Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots

Do they really work to change behavior? Studies for the past seven or so years have debated efficacy; a quick search online will show you a wealth of articles with findings on both sides. We know healthcare-related (consumer behavior and professional apps) are growing like weeds after rain– over 320,000 mobile, wearable, and IoT health apps were available for use in 2017, with 200 added daily (Research2Guidance, IQVIA estimates). But qualitatively, the jury is out.

Three studies published in the last two months come somewhere in the middle.

Obesity and weight loss: A telemedicine-based 12 week study from California State University found that the combination of a secure mobile phone-based platform for data tracking and video conferencing with the research team, plus meeting with the medical doctor once per month, and weekly with a registered dietitian worked to clinical standards, ≥5% of initial body weight loss over six months, for 69 percent of the telemedicine participants (n=13) versus 8 percent in the control group (n=12). Note the substantial hands-on human support each of the 13 participants received. Journal of Telemedicine and Telecare, Clinical Innovation & Technology

Activity monitoring not effective unless users set goals: A 400-person study performed by researchers from the Oregon Health & Science University (OHSU) School of Medicine and their Knight Cardiovascular Institute found that when people used such monitors and apps without a specific goal in mind, their physical activity declined and their heart health did not improve, even if 57 percent thought it did. The subjects, primarily office workers at one site, wore a Basis Peak band for about five months. To gauge heart health, the researchers also tracked multiple indicators of cardiac risk: body mass index, cholesterol, blood pressure and HbA1C. Cardiac risk factors did not change. However, the corresponding author, Luke Burchill MD PhD, told EurekAlert (AAAS) that when paired with specific goals, the trackers could be powerful tools for increasing physical activity. The original study published in the British Journal of Sports Medicine doesn’t go quite that far. 

But it’s great for your morale, especially if you pay for it: A Brigham Young University study published in JMIR MHealth and UHealth (August) confirmed that physical activity app usage in the past 6 months resulted in a change in respondents attitudes, beliefs, perceptions, and motivation. This study’s purpose was to track engagement factors such as likeability, ease of engagement, push prompts, and surprisingly, price–that higher-priced apps had greater potential for behavior change. Possible reasons were that the apps provide additional features or have higher quality programming and functionality. (And user investment?)

One growing area for apps is mental health, where the metrics are solidly behavioral and the condition is chronic. The UK’s National Institute for Health and Care Excellence (NICE) has moved forward in favor of piloting them with NHS England. The latest is one from Germany, Deprexis, that uses texts, emails, questionnaires, and cognitive behavioral therapy to give feedback to users. It also has tools to relax users through audio and visual programs. NICE recommends therapist guidance for the trial. According to Digital Health News, NICE is recommending it should be trialed for up to two years in at least two of the specialist services that were set up to improve access to psychological therapies. Again, cost is a factor in rolling out but others are access to care and freeing up therapist time. The organization also plans to review up to 14 digital programs to treat anxiety and depression over the next three years.

Hat tip to Toni Bunting for much of the above

For further reference: The 2017 R2G mHealth App Developer Economics 2017 study has been released and is available for free download here. The 2017 study surveyed 2,400 mHealth developers and practitioners. (Disclosure: TTA was a media sponsor for the study.)

5 vital signs, one ‘heavyweight’ device on the back of your Moto X smartphone

click to enlargeAre we getting to the ‘tricorder’ through the smartphone mod back door? Smartphone clip-ons to measure a vital sign are nothing new–the early 2010s AliveCor device was a snap-on case for the iPhone containing EKG electrodes, now replaced with the Kardia Mobile and KardiaBand for the Apple Watch. But the Vital USA Moto Mod has to be the heavyweight champ of clip-on ‘mods’. It is for the Motorola Moto Z only, and the reveal at CES was by Lenovo, the official global distributor. Release (PDF).

The Vital Moto Mod measures five vital signs–heart rate, respiratory rate, blood oxygen saturation (SpO2), non-contact core body temperature, and systolic/diastolic blood pressure–through primarily a finger cuff and sensors. For BP, the cuff uses sensors and a novel inflatable bladder. Vital USA claims that running through all five readings takes between two to three minutes. The results download to the HIPAA-compliant Vital app which will be available through the Google App Store. The app also guides the user through how to take one or more of the vital signs. The Vital Moto Mod is not yet FDA cleared or CE Marked. 

As CNet remarked, the mod is huge and not exactly something you slip into your back pocket. They didn’t have the opportunity to check it for accuracy against other standard medical devices. It will be available after April 8 for $395 (£290).

One questionable aspect of the website is the consistent usage and demonstration of ‘vital signs monitoring’ and confirmation of its accuracy when in the FAQs, under “Is the product FDA approved”, it states that “this is a health and general wellness product. The Vital Moto Mod is not a medical device and therefore not currently regulated by the FDA.” 

