Weekend must read: The Death of Patient Zero

click to enlargeThe story of one woman with advanced cancer–Stephanie Lee–as doctors and researchers at Mount Sinai NYC race to save her with genomics-driven personalized medicine. We see its limitations, along with the limitations of conventional medicine and the problems of the stateside military medical system–Mrs Lee’s husband was killed in combat in Iraq in 2005. What was unlimited was the courage of her family, her friends and her medical advocates, especially one of those Mount Sinai genomicists, Eric Schadt, an “evangelical Christian turned mathematician turned biologist turned genomicist who had become one of the evangelical forces behind the “Big Data” revolution” and Dr Dennis Charney, the head of Mount Sinai’s Icahn School of Medicine who has made a home for gene sequencing research there. Tom Junod writes about Patient Zero in Esquire –including why she was given that name.  Photo–Esquire

Smartphone and sensors the latest ‘medic’ for diagnosing battlefield TBI

click to enlargeFinally a more reliable device for combat medics to screen for TBI in the field. The US Department of Defense, before its EHR bombshell (so to speak) yesterday, issued this short Armed With Science article on a sensor-smartphone for quick field diagnosis of TBI. The FDA-cleared BrainScope Ahead 200 marries an Android smartphone with a headset and disposable sensors to measure brain electrical activity, The app in the smartphone then analyses the brain data using algorithms to correlate them to elements relating to TBI. Currently, most combat-related TBI tests are subjective, based purely on symptoms such as headaches, nausea and light sensitivity. The only ‘objective’ test would be a CT scan in a medical facility well off the front lines, which means time wasted in a definitive diagnosis. This is being implemented by the Army Medical Research and Materiel Command at Fort Detrick, Maryland.

Just one look to assess your health, emotional state (US, EU)

Just one look, that’s all it took–Doris Payne, Gregory Carroll 1963 (covered by the Hollies, the Searchers, Linda Ronstadt…..)

click to enlargeHealthcare professionals whether primary care/GP, psychiatrist or nurse, pride themselves on being able to make initial health assessments within seconds based on the patient’s physical appearance, manner and posture. It was only a matter of time before digital health aspired to ‘read’ the emotional or physical state remotely and deliver it as part of a virtual consult.

Boston-based emotional recognition software Affectiva has been around for awhile; it reads facial cues and claims it has the largest emotional data repository of over 2 million facial videos and 11 bn data points. It was developed for advertising research (backed by ad giant WPP) and now is moving into telemedicine. MedCityNews.

Compared to WizeMirror, that’s just surface. The mirror’s 3D scanners, multispectral cameras and gas sensors are able to look for stress or anxiety, over time look for weight gain or loss, evaluate skin tone, facial expressions, breath (for smoking and alcohol) plus monitor heart rate and hemoglobin levels. Originating at the National Research Council of Italy, it is being developed by a consortium from seven EU countries, SEMEOTICONS EU. Clinical trials will start next year at three sites in France and Italy. The mirror produces a score that tells the user how healthy they seem and personalized advice on improving health. New Scientist, MedCityNews, Daily Mail

However, standalone tech stands pretty much alone against a tide of partnerships. How they will integrate not only with telemedicine but also with telehealth, which could use this in mental health and pain management, isn’t addressed. 

(Graphic: Daily Mail)

US Department of Defense picks Cerner/Leidos/Accenture for $4.3 bn EHR

Breaking News Updated  The winner of the massive, potentially ten year contract for the Defense Healthcare Management System Modernization program is defense computer contractor Leidos, which brought in Cerner and Accenture Federal Systems.The DOD announcement mentions only lead contractor Leidos, interestingly under the US Navy Space and Naval Warfare Systems Command, San Diego, California. The announcement was released just after 5pm EDT today.

This combination beat the Epic/IBM and the Allscripts/Computer Sciences/HP bids. According to the DOD announcement, “This contract has a two-year initial ordering period, with two 3-year option periods, and a potential two-year award term, which, if awarded, would bring the total ordering period to 10 years. Work will be performed at locations throughout the United States and overseas. If all options are exercised, work is expected to be completed by September 2025. Fiscal 2015 Defense Health Program Research, Development, Test and Evaluation funds in the amount of $35,000,000 will be obligated at the time of award.” Modern Healthcare attended the embargoed press conference this morning and adds in its article that only one-third is fixed cost, with the remainder as ‘cost plus’, which could conceivably run the contract to the $4.33 bn ceiling over the 10 years. The system will be used in 55 military hospitals and 600 clinics, with an initial operational test as early as 2016 (Washington Post) and full rollout by 2023.  Interoperability with private EHR systems was a key requirement (Healthcare IT News).Over the 18 year life cycle, the contract value could be up to $9 bn, according to the WaPo.

