Why ‘masking up’ isn’t such a great idea–more than a false sense of security

The signs and reminders to wear a mask outside the home, lest those COVID-19 germs get in (or out), are everywhere. You could be strolling on the beach, with hardly anyone in sight, or in a park with everyone more than 6′ away, and you’re made to feel guilty for wanting to breathe fresh, unimpeded air. This Editor has seen people driving cars solo–with masks on, steaming up their glasses, and restricting their vision. And even in a short visit to a supermarket, a fabric mask of the type most common to us civilians can make you feel a little light-headed, as you breathe in less O2 and more of your own CO2–as you touch the cheese and the detergent. It all begins to appear a little less than logical, a belief shared with medical professionals with whom I’ve spoken.

Along comes the BMJ to confirm exactly these concerns–and add a few more. A team from University College London and UCL Institute of Epidemiology and Health Care responded to a BMJ editorial that advised that “surgical masks should be worn in public to prevent some transmission of covid-19 [sic], adding that we should sometimes act without definitive evidence, just in case, according to the precautionary principle”. The authors of the ‘Rapid Response’ article note that the ‘precautionary principle’ also should prevent the neglect of potentially harmful side effects of any intervention, including the wearing of masks in public.

The two acknowledged (by most) side effects are: a false sense of security that may lead some to neglect proven infection control measures like hand washing and inappropriate use of a face mask including touching and infrequent washing. The writers added five others:

  • Speech is compromised, leading people to come closer simply to hear each other, and increasing contact risk
  • The face mask propels exhaled air into the eyes, leading a person to touch their eyes and possibly contaminate them
  • “Face masks make breathing more difficult. For people with COPD, face masks are in fact intolerable to wear as they worsen their breathlessness.” The rebreathed CO2 also may increase breathing frequency and deepness, thus more contaminated air exhaled in the infected, and conversely increasing their viral load.
  • If face masks are already infected, these points are amplified
  • Reduction in innate immunity that limits the spread of pathogens through the body. “If face masks determine a humid habitat where the SARS-CoV-2 can remain active due to the water vapour continuously provided by breathing and captured by the mask fabric, they determine an increase in viral load and therefore they can cause a defeat of the innate immunity and an increase in infections.”

In short, there are both positive and negative effects of mask-wearing–and risks –and they certainly are not the cure-all for COVID spread.

Reflections of a TechForce19 Participant

Ever wonder what it’s like to successfully apply for, and then to deploy your program, as part of a high-stakes challenge? Reader Adrian Scaife, Business Development Manager of Alcuris Ltd., has been on an eight-week merry-go-round on hyperdrive (to mix a few metaphors). We invited him to tell us what it was like after the reports were handed in, and his impressions follow. Thank you, Adrian!

Now the Rapid Feasibility stage has been completed and outcome reports submitted, it’s a good time to sit back and take stock of the last 8 weeks.

It all started in late March when Matt Hancock asked for innovative tech companies to support vulnerable people during the Covid crisis around three themes, Optimising Staffing in Care and Volunteering Sectors, Mental Health and Remote Care. The funding available totalled £500,000 and was planned to be shared across 20 companies.

Even at the start the ambition, the scale and the pace of the initiative were very clear.

Looking back, it is apparent that the initiative has become a brand–TechForce19 – a great name, logo and its own website. The benefit to all is a set of unifying objectives, direction, urgency, and something that people and organisation can come together to support.

The sheer number of organisations involved in the initiative was breath-taking. Funding was from the Department of Health and Social Care along with the Ministry of Housing, Communities and Local Government. It was run by NHSX supported by Public Ltd., the Academic Health Science Networks including the Health Innovation Network in London and other experts from a variety of organisations.

The application process was at speed with a launch date of 24th March and application submission by noon 1st April (and that was the extended deadline!). The application form was thorough in the questions asked particularly around how you would conduct a two-week test to demonstrate that you can solve the challenge(s). We also knew it was going to be scored based on Solution feasibility, Company credibility, Impact, and Digital maturity.

The selection process was equally fast with feedback on the next stage due Friday 4th April. Friday came and went, and we feared the worst. Little did we know at the time that over 1,600 applications had been received. Just before midnight on Saturday an email was received announcing we were through to the interview stage and ours was on Monday. 60 interviews were completed over the next few days.

