Three recent articles from the IEEE (formally the Institute of Electronics and Electrical Engineers) Spectrum journal are significant in pointing to advances in artificial intelligence (AI) for specific medical conditions–and which may go into use faster and more cheaply than the massive machine learning/decision support program represented by IBM Watson Health.
A Chinese team developed CC-Cruiser to diagnose congenital cataracts, which affect children and cause irreversible blindness. The program developed algorithms that used a relatively narrow database of 410 images of congenital cataracts and 476 images of normal eyes. The CC-Cruiser team from Sun Yat-Sen and Xidian Universities developed algorithms to diagnose the existence of cataracts, predict the severity of the disease, and suggest treatment decisions. The program was subjected to five tests, with most of the critical ones over 90 percent accuracy versus doctor consults. There, according to researcher and ophthalmologist Haotian Lin, is the ‘rub’–that even with more information, he cannot project the system going to 100 percent accuracy. The other factor is the human one–face to face interaction. He strongly suggests that the CC-Cruiser system is a tool to complement and confirm doctor judgment, and could be used in non-specialized medical centers to diagnose and refer patients. Ophthalmologists vs. AI: It’s a Tie (Hat tip to former TTA Ireland Editor Toni Bunting)
In the diagnosis of skin cancers, a Stanford University team used GoogleNet Inception v3 to build a deep learning algorithm. This used a huge database of 130,000 lesion images from more than 2000 diseases. Inception was successful in performing on par with 21 board-certified dermatologists in differentiating certain skin lesions, for instance, keratinocyte carcinomas from benign seborrheic keratoses. The major limitations here are the human doctor’s ability to touch and feel the skin, which is key to diagnosis, and adding the context of the patient’s history. Even with this, Inception and similar systems could help to triage patients to a doctor faster. Computer Diagnoses Skin Cancers
Contrasting this with IEEE’s writeup on the slow development of IBM Watson Health’s systems, each having to be individually developed, continually refined, using massive datasets, best summarized in Dr Robert Wachter’s remark, “But in terms of a transformative technology that is changing the world, I don’t think anyone would say Watson is doing that today.” The ‘Watson May See You Someday’ article may be from mid-2015, but it’s only this week that Watson for Oncology has announced its first implementation in a regional medical center based in Jupiter, Florida. Watson for Oncology collaborates with Memorial Sloan-Kettering in NYC (MSK) (and was tested in other major academic centers). Currently it is limited to breast, lung, colorectal, cervical, ovarian and gastric cancers, with nine additional cancer types to be added this year. Mobihealthnews
What may change the world of medicine could be AI systems using smaller, specific datasets, with Watson Health for the big and complex diagnoses needing features like natural-language processing.
28 April, 9:30am-5pm, Royal College of Obstetricians and Gynaecologists, London
Henry Purcell of the BJC was kind enough to post us with information on the first-ever BJC Digital Healthcare Forum. Organized by the BJC in association with the NHS, the Digital Health and Care Alliance (DHACA), and the Telehealth Quality Group, it is a novel ‘hands on’ meeting to assess if digital medicine can fill gaps in healthcare provision throughout the NHS. It is also in response to the massive pressures which winter has wrought on NHS health and social services. The Forum was designed by clinicians and leaders in healthcare informatics for UK commissioners, doctors and other HCPs involved in the management of long-term conditions (cardiovascular, obstructive pulmonary disease, diabetes etc.), as well as those engaged in health informatics, IT, and Trust CEOs. Speakers include Dr Malcolm Fisk of De Montfort University, our own Charles Lowe of DHACA, Professor Tony Young, National Clinical Director for Innovation (NHS England) and many more experts in digital health and care. For the latest information and to register, see the event website or the attached PDF.
research2guidance has published a short article on how migraine sufferers constitute an underserved market, and how present apps do not meet their needs. Here is an opportunity for app developers and companies to address a common and often near-intractable pain that affects everyday life. The author is David Ireland, Research Analyst, r2g Berlin.
Migraine is the third most prevalent illness in the world affecting 1 billion people worldwide^. However, this demographic of migraine sufferers is heavily underserved by mobile health applications, with only 0.2% of migraine sufferers using a migraine app*. But why? A major opportunity exists for an application with the right strategy, and the right balance of features and functionalities to lead the market, while having a positive impact on the health of migraine sufferers.
