The Telecare Services Association (TSA) in the UK has recently released a white paper addressing the impact of a fundamental change to the UK Public Switched Telephone Network (PSTN) that is now being contemplated. This change will eventually see the replacement of the current PSTN and Integrated Services Digital Network landline networks with IP telephony (the type of phone connectivity that has been commonly used in most modern office environments for some years).
Two years ago BT, who essentially owns practically the whole of the UK PSTN, proposed that the change of their network would be completed in 2025.
This has an impact on the telecare services to the extent that many telecare alarm devices in use connect to the call centres via the PSTN and hence such devices and/or the infrastructure used by suppliers of such services will need to be upgraded when the underlying network is changed. There are, according to the TSA paper, 1.7 million users of such devices in the UK.
The TSA is essentially the UK industry body for telecare and telehealth and as such it is understandably trying to raise awareness of the need for both the commissioners and suppliers of these services to prepare for the change. This paper is said to be a result of gathering views from “key stakeholders” related to this change.
The potential impact, however, seems to be somewhat exaggerated. It should be remembered that the UK very successfully underwent another major switch-over not that long ago in 2012 – from analogue to digital TV. It required every analogue TV in the country to be either fitted with a set top box or replaced with a digital TV.
TSA also suggest that this changeover be used as an opportunity to roll out more internet based digital health functionality to end users. Of course, such functionality is already widely appearing in the form of health monitors, exercise and medication reminders etc. and are not dependent on the switch over. So it is unfortunate that the paper flips between the two topics and asserts a dependence of internet based digital services on the PSTN switch-over.
The document feels more like marketing material than a white paper with about 1/3 of it taken up by irrelevant photographs of random happy smiling or laughing (mostly older) people. It reminded me of some of the material that came out the the 3 Million Lives project. If only our elderly people living alone or in our care homes were as happy as this!
The paper is available to download here.
(On the lighter, lower-tech side–there are stories that just ask for alliteration running amok, with a few bad puns in tow–Ed. Donna)
Who Is The Tack Saboteur? In the traditional English seaside town of Clacton-on-Sea in Essex, there are quite a few resident pensioners (US=retirees) who use mobility scooters. According to the Telegraph (PDF), Clacton, in fact, has one of the highest numbers of what are also called disability buggies. The Telegraph and the local Clacton Gazette report that someone is not tossing out welcoming rose petals on the sidewalks but new half-inch roofing tacks. This tack (not hack) attack has been keeping local repair shops in the chips repairing punctured tyre tubes, with at least 15 buggy blowouts reported in two weeks. According to a local disability campaigner, it’s revenge on scooterers, who seem to have earned a poor driving reputation on Clacton’s sidewalks. Here’s hoping the local police track down the tacky person who is doing this. On the other hand, buggy driving lessons may also be in order. Hat tip to reader John Boden of ElderIssues (FL), who is alarmed at the prospect of out-of-control buggy drivers.
The problem of Japan’s aging population–the oldest worldwide with 32 percent aged 60+ (2013, RFE
)–and shortage of care workers has led to a variety of ‘digital health solutions’ in the past few years, some of them smart, many of them gimmicky, expensive, or non-translatable to other cultures. There have been the comfort robot semi-toys (the PARO
seal, the Chapit
mouse), the humanoid exercise-leading robots (Palro
), and IoT gizmos. Smarter are the functional robots which can transfer a patient to/from bed and wheelchair disguised as cuddly bears (Robear,
developed by Riken and Sumitomo Riko) and Panasonic’s
exoskeletons for lifting assistance.
Japan must support more older adults in homes with increasingly less care staff. The Financial Times quotes Japan government statistics that by 2025 there will be 2.5m skilled care workers but 380,000 more are needed. The working age population is shrinking by 1 percent per year and immigration to Japan is near-nonexistent. It is not only doing more with fewer people, transferring hard and dirty work to the robots, but also producing the devices at a reasonable price for both domestic use and export.
