Comings and goings: Cuts hit Athenahealth, IBM Watson’s Drug Discovery unit; Bain may sell Waystar RCM

Athenahealth has announced they are trimming 4 percent of their total workforce. With a large 900-person campus in Belfast, Maine that once belonged to MBNA credit cards, and a workforce of about 5,000 headquartered in Watertown, Massachusetts, there is considerable local concern in an area of Maine that offers few well-paying jobs. Reportedly dozens of jobs there will be lost. This caps a tumultuous period with the company. Athenahealth was acquired last November by Veritas Capital and Evergreen Coast Capital, then merged with a GE Healthcare spinoff they owned, Virence Health, in value-based care, under the Athenahealth name. Bangor Daily News

IBM Watson’s Drug Discovery product, which was targeted to pharmaceutical companies, is being cut back to work with only current partners and with clinical trials due to poor sales. According to The Register, a tart-tongued UK tech website which actually reached an IBM spokesperson, IBM’s Ed Barbini stated that “We are not discontinuing our Watson for Drug Discovery offering, and we remain committed to its continued success for our clients currently using the technology.” Also Seeking Alpha. IBM Watson and Watson Health, like Athenahealth, are moving through a rocky period of closing initiatives (Watson Workplace), layoffs, executive departures (head Deborah DeSanzo last November), bad publicity, and clients like MD Anderson who don’t part quietly. [TTA 8 Nov 18].

Another merged health infotech company may have a new owner soon. Waystar, which was formed by the acquisition of ZirMed and Navicure in 2017 and manages revenue cycles for 450,000 practices, is rumored to be up for sale by owner Bain Capital. Interested parties include Visa and OracleBloomberg

The Theranos Story, ch. 59: there’s life left in the corporate corpse–patents! And no trial date in sight.

You can get blood out of this. Really! The US Patent and Trademark Office (USPTO) awarded five–count ’em, five!–patents to Theranos in March and April. All of them were filed between 2015 and 2016, when the whispers of fraud were getting louder, as were the legal threats.

The five patents are:

1. Systems, devices, and methods for bodily fluid sample collection, transport, and handling
2. Systems, devices, and methods for bodily fluid sample transport
3. Systems and methods for sample preparation using sonication
4. Systems and methods for sample preparation using sonication (cell disruption)
5. Rapid measurement of formed blood component sedimentation rate from small sample volumes

The CB Insights Research article has the details on what they cover, including patent application illustrations. It’s not stated, but looking back to TTA’s many articles, in this Editor’s judgment, the heir to these patents cannot be Elizabeth Holmes or her many investors now feeling the lint in their pockets, but the company holding the last note, the $65 million (not $100 million) loan from Fortress Investment Group LLC, part of Japan’s SoftBank Group [TTA 28 Dec 17]–collateralized by the portfolio of over 70 patents. Hat tip to HISTalk 19 April

If you hunger for a deep dive into the design of Theranos’ blood analyzers that never really worked, and can appreciate that the miniLab was what “one expert in laboratory medicine called “theater … not science”, this Design World article is for you: Schadenfreude for Theranos — and satisfaction in how engineering doesn’t lie

Meanwhile, back in the US District Court in San Jose, California, we learn that the trial of Ms. Holmes (now engaged to William “Billy” Evans, a 27-year-old heir to the Evans Hotel Group, which has three West Coast resort properties and who is also a techie) and former Theranos president Ramesh ‘Sunny’ Balwani has been delayed indefinitely. Originally reported to be summer entertainment with a start date of 8 July, the judge set the next status conference for the case for 1 July, but refused to set a trial date, which means that the trial may not begin till next year. According to the San Jose Mercury News, the defense is seeking materials from the FDA and CMS, which are, according to defense lawyer, lawyer Kevin Downey, are “in many instances exculpatory.”

Ms. Holmes’ lawyers are also seeking information on the communications between John Carreyrou of the Wall Street Journal, the FDA, and CMS. In a motion filed last week, they accused Mr. Carreyrou under the guise of investigative journalism of “exerting influence on the regulatory process in a way that appears to have warped the agencies’ focus on the company and possibly biased the agencies’ findings against it.” Stat

The bubbly Ms. Holmes and Not-So-Sunny Balwani are facing Federal charges of two counts of conspiracy to commit wire fraud and nine counts of wire fraud. They each face a maximum of 20 years in prison and up to $2.7 million in fines.