According to the Migraine Research Foundation (2017), migraine is the sixth most disabling illness in the world. More than 4 million people suffer from chronic migraine attacks every day. U.S. healthcare and loss of productivity costs are estimated to be around US$36 billion annually; just the cost of brain scans of headache sufferers alone comes in at around US$1 billion per year. Migraines are responsible for a huge loss in productivity, rendering 90% of sufferers unable to function normally, costing U.S. employers US$13 billion, and 113 million work days in 2016.
Far from being just a bad headache, migraine attacks can cause a diverse range of disabling symptoms such as severe pain, nausea and visual disturbance. While medications exist to help treat symptoms, migraine sufferers need to carefully manage their medication intake, while monitoring risk factors such as food, sleep and triggers to treat, and prevent the condition from becoming chronic. Tracking medication is critical, as most chronic migraine sufferers are a result of medication overuse^.
The main promise of migraine apps is to provide migraine sufferers with a way to better manage their condition, decreasing the chances of migraine attacks, of headaches intensifying into migraines, and of the condition becoming chronic. To achieve this, migraine apps could provide users with the following (in no particular order of priority):
- Log-books / diaries: recording migraine events to help the user better understand their condition, while allowing for a better communication between the user and GP
- Reporting: for analyzing and summarizing the users’ behavior, triggers, risk and symptoms, while allowing for a better communication between the user and GP
- Information repository: peer-reviewed educational content aimed at educating the user on neurological conditions, and how best identify, treat, manage and prevent them
- Pattern recognition: based on historical user data to notify the user of high-risk scenarios (more…)
Action This Day, in Churchill’s words. Today’s news of President Trump meeting with the CEOs of US pharmaceutical companies– Novartis, Merck, Johnson & Johnson, Lilly, Celgene, and Amgen–along with the PhRMA association head, indicates the speed of change that this two-week old Administration intends in healthcare. Trump’s points to the Pharma Giants: drug prices need to be brought down, especially for Medicare and Medicaid patients, through competitive bidding not price-fixing; bringing home production to the US; and that there is ‘global freeloading’ on US drugs. This last is a bit vague, and the pricing part may stir some Standard Republican Resistance, but what Trump also came down firmly for is speeding up the drug approval process. In return, the execs asked for tax reform.
Notable here is this quote: “I’ll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market,” Trump said. “That includes price-fixing by the biggest dog in the market, Medicare, which is what’s happening.” The Hill, Business Insider
Does this mean an open door and encouragement for healthcare technology?
Certainly many startups, early-stage companies, and Grizzled Pioneers are eagerly anticipating a more open healthcare business environment than the many dictates, restrictions and the constant changing of goalposts they have faced for the past eight years. The hope is an openness of the Powers That Be on the Federal side (CMS, HHS, FDA) to innovation, patient-centered care and a change away from hammering constantly on lowering cost through a multitude of controls and top-down diktats on what Healthcare Should Be.
This Editor has seen companies straining to hang in there, playing the niches, moderating their equity raises, merging, projecting profitability sometime in the future. Some have not made it. One is the pioneer telehealth company Viterion Corporation, which was quietly dissolved by its parent company in Japan for various reasons at end of last year. (Editor’s disclaimer: I was marketing director for the company.)
Already innovation is reaching long-neglected areas like home care. Home support for the aging population isn’t buzzy, analytic or sexy, but it’s ready for change. The Financial Times takes a look at this $40 bn US market, focusing on the Hometeam caregiving service presently in New York, New Jersey and Pennsylvania, which has over $43 million in investment after only three years (Crunchbase); Honor, which has over $65 million in funding, operating California and Texas. Their points of difference from traditional home care agencies involve models and technology. Hometeam employs carers who are full employees with benefits and an average of $15/hour pay, double that of the usual minimum wage paid to independent contractors. They equip carers with iPads to track what happens in the home, and to report daily to families. Honor has an algorithm to help it scale up from the 100 or so carers who are the ‘break point’ in matching carers with patient needs. In contrast, the UK is far behind in development. The article looks at Vida which uses a mix of carers and technology for its private pay clients. Now approved by the Care Quality Commission, Vida is already in talks with local councils across London and Brighton. But funding is thin: £400,000 of start-up funding and planning to raise £1 million. Tech start-ups try to fix ailing US elderly care sector. If paywalled, search on the title. Hat tip to Susanne Woodman
Action Next Days? Predictions have been all over the place since the election. Many have been overheated (and highly political), but others explain the complexities of undoing the past six years. A reminder: the PPACA did not go into effect until 2010 and most of the provisions kicked in during 2011. Health tech law firm Epstein Becker Green trotted out its crystal ball (more…)
It’s clearly aimed at a younger market than typical for PERS, concerned with stylish safety in ‘lone’ situations and not with ‘falling and I can’t get up’. The stated Kickstarter price is also appealing: $129 for the standard sensor, $199 for a specially designed sterling locket style, both inclusive of one year of monitoring service. Release is scheduled for April.
