Tender/RFI up: two more from EU-Supply (UK, IRL)

Susanne Woodman, our Reader who is our Eye on Tenders, has located two new tenders available on the EU-Supply site:

(NHSSBS)Telemedicine Advice and Guidance Service Deadline is 8 March 2017. Documents are attached and available after registration and log in. Contact Greg Reide, phone: +44-161-2123701

(CTM) Pobal on behalf of the Department of the Housing, Planning, Community and Local Government invites responses from organisations for the purpose of market research. This is a Request for Information and not a tender process. This is a market sounding exercise to obtain market information in respect of Telecare Equipment in relation to the Seniors Alert Scheme. Please refer to the Request for Information document which is available via this notice. Submissions should be sent to procurement@pobal.ie on or before 3.00pm, on Thursday the 2nd March 2017. Registration and log in required for further information.

Towards 2020: Big Tech developments predicted to impact healthcare delivery

click to enlargeHealthcare doesn’t stand outside major technology trends, and two we’ve covered extensively are machine learning and artificial intelligence (AI), which this Editor observed [TTA 3 Feb] may beat out Massive Data Crunchers like IBM Watson Health for many diagnoses. What has been ‘bubbling up’ in the past year is blockchain, the technology behind bitcoin which is a ‘distributed, secure transaction ledger’ that uses a private key. Each record block has an identifying hash that links each block into a virtual chain [TTA 16 July]. Brian Ahier, Director of Standards and Government Affairs at Medicity, Aetna’s data analytics/population health subsidiary, predicts in Health Data Management that both will be the Big Trends for the next three years, with a substantial discussion behind both, particularly AI (though citing global equity funding of $1.5 bn in AI for healthcare since 2012 seems a paltry reinforcement). There are links to two blockchain studies from Deloitte and IEEE (requires subscription or purchase) for further reference. Two other bonuses: a link to New School’s Melanie Swan’s blockchain blog with four potential uses in healthcare and a Gartner hype cycle chart (left above) identifying both machine learning and blockchain (distributed ledger) near the peak of the curve. His third trend, digital transformation, is less a trend than an admonition that our present business structures need to change, that they must realize the potential of fully utilizing data, and to consider the customer experience.

Buddi looking for two dynamic Sales Account Managers (UK)

click to enlargeA note from reader Fiona Carmichael advises us that the Buddi personal emergency response system is seeking two professionals to become UK Sales Account Managers. “Your role will have a key focus on driving new business within a B2B environment, as well as building and developing existing customer accounts for organic growth.” Please contact Fiona directly after you read the job description (docx). (This closes 28 Feb.)

(A reminder to our Readers that Who’s Hiring–and Who’s Available–are free services of TTA and a great way to connect with thousands of readers in the UK and the US. We post initially in Latest News and archive in ‘Who’s available?’ and ‘Who’s hiring’.)

Telestroke continues to expand (US)

Telestroke has expanded over the years and one of the most recent click to enlargeimplementations is in New York at a group of hospitals in Hudson Valley. Health Alliance of Hudson Valley announced last week that its Kingston Hospital is now operating a telestroke service provided by Neurocall that uses a team of 40 “tele-neurologists” based in New York, Texas and Florida.

Stroke is one of those medical emergencies where the speed of diagnosis – usually within minutes of symptoms appearing – can have life-long impact on the patient’s ability to return to an independent life. What is particularly complicated in a stroke is that it can be caused by a blood clot or a burst blood vessel and the treatment for the two types are very different. When a specialist who is able to identify the type of stroke quickly is not available at the hospital, as is commonly the case, the ability to use telemedicine has proved to be a great boon.

A survey in 2012 identified 56 telestroke programs across the US and no doubt this has grown over the years with many well known health service providers such as the Mayo Clinic, Massachusetts General and Cleveland Clinic operating a telestroke service as well as acting as a hub to regional and rural hospitals.

Stroke is the fourth leading cause of mortality in the USA and the leading cause of serious long term disability according to the American Heart Association. With only 1100 stroke specialists in the US, half of US hospitals do not have a stroke specialist on the staff and nearly half the US population live more than 60 miles from a stroke centre according to “Telestroke—the promise and the challenge“, a paper published last year in the British Medical Journal. These factors have led to telemedicine being firmly established as an important part of acute stroke treatment.

