Technology for Aging in Place, 2017 edition preview

Industry analyst Laurie Orlov previews her annual review of ‘Technology for Aging In Place’ on LinkedIn with six insights into the changes roiling health tech in the US. We’ll start with a favorite point–terminology–and summarize/review each (in bold), not necessarily in order.

“Health Tech” replaces “Digital Health,” begins acknowledging aging. This started well before Brian Dolan’s acknowledgment in Mobihealthnews, as what was ‘digital health’ anyway? This Editor doesn’t relate it to a shift in investment money, more to the 2016 realization by companies and investors that care continuity, meaningful clinician workflow, access to key information, and predictive analytics were a lot more important–and fundable–than trying to figure out how to handle Data Generated by Gadgets.

Niche hardware will fade away – long live software and training. Purpose-built ‘senior tablets’ will likely fade away. The exception will be specialized applications in remote patient monitoring (RPM) for vital signs and in many cases, video, that require adaptation and physical security of standard tablets. These have device connectivity, HIPAA, and FDA (Class I/II) concerns. Other than those, assistive and telehealth apps on tablets, phablets and smartphones with ever-larger screens are enough to manage most needs. An impediment: cost (when will Medicare start assisting with payments for these?), two-year life, dependence on vision, and their occasionally befuddling ways.

Voice-first interfaces will dominate apps and devices. “Instead we will be experimenting with personal assistants or AI-enabled voice first technologies (Siri, Google Home, Amazon Alexa, Cortana) which can act as mini service provider interfaces – find an appointment, a ride, song, a restaurant, a hotel, an airplane seat.” In this Editor’s estimation, a Bridge Too Far for this year, maybe 2018. Considerations are cost, intrusiveness, and accuracy in interpreting voice commands. A strong whiff of the Over-Hyped pervades.

Internet of Things (IoT) replaces sensor-based categories. Sensors are part of IoT, so there’s not much of a distinction here, and this falls into ‘home controls’ which may be out of the box or require custom installation. Adoption again runs into the roadblocks of cost and intrusiveness with older people who may be quite reluctant to take on both. And of course there is the security concern, as many of these devices are insecure, eminently hackable, and has been well documented as such.

Tech-enabled home care pressures traditional homecare providers – or does it? ‘What exactly is tech-enabled care? And what will it be in the future?’ Agreed that there will be a lot of thinking in home care about what $200 million in investment in this area actually means. Is this being driven by compliance, or by uncertainty around what Medicare and state Medicaid will pay for in future?

Robotics and virtual reality will continue — as experiments. Sadly, yes, as widespread adoption means investment, and it’s not there on the senior housing level where there are other issues bubbling, such as real estate and resident safety. There are also liability issues around assistance robotics that have not yet been worked out. Exoskeletons–an assistance method this Editor has wanted to see for several years for older adults and the disabled–seems to be stalled at the functionality/expense/weight level.

Study release TBD

Debate on Care Quality Commission’s position on online prescription services on Radio 4’s TODAY (UK)

Friday’s BBC Radio 4 TODAY breakfast show has two segments discussing the Care Quality Commission‘s public warning on online prescription services and potential danger to patients. The first is a short interview of Jane Mordue, Chair of Healthwatch England and independent member of the CQC (at 00:36:33-00:39:00). The second, longer segment at 02:37:00 going to 02:46:30 features our own Editor Charles Lowe, in his position as Managing Director of the Digital Health and Care Alliance (DHACA), debating with Sandra Gidley, Chair of the Royal Pharmaceutical Society (RPS) English Board. The position of the RPS is that a face-to-face appointment is far preferable to an online service, whereas Mr Lowe maintains that delays in seeing one’s GP creates a need for services where a patient can see a doctor online and receive a prescription if necessary. The quick response allays anxiety in the patient and provides care quickly. Both agreed that a tightening of guidelines is needed, especially in the incorrect prescribing of antibiotics, and that there is no communication between patient records. Mr Lowe notes that GPs have always been comfortable with a telephonic consultation but are far less so with telemedicine consults via Skype. Here’s the BBC Radio 4 link available till end of March.