AI and machine learning ‘will transform clinical imaging practice over the next decade’

The great challenges in radiology are accuracy of diagnosis and speed. Yet for radiology, machine learning and AI systems are still in early stages. Last August, a National Institutes of Health (NIH)-organized workshop with the Radiological Society of North America (RSNA), the American College of Radiology (ACR) and The Academy for Radiology and Biomedical Imaging Research (The Academy) kickstarted work towards AI. Their goal was to collaborate in machine learning/AI applications for diagnostic medical imaging, identify knowledge gaps, and to roadmap research needs for academic research laboratories, funding agencies, professional societies, and industry.

The report of this roadmap was published in the past few days in Radiology, the RSNA journal. Research priorities in the report included:

  • new image reconstruction methods that efficiently produce images suitable for human interpretation from source data
  • automated image labeling and annotation methods, including information extraction from the imaging report, electronic phenotyping, and prospective structured image reporting
  • new machine learning methods for clinical imaging data, such as tailored, pre-trained model architectures, and distributed machine learning methods
  • machine learning methods that can explain the advice they provide to human users (so-called explainable artificial intelligence)
  • validated methods for image de-identification and data sharing to facilitate wide availability of clinical imaging data sets.

Another aim is to reduce clinically important errors, estimated at 3 to 6 percent of image interpretations by radiologists. Diagnostic errors play a role in up to 10 percent of patient deaths, according to this report.

It is interesting that machine learning, more than AI, is mentioned in the RSNA materials, for instance in stating that “Machine learning algorithms will transform clinical imaging practice over the next decade. Yet, machine learning research is still in its early stages.” Radiology actually pioneered store-and-forward technology, to where radiology interpretation has been farmed out nationally and globally for many years. This countered a decline in US radiologists as a percentage of the physician workforce that started in the late 1990s and continues to today with some positive trends (Radiology 2015). Perhaps this distribution model postponed development of machine learning technologies. Also Healthcare Dive, RSNA press release  

Win the Trillium II prize and get €1,000!

The Trillium II EU project has just extended the deadline for entries to the Trillium II prize to 15th May, so there’s still plenty of time to enter. The prize of €1000 will go to the organisation that comes up with the best proposal to publicise and deploy the International Patient Summary (IPS). This is an internationally-agreed standard for summarising a person’s health record – as it is adopted worldwide, wherever someone is in the world a clinician will be able instantly to see and understand the main aspects of that person’s health record. This will particularly result in improved patient outcomes, faster treatment, lower healthcare costs and reduced medical errors. It will be of particular interest to readers whose products or services access local health records, as it should mean that in future they no longer need tailoring to the specifics of those records.

Details are here – note that to enter you will need to contact Lene Taustrup at lta@medcom.dk

To date, not many entries have been completed, so the probability of winning with a new entry could be high.

(Disclosure: this editor is CEO of DHACA, the Digital Health & Care Alliance, which is a participant in this EC-funded project).

International news roundup: ATA dispatches, compete for funding in Helsinki, Spry FDA-cleared for COPD, Merck acquires ConnectMed Kenya

There’s not much news so far from the just-wrapped ATA 2019 conference in New Orleans, but POLITICO Morning eHealth highlighted a drop-by by Sen. Bill Cassidy from Louisiana, urging attendees to demonstrate to their local politicos that telemedicine is safe and effective–and be ready to answer questions about fraud or misuse. Louisiana’s Ochsner Health System is branching into retail with the O Bar, cleverly designed to look like an Apple Store to merchandise wearables and other health tech devices. For Ochsner patients, they can enroll into RPM programs and have their data directly input into their Epic EHR. American Well released a survey of 800 doctors, with the unsurprising finding that 22 percent have used telehealth to treat patients, but this is up 340 percent since 2015; also that the doctors finding telehealth most attractive to practice are also reporting high levels of burnout. Looking for more substantiative news from NOLA.

It’s Helsinki for pitching your digital health idea in June. The 11th edition of the interestingly named EC2VC Investors Forum and Pitch Competition is now part of HIMSS/ Health 2.0 Europe 2019. Healthcare startups and SMEs looking for funding can apply, with 12 companies to be selected to present before a jury panel of digital health investors. The format is a four-minute pitch, followed by six minutes of Q&A. More information and to apply by 6 May, with finalists selected by 13 May. The event is 11 June from 13:00 to 16:00 at Messukeskus Helsinki Expo & Convention Centre. 

