Babylon as AI diagnostician that is ’10 times more precise than a doctor’

The NHS announced at the top of this month that it would test Babylon Health‘s ‘chatbot’ app for the next six months to 1.2 million people in north London. During the call to the 111 medical hotline number, they will be prompted to try the app, which invites the user to text their symptoms. The app decides through the series of texts, through artificial intelligence, in minutes how urgent the situation is and will recommend action to the patient up to an appointment with their GP, or if acute to go to Accident & Emergency (US=emergency room or department) if the situation warrants. It will launch this month in NHS services covering Barnet, Camden, Enfield, Haringey, and Islington, London. TechCrunch.

The NHS’ reasons for “digitising” services through a pilot like Babylon’s app is to save money by reducing unnecessary doctor appointments and pressure on A&Es. It provides a quick diagnosis that usually directs the patient to self-care until the health situation resolves. If not resolved or obviously acute, it will direct to a GP or A&E. The numbers are fairly convincing: £45 for the visit to a GP, £13 to a nurse and £0 for the app use. According to The Telegraph, the trial is facing opposition by groups like Patient Concern, the British Medical Association’s GP committee, and Action Against Medical Accidents. There is little mention of wrong diagnoses here (see below). The NHS’ app track record, however, has not been good–the NHS Choices misstep on applying urgency classifications to a ‘symptom checker’ app–and there have been incidents on 111 response.

Babylon’s founder Ali Barsa, of course, is bullish on his app and what it can do. (more…)

TechLaw: NDAs are not one size fits all; they are dangerous!

The subject of nondisclosure agreements–NDAs–is often treated as routine, not only in the US but also in the UK and Europe. Editor Donna has reviewed and signed a few, modifying only limited areas of ‘boilerplate’. Our contributor today is an attorney specializing in technology law, Mark Grossman, JD, and he explains to us that an NDA should not be treated quite so cavalierly–and that red flags should fly any time a trade secret is involved. (Editor’s emphases are italicized and bold.)

In the world of tech deals — more than other types of deals — my clients want to sign nondisclosure agreements quickly. I’m sure that many people will disagree with me on this one, but I like to avoid NDAs in the early stages of a deal. My feeling is that you shouldn’t be exchanging secrets with strangers and that doesn’t change no matter what they’ve signed.

Experience tells me that most deals at the “initial feeler” stage never reach fruition. It’s a long way from that first lunch to a closing and a bottle of champagne. I say skip the paperwork and legal entanglements until you’ve at least gone as far as thinking: “This is getting interesting and serious.” In the meantime, keep your secrets to yourself.

Usually, you can get through the early stages of a negotiation with a demonstration of what “it” can do without revealing how it does it. Of course, if what it does is as much a secret as how it does it, then my generalization may not be true for you.

In case you’re not familiar with NDAs, the idea behind them is that you’ll reveal confidential information only if the other side agrees not to improperly disclose or use the information. Right here, it starts getting tricky because you have to decide to whom they can disclose it and for what use.

Watch out for a form with a line for your company name. If you’re tempted to sign it, I have some simple advice: Don’t. Not ever.

Every NDA is customized. Since tech lawyers see NDAs constantly, writing a good one should never be an exercise in reinventing the wheel. Still, they do require some thought. (more…)

UK news updates: UKTelehealthcare changes the guard, Tynetec’s Dementia Dog

UKTelehealthcare, the membership association which supports health and care professionals and suppliers in delivering the widest choice and range of appropriate Technology Enabled Care Services, announced the retirement of John Chambers. Mr Chambers and Doug Miles founded the holding company of UKTelehealthcare, London Telecare Ltd., in 2005. He stepped down as a director at the end of November but will continue to be involved through his shareholding and consulting, especially in PR and marketing. Mr Miles will remain as a director and Chairman. Taking the roles of managing director and company secretary are Gerry Allmark, who joined UKTelehealthcare from Bosch Healthcare three years ago, and Julia Allmark, an IT specialist. Release (top of news page).

