Tender Alerts: Nottingham NHS telestroke, Scotland remote health and care

Our Eye on Tenders, Susanne Woodman of BRE, brings to our attention two from UK.Gov’s Contracts Finder and TED, with full information at the links:

  •  Telemedicine Solution for Stroke Services from Nottingham University Hospitals NHS Trust. Nottingham City Hospital requires an immediate replacement for a stroke Telecart which deals with out of hours (OOH) stroke emergencies. This system allows the consultants to remotely interact with patients and staff on the stroke unit. The patient is seen in real time video and audio. Future plans, not in this contract, are for a replacement system in multiple locations. Contact is Niall Fowler of the NUH NHS Trust. Closing 26 May.
  • NHS National Services Scotland Remote Health and Care Monitoring and Communication System. The procurement is intended to support the delivery of home/mobile health monitoring and video conferencing enhanced care. At a later date, this will expand to incorporate future digital telecare or wellbeing solutions. A registration of interest is required for more information, available at the Public Contracts Scotland website. Value is £ 2 million. Note: this listing is a Prior Information Notice with estimated publication 21 June. These are generally released for high-value contracts with usually a compressed application period since information has been previously published.

Better than ‘Dallas’? Anthem and Cigna in Delaware court (updated); Anthem’s SCOTUS appeal

click to enlargeThe War of the Payers grinds on. It’s altogether appropriate that this is the 100th anniversary of the US entry into the Great War. It was marked by a costly strategy that stalemated in the trenches and fatally ground into dust over four years men, machines, national treasuries, and ultimately a world order. In this Editor’s view, we are witnessing it writ large in Anthem’s, and to a lesser extent Cigna’s, actions after their merger was put paid to, first by a DC Federal District, then a District Appeals court, in a suit brought by the Department of Justice (DOJ) and 11 states.

Update: In Delaware Chancery Court May 8, Anthem requested a 60-day preliminary injunction to prevent Cigna from ending their merger. This was in a hearing on the February restraining order that Anthem received to block Cigna’s exit, filed in that court, from the merger after the District Court decision. Vice Chancellor Travis Laster said (after five hours of argument) that he would rule as soon as possible. Reuters  New: Even Judge Laster admits it’s a ‘long shot’ that Aetna could find a path to success after two courts turned down the merger. Cigna’s legal spokesperson further amplified that, stating that it was ‘a near impossibility’ and that no “divestiture package would have solved” the merger’s problems. Bloomberg  See the back story below

Watch for fireworks whatever the decision. Antitrust lawyer David Balto rated its potential “more fun than watching an episode of [the television melodrama] Dallas“. CT Mirror

The Chancery Court action is far more important than Anthem’s ‘petition for writ of certiorari’ to the Supreme Court of the US (SCOTUS) for review of the lower court ruling, citing the following:

  1. The 2 to 1 split in the court decision
  2. That the 1960s court precedents relied on by the District Court must be updated to today’s understandings of economics and consumer benefit
  3. And asserting that the loss of the merger “would limit access to high quality affordable care for millions of Americans and deny them more than $2 billion in medical cost savings annually” from the improved bargaining power of the new entity

(What perhaps was not included was that the merger partner, Cigna, wants out, out, out of the merger, which does tend to put a negative cast on the whole affair, as it did for the DC District Court.)

This Editor believes that the Chancery Court decision to extend for 60 days–into July– is critical to any SCOTUS hearing, as it is unlikely there would be any merit in a review of a dead deal even if there is a potentially novel issue. In the Reuters report, Anthem’s attorney mentioned the SCOTUS petition with a decision date by early July (the end of the term). He confirmed their intent to appeal to the DOJ for a ‘negotiation’ once the Trump Administration had its nominated officials in place. In Bloomberg, Cigna’s attorney’s position is that SCOTUS wouldn’t even consider the petition until September, which would put it past the extension and a decision into the next term.