Spry Health’s Loop wearable device gained FDA clearance. Spry is a RPM device company with a wrist-wearable device that measures pulse oximetry, respiration, heart rate, and blood pressure (research only) through optical sensors. While users can receive reports on the display and alerts, it is primarily meant for clinical monitoring by physicians in healthcare systems. The RPM is meant to detect signs of patient deterioration and exacerbations early so that actions can be taken. For the present time, the company is focusing on the device’s use in COPD patients. Certainly there is a large market in the US–there are 12 million diagnosed patients, with COPD the third leading cause of death with over 120,000 deaths per year. Mobihealthnews, BusinessWire, MDDIOnline

Merck acquires Kenyan digital health startup ConnectMed. The pharma company is purchasing ConnectMed’s telehealth applications in Kenya serving about 8,000 consumers, as well as related management systems. Merck will use the platform in conjunction with its Curafa point of care clinical and pharmaceutical services. Started in September of last year, these are run by local independent pharmaceutical technologists, clinical officers and nurses for underserved populations in Kenya. ConnectMed will cease operations. During its lifetime, it developed three DTC digital health services in Kenya and South Africa. WT/Startup Africa

Babylon Health’s expansion plans in Asia-Pacific, Africa spotlighted

Mobihealthnews’ interview with Ali Parsa of Babylon Health illuminates what hasn’t been obvious about the company’s global plans, in our recent focus on their dealings with the NHS. For its basic smartphone app (video consults, appointments, medical records), Babylon last year announced a partnership with one of Asia’s largest health insurers, Prudential [TTA 18 Sept 18], licensing Babylon’s software for its own health apps across 12 countries in Asia for an estimated $100 million over several years. Babylon has also been active in Rwanda and now reaches, according to their information, nearly 30 percent of the population. There’s also a nod to developments with the NHS.

Parsing the highlights in Dr. Parsa’s rather wordy quest towards less ‘sick care’, more ‘prevention over cure’, and making healthcare affordable and accessible to everyone ’round the clock:

  • Asia-Pacific: Working with Tencent, Samsung and Prudential Asia through licensing software is a key component of their business. By adding more users, they refine and add more quality to their services. (Presumably they have more restrictions on the data they send to Tencent than what they obtain in China.)
  • Africa: How do you offer health apps in an economically poor country where only 5 percent of the population has a smartphone? Have an app that works for the 75 percent who have a feature phone. Babyl Rwanda has 2 million users–30 percent of Rwanda’s population–and completes 2,000 consultations a day. Babyl also works with over 450 health clinics and pharmacies. The service may also be expanded across East Africa, and may serve as a model for similar countries in other regions.
  • UK and NHSX: About the new NHS-formed joint organization for digital services, tech, and clinical care, Dr. Parsa believes it is ‘fantastic’ and that “it is trying to bring the benefits of modern technology to every patient and clinician, and aims to combine the best talent from government, the NHS and industry. Its aim, just like ours, is to create the most advanced health and care service in the world, to free up staff time and empower patients.” (Editor’s note:  NHSX will bring together the Department of Health and Social Care, NHS England and NHS Improvement, overseeing NHS Digital. More in Digital Health, Computer Weekly.)

Tyto Care inks deal with Best Buy for retail sales of remote diagnostic device

Tyto Care’s long-planned retail debut of the TytoHome remote diagnostic device has arrived at Best Buy. The telehealth device which incorporates a camera, stethoscope, otoscope, tongue depressor, basal thermometer, and smartphone app can be bought online for $299.99. According to their release, TytoHome will be available at select Minnesota Best Buy stores and will roll out to North Dakota, South Dakota, California and Ohio.

TytoHome has been from the start (late 2016) pitched to parents as a 24/7 service for ill children in that middle-of-the-night sick call to the doctor, but more recently for adults as an adjunct to a virtual visit. The Israel-based company with US offices in NYC partnered with American Well early [TTA 2 Dec 2016]. For Best Buy customers outside of Minnesota, North and South Dakota, TytoHome will connect to doctors via LiveHealth Online, an American Well partner. In those three states, TytoHome will connect to Tyto Care health system partner Sanford Health and their medical providers. Each visit will be $59, possibly less if the service is covered by the person’s or family insurance plan.