Despite this announcement, the Kickstarter site is not up yet. The Ripple website has a flashy animation homepage without detail, found only through their LinkedIn company page which also is bereft of details. Other than the release pickup on ReadItQuik.com, this Editor cannot locate the release on the standard PR release sites such as Business Wire or PRWeb. (The Tunstall Americas website has not been updated for news since last August.) A curious start indeed.
Update: Ripple’s communications director in the Comments has supplied the Kickstarter link which went live on 1 Feb, and is here. The website now has an Order Now button which links to the Kickstarter page. Key features: click once to receive a call from the monitoring center, or click 3 times or more to summon emergency help or a call per your profile setup. A potential drawback: no two-way communication except via phone and the BTE connection, which if you are separated from it (for instance, your purse is stolen), the system won’t work.
The requested raise is $50,000 by 3 March. PRNewswire release.
Susanne Woodman, our Reader who keeps an eye on telecare procurement tenders, has alerted our UK readers to two current postings:
Telecare IT Platform for East Lothian Council (Scotland). This is for the purchase an integrated call handling facility and telecare asset management system to respond to alerts from telecare equipment in the homes of vulnerable people. Contract duration 60 months. Deadline 1 March. (Public Contracts Scotland)
NHS Wales Informatics Service–Velindre NHS Trust. The NHS in Cardiff, Wales is looking to appoint partners to develop solutions to engage citizens digitally in the proactive management of their health. It is anticipated that this could encompass a wide range of services from existing applications (Apps) to innovative joint developments. Contract notice will be published 4 April, but the notice as published does not have a deadline. (Tenders Electronic Daily) See the Sell2Wales website for documentation.
The word ‘institutionalization’ deservedly strikes fear on both sides of the Atlantic as a recipe for patient decline, physical and verbal abuse, theft and generally bad care. It’s a blunderbuss solution to ‘bed-blocking’ which we discussed here [TTA 7 Sep 16]–the care plan becomes ‘move ’em out’. By going this way in policy, NHS England is going counter-trend, against more personalized care delivered in home settings, and setting an unfortunate trend for other countries like the US.
Outside the scope of the article, but in this Editor’s thoughts, is the knock-on effect it will have on the UK’s developers and providers of telehealth and telecare services/TECS designed to support home care. Many of these technologies are in a transition period to the greater capabilities (and freedom from land line) of digital from analogue care, which was discussed in TTA here. Cutting domestic demand may not only be critical not only to companies’ survival, but also to their expansion in the (now far more open to the UK) US market. Readers’ thoughts?
Breaking News from Washington Judge John B. Bates of the Federal District Court for the District of Columbia ruled today (23 Jan), as expected, against the merger of insurance giants Aetna and Humana. Grounds cited were the reduction in competition for Medicare Advantage plans, where both companies compete. “In this case, the government alleged that the merger of Aetna and Humana would be likely to substantially lessen competition in markets for individual Medicare Advantage plans and health insurance sold on the public exchanges.” The decision could be appealed in the US Appeals Court for the DC Circuit, or could be abandoned for different combinations, for example a rumored Cigna-Humana merger, or smaller companies in the Medicare/Medicaid market such as Centene, WellCare, and Molina Healthcare. Certainly there is money about: Humana would gain a $1 bn breakup fee from Aetna, and Cigna $1.85 bn.