TTA also happily supported the Dementia Dog fundraiser in memory of Tynetec’s Billy and Lisa Graham that achieved their £15,000 goal on JustGiving to train a dog to support people with dementia [TTA 5 Dec]. Up on Twitter is a 30-second snippet of a program dog trainer explaining the bonding process. According to the JustGiving listing, Independent For Longer will be following the dog’s progress during training; also see #DogsforGoodUKBoth UK Telehealthcare and Tynetec (Legrand) are long-time supporters of this website.

The King’s Fund Digital Health and Care Congress ’17–update

The latest from The King’s Fund on the upcoming Digital Health and Care Congress, 11-12 July (only six months from now!) is in this video now available on Vimeo. It gives a great overview of how digital health has to be integrated to improve care in the NHS and also in other countries, and the scope of its effects on clinicians, HIT, and patients. This Editor has also received word that the successful projects submitted in the meeting’s call for papers will be announced on Friday 20 January, and that the full programme will be announced at the end of this month.

The King’s Fund’s event page; the Digital Health Congress fact sheet includes information on sponsoring or exhibiting. To make the event more accessible, there are new reduced rates for groups and students, plus bursary spots available for patients and carers.  

Hat tip to KF’s Claire Taylor for the information and the update. TTA will be a media partner of the Digital Health Congress 2017. Updates on Twitter @kfdigital17

US Army researchers use sensors, gels to study, mitigate brain and body blast effects

click to enlargeUS Army research labs have been leading the way for some years in researching how impacts, such as those experienced from explosive devices or other sources of concussion, can affect the brain and body. One tactic Army researchers in the Research, Development and Engineering Command (RDECOM) are taking is to engineer increased protection in ground vehicles (ground vehicle systems in Army-speak). However, testing designs can’t be done with humans. One method used is a sensor-laden crash dummy (Warrior Injury Assessment Manikin or WIAMan, seen above left). Fred Hughes, director of the WIAMan Engineering Office, commented that “The manikin’s sophisticated bio-fidelity and robust sensor design provides an unmatched level of accuracy determining the potential effects of blast on soldiers in new vehicle systems.” Another tool is the Microsoft-designed Hololens which allows researchers to virtually explore explosion simulations. Both are being used to assess survivability and mobility design in vehicles. Armed With Science

At another part of RDECOM located at the Aberdeen (Maryland) Proving Ground, US Army Research Laboratory researchers have simulated brain texture and mass through a specially designed gel. These nanomaterials are designed to fluoresce at graduated intensities under pressure. The goal is that researchers can track blast effects on the brain at the cellular level. ARL research in this area is jointly conducted with counterparts in the Japanese Defense Ministry, where researchers are contributing their knowledge of physiological effects such as cortical depressant, blood circulation and oxygen levels in tissue. ARL News, YouTube video. Both tracks of research are designed to protect soldiers in the field from TBI, and better understand the effects of blast-created trauma to the brain.

The Theranos Story, ch. 33: Arizona gets its lawsuits on

click to enlargeThe state of Arizona is lawyering up to sue Theranos for consumer fraud. TechCrunch found a bid solicitation on Arizona’s state procurement website from the Office of the Arizona Attorney General (AGO). It requests bids for outside counsel to assist the AGO in legal action against Theranos for fraudulent blood testing. From the Outside Counsel RFP:

The purpose of this contract is to retain Outside Counsel to aid the Arizona Attorney General’s Office (the AGO) in commencing legal action against Theranos, Inc. and its closely related subsidiaries for violations of the Arizona Consumer Fraud Act arising out of Theranos Inc.’s long-running scheme of deceptive acts and misrepresentations relating to the capabilities and operation of Theranos blood testing equipment, including but not limited to deceptive acts and misrepresentations made to Arizona consumers in connection with Theranos Wellness Centers in Arizona and California. Upon retention, Outside Counsel will assist the AGO on a contingency fee basis per the terms set forth in this Request for Proposal.

