’s reorganization

At the end of our 8 October article, we noted that Tunstall Group Holdings was purchased by a Jersey-based group. It is a registered private company listed as Tunstall Integrated Healthcare Holdings Limited, registered in St Helier on 31 July. Its previous name, which may be found in the Companies House reports, was Don Jersey Topco Limited. JFSC Companies Registry, OpenCorporates

Tunstall Healthcare Group Limited, which we noted had not filed a report by the 30 September deadline, now links to a new company name on Companies House, Exdon 1 Limited. The board voted for liquidation on 30 September, to be wound up by Cork Gully LLP at Snow Hill, London (PDF link). Liquidation will shift any assets or debts to other companies. The other pertinent document is a declaration of solvency (PDF link). There are several Exdons (CH link) with the Cork Gully address (not the ones in Devon) with Exdon 1-4 being liquidated. Balance sheets are included in the solvency declarations, with Exdon 3 having the most substantial list for redistribution.

Shareholder lists may be of interest to those in the industry. Barings is of course included on the shareholder votes for liquidation but so is the Bill and Melinda Gates Foundation (!). Once again, hat tip on the reports to a Reader in the UK industry who wishes to remain anonymous.

Breaking: Teladoc and Livongo close merger in $18.5 billion deal, staff/board changeovers

Breaking: Today (30 October) Teladoc announced the closing of its merger with Livongo. The release itself is pro forma. The acquisition is interesting in how rapidly it was completed: from ‘git to gone’ in under three months. By contrast, Teladoc’s close on much smaller InTouch Health took eight months. It is, of course, still positioned as a merger, but it is clearly a purchase based on the terms and their branding. (More of Editor Donna’s thoughts on this here and here.) 

Livongo shareholders will receive 0.5920 Teladoc shares plus cash of $11.33 for each Livongo share (including the special dividend declared by Livongo). The Motley Fool did the math and valued it at $18.5 million after the shareholder approval. Current Teladoc shareholders will own 58 percent, with Livongo investors holding 42 percent. Mr. Market continues to be cross, as the day started with TDOC above $215 with the current price (1pm Eastern time) at just above $197, though Teladoc’s 3rd Q earnings were excellent. TDOC’s share price just before the acquisition hovered in the $230s.

This Editor has already noted the reported exodus of many of Livongo’s top management, presumably to the bank: CEO Zane Burke, President Jennifer Schneider, MD, CFO Lee Shapiro (widely conceded as the merger engineer), and SVP of business development Steve Schwartz. David Sides, Livongo’s COO, and Arnnon Geshuri, Cheif (sic) Human Resources Officer, retain their same position as at Teladoc. According to their latest (29 Oct) 8-K, new members of the board effective 19 November will include Glen Tullman (formerly Livongo Executive Chair), Chris Bischoff (Kinnevic AB), Karen L. Daniel, Sandra Fenwick, and Hemant Taneja (General Catalyst, of which more follows).

MedCityNews detailed the above plus that R&D will be headed on an interim basis by Yulun Wang, PhD, who came over from InTouch. Also, a number of Livongo execs (Glen Tullman, Schneider, and three other managers) are putting their new wealth to work for their futures with General Catalyst’s Hemant Taneja, a Livongo backer. An S-1 was filed on 19 October to create a new special-purpose acquisition company with the goal of raising $500 million. Commonly dubbed a ‘blank-check’ company, a SPAC is a public company designed to quickly take a private company public versus the slower process of an IPO. Recent healthcare examples have been Hims Inc. and SOC Telemed

Livongo’s website as to management is already updated and cut over. The Teladoc site does not have a Livongo page other than on press releases and a landing page here. Much remains to be seen in this consolidation of telemedicine and monitoring/coaching, including whether the combined company can deliver on much-needed profits.

Perspectives: How Advanced Communications Technology Has Created A ‘New Normal’ In Healthcare

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today, we have a contribution from Dave O’Shaughnessy, Avaya’s Healthcare Leader for EMEA and APAC, with a brief discussion of how AI and advanced communications technology can help healthcare in the long term. (It’s hard to say ‘a post-COVID world as France and Germany are experiencing second round lockdowns, and UK may not be far behind.) Interested contributors should contact Editor Donna. (We like pictures and graphs too)

Across industries, we see working patterns being transformed to create the ‘new normal’ as a result of COVID-19 and our reactions to the pandemic. The healthcare sector has been no different. The pandemic and its restrictions have brought a great number of new challenges to healthcare systems. And as has been the case across so many other sectors, communications technology has stepped in to plug the gaps caused by the pandemic.