No decision to date has been made in the Anthem-Cigna merger, but the general consensus of reports is that it will be denied by Federal Judge Jackson soon. [TTA 19 Jan]
Of course, with a new President determined to immediately roll back the more onerous regulatory parts of the ACA, in one of his first Executive Orders directing that Federal agencies ease the “regulatory burdens” of ObamaCare on both patients (the mandatory coverage) and providers, the denial of these two mega-mergers in the 2009-2016 environment may be seen as a capital ‘dodging the bullet’ in a reconfigured–and far less giving to Big Payers–environment. FoxNews
First, the Conspiracy Theory. This is being propounded by early Theranos investor Tim Draper of Silicon Valley VC Draper Fisher Jurvetson. It was all John Carreyrou’s ‘strange vendetta’ against her, to wit: “Elizabeth is the victim of a witch hunt.” The Wall Street Journal reporter set off a cascade of press coverage that compelled, nay, forced Federal regulators (FDA, CMS, SEC, DOJ) and state counterparts to go after Theranos and CEO Elizabeth Holmes. Mr Draper bluntly accused Mr Carreyrou of doing it for money; “the guy is getting $4 million to continue this charade”, referring to the advance on his book proposal “Bad Blood”. The most nauseating part of the Ars Technica interview is this mock-libertarian rejoinder from Mr Draper: “It’s the press creating a series of events that negatively impact technology, progress and our economy.”
So it was all a mistake, an illusion–there was nothing significantly wrong with the Edison Lab, or Theranos’ business practices! (Hat tip to Bill Oravecz of Stone Health Innovations)
Mr Draper perhaps did not consider that Mr Carreyrou’s reporting blew up the $100 million investment of the WSJ‘s owner, Rupert Murdoch (Ch. 27), not just DFJ’s. And Safeway, Walgreens, Larry Ellison, Cox Enterprises, Bechtel Group….
Second, the belated reporting of deficiencies at the Scottsdale lab found by CMS (Centers for Medicare and Medicaid Services) on 29 September. According to the Wall Street Journal report (co-authored by Mr Carreyrou), “Theranos responded to the inspection findings in Arizona with a plan to correct its lab deficiencies, but the lab regulator in November rejected the plan and proposed sanctions for the Arizona lab as well.” This preceded the closing of all labs and the ‘refocusing’ of Theranos on the miniLab. Their general counsel stated, “After months of careful consideration, and prior to CMS’s unannounced inspection in Arizona, Theranos decided to close its laboratories.” Usually, these CMS reports are issued after 90 days. Theranos is appealing the sanctions arising from the California lab inspection with an administrative law judge, which include lab license revocation and a two-year ban on Ms Holmes from blood-testing operations.
Third, Theranos announced an eight-person Technology Advisory Board (TAB) to be led by Dr. Channing Robertson and Howie Rosen. The academics, executives, and entrepreneurs will be charged with “reviewing specific Theranos technology initiatives associated with product development, design and deployment” as well as four other mandates. Analogies concerning horses, roads and the status of barn doors come to mind. Release.
And finally another Theranos Washington connection, besides new SecDef and ‘Warrior Monk’ James Mattis, now an alumnus. It seems that the vetting of Betsy DeVos, nominee for Secretary of the Department of Education, uncovered that she has an investment in Theranos of more than $1 million. However, the Office of Government Ethics also reported her whopping earnings of less than $201. Since others like Rupert Murdoch, Bechtel, Walgreens, Cox, and others ponied up $50 to $100 million, hers is a mere bag of shells by comparison. MedCityNews, who has dubbed it the ‘As Theranos Turns’ soap opera. Hat tip to Bill Oravecz of Stone Health Innovations.
See here for the 33 previous TTA chapters in this Continuing, Consistently Amazing Saga, including Arizona’s lawyering up for a prospective Theranos lawsuit (Ch. 33) the firing of 155 remaining staff (Ch. 32), the resignation of now-DOD Secretary General Mattis from the BOD (Ch. 31), and Theranos’ annus horribilis (Ch. 30).
Breaking News Judge Amy Berman Jackson of the Federal District Court for the District of Columbia is expected to rule against the Anthem-Cigna merger on anti-trust grounds, sources have informed the New York Post. In anticipation of the appeal, Anthem has already filed an extension to the merger deadline from 31 January to 30 April, which Cigna is reportedly opposing in hopes of killing the merger.
