Veteran health reporter Anne Zieger has uncovered another instance of data mining that could be a benefit–or not. USAA, a financial services company for military and veteran families, has started to collect health data via electronic records from life insurance applicants at the Department of Veterans Affairs and Department of Defense. They have streamlined the health records process in the application by developing with Cerner a feature called HealtheHistory that retrieves the data via the patient portal from the applicant’s EHR after consent. It cuts application time by 30 days, but the implications raise some alarms. In Ms. Zieger’s view, we should consider this carefully before huzzahing this type of data sharing:
- Is an insurer going to care much about HIPAA compliance on PHI? In her view, not likely.
- Is it a good idea to give an insurer full access to health data? There is the case of an otherwise healthy woman who tested positive for the BRCA 1 gene which indicates that the carrier has an increased risk of breast and ovarian cancer, who was turned down for insurance by USAA. To not disclose would be fraud, but the nuance is risk, not the condition.
- Will the information be shared within USAA for judgment on other financial instruments, such as mortgages–regardless of legality?
EMR and EHR Our previous look at data gathering on medical conditions run amok is here
9 to 5 Mac, the tip sheet for all things Apple, tracked down a patent granted to Apple (via Patently Apple) for computing health measurements using the iPhone. According to Apple in the patent, “electrical measurements may be used to measure heart function, compute an electrocardiogram, compute a galvanic skin response that may be indicative of emotional state and/or other physiological condition, and/or compute other health data such as body fat, or blood pressure.” It would use the front-facing camera, light sensor and proximity sensor to emit light that would be reflected back to the sensors. Additional sensors mounted in the same area would also generate additional health measurements such as body fat and EKG, which is already measured by the Kardia Mobile/Alivecor attachment. The camera and light sensor alone, based on the patent and the article, would measure oxygen saturation, pulse rate, perfusion index and a photoplethysmogram (which can monitor breathing rate and detect circulatory conditions like hypovolemia). Another demonstration of Apple’s keen interest in the health field, but what features will show up on real phones and apps–and when?
The Future Health Index–a blockbuster 100-page annual study from Philips with research conducted by IPSOS, Schlesinger, and Braun–reflects findings of over 29,000 consumers and 3,300 healthcare professionals in 19 countries. The survey includes analysis by country and aggregate of perception versus reality (both difficult measures) in access to healthcare, integration between healthcare systems, and adoption of healthcare technology. It is, needless to say, complex and hard to parse into a headline and finding or two or four. The UK press release helpfully discusses particulars of the UK findings which are hard to find in the main report. Overall, it’s positive, but nowhere near a tipping point where connected care is expected and routine.
- About half (48%) of (UK) HCPs have seen an increase in the use of connected care technologies by primary care doctors in last 12 months
- About a third of the (UK) general population (31%) have used connected care technologies to monitor a health indicator in the last 12 months
- Over half of the (UK) general population (57%) who have used connected care technology to track health indicators have shared their data with an HCP in the last 12 months
- Six-in-ten (62%) of the (UK) general population think that integration of the health system would make the quality of healthcare better
The appendix with the UK summary results is available online here and the US here. The full study is available for download here. (All countries are in the appendix)
Out of the global results, there’s a disconnect between having the data and making it useful: “Only 23% of the general population surveyed who used connected care technology within the last 12 months claim to completely understand when to share data from connected care technology with a healthcare professional, or the easiest way to do so.”
A not surprising finding was that quick wins would be found in the home care area and in preventing avoidable readmissions:
- Connected care was important to healthcare professionals in improving home care and for geriatric care–81 percent and 82 percent respectively
- 55 percent of professionals chose home care and related aspects in improving long-term management and tracking of medical issues
Looking forward into the future, the general population group was asked to speculate on artificial intelligence and on what AI technology would have the most impact on improving healthcare if available today. The two leaders were health tracking wearables/apps on smartphones and AI-assisted tools for guidance. Hologram doctors and robots cruised around 10 percent (!)
Editor’s note: While incredibly comprehensive, this Editor will express a certain disappointment in the researchers’ selection of US and UK experts. This Editor could name five to ten experts and patient advocates in US and UK from personal contacts (including our UK-based Editors) without thinking particularly hard–and with a little homework UAE and Africa–who could have informed their study.
This Editor also had the pleasure to meet two of Philips’ connected health executives at this month’s Health 2.0 NYC/MedStartr meeting on population health and value-based care: Nick Padula, VP of Home Healthcare Monitoring, and Eduardo Da Silva, Strategic Sales Director of Philips Wellcentive. Mr. Padula was a panelist for the evening.
