Legrand adds Jontek to assisted living and healthcare businesses (UK)

Jontek Ltd, a Stockport-based developer and provider of monitoring software and response centers for telecare, telehealth, lone worker and mCare, is being acquired by Legrand, a specialist in digital building and electrical infrastructure. Jontek will be joining Tynetec in Legrand Electric Ltd’s Assisted Living & Healthcare Business unit. Like Tynetec, Jontek is one of our Grizzled Pioneers of telecare, having started their business over 20 years ago. Currently they provide services to over 60 organizations in the UK and are a Government Procurement Supplier.

Looking at the release, Legrand sees an opportunity to complement Tynetec’s current lines in at-home alarms and assisted living call systems with Jontek’s Answer-link monitoring software, which is a system integrating database queries/reporting, document management, emailing and incident logging. (This Editor also sees potential for these systems to enhance Tynetec’s telehealth RPM systems and Intelligent Care.) Managing Director Chris Dodd: “Historically, both Jontek and Tynetec have been committed advocates of an open protocol philosophy. This will continue to remain one of our primary considerations when developing integrated digital solutions and innovative IP care platforms of the future.” Legrand release.

Two important takeaways: We continue to see consolidation of health tech businesses with an eye to enhancing and widening capabilities. Companies with established businesses are moving to make their products more accessible and user-friendly with mobility and enhanced response–BYOD and call centers. In design, they are incorporating secure data integration and reporting capabilities to make the data useful to clinicians and to prove worth, reducing the number of time-consuming steps to obtain data–or fall inevitably behind other digital health competitors. The other is ‘open protocol’ which this Editor interprets in this context as the ability to integrate sensors, peripherals, software and other kit which are not proprietary–in other words, to play nicely in the sandbox. Another indicator that the ‘walled garden’ is coming to an end. Not that it is going to be easy for those firms which have invested in a certain way of doing business–a challenge that many heretofore successful companies are facing. Ed. disclosure: Tynetec is and has been a long time supporter of TTA.

Sleepio and Alivecor enhance digital health credibility

This has proved to be a great week for digital health credibility.

Firstly Sleepio picked up two honours – one was scoring the highest mark on the first Ranked Health output. The second was getting the American College of Physicians to come out and say that CBT-I should be the treatment of choice for insomnia (above hypnotics).

Meanwhile a study has shown that “A Smart Phone-based ECG Recorder Is Non-inferior to an Ambulatory Event Monitor for Diagnosis of Palpitations”. In layman’s language, the Alivecor/Kardia smartphone peripheral and app are as good as the awkward to wear & cumbersome Holter monitor.

Well done both!

Those who have heard Dr Sophie Bostok, the indefatigable Sleepio Sleep Evangelist, explain (more…)

‘Silicon Valley Tech Press’ blamed in the Theranos buildup; WSJ threatened

click to enlargeA fascinating view from an ironic source. Vanity Fair’s short article tags the buildup of Theranos and its founder/CEO Elizabeth Holmes to a purposefully gullible Silicon Valley Tech Press and their moneymaking conferences. While not naming specific publications, it cites TechCrunch’s Disrupt as an early builder-upper of Ms Holmes (drawing blood onstage, how daring!). The operating thesis here is that the tech press vetted her with uncritical and fawning coverage, which led to profiles and shiny articles in the New York Times, the New Yorker and ….Vanity Fair, which also featured Ms Holmes at their 2015 New Establishment Summit. It’s a classic PR strategy to me, one that any skilled marketer has in their playbook (Ed.–it also works in reverse, having mainstream press vet a technology sold B2B), and one that evidently worked.

One would think that writers and editors with some biotech and science knowledge would raise more questions. The author, Nick Bilton, critically outlines the ‘Game of Access’ underpinning the tech press and blogger business model: you say nice things and play ball, you get a preview of the latest gadget or a sitdown with the CEO. If you don’t, you’re shut out. So writers don’t ask tough questions, probe hard enough, or tell the truth about where the facts are leading them, because if they do, there goes the access and the sponsorships, as well as your job. While the former doesn’t apply to your Editors, many of us who write also hope that we uncover a technology that benefits people, or is even revolutionary. We like a bracing story.

However, Mr Bilton, perhaps mindful of the cart he rode in on, doesn’t scoop an equal share of blame onto the ‘mainstream’ press. To this Editor’s mind, the Ken Auletta profile in the New Yorker should have been stopped by the New Yorker’s EIC and sent back to Mr Auletta with a blue-penciled “DIG DEEPER”. This excerpt is from the VF article:

Auletta acerbically noted that the technology behind Theranos was “treated as a state secret, and Holmes’s description of the process was comically vague.” She told him, for instance, that one process occurred when “a chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.”

