Can Big Pharmas hiring of digital execs actually ‘reimagine medicine’?

Reimagination or hallucination? In recent weeks, both Glaxo Smith Kline and now Novartis have hired digital analytics and marketing executives out of non-healthcare businesses to lead their digital transformation. For GSK, Karenann Terrell joined in the new position of chief digital and technology officer from six years as chief information officer for Walmart and CIO for pharma Baxter International. From Sainsbury’s Argos, Bertrand Bodson will be assuming the chief digital officer title at Novartis without any previous healthcare experience.

Both are expected to be transformative, disruptive, and ‘reimagine medicine’. Ms. Terrell’s experience and accomplishments appear to be the closest fit to her GSK’s job expectations of integrating digital, data, and analytics strategy with enhancing clinical trials and drug discovery, as well as improving professional and consumer interactions. Novartis’ mission for Mr. Bodson aims even higher. In addition to these, he will be ‘transforming our business model using digital technologies’, ‘reimagine (sic) medicine by leveraging digital on behalf of millions of patients and practitioners’, and ‘leading cultural change’.

Both companies have good starts in advanced technologies–GSK in AI, sensor technologies for managing COPD, and a medical device mobile app; Novartis with ‘smart pill’ Proteus, a pilot with heart medication Entresto tied to monitoring and coaching, and through its Alcon subsidiary with Google, a wired-up contact lens that detects blood glucose [TTA 17 July 14]. However, this last appears to be stalled in trials and Alcon on the block. According to the FT, Novartis is feeling the pressure to develop more digital partnerships, such as Novo Nordisk’s teaming with Glooko and Sanofi with Verily Life, all in diabetic management. Acquisitions may also be the way forward.

A significant impediment to all this integration is consumer and professional trust. If too closely tied to a pharmaceutical company or appearing to be too self-serving, remote monitoring and counseling may not be trusted to be in the patient’s (or doctor’s) best interest or objective as to better approaches. The overuse of analytics, for instance in counseling or patient direction, may be perceived as violating patient privacy–creeping out the patient isn’t helpful. The bottom line: will these digital technologies serve the patient and maintain medical best practices–or best serve the pharmaceutical company’s interests?

This Editor doesn’t question these individuals’ ability, but the organizations’ capability for change. But count this Editor as a skeptic on whether one or two digital execs can marshal the bandwidth and the internal credibility to transform these lumbering, complex, regulated, and long cycle businesses. Big Retail is fast moving by comparison. PMLive 31 July (GSK), 13 Sept (Novartis)  Hat tip to TTA alumna Toni Bunting

The REAL acute care: hurricanes, health tech, and what happens when electricity goes out

This afternoon, as this New York-based Editor is observing the light touch of the far bands of Hurricane José’s pass through the area (wind, spotty rain, some coastal flooding and erosion), yet another Category 5 hurricane (Maria) is on track to attack the already-wrecked-from-Irma Puerto Rico and northern Caribbean, thoughts turn to where healthcare technology can help those who need it most–and where the response could be a lot better. (Add one more–the 7.1 magnitude earthquake south of Mexico City)

Laurie Orlov, a Florida resident, has a typically acerbic take on Florida’s evacuation for Irma and those left behind to deal with no electricity, no assistance. Florida has the highest percentage of over-65 residents. Those who could relocated, but this Editor from a poll of her friends there found that they didn’t quite know where to go safely if not out of state, for this storm was predicted first to devastate the east coast, then it changed course late and barreled up the west (Gulf) coast. Its storm surges unexpected produced record flooding in northeastern Florida, well outside the main track. Older people who stayed in shelters or stayed put in homes, senior apartments, 55+ communities, or long-term care were blacked out for days, in sweltering heat. If their facilities didn’t have backup generators and electrical systems that worked, they were unable to charge their phones, use the elevator, recharge electric wheelchairs, or power up oxygen units. Families couldn’t reach them either. Solutions: restore inexpensive phone landlines (which hardwired, mostly work), backup phone batteries, external power sources like old laptops, and backup generators in senior communities (which would not have prevented prevent bad fuses/wiring from frying the AC, as in the nursing home in Hollywood where eight died).  Aging In Place Tech  (Editor’s note: another excellent argument for ensuring that if your family member is living in senior housing of any type, or you manage a community, there is a disaster preparedness/evacuation plan in place and one that is executable.) 