In the US with 24/7/365 telemedicine services such as Teladoc, MDLive and American Well, there is a similar problem with patient records in many cases except for history that the patient gives, but this is an across the board problem as the US does not have a centralized system. The prescribing problem is less about antibiotics, though MRSA/MSSA resistant superbugs are a great concern. According to Jeff Nadler, CTO of Teladoc during his #RISE2017 presentation here in NY attended by this Editor, Teladoc has a 91 to 94 percent resolution rate on patient medical issues. Of that 9 percent unresolved, 4 percent are referred, 2 percent are ‘out of scope’, 1 percent go to ER/ED–and 2 percent of patients are ‘seeking meds only’, generally for painkillers. Teladoc’s model is B2B2C, which is that patients access the service through their health plan, health system, or employer.

CHANGED DEADLINE Calling all diabetes prevention apps: may be your chance for greatness!

Our Mobile Health is seeking to identify the best digital behaviour change interventions aimed at helping people diagnosed as pre-diabetic to reduce their risk of onset of Type 2 Diabetes. They are working with NHS England and the Diabetes Prevention Programme to identify the best 4-5 of these that are suitable for deployment to around a total of 5000 people across England. The aim is to build up an evidence base for digital behaviour change interventions for people diagnosed as pre-diabetic.

Organisations with suitable digital behaviour change interventions are invited to submit their solutions for inclusion. These should be either actually deployed or will be ready to be deployed within three months. They should be suitable to be, or have been, localised for the UK market, and they should not be dependent on any further integration with the UK health system for deployment.  Shortlisted digital behaviour change interventions will be invited to participate in Our Mobile Health’s assessment process; the final selection will be made based on the results of that assessment.

The deadline for submissions, which can be made directly online is midday on Wednesday 15th March.  NOTE THIS IS A CHANGE FROM THAT PREVIOUSLY ADVISED. There is more about the programme on the NHS website.

(Disclosure: this editor has been asked to assist with the assessment process referred to above)

A cornucopia of events and opportunities (UK/EU)

This editor has been extremely busy of late representing DHACA members’ interests in Brexit discussions, finalising RSM events and researching technology to help carers. However the requests to promote events have continued to arrive so here is a very brief summary:

Innovate UK is looking for new assessors – click here for more information.

On 7th March ADASS is holding its Care Apps Showcase and Conference event in Central Birmingham. Book here.

The Wearable Technology Show is on 7th & 8th March at Excel, and for the first time will include within it the Digital Health Technology Show. This editor is presenting. Readers can get free entry to the exhibition and cut-price entry to the conference sessions (quote DHTDHAC17).

On 23rd March, the London Health Technology Forum has its annual pitch session. If you fancy trying your hand at pitching your start-up, or your new idea, we want you! There’s no guarantee that winners will get funded. However there are lots of finance people coming, and winners will certainly get some nice champagne…and bag lots of useful experience. Book here. Contact marie.carey@bakerbotts.com if you want to pitch.

The RSM’s Apps event is in its fifth year and on 4th April. We have a veritable constellation of who’s who in mHealth apps presenting this year: I hate the expression “must see” though it’s very appropriate in this case. Book here. These are incredible value events because one of the charitable objects of the RSM is education: compared with commercial events they are a steal, and the quality is superb.

PwC has a 13 week startup growth programme for revenue generating health companies, entitled ‘future of health’ starting 6th March. They still seem to be taking enquiries though, more details here.

Aging (sic) 2.0 has come to London and holds a global startup search event on 11 April. If you want to register on their startup database,  perhaps to participate in that event, go here.

The DigitalHealth.London Accelerator is now open again for applications. Closing date is 12 midnight on Thursday 20 April

EHTEL have their Symposium in Brussels on 15-16 March – apply here.

The RSM is working with the IET in partnership for the third year to offer you Future of Medicine; the role of Doctors in 2027 on 18th May with the now-expected array of iconoclastic presenters telling us how different the delivery of care will be in ten years. Book here.

More shortly.