Best Buy, of course, has made a large bet on retail health tech with its purchase of GreatCall, well-known for its Jitterbug phones targeted to older adults with its 5-Star PERS, but also prior to the acquisition with GreatCall’s purchases of Lively’s tech for consumer devices and HealthSense in LTC systems. Their current plans are outlined in a recent interview with CEO David Inns.

China’s getting set to be the healthcare AI leader–on the backs of sick, rural citizens’ data privacy

Picture this: a mobile rural health clinic arrives at a rural village in Jia County, in China’s Henan province. The clinic staff check the villagers, many of them elderly and infirm from their hard-working lives. The staff collect vital signs, take blood, urine, ECGs, and other tests. It’s all free, versus going to the hospital 30 miles away.

The catch: the data collected is uploaded to WeDoctor, a private healthcare company specializing in online medical diagnostics and related services that is part of Tencent, the Chinese technology conglomerate which is also devoted to AI. All that data is uploaded to WeDoctor’s AI-powered cloud. The good part: the agreement with the local government that permits this also provides medical services, health insurance, pharmaceuticals and healthcare education to the local people. In addition, it creates a “auxiliary treatment system for general practice” database that Jia County doctors can access for local patients. According to the WIRED article on this, it’s impressive at an IBM Watson level: 

Doctors simply have to input a patient’s symptoms and the system provides them with suggested diagnoses and treatments, calculated from a database of over 5,000 symptoms and 2,000 diseases. WeDoctor claims that the system has an accuracy rate of 90 per cent.

and 

Dr Zhang Qiaofen, in nearby Ren Zhuang village, says the system it has made her life easier. “Since WeDoctor came to my clinic, I feel more comfortable and have more confidence,” she says. “I’m thankful to the device for helping me make decisions.”

The bad part: The patients have no consent or control over the data, nor any privacy restrictions on its use by WeDoctor, Tencent, or the Chinese government. Regional government officials are next pictured in the article reviewing data on Jia County’s citizens: village, gender, age, ailment and whether or not a person has registered with a village health check. Yes, attending these health checks is mandatory for the villagers. 

What is happening is that China is building the world’s largest medical database, free of those pesky Western democracy privacy restrictions, and using AI/machine learning to create a massive set of diagnostic tools. The immediate application is to supplement their paucity of doctors and medical facilities (1.5 doctors per 1,000 people compared to almost double in the UK). All this is being built by an estimated 130 private companies as part of the “Made in China 2025” plan. Long term, the Chinese government gets to know even more intimate details about their 1.3 billion citizens. And these private companies can make money off the data. Such a deal! The difference between China’s attitude towards privacy and Western concerns on same could not be greater.  More on WeDoctor’s ambitions to be the Amazon of healthcare and yes, profit from this data, from Bloomberg. WeDoctor is valued at an incredible $5.5 billion. Hat tip to HISTalk’s Monday morning update.

NHS App’s pilot results: renewing prescriptions good, making appointments…not so much

The NHS App, announced at the end of 2017, piloted in September-December 2018. It started with one GP practice in Liverpool and grew to 34 practices across England, eventually growing to 3,200 registered patients, exceeding its target registration group by over 1,200. The NHS report was issued on 8 April.

  • Most used the app to view their patient records. Unless the patient had given prior consent to their GP to view their full patient record, only a summary was available through the app. This will revert to full patient records with the ability to add to the record as the default by April 2020.
  • For the pilot users, they reported positively on the app for prescription renewals; it was used for 662 repeat prescriptions and was found by 87 percent to be ‘easy and convenient’ as well as the app’s ‘most useful service’.
  • On booking appointments, the feedback was not so positive. Users had difficulty understanding the jargon used in booking.
  • They also found the two-factor authentication for security purposes annoying. For the full implementation, the development team is planning to add a biometric log in.

