What a telehealth device company may be worth

Brian Dolan of Mobihealthnews did some panning among Alere‘s SEC filings and found this nugget in their 8 November 10-Q (not cited in the article, but readily available on the Alere corporate website). Under ‘Acquisition-related Contingent Consideration Obligations’ (page 26), this refers to the undisclosed July acquisition price of MedApps, now Alere Connect:

With respect to MedApps, the terms of the acquisition agreement require us to make earn-out payments upon achievement of certain technological and product development milestones through January 15, 2015. The maximum amount of the earn-out payments is $22.0 million.

The headline and article, Alere to pay as much as $22M for MedApps, created an interesting debate on the Digital Health LinkedIn group (member access only) on what seemed to be a dismayingly low price for a company considered to be a development pioneer and quality leader in wireless telehealth, replete with FDA Class II, CE and Health Canada clearances, plus plenty of sweat and tears. Editor Donna pointed out that the SEC filing did not disclose the closing payment at time of sale–the earn-out structure, so typical of early-stage technology acquisitions, is in addition to the closing (which could be substantial, or little, in cash and stock) because outside investors generally want to exit at that time. What is also apparent is that the earn-out is based on ‘milestones’, which look fine in the rosy light of purchase but can prove to be very difficult to achieve, potentially reducing the $22 million earn-out. But what this bit of legwork gives us is a chalk mark on the board for mobile telehealth devices, and it’s a little lower than we thought.

First funding kickoff for 2013

The first business day of the New Year started off positively for telehealth, with the announcement of the $5 million Series A financing of Independa, developer of the Angela social engagement system for older adults and the Artemis telehealth system. Investors are healthcare investment firm City Hill Ventures, a previous investor, and strategic partner LG Electronics USA, with participation by additional investors. LG became a partner with Independa last year with the Angela system piloting on LG’s Pro:Centric Healthcare TVs. Independa release

MediSafe Project for medication compliance launched (Israel)

MediSafe Project, based in Haifa, Israel, has developed an Android and iPhone medication reminder app that both advises the user and alerts family members when medications are not taken. The HealthWorks Collective article claims MediSafe is the first cloud-based mobile med reminder app (which Editor Donna questions, thinking of Merck’s Vree and Janssen’s Care4Today here in the US), but what is interesting here is the potential for big data analytics; according to the CEO, “which demographics have higher non-compliance for a drug compared to the general population, the doctors or areas that have the lowest prescription rates with a city, competitive drugs patients are switching to, and so on.” This big data is clearly the revenue model, as the app is free on Google Play and the iTunes App store worldwide in multiple languages for Android (iTunes English only). Interestingly, the reminder system is being translated shortly to an automated phone system for those with simple or feature phones.

The incredible shrinking devices

A trend to mark for 2013 is how monitors and testing devices are shrinking in size–and getting cheaper. Misfit’s Shine [TA 22 Dec], the Smart Steth [TA 18 Dec], the GE Vscan, the iTube food tester [TA 13 Dec] and in fact the entire area of simple mobile-enabled devices for testing in developing countries point the way. Here are three more fresh from the university labs, just waiting for commercialization:

  • Wearable wireless, button-sized computers (well, a large button). Dr. Roozbeh Jafari, assistant professor of electrical engineering at University of Texas-Dallas, is designing highly power-efficient sensors and microcontrollers which can be used in gait detection (the Holy Grail of fall prediction). UTD release
  • Flexible, organic, fully sterilizable transistors will facilitate wearable, patch-like health monitors or implantable devices. Developed by a team from University of Tokyo, Japan Science and Technology Agency and Princeton University with key work done at the Brookhaven National Laboratory in Long Island, NY. Brookhaven Lab release. Both Dr. Jafari’s sensors and the transistor are featured in the Risk Factor blog on IEEE Spectrum.
  • Run blood tests on a credit card-sized chip. The V-Chip (volumetric bar-chart chip) can instantly check a single drop of blood for up to 50 different substances. It also costs an amazing $10. Developed at Houston’s Methodist Hospital Research Institute and MD Anderson Cancer Center. Gizmag. Full paper in Nature Communications.