The race to replace DOD’s AHLTA accelerated with the final failure to launch a plan to create a joint DOD-VA EHR in March 2013 [TTA 27 July 13], though hopes revived in Congress occasionally during the past two years [TTA 31 Mar].

It is also widely interpreted as a blow to Epic, which has been defensive of late about its willingness to play in the HIT Interoperability sandbox with other EHRs; certainly it cannot make Big Blue, which would undoubtedly have found some way to sell Watson into this, happy.

POLITICO’s Morning eHealth had many tart observations today, mostly pertaining to the belief of some observers that Cerner will be strapped in meeting this Federal commitment and would find it increasingly difficult to innovate in the private sector.

Example–From Micky Tripathi, CEO of the Massachusetts eHealth Collaborative: “My biggest worry isn’t that Cerner won’t deliver, it’s that DOD will suck the lifeblood out of the company by running its management ragged with endless overhead and dulling the innovative edge of its development teams. There is a tremendous amount of innovation going on in health IT right now. We need a well-performing Cerner in the private sector to keep pushing the innovation frontier. It’s not a coincidence that defense contractors don’t compete well in the private sector, and companies who do both shield their commercial business from their defense business to protect the former from the latter.”

Unnerving mergers (US-UK); DoD’s EHR picked; EHRs & AMA

Blues feeling Blue about…The Anthem-Cigna merger, finalized last week (but yet to be approved by the US and likely the UK Governments as Cigna issues policies there), gives them bragging rights over the Aetna-Humana merger and Optum/United Healthcare in their covering of 53 million US lives as the largest US health insurer. Unnerved is the Blue Cross and Blue Shield Association, of which Anthem is a part of with the Anthem and Empire Blue Cross plans plus others in a total of 14 states. But Anthem also competes with ‘the Blues’ in 19 additional states where it markets under a non-Blue brand, Amerigroup, primarily for Medicare and Medicaid (state low-income coverage). Many of the Blues are non-profit or mutual insurers; many are partial or single-state, like Independence, Capital and Highmark (PA/DE/WV) in Pennsylvania and Horizon Blue Cross of New Jersey. Their stand-alone future, not bright since the ACA, now seem ever dimmer in this Editor’s long-time consideration and that of Bruce Japsen writing in Forbes. Also Morningstar considers Anthem’s overpaying and the LA Times overviews.

Walgreens Boots Alliance, another recent merger of quintessentially American and British drug store institutions, named as its interim CEO Stefano Pessina. He previously ran Alliance Boots prior to the merger and is the largest individual shareholder of WBA stock with approximately 140 million shares, so one cannot call it a surprise. At a youthful 73 (see video), one assumes he also takes plenty of Walgreens vitamins and uses Boots No 7 skin care. Forbes.

Updated: The big EHR news is the US Department of Defense announcing the award of its Defense Healthcare Management System Modernization contract this week. At 10 years and $11 billion, even giant EHRs went phalanxed with other giant government contractors to face DOD: Epic with IBM; Cerner with Leidos, Accenture and Intermountain Healthcare; Allscripts with Computer Sciences Corp. and Hewlett Packard. Certainly there will be ‘gravitational pull’ that affects healthcare organizations, but the open and unanswered question is if that pull will include the far nearer and immediately critical lack of interoperability with the Veterans Health Administration’s (VA) VistA EHR. The Magic 8 Ball reads: Hazy, try again later.  Leidos/Cerner announced as winners close of business Wednesday 29 July. 