NY’s Northwell Health Home Care partners with HRS for telehealth tablets

click to enlargeNew York State’s largest health system, Northwell Health, is partnering with Hoboken, New Jersey-based (and Blueprint Health grad) telehealth provider Health Recovery Systems (HRS) on introducing their tablets into their Home Care Network. The picture at left is of Bernard Feinstein, a 100-year-old Queens-resident Northwell Health patient, who seems to be easily using and handling the touchscreen tablet. HRS tablets are video-enabled for consults and monitor vital signs, connecting via Bluetooth to devices: stethoscope (heart and lung), pulse oximeter , blood pressure, and weight scale. If one enjoys examples of pretzel logic, the release states that Northwell’s telehealth implementation is one of the first–of Bluetooth-enabled monitoring in NY State home care and the first on Long Island. (Cable-connected telehealth systems have been commonplace since 2003, including Northwell’s home care.) The HRS partnership follows on Northwell Ventures’ $1 million Series A investment in Virginia-based telemedicine provider Avizia. Innovate LI,

Robotic cats, parrot aid dementia patients at Lincolnshire Manthorpe Centre (UK)

click to enlargeAn engaging item picked up from the P.E.T.S. (Patient Engagement Treatment Services) blog via LinkedIn updates is about the innovative use of robotic pets in dementia therapy at Lincolnshire Partnership NHS Foundation Trust’s (LPFT) Manthorpe Centre, which cares for adult patients suffering from dementia. The two robotic kitties appear to be comfort ‘animals’ that move and respond, but the robotic parrot is different. According to occupational therapist Liz Lester at LPFT, who introduced the robotic animals to the ward, Pete the Parrot was developed by a man whose mother had dementia. The lifesize parrot blinks, yawns and responds directly to voice control. The patients react to handling the animals with better moods and respond more positively. Lincolnshire Reporter

Checking on “Pete the Parrot”, this Editor found a series of articles on an Alzheimer’s blog (Reading Room) that reinforces the occupational therapist’s information. The “Pete the Parrot” is a widely available and inexpensive parrot toy which repeats what you say (and flaps wings). These are widely used as helpers for those with short-term memory loss and children with delayed speech (MaxiAids). This Editor would have greatly appreciated this in assisting her mother years ago who responded positively to stuffed animals and music, was verbal until near the end, but could have benefited greatly from a toy like this. Click on various links in the articles for users’ experiences and tips (including videos).

Jawbone still in business–with Fitbit in court

While most industry observers are perceiving Jawbone’s abandoning the consumer fitness tracker market, repositioning into the clinical B2B2C vitals market, and seeking fresh financing as a last-ditch effort to save the company, Jawbone continues to be highly active in one place–court. Last week, Jawbone filed a lawsuit against Fitbit and five former employees in California state court for theft of trade secrets and has rebutted Fitbit’s motion to dismiss in a 27-page filing. According to Fortune’s account of the lawsuit, Jawbone’s filing states: “Each of the defendants has been, for more than five months, the subject of a criminal grand jury investigation regarding theft of Jawbone’s trade secrets that is being conducted by the Department of Justice and the Department of Homeland Security,” a charge that Fitbit calls ‘fictional’ and false. The court hearing in San Francisco is 15 February.

The legal skirmishing, which largely has gone Fitbit’s way [TTA 27 July] in the US International Trade Commission, indicates that Jawbone is still spending money to protect what is left of value in the company–its patents and intellectual property (whatever hasn’t been voided). Jawbone $100 million ‘gem’: the BodyMedia patents acquired in 2013 [TTA 30 Apr 13]. BodyMedia had FDA Class II clearance but a clunky form factor. This IP is a critical save if they want to go clinical. Fitbit’s shares continue to go down, an indicator that the mud is rising. Also Bloomberg with video.

The Theranos Story, ch. 35: Arizona lab in violation, is there a biotech ‘Theranos effect’?

click to enlargeAnd we were starting to grow nostalgic for our Weekly Episodes! One would expect Nary A Peep from Theranos until the lawsuits start to move forward, they set up another Board of Experts, and/or if the Alphabet Agencies (FDA, SEC, DOJ) decide to take their own actions. A short article out of the (thoroughly paywalled) Wall Street Journal, summed up in MarketWatch, confirms that as suspected, the September 2016 Federal inspection of the Scottsdale, Arizona lab turned up multiple lab and patient notification violations. According to a Federal inspection report cited in the WSJ article, lab staff inaccurately configured a machine processing blood coagulation tests; “Theranos additionally failed to verify that devices’ precision or accuracy were in line with their manufacturer’s instructions for tests such as those for blood-glucose, pregnancy and triglycerides.” Patients were not notified of potentially inaccurate diabetes test results. This provides an extra entreé for the dining pleasure of the Arizona Office of the Attorney General (OAG), which last month put out a bid solicitation for outside counsel to assist in planned actions against Theranos for fraudulent blood testing [Ch. 33]. Hat tip to Bill Oravecz of Stone Health Innovations