Brace yourself: worldwide telehealth to grow by 55% in 2013

InMedica, the health tech research analytics arm of UK-based IMS Research, released in December this startling growth number for telehealth–55% vs. 2012–applying to both device and service revenue for 2013. Startling because 2012/2011 growth in revenue was only 18% and 2011/2010 growth was a paltry 5%, even as patients grew by 22%. InMedica cites the uncertain economic situation in Europe and ‘ambiguity on the impact of healthcare reform’ in the US as dampening growth. In 2013, InMedica sees growth drivers in the US as the implementation of CMS 30-day re-admissions penalties and the influence of new care models for hospital systems and large practices such as ACOs (accountable care organizations). The release is mysteriously silent on changes driving European telehealth, and remarkably ambiguous on exactly how remote patient monitoring and telehealth will integrate into care models. More in FierceMobileHealthcare.

TSA seeks managing director (UK)

The Telecare Services Association’s (TSA) Board of Directors is seeking an ‘inspirational managing director’ to direct and deliver the Association’s 3 year business plan and to support the chief executive. Key challenges will be to build and maintain influential relationships with members and key external stakeholders, continue to raise the profile of the Association and to develop the business to take on the significant challenges ahead. The person appointed is expected to have skills in management and implementing change, be able to engage and influence with government departments and external stakeholders at a senior level, and be an effective public speaker. Salary £55,000 plus benefits. Closing date 11 January. Application details here.

The future of doctors in a world of automated diagnostics

One last 2012 take on this eternally buzzy subject. Despite the illogical Fast Company Co.Exist headline (What’s the future of doctors when sensors in your electronics diagnose disease? Even Vinod Khosla would say the sensors do not and the algorithms aren’t there yet), this is a reasonably nuanced article on the downside of The Quantified Self–that even the Ph.D gearheads will have to use automation to sort out everyday changes from those which are leading indicators of something significant; that big data analysis and data mining at the heart of personal automated diagnostics can be kind of creepy, but with the capacity for devastation and inaccuracy. The positive conclusion: doctors will work with people to sort out not only the physical but also the emotional state of well-being. It is cheerful enough, but then the picture of your average PCP (GP) waist-deep in patient data, alerts and forms, tablet and smartphone beeping, materializes as the Ghost of Christmas Present to Near-Future. Marley shows up dragging the last three FBQs* piled in a sack–and we begin to realize that the only Charles Dickens who’ll be writing The Ghost of Christmas Future, is us.

*Who’s looking at the data, who’s actioning it, how data is integrated into patient records

Editors Donna and Steve wish all our readers the best for the remaining holiday season, and for the New Year!

The last weekend update for 2012

Where did it go? Some short cuts and loose ends tied up from a very fast year…

LifeNexus scores $2.2 million for credit card-type PHR from 16 investors. The proprietary software/card reader/provider terminal system can handle up to six persons per card and also can double as a prepaid card. According to reports, 4,000 cards are already in use in Washington state. Pluses: convenience, privacy and security. Minuses: potential loss, closed system and EHR interoperability. MedCityNews

We haven’t heard from the LifeBot emergency telemedicine system in a long time–early 2011. Their news is that they have finally untethered their units from the original ‘super ambulance’ concept to a fully portable 15 lb. unit which connects an EMT anywhere to a hospital with patient data and live video feeds. The LifeBot 5 Interceptor has voice and video transmission, ECG leads, monitors heart rate and blood pressure, blood oxygen levels and body temperature and also connects to EHRs. Cost is estimated at $20,000. The LifeBot DREAMS communications system was developed by the Department of Defense’s TATRC and the US Army Medical Research and Material Command. SingularityHub Hat tip to reader Toni Bunting.