Just over a week later, confirmation that our proposal had been accepted, one of just 18 participants. Time to deliver on our plan. Just 10 days to plan the project in detail, provide partner training, deliver the hardware, for our partners to collect their referrals and then to deploy the Memo Connected Care Suite. Two weeks of live running. Evaluation and an outcomes report to be submitted by the 18th May.

I must give enormous praise and thanks to our partners for their commitment to deliver when all around them the pressures on their services due to Covid were unbelievable.

So now the Feasibility and Outcomes report has been submitted. We have received some terrific feedback both from families and Social Care staff. Did the project go according to plan? Well not entirely but when do they ever, especially during a national crisis.

One surprise that I shall never forget is Nasdaq, the American stock exchange, wanted to applaud digital innovators globally who were supporting the Covid fight. They promoted the work of TechForce19 on their seven storey Nasdaq Tower in Times Square, New York by highlighting each of the 18 participants.

TechForce19 is an NHSX Covid-19 response initiative, supported by PUBLIC and the AHSN Network. The views expressed in this article are those of the author and not necessarily those of NHSX or its partners.

PUBLIC’s website has profiles on the 17 other TechForce19 participants, including many names familiar to our Readers, such as Just Checking and Buddi. Our earlier article is hereHat tip to Reader Alistair Appleby.

 

 

Optum buys naviHealth for reported $1 billion; Amwell raises $194 million in Series C

In non-COVID-19 news, Optum has confirmed to industry press that they have acquired post-acute management company naviHealth. Becker’s HealthIT cites sources that the purchase price is in the vicinity of $1 billion. Continuing their PAC-MAN path, this pharmacy benefit, population health, and care services wing of UnitedHealth Group in the past six months finalized the purchase of DaVita Medical Group from renal treatment giant DaVita for over $4.3 bn and is reportedly closing on a full acquisition of virtual behavioral health provider AbleTo [TTA 29 Apr] for a less stunning $470 million.

naviHealth provides post-acute care clinical decision-making tools that manage pre and post-acute care as part of value-based care programs such as the Bundled Payments for Care Improvement (BPCI) program with CMS. Their customer base includes health plans (4.5 million members within Medicare Advantage alone), over 140 hospitals, and post-acute care providers such as nursing homes, LTC facilities, rehabilitation, and home health. The company will retain current management and staff, and operate as a stand-alone company within OptumHealth. It’s a well-paid exit for Cardinal Health and Clayton, Dubilier & Rice. Also MedCityNews

Amwell raises $194 million in a second Series C. The former American Well did not need telehealth to receive a gratifying boost from its investors Allianz X and Takeda Pharmaceuticals. This follows on a February $60 million venture round from Chetrit Ventures (BostInno). Amwell has raised $711 million in nine funding rounds (Crunchbase). Their main business has been with payers, health systems, and employers. In April, they added a branded program, Amwell Private Practice, for practices under 100 providers for these mostly shuttered offices to reach their patients at home and to continue care. Release, Mobihealthnews.

DHACA home testing webinar 20th May 10am–next one 3 June

DHACA is running its eighth WebinarWednesday on 20th May 10am on the topic of home testing. One of the two main themes of our webinars to date has been how technology can minimise face:face clinical interactions with patients whilst simultaneously improving patient outcomes and reducing costs.

This webinar continues that theme by showing how after electronic triage and remote consultation, a growing number of tests, of blood, urine, skin etc., can continue to be used to minimise face:face engagement, as well as improving patient access to prompt testing. We will look at the challenges and the benefits through the eyes of four brilliant speakers.

More details here, register here.

From Editor Donna: DHACA will have its ninth #WebinarWednesday on 3 June at 10am UK time. The topic is how best to promote technology to carers in the light of the pandemic. Editor Charles will be part of a panel discussion. More details and registration are right here.

Post-COVID back to work: for workplace screening, testing, contact tracing, there’s an app for that

If you’re looking forward to going back to the office without the children and the dog barking, and seeing people other than your family, don’t expect to go back to “The Office” Normal with kibitzing over the divider and in the kitchen/break room. Chances are the latter will be locked, and the nearest person over the divider will be six feet away. There will not only be serious physical changes to the office, starting with many fewer people there, but also apps to track your health and who you come in contact with. Your employer will be managing your potential risk for infection of yourself and others.