#HIMSS17 roundup: machine learning, Proteus, Soon-Shiong/NantWorks’ cancer vax, Uniphy Health, more

HIMSS17 is over for another year, but there is plenty of related reading left for anyone who is not still recovering from sensory overload. There wasn’t big news made, other than Speaker John Boehner trying to have it both ways about what the House needs to do about replacing the failing ACA a/k/a Obamacare. Here’s our serving:

  • If you are interested in the diffusion of workflow technologies into healthcare, including machine learning and AI, there’s a long-form three-part series in Healthcare IT News that this Editor noted has suddenly become a little difficult to find–but we did. The articles also helpfully list vendors that list certain areas of expertise in their exhibitor keywords.
  • Mobihealthnews produced a two-page wrap up that links to various MHN articles where applicable. Of interest:
    • a wound measurement app that Intermountain Healthcare developed with Johns Hopkins spinoff Tissue Analytics
    • Children’s Health of Dallas Texas is using the Proteus Health ingestible med sensor with a group of teenaged organ post-transplant patients to improve med compliance
    • the Medisafe med management app has a new feature that alerts users to drug, food and alcohol interactions with their regimen, which is to this writer’s knowledge the first-ever med app to do this
    • Info security spending is rising, according to the Thales Data Threat Report. This year, 81 percent of U.S. healthcare organizations and 76 percent of global healthcare organizations will increase information security spending.
  • Healthcare and sports mogul Patrick Soon-Shiong presented on NantHealth‘s progress on a cancer vaccine that became a significant part of the former VP Joe Biden’s initiative, Cancer Breakthroughs 2020. Dr Soon-Shiong stated that the FDA has given approval to advance the vaccine into later clinical trials, and also unveiled Nant AI, an augmented intelligence platform to high-speed process genome activity of cancer tumors and the Nant Cloud, a cloud server which can generate bioinformatic data at 26 seconds per patient. This is in addition to the NantHealth GPS Cancer diagnostic tool used to isolate new mutations in a given tumor. HealthcareITNews MedCityNews takes a dimmer view, noting two recent cancer vaccine failures. Dimmer still is Stat’s takedown of Dr Soon-Shiong, which reportedly was the talk of HIMSS.
  • Leading up to HIMSS, Newark’s own Uniphy Health announced UH4, the latest generation of its enterprise-wide communications and clinical collaboration platform for hospitals and clinics to facilitate the ‘real-time health system’. Release

Not enough? DestinationHIMSS, produced by Healthcare IT News/HIMSS Media, has its usual potpourri of official reporting here.

Here’s Howz: now electricity consumption as elder minder (UK)

click to enlargeIntelesant’s latest project, Howz, has added electricity consumption to the monitoring set of Activities of Daily Living. The Howz set of multiple sensors generally monitors activity in the home, home temperature, lights on/off, and exterior door opening/closing, depending on their placement, but one sensor monitors electricity consumption by directly going into the meter to determine whether appliances are being used as an indicator of activity. These activities are reported over a smartphone app to those who have permission for reports. After a trending baseline over a few days is established via algorithms, the Howz system tracks departures from that norm and alerts via the smartphone app. This bears resemblances to this Editor’s former company which developed the behavioral telecare (first and still in market) QuietCare system, but the ‘meter reader’ is a new and smart twist.

Intelesant is testing Howz in 100 Manchester homes and is scheduled to be in a pilot with dementia patients at home in partnership with the Surrey and Borders Partnership NHS Foundation Trust. In December, they also announced that they are a finalist with the EDF Energy Blue Lab Acceleration Programme.

Howz is more comprehensive (and expensive) than 3rings‘ single appliance plug which keys into specific activities (tea kettle, TV on) [TTA articles here] but the objective for family peace of mind for older adults, especially those living alone, is the same. Available consumer direct from their website in the UK only (unfortunately) from £199 for the starter kit. New Scientist, Howz video on YouTube Hat tip to former Northern Ireland Editor Toni Bunting

Telemedicine used in MS neuromodulation study at NYU Langone, with positive results (US)

MS patients in a small NYU Langone Medical Center-led pilot of neuromodulation and cognitive training using telemedicine supervision experienced significant improvement in complex attention and reaction time. Non-invasive transcranial direct current brain stimulation (tDCS) was added to a previously tested cognitive training program for MS patients. Telemedicine (real-time video) was used to deliver the training, monitor patients in the program and provide follow-up support.