Telehealth innovating the clinical trial in 2013. Expanding upon Editor Steve’s recent noting of startup Transparency Life Sciences gaining the first FDA approval of a clinical trial using telehealth monitoring (on the use of the blood pressure drug lisiniprol on MS patients) is Mobihealthnews. Other companies are slicing off digital pieces, such as Janssen R&D’s Clinical Trial Innovation Unit (of Johnson & Johnson) developing a shared online databank of non-proprietary clinical information plus a standard online portal for investigators to communicate with pharmaceutical companies. Omniscience Mobile is currently using mobile communication between participants and investigators for companies like Pfizer and Merck. The pointer to the future is that mobile data collection can make trials more efficient, more accurate and decrease cost. Clinical trials still ripe for mobile-enabled innovations

A digitalized tuning fork for detecting diabetic neuropathy. Podiatrists and physicians use the 128-Hz tuning fork to detect early signs of diabetic loss of sensation in the feet. Serial inventor and device entrepreneur Todd O’Brien, DPM has now invented, with design at the Advanced Manufacturing Center at the University of Maine, a tubular digital device which reproduces the vibrations and duration in a quantifiable manner. A small clinical trial has already won recognition by the American Podiatric Medical Association. He is seeking to commercialize its use in both podiatry and for the home with a mobile platform. MedCityNews

Unhappy 2013 for telehealth/telemedicine in Australia

Following on from our 1 November article Is Australian telehealth alive, dead or just comatose?, it is now officially ‘beleaguered’. As of 1 January, more than eight million people formerly considered distant enough to qualify for telehealth and telemedicine services are now considered ‘urban’ and will no longer qualify due for a (AU) Medicare rebate for internet video consultations with medical specialists started in 2011. According to the article, it seems to affect psychiatric services and other specialist services; also GPs who’ve installed now un-utilized telehealth equipment in clinics. The savings will be (AU) $128.5 million on the $620 million scheme, although it spurred broadband development across Australia. According to a comment on LinkedIn by reader/commenter Dr. George Margelis, “The net effect is that telemedicine in Australia will flounder, because uncertainty is the greatest deterrent in medicine.” Millions across Australia to lose Telehealth rebates from New Year (News.com.au) Hat tip to reader Ellen Fink-Samnick of LinkedIn’s ‘Ellen’s Ethical Lens’.

Roboy & ….Mule?

roboy splashA not-far-from-here-and-now take on the recent film Robot & Frank may be Roboy & Mule. The Roboy (left), an advanced humanoid robot, is being developed by engineers at the University of Zurich’s Artificial Intelligence Lab in only nine months (yes, the same as a human baby) for its debut at the Zurich Robots on Tour conference 9 March 2013. Kid-sized with a cute ‘face’ and tendon-driven locomotion, its artificial muscles will eventually be covered by a soft ‘skin.’ Its purpose is to help people in everyday environments. The Mule is an un-cute Defense Advanced Research Projects Agency (DARPA) four-legged pack robot (a/k/a LS3) capable of carrying 400 lbs over 20 miles of rough terrain, taking voice commands, avoiding obstacles and even recharging the devices of the modern soldier and Marine. Its purpose is to relieve them of part of the insanely heavy loads (100 lbs.) they carry. Both robots and their underlying technologies have many imaginable assistive uses for older adults and the disabled in the home and in communities. Roboy in CNET News, PopSci. The Mule in Armed with Science. Videos on both. A New Year’s hat tip to Toni Bunting on Roboy.

Reader’s request: Telecare suggestions (UK)

Ann Collins is the Assistive Technology Project Manager for Brandon Trust (website) which provides homes for people with learning disabilities. She has a particular situation to deal with and would appreciate suggestions from readers. She says: “I am working on the reconfiguration of a property and am ideally looking for an integrated telecare solution for the people living there that will also accommodate the specific needs of an individual living in an adjoining self contained flat supported by the same team.

The individual needs an incontinence sensor that can be integrated into a chair. It cannot be placed under a cushion as it will be removed. It would need to be accessible so that the sensor(s) can be removed and cleaned. All wires and transmitters will also need to be hidden or remote as, if visible, they would be damaged. If the individual becomes distressed the first indication of this is that they start to tip over furniture. Is anyone aware of ways that we could use sensors (accelerometers, I assume) that would be able to detect if the furniture is turned over? Any ideas about standalone, integrated solutions or possible suppliers would be very welcome.” Leave suggestions in comments or email Ann.