No Theranos Effect? The biotech, VC and investor community has put on its Game Face and declared everything’s just fine, and move on. Theranos–now seen as an outlier. After all, they didn’t present their data and kept everything tightly under wraps. (But two years ago, who questioned that? Few.) Unicorns continue to romp, with the Business Insider article mentioning Samumed’s $12 billion valuation for alopecia and wrinkle drugs, none past Phase 2 clinical trials, plus others like Neon Therapeutics and Unity Biotechnology with sizable raises. So no more Theranoses…till the next time.

See here for the 34 previous TTA chapters in this Continuing, Consistently Amazing Saga.

Further clarification on telehealth tenders and the North Yorkshire County Council

From Reader Vicki comes this clarification on what this Editor incorrectly reported as an open tender [TTA 9 Jan]. We are separately printing her comment to the original article, as a service to those interested in providing assistive technology to North Yorkshire:

A tender has not been issued by North Yorkshire County Council. There is some information regarding a market engagement event and an outline of the Council’s intentions. This reads:

This reads:
Thank you for your interest. The Council is shaping the future of assistive technology in North Yorkshire, and has carried out some initial engagement with the wider market, in May 2016, to shape our future of the assistive technology strategy that we are developing. To allow sufficient time to ensure that a robust strategy is in place which reflects the needs of people in North Yorkshire and the available market, we are delaying the launch of the new service until 1 April 2018. We are currently working on the draft assistive technology strategy which we will be consulting on in spring/summer 2017. It is our intention to launch the procurement exercise following this consultation. Further information and all the contract documentation will be made available through YORtender.

Our thanks to Vicki–Ed. Donna

Anthem-Cigna merger nixed, finally (US)

click to enlarge Breaking News. Not with a bang, but a whimper. Late Wednesday 8 Feb, the anticipated decision derailing the $54 million Anthem-Cigna merger was released by the Federal District Court, District of Columbia. Judge Amy Berman Jackson’s decision denying the merger was very much along the anti-competitive and anti-trust rationales contained in the 19 January advance report by the New York Post. There’s little that hasn’t already been explored in our prior reports, so we will leave the rehashing to sources like CNBC. The general consensus is that the four Big Payer Merger participants (Aetna and Humana merger denied [TTA 24 Jan]) will be moving on, perhaps to their advantage as most of the premises for merging, based on ACA’s effects, are expected to change, drastically.

Cigna must also be relieved after its reported ‘merger remorse’ after too many rumored disagreements with Anthem. According to Bloomberg, Cigna is sitting on $7 to $14 billion deployable capital, with the high end including extra debt. (Does this include the $1.85 bn breakup fee that Anthem owes to Cigna? Stay tuned on how Anthem tries to get out of this.) And the American Medical Association is beyond delighted (release).

Of course, there’s a lot of speculation about all that loose cash being deployed on new merger targets, which include the Usual Suspects of Humana, WellCare, Centene and Molina. Some free advice: all these companies should, for the next year, sit quietly and breathe deeply (as many employees who would be redundant in any merger are). They should also take care of business (TCB!), refocus on serving their policyholders, make their processes far less onerous on providers, and let it all shake out rather than rushing out to find out Who To Buy. (New Attorney General Jeff Sessions was sworn in this morning, and many changes are coming in both healthcare policy and the judiciary.) Also Neil Versel’s pointed take in MedCityNews.

Humana-Omada Health diabetes prevention program could cut $3 bn in Medicare expense: study

A study performed by insurer Humana using the Omada Health program for diabetes prevention effectively lowered weight, improved cholesterol, blood glucose and mood. 500 volunteer subjects from Humana’s Medicare Advantage program, enrolled during 2015, lost an average of 13 to 14 pounds over a year (7.5 to 8 percent). They also saw improvements in cholesterol levels, blood glucose levels and subjective measures of moods and self-care. Individuals were chosen from administrative medical claims based on metabolic syndrome diagnosis or a combination of three of four of the following diagnoses: prediabetes, hypertension, dyslipidemia, and obesity. Based on the researchers’ calculations, this type of prevention program among this group if widely implemented among overweight adults could reduce Medicare costs by $3 bn over 10 years, not only for diabetes but also heart disease and high blood pressure.