The study control was a cognitive training (CT)-only group. According to the abstract, “after ten sessions, the tDCS group (n = 25) compared to the CT only group (n = 20) had significantly greater improvement in complex attention (p = 0.01) and response variability (p = 0.01) composites. The groups did not differ in measures of basic attention (p = 0.95) or standard cognitive measures (p = 0.99).” These results corresponded to the stimulation area in the dorsolateral prefrontal cortex, according to the lead researcher Leigh Charvet, PhD.

The current used in the tDCS unit helps neurons fire more readily, versus making them fire. The tDCS unit used was likely provided by NYC-based Soterix Medical, a developer of neuromodulation systems used in clinical trials. One of the study authors, Abhishek Datta, PhD, is their CTO.

The research is also promising in helping to deliver therapy to MS patients at home, reducing the travel need on both sides, and to develop analytics to optimize medication. In future, the researchers hope to expand the study group to Parkinson’s disease patients. MedCityNews, Neuromodulation (the official journal of the International Neuromodulation Society; abstract only, full study requires additional access)

Utah telehealth expansion bill passes Senate and House

The bill to expand telehealth in Utah, which was amended by a click to enlargeUtah Senate committee on February 14th (see previous TTA article) has now been passed by both the Senate and the House of Representative in the state. The amended bill was passed by the Senate on Thursday last week and by the House the next day according to the Utah government website.

The original bill, HB154, sponsored by Rep. Ken Ivory, had a controversial clause restricting the prescription of abortion medication during a telemedicine consultation. The amendment removed this restriction on the basis that such restrictions have been successfully challenged in the courts in other states.

The bill is now being “enrolled” and is expected to be signed into law in due course.

HIMSS17 dispatches: Mayo maps neonate telemedicine, Amwell-Samsung, Samsung-T-Mobile

Mayo maps out an enterprise telehealth (telemedicine) support structure. Here’s how the Mayo Clinic deployed neonatology remote telemedicine to their sites in Minnesota, Arizona, and Florida. There’s plenty of flow charts and summary points in this presentation deck around team building, staffing consistently and reporting that improves processes. Hat tip to our HIMSS correspondent on the scene, Bill Oravecz of Stone Health Innovations. Update: If you are using Chrome, you may have difficulty downloading session handouts from the HIMSS17 website Schedule pages. Try another browser. If you are interested, you may be able to obtain through contacting the two session presenters, Susan Kapraun and Jenna A. Beck, MHA, directly.

American Well and Samsung are partnering on integrating care delivery. Their joint release is low on details, but towards the end there’s an indication that American Well, its partners, and other providers and payers will be able to offer their services to Samsung customers. Other reports (Healthcare Dive) indicate the partnership is destined to enhance Amwell’s Exchange platform between payers and providers. Partners listed are Cleveland Clinic, New York-Presbyterian Medical Center and Anthem (undoubtedly resting after sparring with Cigna). Also Healthcare IT News.

Separately, Samsung also announced a partnership with T-Mobile for developing IoT in the senior care space. This would pair Samsung’s ARTIK Cloud with T-Mobile’s cellular network for Breezie, a social engagement for seniors interface built on a Samsung tablet which has apps and connects to various peripherals for post-acute care and daily living. It sounds interesting, but once again the release hampers the reporter by being as clear as mud in what it’s all about. See if you can decipher this: ARTIK Cloud permits “Amazon Alexa, Samsung SmartThings, iHealth Feel Wireless Blood Pressure Monitor and the Pulse Oximeter – to intelligently communicate with each other.” “Each Breezie interface has more than 40 preconfigured accessibility settings and sensor driven analytics to adjust for different levels of digital literacy, as well as physical and cognitive ability.” The Breezie website is far more revealing. Healthcare Dive also takes a whack at it towards the end of the above article.

The Theranos Story, ch. 37: the Object Lessons for future healthcare entrepreneurs

click to enlargeThere’s an interesting take on the Theranos debacle in Entrepreneur by management consultant/author Steve Tobak. He takes a step back from the healthcare technology that didn’t work, the big money lost and the puffery, where most of us have concentrated. Mr Tobak instead sketches a case study of a Startup House of Cards as an Object Lesson in how entrepreneurialism is NOT supposed to work.