Another solution: purchase 200-400 watt battery packs that recharge with solar panels, AC, and car batteries (AARP anyone?). Campers and tailgaters use these and they range below $500 with the panels. Concerned with high-power lithium-ion batteries and their tendency to go boom? You’ll have to wait, but the US Army Research Laboratory and University of Maryland have developed a flexible, aqueous lithium-ion battery that reaches the 4.0 volt mark desired for household electronics without the explosive risks associated with standard lithium-ion power–a future and safer alternative. Armed With Science

Telemedicine and telehealth are not being fully utilized to their potential in disaster response and recovery, but the efforts are starting. Medical teams are starting to use telehealth and telemedicine as adjunct care. It has already been deployed successfully in Texas during Harvey. Many evacuees were sent to drier Dallas and the Hutchinson arena, where Dallas-based Children’s Health used telemedicine for emergency off-hour coverage. Doctor on Demand and MDLive gave free direct support to those affected in Texas and Louisiana through 8 September, as well as Teladoc, American Well, and HealthTap for a longer period to members and non-members. Where there are large numbers of evacuees concentrated in an area, telemedicine is now deployed on a limited basis. Doctor on Demand releaseSTAT News, MedCityNews 

But what about using affordable mobile health for the thousands who long term will be in rented homes, far away from their local practitioners–and the doctors themselves who’ve been displaced? What will Doctor on Demand and their sister telemedicine companies have available for these displaced people? What about Puerto Rico, USVI, and the Caribbean islands, where first you have to rebuild the cellular network so medical units can be more effective, then for the longer term? (Can Microsoft’s ‘white space’ be part of the solution?)  

One telehealth company, DictumHealth, has a special interest and track record in both pediatric telehealth and global remote deployments where the weather is hot, the situation is acute, and medical help is limited. Dictum sent their ruggedized IDM100 tablet units and peripherals to Aster Volunteers who aid the permanently displaced in three Jordanian refugee camps in collaboration with the UNHCR and also for pediatric care at the San Josecito School in Costa Rica. In speaking with both Amber Bogard and Elizabeth Keate of Dictum, they are actively engaging with medical relief agencies in both the US and the Caribbean. More to come on this.

Now EHR data entry 50% of primary care doctors’ workday: AMA, University of WI report

click to enlargeWhere’s the doctor? Typing away! A fact of life doctors have agonized on over the past ten years–even great advocates like Robert Wachter, MD above at NYeC last year–is the clerical burden of EHRs and patient data entry. A late 2016 time and motion study in the ACP Annals of Internal Medicine (AMA, Dartmouth-Hitchcock, Australian Institute of Health Innovation) noted a mere 49.2 percent of ambulatory physicians’ time spent on EHR and desk work. Mayo Clinic (above) has been tracking both the burnout and the burden as 50 percent (above).

Now we have a new study published in the Annals of Family Medicine led by the University of Wisconsin Medical School tracking EHR data entry as 52 percent: 5.9 hours of an 11.4 hour workday. This includes allied clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounting for 2.6 hours, close to 50 percent of the 5.9 hours daily.

Is there a way out? The study’s recommendations were:

  • Proactive planned care
  • Team-based care that includes expanded rooming protocols, standing orders and panel management
  • Sharing of clerical tasks including documentation, order entry and prescription management
  • Verbal communication and shared inbox work
  • Improved team function.

Much of this sounds like burden shifting to deal with the EHR, not a redesign of the EHR itself, but the commentary in AMA Wire makes it clear that it was shifted in the first place by the EHR from other staff to the doctor. Other time savings could be realized through moving to single sign-on (versus dual entry passwords) to advanced voice-recognition software. (UW release)

The earlier ACP study excerpt in NJEM Journal Watch has physician comments below the article and they blast away: (more…)

Want to know effectiveness of telehealth, interoperability? NQF reports take their measure.