However, announced on the 24th was their partnership with Partners Connected Health of Boston to validate the readings in a clinical trial that will compare the Vital Moto Mod to predicate medical devices, which is preliminary to FDA approval. Release

It appears that the US company, HQ’d in Boca Raton, FL, has an Irish parent, ARC Connected Health.

click to enlargeAn earlier, less clunky entrant, which this Editor first saw at Connected Health 2015 is the Sensogram SensoSCAN finger cover monitor which is a 4-in-1, measuring blood pressure, heart rate, blood oxygen saturation (SPO2), and respiration rate (but not temperature). Measurements are viewable on a screen readout. It is currently available for $499 through their website and is in the process of FDA clearance. In development is the VitalBand, which adds fall detection, medication reminders, goal notifications, and pre-programmed contacts to the SensoSCAN’s four vital signs. Data is stored on both devices and uploaded to their app via Bluetooth.

This Editor is impressed with the idea of consumers not having to work with multiple devices but sees two definite drawbacks: size of the Vital Moto Mod and the cost of both up to $499. They are most useful to those who have to monitor multiple vitals for chronic conditions, yet they are both, at this time, stand-alone, not reimbursable, and not integrated with any major telehealth system. It’s yet to be seen if they will be accepted by telehealth companies (which kit their tablets or hubs with multiple devices), payers, and patients.

InTouch Health launches a three-way collaboration on virtual acute care with Jefferson Health, Mission Health

Telehealth provider InTouch Health announced a five-year joint partnership with Asheville, North Carolina-based Mission Health and Philadelphia-based Jefferson Health to develop 10 new models in virtual acute and outpatient care. These use cases are not “typical telehealth” and include stroke, sepsis, and acute heart failure.

It’s an interesting expansion of the telemedicine/telehealth acute care model, especially if it extends to outpatient care. InTouch is building upon several years of separate work with each health system. In this joint development arrangement, the health systems will share information and with InTouch Health. What is also interesting that working with both systems allows InTouch to test virtual care access and whether it increases care coordination in diverse settings. Jefferson is an urban university hospital based in Center City Philadelphia, while Mission serves an economically mixed suburban and rural area. According to the release, this is to “ensure the care pathways and supporting technologies improve patient access and quality of care and are applicable across markets and geographies.”

Jefferson Health has worked with InTouch for nearly a decade, using the InTouch telestroke program for its 30 hospitals in the Jefferson Neuroscience Network. Mission Health is using their telestroke, telepsychiatric, tele-hospitalist, and tele-neonatology programs. The InTouch programs include virtual platforms, clinical workflow solutions, and software.

There is no mention here of using new telehealth partner Vivify Health [TTA 19 Dec] for their Managed Kit and BYOD, but to this Editor the most likely place for their systems would be integration into outpatient care. Outpatient service could also be furnished by their new home-based video consult services acquired through their purchase earlier this month of TruClinic.

Since 2003, InTouch has rounded up over $26 million in funding through a 2010 $6 million Series D. The fact that their funding has been conservative (compared to the over $158 million Practice Fusion raised in a dozen years before their acquisition earlier this month by Allscripts) and have managed to make several acquisitions in that time either indicates excellent cash flow from existing business or undisclosed sources of private financing. Release. Mobihealthnews.

What’s up with Amazon in healthcare? Follow the money. (updated)

Updated–click to see full page. Amazon is the Scary Monster of the healthcare space, a veritable Godzilla unleashed in Tokyo, if one listens to the many rumors, placed and otherwise, picked up in mainstream media which then are seized on by our healthcare compatriots.

According to CNBC’s breathless reporting, they have set up a skunk works HQ’d in Seattle. When they posted job listings, they were under keyword “a1.492” or as “The Amazon Grand Challenge a.k.a. ‘Special Projects’ team.” In late July, these ads for people like a UX Design Manager and a machine learning director with experience in healthcare IT and analytics plus a knowledge of electronic medical records were deleted. Amazon has separate initiatives on selling pharmaceuticals and building health applications to be compatible with Echo/Alexa and other smart home tech. Both have come up in the context of the CVS-Aetna merger, where buying up state pharmacy licenses cannot be kept secret (see end of our 8 Dec article) and that efforts to extend Alexa and Echo’s capabilities aren’t particularly secret.

A quick look at Bezos Expeditions, Amazon supremo’s Jeff Bezos’ personal fund, on Crunchbase reveals several healthcare investments, such as GRAIL (cancer), Unity Biotechnology (aging), Rethink Robotics, and Juno Therapeutics (cancer). Not really things easy to sell on Amazon.