In other EHR news, US doctors vented last week on how much they hate the @#$%^&* things to the American Medical Association‘s ‘town hall’ in Atlanta. Bloat, diminished effectiveness, error, getting in the way of care due to design by those without medical background presently prevail. The AMA’s Break the Red Tape campaign asks CMS to “postpone” finalizing Stage 3 Meaningful Use (MU) rules so that it can align with new payment/delivery models. Better yet, they should buy thousands of copies of Dr Robert Wachter’s book [TTA 16 Apr] and drop them on every policymaker’s desk there, with a thud. Health Data Management 

‘Déjà vu all over again’ or critical mass? NYTimes looks at older adult care tech

“It’s like déjà vu all over again” as Yogi Berra, the fast-with-a-quip Baseball Hall of Fame catcher-coach-manager once said. About 2006-7, telecare broke through as a real-world technology and the tone of the articles then was much like how this New York Times article starts. But the article, in the context of events in the past two years, indicate that finally, finally there is a turning point in care tech, and we are on the Road to Critical Mass, where the build, even with a few hitches, is unstoppable.

Have telehealth, telecare, digital health or TECS (whatever you’d like to call it) turned the corner of acceptability? More than that, has it arrived at what industrial designer Raymond Loewy dubbed MAYA (Most Advanced Yet Acceptable) in keeping older adults safer and healthier at home? The DIY-installed Lively! system keeps an eye on a hale 78 year old (more…)

A Tuesday Must Read: “Confessions of a non-compliant patient”

Carolyn Thomas is the ‘Heart Sister’ of the eponymous blog, and has been a guest columnist and commenter in these pages. Via Twitter she brought to her followers’ attention this back posting which chronicles how a person who normally copes with a chronic disease can be absolutely kicked in the kishkes* when a few other physical troubles are added to the pile. Alone, they could be coped with; aggregated and on top of difficulty functioning, they make for Misery. And Misery makes for Non-Compliance. And Non-Adherence. And the Burden of Treatment gets ever heavier, and the frustration of both patient and doctor (pressed to quantify and meet goals) ever grows.

If you are designing technology around compliance, don’t be surprised if many of the people you could benefit treat it like measles if it’s not positioned right or is thinly disguised Nanny Tech. (See ‘Uninvited Guests‘)

Editor Donna will let Ms Thomas take it from here.

Related reading: Is how we are treating patients for chronic diseases (and pre-diseases) all wrong?

*Kishkes (New York Yiddish, antique) = guts.

Weekend Must Read: WSJ’s experts sketch out future healthcare

Fortunately not paywalled on the Wall Street Journal‘s site is The Future of Health Care: Hacking, Hospitals, Technology and More, a view of Healthcare and Us out to about 2030. Most of these ten short essays give cause for optimism, except for that first one–hacking. If you thought PHI breaches were bad, DNA hacking will make that look benign. ‘The Experts’ include Robert Wachter, MD [TTA 16 April, author of ‘The Overdose’], Dr John Sotos who was medical adviser on ‘House’, David Blumenthal of the Commonwealth Fund, Marc Agronin of Miami Jewish Health System and Dr Drew Harris of Thomas Jefferson University’s School of Population Health.

Here’s the topic list:

* How Future Hackers Will Target Your DNA
“In the future, DNA hackers won’t sneak viruses into your laptop and crash websites. Instead, they’ll sneak viruses into your body and crash you, and maybe billions of other people, too.”
* What Health Care Will Look Like in 2030. Maybe.
” Computerized algorithms will empower individuals to make rapid, sound decisions about their own health and health care.”
* The Nursing Home of the Future Will Be in Our Homes
“The future solution, however, will be wholly home-based, with regular visits from a variety of different professional and volunteer caregivers providing assistance in every shape and form…Ultimately, much of the care provided by nursing-home or assisted-living staff today will be condensed into a mobile robot (or screen presence)…” (more…)

No future for mHealth as m-health

There is, but not what was envisioned five to six years ago. If you still think of mHealth as a subset of ‘health’ and defined by its devices as a separate strategy or ‘revolution’, it’s time to check your glasses’ prescription. Thus an article like this published in HIMSS Media’s mHealthNews that focuses on mobile devices starts off feeling antique (as in 2008-9) in its emphasis on video and direct to consumer apps and problems thereof–then fast forwards to This Modern World: the Graettinger-esque dissonance of data insecurity, the entry into the City of Glass of integration–multiple platforms, data sets and apps/tools into personalized, proactive care and clinical decision support.

