Breathe, exhale: a future bracelet that may predict asthma attacks through breath

click to enlargeA sensor developed by a research team from Rutgers University may in future lead to wearables that predict asthma attacks. The team developed a reduced graphene oxide sensor to detect telltale biomarkers–elevated nitrite levels in exhaled breath condensate (EBC)–that mark the increased airway inflammation present in a developing asthma attack. Currently, breath has to be condensed before being sampled by the nanoelectric sensor, but the team’s goal is “to develop a device that someone with asthma or another respiratory disease can wear around their neck or on their wrist and blow into it periodically to predict the onset of an asthma attack or other problems,” according to researcher Mehdi Javanmard. This concept is far more convenient than a bulky spirometer. Beyond warning the person of an asthma attack, the technology could also be used for other obstructive lung diseases and for tracking treatment/drug effectiveness. Hat tip to Toni Bunting of TASK Ltd. FuturityMicrosystems & Nanoengineering (journal, full text)

It is good to see credible academic R&D in this area of wearables, since there have been others claiming measurement of calories, blood glucose, and hydration, that have been, or been close to, scams. We suspected the Healbe GoBe couldn’t do what it claimed in calorie and BG measurement in 2014 [TTA 26 June 14 and 24 Feb 15] after raising $1 million (more…)

In-home video monitoring acceptable to 90 percent of dementia carers: Age NI study

What used to be the ‘third rail’ of caring may no longer be. The idea of cameras in the home to view activity of an older family member was so abhorrent to caregiving relatives that it was a key in selling purely sensor-based monitoring systems from the early 2000s on, such as QuietCare, GrandCare, Alarm.com Wellness, Healthsense, Lively, Tynetec/Legrand and many others. Today, in the age of selfies and video on social networks, video surveillance doesn’t seem so foreign. Age NI‘s study conducted through Ulster University had the surprising finding that over 90 percent of participants in several focus groups supported it, with two important caveats; that there was initial consent from the older person being monitored, and that only family members could view the video. With that, they found it ‘useful’, ‘ethical’ and ‘moral’. It would support the person’s safety in aging at home longer, and provide peace of mind for carers. Hat tip to Toni Bunting of TASK Ltd. PharmaTimes, Ulster University News

Want to attract Google Ventures to your health tech? Look to these seven areas.

The GV Hot 7, especially the finally-acknowledged physician burnout. Google Ventures’ (GV) Dr. Krishna Yeshwant, a GV general partner leading the Life Sciences team, is interested in seven areas, according to his interview in Business Insider (UK):

  • Physician burnout, which has become epidemic as doctors (and nurses) spend more and more time with their EHRs versus patients. This is Job #1 in this Editor’s opinion.

Dr. Yeshwant’s run-on question to be solved is: “Where are the places where we can intervene to continue getting the advantages of the electronic medical record while respecting the fact that there’s a human relationship that most people have gotten into this for that’s been eroded by the fact that there’s now a computer that’s a core part of the conversation.” (Your job–parse this sentence!–Ed.)

Let’s turn to Dr. Robert Wachter for a better statement of the problem. This Editor was present for his talk at the NYeC Digital Health Conference [TTA 19 Jan] and these are quoted from his slides: “Burnout is associated with computerized order entry use and perceived ‘clerical burden’ [of EHRs and other systems]”. He also cites the digital squeeze on physicians and the Productivity Paradox, noted by economist Robert Solow as “You can see the computer age everywhere except in the productivity statistics.” In other words, EHRs are a major thief of time. What needs to happen? “Improvements in the technology and reimagining the work itself.” Citing Mr. Solow again, the Productivity Paradox in healthcare will take 15-20 years to resolve. Dr. Wachter’s talk is here. (more…)

Winston Churchill Memorial Trust – 2018 Travelling Fellowships

Here’s a great opportunity to get funding to go and investigate a health & care innovation elsewhere in the world – there are plenty of them!