The good news is that, not only have communications solutions successfully plugged the gaps, but they’ve also provided a blueprint for the future of healthcare. As we’ve found in other industries, we’ve actually seen the intelligent adoption of this technology lead to better experiences for patients, and better outcomes for providers, than were present before.

The most important (and immediate) area where this is most obvious is in contact tracing – tracking the physical, interpersonal interactions of those who have tested positive for COVID-19. This helps identify people who may need to be quarantined more quickly, therefore reducing the spread of the virus.

Helping government and healthcare organizations across the world with their contact tracing efforts, what we’ve found is that the most effective contact tracing efforts make use of artificial intelligence and automation. After all, the effort involves mountains of meticulous information gathering and analysis—all required to meet standards set by global health and government agencies. Acting upon that data manually just isn’t feasible, given the immediate needs at hand.

Therefore, the best systems employ AI virtual agents for initial patient contact, as well as for the simple data collection interactions – only falling back to live agents when the interaction becomes more complex. AI is also employed to deliver cloud-based, proactive notifications to automatically reach out to individuals or groups with optional response tracking, text interaction, and auto-forms to capture critical information.

Patients benefit from a smoother experience while providing the tracing information required, while healthcare providers and governments are able to collect more information with the resources they have.

Even without these focused AI technologies, however, our customers are putting their advanced contact centers to good use in combating the pandemic. In Saudi Arabia, for instance, one medical facility adopted a multi-experience approach, making it easy for patients to get the COVID-19-related information they need through a wide range of communications channels. This provided demonstrated results for improved knowledge on coronavirus safety measures in the community.

Going forward, we see tremendous use cases for extending this technology to make it easier for patients to directly engage with their doctors through asynchronous messaging. Such capabilities are of particular interest to mental health providers, who have found themselves unable to conduct in-person therapy sessions in the face of increased demand.

All of these solutions were implemented because of specific, pandemic-related challenges. But once the pandemic subsides, they’ll continue providing value, making it easier for patients to consume healthcare services, while delivering increased efficiency for providers.

Hat tip to Mary Burtt of AxiCom UK

Telemedicine office visits versus in-person recede to 6%, concentrating in behavioral health. Will the gains hold?

Has the telehealth wave receded to a ‘new normal’ tide? An updated Commonwealth Fund/Phreesia/Harvard University study, including data through 4 October, confirms that we are far past the point of telemedicine dominance of the office visit. Office visits to providers have largely returned to the 1-7 March baseline and even slightly above for ages 6 and above. But telemedicine visits, from their high in this study of 13.9 percent on 18 April during the peak of the COVID-19 pandemic, have continuously dropped and have leveled off to 6.3 percent. (Telemedicine here includes both video and telephonic visits; the sample is 50,000 providers that are Phreesia clients.)

To put this in proper perspective, the pre-pandemic baseline of telemedicine in practice use was an infinitesimal .1 percent.

Larger organizations use more telemedicine than smaller ones. Primary care practices with 6 or more physicians in the group account for 9.4 percent of telemedicine visits, while practices of 1 to 5 physicians account for 4.3 percent.

Even so, by September, only 9 percent of practices were heavy users (20 percent +) of telehealth, compared to 35 percent in April. Minimal use (5 percent or less) moved up to 39 percent. One-third never used telemedicine at all–did they shut down completely?

For those seeking to segment the overall telehealth market, the chart detailing telemedicine in visits to medical specialists is of interest. It confirms the anecdotal information this Editor has heard that telehealth remains highly popular and used in behavioral health (psychiatry)–41 percent of visits. By comparison, the next most popular are rheumatology and endocrinology at 14 percent of visits. The pandemic apparently has forever changed the mental health visit and acceptance of non-face-to-face delivery, with interesting (isolating?) consequences for both patients and doctors.

crystal-ballCan telehealth hold this gain, and develop from this base? What will it look like for the average practice? Pay the lady with the crystal ball! CMS will eventually roll back the waivers on usage of non-HIPAA platforms such as Facetime (appropriately so for security and privacy reasons). Reimbursement by Medicare and commercial plans will be a major hot button. A recent survey of health system executives presented at the HLTH virtual conference indicated yawning uncertainty at the top level:

  • 30 percent of respondents said they were unsure what their plans are if telehealth reimbursements return to pre-COVID levels
  • 13 percent said they’d return to face-to-face visits
  • 20 percent said they’d continue doing virtual visits regardless
  • 17 percent said they’d analyze the financial viability of continued use