There’s been an increase in doubt about the efficacy of telemedicine (virtual visits) and telehealth (vital signs monitoring) as a result of the publication of two recent long-term studies, one conducted by the University of Wisconsin and the other by CCHSC for Telemonitoring NI [TTA 13 Sep]. These follow studies that were directionally positive, and in a few cases like the VA studies conducted by Adam Darkins, very much so, but mostly flawed or incomplete (low N, short term, differing metrics). What’s missing is a framework for assessing the results of both. In an exceptionally well-timed announcement, the National Quality Forum (NQF) announced their development of a framework for assessing the quality and impact of telehealth services. 

In a wonder of clarity, the NQF defines telehealth’s scope as telemedicine (live patient-provider video), store-and-forward (e.g. radiology), remote patient monitoring (telehealth), and mobile health (smartphone apps). Measurement covers four categories: patients’ access to care, financial impact to patients and their care team, patient and clinician experience, and effectiveness of clinical and operational systems. Within these categories, NQF identified six areas as having the highest priority for measurement: travel, timeliness of care, actionable information, added value of telehealth to provide evidence-based practices, patient empowerment, and care coordination. Finally, the developing committee identified 16 measures that can be used to measure telehealth quality.

The NQF also issued a similar framework for interoperability, a bête noire that has led many a clinician and developer to the consumption of adult beverages. Again there are four categories: the exchange of electronic health information, its usability, its application, and its impact—on patient safety, costs, productivity, care coordination, processes and outcomes, and patients’ and caregivers’ experience and engagement. And it kept the committee very busy indeed with, from the release, “53 ideas for measures that would be useful in the short term (0-3 years), in the mid-term (3-5 years) and in the long-term (5+ years). It also identified 36 existing measures that serve as representative examples of these measure ideas (sic) and how they could be affected by interoperability.”

Both reports were commissioned and funded a year ago by the US Health & Human Services Department (HHS). We will see if these frameworks are extensively used by researchers.

NQF release, Creating a Framework-Telehealth (download link), Creating a Framework-Interoperability (download link), Mobihealthnews 

AARP/Rock Health 2017 Aging in Place $50K Challenge–deadline 2 Oct!

The 2017 Aging in Place Challenge, sponsored by the AARP Foundation and Rock Health, is calling for digital health companies to improve the lives of vulnerable seniors (their words, not this Editor’s) and reduce unnecessary healthcare utilization for older Americans. The Challenge is interested in four areas:

  • Reducing hospital readmissions
  • Avoiding penalties from providers
  • Providing post-acute care assistance
  • Increasing overall patient satisfaction

Another requirement: competitors should have “a good handle on product-market-fit and an ARR (annual recurring revenue) of at least $100K.”

Apply now through 2 October, with the top five finalists to be announced on November 6. The pitch event will be at Rock Health in San Francisco during the week of December 11th with one winner selected. More information and application link here.

September Health 2.0 NYC/MedStartr events–hurry!

If you are located in the NYC metro area, two Health 2.0 NYC/MedStartr meetings are coming up very soon!

Endless Summer Social–Friday 22 September, 6 pm, Spark Labs, 25 W. 39th Street, 14th Floor

Grab your surfboard and celebrate the end of summer next week at the MedStartr Labs Beta site embedded within Spark Labs’ new Bryant Park co-working space in midtown. Organizer Alex Fair promises good food, a great selection of beer and wine (courtesy of MedAux), a few presentations and awards, plenty of participation from members of the NYC health tech community, and tours of the new MedStartr beta site. Register at the Meetup site here.

Mental Health Innovations Summit–Thursday 28 September, 6-9pm, CohnReznick LLP, 1301 6th Avenue

One in every five adults in America experiences some form of a mental illness. Nearly one in 20, or 13.6 million, adults in America live with a serious mental illness. We aren’t replacing retiring psychiatrists. Mental health resources are maldistributed across the country. These problems call for new approaches. Panelists and presenters include leaders in the field and six early-stage companies presenting. Register at the Meetup site here.