Arizona’s involvement with Theranos went above and beyond ‘deceptive acts and misrepresentations’ made to Arizona consumers. As we noted last September in Chapter 20, in early 2015 lawmakers quickly deregulated blood testing to permit direct consumer order of blood tests, after Elizabeth Holmes and company swept in and turned the governor and legislators quite ga-ga. It turns out the unimpressed Arizona Medical Association was on the mark in their objections. So undoubtedly this first move by a state entity is Powered by Embarrassment.

One wonders which law firm out of their lengthening list Theranos will choose. (See Chapter 29) Bids are due by 27 Jan. Hat tip to Bill Oravecz of Stone Health Innovations.

See here for the 32 previous TTA chapters in this Continuing, Consistently Amazing Saga, including the firing of 155 remaining staff (Ch. 32), the resignation of General Mattis from the BOD (Ch. 31), and Theranos’ annus horribilis (Ch. 30).

VA Digital Health Platform proof-of-concept unveiled; new VA head nominated

Back in April 2016, the Department of Veterans Affairs (VA) in Congressional hearings hinted at an end of year preview of a ‘state-of-the-art’ digital health platform which would integrate veteran health information from multiple sources. That debut was revealed this week in analytics vendor Apervita‘s announcement that they are participating in a proof-of-concept of the VA Digital Health Platform (DHP). According to their release, in the first three weeks, they and the DHP partners demonstrated that they could organize and extract insights from veteran data originating from VA, military, and commercial electronic health records, plus e-prescribing, apps, devices, and wearables. The end outcome is to provide a unified view or dashboard that integrates data, implements a care plan, tracks clinical encounters, optimizes medications, responds to patient needs, and more. The prime contractor in DHP is Georgia Tech, which brought on board Apervita, Salesforce (workflow user engagement), and MuleSoft (API). Next steps are not disclosed. Mobihealthnews, Health Data Management

One of the sparkplugs behind the DHP and also interoperability of DOD’s and VA’s badly outdated VISTA EHR is current VA Undersecretary for Health David Shulkin, MD. Today, at an eventful press conference, President-Elect Donald J. Trump nominated him for the VA secretary position. Dr Shulkin was previously CEO of Beth Israel Medical Center in NYC and president of the Atlantic Health System ACO. He will also be, upon Senate approval, the first non-veteran head of the VA. What is apparent is that P-E Trump has not moved one iota from the promise he made during the campaign to move fast on modernizing, improving quality and speeding up veterans health services–and for that he needs an insider.  Health Data Management

Was 2016 a great or off year for digital health funding, M&A, IPOs? (updated)

It depends on the study you read and how jaundiced your view is. If you believe the StartUp Health Insights 2016 ‘Health Moonshots’ report, 2016 digital health funding has hit a zenith of $8.18 bn (up 38 percent from 2015), with 500 companies enjoying funding from over 900 individual investors. Yet over at fellow funder Rock Health, the forecast is far more circumspect. They tracked only half the funding–$4.2 bn in funding–with 296 deals and 451 investors, down from the $4.6 bn over 276 deals in 2015.

There are significant differences in methodology. Rock Health tracks deals only over $2 million in value, while StartUp Health seems to have no minimum or maximum; the latter includes early stage deals at a lower value (their cross-section of ~$1 million deals has 15). StartUp Health gathers in international deals at all levels (pages 11-12),  whereas Rock Health only includes US-funded ventures. Another observation is that StartUp Health defines ‘digital health’ differently than Rock Health, most notably in ‘patient/consumer experience’, ‘wellness’ and ‘personalized health’. This can be seen by comparing their top 10 categories and total funding: (more…)

A ‘wearable airbag’ belt that prevents hip fractures due to falls (updated)

click to enlargeEditor’s Note: We are reprinting this article (originally from 23 November 2016) due to the comments by the CEO of ActiveProtective, Drew Lakatos, on 10 and 12 January, responding to the reasoned misgivings of one of our Readers. (Click ‘read more’ and scroll to comments at the end of the article.) This unusual step is being taken because this Editor believes that the problem is major–adults at high risk of falling and hip fractures. A technology solution such as this is worthy of examination by our Readers and further debate.