This Editor thought it would be quiet for the rest of the month, but our Eye on Tenders, Susanne Woodman, has alerted us to two freshly posted–and the first is major:
- Scotland: The tender for the CAN DO Innovation Challenge Fund – Health & Social Care Challenges is so large it is in 10 lots which offer an initial market test, an evaluation by the fund, then a decision made on whether to pursue the potential project further with the public body. There are eight that directly involve healthcare technology:
- Point of care lab testing
- Adopting technology for care in the north of Scotland
- Transforming nursing care processes for the 21st century
- Creating and driving a clinically and cost effective pathway to improve recovery after critical illness enabled by data from hospital information systems
- An IT system for care workers and patients for adherence to stroke management plans to enable real time monitoring
- Transforming management of people with severe COPD to improve patient outcomes and quality of life and reduce healthcare costs
- Glasgow TECS development to support care and digital cutover
- Develop and integrate digital services that allow for consent-driven data sharing from patient records
There is no deadline listed. More information and required document links here on Public Contracts Scotland.
- Bootle (Merseyside) and Sovini Ltd are seeking assistive technology for about 1,000 residents of its local One Vision Housing with retirement and dispersed housing. Estimated value £180,000 over 24 months. Deadline is 18 Sept at noon. More information at Delta e-Sourcing and Tenders Electronic Daily.
Bitcoin + Smart Contracts or Bust! A surprise to this Editor was that Bitcoin (on 14 Aug an eye-blinking $4,400) has a host of ‘currency token’ competitors–Ethereum‘s Ether ($286), DCorp‘s DRP, and others in the wings waiting for their initial coin offerings (ICOs). These cryptocurrencies, while still hard to use (don’t try to shop for groceries with them), are demonstrating credible, real-world value despite shady uses in hacking.
The tech behind currency tokens, blockchain, with its distributed data ledger also offers another more intriguing development beyond what this Editor has noted in healthcare [TTA 16 July 16, 5 Apr]–smart contracts. These are built on blockchain that stores, verifies, and executes the terms of an agreement without a middleman. This is proving to be high value–Royal Bank of Scotland is building a distributed clearing house to speed cross-border payments based on Ethereum’s distributed ledger and smart contracts tech.
The combination of cryptocurrencies and smart contracts could create the next unregulated startup funding vector, according to this article in Forbes. It would more closely resemble an IPO, but using currency tokens. Smart contracts can also assure startup investors that entrepreneurs will be accountable and that investment and loan agreements will be enforced. The nearly unregulated world of crowdfunding has been surprisingly lucrative, with $34 billion invested in 2015. However, startups going this route had a high failure rate, nearly 40 percent, and crowdfunding is now more frequently used to test concepts and cause fundraising. We’ll see if blockchain-enabled funding becomes the Next Big (Funding) Thing. Hat tip to fellow NY Financial Writers Association member Katherine Heires of Mediakat.
Recently released by the New York-based Commonwealth Fund health policy foundation is a case study of a new model for extending medical care in Mexico and with a variant in the US for the Spanish-speaking population. In Mexico, MedicallHome (not a typo) connects subscribers by phone and mobile app to a 24/7 national network of physicians and discounted health resources such as clinics, labs, pharmacies, in-person medical services, and hospitals. The 60-person Healthcare Contact Center, staffed by primary care doctors, psychologists, and nutritionists, triage emergencies (press 1) to medical advice (press 2) to referrals (press 3). They also arrange in-person visits and emergency services.
MedicallHome’s model is targeted to low and middle-income Mexicans. It is primarily a direct-to-consumer offering, with subscriptions from $2 to $5/month, including travel health (60 cents for a bus trip) and low-cost insurance for students, but they also partner with private insurance, companies, and employers. With an average of 500,000 calls per year, MedicallHome staff resolve 62 percent of cases by phone and refer the remaining cases for in-person treatment. Prescribing medications without an in-person consult is illegal in Mexico.
The profitable MedicallHome complements the free (but overwhelmed and with long waits) national health service Seguro Popular. It also benefits from the oversupply of primary care physicians who work at multiple hospitals, clinics and private practices, and find the shift work in a call center convenient. Their parent, Salud Interactiva, built the infrastructure, IT, EHR, and worked with Telmex, the largest phone company in Mexico. They have also extended it to the Philippines as of July 2015 as Konsulta MD, a joint venture between Salud Interactiva and Globe Telecom, the Philippines’ primary telecommunications provider.