Predictions for 2013, #1

crystal-ballThe Gimlet Eye dusts off her Crystal Ball and sees yet another dozen 2013 predictions from HIT experts. Personal health records are ‘it’ for 2013, revived at last, driven by the consumer, collecting data from multitudinous sensors, sending information over exchanges (HIEs, hopefully conquering their interoperability problems), user friendly EHRs (!) reaching critical mass, but being scrutinized for incentive payments [TA 30 Nov] and interoperability, interoperability, interoperability…All big data, genome sequencing and all those goodies, gamified, predictively analyzed and maybe even care coordinated. And whither the doctors? Abandoning their independent practices and swallowed up by hospitals…until they get the vision and use technology to be financially autonomous, which is like having your cake buttered. Information Week Healthcare

Predictions for 2013, #2

crystal-ballThe Gimlet Eye sees…affective health. Using physical data for monitoring mood has a lure to it that in stressful times says ‘consumer acceptance’ — and there’s always PTSD. Both Boston-based MIT spinoff startup Neumitra and MIT Media Lab spinoff Affectiva [TA 2 July] measure the sympathetic nervous system for leading indicators of mood, such as perspiration, motion and increased temperature, processing the data through algorithms as leading indicators of possible anxiety and sending it to a platform via smartphone. Neumitra is currently being tested at Massachusetts General Hospital to gain better information on anxiety disorder triggers. Although the Technology Review article states that both are ‘experimental,’ Affectiva will be at next month’s CES Eureka Park for early-stage/startup companies.

The Eye sees…gesture control. This ReadWrite article predicts that Leap Motion will be the must-have gizmo of 2013. For $70

leap motion

(to ship early 2013), you will be able to control your desktop, laptop and maybe even tablets (with USB connectivity) through hand and figure movements. Potential in healthcare could be immense: robotic surgery, rehabilitation, ability assessment, remote monitoring and socialization. Video (1:12) which only sells the ‘whiz-bang’ aspects.

A Dutch ‘alternate reality village’ for those with dementia

The Hogeway care home near Amsterdam provides an environment for dementia sufferers which is quite unlike what we see in memory care units. It is an eight ‘house’ community built around a large enclosed courtyard where residents are free to walk and sit. Each house is structured like a large family home with eat-in kitchen and a lifestyle theme (e.g. urban) that influences the decor, food and experiences. ‘Alternate reality’ is what it is dubbed in the 1:26 video from BBC News, but what it does is give a resident understandable surroundings with appropriate stimulation and most importantly, socialization that seems to work within their limitations, for some happiness and improved quality of life. Editor Donna would have liked more observation of the residents, but appreciates that even the most discreet film crew would be profoundly disruptive of their everyday routine and potentially upsetting. It should give senior housing people in the US and UK at least a few ideas away from the isolation that tends to pervade many memory care wings. Dementia patients in Dutch village given ‘alternative reality’.

Your holiday weekend ‘short cuts’

In Editor Donna’s ‘in box’:

  • Much hype around Misfit Wearables, which incorporates in its bracelet and pocket clip (necklace to come) a metallic activity/aerobics tracker called the Shine, which is the size of a quarter, uploads on both iPhone 4/5 and most Android devices via Wi-Fi, and will retail in the $79-199 range when released sometime in mid-2013. It’s raised more than $500,000 on crowdfunding site Indiegogo.com, plus developer Sonny Vu is backed by partner John Sculley (remember him a century ago at Apple?), Founders Fund and the ubiquitous Khosla Ventures. Activity-Tracking Tech Moves From Wrist to Neck, With Sculley’s New Shine Necklace (AllThingsD) (This is the only mention where Sculley gets the lead!)
  • Researchers at the University of Pittsburgh have successfully developed a prosthetic hand controlled by the thoughts of a quadriplegic patient detected via electrode implants in the motor cortex part of the brain. According to The Scientist, it “rivals the way an unimpaired brain directs limb movement.” Published 16 December in The Lancet. Thoughts control robotic hand (The Scientist)
  • A health texting provider, Televox, claims that 34% of Americans say they are more honest discussing their health problems through automatic calls, email, or text messaging, than in a face to face conversation with a doctor, and a similar percentage felt that receiving emails, texts and voicemails from their doctor increased trust. Despite the relatively large N of the study (over 1,000), the self-reporting online poll recruited via email and the sponsorship by Televox leaves one wondering how honest or objective the study is. Mobihealthnews.