Do you believe older adults at high fall risk would voluntarily wear a belt that would deploy cushioning air bags around the hips in the event of a fall? This Editor was initially skeptical reading the MedCityNews article on ActiveProtective‘s $2.6 million Seed 3 round raise. The belt, looking at their photo and the one on the ActiveProtective website (left above), looks like a hard and uncomfortable ring, which didn’t make much sense as the ring in a fall impact could itself create injury. There was also a brief mention of fall detection but not how they worked together.

But before nominating this as a Thanksgiving Fowl, this Editor wanted to Dig Deeper. In their press, this TEDMED video with founder/presenter Drew Lakatos, while originally from 2014, explained its workings far better. (more…)

Assistive technology tender open for North Yorkshire County Council (UK)

There’s an open assistive technology tender issued by the North Yorkshire County Council closing on 31 March. It doesn’t say ‘telehealth’ but describes needs for a patient-monitoring system, emergency and security equipment, surveillance and security systems, sensors, GPS, health/social work and community health services which are in the aggregate quite close. Award appears to be shortly thereafter but listed as 1 April. Duration is one year out to 31 March 2018. Registration is required on the YORtender website for DN198838 (Historical Ref: CONTRACT-A8SL-W8IAL7) and the contact is Matt Clothier of NYCC. Hat tip to Susanne Woodman, our eye in the sky for tender opportunities.

The Theranos Story, ch. 32: 155 employees out in latest layoffs, 220 left to go

click to enlargeEndlessly, flatly spinning, towards Ground Zero…. As a marketing person made redundant (US=laid off) for various reasons by companies (moving out of area, acquisition, dissolution, etc.), this Editor has zero joy in reporting that 155 Theranos employees will be discharged as it “re-engineers its operations” “towards commercialization of the miniLab testing platform and its related technologies” “aligned to meet product development, regulatory and commercial milestones.” Their Friday press release successfully buried itself on a weekend, aided by a tragic Heaping Helping of Bad News out of Fort Lauderdale. The rationale is that this is justified to better position itself to commercialize the miniLab and “related technologies”. The miniLab reportedly is a compact, microwave-sized lab that automates small volume samples by sending them for analysis to a central server which would do the full analysis, thus driving down cost and time.

Theranos is a company flailing. This Editor notes in its string of releases an endless emphasis on compliance, regulation and operational expertise, the kind of attitude and caution that should have been present years ago. The layoffs follow on last October’s involuntary exits of 340 employees and lab closings (Chapter 21). Run the numbers and there are 220 employees left to go. Will the miniLab, seemingly hastily concocted, be their salvation? Flip back to our Chapter 18 about the October AACC meeting.  Chemical laboratory professionals were distinctly underwhelmed by the miniLab and CEO Elizabeth Holmes’ presentation. Also not boding well was Theranos’ withdrawal of a miniLab Zika test FDA emergency clearance in late August, at the height of the crisis. What may be wafting is the aroma of performing seals on a hot day.

Speaking of leadership, is Ms Holmes among the fired or demoted? Highly unlikely as she controls all $9 of the company’s formerly $9 bn Unicorn Worth. Is she even taking a pay cut? Will you see her out in front of Palo Alto HQ mowing the long grass?

To nearly 500 people now wondering about their livelihood in one of the most expensive areas of the US, how damaged they will be by their association with Theranos? Despite the ‘fail fast’ mantra of Silicon Valley, there’s little tolerance by employers for those at the operational level having a failed company in their past. These people should have our empathy, not ‘guilt by association’, and as appropriate, respect for their skills which were badly used in their last situation.

One also wonders how long it will take before there is another Chapter in The Theranos Story, one that they will file via one of their multitudinous law firms–Chapter 11. Consumerist (Consumer Reports), Yahoo News.