Salud’s joint venture in the US, ConsejoSano (healthy advice) is also profiled in the case study. Since ConsejoSano connects to the Mexico-based call center and not to US doctors, (more…)
One more from our Eye on Tenders, Susanne Woodman, is from NHS South West which is reviewing their currently in-house delivery of TECS, including monitoring, in Torbay. The Torbay and South Devon NHS Foundation Trust is seeking a fresh look at innovative services from providers who are interested and able to provide the full service from equipment, installation and monitoring, as well as bench-marking information. To review their current services and equipment (Tunstall), they helpfully provided this link. This was posted today (15 Aug) and closes 1 September, so there’s only a short window. Refer to the Gov.UK Contracts Finder page for contact information and (importantly) document attachments.
An interesting short (free) article on POLITICO Morning eHealth today was an interview with VA Secretary David Shulkin, MD on the Cerner transition, stating that if all went well with negotiations later this year, VA clinicians could be using the Cerner system by mid-2019. “There’s a lot of understandable concern about whether the Cerner EHR will have the same functionality as VistA, which has evolved to the physician’s needs over the past 35 years.” One of the problems with VistA was that it wasn’t one system, it was 130 systems, which is echoed in many EHRs. POLITICO goes on to quote Dr. Shulkin: “I don’t hear as many concerns about that as I do relief about finally making a decision because people felt this was the slow death of a system that they have poured their hearts and souls into. Knowing we’re committed to doing a transition as well as we can is reassuring to people.” Sadly, the rest of the interview is paywalled on POLITICO PRO. Earlier analysis: VA says goodbye to VistA, hello to Cerner. We wonder what the involvement and engagement of the four Home Telehealth winners of the 5-year contract will be.
A new Innovate UK challenge
has opened for digital health technology developers. They are seeking subject matter experts (SME) to lead a group in designing digital health innovations which achieve at least one of these objectives: improving patient outcomes, transforming healthcare delivery, and enabling more efficient delivery of healthcare. Total funding is £35m. It appears that each winner will be granted up to £8m as follows: feasibility–£50,000 to £75,000; industrial research and experimental development–£500,000 to £1 million.
This follows on our previously reported £12m Biomedical Catalyst program [TTA 5 Apr]. Innovate UK’s digital health program is being funded by the Industrial Strategy Challenge Fund which is also backing battery power and robotics challenge programs.
Detailed information and application information may be found here. Applications close Wednesday 11 October 2017 at noon. Hat tip to Tynetec via Twitter. (Illustration from Innovate UK and innovation leader Chris Sawyer’s blog.)
Updated. Our past contributor and TelehealthWorks’ Bruce Judson (ATA 2017 coverage) has penned this weekend’s Big Read in the HuffPost. His hypothesis is that telemedicine specifically will disrupt location-based care, followed by other digitally based care–and that executives at health systems and payers are in denial. More and more states are recognizing both parity of treatment and (usually) payment. Telemedicine also appeals to three major needs: care at home or on the go, with a minimal wait; maldistribution of care, especially specialized care; and follow-up/post-acute care. His main points in the article:
- Healthcare executives are being taken by surprise because present digital capabilities will not be future capabilities, and the shift to virtual will be a gradual process
- Telemedicine will address doctor shortages and grow into coordinated care platforms embedding expertise (via connected diagnostics, analytics, machine learning, AI) and care teams
- Telemedicine will eventually go up-market and directly compete with large providers in urban areas, displacing a significant amount of in-person care with virtual care
- Telemedicine will start to incorporate continuous feedback loops to further optimize their services and move into virtual health coaching and chronic care management
- Telemedicine platforms are also sub-specializing into stroke response, pediatrics, and neurology
- Centers of expertise and expert platforms will become larger and fewer–centralizing into repositories of ‘the best’
- Platforms will be successful if they are trusted through positive patient experiences. This is a consumer satisfaction model.
Mr. Judson draws an analogy of healthcare with internet services, an area where he has decades of expertise: “A general phenomenon associated with Internet services is that they break activities into their component parts, and then reconnect them in a digital chain.” Healthcare will undergo a similar deconstruction and reconstruction with a “new set of competitive dynamics.”