Say wot? Sheer gobbledygook. For the WSJ investigative reporter John Carreyrou, who read this and eventually blew the lid off Theranos, this was caviar on toast too delicious to pass up. (Vanity Fair, on the other hand, was too busy making Ms Holmes one of its New Establishment, but investigative reporting has never been one of their strong points. Another reason why this article is an interesting read.)

A side note: Ms Holmes kept on refusing to disclose, even to VCs, the blood analysis process as a technology too secret to share, even with fellow researchers to get verification and validation. And that led to very few truly major VCs investing in the formerly $9 bn valued company, a point Mr Bilton relishes.

The final revelations in the article–truly the lead–should scare anyone who values a free press. They are the bullying tactics taken by Theranos’ legal team led by that new governing board member, David Boies, to intimidate both Mr Carreyrou and the WSJ from their investigative reporting. Mr Bilton’s source describes the team marching into the WSJ office in June, threatening legal action on the proprietary information Mr Carreyrou supposedly had (he did have internal documents). After repeatedly denying all requests for an interview with Ms Holmes, the WSJ went with the story in October, and the rest is history. Mr Boies now has his hands full elsewhere with other types of letters: CMS, SEC, DOJ and FDA. And Ms Holmes is no longer making herself available to the media, even to her former friends in the tech press. The Secret Culprit in the Theranos Mess

It’s Alive! Augmedix’s $17 million raise raises Google Glass in medicine

Just when we thought that Google Glass was going to be a tax writeoff for Alphabet (the Google parent company), along comes Augmedix, a Google Developers/Glass At Work enterprise partner which has raised, without a lot of fanfare, a tidy $17 million in venture capital funding. The round was funded primarily from customers–in this case Sutter Health, Dignity Health, Catholic Health Initiatives (CHI), TriHealth Inc. and an anonymous funder, plus traditional VCs Redmile Group, Emergence Capital and DCM Ventures, the last two which were also in the $16 million Series A. Augmedix’s Google Glass is used during the visit by the doctor to connect to a remote scribe who enters patient data into the EHR instead of the doctor. Our Readers familiar with a typical doctor’s office can readily see this as a useful function, though the Glass itself might put off some patients. No word of the dramatic surgery/telesurgery consults this Editor has seen demonstrated. It also appears that Augmedix is the only enterprise developer of Glass that has stayed with medical use, shifting its focus to large healthcare organizations. Mobihealthnews. CrunchBase

Telehealth and COPD: meta-study shows little QoL improvement

A review of studies on the use of telehealth interventions (generally remote patient monitoring but also education and pulmonary rehabilitation) with COPD patients is equivocal to somewhat negative on the effectiveness of telehealth on quality of life (QoL) improvement and positive impact on disease progression. Only three of the 18 studies surveyed showed statistically significant improvements, with the others showing no significant improvement. However, the researchers noted the low number of studies and that large-scale controlled trials would be called for; also at the end, they note that what might be more valid is the “comparison to absence of deterioration, relative to control groups, as a perhaps more realistically acceptable success criterion.” Stasis might be a better thing to evaluate given that COPD patients can deteriorate quickly without the right care. Published by a Danish research team at the International Journal of Chronic Obstructive Pulmonary Disease.  Dove Press open access. Also FierceHealthIT

‘Protecting Patient Information’–a ‘worst case scenario’ book for HIT

A much-needed book in the age of Hacker/RansomwareMania. A new book published, ‘Protecting Patient Information’ by Paul Cerrato, is subtitled ‘A Decision-Maker’s Guide to Risk, Prevention, and Damage Control.” It’s not a tome at 162 pages, since it’s written not for academics or IT Gearheads, but for physicians (including doctors running small practices), nurses, healthcare executives and business associates. It takes a practical, three-part approach to IT security in healthcare organizations which can be applied internationally:

  1. How to do an in-depth analysis of the organization’s risk level
  2. How to lower the risk of a data breach within the myriad of Federal and state rules regarding protected PHI
  3. How to deal with a data breach, even if you’ve followed 1) and 2) (This may be the ‘worst case scenario’ part of the book)

The preface to the book is written by John Halamka, MD, himself a CIO of Beth Israel Deaconess Medical Center in Boston and a professor at Harvard Medical School. It will set you back about $42, but worth it. Hat tip to our friends at HITECH Answers via Twitter. If you’ve read the book or will read it soon, this Editor and your fellow Readers would be interested in your thoughts or even a review.