Do you have the drive and determination to undertake global research? If so the Winston Churchill Memorial Trust funds UK citizens to investigate ground-breaking practice in other countries and return with innovative ideas for the benefit of people in the UK. Whatever your background, they can help you bring positive change to your community, sector, or profession.

They are looking for people who are passionate about making a difference in their field – that means just about every TelecareAware reader! (Though note sadly only UK citizens can apply.)

Grants cover return and internal travel, daily living and insurance within the countries visited. Apart from UK citizenship, there are no other required qualifications.

Categories include (directly health-related in bold):

  • Environment, Conservation and Sustainable Living
  • Education
  • Health and Wellbeing
  • Mental Health – Community Based Approaches
  • Migration – Living Well Together
  • New Approaches to Social and Affordable Housing
  • Nursing and Allied Health Professions
  • Science, Technology and Innovation
  • Supporting Vulnerable Children following Bereavement

Apply before 5pm on 19th September 2017.

For more details please go here.

The Theranos Story, ch. 42: the 2-for-1 share offer to investors closes, clock ticks

click to enlargeIs this a sincere and generous offer, or staving off the inevitable? Theranos reported this week that it closed its 2:1 new preferred share offer. This was offered only to C-1 and C-2 round investors, the 2014-2015 $600 million round which bought in at about $15-17/per share. The hold on this was released when Theranos settled with Partners Fund Management on 1 May for an undisclosed amount [TTA 2 May].

Theranos claimed that “Holders of more than 99 percent of the shares eligible for the transaction elected to participate. Participants received new shares of the Company’s preferred stock in exchange for their existing preferred stock.” By accepting the offer, they also released any potential claims against Theranos.  Release

Fortune mostly recaps previous events such as the CMS and Arizona settlements. One interesting snippet we missed: when the investor offer was first made in April, there were reports that Ms. Holmes owed her company $25 million, which would have been the exchange basis for the return of her shares. This Editor considers that company survival drove this un-Silicon Valley-like founder equity drain, but perhaps with favorable tax or financial outcomes for Ms. Holmes.

The company buys time, but where is their technology and how much is left in the bank? The clock ticks….  Our index of previous Theranos coverage is here.

Digital health & insurance: perfect partners?

The BMA is claiming at their annual conference today that GPs are struggling with workload. Once upon a time, everyone thought digital health alone was one answer to reduce that workload. However until we have better algorithms to sort the signal from the noise, many doctors claim that more data is contributing to the problem rather than solving it. So how to get patients to use digital health data to take more responsibility for their own health? In technical terms, how to raise their patient activation measure (PAM)?

One way of improving the effectiveness of digital health might therefore be to add incentives to become more activated; insurance could provide such an incentive. The Royal Society of Medicine has therefore put together, as a ‘first’, an event on 1st June to explore this combination (disclosure: organised by this editor).

The speakers have been chosen to cover the full spectrum of participants in this field. Beginning with the software, Caty Ebel Bitoun from the Netherlands will describe software she builds to support health insurers, and Justin Lawler from We Savvy in Ireland will describe how that software can be configured to deliver maximum benefit.

Guy Gross will explain how careful segmentation of insured populations by PAMs can substantially reduce (more…)

International Conference on Rural and Elderly Health Informatics (Togo, W. Africa)

click to enlarge14-17 December, University of Lomé, Togo, West Africa

The IREHI conference is an annual international conference organized by IEEE International and the University of Lomé. The first meeting will be in Togo and will concentrate on the crisis of care delivery in developing countries, particularly acute in rural areas. The conference will look at how information and communication technologies (ICT), including telehealth and distance care, can improve healthcare. These solutions could significantly contribute to the improvement of health education, diagnosis of diseases, the effectiveness of treatment and monitoring of the elderly, both in urban and rural areas where specialized services are still limited or sometimes non-existent. (more…)

Successful Aging 2030: how far we haven’t come, how far we have to go

click to enlargeThis Editor attended last Wednesday’s (10 May) d.Health Summit 2017–Successful Aging 2030, sponsored by the University of Rochester and West Health. It was an expansive, well-organized and attended seminar at the New York Academy of Sciences at the impressive new 7 World Trade Center. Panels covered economic, housing, health outcomes, government policy, technology innovation, and investing factors key to one central fact: that in the US, nearly 20 percent of the population will be over 65 by 2030. Worldwide, the numbers are already much higher as of 2015: Japan (26 percent), Italy (22), Greece, Germany, Portugal (21) with nearly all of Europe already near that magic number (World Bank).