Petitions for writ of certiorari are the Hail Mary pass–the last-ditch move–of court actions. (more…)

d-Lab opens Challenge to transform use, governance of Personal Health Data

d-Lab is calling for international healthcare innovators to take a good, hard look at how we can use, secure and increase access to personal health data (PHD). In this Challenge, d-Lab is seeking innovative ideas, projects, and solutions that consider wider uses of PHD for patients and research, such as:

  • innovative modes of PHD governance
  • future use in health and medical research
  • inclusion of new types of data, such as from wearables
  • contribution to wellbeing and aging solutions
  • innovative business models that assure the long-term sustainability of PHD usage and governance

The Challenge opened this past Tuesday and closes on 27 June, with winners announced in September. There will be a maximum of two
winning proposals that will lead to the setting up of a maximum of two partnerships and two pilots. See here for d-Lab’s website and here for the terms and conditions PDF. d-Lab is a program of Mobile World Capital-Barcelona. The Challenge is supported by Clinic Barcelona, Research2Guidance, and TicSalut.

Two London events worth considering

A quick blog to draw your attention to two events at the Royal Society of Medicine that this editor has been involved in setting up, and that should be of interest.

The first is the Future of Medicine: the Doctor’s Role in 2027, on May 18th, which has a host of excellent speakers looking at how technology is likely to change the way medicine is practised in ten year’s time, to help clinicians, healthcare managers, academics and suppliers prepare for those changes to ensure maximum improvement in patient outcomes. Book here

The second event, in partnership with the IET, Digital Health and Insurance: a Perfect Partnership? on June 1st brings in a wide range of international speakers to explore how, by giving insurers precision over the risks they are taking, digital health is transforming health insurance, both for humans and for pets, and in the process may well result in a fundamentally different way of providing, and paying for, health in the future. Not to be missed! Book here.

As has been said before, the RSM has medical education as one of its charitable objects (the other is promoting medical advances) so their events are extremely attractively priced.

Fitbit reaching out to NHS–but new smartwatch ‘a giant mess’ (updated)

There have been sketchy reports of Fitbit’s CEO James Park meeting with the NHS last month to get Fitbits into the ‘big moves’ in wearables and apps promised by Health Secretary Jeremy Hunt. Mr. Park’s interview with the Sunday Times (limited access) indicated that Fitbit’s NHS project, should it happen, would be for exercise and activity monitoring, similar to the partnership with UnitedHealthcare which reduces premiums based on policyholder exercise monitoring. This move towards payers is in line with reports starting last year of Fitbit’s seeking clinical markets and moving away from the fickle B2C market. City AM

click to enlargeGiven this week’s leak/reveal and scuttlebutt on the new Fitbit smartwatch, Mr. Park needs to gin up a big payer, quickly. The advance buzz is not positive nor kind. It’s delayed from spring to end of year–in competition with the latest iteration of the Apple Watch. This advance photo of codenamed ‘Higgs’ from Yahoo!Finance indicates a certain clunkiness (and derivation from the panned semi-smartwatch Blaze). It’s pricey, rumored to be priced at around $300. Features include a 1,000nit, built-in GPS, heart-rate monitoring, contactless payments, Pandora and four days of battery life along with connectivity to new Bluetooth headphones. Yet TechCrunch notes “complaints about design, production delays, antenna issues and software problems.” in what they dub “a giant mess”. Forbes notes problems in waterproofing and GPS signal. There are other Android-based smartwatches that do the same for the same price or less. Will this save Fitbit? To be determined….

Update: CEO Park denies delays in the new smartwatch, saying “all new product introductions are on track”, but then again–it hasn’t been officially announced! On the earnings call Thursday, Fitbit stated that new products are now accounting for 84 percent of 1stQ revenue. The company also reported better-than-expected earnings for the first quarter of 2017, reporting an adjusted loss of 15 cents per share on revenue of $299 million. Full year projected at $1.5 – 1.7 bn. Marketwatch, The Verge