The Abe government in 2012 budgeted ¥2.39bn ($21m) for development of nursing care robots, with the Ministry for Economy, Trade and Industry tasked to find and subsidize 24 companies. Five years later, the Ministry of Health, Labour and Welfare determined that “deeper work is needed on machinery and software that can either replace human care workers or increase staff efficiency.” Even Panasonic concurred that robots cannot offset the loss of human carers on quality of services. At this point. Japan leads in robots under development with SoftBank’s Pepper and NAO, with Toyota’s ChihiraAiko ‘geisha robot’ (Guardian).
The next generation of care aids has moved away from comfort pets to sensors and software that anticipate care needs. Projects under development include self-driving toilets (sic) that move to the patient; mattress sensor-supplied AI which can sense toileting needs (DFree) and other bed activity; improved ‘communication robots’ which understand and deploy stored knowledge. Japan’s businesses also realize the huge potential of the $16 trillion China market–if China doesn’t get there first–and other Asian markets such as Thailand, a favored retirement spot for well-off Japanese. But Japan must move quickly. Already Thailand is pioneering smart cities with Intel and Dell [TTA 16 Aug 16] and remote patient monitoring with Western companies such as Philips [TTA 30 Aug]. There’s the US and Western Europe, but incumbents and the bumpy health tech ride tends not to suit Japanese companies’ style. Financial Times (PDF here if paywalled) Can they? Hat tip to reader Susanne Woodman of BRE (Photo
Boston-based American Well and Dublin-based Medtronic announced this week a partnership to integrate telemedicine and telehealth for chronic care management, targeting complex, chronic and co-morbid patients. Under the agreement, American Well’s telemedicine services will integrate into Medtronic Care Management Services (MCMS) video-enabled telehealth platforms for remote patient monitoring and video consults. The goal is to provide more information so that clinicians gain a more complete view of a patient’s health status when making care decisions, thus reducing the cost of care and improving patient outcomes. Care for patients with multiple chronic conditions accounts for over 70 percent of healthcare spending, according to an AHRQ study.
American Well is currently partnered with 250 healthcare partners in the US and more than 750 health systems and 975 hospitals, along with most major health plans. MCMS has two video telehealth platforms including the mobile NetResponse and the LinkView Wi-Fi tabletop. Their most recent activity is with the Midwest’s Mercy healthcare system for data sharing and analysis to gather clinical evidence for medical device innovation and patient access. MCMS platforms are also being integrated into the VA’s Home Telehealth program [TTA 6 Feb and 15 Feb]. It indicates that Medtronic is seeking to grow its telehealth device business, which has largely (except for VA) been a backwater in the immense Medtronic empire.
This is a very logical and in this Editor’s estimation, overdue type of partnership between a telehealth provider to enhance telehelath and RPM. (An easy bet: expect Teladoc to follow with another telehealth provider)
American Well/Medtronic release, Healthcare Informatics, MassDevice
Susanne Woodman, our Eye on Tenders, alerts our Readers to a fast-closing bid. NHS Shared Business Services in Salford is looking to procure Best Practice Case Studies – Online Consultations on behalf of NHS England. Bids are due by Friday 3rd November at 10am, with clarification questions due by Wednesday 25th October 2017 noon. Base information is on UK.gov with links to MultiQuote for more information.
Wednesday, 1 November at the Edison Ballroom, NYC, 6:30pm
The New York eHealth Collaborative, which promotes healthcare in NY State and elsewhere by leading, connecting, and integrating health information exchanges in New York, will again host their annual evening Gala and Awards in NYC. This year the lead award (Transformative Leadership) will be awarded to David Blumenthal, MD, President of The Commonwealth Fund (the home of the Triple Aim). Having been to this event in the past, it is attended by the leadership of most major health organizations in New York such as New York-Presbyterian, NYU-Langone, Maimonides, and payers such as Aetna. Click here for more information and for tickets. The revenues support the work of NYeC in promoting interoperability through entities such as the Statewide Health Information Network for New York (SHIN-NY), which links New York’s eight regional health information organizations (RHIOs) or Qualified Entities (QEs) throughout the state. They also fund NYeC’s work in developing policies and standards supporting the use of health IT and EHR adoption. Hat tip to Jesse Giuliani of NYeC and Sarianne Gruber of Answers Media.