TTA has been a MedStartr and Health 2.0 NYC supporter/media sponsor since 2010; Editor Donna is active as co-organizer/host and a MedStartr Mentor. 

Keeping it cool: LifeinaBox mini fridge for meds goes Indiegogo

click to enlargeThe LifeinaBox two-pound mini-refrigerator for medications has debuted today (13 Sept) with a crowdfunding raise on Indiegogo. Since our 3 July article, the company headed by Uwe Diegel in France has determined its delivery date (June 2018) and directed all pre-orders previously made on the website to the Indiegogo US site. The goal is $50,000 over the next month on a flexible raise (funds are kept even if goal is not met), so this is clearly a test of market demand. The website and the Indiegogo site are beefed up considerably with the basic unit now at $180 for early birds (still available) and $250 with a battery pack. Prototype units run on 110 or 220 volt AC current, external battery pack, or car charger, and are monitored via app. As back in July, this Editor thinks that solutions for specific, even narrow, but important problems are absolutely on trend in this uncertain environment–and the more important (painful?) they are, the better for the company. Hat tip to CEO/founder Uwe Diegel.

Equivocal long term telemonitoring studies released by Telemonitoring NI, U. of Wisconsin

The HSC Public Health Agency for Northern Ireland and Queen’s University Belfast have released an evaluation of the six-year (2011 – 2017) Remote Telemonitoring Service for Northern Ireland (RTNI). The Centre for Connected Health and Social Care (CCHSC) launched the Telemonitoring NI project in 2011, which enrolled over 3,900 patients with COPD, diabetes, weight management, stroke, heart failure and kidney problems in both telehealth (vital sign) and telecare (behavioral) monitoring. The study period was through 2015, but the program continues to be implemented by all five NI Health and Social Care (HSC) Trusts across a range of chronic conditions. 

The Northern Ireland findings were at best equivocal. While the qualitative data gathered from patient, carer, and clinician focus groups and interviews were positive in terms of engagement and on reassurance–to be able to carry on with their lives as usual–the quantitative data did not confirm gains in effective care.

Although there were a number of testimonials from the participants in the patient focus groups regarding
reduced hospitalisations and a reduced need to attend outpatient clinics, this did not carry through to
the data obtained in the effectiveness aspect of the current evaluation. In general terms, the number
of hospitalisations, length of hospital stay and outpatient clinic attendance (and therefore overall cost
of healthcare provision) did not differ between the quasi-control ‘never installed’ group and any of the
groups who received some amount of telemonitoring. The results, where they were statistically
significant, were largely driven by an anomalous result for the heart failure ‘never installed’ group. (page 17)

The Executive Summary, Telehealth, and Telecare Reports are available for free download on the HSC R&D Division website. Many thanks to former TTA Ireland Editor Toni Bunting for the information, summary, and researching the previous TTA coverage below.

This is the second discouraging study on the long term effectiveness of patient monitoring released in the past month. A five-year, 140,000 patient/90 provider study conducted by the University of Wisconsin found that giving patients the option of telemedicine, instead of being more convenient for the provider, created new issues. It increased office visits by six percent, added 45 minutes per month of additional visit time to practices, and reduced the number of new patients seen each month by 15 percent. For the patient, the researchers found “no observable improvement in patient health between those utilizing e-visits and those who did not. In fact, the additional office visits appear to crowd out some care to those not using e-visits.” The study suggested that the telemedicine visits could be made more effective by structured questions prior to the visit. (This approach has been taken by telemedicine provider Zipnosis with adaptive online interviews and patient triage.) Mobihealthnews