See here for the 31 previous TTA chapters in this Continuing, Consistently Amazing Saga, including the resignation of General Mattis from the BOD (Ch. 31), Theranos’ annus horribilis (Ch. 30) and the law firm feeding frenzy (Ch. 29).

Common Services Agency awards feasibility study for over-75s telecare (Scotland)

Our Reader Susanne Woodman, who keeps an eye on UK award opportunities, has forwarded information for an Award of Telecare for over 75s Feasibility Study. This ‘mini tender’ was awarded by The Common Services Agency (NHS National Services Scotland) to Deloitte in Edinburgh. Value is £120,190. For more information, see the full notice text tab in Public Contracts Scotland. Note to companies–keep an eye on these sites!

The Theranos Story, ch. 31: subtract one Marine general from the Board

click to enlargeThe Warrior Monk has left the building, to paraphrase what was said post-performance of Elvis (birthday, 8 January). Yes, James Mattis, General, USMC (ret.), has finally resigned from the Theranos Board of Directors, which was reorganized last month [TTA 3 Dec]. According to the Wall Street Journal relying on its usual ‘persons close to the matter’, he “left Theranos partly because he believed he was no longer a good fit after a broader board overhaul”.

In preparation for Senate hearings on his Secretary of Defense nomination, which begin 12 Jan, Gen. Mattis resigned from all corporate boards save General Dynamics, which was retained as to not be presumptuous of confirmation. His confirmation is more complicated than usual because he requires a Senate waiver of the seven years post-retirement requirement. Even with this, his confirmation is expected, and the resignation from the Theranos board mitigates a sticky set of questions.

The WSJ article rehashes in some detail the 2012 review of the Theranos lab which Gen. Mattis proposed while head of Central Command (CENTCOM), which ultimately was derailed at Fort Detrick, home of the US Army Medical Research and Materiel Command. However, reports are that little money was actually expended and Gen. Mattis accepted the decision.

Theranos, having shuttered its labs, is appealing the regulatory sanctions, including CMS’ ban on Elizabeth Holmes’ operating labs, and is reportedly cooperating with a myriad of civil and criminal investigations, both by an alphabet soup of Federal agencies (CMS, DOJ, FDA, SEC) and state regulators.

If the WSJ article is paywalled, search on the headline “Trump Defense Nominee James Mattis Resigns From Theranos Board”. Also MarketWatch. See here for the 30 previous TTA chapters in this Continuing, Consistently Amazing Saga, including Theranos’ annus horribilis (Ch. 30) and the law firm feeding frenzy (Ch. 29). Hat tip to reader Bill Oravecz.

Health execs’ wish list for 2017: security, analytics, pop health…and telehealth (US)

click to enlargeHealthcare IT News published the results of their October survey of 95 healthcare executives as to their forward plans (resolutions?) for 2017. It’s unsurprisingly centered on upgrades to the following areas:

  • Data security (52 percent)–definitely making up for lost time and spending due to the obvious threats from hacking and data breaches. In November alone, nearly two incidents a day (57) and over 458,000 records were reported by healthcare entities to HHS. (Protenus Breach Barometer)
  • Data analytics (51 percent)–figuring out what to do with all that patient data generated by….
  • Patient engagement and population health (44 percent each)–demanded by quality standards in CMS’ MACRA Quality Payment Program (QPP), including the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs)
click to enlargeThe surprises come here–the technologies they expect to introduce or investigate. Analytics and workflow correspond to the last two points above, but what is compelling is an apparent tipping point for technology which links the patient to care monitoring and access: telehealth (44 percent), smart medical devices (41 percent) and remote patient monitoring (34 percent). These overlap (as in telehealth and RPM require smart medical devices), yet these are strong numbers if they accurately reflect these execs’ actual (or eventual) spending. (Does it point to more clinically validated use of trackers like Fitbit? The Magic 8 Ball does not tell here….)

The presence of 2016-17’s ‘It Girl’, precision medicine (21 percent), which applies both data analytics and genomics to improve patient outcomes, isn’t surprising with the emphasis on quality care.