  • UnitedHealth Group and Microsoft’s ‘ProtectWell’ app will screen your health everyday (using Microsoft’s COVID-19 triaging Healthcare Bot and Azure. If there’s a risk of exposure or if you are exhibiting symptoms, it will direct you to a COVID-19 testing process that enables closed-loop ordering and reporting of test results directly back to employers, managed (of course) by UnitedHealth. The app will also provide guidelines and resources for a safer work environment, including physical distancing, personal hygiene, sanitation, and more. UHG and Microsoft are furnishing the app to employers at no charge. UHG has already implemented this ‘contact tracing lite’ for frontline workers and will roll out to its over 320,000 employees; Microsoft will do the same for its US-based workers. Release
  • Enterprise software company Appian released Workforce Safety and Readiness, an app to enable HR departments to plan and maintain a return to work for employees and to maintain a safer workplace. This ’employee re-entry’ app as their CEO Matt Calkins put it, is not for every company. The app will quiz employees on factors such as health data, possible virus exposures, and details about their jobs to determine when and how they should return, based on their jobs plus CDC and state guidance, both of which keep shifting; state and local guidance in particular is keeping more than one law firm quite busy. The app can then push information to workers about their new hours, area, and similar. When the employee is back to work, they can then use the app to provide feedback on crowding and lack supplies such as hand sanitizer or wipes. The app is built on a HIPAA-compliant system and originated with a self-reporting disease app. Appian is targeting larger companies with thousands of employees on a $5,000 per month subscription model. Appian page, The Protocol
  • Companies large and small have devised their own mass testing procedures for current workers and those returning, as early as the next two weeks. This next article from Protocol details several approaches, mostly around detecting the imminently ill.
  • PWC has already set up a contact tracing system for returning workers, an app that tracks contacts with the phones of others of a person who self-reports being ill. While the privacy seems pretty robust–it works on employee self-reporting and his or her AD ID on my phone, then all the other phones it had contact with over the past X days via Bluetooth. As PWC’s David Sapin of their connected solutions area put it, “But if you’re going to come back into the workplace, you need to accept having this type of app on your phone.”
  • For a really dystopian view, see this article in Bloomberg. You may be scanned thermally, have an elevator operator (back to the past!), and lots and lots of sensors monitoring your comings and goings. Facilities departments will be retrofitting for anti-microbial surfaces and plexiglass guards. Before you are allowed to return, if you are allowed to return, you may be pre-assessed for risk before you are allowed to, with bonus point for antibodies. And when you’re back in your ‘six feet office’, you’ll have many more rules governing daily desk coverings, how you interact with your colleagues, walk in the hall, go to the bathroom. Hint: buy acrylic polycarbonate manufacturer stock. ZDNet

Of course, one wonders if Unintended Consequences will be to very firmly establish a remote workforce, which is anathema to some companies, or encouraging further outsourcing of work to offshore entities.

Founder of Call9 springing back with Curve Health for nursing home telemedicine

Tim Peck MD, founder of Call9, which provided in-facility emergency care staff with telehealth capability for nursing homes, announced a new venture also targeted to nursing home/skilled nursing home (SNF) and rehabilitative health. Curve Health will provide telemedicine and health information exchange technology to SNFs and physician groups. Physicians calling on SNF patients will be able to access patient information before a telemedicine visit. According to Dr. Peck, Curve Health’s telehealth and HIE software are built on that of Call9’s. POLITICO Morning e-Health.

Call9 closed operations last July after four years and $34 million in investment. It achieved some success in New York state, covering 3,700 beds and a total of 11,000 patients treated. While they experienced measurable success–in a 200-bed SNF, they achieved a 50 percent reduction in ER admissions and a savings of $8M per year–made inroads with major payers like Anthem and Healthfirst plus expanded into community telemedicine, it ran into a funding wall all too common with this sector. While the book of business was decent and they had gone through two well-funded rounds, Call9 could not move easily into a Series C. Value-based care is a great buzzword and beloved by CMS, but it is a long payout curve, too long for many investors. More discussion on this is in our article 26 June 2019

It is a shame as New York has been the epicenter of COVID-19 nursing home fatalities, due to a foolish (and this Editor is understating) state mandate of returning recovering patients right back to their nursing homes, which could not provide the level of care or isolate them. These patients often worsened, but also infected other patients and staff. Perhaps this could have been mitigated by Call9 or similar–but likely not.