A stride ahead in gait analysis for detecting potential health issues

click to enlargeReaders experienced in senior healthcare know that changes in gait can be predictors or a proxy for negative change in physical or mental status, for instance when walking becomes slow or unsteady and the risk of falling rises. We’re familiar with various remote monitoring approaches such as pads, sensor arrays, camera systems such as the VICON tracker, worn sensors, and Fitbits but none so far have proven workable, widespread, or particularly accurate. A research group at MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) have designed a system using wireless signals which can measure the walking speed of multiple people with 95 to 99 percent accuracy, the same as clinical measurement and VICON. The WiGait device is the size of a small painting and emits signals at about the level of a smartphone. It analyzes reflected signals off the body and can differentiate through algorithms the type of movement, e.g. walking versus brushing teeth. It can also gauge stride length, since changes in that may indicate progression in diseases such as Parkinson’s. Since the WiGait can be used for longitudinal tracking, gait changes can be further correlated with disease state with the intent of avoiding hospitalization. The researchers built off of previous work on WiTrack, which used signals to track behaviors from breathing and falling to specific emotions.  MIT NewsPaper: Extracting Gait Velocity and Stride Length from Surrounding Radio Signals

Blue Cedar releases new security for health apps, built into the app

click to enlargeFor healthcare organizations, device and app developers, one stumbling block for apps has been securing data. The endpoint for security has been to secure and manage the device, which constrains widespread BYOD use and convenient downloading. What if, instead, the apps and the data on them were secured without needing to further secure the device? This is what Blue Cedar, a mobile security developer, has done with what they call a mobile device management (MDM) alternative, with security ‘baked into the app”.

One of their first for the new platform is MedStar Health, the largest healthcare provider in the Maryland and Washington, DC region. Blue Cedar’s MDM enabled them to secure their mobile app for clinicians that contained protected patient information (PHI) yet run securely on personal mobile devices.

Blue Cedar’s Chief Product Officer, Chris Ford, spoke with this Editor and explained that their new platform (V3.14) works through injecting a security code in the mobile app, which enforces policy on encryption and use. Their Enterprise Mobility Management (EMM) can now incorporate support for secure apps on unmanaged devices, security and connectivity for VoIP-based apps, and enforcement of granular controls for HTTP-based apps. This and other features of the new platform will permit healthcare app developers to distribute apps through sites like the Apple Store or Google Play and “trust functionality” that allows control of data sharing between apps on the same device.

Blue Cedar spun off last year from IoT security company Mocana, founded in 2002, and now has over 150 customers in multiple verticals. They believe their MDM alternative is ideal for healthcare organizations and health app/wearable developers, recently adding representation in the UK and Europe. Release (PDF)

Is startup funding actually going to startups? Where are all of them, anyway?

Markus Pohl of Research2Guidance, in two successive blog postings, asks provocative questions on Whither Startup Funding. This Editor will attempt to summarize his key points but read both articles to get the real impact–and surprise.

  • There is $4 bn annually managed by accelerators and incubators that invest in health–over $1 bn in 1st Quarter–but only a portion of this funding goes to startups. (The $4 bn / $1 bn are not footnoted, but they are the Rock Health investment numbers [see TTA 10 Jan and 11 Apr])
  • After subtracting for ongoing investments in portfolio companies, operational costs, and ex-healthcare investments, this funding for startups is realistically closer to $300 million
  • This money will only be spent if there are startups that qualify for the 340+ accelerator and incubator programs
  •  According to the last year’s R2G survey, mHealth App Developer Economics, there are 58,000 mobile health app developers. 15,000 are considered to be in the startup phase (eligible for an accelerator or incubator program). But “The majority of mobile app developers in healthcare tend to struggle on the finance and business side.”
  • The surprise: there are not enough quality startups for the available programs, even though most startups apply to more than one.
  • “Accelerators struggle to build up a high-quality selection funnel.” They suffer from lack of awareness, especially regional accelerators.
  • Accelerators and incubators will be adapting to startup candidate scarcity–or fail–within the next two years. Narrowing their focus to certain healthcare niches and focusing on their target may help. (But there may be a bubble here–Ed.)

More than US$4bn funds raised by accelerators & incubators investing in health. Why is only a small portion landing in the hands of start-ups? and Most digital health accelerator and corporate start-up programs must refocus to survive

For TTA readers, the R2G sponsored 7th Annual mHealth App Developers survey is here. It takes about 10-15 minutes to complete, so grab a cup of coffee or tea, and go! The survey is still open for about two weeks more. It is most applicable to mobile health app developers, project managers, publishers, co-founders, digital health experts, influencers, opinion makers, and investors–in other words, our Readers! Anyone who completes the survey will receive a copy near the end of 2017.