What was dispiriting to this Editor was that in her now 11 years in related health tech (telehealth and telecare), the status of many issues were the same as in 2006. The inadequacy of ‘aging in place’ supports and “assisted living”; a culture that brutally devalues people as they get older starting after 50; a belief that whiz-bang technology will fix it, but it doesn’t; the non-recognition of ‘aging-consumer-driven healthcare’; the lack of attention from investors because aging is not glamorous–are still there. What was hopeful? The candid recognition of these factors and the open discussion around them. There was a blunt admission expressed somewhat differently by two speakers, June Fisher MD of UC Berkeley and Charlotte Yeh of AARP, that without co-designing solutions with older people, we will get nowhere, and that imposing ‘fixes’ from the outside hasn’t and isn’t going to work. We also have a new middle age of 55-75, but the work market and employers have not adapted to that lengthening of productiveness, with the ‘pasture’ of retirement still pegged theoretically at 65.

Highlights of each panel:

The Longevity Economy, or the Silver Economy, was estimated by Merrill Lynch‘s Surya Kolluri at $7 trillion, with a surprising 90 percent of package goods spending done by 65+, and not just that but also areas such as home improvement. But healthcare spending is about 200 percent over the population average, and caregiving factors into that as well. There are profit opportunities for companies in this market, including developing/future areas such as robotics. (more…)

Dry the tears: WannaCry stymied, North Korea hackers suspect. Is this a poke for a worse attack?

Breaking News This morning’s (Tuesday 16 May) news is about reputable security organizations–Kaspersky Lab and Symantec–connecting the dots that lead for now to a North Korea-linked hacking organization, the Lazarus Group. This group has been identified in previous hack attacks and is based upon WannaCry code appearing in Lazarus programs. US Homeland Security has admitted seeing the same similarities, but all are working to gain more information.

Lazarus has been previously identified as the source of the 2014 Sony attack and the theft of $81 million from the Bangladesh central bank, again linked to fundraising for North Korea for its missiles, army, EMP and nuclear arming while its terrorized people starve. However, this attack was a flop; according to US Homeland Security, about $70,000 was raised in ransom. The Homeland Security spokesman also distanced the NSA from the original information which targeted weaknesses in Microsoft’s systems.

According to reports, WannaCry disproportionately affected Russia, Taiwan, Ukraine and India, according to Czech security firm Avast. No US Federal government systems were affected. China on Monday reported that it attacked traffic police and school systems.

The Telegraph has posted a speculative list of 34 NHS organizations which suffered IT failure during the WannaCry attack. The article includes a map produced by MalwareTech that geographically spots the infection locations; the Boston to Washington corridor is a sea of blue dots. And…Marcus Hutchins has been identified as the young UK tech working for Kryptos Logic who redirected the attacks by buying a domain embedded in the WannaCry code. How it worked, according to PC World, is that if the malware can’t connect to the unregistered domain, it infects the system. By registering the domain and creating a page for the malware to connect to, he stopped the malware spread. (Video in Telegraph article)  Also FoxNews