Sadly, there’s a spotlight on nursing homes, rehabs, and LTC because of this pandemic. We look forward to more news from Dr. Peck and Curve Health in this specialized and underserved area of telehealth.

The Theranos Story, ch. 63: 12 new wire fraud, conspiracy, forfeiture charges for Holmes, Balwani

The Fraud That Is Theranos manages to stay in the news, despite a global pandemic, with more fraud charges. Only a few weeks ago, things were looking up for former executives Elizabeth Holmes (left, in the Female Steve Jobs days) and ‘Sunny’ Balwani. The defense insisted that they couldn’t prepare a proper defense without breaking shelter-in-place executive orders, which built their case for delaying the original August trial date. Prosecutors are requesting 27 October; the defense 2021. In February, the nine counts of wire fraud and two counts of conspiracy were reduced by the judge, who dismissed the two conspiracy charges related to defrauding patients who did not pay directly (e.g. insurance payment) and directing doctors to misrepresent Theranos to patients. 

Now Federal prosecutors have filed 12 fresh counts of wire fraud and conspiracy against Holmes and Balwani, plus forfeiture, in the Federal US District Court, Northern District of California, in San Jose. The superseding information (link to PDF) filed on 8 May details the very public splash and claims on their capabilities made by Holmes to the media, on their website, in their Walgreens partnership, and in advertising, from 2013 to 2015. Revealed today (12 May), the expansion of charges include 12 counts of:

  • Wire fraud against Theranos investors, including conspiracy to defraud investors through false representations of their revenue, financial models, and technology, going back to 2010
  • Wire fraud against Theranos patients, through representing to doctors that the tests were accurate while knowing they were not
  • Six additional charges of wire fraud through using electronic media and electronic transfers of funds
  • Four additional charges of wire fraud in transmitting through phone and internet laboratory and blood test results, plus payments for the purchase of nearly $1.3 million in ads targeting patients and doctors for the Wellness Centers

Wrapping this up is a demand for forfeiture of proceeds (which were at least $700 million).

These felony charges carry a potential sentence of 20 years imprisonment, a $250,000 fine, three years supervised release, plus a $100 special assessment (ahem), in addition to whatever proceeds can be clawed back in what is now a worthless company.

The actual indictment needs a grand jury to be convened, which cannot happen until 1 June or later.

Additional information on The Register, BioSpace, and Fox Business.

Theranos’ fraudulent blood testing is even more relevant in this Age of COVID with reports of the proliferation and uneven performance of virus and antibody tests. Tyler Shultz, who worked at Theranos and was related to investor/advisor George Shultz, warned on 2 May that Theranos would have thrived in this hothouse. The UK alone ordered millions of kits from China, only to send them back due to poor sensitivity (ability to avoid false negatives) and specificity (ability to avoid false positives). Rapid testing kits have come under particular fire. The US opened the gates to non-FDA cleared tests in March, only to close them shut a few days ago. Only Belgium, with the highest rate of fatalities per 1,000 infections, has banned the rapid tests. Other tests are more accurate but they take more time to return results and cannot be administered at home. Many believe that they already had COVID and anxious to see if they have the antibodies (IgG) floating about in their plasma. Bloomberg

Important UK government guidance on safer workplaces during and after the COVID-19 pandemic

The UK Department for Business, Energy & Industrial Strategy has issued on Gov.UK specific advisories on workplaces and to keep workers healthy during and after the peak of this pandemic. In addition to those who’ve had to work on-site through the lockdown, as we return to business, this guidance will be helpful in assessing risk and engaging staff in changes such as physical distancing, reconfiguring offices, creating barriers, and reconfiguring work teams.