At MedCity News, the snark prevails in coverage of a World Congress Boston mHealth + Telehealth World conference where participants seemed to treat mHealth as m-health–chattering on about smartphones and tablets as devices not delivery vehicles, (more…)

Forget fitness and sleep–now chemical exposure tracking

click to enlargeChemical exposure is no laughing matter. MyExposome is a seemingly simple silicone rubber wristband similar to those issued for various causes. But the silicone is different–it absorbs and stores environmental chemicals to which an individual may be exposed. It’s the commercialization of research from Oregon State University undertaken by Drs Kim Anderson and Steven O’Connell, who founded the company.  The test is a simple one: wear the specially packaged bracelet for one week, mail it back in its impermeable pouch, and they will run tests that screen for 1,400+ chemicals (full list on their website). There’s a separate, additional cost panel for flame retardant chemicals. The wearer then receives a report detailing their exposure to specific chemicals, and against their database of MyExposome users. The analysis process is the complicated and expensive part. It is designed to pick up external chemicals, not ones ingested unless excreted through the person’s skin. The company also makes it clear that they don’t make recommendations or give advice re the chemical exposure.

Currently the founders (plus another OSU program director and a CEO/entrepreneur) are reaching out via Kickstarter for funding and to determine acceptance of the present design and pricing. Based upon this, the band pricing (more…)

Can digital health solve China’s healthcare quality, distribution problems?

Earlier this year [TTA 21 May] we noted China’s interest, governmental moves and private investments in digital health as part of ‘Internet Plus’: Tencent Holdings and Fosun International led the $35 million Series B round for ‘healthcare tricorder’ Scanadu; ZTE Health; Alibaba‘s investment in data cruncher CITIC 21CN. Now McKinsey partner Florian Then analyzed for Yahoo! Finance the promise of telemedicine and telehealth in that country, and the great problems they must solve. The huge disparity of care between urban and rural hospitals drives patients to the former, regardless of long distances and inconvenience. In population health, the unhealthy habits of much of China’s population make US/UK/EU concerns look unimportant: one of every three of the world’s smokers and 300 million hypertensives live in China.

A possible telemedicine-driven solution would be for urban hospitals to support via doctor consults and email rural hospitals to get patients into the medical system locally and earlier. Education would be delivered online, probably through those 847 million mobile phones on which 83 percent of Chinese Internet users access the web (market intelligence firm IDC). China also appears to be liberalizing (more…)

67% of 50+ users found activity trackers beneficial: AARP study

The just-published AARP study of 50+ consumers and design of sleep and activity trackers has found that a near-or majority surveyed found activity and sleep trackers useful in maintaining health. 71 percent found they increased awareness of habits; 67 percent found them useful and beneficial. Four user personas emerged: sticklers, achievers, enthusiasts and the ‘why not’-ers. Yet these mostly enthusiastic users experienced difficulties. During the six-week trial, many discontinued use of the trackers due to data inaccuracy, finding and using instructions, perceived device malfunctions, difficulty in syncing, difficulty in putting on the device and comfort in wearing. The seven trackers used by the 92 participants were from Misfit, Spire, Jawbone, Lumo and Withings. Conducted by Georgia Tech Research Institute’s HomeLab with AARP’s Project Catalyst: The Power of We initiative which encourages good product and service design for the 50+ demographic. Coming up: med management tools. iHealthBeat. AARP release. AARP’s Building a Better Tracker research paper

Digital health startups filling the gaps in Health Canada

click to enlargeCanada’s health system is nominally nationalized, but in a way that leaves large gaps in coverage–for long term, in home, specialty care and prescriptions–as well as variable by province. According to this article in HIT Consultant, VC funding is also thin on the ground, which leads to a short-term outlook. Local governments are stepping into the gap with innovation funding (similar to the Partnership for NYC) and the national government has eased restrictions on foreign investment. EHRs haven’t been a priority (skipping the troubles experienced in the US) which leaves digital health–telehealth, telemedicine and diagnostic apps–to enjoy the available talent and funding. This Editor doubts that any of the 20 profiled here will be familiar names other than possibly InterAxon which we noted at last year’s NYeC Digital Health Conference, and many tread the familiar ground of genomics, social sharing of medical images, and gamification for behavior change, but there are three unique companies in the neurological area in nerve stimulation (MyndTec), nerve disorder diagnostics imaging (NerveVision) and pharma (Oxalys.) We salute the Royal Canadian Air Force with their WW2 roundel on the anniversary of the Allied invasion of Sicily, July – August 1943