Last week, Amazon reportedly hired Dr. Martin Levine, who ran integrated primary health Iora Health’s Seattle-based clinics, according to CNBC and Becker’s. They met with Iora, Kaiser, and the now-defunct Qliance about a year ago on innovative healthcare models. More breathless reporting: they are hiring a “HIPAA compliance lead.” 

What does this all mean? It may be more–or less–than what the speculation is. Here’s what this Editor believes as some options:

  • Alexa and Echo are data collectors as well as assistants–information that has monetary value to healthcare providers and pharma. To this Editor, this is the most likely and soonest option–the monetization of this data and the delivery of third-party services as well as monitoring.
  • Amazon now employs a lot of people. It is large enough to create its own self-funded health system. It’s already had major problems in the UK, Italy, and even in the US with healthcare and working conditions in its warehouses. Whole Foods’ non-union workers are prime for unionization since the acquisition (and also if, as rumored, robots and automation start replacing people).
  • A self-funded health system may also be plausible to sell  (more…)

MediBioSense and Blue Cedar take a new approach to secure medical wearable data (UK/US)

click to enlargeDoncaster UK-based MediBioSense Ltd. has partnered with San Francisco-based Blue Cedar to protect their VitalPatch app on smartphones and tablets. MediBioSense uses VitalPatch in their MBS HealthStream system marketed in the UK in acute care and long-term care setting. Blue Cedar is securing the app through their patented code-injected technology which protects the VitalPatch-collected data from the app to the provider database. The system with Blue Cedar’s security is available directly from MediBioSense.

VitalPatch is a single-use adhesive biosensor patch applied to the patient’s chest (see left above). It monitors eight vital signs and activity signs: heart rate, respiration, ECG, heart rate variability, temperature, body posture including fall detection/severity, and steps as an indicator of activity. MediBioSense contracted with the US-based developer, VitalConnect, to sell the system in the UK. VitalPatch is US FDA-cleared (Class II) and CE Marked for the EU.

One impetus, according to the release (PDF), is the GDPR (General Data Protection Regulation), the pan-European/UK data-protection law slated to take effect in May. This not only applies to European Union citizens’ personal data but also requires reports on how organizations safeguard that data. 

Blue Cedar, which this Editor has previously profiled [TTA 3 May 17], has developed code-injection technology that secures data from the app to the provider location on their servers or in the cloud. It secures the app without the device being managed. Devices have their own vulnerabilities when it comes to apps even when secured, as 84 percent of cyberattacks happen at the application layer (SAP). Blue Cedar’s security also enables tap-and-go from an icon versus multiple security entries, thus quick downloading from app stores or websites. For companies, the secured app provides granular analytic reports about users, app usage, devices, and operating systems which are useful for GDPR requirements.

Blue Cedar’s latest release of app security is Enforce, to secure existing mobile apps using in-app embedded controls to enforce a broad range of security policies. It is sold on the Microsoft Azure cloud platform and is primarily targeted to the value-added reseller (VAR) market. 

All the more reason to use all means to secure devices and apps. When as of last week Allscripts‘ EHR for e-prescribing was hit with a ransomware attack (FierceHealthcare), yet another hospital (Hancock Regional in Indianapolis) paid $5,000 to hackers to get back online (Digital Health), and Protenus/DataBreaches.net tracks a breach a day [TTA 29 Dec 17], cybersecurity has become Job #1 for anyone in the healthcare field. (And Big Healthcare now votes for security. Protenus today announced their $11 million Series B led by Kaiser Permanente Ventures and F-Prime Capital Partners. Release.)

Hip-protective airbags get another entrant from France. And fall prediction steps forward.

click to enlargeclick to enlargeCES served as the US debut (the first was at November’s Medica fair in Dusseldorf) for Fontaine-lès-Dijon, France-based Hip’Air. Hip’Air by Helite is a soft belt with hip-positioned airbags that triggers upon fall detection but before ground impact. It is designed to be worn outside the body (unlike conventional pads), is reusable, claims a 90 percent reduction in fall impact, with a battery charge that lasts for over one week. According to their website, it will debut in Europe this spring after testing in nursing homes for €650 (US$800, UK£570). Video on their website above and on CNet.

Our Readers are well acquainted with the toxic statistics around falls and hip fractures. The US CDC found that 95 percent of hip fractures are caused by falls, usually sideways, they disproportionately affect women, and in the US they amount to about 300,000 per year. Hip’Air quotes their sources as 65,000 per year in France alone. NIH’s 2010 study found a 21 percent mortality rate after one year. Surgery/recuperation cost is around $30,000. Here is a largely avoidable cost.