It’s certainly a provocative POV that at least gives a rationale for the sheer messiness and stop-n-start that this Editor has observed in Big Health since the early 2000s. A caution: the internet, communications, and retail do not endure the sheer volume of regulatory force imposed on healthcare, which tends to make the retail analogy inexact. Governments monitor and regulate health outcomes, not search results or video downloads (except when it comes to net neutrality). It’s hard to find an industry so regulated other than financial/banking and utilities. FierceHealthcare also found the premise intriguing, noting the VA’s ‘Anywhere’ programs [TTA 9 Aug] and citing two studies indicating 96 percent of large employers plan to make telemedicine, also with behavioral health services, available, and that 20 percent of employers are seeing over 8 percent employee utilization. (Under 10 percent utilization gave RAND the vapors earlier this year with both this Editor and Mr. Judson stinging RAND’s findings with separate analyses.)
Susanne Woodman, our Eye on Tenders, brings to our attention two upcoming opportunities:
- NHS Wales Informatics Service (NWIS) is developing a “cutting edge procurement project to establish a Dynamic Purchasing System (DPS) for Digital Patient Services Partners”, the first ever for health in the UK. It cautions, “DPS are a relatively new and untested procurement process that is believed will have significant benefit not only for the NHS but also as a catalyst to create innovative and agile markets.” Deadline for submission is 29 August. Details at Sell2Wales.
- Southend-on-Sea Borough Council in partnership with South Essex Homes and the Southend CCG is in the early stages of evaluating technology enabled care (TEC). They are seeking to pilot assistive technology enabled care in a 96 independent living residential block ‘Living Laboratory’. No deadline listed. Details at Gov.UK.
With New Jersey’s telemedicine regulations
now signed into law by Governor Christie to be effective 21 July, both providers and payers are adjusting to what the expansion means for those covered by Medicaid, Medicaid managed care, commercial health plans, and NJ state-funded health insurance. Our 27 June
article reviews key points, and they are largely positive for expanding telemedicine in the (now official) Garden State. However, the payment parity part was diluted in the final version, with the in-person reimbursement rate set as the maximum ceiling for telemedicine and telehealth reimbursement rates.
Unique parts of the NJ bill require:
- Telemedicine or telehealth organizations operating in NJ to annually register with the Department of Health
- Submit annual reports on activity and encounter data, which will include patient race and ethnicity, diagnostic and evaluation management codes, and the source of payment for the consult (final details determined by succeeding legislation)
- A seven-member New Jersey Telemedicine and Telehealth Review Commission
- Mental health screeners, screening services, and screening psychiatrists are not required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes
Full reviews of the legislation are available from law firms Foley & Lardner and in the National Law Review by an attorney from NJ firm Giordano, Halleran & Ciesla.
This Editor and publication have had relationships at different levels with the American Telemedicine Association (ATA) since at least 2006. Our Readers know of TTA’s long-standing support of ATA’s annual meeting as a media partner. As a marketer, I’ve negotiated booths, sponsorships, and sent staff (including myself) to meetings, which makes this experience like many of our Readers.
It is worth reflecting that in 1993, when Jon Linkous took the ATA helm, few of us other than academics had email or used the Internet except in limited ways like IBMMail or Minitel. Once telemedicine, video consults, and vital signs data capture were the future and mostly theory. We went through the whiz-bang gadget phase, where every new one was going to change healthcare as we know it. Now we are past the buzzy cocktail party hangover into trying to make it work. We are in 2.0 and 3.0 where it’s all about integration of telemedicine and telehealth into patient engagement, behavior change, data analytics, predictive care, genomics, improving life for the aging and chronically ill population, managing the tsunami of patient data for better outcomes, smart pills, hacking and data security, EHRs, ACOs, meeting standards such as MACRA…and heavy engagement with national (Federal) and local entities. And always–getting paid enough to stay afloat!
As an organization, ATA faces an ever-expanding HIMSS, which has expanded far beyond its health information/IT/data analytics raison d’être to media properties, multiple health tech conferences, and now presence with early-stage companies through acquiring Health 2.0.
Dizzying changes, and more to come.
Who do you want to see at the helm of ATA? What will be the new CEO’s problems to solve? List your choices and thoughts in Comments below! (If you wish to be anonymous, email Editor Donna in confidence.)