Manchester as ‘age-friendly city’, King’s Fund on health, social care (UK)

By 2030, 15 percent of the world’s city population will be 60+. This projection led researchers from The Manchester Institute for Collaborative Research on Ageing (MICRA) at the University of Manchester to examine the experience of aging, and where better than Manchester, in 2010 recognized by the WHO as the UK’s first ‘age-friendly’ city? The result is a short film presenting their findings: “social inclusion (as) the secret to ageing well – while age-friendly transport and housing make them feel more a part of the urban neighbourhoods they live in.” The film was premiered at a community event in Whalley Range on 23 June and also shown at the British Society of Gerontology’s annual conference at the start of July. Trailer (1 min 24 sec), video (15 min), University of Manchester article.

Integrated health and social care in England – Progress and prospects is now available in full text in the July issue of Health Policy. Written by Richard Humphries of The King’s Fund, it examines the patchy and limited success of 40 years of policy goals by successive Governments, including the last coalition government. It illustrates the tensions among of a variety of new initiatives, along with the NHS reaching for new models of care delivery. “Expectations that integration will achieve substantial financial savings are not supported by evidence. Local effort alone will be insufficient to overcome the fundamental differences in entitlement, funding and delivery between the NHS and the social care system.” TTA has been a media partner of The King’s Fund Digital Health and other events

HealthSpot, Rite Aid open 25 locations in Ohio

click to enlargeTelehealth/telemedicine kiosk HealthSpot and retail drug chain giant Rite Aid, which announced their partnership last November [TTA 11 Nov], have now set up shop in 25 locations in three Ohio areas–Akron/Canton, Cleveland and Dayton/Springfield. Since late May, the staffed stations have treated over 5,000 customers ages 3 and above for minor and common health conditions, including cold and flu, rashes and skin conditions, eye conditions, earaches and seasonal allergies. The kiosks combine video consults with hands-on assistance in vital signs measurement from a wellness attendant, and their recording software interfaces with insurance eligibility, electronic medical records and billing systems. The network of medical professionals on the telemedicine consults are from Cleveland Clinic, Kettering Health Network and University Hospitals, with pediatric specialists from UH Rainbow Babies & Children’s Hospital. According to HealthSpot’s CEO Steve Cashman, a significant portion of early visitors are Medicaid recipients, who through a $60 station visit may be avoiding a far more expensive (~$600) ER visit. For the early stage HealthSpot it’s a major rollout, but for Rite Aid, which is not known for being as cutting edge in location design as CVS or Walgreens, it represents a significant move forward into onsite wellness services. Cleveland.comDrug Store NewsRite Aid/HealthSpot demo videoBusiness Wire release.

6 helpful hints for healthcare startup founders–and funders

Investor Skip Fleshman of Palo Alto (of course)-based Asset Management Ventures has six points of sound advice for founders and developers–and funders of same–who think that their Big Idea(s) are the one thing which will revolutionize healthcare, particularly because of their personal experiences. We’ve observed that successful startups have fitted themselves into the Healthcare Establishment’s game [TTA 19 May], but if an investor is still seeing that attitude, it’s still there. AMV’s track record is there with investments in several healthcare companies, including Proteus Digital Health and HealthTap. Mr Fleshman’s points with this Editor’s comments:

1. Listen to the market–and it’s not direct-to-consumer, despite a cursory reading of Eric Topol. Find where your product or service can reduce or avoid cost, increase engagement and improve quality i.e. patient outcomes (which are all linked, see #4)
2. Hire people who know how to speak the language–experienced healthcare people who can work the system but also get the changes and want to make a difference. And no, they may not look or act like you. They’ll often have gray hair and families. Unless they are independently wealthy, they also expect to be paid decently. Quite a few will be women who don’t act or look like you either, but are invaluable in your organization in multiple ways.
3. Understand how the money flows–and the money is with providers, payers, self-insured employers and (Mr Fleshman doesn’t mention this) government (Medicare, Medicaid, the alphabet soup of HHS, CMS…). The incentives (shared savings) are now to providers to pull cost out of their system but somehow maintain population health quality and outcomes. How to pull this off is where the innovation is needed. Partner wherever you can–and this Editor would add, with other successful early-stage companies as well.
4. Read the Affordable Care Act–with a bottle of painkillers and eyedrops. (more…)