Eight work situations are identified: 

  1. Construction and outdoor work
  2. Factories, plants, and warehouses
  3. Labs and research facilities
  4. Offices and contact centres
  5. Other people’s homes
  6. Restaurants offering takeaway and delivery
  7. Shops and branches
  8. Vehicles

While not strictly digital health, this is pertinent information for us in our businesses to keep safe, particularly #3-5. Most of us won’t be working remotely forever, and quite a few of us visit homes and other offices. For our US readers, this type of guidance will also be useful–and hasn’t been seen by this Editor from the state or Federal level.

Mount Sinai Health Partners (NY) launches Babylon Health telehealth app

Mount Sinai Health Partners, through New York Telemedicine Associates, has premiered Babylon Health’s telehealth app as part of its services with five large New York health plans: Empire Blue Cross Blue Shield Commercial and Medicare Advantage; Humana Medicare Advantage; Oscar Commercial, and Cigna Commercial. The coverage of these five plans is claimed to be in the millions. Mount Sinai’s network covers Manhattan, Brooklyn, Queens, and most of Long Island.

The app includes the Babylon chatbot and the opportunity to set video consults with a doctor. The app also has COVID-19 information and a chatbot app which leads you through a self-diagnosis menu, interactive advice, and will set up an appointment to speak to a healthcare professional. Release, Babylon Health US’ page on the Mount Sinai program   This Editor will add that Mount Sinai is rather late to the party, as rival NYU Langone has been promoting their telehealth Virtual Urgent Care program for months.

The Forbes article starts off like a glossy Babylon press release, but continues on to some of Babylon’s recent and controversial press, such as Saudi Arabia’s Public Investment Fund (PIF) participating in the last $550 million investment round and the tart feedback of many UK doctors on how much ‘care’ can be pushed off onto apps like ‘GP At Hand’. Not mentioned is the controversy around the accuracy of the chatbots when it comes to giving advice, which was the subject of Newsnight and @DrMurphy11 (Dr. David Watkins), who has been raising performance issues for some time. [TTA 27 Feb]

Is a COVID-19 ‘immunity passport’ next for the UK to get back to work?

The Guardian is reporting that UK ministers are in talks with Onfido, a UK company which uses facial biometrics for identity verification. An ‘immunity passport’ would combine identity verification with a medical history on whether that person has had COVID-19. The government could use antigen tests, which show current infections, or a test that detects IgM antibodies. For past infections, the test would need to detect IgG antibodies. This passport would be several months in the future.

The question is if the tests work especially for past infections and access to reliable testing. For instance, the earliest instances of COVID-19 may have occurred in the US starting in late November. Will the IgG antibody still be present? These tests are still developing and are not widespread yet, despite many companies’ claims. Both Roche in the US and Quotient in Edinburgh have new lab-based tests that apparently have superior accuracy. Roche received emergency use approval from the US Food and Drug Administration (FDA) for their test, while Quotient is claiming 99.8 accuracy for 36,000 antibody tests a day in 35 minutes.

The process that Onfido outlined works like this:

  1. Use an app to take a facial picture that you match to your government-issued id. The app matches the two to verify your identity and can also detect if the ID is fake.
  2. Get a test to determine whether you have had the coronavirus
  3. At work, you open the app at reception and take a picture of your face that generates a QR code. This is scanned by the receptionist and confirms whether you have immunity or not.
  4. If you have a match, you can enter the workplace.

Of course this discriminates against those with smartphones, and if your facial appearance has changed. Example: if your government ID was taken with a beard and you’re now clean-shaven, in this Editor’s estimation you will have a problem. Most government IDs also look like the pictures of missing appearing on milk cartons, so what your app takes could very well not match.

It’s also unknown whether the antibodies even confer immunity–and for how long.

Contact tracing in the UK: the biggest digital health test yet?

Is uncertainty over risk of data breaches and violation of data privacy in the NHS contract tracing app the real barrier to adoption? Or is the risk more complicated–the user perception of  app reliability for them to upend their life? A person might not want to have the government on record as telling them that they were “sufficiently near” a person diagnosed with coronavirus–and also believe that the app does not provide reliable information. The person receiving the alert very well may not be infected, but the risk is that they may be compelled to self-isolate and even test with repeated alerts that may or may not be accurate.

In other words, the ‘false positive’ alert syndrome. We go back to this syndrome to understand that the real test of confidence is the perception that the algorithms will, with a good deal of confidence, screen for the number and duration of contacts of other people with symptoms, and that the complex algorithms will create a correct evaluation.