In that context, it’s encouraging that Fort Washington, Pennsylvania-based ActiveProtective, which we profiled a year ago and received numerous Reader and company founder comments [TTA 10 Jan 17], is testing its belt-worn approach with Eskaton Village, an assisted living residence, in Carmichael near Sacramento California, and nearing a commercial debut. It is also based on sensors (3D) that sense a fall and deploy before impact in what they call ‘fall disambiguation’ and claims a comparable 90 percent impact reduction. It gained $4.7 million in Series A funding in December [TTA 19 Dec 17]. CBS 13 video. While Hip’Air is direct competition, albeit in Europe, more than one provider serves to convince funders and customer markets that the concept is valid.

Fall prediction is also stepping off the sidelines. Our earlier article covered four tech approaches that help to estimate and proactively act against falls [TTA 10 Jan]. Here’s another one from Spain, the FallSkip, which allows a physician or therapist to measure fall risk in under two minutes and in walking under 10 feet. Developed at Spain’s Universitat Politècnica de València, it consists of an Android-based mobile device Velcro-mounted on the back of a soft waistband for the patient which is worn during the walking test. The custom app provides and interprets motion readings to the doctor. New Atlas  YouTube videoHat tip to Toni Bunting 

To this Editor, advances in estimating fall risk are long overdue. Fall cushioning is too, and the less clunky but effective the better. But strength training is a needed adjunct, per the Dutch program. This physical training helps older adults and the disabled prevent falling and fall better, if they must. So what organizations in the US, UK, and EU are advocating this? There’s plenty of room for tech too. Not sexy or cocktail-party-buzzy at Silicon Valley parties, but a direct way to decrease cost and increase older/disabled quality of life.

Robots, robots at CES: ElliQ, Sophia the ‘humanoid’, companions, pets, butlers, maids…and at a supermarket near you?

click to enlargeCES as usual was a Robot Showcase, though without the presence of our recent Spotlight Robot Kompaï.  One of our other Spotlighters, Intuition Robotics‘ ElliQ companion robot, won the CES Best of Innovation Award in the Smart Home category (release).

click to enlargeMuch press went to Hanson Robotics’ Sophia, a Frubber-skinned humanoid robot from Hong Kong. It (She?) sees through cameras and sensors, through them recognizes speech and facial expressions, responds through natural language processing, and has a motion control system. It started walking on its own at CES courtesy of DRC-HUBO-developed legs. Its creator David Hanson, backed by Disney (Animatronics!) looks forward to an adult-level of general intelligence via AI development for future uses such as customer service, caring for children or older adults, or therapy. It has the ‘uncanny valley’ problem of verging on lifelike. The BBC interviewed Sophia at CES. (No, they didn’t sign her to be a presenter.) SFGate. The AI crowd in Silicon Valley and Facebook’s AI head with the interesting name of Yann LeCun performed a Two-Minute Hate about her to a rather partisan writer in The Verge. (Not Invented Here Syndrome? Perhaps they’re just envious.)

click to enlargeMost of CES’ robots were a Parade of Cute and When Not Cute, Wistful. Or Not Working. Sony’s brought back the Aibo robot dog out of its 2006 retirement with the ERS 1000, which lacks only a non-shed coat to be puppy-like. According to the WSJ, $1,700 will make Aibo your companion–and it doesn’t need food or walking. Blue Frog Robotics’ Buddy is a family companion, control point for connected homes, and security monitor. You might trip over it and the $1,500 cost. More in the utility line is Ubtech Robotics’ Walker which, unlike the Walker of ‘Point Blank’, isn’t looking for his $93,000 but will walk point around your house for security, connect you to your home controls, and ‘butler’ your appointments, emails, and video calls. The maid’s duties will be done by the Aeolus Robot, which will sweep, pick up and put away your things, and also do some assistant work. Honda’s 3E robots are Transformer-like for more commercial duties like assistants, smart scooters, and carriers. A more here-and-now robot addressing a major need is another robotic glove for those with hand or mobility restrictions, the leather glove-like NeoMano.

click to enlargeNot every robot was on their best behavior. Going on the fritz were LG’s CLOi smart home controller–on stage, no less. YYD’s latest robot, not only a home assistant but also a health status/chronic disease monitor, died into screen code in front of a BBC reporter. One of Softbank’s Pepper robots (left) was so overwhelmed by the excitement of CES that it fainted. Perhaps time to return to the calm of the Ostend, Belgium hospital? [TTA 21 June 16] Wired UK, South China Morning Post, CNet

Back in the Real World. Welcomed into Scottish supermarket chain Margiotta was ‘ShopBot’, dubbed Fabio. In an experiment run by Heriot-Watt University for the BBC’s Six Robots & Us (UK viewers only), Fabio was programmed with directions to hundreds of items in the store. It had an abundance of cute. Customers initially liked Fabio. Unfortunately, its conversational quality and conveyance of information were sorely lacking. For instance, Fabio told customers to go to the ‘alcohol section’ when they wanted beer. (Now if they wanted Scotch….) On top of it, its mobility was limited, and the disability laws don’t apply. So the Margiottas sacked Fabio, with regrets but no severance, after one week on the job. Oh. Telegraph (paywalled), Yahoo News UK

Robots, robots, everywhere…even when they’re NHS 111 online algorithms

click to enlargeThe NHS continues to grope its way towards technology adoption, gets slammed–but is it justified? The Daily Telegraph (paywalled–see The Sun) revealed a draft December NHS report that recommended that the NHS 111 urgent non-emergency care line’s “enquiries will be handled by robots within two years.” Moreover, “The evaluation by NHS England says smartphones could become “the primary method of accessing health services,” with almost 16 million inquiries dealt with by algorithms, rather than over the telephone, by 2020.” (That is one-third of demand, with one-quarter by 2019.)