The lawsuit was brought by the Department of Justice after Senate anti-trust subcommittee hearings and the displeasure of many state insurance regulators [TTA 21 July]. The hearing starting 21 November had two phases: the first on the merger’s effect on national employers, the second starting 12 Dec on local markets [TTA 21 Nov]. The huge stumbling block, according to the report, is Anthem’s unresolved conflict in a merger due to the ‘Blues Rule’, which requires that they have no more than one-third of its marketed products from other insurers in a state where they also market Blue Cross Blue Shield plans. Anthem is the licensee for Blue plans in 15 states, and according to court testimony by Anthem VP of corporate development Steven Schlegel, may have faced a $3 bn (£2.43 bn) penalty. This likely would have come from the Blue Cross Blue Shield Association, the licensor. Anthem’s hope reportedly was to transfer Cigna customers to its Blue plans to balance this out.
The NYP report also adds fuel to two years of rumors concerning governance and management succession conflicts between the two insurers. One revelation in the DOJ complaint was that in April 2016 “Anthem had established a separate, highly confidential team to work on integration planning without Cigna’s participation”. Earlier reports publicized that Cigna hoped that the DOJ lawsuit would have killed the merger; now Cigna wants no extension and to collect its $1.85 bn breakup fee. Sounds like a Fatal Case of Merger Remorse. Stay tuned.
The separate Aetna-Humana hearing concluded on 30 December under a different DC District Judge, John D. Bates. Arguments here focused on overlaps in two areas: exchange policies (sold by Aetna in only four states, with overlap in 17 counties) and Medicare Advantage monopolies or near-monopolies. The judge’s ruling is still pending. Bloomberg, Hartford Courant, which lets hometown Aetna have its say.
Now that the bustle of the holidays is over and the frigid days of winter are here, this weekend grab your cup of hot cocoa, an afghan rug or snuggie, and click through a one-page compendium of the NYeC Digital Health Conference in NYC last December. The page links to presentation slides and video; most have both. (Unfortunately, not all presentations nor the lunch breakouts are included.)
This Editor highly recommends the following:
- The Tuesday keynote on ‘The Digital Doctor’ by Dr Robert Wachter, who is influencing the NHS. (Yes, EHRs and e-prescribing have turned physicians into data entry clerks.)
- ‘Turning Impossible on Its Head’ on disrupting healthcare with technology: Robert Putrino of Burke Rehabilitation Center on a miracle of 3D printing
- DSRIP 2017 and readmissions may not sound very interesting, but the presentations by Veyo‘s Josh Komenda on how transportation assistance can also aid compliance, and the discussion on the missing link of population health may be social determinants of health care, are.
- Wednesday’s ‘Universal Patient Identity’ presentation by Tom Foley of Lenovo Health; a must-see by anyone interested in preventing identity fraud and theft at the provider level
- “The Patient Room of the Future’ by Joan Saba, partner of NBBJ Architects. Responding to this Editor’s question via Twitter on how design can prevent nosocomial (healthcare-acquired) infections, I was directed to an excellent Becker’s Hospital Review article written by two of their firm’s leaders.
- The very last presentation, ‘Resuscitating the Child’, was one of the finest and may also break your heart. Peter Antevy, MD, medical director of two EMS in Palm Beach County, Florida, presented the human cost of both EMTs/paramedics in rescue and the frustration of not having the proper tools to calibrate medication and procedures quickly on a patient who cannot be administered full doses, all in emergency situations. His company, Pediatric Emergency Standards, is developing software that can do so quickly and on-scene. Dr Antevy’s passion for his work and for applying technology to this situation is abundantly present.
NYeC Digital Health Conference final presentations page. TTA was a conference/media partner of the 2016 NYeC DHC, and thanks Jesse Giuliani and Andie Egbert for their invitation and coordination assistance.
UKTelehealthcare’s new Managing Director Gerry Allmark was kind enough to advise Editor Donna of upcoming events either organized by UKTelehealthcare, or where they will be represented. His note is reproduced here with minor edits and emphases. Click their advert on the right sidebar or here, which directly links to their special About/Upcoming Event page, for more information.