With a system that relies on about 80 percent of adoption, according to a University of Oxford team, the real factor in a successful contract tracing app may be Human Behavior– how users with smartphones perceive the app as reliable in alerting them for enough risk to self-isolate, with privacy and security lesser concerns.  UKAuthority  Hat tip to reader Alistair Appleby

Telehealth and the response to COVID-19 in Australia, UK, and US: video

Malcolm Fisk, whom our Readers know as Senior Researcher at the De Montfort University in Leicester, was kind enough to forward information on a recent video interview with André Martinuzzi of the Living Innovation Project, a Europe-wide innovation group with 14 partners ‘co-creating the way we will live in 2030’.

This 17:30-minute video covers a lot of ground on the UK response to the coronavirus (the uncertainty as of mid-April), how the UK, US, and Australia have used telehealth in response, and how telehealth can ‘stick’ after the crisis, but only if we design an inclusive infrastructure. You can view the video on the Living Innovation page by clicking on ‘View Video’ on the upper right hand side, or go directly to YouTube.

There’s a brief preview in the video of Dr. Fisk’s paper (awaiting publication, co-authored with Anne Livingstone and Sabrina Pit) on ‘Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom and the United States’. Telehealth was very rapidly put into use for diagnosis, monitoring, and home treatment of COVID patients. Restrictions were lifted and investments made in communicating the availability of telehealth. However, the infrastructure for telehealth is strained, especially in the US with a mixed, primarily private model dependent on payers or individuals paying per virtual visit. In the UK, health trusts have encouraged the use of telephonic and audio/video models. In Australia, telehealth, particularly in remote areas, is well established. TTA will keep Readers posted on the publication of this paper. A big hat tip to Malcolm Fisk.

Has the ‘river of knowledge’ reversed its natural course? A lighter look at technology’s other effects.

A long-time TTA Reader, John Boden, takes a rueful glance at how ‘smart’ technology has not just disrupted the phone and computing markets, but has disrupted the ‘natural order’ between generations today. A virus-free look at a phenomenon that’s changed a natural dynamic.

As I am writing my experiences, and thinking about my grandparents and parents, I remember how many of the little things they taught me. It is not the big lessons I am talking about, but the details. A few examples: how to sharpen a knife; how to ground a sparkplug without getting shocked; how to tie a bowline; how to saw a board; how to chop down a tree, and hundreds of other skills. The most amazing change has taken place today. Now, so many times it is the grandchildren teaching the grandparents. The advent of technology is the cause. Cell phones, e-readers, Google, directions to anywhere from anywhere, Amazon shopping, Uber, movies, music, and on and on. All came screaming into our lives in the last decade or two, like an avalanche filling those little machines we hold in our hand.

The acquisition of the new skills needed is no longer based on the experience and hard-learned lessons that were passed down from one generation to the next, from the master craftsman to the apprentice, from parent to child, as has always been the way.

Suddenly we elders were having to learn new ways of doing things and it felt like we were drinking from a firehose. We finally gave in and bought ourselves one of those new phones we can carry around with us and flip open to use wherever we are, and then, BAM, there is a newer one, and then a newer one, and now it is much more than a phone. It is a map with a guide that tells you directions and even insists on telling you when to turn. It is a record player, a camera, a mailman that delivers immediately and you can even answer back immediately.

WHOA – WHOA – WHOA, this is too much. I cannot even get it out of my pocket before it stops ringing. Then, which button do I push to see who called? Oops, did they leave a message? Why is this screen blinking? Icon? What icon? (And what’s an icon anyway?) Do I push? Oops! Tap! Do not push! And this is just the phone part of the thing.

Where have all the dials gone? Where are the gauges with needles that told us how everything was working? What do you mean I just walk up to my car and it will know who I am and unlock the doors so I can get in? How can all this stuff that did not exist even a few years ago have so completely taken over our lives?

Ah, the instruction manual, that will explain it all! Where is it? What do you mean it is on the phone? I cannot see it. Where is it? Just go to the URL, we are told. The URL? What is that? Is it in the bathroom near the URinaL?

At about at this point that there is only one way out of the mess. Call a child or grandchild to help lead you out of this technology maze we have found ourselves in. Right now there never seems to be a skill that we have learned in our many years of experience that they need. So, today the river of knowledge seems to be in reverse of how it has been for centuries, flowing uphill.