Theranos was a Top Ten List of fatal errors. This Editor’s summary:

  1. They generated no revenue. In just over a decade, Theranos blew through hundreds of millions in funding (he says $700 million, the WSJ has estimated $900 million).
  2. They weren’t anywhere near break-even. By the time Theranos was in 40 Walgreens Wellness Centers, it should have been on a road to break-even and scalable.
  3. The company was built as a fraud from the start or near-start, much like Enron and WorldCom
  4. The company was doomed by a culture of utter secrecy (Editor’s note: none of their technology was peer reviewed, tested or published)
  5. The company was doomed by Ms Holmes’ falsity and hubris in not having a backup plan; black turtlenecks aren’t it
  6. The company was doomed by its own hype: a PR machine AND gullible press, who created a Steve Jobs-esque icon sans accomplishments out of Ms Holmes
  7. The company sold a bill of goods to EVERYONE, including multiple Federal regulators, patients and the public (Editor’s note: he doesn’t mention the Board of Directors and Stanford University!)
  8. Investors, swept up in the private equity bubble, didn’t do their due diligence (though some did)
  9. Ms Holmes had no ability to run this business, but she controlled it 100 percent so no one said boo
  10. “This is what happens when people treat ventures so casually and callously that risk becomes immaterial.”–Mr Tobak

Perhaps we should be grateful that the Edison lab didn’t actually work with all these dysfunctions on parade!

The close to this article is sobering: “Today, there are 186 venture-backed startups valued at $1 billion or more and countless companies valued above $100 million, according to CB Insights. Not too long ago, Theranos was near the top of that unicorn list with a valuation of $9 billion. We still have no idea if it’s a one-off or the beginning of a trend. Remember the Theranos saga as a cautionary tale. Nothing about it is the way business should be. Nothing.” And it will continue, because $900 million makes Theranos a Big Cautionary Tale. Hat tip to our Eye on Theranos, Bill Oravecz of Stone Health Innovations.

See here for the 36 previous TTA chapters in this Continuing, Consistently Amazing Saga

HIMSS17 dispatch: developing a telehealth IT team in health system and multi-site networks

Reader Bill Oravecz of Stone Health Innovations is attending HIMSS17 in Orlando, and was kind enough to forward a ‘hot off the presses’ link to this presentation deck given by Jay Weems of Avera eCARE (downloadable as PDF). The subject is ‘Telehealth Workforce Offers Unique Competencies & Opportunities’ and covers how telehealth/telemedicine IT is developed in a health system, mentoring rural originating sites in building proficiencies, and Avera’s experience in supporting a 13-state, multi-system, multi-specialty network. This is more about telemedicine (virtual consults) but offers lessons in developing both in a B2B model.

Update If you are using Chrome, you may have difficulty downloading session handouts from the HIMSS17 website Schedule pages. Try another browser.

HIMSS17 news flashes: Lenovo, Orbita, Tactio, Garmin, Parallax, Entra Health, Philips, IBM

Voice commands a new frontier in telehealth. Why not dispense with the pill dispenser, the smartphone, the tablet? Lenovo Health and Orbita have put together a solution that works via Amazon Alexa. The Orbita Voice is a voice-controlled speaker for the home that connects with the Lenovo Smart Assistant to “help patients with chronic and post-acute care needs be more fully engaged in their wellness at home. Enhancing a patient’s ability to access and share information with providers, caregivers, and family members contributes to improved care journey management, treatment adherence, and medication compliance.” The release isn’t informative as to how it will do this, but apparently it’s all in the programming. This is the second Lenovo Health initiative on view in the past few months. This Editor saw at NYeC Digital Health their Authoritative Identity Management Exchange establishing a universal, verifiable patient ID system [TTA 19 Jan video] and was impressed.

Canada’s Tactio telehealth platform is adding Garmin wearables to its compatible peripherals. TactioRPM is a mobile platform that combines mobile apps, hundreds of connected health integrations (Garmin, A&D, Fitbit, Roche, Nonin, Omron and Welch Allyn), patient questionnaires, digital coaching programs and HIPAA-compliant messaging. TactioRPM has FDA Class 1, CE and ANVISA (Brazil) clearances. Release via Yahoo Finance

Parallax Health Management (PHM) is presenting with Entra Health (mobile HIT) and Microsoft Cloud its remote patient monitoring systems. Based on the PHM website, they are tablet based with a raft of peripherals for the multiple-chronic condition patient. The release highlights their chief medical officer, Bob Arnot, MD who is well known in the US as an author and television presenter.