The NHS hopes to roll out the app to all English GP practices by July 2019. While the app became available in December on Google Play and the Apple App Store, patients have to wait for their GP to connect to it. Mobihealthnews, NHS report site

A counterpoint to this is the final closing of the Microsoft HealthVault later this year. Users will have until 20 November to migrate their data. HealthVault was one of the first services to allow consumers to record and share electronic health data. Microsoft has already shut down two related services, HealthVault Insights and the Health Dashboard. Most of these storage services have shut down (Revolution Health, Google Health, Google Fit, Dossia) with the surviving Apple Health Records and GetReal’s Lydia. Mobihealthnews

Leeds Digital Festival 2019: a two-week showcase of digital health and care

100% Digital Leeds, Tuesday 23 April – Sunday 4 May, Leeds, several venues including Co>Space North

This Editor is quite surprised at a two-week festival mainly about digital health and care in Leeds, but this program seems to have something for everyone–tech developers, interested consumers, medical staff, NHS policymakers, and many more. 

100% Digital Leeds centers around the city’s health mission statement–“Our city’s Health and Wellbeing Strategy 2016-2021 sets out a clear vision that ‘Leeds will be a healthy and caring city for all ages, where people who are the poorest improve their health the fastest’. This includes maximising the benefits from information and technology as a key priority.”

There are 16 events planned across the two weeks as of now, with such intriguing titles as “The future for artificial intelligence in health and care – dystopian future or digital paradise – you decide!”,  a session on teen mental health and social media, “Putting the human into redesigning health and care services”, a session on design, and “Can digital offer sanctuary for refugees and asylum seekers?” which is the first I’ve seen this topic addressed.

The events are curated by mHabitat on behalf of Leeds City Council and NHS Leeds Clinical Commissioning Group (CCG). Key speakers will include representatives from the event program’s sponsor, the UK’s leading privately-owned IT and business consultancy BJSS, NHS England, NHS Digital, international speakers, academic experts, patients and citizens with first-hand experience of using digital to manage their conditions, and industry.

Much more on the Leeds Digital Festival website here including detailed descriptions of the sessions and venues. #LDF19, Twitter and Instagram @wearemhabitat  Hat tip to Anna Goddard of KC Communications for the alert.

Spring is here, so are some events to enjoy–and broaden your horizons

AI in healthcare: hope or hype? MedStartr, Rent24NYC, Thursday 18 April, 6 – 9pm

Our colleagues at MedStartr are hosting a panel discussing a hot topic: AI in healthcare. Panel and speakers include Melissa Honour, IBM Watson, Artificial Intelligence Portfolio Lead; Joseph Gough, EVP Innovation, Remedy Health;  Samantha Nazareth, MD, Gastroenterologist, writer, broadcast commentator, and healthcare analyst. More to come! Cost is $20 but there are drinks and snacks throughout. Register on Meetup. TTA is a media partner of Health 2.0 NYC and MedStartr.

Validating Your Digital Health Solution: Why, When and How. Partners HealthCare Pivot Labs, Liberty Hotel, Boston, Monday 22 April, 6-9pm

On the journey to commercializing your health tech product, there are multiple ways to test it. It can be difficult to determine where to start, how to do it and what to evaluate. During this free session, Partners HealthCare Labs will address why validating your digital health solution – whether for clinical or economic outcomes – can benefit your product. RSVP at this link.

Two coming up very soon via Aging 2.0 NYC:

Thursday-Friday 11-12 April: The Center for Research and Education on Aging and Technology Enhancement (CREATE) will hold a two-day workshop on Design For Older Adults at Weill Cornell’s Division of Geriatrics. If you are designing technology, consumer or health products, or living environments for older adults, this is a unique opportunity to network with colleagues and glean advice from leading experts in aging and design. Because of the highly interactive nature of this workshop, attendance is limited to 35 attendees. Aging2.0 members receive a discount. Email Adrienne Jaret at adj2012@med.cornell.edu or call 646-962-7153 (mention Aging2.0).

Monday, April 29: Aging2.0 and CaringKind will host the third annual Technology for Caregivers showcase from 1:30pm-7:30pm at CaringKind’s headquarters at 360 Lexington Avenue. This one-day event will give caregivers and the Aging2.0 community the opportunity to try the latest technology for caregiving and dementia, and provide startups the opportunity to showcase their products. Last year’s event was featured on CBS and saw more than 300 caregivers interact with 25 innovative startups. If you would like to have your company featured contact us at newyork@aging2.com. Register here.