One can quibble that the sample size is small N, and the report doesn’t confirm the selection details like title, location, and type of organization, but the direction has to be cheering on many fronts. HITN’s overview, survey results (16 slides)

Fitbit, Qualcomm Life get in step with UnitedHealthcare’s Motion

click to enlargeAnother step towards maturity in the fitness tracker and employee wellness business? Today’s news out of CES was the announcement by Qualcomm Life and UnitedHealthcare to expand the proprietary UHC employee wellness program, Motion. Qualcomm Life’s 2net is the platform that will eventually integrate with medical-grade connectivity multiple fitness trackers. The first will be Fitbit’s Charge 2.

The Motion program was tested in 12 states with select employers. It will expand to UnitedHealthcare’s self-funded employer health plans covering five or more eligible employees, plus companies with fully insured health plans with 101 or more eligible employees, in 40 states.

Employee incentives are up to $1,500 per year or $4 per day, but requirements are strict, based on Frequency, Intensity and Tenacity, or FIT.  The frequency requirement is six times per day with 300 steps within five minutes at least one hour apart; intensity of 3,000 steps within 30 minutes and tenacity of 10,000 total steps each day. The employers receive premium savings based on combined FIT results. Infographic above and left.

Through a Gimlet Eye…It gives a head start to Fitbit in a BYOD program, and a testing platform for a more clinical use of a new tracker, moving beyond the casual athlete who discards it in a few months and another sign confirming our 2017 View. For Qualcomm Life, it’s yet another pivot to stay in the Healthcare Game as apparently, their much-touted HealthyCircles care coordination platform has faded to black. For UHC, it’s a value-add for employers to sell a health plan. But employee wellness programs have yet to prove real health outcomes and real savings. The problem with all wellness programs, especially at the ‘frequency and intensity’ that UHC wants employees to achieve before they earn anything, is that they concentrate on making the well weller. How would it help the marginally fit or heaven forbid, those trying to regain their fitness with a chronic condition? One last point for employers: to get FIT, it involves a lot of employee time away from a desk or a station! ZDNet, UHC/Qualcomm release

Another bit(e) from Fitbit: Quietly at the end of year, Fitbit moved to terminate one of its multiple patent infringement-related suits against the now moribund Jawbone. (more…)

Welbeing’s expansion on BBC Norfolk, Tunstall’s #MarysVIPHome Christmas (UK)

We start the New Year off we hope in the right way with some good news on telecare expansion and media coverage, traditional and social, versus the gloominess that dominated 2016.

Welbeing, which has become one of the larger telecare providers in the UK from its Eastbourne and Wealden Council roots, was the subject of a feature on Nick Conrad’s breakfast show on BBC Radio Norfolk. This focused on their East Anglia expansion to 4,500 new customers acquired from Flagship Home, with phone-ins by an operator from their new call center in Dereham, a local Welbeing customer and a representative from Norfolk County Council. Welbeing has been on a recent tear with acquisitions in East Sussex, Cumbria, Stonewater and with Muir Housing, cresting their total users to more than 70,000. Of late there’s been a lot of downbeat feelings about the fate of telecare in the UK, so it’s refreshing to hear an upbeat local story for a change. News release. Hat tip to Charlene Saunders, marketing manager of Welbeing. 

Tunstall in UK has also developed a smart home type test bed in a sheltered housing flat to showcase how existing TECS kit, Tunstall’s and others, can be combined in everyday living. Smart home demos to interested parties may be old news, but Tunstall is cleverly using social media marketing to build it up. It’s hashtagged #MarysVIPHome with updates on Twitter. There are also has five demo videos on YouTube which show how a family can observe activity/ADLs without intrusion, plus connect the resident to care, improve their socialization and remotely control the home environment. This Editor saw it on a LinkedIn post before the holidays from Tunstall’s Adrian Scaife thanking their visitors and wishing us a Mary Christmas. Now we hope to see more of a narrative about a real Mary living there and using all that TECS. It’s a nice start to what we hope is an innovative 2017.