But is this a prelude to more and worse? Is this testing our preparedness? If so, we’ve been found wanting on an enterprise level with vulnerable systems and administrators not updating their software and OS. George Avetisov, the CEO of HYPR, a biometric authentication company, in The Hill, summarized it neatly today: “We’ve also learned the hard way that, simply through a coordinated phishing attack on unsuspecting users, hackers can disrupt the day-to-day activities of enterprises that provide communications, travel, freight and healthcare administration simply by remotely deploying malware.” He then goes on to praise President Trump’s executive order (EO), “Strengthening the Cybersecurity of Federal Networks and Critical Infrastructure,” which he signed on Thursday–right before all this began. As if in confirmation…ShadowBrokers, the group that hacked the NSA files, today announced the availability of a subscription to a ‘members only data dump’ like a Wine of the Month Club. Watch out, banks and healthcare, it’s open season! NHS, better pay attention to another kind of hygiene–cyberhygiene. Without it, plans for patient apps and data sharing will go sideways–and deserved fodder for Dame Fiona [TTA 10 May]. The Hill  Earlier coverage here

Updated 15 May: 20% of NHS organizations hit by WannaCry, spread halted, hackers hunted

Updated 15 May: According to the Independent, 1 of 5 or 20 percent of NHS trusts, or ‘dozens’, have been hit by the WannaCry malware, with six still down 24 hours later. NHS is not referring to numbers, but here is their updated bulletin and if you are an NHS organization, yesterday’s guidance is a mandatory read. If you have been following this, over the weekend a British specialist known by his/her handle MalwareTech, tweeting as @malwaretechblog, registered a nonsensical domain name which he found was the stop button for the malware as designed into the program, with the help of Proofpoint’s Darien Huss.

It looks as if the Pac-Man march is over. Over the weekend, a British specialist known as MalwareTech, tweeting as @malwaretechblog, registered a nonsensical domain name which he found was the stop button for the malware, with the help of Proofpoint’s Darien Huss. It was a kill switch designed into the program. The Guardian tagged as MalwareTech a “22-year-old from southwest England who works for Kryptos logic, an LA-based threat intelligence company.”

Political fallout: The Home Secretary Amber Rudd is being scored for an apparent cluelessness and ‘wild complacency’ over cybersecurity. There are no reported statements from Health Secretary Jeremy Hunt. From the Independent: “Patrick French, a consultant physician and chairman of the Holborn and St Pancras Constituency Labour Party in London, tweeted: “Amber Rudd is wildly complacent and there’s silence from Jeremy Hunt. Perhaps an NHS with no money can’t prioritise cyber security!” Pass the Panadol!

Previously: NHS Digital on its website reported (12 May) that 16 NHS organizations have been hacked and attacked by ransomware. Preliminary investigation indicates that it is Wanna Decryptor a/k/a WannaCry. In its statement, ‘NHS Digital is working closely with the National Cyber Security Centre, the Department of Health and NHS England to support affected organisations and ensure patient safety is protected.’ Healthcare IT News

According to cybersecurity site Krebs on Security, (more…)

The End or Beginning? Anthem ends Cigna merger, won’t pay breakup fee, seeks damages (updated)

click to enlargeUpdated. Anthem on Friday 12 May beat Delaware Chancery Court’s Judge Travis Laster’s ticking clock [TTA 11 May], and finally, formally called off its merger with Cigna. Instead of sighs of relief and seeking oblivion in a few bottles of adult beverages, Anthem still won’t stop and let Cigna go. Anthem now refuses to pay the breakup fee per their agreement, claiming once again that Cigna sabotaged the merger, and wants blood from that rock. From the Anthem announcement:

In light of yesterday’s decision and Cigna’s refusal to support the merger, however, Anthem has delivered to Cigna a notice terminating the Merger Agreement. Cigna has failed to perform and comply in all material respects with its contractual obligations. As a result, Cigna is not entitled to a termination fee. On the contrary, Cigna’s repeated willful breaches of the Merger Agreement and its successful sabotage of the transaction has caused Anthem to suffer massive damages, claims which Anthem intends to vigorously pursue against Cigna. (Editor’s highlight)

Now we have Anthem seeking damages from Cigna, which is a matched set with Cigna’s Funny Valentine of 14 February adding over $13 bn in damages to recoup the unrealized premium that shareholders did not earn as a result of the merger failure. Anticipating Anthem’s position even at that time, they flipped a wicked backhand in their statement:

Anthem contracted for and assumed full responsibility to lead the federal and state regulatory approval process, as well as the litigation strategy, under the merger agreement. Cigna fulfilled all of its contractual obligations and fully cooperated with Anthem throughout the approval process.