Pretty soon our employment laws will be saying only those under the age of 16 are allowed to do this type of work!

Contact tracing app ready for Isle of Wight trial this week: Hancock. But is it ready for rollout? (updated)

Announced today was what in normal times we’d call a beta test of the contact tracing app [TTA 25 April] developed by NHSX on the Isle of Wight. Transport Secretary Grant Shapps announced it Sunday to Sky News. BBC News detailed today that council and healthcare workers will be first to try the contact-tracing app starting Tuesday at 4pm, with the rest of the island able to download it starting Thursday. Gov.UK  The Isle of Wight has approximately 80,000 households.

Update: How the Isle of Wight residents reacted to the app. BBC News

How the app works: if someone reports COVID-19 symptoms through the app, that information goes to the NHS server and the server downloads that tracking information. The app then notifies the other app users that the person has been in contact with over the past few days, contact being defined as within 6 feet for 15 minutes. This can include someone a person has sat next to on public transport. The tracking in the app is via Bluetooth LE to other mobile phones. The app then alerts contacts with the app and gives advice, including how to get a test to confirm whether or not they do have COVID-19. Users will be able order tests through the app shortly.

Use of the app is voluntary and personal data is limited to postal code and what the user opts in to. So the intent of the app is to warn and test to reduce future outbreaks, as full lockdown is not and cannot be a permanent state. Mr. Shapps stated to Sky that the goal is 50 to 60 percent of the country using the app.

Unfortunately, many of the most vulnerable–older, sicker, and poorer adults–won’t have the smartphone, much less the app, and even with the smartphone, won’t be able to download the app or use it. It’s dependent on self-reporting, which may or may not be reliable. Phones can turn off Bluetooth LE. Another consideration, and one this Editor hopes has been tested, are extremes: extreme density in population and contact areas, and extreme distance, as in rural areas. Additional from BBC News, including a short Matt Hancock clip from the Monday briefing with an almost-touch of his nose or mouth right at the start (!)

The Guardian brings up privacy concerns as well as a Health Service Journal (HSJ) report that the app was ‘wobbly’ and had cybersecurity concerns which would exclude it from the NHS’ own app store. The HSJ story quoted their source stating that the government is “going about it in a kind of a hamfisted way. They haven’t got clear versions, so it’s been impossible to get fixed code base from them for NHS Digital to test. They keep changing it all over the place”.  The reporting data also will reside on NHS servers, not individual phones, but pushes out the alert from the server.

Worldometer gives the current UK statistic as total of 190,584 with 28,734 deaths. While case diagnosis continues to increase, fatalities have been steeply declining. There is concern that COVID is yet to spike in rural areas, as cases have concentrated in Greater London, the Midlands, and the North West. New York and New Jersey alone in the US have over 456,000 cases with just under 32,900 fatalities attributed to COVID-19, 3/4 of which have been in NY–almost as much as the entire UK. (However, the fatality statistic is widely questioned as not screened for contributing causes, since there are certain incentives for attribution.)

In other NHS news, NHS Digital, the information and tech side of NHS (not the innovation unit) has named a new deputy chief executive. Pete Rose will also take on the role of chief information security officer for the Health and Care System, including live services, cybersecurity, solutions assurance, infrastructure, and sustainability.

10 years in 2 months: prognosticating the longer-term effect of COVID-19 on telehealth, practices, and hospitals

crystal-ballThis Editor recounted last night in the article below on The TeleDentists’ fresh agreements with Cigna and Anthem the observation of a former associate who has been in the thick of the remote patient monitoring wars for some years that telehealth/telemedicine has progressed 10 years in 2 months. Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), stated to the Wall Street Journal (paywalled),  “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.” Even in a short period of time, CMS-reported telehealth visits as of 28 March trebled from 100,000 to 300,000. When the April numbers are in, it would not be surprising to see it grow well into seven figures.