Let’s unpack these reported statements.

  • An algorithm is not a ‘robot’. This is a robot.click to enlarge
  • What is so surprising about using algorithmically based questions for quick screening? Zipnosis in the US has been using this method for years as a pre-screener in major health systems. They call it an ‘online adaptive interview’ guiding the patient through branching logic of relevant questions; a provider can review the provided clinical note and make a diagnosis and treatment recommendation in 2 minutes. It also captures significant data before moving to an in-person or telemedicine visit if needed. Babylon Health uses a similar methodology in its chatbot-AI assisted service [TTA 26 Apr 17].
  • Smartphones as a primary means of accessing health services? How is this surprising when the Office of National Statistics says that 73 percent of adults use the internet from their mobiles? 51 percent go online for health information.
  • Based on the above, 66 percent would still be using telephonic 111 services.

It seems like when the NHS tries to move forward technologically, it’s criticized heavily, which is hardly an incentive. Over New Year’s, NHS 111 had a 20 percent unanswered call rate on its busiest day when the flu epidemic raged (Sun). Would an online 111 be more effective? Based on the four-location six-month test, for those under 35, absolutely. Yes, older people are far less likely to use it, as undoubtedly (but unreported) the disabled, sight-impaired, the internet-less, and those who don’t communicate in English well–but the NHS estimates that the majority of 111 users would still use the phone. This also assumes that the online site doesn’t crash with demand, and that the algorithms are constructed well.

Not that the present service has been long-term satisfactory. David Doherty at mHealth Insight/3G Doctor takes a 4G scalpel to its performance and offers up some alternatives, starting with scrapping 111.

Iron Bow’s uncertain future with $258 million VA Home Telehealth contract

Iron Bow Technologies’s setback with their VA contract confirmed. Iron Bow, which partnered last year with Vivify Health to provide telehealth services to the US Department of Veterans Affairs, received an unfavorable ruling on the US country of origin of the Vivify Health system that essentially stops the contract implementation.

Under Title III of the Trade Agreements Act of 1979, Federal suppliers must produce their products in the US or substantially transform the components in such a way that it becomes a product of the US. US Customs and Border Protection (CBP), Department of Homeland Security (DHS), makes this determination. Vivify Health contended that their Vietnam-produced tablet, because of their US-produced Vivify Health Pathways software and further US-based modifications to convert it into an FDA-regulated medical device, was transformed into a US product. In August, the CBP determined that the end product did not meet the transformation standard based on decades of precedent and the country of origin remained Vietnam. Transformation, yes, but not enough or the right kind for the CBP. Federal Register 8/22/17

An interesting Federal regulatory disconnect is that the FDA considers the Vivify tablet a regulated medical device. CBP considers it a communications device as the tablet transmits data from other medical devices but does not take those measurements itself. 

Vivify Health has publicly used in implementations with health organizations Samsung tablets. It is not known if the tablet reviewed by the CBP is manufactured by Samsung.

Both Iron Bow and Vivify Health were asked by this Editor for comments. Iron Bow’s response:

We have received an unfavorable ruling from United States Customs and Border Protection (“Customs”) regarding our proposed solution for the Home Telehealth contract. We respectfully disagree with the findings by Customs and have appealed the matter to the United States Court of International Trade. We are currently in discussions with our customer regarding the possible options for a path forward.

Vivify has not responded to date. 

Certainly, this is a sizable financial loss to both Iron Bow and Vivify if they cannot go forward with the VA, whether through a court decision or a different procurement process for the tablet to qualify it as US origin. Last February, we reported that the VA awarded the billion-dollar five-year Veterans Health Administration (VHA) Home Telehealth contract to four providers: incumbent Medtronic, Iron Bow, Intel Care Innovations, and service-disabled veteran-owned small business 1Vision. The award amount for each was $258 million over a five-year period, re-establishing the VHA as the largest telehealth customer in the US. All four awardees had in common that they were prior Federal contractors, either with the VA or with other Federal areas [TTA 1 Feb 17].