Our Readers will also recall that in March, Cigna joined with Anthem in supporting Anthem’s appeal to the DC Court of Appeals, an unusual move in this light, but one that further reinforced their non-saboteur ‘we’re just innocent victims here’ position. Cigna has not yet publicly responded. The AMA cheered its apparent complete victory in the name of doctors and patients.

They hate each other and have from the start. The real victims here are the policyholders–patients–of both companies, with both companies distracted by a legal battle. How different they are from both Aetna and Humana, which (at least publicly) politely ended all efforts after the merger denial, paid out their breakup, and went back to business, which right now presents challenges with ACA hitting the long-predicted Actuarial Brick Wall. (Aetna exiting ACA individual exchange plans in 2018)

Judge Laster’s plans for a restful summer on Delaware’s beautiful beaches and bays are likely to have gone the way of the mouse in Robert Burns’ poem ‘To A Mouse’ (stanza 7). He is not alone in Indianapolis or Bloomfield, Connecticut:

But Mousie, thou art no thy-lane,
In proving foresight may be vain:
The best laid schemes o’ Mice an’ Men
Gang aft agley,
An’ lea’e us nought but grief an’ pain,
For promis’d joy!

See you in court! Fortune, Modern Healthcare, Healthcare DiveInterested in the previous details? See our coverage here, including our take on ‘whither the policyholders (patients) and corporate buyers’.

Texas gets its telemedicine on: House, Senate pass full direct-to-consumer access

The telemedicine stars at night–and day–are big and bright, deep in the heart of Texas with the passage of House Bill 2697 permitting direct-to-consumer virtual doctor visits. With last week’s passage of a concurrent bill SB 1107 in the Senate, it is now on the desk of Governor Greg Abbott for signature, which is expected shortly. JD Supra (Jones Day), Modern Healthcare

The new legislation allows for previously prohibited initial care via telemedicine (versus in person), asynchronous “store-and-forward” typically used for data and images or other such audiovisual technology so long as it complies with rules that ensure safety and quality. The bill’s terms were negotiated between the Texas Medical Association, the Texas eHealth Alliance, and Teladoc. It also effectively ends the long-running, six-year standoff between Teladoc and the Texas State Medical Board, and the shutout of other providers such as American Well.

Both rivals cheered the good news on, which was timed beautifully for Teladoc’s 1st Quarter earnings call on May 9, adding to record-high visits, plus healthy revenue and membership increases. While it has many internationally known medical centers, Texas is a huge state and is notoriously short of primary care physicians, with 71.4 primary care physicians per 100,000 people and 46th among all the states for primary care physicians per capita.

There is one aspect of the bill that ensures further legal challenge, which is the language prohibiting the use of telemedicine to prescribe abortion-inducing medication as it does in 20 other states. Mobihealthnews. Further background in March article

The weekend charmer: fitness tips from a 105 year-old practicing doctor

How do you get to a very advanced age and still be active in your work, if you’re not the Duke of Edinburgh with a staff (and a younger working wife)? Especially when your 105 years have included being a soldier in WWII and a stint as a Japanese POW? Dr Bill Frankland credits his one hour of daily exercise for his longevity and sharpness, especially repeatedly rising from a sitting position. We also note that he wears a PERS wristlet–just in case. Is someone studying his genome? Learn his secrets in the video from BBC Today.