Susanne Woodman, our Eye on Tenders, has offered Readers a ‘heads up’ on a future tender for NHS England in Leeds. This is for the establishment of a national dynamic purchasing system (DPS) for the procurement of online consultation systems. According to the listing on Tenders Electronic Daily–TED, the DPS will allow NHS contracting bodies (e.g. CCGs and GPs) to procure online consultation systems in a robust and compliant way on a regional/local basis. “Online consultation is also increasingly a key part of patient pathways in urgent care, and the 111 Online programme seeks to connect patients to urgent care settings following a digital triage….to bring together a seamless experience for patients bridging primary and urgent care needs.”
This initial expression of interest is to gather information on the opportunity and to give interested parties the opportunity to ask clarification questions about the process. Deadline is 19 November for this information gathering exercise. Download any associated documentation via the In-Tend e-procurement system via the following link: https://in-tendhost.co.uk/scwcsu/aspx/Home. This may be part of an eventual investment of £45 million towards the purchase of online consultation systems.
3rings is launching another extension of its smart plug sensor that monitors daily use of a key appliance like a tea kettle or TV with a multi-sensor IoT system. ‘Things That Care‘ uses proprietary ‘things’ (sensors) to monitor patterns of activity and the home environment to create a safety net for an older adult, perhaps growing frailer, usually living at home alone, so that family or caregivers can ‘look in’ to see if all is fine. It also integrates the Amazon Echo interactive personal assistant as announced in June [TTA 27 June].
The other 3rings development is the system’s ability to analyze data for trends and insights (screenshots below). The introduction of self-learning algorithms to detect potential changes in activity that may be early signs of a change in health is a proactive care advance similar to capabilities in the far more complex and expensive QuietCare and Healthsense (now Lively) but affordable for families. It also puts the 3rings system into the professional space for councils and sheltered housing. According to 3rings CEO Steve Purdham, “our new platform gives professionals real time information to support efficient care planning and delivery, and provides a cost effective means of managing risks and providing tailored care to people to enable them to stay independent at home.” Again, we wish 3rings the best with these new developments. Release (PDF)
What’s being called Black Monday in the security world is the discovery of a fundamental flaw with WPA2 (Wireless Protected Access v2), which secures an estimated 60 percent of the world’s Wi-Fi networks. According to all reports, the WPA2 protocol (the ‘handshake’ between the device and the router) can be manipulated into reusing encryption keys. ‘KRACK’–for Key Reinstallation Attack–threatens any Wi-Fi enabled device and all Wi-Fi networks. It was discovered by researchers at KU Leuven, a university in Flanders, Belgium.
Threats include attacks on any sensitive information–hackermania potentially running wild. The vulnerability also permits an attacker to inject malicious information–ransomware and malware–into a Wi-Fi network.
Security firm Varonis narrows the greatest threat down to Android users and devices that implement the WPA2 protocol very strictly. They consider Apple iOS devices and Windows PCs to be mostly (as of now) unaffected “since they don’t strictly implement the WPA2 protocol and key reinstallation.”
This obviously affects any public networks or lightly protected networks in practices and hospitals. Varonis notes that the attack depends upon being within Wi-Fi range of the target device with the attacker sending forged data to the client. But this is difficult–it requires not only proximity but also access to a specialized networking device and to be able to code the attack manually.
Updates are allegedly on the way from Apple and Google, while Microsoft has already included it in last week’s updates for Windows 7, 8, and 10 (Telegraph). Most vulnerable devices are Android smartphones and tablets, which according to The Verge have an additional variant vulnerability affecting 41 percent of devices–and Android devices are notoriously slow to send out updates.
Monday also marked a second threat called ROCA, an attack on public key encryption which may weaken authentication of software when installing it. This will be fixed in software updates.
Recommended protection for now, as listed in the Telegraph, is to ensure that all your Wi-Fi access is password-protected and to implement updates on networks. Don’t use public unsecured networks. Shop only on https-protected sites. Computers and devices are issuing firmware and driver updates, and a constantly updated list is published over at the wonderfully-named Bleeping Computer, but your router may not automatically update, so you will have to do some searching and consulting with your internet provider. Also Wordfence (hat tip to Founder Steve) and a second article in The Verge.