The new Veterans Affairs Secretary, David Shulkin, has wasted no time since his appointment in introducing several technology and mobile-based services at the VA, all of which are long overdue in this Editor’s estimation:
- Anywhere to Anywhere VA Health Care will authorize telehealth consults and cross-state care for veterans no matter their location and regardless of local telehealth restrictions. VA is already the largest provider of telemedicine services (called VA Telehealth) in 50 specialties to 700,000 veterans annually. This new regulation will enable VA to hire primary care and specialist doctors in metro areas to cover veterans in rural or underserved areas.
- Rolling out nationally over the next year is the VA Video Connect app where veterans can use their smartphones or home computers with video connections to consult with VA providers. At present 300 VA providers at 67 hospitals are using it.
- The Veteran Appointment Request (VAR) app will also roll out from its test. It will enable veterans to use their smartphone, tablet or computer to schedule or modify appointments at VA facilities nationwide.
Dr. Shulkin advocated these programs while undersecretary, especially ‘Anywhere to Anywhere’, which required advice from the Justice Department. VA’s technology is also being supported by the American Office of Innovation to improve care transitions between the Defense Department and VA.
President Trump participated in the announcement with Dr. Shulkin and sat in on between Albert Amescua, a 26-year Coast Guard veteran at a VA clinic in Grants Pass, Ore., and Brook Woods, a VA internist in Cleveland. VA announcement with videos, POLITICO Morning eHealth, HealthcareITNews
Mediterranean Towers Ventures of Ganei Tikva, east of Tel Aviv, has launched an investment fund dedicated to supporting technologies that support quality of life–health, culture, and leisure–for older adults. Co-CEO Dov Sugarman, via email to this Editor, confirmed that the venture fund is limiting itself for the time being to Israel-based companies in pre-seed and seed stages, although some later stage investments may be considered. They are “open to all opportunities in the aging tech space”. Interested companies should review their website and apply for funding here.
While Israel is statistically a young country, with only 11 percent or 900,000 aged 65 and over, this number is expected to increase to 1.3 million by 2025. At present, 25 percent of households have a member over 65, and because of this distribution, there is a substantial support network of supportive and adult housing. The venture fund grew out of Mediterranean Towers’ main business as a leading publicly traded provider of retirement housing.
The venture capital group is headed by Dr. Yael Benvenisti, who is the chair of the SIG Technologies of Aging Well (Society of Electrical and Electronic Engineers in Israel), a member of the board of the Israel Association of Gerontology and an advisor to government bodies. Mr. Sugarman is the CEO of Aging2.0 Israel and founder of the third-generation technologies sector at JDC-Israel. (‘3rd generation’, ‘3rd tech’, and ‘third age’ are common expressions for aging and related tech in Israel.) Release, The Marker (in Hebrew)
The American Telemedicine Association’s CEO, Jonathan Linkous, has left ATA after 24 years as CEO. An ATA spokesperson cited personal reasons, according to MedCityNews. Sources told POLITICO Morning eHealth that Mr. Linkous “simply told the organization he was leaving the job effective immediately before its board meeting this week.” It was certainly an unusual departure, without the standard transitional period of months or even a year. The ATA release was short and concentrated on the ‘transitional period’.
Acting as interim CEO will be Dr. Sabrina Smith, who joined last January as COO after senior VP/COO-level positions with the Regulatory Affairs Professionals Society (RAPS) and the American Academy of Physician Assistants (AAPA) after 12 years with MedStar Health, the largest health system in the Washington DC metro. MedCityNews quoted ATA board president Peter Yellowlees, MD that the search is expected to take about six months. This will take the search through ATA’s Fall Forum in October and well into the ramp-up for ATA 2018 in April. ATA is seeking “a vision for the future of healthcare” and “extensive knowledge of telemedicine”, so if you have it, step up!
Jon Linkous, from the formation of ATA to yesterday, gained much recognition for telemedicine and telehealth, to where ATA presently has 10,000 members and 450 health system and industry partners, a leading annual conference, multiple events and educational programs. They have concentrated much (and successful) effort in gaining parity of payment for telemedicine, a state by state battle, though the POLITICO report (using a quote from a former HIMSS executive director now consulting for ATA!) did not think much of ATA’s influence in the Washington DC swamps. Another major change apparent over the past five years: as an association, healthcare technology has developed way outside ‘telemedicine’. Organizations like HIMSS have exploded in size through redrawing their definitional lines plus aggressive acquisitions in media and of competitors such as Health 2.0. The next chapters won’t be simple or easy for the new CEO. Also FierceHealthcare. (Disclosure: TTA has been for many years a media partner of the ATA annual conference.)