Philips announced US FDA 510(k) clearance of the IntelliVue Guardian software system, which pairs with the single-use, adhesive Philips Wearable Sensor for continuous clinical-grade monitoring of high-acuity patients. The software gained CE Mark certification last October. They also debuted a mobile app called Jovia Coach for healthcare systems to reach patients at risk for Type 2 diabetes. MedCityNews.  Philips’ ongoing Intensive Ambulatory Care (IAC) pilot program with Banner Health in Arizona so far has delivered impressive reductions in overall costs of care by 34.5 percent and hospitalizations by 49.5 percent. LeadingAge/CAST

IBM Watson heralds cognitive computing, or computers that learn, according to IBM CEO Ginni Rometty, and will profoundly change medicine as well as IBM, as they are betting the company on it. In the meantime, they have announced the Watson Platform for Health Cloud and a specialized Watson Health Consulting Services unit. Health Data Management. An elephant in the ointment is that the prestigious MD Anderson Cancer Center, part of the University of Texas, has put their Watson program, the Oncology Expert Advisor, on indefinite hold as it checks out other contractors after sinking $62 million into OEA over three years without a measurable result. Forbes

The Theranos Story, ch. 36: Their money–and time–are running out

click to enlargeA garage sale soon for Theranos? A report in the Wall Street Journal, citing sources on a January investor call, revealed that Theranos has $200 million on hand, but zero revenue in 2015 and 2016. $200 million on hand sounds like–and is–a lot. But Theranos is, once again, oh so special. It’s less than 25 percent of their over $900 million raise. They’ve made no money in the past two years and are likely to make none in 2017 with an unapproved miniLab. Their CEO cannot run a lab by Federal action. They’ve laid off all but 200+ employees, all of whom with any shred of intelligence are job hunting. Then think of all the lawsuits: Walgreens Boots seeking to claw back its $140 million, individual and class actions on behalf of other investors, and the looming Arizona state fraud action. It’s a mere pittance when Theranos has to hire armies of attorneys who charge Billable Hours Galore and will likely lose some if not all of the lawsuits. This Editor is making an educated guess that at least one legal team is working on a bankruptcy filing. Fortune, TechCrunch, Business Insider

Forbes, like TechCrunch once a hyper-overdrive cheerleader for Ms Elizabeth Holmes and Theranos, offers up a profile of John P.A. Ioannidis, MD, DSC who holds the C.F. Rehnborg Chair in Disease at Stanford University and is director of the Stanford Prevention Research Center at the School of Medicine. Dr Ioannidis, according to the article, was the first to raise questions about Theranos’ methodology based on the obvious–that Theranos had published nothing in scientific journals. Theranos’ general counsel then reached out to suggest co-authoring an article with Ms Holmes in a major journal. Per Dr Ioannidis, it would support “the company view that FDA clearance offered the highest possible level of evidence for any diagnostics blood test technology.” They also said, “recant your existing views and writings about these misgivings.” He did neither, to his credit. The article interestingly does not explore the heat he, in as prestigious a position as he was, must have received, based on the close ties this Editor and others have noted between Stanford and Ms Holmes. Hat tip to Bill Oravecz of Stone Health Innovations

“This is the way the world ends/Not with a bang but a whimper.” T.S. Eliot puts a fine point on a Hollow Company, indeed.

See here for the 35 previous TTA chapters in this Continuing, Consistently Amazing Saga.

Tender up: Durham Smart County on Social Isolation

Susanne Woodman, our Eye on Tenders, has uncovered an interesting one that potentially involves telehealth.