Florida is one of the 34 states (plus the District of Columbia) to have legislated telehealth commercial insurance coverage, usually termed ‘parity’, for telehealth (telemedicine) virtual visits. It’s also the headquarters of many telehealth related companies, which makes it surprising that it took till 2016 for legislation to pass. In the law was the formation of a Telehealth Advisory Council within Florida’s Agency for Health Care Administration (AHCA) to report on the actual performance of insurers in paying for telehealth services. This Advisory Council recently met to review a draft copy of a 32-page report that will be sent to Florida’s Governor and Legislature later this month. That report contained some aggressive recommendations based on their provider survey, such as:
- Establishing a practitioner/patient relationship through telehealth alone, without a prior in-person visit
- Real parity in insurance company payment with in-person visits–in other words, payment at the same rate, which is explicitly stated in regulations in only three of the 34 states with telehealth ‘parity’ legislation
- Amend Medicaid rules to give provider reimbursement for more telehealth services–currently, Medicaid provides for reimbursement of live video conferencing only
- Authorize participation in interstate “compacts” that enable cross-state licensure for telehealth services. This was in the Florida House version of the bill in 2016 but dropped from the final version approved by both chambers.
The Advisory Council’s survey prior to the draft report showed lower than the national usage of telehealth: 6 percent of practitioners versus nationally 16 percent. 45 percent of Florida hospitals used telehealth, below the 52 percent of hospitals (with another 10 percent in the process) found in a 2013 national poll. For practitioners, the key barrier was financial in three areas: required investment, adequate reimbursement for services, and a financial return.
By law, the Advisory Council must complete its report by December 1, 2018, but it appears they are well ahead of schedule. Health News Florida (WUSF). Background from law firm Foley on the original legislation 14 March 2016
Wed 13 December, 9.00am-4.30pm
Horizon Leeds, Kendall Street, Leeds
The King’s Fund is hosting a December conference in Leeds on the digital sharing of health and care records. Delivering the key benefits of coordinated care requires three things: the appropriate technology, the right governance structure and a culture of adoption. Attendees will learn more at this full-day event about:
- The direction of national programmes on interoperability and data sharing across and between local areas
- Case studies from around England where teams have developed ways to share health and care records locally
- The challenges involved in implementing data sharing across and between local areas and learn how others have overcome them
Keynote speakers include Will Smart (CIO, NHS England), Prof. Maureen Baker (Chair, Professional Record Standards Body), Andy Kinnear (Director of Digital Transformation, NHS South, Central and West Commissioning Support Unit and Chair, BCS Health), Nicola Quinn (Project Manager, Health Informatics Unit, Royal College of Physicians), and Jan Hoogewerf (Programme Manager, Health Informatics Unit, Royal College of Physicians).
For complete information, agenda, and to register, click on the sidebar advert or here. TTA is pleased to be a long-time supporter of The King’s Fund and a supporter of this event. Hat tip to Claire Taylor of The King’s Fund–if you are interested in supporting this conference, contact her here.
Connected Health Conference
25-27 October, Seaport World Trade Center, 200 Seaport Boulevard, Boston
The eighth annual Connected Health Conference, presented by the Personal Connected Health Alliance (PCHAlliance) in partnership with Partners Connected Health, is coming up in just a few days.
Wednesday is packed with special sessions that cover the state of the market in wearables, artificial intelligence (AI), voice-activated technologies, the smart home (hosted by Parks Associates) and the innovation economy.
- The Life Sciences and MedTech Roundtable will explore the emerging category of digital therapeutics, the evolution of traditional pharma and med tech business models and the impact on relationships with patients, providers and other stakeholders in healthcare.
- Europe Meets North America will exchange views and strategies on issues like interoperability and the free flow of data across borders in an all-day workshop hosted by the ECHAlliance. (For more on the PCHAlliance’s EU efforts to ensure consistent regulations governing digital health with the implementation of the General Data Protection Regulation (GDPR), see this release.)
Recent additions to the main conference on Thursday and Friday:
- A new fifth track focusing on health system innovation projects, outcomes and processes with the leading partnerships that are disrupting and redesigning healthcare delivery, including Healthbox and Intermountain Healthcare, Brigham Digital Innovation Hub, Johns Hopkins Medicine Technology Innovation Center and MITRE sharing their work with Dana-Farber.