And finally, we’d be remiss in not mentioning next week’s ATA19 which will be held 14 – 16 April in New Orleans at the Convention Center. Less and less referring to itself as the American Telemedicine Association, the conference is also less significant than it once was due to the specialization of health tech, the rise of HIMSS earlier in the year, as well as early fall’s Health 2.0 and the Connected Health Conference. Nevertheless, for many companies in the field it is still a must-attend if not a must-exhibit. Registration is still open here.

Drawn-out decision on the CVS-Aetna merger held up again in Federal court

“The Perils of Pauline” saga that is the CVS-Aetna merger continues. Judge Richard Leon of the US District Court for the District of Columbia twirled his mustache and announced that his court will hold a hearing in May on the merger. Practically nobody dislikes this particular $69 billion merger that’s already closed–not the companies, shareholders, Congress, the states, and not the Department of Justice, once Aetna sold off its Medicare Part D drug business to WellCare. But Judge Leon is an exception.

The Tunney Act requires the government to file proposed merger settlements as an approval of the consent decree with a Federal district court to assure they are in the public interest. Most are filed, reviewed by a judge, and approved with no hearings. Since October, Judge Leon has been examining the merger up, down, and sideways in, of course, the public interest and great attention by the press. Now a week (or more) of May hearings will commence with those who don’t like this merger, including the American Medical Association, the AIDS Healthcare Foundation, pharmacy and consumer groups.

Certainly this is long and drawn out, even for the DC district court. Even the high drama of the Aetna-Humana and Cigna-Anthem mergers took a little less time. Judge Leon continues to get coverage and the merger continues to be held up. Reuters, Fox News, Seeking Alpha

EHRs: The Bridge to Nowhere–other than despair. An investigative Must Read on ‘an unholy mess’.

If you hate your EHR, think it’s swallowing your information, adding hours to your day, and if you don’t watch it, you’ll make an error, you’re not a Luddite. You’re right. An exhaustive investigation by Fortune and Kaiser Health News (KHN) concludes that it’s ‘an unholy mess’. In fact, even if you are not a physician or clinical staff, it will make you wonder what was going on the collective brains of the digerati, Newt Gingrich, Barack Obama–and the US government–in thinking that EHRs would actually “cut red tape, prevent medical mistakes, and help save billions of dollars each year,” committing $36 billion to pursuing the ‘shovel-ready’ HITECH stimulus in the depths of the 2008-9 recession. Perhaps the shovel should have been used on a body part. Now if only those billions went towards an interoperable, useful, and national system rather than a money giveaway–which even Farzad Mostashari, then ONC deputy director and later director, now admits was “utterly infeasible to get to in a short time frame.” (Mr. Mostashari is now head of Aledade, counseling those mostly independent practices which lined up–hungry or terrified–for meaningful use EHR subsidies on how they can continue to survive.) Even the vendors were a bit queasy, but nothing was stopping HITECH. (Your Editor was an observer of the struggle.)

Now that we have been living with them for over a decade, EHRs have been found culpable of:

  • Soaring error rates, especially in medication and lab results
  • Increasing patient safety risks in lack of pass-through of critical information
  • Corporate secrecy, enforced by system non-disclosures, around failures
  • Lack of real interoperability–even with regional HIEs, which only exchange parts of records
  • Incomplete information
  • A very real cognitive burden on doctors–an Annals of Family Medicine study calculated that an average of 5.9 hours of a primary care doctor’s 11.4 hour working day was spent on the EHR
  • Alert fatigue
  • Note bloat
  • Plain old difficulty or unsuitability (ask any psychiatrist or neurologist)
  • A main cause of doctor burnout, depression, and fatigue–right up to high suicide rates, estimated at one US physician per day
  • Lack of patient contact (why the scribes are making a good living)
  • All those dropdowns and windows? Great until you click on the wrong one and find yourself making a mistake or in the wrong record.

Not even the head of the Centers for Medicare and Medicaid Services is immune. Seema Verma’s husband, a physician, collapsed in the Indianapolis airport. She couldn’t collect his records without great difficulty and piecing together. When he was discharged, he received a few papers and a CD-ROM containing some medical images, but without key medical records.