Medtronic and Care Innovations had long-established integrated telehealth systems but Iron Bow and 1Vision, as telemedicine and IT service providers respectively, did not have vital signs remote monitoring capability. In the solicitation, Iron Bow partnered with Vivify [TTA 15 Feb 17]. For 1Vision, it took nearly one year to announce that their telehealth partner was New York-based AMC Health, an existing provider of VA health services. It was also, for those in the field, a Poorly Kept Secret, as AMC Health had been staffing with VA telehealth veterans from the time of the award. (The joint release is on AMC Health’s site here.) The reason for the announcement delay is not known. AMC Health does not use a tablet system, instead transmitting data directly from devices or a mobile hub to a care management platform. They also provide IVR services.

Vivify has moved forward with other commercial partnerships, with the most significant being InTouch Health, which itself is on a tear with acquisitions such as TruClinic [TTA 19 Dec 17].

Hat tip to two alert Readers who assisted in the development of this article but who wish to remain anonymous.

Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? Is Carillion’s collapse a spanner in the works?

NHS England won’t be rolling out the Babylon Health ‘GP at hand’ service anytime soon, despite some success in their London test with five GP practices [TTA 12 Jan]. Digital Health cites an October study by Hammersmith and Fulham CCG (Fulham being one of the test practices) that to this Editor expresses both excitement at an innovative approach but with the same easy-to-see drawback:

The GP at Hand service model represents an innovative approach to general practice that poses a number of challenges to existing NHS policy and legislation. The approach to patient registration – where a potentially large volume of patients are encouraged to register at a physical site that could be a significant distance from both their home and work address, arguably represents a distortion of the original intentions of the Choice of GP policy. (Page 12)

There are also concerns about complex needs plus other special needs patients (inequality of service), controlled drug policy, and the capacity of Babylon Health to expand the service. Since the October report, a Babylon spokesperson told Digital Health that “Commissioners have comprehensively signed off our roll-out plan and we look forward to working with them to expand GP at Hand across the country.” 

Re capitation, why ‘GP at hand’ use is tied into a mandatory change of GP practices has left this Editor puzzled. In the US, telemedicine visits, especially the ‘I’ve got the flu and can’t move’ type or to specialists (dermatology) are often (not always) separate from whomever your primary care physician is. Yes, centralizing the records winds up being mostly in the hands of US patients unless the PCP is copied or it is part of a payer/corporate health program, but this may be the only way that virtual visits can be rolled out in any volume. In the UK, is there a workaround where the patient’s electronic record can be accessed by a separate telemedicine doctor?

Another tech head-shaker: 45 percent of GPs want technology-enabled remote working. 48 percent expressed that flexible working and working from home would enable doctors to provide more personalized care. Allowing remote working to support out-of-hours care could not only free up time for thousands of patient appointments but also level out doctor capacity disparities between regions. The survey here of 100 GPs was conducted by a cloud-communications provider, Sesui. Digital Health. This is a special need that isn’t present in the US except in closed systems like the VA, which is finally addressing the problem. The wide use of clinical connectivity apps enables US doctors to split time from hospital to multiple practices–so much so on multiple devices, that app security is a concern. 

Another head-shaker. 48 percent of missed NHS hospital appointments are due to letter-related problems, such as the letter arriving too late (17 percent), not being received (17 percent) or being lost (8 percent). 68 percent prefer to manage their appointments online or via smartphone. This preference has real financial impact as the NHS estimates that 8 million appointments were missed in 2016-2017, at a cost of £1bn. Now this survey of 2,000 adults was sponsored by Healthcare Communications, a provider to 100 NHS trusts with patient communications technology, so there’s a dog in the hunt. However, they developed for Barnsley Hospital NHS Foundation Trust a digital letter technology that is claimed to reduce outpatient postal letters by 40 percent. Considering my dentist sends me three emails plus separate text messages before my twice-yearly exam…. Release (PDF).

Roy Lilley’s daily newsletter today also engages the Tech Question and the “IT desert” present in much of the daily life of the NHS. Trusts are addressing it, junior doctors are WhatsApping, and generally, clinicians are hot-wiring the system in order to get anything done. It is much like the US about five to seven years ago where US HHS had huge HIPAA concerns (more…)

CVS-Aetna: It’s not integrated healthcare, it’s experiential retail!

click to enlargeThis very interesting take on financial analysis site Seeking Alpha draws another insight from the CVS-Aetna merger–it’s actually part of the rising commercial real estate trend of experiential retail. Here’s the logic. CVS MinuteClinics increase traffic to CVS stores. If they are part of a shopping center, that means those patients might grab a meal, coffee, or shop. Reportedly CVS and Aetna will add nurses and nutritionists, which will further increase attraction, stickiness, and traffic. 