- The new Innovation Lounge will showcase provider, industry and institutional innovation centers and novel collaborations. The Innovation Lounge stage will present groundbreaking initiatives from Intel, IBM, MDRevolution and Becton Dickinson, HHS Idea Lab, data from the IPSOS Digital Doctor Survey, and results of a recent connected health survey. Dr. Joseph Kvedar will share a preview of his new book, The New Mobile Age, How Technology Will Extend the Healthspan and Optimize the Lifespan. (more…)
Verily‘s visit to last week’s Health 2.0 conference had an odd-but-fun tack, comparing the data received from human bodies to the billions of data points generated by an average late-model automobile in normal operations. We generate a lot less (ten orders of magnitude difference, according to Verily Chief Technology Officer Brian Otis), but Verily wants to maximize the output by wiring us to multiple sensors and to use the data in a predictive health model. Some of the Verily devices this Editor predicts will be non-starters (the sensor contact lens developed with Alcon) but others like the Dexcom partnership to develop a smaller, cheaper continuous blood glucose monitor and Liftware, the tremor-canceling silverware company Google acquired in 2014, appear promising. Key to predictive health is the Study Watch, which is a wearable that collects a lot of data but is easy to wear for a long time. Mobihealthnews
But what to do with this All That Data? Where this differs from a car is that the operational data goes into feedback loops that tune the engine’s performance, perform long-term monitoring, electrical system, braking, and more. (When the sensors go south or the battery’s low, watch out!) It’s not clear from the talk where this overwhelming amount of healthcare data generated goes to and how it becomes useful to a person or a doctor. This has its own feedback loop this Editor dubbed a few years ago as the Five Big Questions (FBQs): who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records. That’s not answered, but presumably these technologies will incorporate machine learning and AI to Crunch That Data into bite-sized parts.
Which leads us back to Verily’s parent, Alphabet a/k/a Google. All that data into Verily devices could be monitored by Google and fed into other Google programs like their search engines and Adwords. Another privacy problem?
Perhaps health systems are arriving at the realization that they have to crunch the data, not avoid it. For the first time, this Editor has observed that a CMIO of a small health system in Illinois and Sanford Health‘s executive director of analytics are actually welcoming patient data and research. Startups in this area such as PreventScripts labor on that “last mile” of clinical decision support, preventative medicine. EHRs are also into the act. Epic launched Share Everywhere, where patients can grant access to their data and clinicians can send updates into the patient portal (MyChart). What’s needed, CMIO Goel admits, is software that combines natural language processing and algorithms to track by disease and specialty–once again, machine learning. Healthcare IT News
And you thought Q2 was ‘crazy’? There’s no cooling in StartUp Health’s reported digital health funding activity in Q3, which at $9bn is already past 2016’s $8.1bn and is poised to cross the $10bn bar by end of year.
- Q3 charted $2.5bn in funding, less than Q2 ($3.8bn) but above Q3 2016 ($2.2bn).
- Series C and D deals led the funding charge at 15 percent of deals, with Series D on average $113 million. It’s an indicator of market maturity, though A rounds were still in the lead at 35 percent and 21 percent in Series B.
- Deals are bigger than ever at an average $18 million versus $14 million in 2016
- Half the deals they tracked were in personalized health and patient/consumer experience, a distinct difference from Rock Health’s shift to B2B. Population health held its own.
- They tracked more mega-deals YTD due to broader category and ex-US. Rock Health’s lead this quarter of 23andMe was only #6 on the list, surpassed by Auris, Peloton, Guardant Health, Outcome Health, and Grail.
- The Bay Area leads for deals substantially YTD, with NYC, Boston, and Chicago combined still trailing
Remember that StartUp Health takes a wider sample than Rock Health [TTA 3 Oct], tracking over 500 international company deals, including those below $2 million as well as both service and biotech/diagnostic companies. StartUp Health on Slideshare.