Omada Health’s program included an online small group support, personalized health coaching, digital tracking tools, and a weekly behavior change curriculum. These one-hour lessons focused on a single topic were delivered via laptop, tablet, or smartphone, and included interactive games or exercises, written reflections, and goal-setting activities. The content was approved by the CDC Diabetes Prevention Recognition Program. Data was gathered via wireless scale, pedometer for physical activity, online food intake logging and standard lab results. “In conclusion, this study demonstrated that older adults who agreed to participate in this program were able to engage meaningfully and gain important health and wellness benefits during a relatively short time frame.”

While the cost reduction estimate is exactly that, other studies directionally confirm health improvement and savings: the National Diabetes Prevention Program (NDPP) which is the model for the Omada program, the BMJ/Noom Health study, and the Fruit Street/VSee telehealth program being used by St. Jude Children’s Research Hospital, University of South Florida and University of Michigan. mHealth Intelligence, study (full text in Journal of Aging and Health/Sage Journals)

TytoCare remote diagnostics comparable to in-person exam results: study

click to enlargeA study of the Tyto Care remote diagnostic device, conducted by Schneider Children’s Medical Center and the Sackler School of Medicine, found that the quality of readings by Tyto Care was ‘on par’ with in-person medical exams using conventional otoscopes and stethoscopes. Ears, heart, lungs and throats of 137 children aged 2-18 seeking care from the emergency department of a tertiary care facility were examined first conventionally and then again by a second remote physician using exam data captured by the TytoCare all-in-one device and attachments. Using standard statistical methods, the results were compared and the study reported “good to excellent agreement for all exams conducted using TytoCare and conventional exam tools, with a p-value <.001.” The study also recorded a separate five-point measure of patient experience and results averaged 4.4 and 4.5 out of 5 (excellent). No adverse events were recorded.

What is lacking in the release are the diagnoses of the young patients, but presumably those results will be presented with the final study. Formal presentations will be at the Israel Society for Clinical Pediatrics (HIPAK) meeting on 8 February in Tel Aviv and at the American Telemedicine Association (ATA) conference 23-25 April in Orlando, Florida. This positive report on efficacy will also aid their rollout with American Well, announced at the end of 2016 [TTA 2 Dec]. Harry Wang at Parks Associates in their blog also named TytoCare one of the two standouts of CES 2017–and the other, Partron (Croise) is not yet on the market.

Tender up: NHS Shared Business Services (SBS) (UK)

Susanne Woodman, our Reader who is our Eye on Tenders, has found this on the Gov.UK contracts finder site:

Lease of telehealth equipment and peripherals by NHS Shared Business Services. Tender # is RA212802. Location is listed as postal code M50 2UW which is Salford, Lancashire. No value assigned. The RFQ expires on Monday 20th February at 12pm. Questions accepted until Wednesday 15th February 2017 at 12:00 with responses returned by Friday the 17th. Quote procedure and more information is via Multiquote.

VA awards over $1 billion in Home Telehealth contracts–at long last (updated)

Breaking News, Updated  The Department of Veterans Affairs (VA) on 1 Feb issued over $1 billion in awards to four companies to provide Home Telehealth vital signs monitoring technologies to veterans in home care and monitoring. The four companies are Medtronic, Care Innovations, Iron Bow Technologies, and 1Vision LLC. The $1 billion is split evenly between the four ($258 million for each company over the five-year duration). The contracts are for an initial year (31 Jan 2018 end date listed on GovTribe.com), renewable annually for five years total. The bid process started in 2015 and the award had originally been scheduled for early-to-mid 2016.