The R2G App Developer Economics Survey is supported by a stellar roster of distribution partners, accelerators, and media partners including Bayer, PCHAlliance, Health 2.0, dhaca…and TTA.

Breaking-The Theranos Story, ch. 41: settling, not fighting, with Partners Fund on fraud

click to enlargeBreaking News and Updated. Settled–but not settled? Theranos’ May Day celebration was an announcement of a settlement with investor Partner Fund Management (PFM) LP on their two lawsuits alleging investor fraud. PFM’s funds had invested $96.1 million in Theranos’ February 2014 funding round. The amount and terms of the settlement were, as usual, not disclosed.

PFM’s original filing in Delaware Chancery Court in October claiming fraud on various representations that Theranos had made, such as 98 percent reliability on its small sample Edison labs. The second filing in April [Ch. 40] temporarily blocked Theranos’ added equity offer to investors, an offer which had the important condition of blocking further legal action once accepted [Ch. 38]. PFM had powerful and damaging evidence on its side from 22 deposed former employees and directors to bolster its allegations of investor fraud, which was revealed in snippets from unsealed documents last week.

This settlement, according to reports, ends both court actions and permits Theranos to continue their equity offer to investors. According to Theranos, 99 percent of investors were willing to accept it, which neatly heads off additional legal actions. The offer to C-1 and C-2 investors expires 15 May. Theranos release.

Yet the depositions obtained in this case appear to have taken on a life of their own. Digging down into the WSJ report (not yet paywalled if you go in through the ‘What people are talking about’ right-hand sidebar on LinkedIn, or if you have a subscription) is the interesting tidbit that “Federal investigators have obtained depositions taken in the Partner Fund litigation, including those of former Theranos employees and directors, according to a person familiar with the matter.” The WSJ also filed to have the depositions unsealed on Monday (1 May), which an outside entity can request under the rules of the Delaware Chancery Court even after a case is closed.

Despite settlements with PFM, the state of Arizona, and CMS, Theranos still faces a live investigation from the Securities and Exchange Commission (SEC) and the Justice Department (DOJ). There are also major lawsuits from Walgreens Boots seeking to recoup its $140 million investment (and remove the egg on their corporate face) and the Colman/Taubman-Dye suit in California. The latter action has the potential to become a much larger lawsuit, as the US District Court in Northern California has requested a show-cause from the plaintiffs on including third-party sellers (Lucas Venture Group, Celadon Technology Fund, SharePost) as defendants. It also personally charges Elizabeth Holmes and former CEO Ramesh ‘Sunny’ Balwani (ch. 39).

Time and money are running out–and with a Federal investigation in the mix, the future of Theranos still resembles our picture above.

  • In March, Theranos reported $150 million in cash holdings. With another settlement, how much is left in the bank?
  • That equity offer, expiring in two weeks, may be a moot maneuver. After investors do the math and look at the calendar, they may decide that legal action may be a better way of capturing whatever’s left, before it’s all gone or tied up in Chapter 11. Perhaps PFM is smart indeed in moving to settle early.
  • Federal investigations usually do not end happily, unless you are Mayor De Blasio of NYC. Who knows what high-powered maneuvering is going on behind the scenes to prevent Ms. Holmes’ black turtleneck from becoming orange? And where in the world is co-defendant ‘Sunny’ Balwani?

Additional coverage: TechCrunch, Bloomberg  Our index of Theranos coverage is here.

Pulmonary telehealth gets hot: FDA clears MTI’s Bluetooth spirometer for home use

click to enlargeMonitored Therapeutics, Inc. (MTI) of Dublin, Ohio received FDA 510(k) clearance for a new home spirometer (left) specifically designed to connect via Bluetooth to smartphones, tablets, and PCs. According to Michael Taylor, MTI’s Chief Development Officer, “The GoSpiro is the only spirometer currently on the market that has met the latest and more stringent ISO and FDA device requirements for home use.”

Bill Zimlich, MTI’s CEO, told this Editor more about their market and the reasons for its development. “The GoSpiro is the first to be developed specifically for the home, and also the first to pass the home use FDA requirements. “Slow spirometry” is an added differentiating feature for highly impaired patients with idiopathic pulmonary fibrosis (IPF), amyotrophic lateral sclerosis (ALS), cystic fibrosis and other conditions who would have difficulty with the fast exhalation needed for the FEV test.”