(Nokia-UPMC Center for Connected Medicine and Klas Research, Healthcare Dive)

More on this: The hazy post-pandemic future of telehealth and From back-to-work to telehealth to retail rebranding: HLTH 2020 takeaways   

Previously: As practices reopen, telemedicine visits continue to plunge from 69% to 21%: Epic (September), COVID effect on US practices: in-person visits down 37%, telehealth peaks at 14% (Commonwealth Fund through July)

News roundup: Kaiser/Best Buy Lively partners; Teladoc’s mental telehealth, Livongo execs depart; approved apps make comeback in US, DE; United Airlines tests COVID CommonPass for international flying

Kaiser Permanente is adding to its existing partnership with Best Buy Health. The joint program will develop remote patient-monitoring tools for older adults centered on Lively Mobile Plus. By pressing a button on the phone, users can connect with individuals trained to triage emergency and nonemergency situations, from car trouble, home lockouts, or medical emergency. Kaiser Permanente has rolled it out to their Medicare members as part of its Medicare Affinity Program for independent living at home. In 2019, the Kaiser system piloted Lively Mobile Plus after Best Buy’s acquisition of GreatCall. Becker’s Hospital Review 6 October and 22 October. Photo from Best Buy via Kaiser on Twitter, @aboutKP.

Teladoc launches mental telehealth to Canadian employers. Four Livongo C-levels will depart after closing. The Teladoc Mental Health Care program is available to employees of Canadian companies and provides access to psychiatrists, psychologists, and therapists via phone, web or mobile app. It is in addition to Teladoc’s Mental Health Navigator and disability products in Canada. Press release, Becker’s Hospital Review  Becker’s has also been keeping a close eye on Teladoc’s SEC filings. The letter, filed 15 October, stated that Livongo CEO Zane Burke, President Jennifer Schneider, MD, CFO Lee Shapiro (widely conceded as the merger engineer), and SVP of business development Steve Schwartz will leave the company after the closing. Livongo’s Executive Chair Glen Tullman will keep his seat on the combined company’s board of directors. Look for more changes that won’t make Livongo employees happy. Our previous Skeptical Takes on the merger here.

Approved Apps Revive! The American Telemedicine Association (ATA) announced a new partnership with the UK’s ORCHA–the Organisation for the Review of Care and Health Apps–to develop an approval procedure for health apps. Announced at the virtual HLTH conference, the objective is to create a review process to vet safe and effective health apps out of various app stores. ORCHA’s automated, intelligent review engine can assess thousands of apps against more than 300 measures in order for a healthcare organization to build and manage a health app program. Both are trying to solve the same problem faced by Happtique and IMS Health (now IQVIA) in those long-ago days of 2014. ATA release, Healthcare IT News 

For Readers with long memories, iMedical Apps is still with us and their team is still reviewing health apps both personal and professional. They’ve extended their reach to reviewing apps to prescribe with iPrescribeApps.

Meanwhile, in Germany, the Digital Healthcare Act (DVG) now finally permits doctors to officially prescribe apps to patients. The Federal Institute for Drugs and Medical Devices (BfArM) certified Kalmeda for tinnitus and Velibra, a therapy program for anxiety disorders as Germany’s first two insured health apps. Germany also is kick-starting prescribed health apps through fast-tracking medical apps that are CE-marked as Class 1 and 2a low-risk medical devices. Healthcare IT News

United Airlines is testing an app-based ‘health pass’ to speed safer global travel. CommonPass, created by the Commons Project Foundation and the World Economic Forum to enable travelers to securely share their COVID-19 test status, taken 72 hours before flight, across borders. The app will also facilitate a health declaration that may be required by the destination country and generates a quick response (QR) code scannable by airline staff and border officials. UAL’s London-Newark test follows on a test with Cathay Pacific between Hong Kong and Singapore. FierceHealthcare, MarketWatch

Weekend reading: contact tracing in assisted living/LTC facilities via sensor-based ADL technology raises ethical issues

Contact tracing for COVID-19 is still ‘not quite there’ in many countries, especially those countries like the UK which had created centralized models and were slow to move to the decentralized systems based on Apple and Google’s APIs, the (Gapple? AppGoo?) Exposure Notification system now in use in Ireland and Germany. For the most vulnerable in assisted living, who aren’t using smartphones that ping adjacency to other smartphones and are moving around most of the time within the residence, other approaches have been developed. Already in place in many communities are sensor-based trackers for activities of daily living (ADLs) for both safety and predictive health analytics, as well as provide conveniences such as apartment entry for residents.