Anthem-Cigna breaking: lawyers may talk, but Cigna gets to walk–and it continues in court

click to enlargeBreaking, with a whimper. This evening (11 May), the Delaware Court of Chancery released its ruling denying a 60-day injunction requested by Anthem to prevent Cigna from ending their merger. The original merger agreement had an end date of April 30. Judge Travis Laster stayed the implementation of his ruling until Monday noon to give Anthem a chance to appeal to the Delaware Supreme Court. Reuters

Is this The End? In this Editor’s opinion, yes, the petition to the US Supreme Court for a writ of certiorari notwithstanding. I stand by my Monday observation that “the Chancery Court decision to extend for 60 days–into July– is critical to any SCOTUS hearing, as it is unlikely there would be any merit in a review of a dead deal even if there is a potentially novel issue. 

So Cigna can walk, pass ‘go’ and collect…? The open issue is now Cigna’s. There is a contractually mandated breakup fee of $1.85 bn. In February, their Funny Valentine also claimed over $13 bn in damages, on the grounds that Anthem had intent to harm Cigna’s business. Not so fast though–there will certainly be a fight over the damages. According to Bloomberg, “the judge said there was significant evidence Cigna may have violated the merger agreement by dragging its feet on antitrust concerns, which could entitle Anthem to “potentially massive damages.” The next phase of court actions will be around damages awarded to Cigna, if any; if so how much; and what is the final settlement. Dirty laundry and ‘Who Shot John?’ will fly in this same court, unless the settlement is quick and quiet, highly unlikely with these two noisy protagonists. If it remains substantial, Cigna could be shopping for acquisitions–or be a cash-rich acquisition target itself. More distractions for management.

Other mergers may be more palatable in a changing healthcare landscape…just not this one. Also Fortune. Interested in the previous details? See our coverage here, including our take on ‘whither the policyholders (patients) and corporate buyers’.

The stop-start of health tech in the NHS continues (UK)

Continuing their critique of the state of technology within the NHS [TTA 17 Feb], The King’s Fund’s Harry Evans examines the current state of incipient ‘rigor mortis’ (his term). Due to the upcoming election, the Department of Health is delaying its response to Dame Fiona Caldicott, the National Data Guardian for Health and Care (NDG), on her review of data security, consent and opt-outs (Gov.UK publications).

People have significant trust and privacy concerns about their data, which led to NHS England suspending care.data over three years ago. But with safeguards in place, public polling supports the sharing of health data for uses such as research and direct care. But…there’s more. Now there is ‘algorithmic accountability’, which may single out individuals and influence their care, much as algorithms dictate what online ads we’re served. What of the patient data being served to Google DeepMind, IBM Watson Health, and Vitalpac for AI development? Have people adjusted their concerns, and have systems evolved to better store, secure, and share data? And how can this be implemented at the local NHS level? The NHS and technology: turn it off and on again Hat tip to Susanne Woodman of BRE.

A reminder that The King’s Fund’s Digital Health and Care Congress is on 11-12 July. Click on the sidebar to go directly to information and to register. Preview video; 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. TTA is again a media partner of the Digital Health and Care Congress 2017. Updates on Twitter @kfdigital17

Hackermania meets The Dark Overlord with 2.3 million 2017 health data breaches

click to enlargeIt’s a cage match! Reports are soaring, with a proliferation of data breaches year to date, after a relatively quiet period in 2016.

The Dark Overlord (TDO), in the mainstream news with dumping unseen Netflix program episodes on illegal file-sharing sites and demanding ransom (Guardian), also has been hard at work dumping PHI hacked from various clinics. DataBreaches.net tallied it at 180,000 records from at least nine medical clinics.

Health data security developer/provider Protenus, whose Breach Barometer tracks the numbers, counted 2.1 million breaches in 1st Quarter. March spiked with 700,000 coming from Commonwealth Health Corporation of Kentucky.

Our standby Privacy Rights Clearinghouse counted over 175,000 to date, but 160,000 came from MedCenter Health in Protenus’ total, so their net addition was 15,000. But PRC’s detail illustrates that ransomware is alive, well, and invading smaller healthcare organizations. Other reasons are unauthorized data server access, third-party vendors, email error, and theft.