Title: Durham Smart County – Tackling the Healthcare Causes and Consequences of Social Isolation. Small Business Research Initiative (SBRI)
Description: Durham County Council’s Corporate Management Team has signed off an innovative approach to stimulating high value economic activity in County Durham. This approach explicitly links economic development activity to delivering transformative public health outcomes: using “problems” as assets, as opportunities for innovative product and service development and catalysing the establishment of a commercial cluster in healthcare.
Coverage area: Durham and Tees Valley
Expression of interest by 31 March
Contact: Vicky Watson, email vicky.watson2@durham.gov.uk, telephone 03000 264860
Address: Durham County Hall, Durham, County Durham, DH1 5UL, UK
https://procontract.due-north.com/Advert/Index?advertId=3dbec8c1-4df4-e611-80dd-005056b64545

Disrupting the pathways of Social Determinants of Health: the transportation solution

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics examines one aspect of social determinants of health, transportation. Social factors have been called the missing links in population health: others are housing, food, finances, and employment. This is not only affordable ‘a to b’ transportation, but also clean, safe and tailored to the patient’s needs. Sarianne interviewed Todd Thomas, then of Veyo and now of Zendrive, a company developing data analytics to make roads safer and to save lives through measuring driver behavior and coaching. Other companies in Veyo’s area are Uber Health and Circulation [TTA 10 Nov].

More and more people are starting to have conversations around the Social Determinants of Health.  And for the first time, the c-suite within healthcare companies are talking about transportation.  People haven’t talked about transportation before because there haven’t been good choices, only poor and expensive service levels. Transportation has always been a low budget item and a cost center. Now people are talking about transportation as a key link in the complete continuum of care. If we are talking about treating the complete person, a huge part of that is making sure they are getting to their treatments on time every time, picking up their pharmaceuticals and shopping to get fresh, clean food. These things make a huge impact in the lives of patients and the members.  It is great that people are becoming aware of transportation and talking about it.Todd Thomas, VP Strategic Business Development at Veyo

Social Determinants of Health, as recognized by the World Health Organization, are the conditions in which people are born, grow up, live, work and age, together with “the systems” that are put in place to deal with illness. Transportation is one of those systems.  In a conversation with Todd Thomas, VP of Strategic Business Development at Veyo, he chronicled how the digitization of this sector broke barriers in Non-Emergency Medical Transportation.  The medical transportation, as Thomas described, was very challenged for decades with the same nationwide providers, all delivering the same levels of service and at the same price.  None had any initiative to adapt to new technologies or evolve their business models.  Medical professionals and companies across the US had come to expect poor service as the norm.  It wasn’t until a couple of years ago when the transportation network companies, the TNCs such as Uber and Lyft, came onboard into the market and really changed transportation in the US and in the world. Thomas contends that what the TNCs did for the transportation world has really turned things upside down, and absolutely raised the level of customer expectations and raised standard of what transportation was going to be.  And ultimately closed a huge care gap for transportation-dependent patients. (more…)

Utah Senate removes telehealth bill abortion restrictions

The controversial topic of abortion has been the centre of discussion of a new telehealth bill in Utah. The bill, HB 154, introduced by Republican Rep Ken Ivory, primarily addresses the issue of insurance coverage for telehealth in Utah and proposes to amend two previous acts and the Utah Insurance Code to achieve this. However, the bill also contained a controversial final clause which stated “A practitioner treating a patient through telehealth services, as described in Title 26, Chapter 59, Telehealth Act, may not issue a prescription through electronic prescribing for a drug or treatment to cause an abortion, except in cases of rape, incest, or if the life of the mother would be endangered without an abortion”

Last week it was reported (in Healthcare IT News) that the bill was discussed in the Public Utilities, Energy and Technology Standing Committee. Similar restrictions on prescribing abortion medication following telemedicine consultations were legally challenged in Idaho by Planned Parenthood resulting in the ban being lifted at the end of January (mobilehealthnews, mhealthintelligence). Earlier, in June 2015, another legal challenge, this time in Iowa, went all the way to the Supreme Court which rejected a state requirement for doctors to see abortion patients in person and ruled that the regional Planned Parenthood unit  could continue to provide abortion inducing medication using remote video consultations.

According to data published by the Guttmacher Institute, as of February 1, 2017, there are 19 states which require a physician to be physically present when abortion inducing medication is prescribed (see Medication Abortion).

This week, when the Utah bill was discussed in the Senate Health and Human Services Committee an amendment proposed by Republican Senator Brian Shiozawa removing the above abortion clause was accepted. Shiozawa expressed fears that a constitutional challenge could give negative publicity to  telehealth as a whole. The bill now moves to the Senate for consideration.