Spirometers collect information on the patient’s inhaling and exhaling air in amount (volume) and speed (flow). The GoSpiro measures forced vital capacity (FVC) and slow vital capacity spirometry (SVC) which are the two main tests used to measure lung function in patients. It connects to MTI’s proprietary platform, CarePortal, based on Qualcomm 2Net, and their GoHome Patient Health Monitor. Specifications are listed here but it appears that MTI will not be selling direct to consumer.

Currently, spirometers are infrequently used in the home, which has been to the detriment of patients with pulmonary diseases such as asthma and COPD, plus associated conditions such as heart disease. Existing units have been expensive (from hundreds to thousands of dollars, excepting some new entrants), bulky, and require manual or cabled input to telehealth platforms. While cost is not disclosed, the MTI GoSpiro appears to be the first FDA-cleared home use device to fully change this picture, and in size and type can be easily bundled with a telehealth kit. Press release. Mobihealthnews.

Others in the now-hot pulmonary game are not far behind. (more…)

ATA 2017: Telehealth 2.0 annual President’s Awards

This year’s ATA 2017 President’s Awards, each honoring a company or individual, are:

President’s Award for the Transformation of Health Delivery (supported by Cerner): New York-Presbyterian OnDemand

NYP OnDemand has five services in its app which delivers services from Weill Cornell, NYP, and ColumbiaDoctors: Second Opinion, Urgent Care, Virtual Visit (telemedicine), Express Care (if you’re already in the ER, a virtual visit may shorten wait time), and Inter-Hospital Consult (a collaboration tool within the NYP network). At a recent Health 2.0 NYC Hospital Innovation Programs meeting, Jonathan Gordon (director of NYP Ventures) and Graeme Ossey (innovation manager) discussed its development (see video here, starting at 18:06, about 15 minutes).

Innovation in Remote Healthcare (supported by InTouch Health): Tyto Care

Tyto Care’s portable diagnostic device includes an FDA Class II cleared digital stethoscope, a digital imaging otoscope for ear exams, a throat scope, a skin camera and thermometer swipe. The Tyto home device includes video guidance instructions as part of the smartphone or tablet platform and connects to an online platform to send the information, either in real time or store-and-forward, to a primary care physician the user selects. Currently, they are working with American Well [TTA 2 Dec] and announced in the past month partnerships with Miami Children’s Health System and Allied Physicians Group, a 35-location pediatrics and specialty group headquartered in Melville, NY.

Other awards were: (more…)

Anthem to Cigna: This merger is on, despite the appeals court decision, but the clock is ticking

click to enlargeThe War of the Payers continues.

Update: The DC Court of Appeals released its decision Friday 28 April to deny the Anthem-Cigna merger, upholding the District Court’s decision. This was a 2 to 1 vote that was issued immediately prior to the 30 April merger expiration. It cited that the savings would not mitigate the anti-competitive effects in the national, large group, and local markets, mainly in Medicare Advantage. What has been under-reported is that 11 states plus DC originally joined with the DOJ to enjoin (stop) the merger. In the US system, any healthcare merger also has to be approved by the states, and this merger was a failure in this area. Remarkably, even the dissenting judge cited problems with hospitals and doctors due to the combined company’s negotiating power.

In any rational business deal, this would be the final nail in the coffin, especially with one of the merger partners already wanting to leave. Unless Anthem wants to appeal to the US Supreme Court, this merger has reached The End of the Line. Yet publicly Anthem is pursuing, at least for the time being. In a statement, Anthem expressed “We are committed to completing the transaction and are currently reviewing the opinion and will carefully evaluate our options.”  Court decision in full. Healthcare Dive. MedCityNews.