State by State report on telehealth laws and policies (US)

A comprehensive scan of telehealth laws and Medicaid click to enlargeprogram policies is available from the recently released report from the Center for Connected Health Policy, part of the Public Health Institute, a California based non-profit. This fourth annual review, State Telehealth Laws and Medicaid Program Policies,  provides a current summary of telehealth policies and laws in all the states and the District of Columbia.

As we have covered in many previous articles, states are actively pursuing legislation to implement their own set of telehealth policies. This report is supposedly an up to date summary of these laws and regulations as of March 2016.

Some significant findings highlighted by the authors are
– 47 states and Washington DC provide reimbursements for some form of telemedicine video conferencing. This number is unchanged from last year.
– 9 states reimburse for store and forward services (e.g. medical images, documents and pre-recorded videos. Primarily sent between medical professionals)
– 16 states offer reimbursement for remote patient monitoring, unchanged from last year

The report is complemented by an interactive map located here.

First apps using Apple’s CareKit clinical care framework hit market

click to enlargeWell, that was fast! Apple’s CareKit framework, specifically for clinical care app developers, was only announced last month and opened its official doors yesterday, but three developers had early access. Their apps hit the market yesterday: One Drop (diabetes management), Iodine for Start (depression medication management), and Glow for Glow Nurture, an app for pregnant women, and Glow Baby, an app for new mothers. Four hospitals have also announced app development underway using CareKit modules: Beth Israel Deaconess (chronic condition management), the University of Rochester (Parkinson’s), Texas Medical Center (care coordination), and Cleveland Clinic (asthma and COPD).

There are four modules which developers can selectively use (pictured).

  • CareCard, which helps patients track care plans and action items
  • Symptom and Measurement Tracker, which helps patients keep a log of their experiences
  • Insights Dashboard which integrates the care plan data from CareCard with the symptom data from the Symptom and Measurement tracker to create insights about the effectiveness of treatments
  • Connect, which helps patients share data with their providers or other caregivers.

The three in market yesterday, for instance, all used Connect; Iodine and One Drop use Care Card and One Drop uses the Symptom Tracker.

The article’s comments from developers and hospitals highlight a move to a standardized framework for clinical apps, which may be wishful thinking as most of the world uses Android, but addresses the validation and certification conundrum that’s plagued health apps for years. We’ll wait and see if Apple sustains the lead here. Mobihealthnews. Apple ResearchKit/CareKit page. The Verge, Ars Technica, TechCrunch

ATA’s daily schedule now available online

click to enlargeAttending or interested in attending this year’s American Telemedicine Association annual meeting in Minneapolis 14-17 May? The daily Saturday-Tuesday schedule is now online here. Plenary session speakers include Nicholas Negroponte, founder of the groundbreaking MIT Media Lab and John Noseworthy, CEO of the Mayo Clinic. There are also Spotlight Sessions on Monday on ‘Consumer Stakeholders Confront Telehealth”, “Is a Prior Provider-Patient Relationship Still Required?” and “The Year in Review: Excellence in Telemedicine Research.” If you’re going, also check out their exposition floor which opens on Sunday with a late afternoon reception. Register by clicking the sidebar advert. TTA is a media partner of ATA2016.

Nokia’s healthcare repositioning confirmed with Withings $191 million acquisition (updated)

“We’re paying for the company, but in reality it’s Withings that’s going to be running the entire digital health business at Nokia.” –Nokia President Ramzi Haidamus

One of the more unusual corporate pivots has taken place over the past few years with Finnish former mobile phone leader Nokia. and has completed a circle with the seemingly friendly acquisition of digital health device and wearables developer Withings.

With the sale of its phone brand to Microsoft in 2013 and the majority acquisition of Alcatel-Lucent last year (finalized in January), Nokia seemed to reposition itself firmly in telecom networking. It retained an impressive brace of IP and international patents in the field managed by Nokia Technologies, plus licensing of its name. Nokia also introduced a successful iPad Mini clone in China, the N1 Android tablet, a virtual reality camera rig built for film studios and sold the HERE map app for $3 bn. But the company retained an interest in health tech over those years. In 2012, it started the annual Nokia Sensing XChallenge, a $2.25 million competition that is part of XPRIZE. Nokia Growth Partners (NGP) invests in the digital health sector.