Susanne Woodman, our Eye on Tenders, has four for your consideration, three of which are high value:
- Wigan Council: “Delivery of Support at Home and Mobile Response Service”. Wigan is seeking TECS to support Borough residents in home-based independent living and in Managed Accommodation developments. The objective is to reduce the local burden of unnecessary hospital admissions, on emergency services, and to reassure families and carers about the person’s wellbeing. The contract is for 60 months and is valued at £2,375,000. Closing is 27 October at 10:15am. More information on TED.
- Salford Royal NHS Foundation Trust: “Provision of a Digital Control Centre”. Salford Royal will be the test bed for this Control Centre to potentially scale to the rest of the NHS. The Control Centre will use the latest advances in “data analytics and digital health to achieve a world-leading organisation which has operational excellence, the best quality healthcare and patient experience across the entire organization which also includes social care.” The five-year agreement starts August 2018 and is budgeted at £2.0m – £3.0m. More information on Gov.UK.
- National Institute for Health and Care Excellence (NICE) in Manchester: This is for the NICE External Assessment Centre Framework, to provide a range of health technology assessment services to support its technology evaluation programmes and related activities. It is in four lots: secondary data analysis, primary data analysis, technical and regulatory support, decision support. The contract is for 33 months from award and total value is in the range of £1-6m. Deadline is 20 November at 5pm. More information on TED.
- And a reminder that NHS Greater Huddersfield & North Kirklees’ tender deadline is 20 October. This tender is open early engagement for the provision of a technology-assisted, rapid access service offering an alternative to hospital-based A&E services. Market test site is in Kirklees for residents of a care home. Requirements are:
- A 24/7 clinical teleconsultation service delivered via secure video link into residential/ nursing homes, that is utilized instead of patients having to be taken to the local A&E department.
- A service that provides clinical consultation not a logarithm based approach like 111.
- A fully managed technical service utilizing bespoke laptops with HD cameras and with 4G SIM or broadband.
- Deadline is 5pm on Friday 20 October. More information on Gov.UK.
Too hot not to cool down? This year’s digital health funding, as reported by Rock Health, may be ‘just one of those things’ depending on what happens next quarter. After a torrid Q2 which brought first half 2017 to an explosive $3.5 bn [TTA 11 July], Q3 added only $1.2 bn for a total $4.7 bn. Bear in mind that this is larger than the full years of 2014-2016, and that Rock Health tracks only US deals over $2 million in value from venture capital, excluding government and grant funding. Rock Health’s report concentrates on deal sizes, trends, and types of companies. Here’s what this Editor found to be interesting:
Here’s what this Editor found to be interesting:
- Number of deals is at a record: 268 digital health funding deals across 261 companies. In 2016, 240 digital health venture deals had closed by the end of Q3 in 2016.
- Few mega-deals this quarter: The only ones are 23andMe with a $250 million round in September followed by cancer data company Tempus’ $70M Series C round. Average deal size dropped to $14.6 million. The cooling is great enough for Rock Health to predict that there may not be any IPOs this year–23andMe was considered the leading candidate but instead went for another round.
- 16 percent of companies funded in Q3 are led by women CEOs, up from 11 percent. Of course, this is influenced by 23andMe’s founder/CEO Anne Wojcicki. But almost more importantly, there’s been a breakthrough in that women’s and reproductive health companies continue to gain funding traction, and most are led by women.
- The two top categories for funding through Q3 are consumer: health information and personal health and tracking tools.
- Yet companies are shifting to a B2B business model from B2C, with 23andMe in the lead targeting drug discovery via the Genentech deal they have had for a long time. 61 percent of digital health startups that Rock Health tracks converted from B2C to B2B. No surprise to this Editor as consumer adoption is a slow and costly road.
- Exits are also cooling down as long-cycle reality hits. The ‘nine-inning ball game’ stated by an investor is, given healthcare’s long cycles, regulation, and slow adoption, is more like 15.
- Some recovery in public companies making money in earnings per share (EPS). Teladoc‘s recovered, while NantHealth continues in the doldrums. (Perhaps it’s Cher suing Patrick Soon-Shiong?)
Awaiting StartUp Health‘s always numerically bigger report, but this Editor’s bet is that it won’t be ‘crazy’ like Q2 [TTA 15 July]. Rock Health Q3 report.