To recap other recent developments: In February, the two insurers were filing and counter-filing each other in Delaware Chancery Court–Cigna to end their merger, Anthem to continue. Last Wednesday (19 April), Anthem filed an injunction to prevent the deal from expiring as per the merger agreement on 30 April. This injunction may be heard by the Chancery Court on 8 May, according to Anthem documents, but the main court documents are still under seal. (Law 360, via Healthcare Dive 24 April)

In prior Federal court actions, the Federal District Court in DC, based on action by the US Department of Justice, first denied the merger on 8 February on antitrust and anti-competitive grounds [TTA 9 Feb]. Unlike the also denied Aetna-Humana merger, it was publicly known, to the point where it was cited in the District Court decision, that the companies had significant disagreements on the merger. After the denial, Anthem wasted no time in appealing for a reversal of the decision with the DC Court of Appeals. Cigna lost no time in initially wanting no part of any appeal of the ruling by Anthem–and filed in Delaware Chancery Court for $13 bn in damages in addition to the contractual breakup fee of $1.85 bn [TTA 14 Feb]. Two days later, Anthem filed in the same court for an injunction to delay the merger agreement’s legal termination [TTA 16 Feb]. In March, Cigna surprisingly filed a brief in support of Anthem’s appeal (Healthcare Dive). Anthem has also denied rumors of an appeal to the Justice Department to save the merger (Reuters), which is now moot if it ever existed.

As the clock winds down, there remain rivers of bad blood and accusations of bad faith between these two organizations which will continue to be fought in court. Was this merger ever really necessary? No, and it never was, and in our 16 February/21 February update (see analysis), this Editor opines on why Anthem’s to-date persistence in pursuing this has been extraordinarily harmful–to their customers and to both companies.

Australian Telehealth Conference 2017

While telehealth is still being tested in pilot projects in primary care in click to enlargeAustralia it is beginning to be business as usual in secondary care, particularly for out patient services in rural areas and emergency care in regional areas, according to a review of this year’s Australian Telehealth Conference (ATC 2017) which concluded on Saturday. The article in Pulse+IT, puts the difficulty of getting telehealth into primary care down to the funding model in Australia.

The much admired Australian health care service is a mixture of public and private health care with, broadly speaking, the publicly (Medicare) funded hospitals providing a universal free service and the primary care being provided by a Medicare subsidised private practice service.

Until July 2014 telehealth services received incentives under the Telehealth Financial Incentives Programme. This programme was instrumental in introducing many telehealth trials through which the medical community learned the benefits and difficulties of telehealth first hand. Although these incentives have stopped, providers still receive higher Medicare benefits for approved telehealth services listed in the Medicare Benefits Schedule (such as video consultations between specialists and patients in telehealth eligible areas). However restrictions in eligibility for Medicare Benefits for telehealth usage have been shown to reduce the potential use of telehealth facilities (see our earlier item Should Australia review restrictions on use of telemedicine?).

Topics discussed at the conference included Telestroke, Innovations (Augmented Reality, AI), delivery models and virtual care. Many of the presentations given at the ATC 2017 are available at the ATC website here.

Sustainable transportation models for patient access to care at lower cost

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics) returns to the transportation aspect of social determinants of health earlier explored in her article on Veyo [TTA 21 Feb]. New on-demand services provide affordable ‘a to b’ transportation not only which is clean, safe and tailored to the patient’s needs, but also accountable to the health system or provider. A surprise here is that Circulation’s service is not smartphone dependent. 

Circulation, Inc. launched its Non-Emergency Medical Transportation (NEMT) system with just a few hospitals back in September 2016. This game changer company provides on-demand rides with a healthcare transportation platform and an Uber app.  To date, they have expanded significantly with over 30 new clients and ride access in over 25 states. Last week, I had the pleasure to speak with Robin Heffernan, PhD., the co-founder and CEO of Circulation, to learn how they have been able to achieve a successful cost-effective and reliable transportation system for patients and providers. A gently edited version of our conversation follows below.

How has Circulation reduced the cost of a ride with an NEMT system? How will cost savings trickle down?

Heffernan: Our health facility clients are saving costs on the ride component only.  When someone transitions from mostly using taxis to being able to use Uber rides, the cost of that ride is 40 to 50 percent less. We have not yet calculated the bigger total cost savings for our clients. When patients actually make their ride appointment, the savings begin because they are not missing a primary care appointment. Without a scheduled ride, they may decide to take an ambulance the next day to the ER for a basic cough.  I think this is a huge advance for this industry. From day one you are going to achieve significant savings on a pure ride cost basis, get increased patient satisfaction and see your patients actually getting to appointments on time. Health facilities can track for the first time a whole downstream value proposition, and actually tie transportation to appointments to costs like ED utilization. Our solution tracks this component with our clients.