We noted their below-the-radar health moves last October, and this confirms that true to the reports, Nokia had been been developing a digital health strategy called WellCare, centered on data and insights collected from wearables. WellCare will now apparently be integrated into Withings. The combination will also be competitive with Apple HealthKit and ResearchKit, which has had extensive takeup by both developers and clinical researchers–but there is plenty of room in the field. Withings retains a strong and uniquely quality design-driven identity, though perhaps not the most well known brand especially in the US, and has a small share in covetable, pricey fitness wearables. But it’s the integration and developments which will be of great interest after the expected closing in 3rd quarter this year. Two articles in Engadget (here, here) and The Verge

Updated: Mobihealthnews publishes an interview with Nokia’s president Mr Haidamus on why Withings, calling it a ‘reverse takeover’ where Withings will be in charge of expanding their health tech presence with no layoffs on either side. However, he’s a little disingenuous in implying that Nokia had no interest in digital health prior to selling their handset business to Microsoft in 2014–see the XChallenge above.

 

Theranos–the drama and examination continues

The latest chapters:

Theranos’ boards–the advisory board chock full of Blast From The Past political figures like George Shultz, Sam Nunn, Bill Frist and Henry Kissinger–and a governing board–are standing by CEO/founder Elizabeth Holmes. Of course, they have essentially no choice, because Ms Holmes utterly and completely controls the company in the Silicon Valley Manner. The governing board, split off from the advisory board after The Troubles started last October–consists of Ms. Holmes, COO Sunny Balwani, Riley Bechtel of the eponymous construction firm, retired Marine Corps General James “Warrior Monk” Mattis and David Boies, prominently featured in both articles below. Mr Boies is politically well wired and the kind of attorney you call in when you are facing Big Trouble and need Big Defense–or Offense. These boards of course bear responsibility for the governance of the company, including fiduciary, and the actions being taken by CMS, the US Attorney’s office in San Francisco and the Securities and Exchange Commission (SEC) may be making for some sleepless nights. New York Times, Vanity Fair (which overlaps the NYT article)

Trust But Verify is the extraordinarily apt ‘eyebrow’ on this ‘rise and fall’ Quartz article reviewing l’affaire Theranos by a professor of medicine at Dartmouth College. For the non-scientists among us, it gives a layman’s explanation on why venous blood for most tests is needed versus fingerpricks (the latter mixes blood and tissue fluid, and doesn’t accurately measure large molecules such as proteins and lipids–but fine for the smaller blood glucose molecules, as testing diabetics know). It also touches on the Icahn Institute/Mount Sinai study [TTA 26 April, see comment] and points to the Smoking Gun of boards largely not constituted of those with medical or biochemical expertise.

Update: Bloomberg explores a POV in an opinion piece that blood tests are inherently variable, and only one factor in a proper diagnosis. Theranos’ promises to run multiple blood tests on a tiny quantity of blood are not only suspect but also that the “assumption that succeeding in this quest would improve public health” is specious indeed. Theranos and the Blood Testing Delusion

The stakes are high, and getting higher, for Ms Holmes, indeed.

[Ed. Donna’s comment below our earlier article, Theranos’ triple whammy: CMS, DOJ and SEC, addresses some concerns our Readers may have about our coverage. While we are a website interpreting the news and the Editors generally refer to multiple published sources in an article to supply various points of view, we also express our opinions. We try our level best to be fair, to stay in good humor and buttress our points. When you the Reader has a point to add, differs with our interpretation, or believes that your Editors are hanging too far out on that swaying limb, please feel free to comment. We do have a Comments policy which isn’t onerous…it’s posted here.]

Blueprint Health graduates the Winter 2016 class

Tomorrow afternoon (April 27) is Graduation Day–Demo Day–for ten startup companies which address problems across the healthcare spectrum. They are:

● Blue Mesa Health – Helps employers reduce health costs through a digital diabetes prevention program
● HealthKick – Provides employers with curated perks for branded health and wellness services
● NexHealth – Provides a mobile-first appointment booking and reminder platform for doctor’s offices
● PatientPrep – Increases physician productivity and patient satisfaction by collecting data prior to a visit
● Rappora – Streamlines the coordination, management and time tracking of home care employees (more…)

BeVITAL: French telehealth, American multi-reading biosensor

click to enlargeParis-based telehealth company BePATIENT has partnered with Silicon Valley biosensor company Vital Connect for a remote patient monitoring system dubbed BeVITAL. The unusual part is that the Vital Connect sensor, HealthPatchMD, is about the size of a standard bandage–it adheres to the skin by the heart–and transmits multiple vital signs including single-lead ECG, heart rate, RR interval, heart rate variability, respiratory rate, skin temperature, body posture, fall detection and activity including steps. The BePATIENT PC/mobile telehealth platform has a patient facing mobile app (‘Fast Path’) app, currently available in the Apple App Store, with a clinician-facing reporting module. BeVITAL has been piloted already in Europe for post-discharge monitoring of over 80 surgical patients in clinical studies at five hospitals, with two more deployments this summer. In the Americas, the two post-discharge pilots will concentrate on heart failure, in the US at John Muir Medical Center in Walnut Creek and Concord, California and at the Hospital Infantile De Las Californias, Tijuana, Mexico. The latter study will be run by Scripps Translational Science Institute in San Diego.