CVS and Walgreens‘ clinics have started, in the new model, to become significant, even anchor, tenants of shopping centers, filling up the empty storefronts left by traditional retail. Doctors’ offices, urgent cares like CityMD, and hospital-run outpatient clinics are filling retail spaces and anchoring new developments. Another part of the experience–fitness clubs, which are also converting vacant office spaces–a line extension increasingly popular with health systems. CVS also bought out department store Target’s drugstores and in-store clinics, which is another model (fill a prescription, buy socks or a TV). Another line extension is partnerships with urgent cares or outpatient clinics, not much of a stretch since CVS already has affiliations with health systems in many areas.

Add telemedicine (Aetna’s partnership with Teladoc) to the above: both MinuteClinics and in-home become 24/7 operations. Not mentioned here is that Aetna can add in-person or kiosk services in CVS stores to file claims, answer questions, or sell coverage.

As this model becomes clearer, big supermarket operators like Ahold (Stop & Shop, Giant), Wegmans, Publix, Shop Rite and others, which have pharmacies in most locations, may ally with or merge with insurers or health systems–or partner with CVS-Aetna. There is also the 9,000 lb. elephant called Walmart, which is 2/3 of the way to an experiential model including nutrition, diet, and fitness (ask any WalMartian). Further insights on how this merger is forcing retailers to adapt are in Drug Store News.

CVS-Aetna could very well be a major mover in experiential retail, which may save all those strip malls. But this article points out, as this Editor has already, that the full shape of what could be experiential healthcare will take years to work and shake out, assuming the merger is approved. Our prior coverage is here.

Babylon’s ‘GP at hand’ has thousands of London patients in hand

click to enlargeApparently Babylon Health’s ‘GP at hand’ is a hit with Londoners, despite the requirement to shift GP practices. The Evening Standard reports that the Lillie Road Surgery in Hammersmith, one of the five London practices in the program (plus Victoria, Poplar, Euston, and Fulham), increased its patient list by nearly 7,000 (4,970 in November to 11,867 last month). (Was it the Tube adverts?–Ed.) No information is available on increases at the other surgeries. 

Helping matters may be the UK flu epidemic, where the incentive to stay at home and have a video consult would be great (and helpful in stemming the spread). These consults on average are available 2 1/2 hours after booking, which to us Yanks used to independent services seems a great delay. One-third are reportedly out of office hours. Duration of the visit is about 10 minutes, which is standard for in-person. What is suspected is that many do not realize that the GP at hand signup also changes your GP to the program. The GP partner quoted in the article claims that homeless people, those with mental health and multiple chronic conditions–not just the young and mobile-savvy–have signed up. 

This Editor will concur with others that it’s time for telehealth to be integrated into the NHS, but the tying of it to specific practices which alters capitation is a large wrinkle which needs ironing out. Our earlier coverage here. Hat tip to Roy Lilley.

Rounding up opportunities for showcasing–and funding–your health tech startup (US)

click to enlargeAlex Fair, whom our Readers know as the head hombre of the MedStartr health innovation community and MedStartr Ventures, has several ex-NYC opportunities in New Orleans and Miami (where it’s a lot warmer than NYC!) for innovative early-stage healthcare companies. Deadlines are soon, so if you are interested, move quickly!

New Orleans

New Orleans Health Innovators Challenge (NOLAHI) during Innovation Week March 20-23- application deadline 1/15 (Expired)
In this Crowd Challenge, hospitals and hospital systems and insurance companies in the New Orleans area are looking for healthcare innovations to pilot plus startups to partner with and fund.  The finals are scheduled after Mardi Gras in March during New Orleans Entrepreneur Week March 20-23. Full details at NOLAHI.com, with a summary of the individual challenges below:
The Diabetes Care Challenge – Create a digital tool that supports diabetic health maintenance. Presented by Blue Cross and Blue Shield of Louisiana and Ochsner Health System
The Navigator Challenge – Use technology to replicate the function of a navigator to enhance patient-centered care, without adding FTEs. Presented by Tulane Health System
The Inter-Operability Challenge – Eliminate errors, fraud, and misinterpretation plus increase inter-operability via the implementation of technologies such as blockchain. Presented by Lafayette General Foundation

Miami

MedMoMiami – application deadline 1/19 (expired). Event is January 25.
The first ever #MedMoMiami will be Jan 25th. This event is jointly organized with the Miami Health 2.0 Chapter. Apply to pitch in Miami here.

Other events are in planning stages for NYC, Austin, Maryland, San Diego, and Saratoga NY. #MedMo18 will be 29-30 November. TTA is a media sponsor and supporter of Health 2.0 NYC and MedStartr. Editor Donna is a co-organizer of NYC events.

€280m addition creates largest investment fund for European health tech (NL)

Amsterdam-based Life Sciences Partners LSP announced that the LSP Health Economics Fund 2 is now the largest European investment fund dedicated to healthcare innovation. An additional €280m was raised from the European Investment Fund, health insurance companies, and institutional investors.