How does Circulation’s transportation model impact value-based care? (more…)

Babylon Health ‘chatbot’ triage AI app raises £50 million in funding (UK)

click to enlargeBabylon Health, which has developed an AI-assisted chatbot to triage a potential patient in minutes, has raised a serious Series B of £50 million (US$60 million). Funders were Kinnevik AB, which had led the Series A, NNC Holdings, and Vostok New Ventures (Crunchbase). According to the FT (through TechCrunch), Babylon’s value is now north of $200 million. Revenues were not disclosed.

The current app uses texts to determine the level of further care, recommends a course of action, then connects the user if needed to a virtual doctor visit, or if acute to go to Accident & Emergency (US=emergency room or department). It also follows up with the user on their test results and health info. The funding will be used to enhance their current AI to extend to diagnosis. They are accumulating daily data on thousands of patients, machine learning which further refines the AI. Founder Dr. Ali Parsa, founder and CEO of Babylon, said in a statement. “Babylon scientists predict that we will shortly be able to diagnose and foresee personal health issues better than doctors, but this is about machines and medics cooperating, not competing.” Like other forms of telemedicine and triage (Zipnosis in health systems), it is designed to put healthcare access and affordability, as they claim, “into the hands of every person on earth”. The NHS pilot in north London [TTA 18 Jan] via the 111 hotline is testing Babylon as a ‘reliever’ though it directs only to a doctor appointment, not a video consult. BBC News, Mobihealthnews

ATA 2017 dispatch: Devices and doom

click to enlargeBruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the third and final article this week he’s written from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].

This Editor agrees with his POV that drowning doctors in more and more data, whether previously accessible or not, isn’t a way forward to a successful business model. The current data is overwhelming–and not interoperable with EHRs. More and more data, looking for a home….

Orlando, April 26. Yesterday, I set aside several hours to walk by the booths of the 200+ exhibitors at the ATA show. As I slowly walked the Exhibit Hall, I was struck by the large number of in-home telehealth patient monitoring devices. (Names are omitted to protect the innocent.)

Colleagues had similar reactions. When I asked about exhibitors, the most common response was “I had no idea there were so many new telehealth monitoring devices that are FDA approved or in the process of obtaining approval.”

As I wandered from booth to booth, I was also struck by the failure of so many, if not most, monitoring device manufacturers to focus on the practical uses of their truly revolutionary technologies. At each monitoring device booth, I asked the same question, “How will the data be used?”  All too often, the answer was, “We provide daily patient data for physicians that have never been accessible before, and doctors receive daily graphs.”

My follow-up questions were always, “You believe busy doctors will look at data on their large patient population each day? Why don’t you provide alerts?” Again, there was a frequent answer, which was some variation of “Yes, now doctors can see daily events which will lead to extraordinary improvements in health outcomes, and we don’t want to create alert fatigue” (false positives that suggest a problem where one does not exist).

In my view, monitoring devices without suites of robust predictive analytics will fail. Doctors are already too busy, and anything that adds to their workload is immediately suspect. Moreover, we still live in a fee for service world, and now we are talking about new, uncompensated work.

As Jonathan Linkous said to me on the first day of the ATA show, “the technology is a tool to provide the service,” not the service itself. Patient monitoring device firms must realize they are offering a service. To succeed, their services must provide actionable analysis, not more and more data. If alerts are ready for prime time, then doctors will value the devices: They can rely on the associated algorithms to indicate when an intervention (also to be compensated) is needed.

Moreover, I strongly suspect doctors would prefer a few false alerts, with algorithms biased toward safety and results that can be quickly checked via the underlying data, as compared to wading through charts looking for anomalies.

A fundamental question for anyone is “what business are you really in?” To succeed, many of the ATA exhibitors need to reorient themselves from the business of providing great technology to the business of providing great service enabled by technology.

Mr. Judson’s first article, a discussion with ATA’s Jonathan Linkous on business models for telehealth is here. The second article on Mercy Health’s catalyzing telehealth innovation at the hospital level is here.