Previous commentary by TTA’s Editor Emeritus Steve Hards on the procurement of the NI Remote Telemonitoring Service:

http://archive1.telecareaware.com/the-long-and-winding-road-that-leads-to-your-doorin-northern-ireland/
http://archive1.telecareaware.com/african-elephant-ecch/
http://archive1.telecareaware.com/remote-telemonitoring-northern-ireland-service-tender-long-list-mystery/
http://archive1.telecareaware.com/short-listed-companies-rtni-service/
http://archive1.telecareaware.com/northern-ireland-remote-monitoring-servicegoes-to-tf3/

 

It’s EPIC: Ehealth Productivity and Innovation in Cornwall and the Isles of Scilly

The EPIC project’s aim is to improve the use of technology in both health and social care for the better health and well-being of people in Cornwall and–quite ambitiously–improve the Cornish economy through developing this sector. Its core is at the University of Plymouth with partners Creative England, Kernow Health CIC, Cornwall Partners in Care, and the Patients Association, with partial funding by the European Regional Development Fund.

Technologies can include: personal and clinical apps, activity/fitness trackers, telemedicine, therapy websites for cognitive behavior, sensor-based alarm and ADLs that can support people in hospital or with dementia. Robots like the humanoid Pepper from SoftBank are also within their scope.

Having started only in May, EPIC (not to be confused with the EHR) is still starting up for its three-year run. The website describes two ‘strands’ of work: the first organized around 10 working groups which are meeting through September (seven left) to identify problems and develop technology-based solutions. The second phase is to help the developers enter the market, when ready matching them with clinician and patient groups. The economic part is that these new Cornish companies supply not only Cornwall but also ‘export’ to the UK.  

More information is available on their website or by emailing Katie Edwards at University of Plymouth. Hat tip to Susanne Woodman of BRE Group.

Can technology meet increasing demand for social care? (N. Somerset UK)

click to enlargeNorth Somerset Council (west of Bristol in UK’s mid-southwest) provides care for more than 2,800 people. Their budget for adult social care this year is £65.3million. Yet even with this large budget, the trend is not its friend, according to Hayley Verrico, the council’s assistant director of adult support and safeguarding. In addition to the demand created by more older people and the ‘old-old’ growing frailer, there are special needs children who enter adult social care. The priority is to enable them to stay at home. Will this increased demand be met by technology? Ms. Verrico believes so, giving examples such as telecare and assistive technology for PERS, automatic tap (water) shutoffs, and door/wander sensors. The paradox is that carers also need to be trained in the meaningful monitoring and support management part of home care, transitional care, and encouraging that person to be more independent in activity, versus the traditional hands-on part of direct care.

This story is a chirping canary in the mine in UK, EU and the US. The last situation is in a way worse. Not only are we in the US not set up for community-wide maintaining of adults at home, but also most direct care workers are paid in the bottom quarter of US hourly wages with few perceived opportunities for advancement. Beyond monitoring, how do we handle the next meaningful step–telehealth and RPM?  North Somerset Times

‘Il Futuro’ of healthcare in Florence 29-30 Sept

Forum of Sustainability and Opportunities in the Health Sector, Stazione Leopolda, Florence Italy  29-30 September

“Futuro”, a two-day conference in Florence, is centered on innovation in the healthcare sector and the main trends in the industry: neuroscience, digital transformation, cybersecurity, future trends, and longevity. The separate technology and innovation track includes value-based care, data analytics, national digitization of health, and startups. Speakers include David Wood, President of London Futurist; Nicola Dragoni, Computer Engineering at Örebro University, Sweden; and LT Col. Marco Biagini, NATO Modeling and Simulation Center of Excellence. Participation in the Forum and to individual events is free with membership. More information, registration, and agenda are on their website (in Italian–registration doesn’t machine translate). Hat tip to Giuseppe Orzati, the forum director, of Koncept Communications.

Events: MEDICA App Competition 15 November (DE)–not too late to enter!

click to enlargeWednesday 15 November, Düsseldorf Exhibition Centre, Hall 15, 3-5pm

MEDICA 2017 (13-16 Nov) will be hosting the sixth annual MEDICA App Competition on the stage of the Connected Healthcare Forum. This is featured as the “the world’s largest live competition for the best App-based Medical Mobile Solution for use in the daily routine of a patient, a doctor or in the hospital.” 15 contestants will pitch on stage for three minutes each with an additional two minutes for the jury to submit questions. First place solution will be awarded €2,000, second €1,000 and third €500, along with the winner going to SXSW and the top three receiving Startupbootcamp (SBC) Digital Health awards.