BePATIENT’s platforms and ‘digital health modules’ are largely used in France, Europe and Australia, and also integrate devices from iHealth, Withings and fitness tracker Fitbit. The Vital Connect Platform is FDA-cleared, CE-marked and Ninsho Certified (Japan). In addition to the HealthPatchMD biosensor, which is reusable up to 500 times, they developed the single-use VitalPatch biosensor marketed in the US and Europe, and being tested by Philips for at-risk hospital patients (ZDNet). Release, KTVU News

Theranos’ triple whammy: CMS, DOJ and SEC

click to enlarge Shocked, shocked! Theranos CEO Elizabeth Holmes is a bit more wide-eyed than ever. On the popular morning (breakfast=UK) program Today, interviewed by the oddly ‘browed Maria Shriver and sans the usual Steve Jobs-channeling black turtleneck, she stated she was ‘devastated’ that they didn’t catch the lab testing issues faster. On CNBC, she was mildly defiant and justifying:

“I know what we’ve built and I know what we’ve created and I know what it means to people and it is a change that needs to happen in the world”

(Yes, it does mean a lot to people when their test results are wrong or not reliable. And the disappointment of those of us who’d like simple, less expensive testing that works.)

Last week CMS proposed (but not yet imposed) sanctions that include banning Ms Holmes and president Sunny Balwani from running or owning labs for two years, and removing licenses from Theranos’ labs in Newark and Palo Alto California. Wall Street Journal. The effect would be to remove them from the company. Yesterday, Federal prosecutors started the process of discovery by subpoenaing Walgreens Boots Alliance, their former customer, and the New York State Department of Health seeking broad information on how Theranos described its technologies to gain Walgreens’ business and NYS licensure. That information may also have misled government officials.

The third whammy is the Securities and Exchange Commission (SEC) looking into a parallel claim–that deceptive claims were made to investors.  No one at the above organizations is commenting to the Wall Street Journal, which broke the story earlier this year. While the company has $700 million in the bank, the famed $9 billion Unicorn Valuation is moving towards $9.

Ed. note: If the WSJ articles are paywalled, search on the headlines “Regulators Propose Banning Theranos Founder Elizabeth Holmes for at Least Two Years” and “Theranos Is Subject of Criminal Probe by U.S.” to get around them. Alternatively, see TechCrunch and MedCityNews, which is playing the World’s Smallest Violin about this.

Two RSM events of interest on medicine’s future and Big Data/IoT (UK)

Make a place in your calendar for two Royal Society of Medicine full day events coming up in May and June. Both organized by the Telemedicine and eHealth Section. Hat tip to Charlotte Cordrey, Event Team Manager, RSM

The future of medicine – the role of doctors in 2025
Thursday 19 May 2016  (Chaired by our own Editor Charles Lowe)

Big data 2016 (Clouds and the Internet of Things)
Thursday 2 June 2016

 

Australia: Most of the benefit of NBN comes from Telehealth and Teleworking

A study has concluded that most of the benefit from the National Broadband Network in Australia comes from two sources, telehealth and teleworking. Economic Benefit of the National Broadband Network (NBN) is a report partially summarising a study by the Centre for Energy Efficient Telecommunications (CEET) at the University of Melbourne. The study analyses the potential economic impact of Australia’s NBN.

Assuming that eventual access speeds will reach 10-25 Mbps, the model used by CEET predicts long-term GDP increase of 1.8% and a 2% increase in real-term household consumption. Of six categories of services considered, cloud computing, e-commerce, online higher education, telehealth, teleworking and entertainment, it is telehealth and teleworking that have come up as the services that will generate the most benefit from the NBN.

The average annual household benefit is estimated to be around $3,800 by 2020. Recognising the significant investment being made in broadband in Australia, the paper attempts to describe how the NBN will influence the national economy through the adoption of new services and new ways of working.

The short summary report is in easily accessible language and well presented and is available here.