Reportedly, the fund will look to invest in around 15 private companies with innovative products “on the market or very close to market introduction”. Rudy Dekeyser, LSP partner, said to Digital Health News that their focus areas are in drug compliance, remote monitoring, big data analytics and clinical software. Further caveats: companies must  “convince us that there is a clear path towards the integration of their innovative product in the complicated healthcare ecosystem, has to know who will pay for their product or services and should have access to the necessary partners for broad implementation of their product in the market.”

This adds to end-of-year UK and European announcements of early-stage life sciences and healthcare innovation funding. As reported in Digital Health News: the UK government’s life sciences industry partnership to advance medical technology in Britain (Digital Health News); Wayra UK (Telefónica) and Merck Sharp & Dohme’s Velocity Health £68,000 healthcare accelerator program for machine learning/AI start-ups. LSP release

Fall prevention: the technology–and Dutch–cures

The ‘Holy Grail’ of fall detection is, of course, fall prevention. The CDC statistics for the US are well known: One in four Americans aged 65+ falls each year. Every 19 minutes, an older adult dies from a fall. Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults–2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths. In 2014, the total cost of fall injuries was $31 billion. In the UK, AgeUK‘s stats are that falls represent the most frequent and serious type of accident in people aged 65 and over, the main cause of disability and the leading cause of death from injury among those aged 75+. 

The technology ‘cures’ as noted in this NextAvenue/Forbes article centers around predicting if and when a person will fall.

  • The ‘overall’ approach, which is constant monitoring of ADLs through activity sensing and modeling/machine learning to detect early signs of decline or health change. Companies in this area are Care Innovations’ QuietCare (sensor arrays) and CarePredict (wrist worn).
  • Gait detection. Relatively small changes in gait and walking speed are an accurate, fast, and straightforward indicator of fall risk. Ten years of research performed at TigerPlace in Missouri showed that people whose gait slowed by 5 centimeters per second within a week had an 86% probability of falling during the next three weeks. Shortening of stride had a 50 percent probability of fall within three weeks.
  • Read the brain. Research at Albert Einstein School of Medicine in NYC indicates that in otherwise high-functioning older people, high levels of frontal brain activity while walking and talking can predict higher long term fall risk, up to 32 percent.
  • Balance impairment. Tests using VR to simulate falling in healthy subjects and tracking their muscular response also could be used to roadmap a person’s balance impairments and future fall risk–along with training and targeted physical rehabilitation.

The Netherlands has taken this last point and gone ‘low tech’ with physical training courses that teach older adults both not to fall and to fall correctly if they do. Students negotiate obstacle courses and uneven surfaces, then learn to fall properly on thick inflated mats. Many of those attending use walkers or canes, but complete the courses which reduce the fear of falling or getting up–and provide both fun and socialization. The courses have become popular enough that they are government rated with insurance often defraying the cost. New York Times

January’s Crazy Week: JP Morgan, StartUp Health, Health 2.0 WinterTech…and CES takes the cake!

This week is Crazy Week for healthcare and technology folk, with multiple major events centered in San Francisco and Las Vegas.

JP Morgan’s 36th annual healthcare conference started today 8 Jan through Thursday 11 Jan in San Francisco. It annually hosts 450 companies presenting to 9,000 attendees. It attracts hundreds of investors and is A Very Big Deal for both investors and companies angling for same. It kicked off with Medtronic‘s Omar Ishrak touting their success with Tyrx, an anti-microbial resorbable envelope for their cardiac devices to prevent post-surgical infection. In value-based care, it may not be in itself reimbursable, but improves outcomes (MedCityNews). The official hashtag for the conference is #JPMHC18 but there’s also #JPM18.

Of interest to Readers will be Teladoc’s presentation at JPM, provided by Seeking Alpha

CNBC’s tip sheet on the action. Genalyte‘s lab-on-a-chip demos their blood sampling in 15 minutes technique to MedCityNews writer. And Vive La Biotech–why American investors should be looking at French companies.

Within the event is the invite-only StartUp Health Festival Monday and Tuesday which hashtags at #startuphealth. Separately, but with many of the usual suspects, is Health 2.0’s one-day WinterTech conference in San Francisco the following day on Wednesday 10 Jan, also with an investment focus. (You can imagine the investor and company hopping between conference locations!) Alex Fair is also leading a Meetup tweetup for the week–more information here. You may also want to check out #pinksockspinksocks is an ad hoc group dedicated to health and wellness innovation and doctor-patient connectedness.

Further south, the sprawl of Las Vegas has been taken over by the sprawl of CES (aptly dubbed ‘Whoa!’) starting Tuesday 9 Jan through Friday 12 Jan. The substantial health tech focus (more…)