A long read for lunch or the weekend. Death by a Thousand Clicks: Where Electronic Health Records Went Wrong. Also the accompanying essay by Clifton Leaf

News roundup from all over: prescribing apps is back! Plus telemental health Down Under, GreatCall’s health tech strategy, Wessex’s diabetic sim, telehealth growth outpaces urgent care

Back to the future with prescribing apps! Early stage Xealth just gained a $11 million Series A from heavyweights such as Novartis, McKesson Ventures, UPMC, Philips, and ResMed. Clinicians can prescribe and monitor digital health care content, apps, devices, and services from within their EHR. Yet another thing to add to their 5+ hours a day in the system! Let’s hope that in staying away from certification, they are more successful than predecessors like the long-expired Happtique and the little-noticed but still in business Xcertia [TTA 6 Dec 15Release 

Telemental health startup Lysn working to spread mental health access in Australia. In two years, it has grown to over 265 psychologists and partners with 53 GP clinics, mainly regional and rural. The creator of the service is a Canadian-born surgeon, Dr. Jonathan King, who is 35–and bootstrapped it with his own earnings and house. In The Black

A good coffee break read is an interview with GreatCall’s CEO David Inns outlining their health tech strategy for older adults, including a reboot of Lively Home (without the exclamation point) with Senior Whole Health in Massachusetts for ADL monitoring (set up by Best Buy’s Geek Squad), the predictive analytics part of HealthSense in using connectivity and monitoring to predict falls, depression, and diseases, and back to wearables with smartphones. What is interesting is the stunning claim that they can back up the “soak up 20 percent of the healthcare costs of the population that we’re working with” through these predictive analytics and monitoring by reducing long-term care expenses. (Reminds me of some of the claims we made at Living Independently!) However, if any company has the muscle to make it happen, they do. BTW, not a peep about the retail Assured Living in Best Buy stores we tried to find last year, in vain. Mobihealthnews.

Oxford Medical Simulation is partnering with NHS England to trial its virtual reality training for diabetic emergencies. The pilot is being directed by Health Education England Wessex at the Portsmouth and Southampton Hospitals. Fifty doctors will use Oculus Rift headsets to walk through Oxford’s 100 or so scenarios. Mobihealthnews.

The growth of telehealth is outpacing urgent care and retail clinics, according to FAIR Health. This healthcare nonprofit calculated a 53 percent growth rate for telehealth (defined as virtual visits) between 2016 and 2017. In contrast, urgent care use increased only 15 percent in urban areas but went flat in rural areas. Retail clinic use fell 28 percent in urban areas and with a small 3 percent increase in rural areas. The advantages of telehealth in rural areas (up 29 percent), of course, is not having to drive when you’re sick. For urban residents, the advantage is not having to leave the house. According to their analysis, the top three reasons for telehealth visits were acute respiratory infections, digestive issues and injuries, each representing 13 percent of telehealth diagnoses. Mental health, which led in 2016, dropped to fifth. Healthcare Dive

News roundup: Teladoc acquires MédecinDirect, Blue Cedar closes $17M Series B, Hill-Rom buys Voalte, Withings bolsters sleep tracking

Teladoc grows its global reach with the MédecinDirect acquisition. Paris-based MédecinDirect currently has 24/7 telehealth operations within France, with patients able to text, video, or phone GPs or specialist doctors 24/7. Terms were not disclosed and the sale is subject to regulatory approval, but expected to close within the first half of this year. Founded by François Lescure, a pharmacist, and Marc Guillemo, a digital marketer, in 2008, the company’s client base grew to more than 40 leading insurance partners and nearly half of the top 30 private medical insurers (PMIs) in France.  MédecinDirect will become the French unit of Teladoc, which now has operations in the UK, Australia, Canada, Spain, Portugal, Hungary, China, Chile and Brazil, covering 130 countries in more than 30 languages with a growing specialist base from earlier acquisitions Best Doctors and Advanced Medical. Teladoc seems to have moved on from its financial and accounting problems that marred 2018, but still is not profitableRelease, Mobihealthnews.

App security innovator Blue Cedar closes on its Series B for $17 million. New investor C5 Capital, a specialist venture capital firm focused on cyber security, joins $10 million (2016) Series A investors Benhamou Global Ventures, Generation Ventures, Grayhawk Capital, and Sway Ventures. Daniel Freeman from C5 Capital will join Blue Cedar’s Board of Directors, Blue Cedar pioneered the approach of securing data from the app to the provider location on a client’s servers or in the cloud, without the smartphone or other mobile device being managed and without additional coding. TTA last year profiled Doncaster UK-based MediBioSense Ltd. using Blue Cedar to protect their VitalPatch app [TTA 23 Jan 18] and later as a case study in how digital partnerships happen and develop [TTA 17 Feb 18]. Release, Blue Cedar blog.