The genie may be out of the bottle, but what will the genie do? Genies are, after all, unpredictable, and fly around.  Out of the smoke, some educated guesses:

  • Insecure, non-HIPAA compliant audio/video platforms will be the first which should be struck from CMS approval. Zoom has become a hackfest, with all sorts of alerts from mobile providers like Verizon on how to secure your phone. (An organization of which this Editor is a member had a panel this week completely disrupted by a hacker in five minutes.) Skype’s problems are well known. The winners here will be telehealth platforms that integrate well with EHRs, population health platforms (or may be part of population health platforms), and have robust security.
  • Primary care practices and specialists, who’ve been surviving on non-F2F visits, will be adjusting their practices to patient demand, and integrating telehealth with physical visits in a way that their patients will prefer. This means a search for integration of EMRs/EHRs with secure platforms and reconfiguring areas such as care coordination. If planned correctly, this could create better management of patients with multiple chronic conditions.
  • Actual physical visits will rebound, creating financial pressure on Medicare, hospitals, and private payers. How many people’s health has declined in two-three months is key. Small practices, who may see this first, will see another level of pressure, because they will be held to their Medicare quality metrics in value-based models even if adjusted. Hospitals will also rebound–if they are able. The dark side: private payers may run the numbers and scale back on benefits for the 2021 year especially if COVID is projected to make a return.
  • Behavioral health may benefit, yet drive individual practices and a wave of retirements, or a consolidation into clinic or group settings. There’s a reason why Optum is buying out AbleTo; we may see a wave of competitor acquisitions in this area with the emphasis will be on cognitive health and short courses. Why retirements? Many psychiatric practices are still independent, concentrated geographically, and the average psychiatrist is over 50. Psychiatric EHRs are both costly and not particularly suited to practices. If faced with technological challenges, a lot of MDs and senior clinical psychologists may very well exit–threatening clinics which need MDs to legally operate.
  • Rural health’s failure accelerated. USA Today’s analysis pinpointed at least 100 rural hospitals to close within the year. They already operated on thin margins, but with COVID expenses for additional equipment, the closing down of more profitable elective procedures and dependence on Medicaid, the over 1,100 unprofitable hospitals, over half of which are the only hospital in their county, have received a body blow. HHS allocated $10 billion to rural hospitals and clinics of the $100 billion aid package, but it may be too little and too late. Becker’s Hospital Review continues to track the bankruptcies and closures. Here there are no easy solutions from the digital health area.
  • A culture of cleanliness should accelerate. If the genie pulls this out of the bottle, one major benefit will be that hospital-acquired infections will decline. Effective sanitization methods that reduce human application and scrubbing will be the ones to look at: disinfecting foggers and UV full room or area systems–or combinations of same. Cleanliness and lack of virii and bacteria may become a new metric. Look and bet on companies that can provide this, from rooms to computers/mobile tablets and phones.

Readers can help with these prognostications and especially how they will play out not only in the US, but also in the UK, Europe, and worldwide.

Anthem Blue Cross Blue Shield adds virtual dental care with The TeleDentists in 9 states

Could it be that a certain sage from New Jersey is on the money in predicting to this Editor that telemedicine has advanced about 10 years in the past two months? Anthem Blue Cross and Blue Shield (BCBS) is adding the virtual dental care provided by The TeleDentists to its plans in nine states: Maine, New Hampshire, Connecticut, Ohio, Kentucky, Indiana, Wisconsin, Colorado, and California. Through 30 June, the plans will cover virtual exams at 100 percent with no deductibles, copays, paperwork or claims to file. The virtual visit dentistry service offered by The TeleDentists is designed for urgent situations and to avoid an initial visit to the ER which can be several hundred dollars.

A member will locate a remote dentist through Anthem’s provider finder, then link to The TeleDentists’ site where the member is screened for history. A connection to a dentist then takes place quickly, in as little as 10 minutes, 24/7/365. The format is a video consult plus chat (TeleDentists uses the HIPAA-compliant VSee platform) to evaluate the plan member, then to guide on next steps. If necessary, the dentist will prescribe medications, such as antibiotics and non-narcotic pain relievers.

In the US, Anthem is #3 after UnitedHealthCare and Kaiser. It is the largest for profit insurer in the Blue Cross Blue Shield Association. In California alone, it has 800,000 members.  This adds to The TeleDentists partnership with Cigna announced earlier this month [TTA 15 April]. Releases (9) on Business Wire. Hat tip to CEO Howard Reis.