As we noted in July, a number of ADL and location trackers have repurposed themselves into highly accurate contact tracers since they retain the history of resident and staff movement. Profiled are CarePredict (ADLs), ZulaFly (location tracking), and CenTrak (location tracking). Residents in many facilities with these systems are early adopters of contact tracing, even if they don’t know it.

While the article is detailed and fairly laudatory about how these systems can assist residents and staff in arresting the spread of COVID-19 which has ripped through nursing homes and senior living, it then diverges into other issues, some worth considering even if some of the verbiage is over the top:

  • These location monitoring systems haven’t been used for infectious disease outbreaks before, but the article admits that the pandemic has presented extraordinary circumstances
  • Use of these systems cannot substitute for effective infection control: staff and resident handwashing, mask wearing, and staff PPE. (Something like wearing a used mask and not washing your hands for the rest of us)
  • These systems are dependent on facility-wide internet/Wi-Fi. Many LTCPAC facilities do not have it, thus creating a digital divide in care even in residences proven to have high-quality care.
  • Resident rights and privacy. Residents apparently have only limited choices in using these technologies, even if they are restricted to their rooms. Not all see the need for monitoring technology for their safety and intrusive ‘alarms’ that bring in staff. There is a real issue around older adults’ autonomy and privacy rights which tends to be forgotten in the balance of privacy and safety, with prediction of illness based on behavior a step further.

Interviewed for this article, Laurie Orlov of Aging in Place Technology Watch, believes “It’s pretty darn useful if you’re in independent living, and you decide to go for a walk. If it’s night, and there’s ice, having a full detection capability that knows where you are is really useful. I think with fall detection, and anything that can help when you’re alone, the benefits exceed the cost of the privacy — assuming that you’re with it enough to opt in.”  Senior Sensors (The Verge)  (Disclosure: Editor Donna consulted for CarePredict in 2017-18)

A counterpoint to this article is also by Laurie Orlov and published on her website, reviewing the future of remote care technology and older adults in 2020. It’s a preview of a to-be-released later this year report.

Alcuris appointed as supplier to Spark DPS (UK)

Alcuris, an assistive technology company based in Loughborough (Leicestershire) announced this week that they have been appointed to the Spark Dynamic Procurement System (DPS) (scroll down page) provided by Crown Commercial Services (CCS).

A DPS permits buyers to access framework agreements that meet common purchasing requirements across the UK government. The Spark DPS is for emerging, innovative technologies and

  • Allows customers access to proven new technology innovations which are useful for solving public sector problems
  • Quality and price can be assessed based on individual customer’s requirement
  • A dynamic filtering system, giving customers flexibility based on requirements
  • Fully compliant with UK and EU regulations.

Suppliers on Spark must demonstrate that they can provide at least one new or innovative technology for one or both of ‘Radical’ and ‘Disruptive’ Innovation. Alcuris submitted its Next Generation Telecare Memo service under the Disruptive Innovation category. The Memo Hub service was entered into TechForce 19 as an Activities of Daily Living (ADL) monitoring system with results here [TTA 6 August]. For more information on the Spark Innovation Marketplace and how it works for buyers, there is a webinar on 18 November (information and registration here). Alcuris press release. Hat tip to Adrian Scaife of Alcuris

Propel@YH digital health accelerator announces 2020 cohort of 10 companies

Propel@YH, commissioned by the Yorkshire & Humber AHSN (Academic Health Science Networks) digital health accelerator, last week announced its 10-company 2020 cohort, to start on 26 October. They are:

  • Co-Opts ltd; a smart speaker for automated recording, transcription and summarisation of therapy sessions
  • CyberLiver Ltd; remote monitoring of at-risk cirrhosis patients using wearables and an app
  • I.M.M.E; a VR experience created to support Williams syndrome, supporting isolation, rehab mobility and mental health
  • Liria Digital Health; a technological solution addressing the health and wellbeing of perimenopausal, menopausal, and postmenopausal people
  • My Food 24; an online food diary system which automates the diet tracking and analysis process
  • SeeAI; a platform that supports early fracture diagnosis through x-ray images 
  • Ufonia Ltd; an AI-enabled accessible clinical assistant called Dora that can conduct an intelligent clinical conversation via a regular voice telephone call
  • Vastmindz; an AI face analysis app to measure real-time heart and respiration rates, oxygen saturation, stress level, blood pressure and atrial fibrillation risk
  • Warner Patch; a non-invasive, wearable wireless (using 2G network) sensor that predicts tissue health disease evolution using AI for clinicians to give preventive care, improve patient outcome and save care costs
  • Written Medicine; a pharmacy label and discharge summary translation system, that works across 11 different languages

Propel@YH is designed to attract international digital health companies to the Yorkshire/Leeds area. The AHSN is one of 15 innovation centers acting as the innovation arm of NHS England. Partners in the program include Nexus (University of Leeds’ academic research and tech development community), Barclays Eagle Labs (business incubation/networking/investment), Hill Dickinson (legal and strategic advice), and Leeds City Council. 