On the suppliers:

  • Medtronic is the incumbent as a supplier since 2011, dating back to Cardiocom’s 2011 award for its home monitoring units (Cardiocom was acquired in August 2013). Medtronic is a Dublin, Ireland HQ’d company with a US headquarters in Minnesota.
  • Care Innovations is well known to our Readers as the developer of Health Harmony and the acquirer of the QuietCare telecare/behavioral monitoring used in senior housing. Their parent is Intel.
  • Iron Bow Technologies is a supplier to VA in other healthcare areas (telemedicine and store-and-forward) and is a large, privately held IT company with multiple Federal contracts and deep Federal contractor roots. Their revenue has been reported at over $462 million (Washington Technology Top 100 2016).
  • 1Vision LLC is a new company formed as a joint venture between HMS Technologies, Inc. and MBL Technologies, Inc. Neither are previously engaged as home telehealth providers, but both are Federal contractors. According to their individual websites, HMS is an IT systems integrator and MBL is engaged primarily in cybersecurity.

The question for this Editor is how Iron Bow and 1Vision, which are not telehealth (vital signs) monitoring companies but telemedicine and IT service providers respectively, will execute Home Telehealth with the VA. Have they partnered with yet-to-be disclosed providers in providing home telehealth services to the VA? (Watch this space)

While the award is the largest in US telehealth, the VA is, by this Editor’s experience in her last position with Viterion Corporation, extremely demanding on its service providers and will be even more so in the future. The future reasons are clear: 1) President Trump has put a Klieg light on the VA and 2) he’s named a new VA secretary, Dr David Shulkin, who is currently VA Undersecretary for Health (confirmation hearing notes courtesy of POLITICO, nomination approved by the Senate committee Tuesday, and easily confirmed Monday night 13 Feb), who has been highly engaged with HIT issues, including both the VistA EHR modernization/replacement and initiatives such as the recently unveiled Digital Health Platform [TTA 12 Jan]. (more…)

Jawbone out of the consumer fitness tracker business, going to clinical model, raising funds: report

Confirming reports from various sources last year [TTA 21 Dec] and prior (July) is a report in TechCrunch confirming what we already guessed: Jawbone is out of the consumer fitness tracker market, is aiming at a B2B2C market of health providers, and needs to raise a lot more money.

Key points in the article:

  • It intends to market a “health product and accompanying set of services sold primarily to clinicians and health providers working with patients”
  • It’s seeking additional funding from investors. TechCrunch‘s sources claim that is at an advanced stage, but no closings as of yet.

We noted in December that research/analytics company CB Insights calculated that 2015 wearable computing (a broader category that includes smartwatches) investment funding fell 63 percent from 2014 to a level comparable to 2012-13, in large part due to the cooling of the fitness segment. TechCrunch’s end of year report from eMarketer and other sources also noted that 2016 sales growth of the wearables sector, forecast at 60 percent, only achieved 25 percent growth and will be equally weak in 2017. Lack of demand, lack of loyalty (most fitness bands are discarded after 3-6 months), unreliable (TechCrunch makes much of customer displeasure), their looks and generally useless (in a clinical sense) data and the greater versatility (and appearance) of smartwatches for those who want them, are all factors. There’s a disenchantment here (‘who needs ’em?’) that mass marketing can’t overcome.

It is worthwhile reflecting that Jawbone, which started off in 1997 as an audio technology company, has burned through over $980 million in 14 funding rounds, generously provided by various VC luminaries of Silicon Valley. (One wonders how much equity is even left in the company, a la ‘The Producers’) (more…)

Updates on Anthem-Cigna, Aetna-Humana mergers

click to enlargeFor our Readers following the Continuing Soap Opera which involves the payer mergers of Aetna-Humana and Anthem-Cigna, some updates:

  • Anthem-Cigna still undecided by despite our 19 January report that the merger would be denied by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia. Reading the SEC 8-K filed in July 2015, the extension to 30 April is automatic if the merger is not consummated or is non-appealable by 31 January. Likely this is to Cigna’s chagrin, as multiple sources over the two years this has been going on have detailed the growing disagreements between the two companies. As we noted in January, Anthem is also running up against ‘the Blues rule’ where it does business as a Blue Cross Blue Shield plan. The arguments that this internal competition is beneficial are pretzel-like indeed.
  • A labor union investor, Westchester Putnam Counties Heavy & Highway Laborers Local 60 Benefits Funds, is suing Aetna for shareholder losses in the Federal District Court in the District of Connecticut (complaint here). The demand is for a jury trial and details what they believe to be false and misleading statements by management and not disclosing adverse facts.

Healthcare Dive is recommended for their two deeper dives: 1 Feb on Anthem-Cigna and the outcomes of both mergers, 30 Jan on the labor union lawsuit. The likelihood of either happening becomes more remote as time goes by, but there could be a surprise.