Our next MarketPlace will be in Carlisle on the 1 March 2017 (registration link); this is an historic occasion for us as this is our first event in the North of England. (Information on the programme is here.)
As part of our national expansion of events and membership we plan to hold MarketPlaces in Luton, Bristol, Nottingham, Dudley and Halifax as well as a high profile London event in 2017/18. Please see the “Coming up at a glance” section on the first page of our website (see link here) for the latest news on these events.
We will also be exhibiting at Naidex 2017 from the 28 to 30 March and at the Health + Care Show on the 28 and 29 June 2017. At both these shows we will be offering special show price membership rates to both provider and supplier members as well as our new membership categories for Clinical Commissioning Groups, Consultants and RPI members.
In conjunction with the H + C Show we will also be expanding our successful Telehealthcare Awareness Day which we have run for the last two years to Telehealthcare Awareness Week which will run from 26 – 30 June 2017. During this week we encourage our members and other TEC providers and suppliers to run local events to raise the profile of health technology in their areas and we will publicise these events though our social media links and website. A Telehealthcare Awareness Day pack / toolkit will be available on our website shortly for both members and non-members who would like to take part in this important event.
The NHS announced at the top of this month that it would test Babylon Health‘s ‘chatbot’ app for the next six months to 1.2 million people in north London. During the call to the 111 medical hotline number, they will be prompted to try the app, which invites the user to text their symptoms. The app decides through the series of texts, through artificial intelligence, in minutes how urgent the situation is and will recommend action to the patient up to an appointment with their GP, or if acute to go to Accident & Emergency (US=emergency room or department) if the situation warrants. It will launch this month in NHS services covering Barnet, Camden, Enfield, Haringey, and Islington, London. TechCrunch.
The NHS’ reasons for “digitising” services through a pilot like Babylon’s app is to save money by reducing unnecessary doctor appointments and pressure on A&Es. It provides a quick diagnosis that usually directs the patient to self-care until the health situation resolves. If not resolved or obviously acute, it will direct to a GP or A&E. The numbers are fairly convincing: £45 for the visit to a GP, £13 to a nurse and £0 for the app use. According to The Telegraph, the trial is facing opposition by groups like Patient Concern, the British Medical Association’s GP committee, and Action Against Medical Accidents. There is little mention of wrong diagnoses here (see below). The NHS’ app track record, however, has not been good–the NHS Choices misstep on applying urgency classifications to a ‘symptom checker’ app–and there have been incidents on 111 response.
Babylon’s founder Ali Barsa, of course, is bullish on his app and what it can do. (more…)
The subject of nondisclosure agreements–NDAs–is often treated as routine, not only in the US but also in the UK and Europe. Editor Donna has reviewed and signed a few, modifying only limited areas of ‘boilerplate’. Our contributor today is an attorney specializing in technology law, Mark Grossman, JD, and he explains to us that an NDA should not be treated quite so cavalierly–and that red flags should fly any time a trade secret is involved. (Editor’s emphases are italicized and bold.)
In the world of tech deals — more than other types of deals — my clients want to sign nondisclosure agreements quickly. I’m sure that many people will disagree with me on this one, but I like to avoid NDAs in the early stages of a deal. My feeling is that you shouldn’t be exchanging secrets with strangers and that doesn’t change no matter what they’ve signed.
Experience tells me that most deals at the “initial feeler” stage never reach fruition. It’s a long way from that first lunch to a closing and a bottle of champagne. I say skip the paperwork and legal entanglements until you’ve at least gone as far as thinking: “This is getting interesting and serious.” In the meantime, keep your secrets to yourself.
Usually, you can get through the early stages of a negotiation with a demonstration of what “it” can do without revealing how it does it. Of course, if what it does is as much a secret as how it does it, then my generalization may not be true for you.
In case you’re not familiar with NDAs, the idea behind them is that you’ll reveal confidential information only if the other side agrees not to improperly disclose or use the information. Right here, it starts getting tricky because you have to decide to whom they can disclose it and for what use.
Watch out for a form with a line for your company name. If you’re tempted to sign it, I have some simple advice: Don’t. Not ever.
Every NDA is customized. Since tech lawyers see NDAs constantly, writing a good one should never be an exercise in reinventing the wheel. Still, they do require some thought. (more…)