Neville Young, Director of Enterprise and Innovation for the Yorkshire & Humber AHSN, said: “This is the second time we’ve been able to offer this great opportunity for innovative digital and data-driven health companies and we were truly blown away by the innovation and talent presented by this year’s shortlist. Our panel had a tough choice choosing our finalists from this year’s entries but we think the mix of businesses and applications we will be working with this year really will play a part in supporting the NHS and healthcare providers throughout the pandemic and the ‘new normal’ ways of working.”  YHAHSN press release

UK highlights: Doro acquires Connexus Careline, Tunstall warns on winter isolation and disconnected care, Buddi seeks Sales Account Manager

Doro continues its acquisition streak in the UK, acquiring the assets of Connexus Careline from Connexus Housing Group. Connexus currently provides services to local authorities, housing associations, the private sector, and charities, with about 25,000 telecare connections in the UK. Terms and timing were not disclosed. Based on the August count, this brings Doro in at over 250,000 UK connections. Doro’s acquisitions have been ElderCare UK [TTA 11 Aug], Invicta Telecare, parent of Centra Pulse and Connect [TTA 19 Sept 19], and Welbeing [7 June 18], Press release (PDF).

So many open questions… What are their future plans for integrating all these individual systems and different technologies? What will Doro UK represent in the market, now that they are second in the UK?

Tunstall Healthcare UK is also reminding local governments, health and social care leaders that winter is approaching, and now is the time to set up remote patient monitoring to connect to care the most vulnerable in cold weather, a factor magnified by their isolation during the continuing pandemic. Tunstall features several solutions in RPM which are mentioned in the release.

Editor’s note: this type of seasonal release was a staple for QuietCare when I was in marketing for our activity/temperature monitoring of those living at home alone. We also included a proprietary study made during winter (and later summer) among our client base. 1) It’s surprising that more RPM and telecare companies don’t take this approach, especially now, but 2) Tunstall could have made an even greater case for itself with some quantitative research stats.

Buddi is seeking a Sales Account Manager position to join their Health Sales Team based in the southern half of England. The particulars are here (PDF) including application and contact information. Thank you Fiona Carmichael of Buddi for reaching out to us! (If you have a position to fill, our listings are complementary.)

Teladoc sues Amwell on patent infringement–again

This week’s Big News in the Telehealth Wars was Teladoc suing their chief rival Amwell (the former American Well) for patent infringement. These relate largely to telemedicine carts and robotic technology patents acquired by Teladoc via InTouch Health, which was finalized in July. InTouch Health’s value in the neighborhood of $1bn, when all was factored in, was reinforced by its over 130 patents and pending applications.

Notices were sent by Teladoc in mid-September for compliance by 18 September. It was mentioned by Amwell as meritless in filings with the Securities & Exchange Commission but apparently did not make a dent in their through-the-roof IPO raise of $742 million on 16 September. Their share price remains steady at over a $10 per share increase from the IPO price.

Amwell’s infringing products, according to reports on the lawsuit filed in the US District Court for the District of Delaware, encompass their Carepoints line of digital scope, stethoscope, and four different types of telemedicine carts, including the Horus HD Digital Scope System and the Thinklabs One Digital Stethoscope. There are nine contested patents. Teladoc is asking for treble damages plus court fees. Amwell has already stated that this type of business for them is in single digits–5 percent of revenue in 2019.

Both Amwell and Teladoc have been down this road before in 2015 and 2016. Teladoc also started it then, with Amwell countersuing–and losing in June 2016, with additional patent challenges filed by Teladoc with the USPTO. This record doesn’t bode well for Amwell, but even though IP fights tend to generate nasty headlines and drain resources, what is contested is a fraction of their business. Curiously, to this Editor’s knowledge, there is no record of InTouch Health, prior to their acquisition, challenging Amwell on these systems. Healthcare Dive, Healthcare IT News, Fierce Healthcare, WSJ (paywalled)