Featured on the jury are Ashish Atreja from Mount Sinai in NYC and Ralf-Gordon Jahns of research2guidance.

Application submissions are being accepted through 30 September with notification early in October–scroll down the page for the link.

Events: UK Telehealthcare’s autumn and 2018 MarketPlaces, UK Health Show

click to enlargeOur long-time supporter UK Telehealthcare has several upcoming MarketPlaces on their events page here–a quick guide below for putting on your calendar:

4 October London MarketPlace, Barnet and Southgate College, Southgate Campus, High St. London N14 6BS. 10am to 3pm

Speakers include
David Byrne – Principal and Chief Executive at Barnet and Southgate College
Alev Cazimoglu – Labour Cllr For Jubilee Ward, Enfield Council – Cabinet Member for Health & Adult Social Care
Doug Wilson – Head of Strategy & Service Development, Health, Housing and Adult Social Care

BSC is London’s newest centre of excellence for Technology Enabled Care Services (TECS). MarketPlace participants can visit the BSC CETEC Living Lab, a fully-furnished flat equipped with the latest technology.

23 NovemberBristol MarketPlace, Bristol City Hall, College Green, Bristol BS1 5TR

In 2018
13 MarchCambridge MarketPlace–more details to follow.
UK Telehealthcare is also planning MarketPlaces in Luton, Nottingham, and Dudley

Links to the MarketPlace pages aren’t up yet, so check the link above for more information.

Their page also reminds our Readers that the UK Health Show is on 27 September at the Olympia. With four shows featuring technology, cybersecurity, procurement, and commissioning, it is designed for senior healthcare professionals and decision makers to help the NHS promote and improve service delivery.

Tunstall Americas acquires Providence Lifeline Medical Alert Service

New Tunstall Americas CEO Oscar Meyer announced today (6 Sept) the acquisition of Providence Lifeline Medical Alert Service from parent Providence Health & Services, a division of Providence St. Joseph Health, a nonprofit Catholic health system with 50 hospitals and over 800 clinics in seven Western states. Terms were not disclosed. The sizing was also not disclosed beyond ‘thousands of customers’. Evidently from its statement, Providence Health will continue to contract with Tunstall and expand PERS health monitoring for its clients: “Providence looks forward to a collaboration that will help people stay safe and independent at home.” Another interesting affirmation is that Tunstall is resuming its collaborating or acquiring “highly regarded regional, state, and local providers of telecare, medical alarms, and medication management services.”  Release (PR Web)

HIMSS new CEO Hal Wolf acknowledges ‘silver tsunami’ healthcare effects, changes

HIMSS has a new CEO at the helm–Hal Wolf, succeeding Steve Lieber, who stepped down after 17 years as announced in December 2016. In this interview with Healthcare IT News (owned by HIMSS), Mr. Wolf finally acknowledges that HIMSS and healthcare IT leaders will have to adjust their approaches to HIT to support the world’s aging population and keep their organizations going financially. Using the term ‘silver tsunami’ (a tired term long since retired by writers), he posits that “We must recognize that healthcare systems are going to be financially strapped. We have a lot of people living longer and there are going to be fewer people producing GDP.” The odd order–first–of this financially-oriented statement in the article sets the stage for the rest, which is at once reassuring (he’s a big supporter of ‘patient-at-home’, connected devices, and predictive modeling with genomic data) and disconcerting (supply chain automation and purchasing). Perhaps his fiscal emphasis is based on his consulting, WHO, and Kaiser Permanente experience. At the end, the comments roll back to HIMSS education, networking, and their role in public policy including blockchain and FDA. Not addressed: whether this new CEO is as acquisition-minded as his predecessor, with Health 2.0 perhaps the cap to Mr. Lieber’s long reign.