Hill-Rom increases its technology bets with Voalte. Voalte is a mobile communications platform used by hospitals and large healthcare organizations for care teams to securely exchange information and data. The privately held company from Sarasota Florida currently serves 200 healthcare customers, 220,000 caregivers, and more than 84,000 devices. Terms of the acquisition were not disclosed but is expected to close during Hill-Rom’s fiscal third quarter of 2019. Hill-Rom, primarily known for its ubiquitous hospital beds, late last year teamed with Israeli company Early Sense to create a smart hospital bed that monitors heart and respiration rates [TTA 12 Dec 18], which ties nicely with Voalte’s monitoring. Release.

Tossing the sheets in your bed at home? The newly reconstituted Withings comes to the rescue with deepening its sleep monitoring with an upgraded sleep sensor mat that detects sleep breathing disturbances in frequency and intensity. The connected Withings Sleep app monitors sleep cycles, heart rate and snoring, displaying scores through the companion Health Mate App. Not quite a sleep apnea diagnostic, but significant breathing interruption detected during sleep could indicate the need for further investigation.  Mobihealthnews

Suddenly hot, redux: mental health telemedicine in long term care, analytics to help predict rehospitalizations in skilled nursing facilities

The positive side of telemedicine for two areas–Long Term Care (LTCF). Skilled Nursing (SNF). Two types of care facilities that don’t get a lot of excited cocktail party chatter or much respect in the health tech field. Yet the needs are there, the tech attention has returned, and apparently the money has as well.

A major provider of behavioral health services for LTCF, Deer Oaks, is turning to telemedicine (SnapMD) to expand their reach. Already working with 1,400 LTCFs in 27 states in the central to southern US, Deer Oaks has been active since 1992 in providing both psychiatric and psychological services for geriatric and disabled patients.

The problem is coverage and the lack of providers. Psychiatry is itself aging out with few young doctors in the field–as well as the uneven distribution of practitioners. Mental health is a significant concern in the older adult population, including those dealing with depression and dementia.

Deer Oaks is adding telemedicine to expand to facilities in smaller, in rural areas, to extend hours, and to reach people with limited mobility. Facilities receive equipment and training. Two significant challenges they found were the lack of tech expertise in the staff, and importantly, the reliability of Wi-Fi in those areas, which is needed at 500 kbs of bandwidth to work. This expansion fits with CMS’ extension of covered telemedicine in rural areas and FCC’s continuing Connected Care Pilot Program, San Antonio-based Deer Oaks is estimated to have over $18 million in revenue (CrunchBase) and sees their growth in this area, according to an interview in mHealth Intelligence.

Assessing developing conditions in a SNF or LTC patient and preventing readmissions will always get this Editor’s attention, as she started in the field with behavioral telemonitoring for this area.

  • Real Time Medical Systems raised at end of February $9.2 million from SunBridge Capital Management to fund the growth of their analytics software which uses EMR information plus information from clinicians in routine monitoring of resident status to alert for early changes in resident conditions. Appropriate intervention could prevent hospitalization or a more serious development. Real Time currently has 500 SNFs and 30 hospitals, for a total of about 60,000 covered residents.
  • Skilled Nursing News also notes that Call9, an emergency medicine provider that embeds first responders at SNFs to provide onsite care and reduce unnecessary transfers to ERs, has raised a stunning $34 million and is concentrating on both SNF and assisted living. It is connected with several major payers and Medicare Advantage plans.
  • More conservatively, Third Eye Health, which provides post-acute emergency telemedicine to 220 SNFs, recently raised $7 million. All these companies have claimed readmission reductions of 40 to as high as 70 percent, and savings from services such as these may be billions.

None of which gets buzzy panels at HIMSS, Health 2.0, or CES, or viral videos on the news as the plight of Mr. Quintana did [TTA 13 Mar, below] but provides a badly needed advance in care services–and savings–for LTCs/SNFs and badly needed and better care for their patient residents.