A ‘next generation’ house call from the patient’s perspective

Guest editor Sarianne Gruber (@subtleimpact) attended May’s d.health Summit on Aging in NYC. She reflects on moderator Christina Farr’s (immediately prior) direct experience with a virtual visit (convenience, proactive care–and utter frustration with her payer) and what the telemedicine ‘next gen’ provider panelists see as their advantages in fixing a fractured healthcare system.

Christina Farr had a “Next Generation” house call for the first time. The on-demand doctor’s visit provided her care and resolved the possibility of a trip to the emergency room, and best of all she felt great. Ms. Farr, an award-winning health and technology journalist, happen to have had her encounter just days prior to the d.Health Summit. Coincidentally, she was to be the moderator for a panel of prominent telehealth business leaders on this very topic. Curious after having had this experience, she wanted to know whether most cases were like hers wondering if they should go to ER, or were the visits more for routine things like coughs and colds, or did people just want a prescription. The d.Health panelists included Damian Gilbert, Founder & CEO of TouchCare (@touchcarehealth), Oscar Salazar, Chief Product Officer and Co- Founder of Pager (@getpager), Dr. Ian Tong, Chief Medical Officer of Doctor on Demand (@drondemand), and Dr. Roy Schoenberg, Co-Founder, and CEO of American Well (@americanwell).  (more…)

Events last week beyond Brexit: London Technology Week, CE Week NYC

The world may have turned upside down (and around) with Brexit, but London Technology Week happened nevertheless. It’s exploded into 400 events and 43,000 attendees, with 300 attending an event at London City Hall on health tech within the NHS. (Attendees invited to contribute in Comments.) Designer Brooke Roberts, an ex-NHS radiographer who advocates the fusion of fashion and tech, debuted her brain scan-inspired knitwear, accomplished by translating scans into digital files capable of programming industrial knitting machines. According to GP Bullhound in their annual European Unicorns report, 18 of Europe’s 47 billion-dollar digital startups are now based in the UK. So who needs the EU?  TechCityNews, CNN, Yahoo Tech

click to enlargeOn the other side of the Atlantic, there was a disappointing absence of wearables and health tech at the Consumer Electronics Association’s NYC summer event, CE Week. It’s been a major feature since 2009 at International CES in January; the NYC summer show and the November CES preview had always featured a mostly local exhibitor contingent and conference content. None this year–a representative cited a mystifying ‘change in direction’. There was one lone wearable way back in the exhibit hall–MonBaby, which came in from 16 blocks uptown. The snap-on button monitor works with any garment (unlike the Mimo onesie and the Owlet sock) (more…)

mHealth Grand Tour: ‘magical’ for cyclists, clinical level information for diabetes

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From the HIMSS Connected Health Conference (CHC)/mHealth Summit

The last Executive Spotlight/keynote on Wednesday morning stepped outside most of this year’s CHC content, first for presenting a European mHealth program and diabetes patients not as overweight, inactive and co-morbid but as athletes. Presented by Benjamin Sarda, Head of Marketing for Orange Healthcare, the mHealth Grand Tour has developed in three years from a fully organized, challenging 2,100 km Brussels-Barcelona ride primarily (but not exclusively) for cyclists with Stage I and II diabetes as a test bed for blood glucose monitoring under extreme exercise, to a 1,500 km Brussels-Geneva three-stage tour with even greater ascent, extreme monitoring and also a full spectrum of vital signs feedback via smartphone to the riders. This past September, 24 riders accumulated 7 million measurements. The cyclists used these measurements (left) click to enlargeclick to enlargeto help manage their food intake, blood glucose, performance and overall wellness. The data is currently being analyzed by France’s Society of Diabetes (SFD), but an early result is that medication compliance was 97 percent. Some had difficulty (with a 22,000 meter climb, who wouldn’t?) but the app helped them manage their ride and what they can do that day. Orange’s interest as a telecom is obviously data but their work with multiple research and mHealth partners (including the Personal Connected Health Alliance which is part of the CHC) and with organizations like the JDRF are part of their big scale. It also represents a ‘jump shift’ in thinking about what is possible in living with diabetes.

What happened in between? Plenty! (More coverage to come.)

90% of industries have had PHI data breach: Verizon (HIMSS Connected Health)

Reporting from the HIMSS Connected Health Conference (CHC)

Cybersecurity is one of the three central themes of this year’s HIMSS CHC, and excellent timing for releasing the highlights of Verizon’s first ever PHI (Protected Health Information) Data Breach Report. This is a spinoff of their extensive, eight years running international Data Breach Investigations Report (DBIR). 

It’s not just your doctor’s office, hospital or payer. It will be no surprise to our Readers that the healthcare sector is #7 in breaches–but that a PHI breach may come from non-healthcare (in US, HIPAA-covered) sources. This Editor spoke with Suzanne Widup, the lead author of the PHI Report and an info security/forensics expert, and included in that 90 percent are workers’ compensation programs, self-insured companies, the public sector, financial/insurance companies and–as a damper on this highly competitive (but hard to gauge results) area–wellness programs. Most organizations, according to Ms Widup, aren’t even conscious that they are holding this information and need to specially protect it from intrusion, as “PHI is like gold for today’s cybercriminal.”

Consistent with other authoritative tracking studies like Ponemon Institute’s and ID Experts’, the threat is from within: physical theft and loss, insider misuse and ‘miscellaneous’ account for 77 percent of theft. And as Bryan Sartin, managing director of Verizon’s RISK team noted in his keynote today, attacks take over a seven-month period on average to even be noticed. The breaches are long term, start small and sneaky. 2/3 of organizations don’t find out on their own, only when it starts to affect other partners. (Surprise!) Despite the proven Chinese and Black Vine involvement in several high profile, high-volume data hacks (Anthem), and ‘brute force’ hacks that make headlines (iCloud last year), the average breach is an inside job where “assets grow legs and walk off” in Dr Widup’s words, or privilege misuse.

When I asked Ms Widup about the Internet of Things (which is moving high on the hype curve, from what your Editor has experienced to the nth degree at this conference), she confirmed that this is an area that needs extra cybersecurity protection. (more…)

Conference report: MedCityNews CONVERGE

Guest columnist Sarianne Gruber (@subtleimpact) attended Breaking Media’s annual MedCityNews CONVERGE two-day conference at Philadelphia’s Hyatt at Bellevue earlier this month, and has a few observations on the surface contradiction of innovation and health insurance.

Breaking Media rightly titled this year’s MedCity News conference “Converge”. Listening to the speakers, meeting the founders of new startups and talking to presenters, it became clear that today’s healthcare ecosystem is interdependent on the all the players to move the needle for better quality health. It was fascinating to learn was how innovation is breaking down the old silos of engagement, and is emerging from all the industry players, as well as joining at new intersections. The proliferation of better products, methodologies and engagement is closing the gap with more data, technology and ideas.

When you think of your health insurance company, usually two words comes to mind, cost and coverage. Keynote Speaker, Daniel Hilferty, President and CEO of Independence Blue Cross, wants to change the focus to consumer and care. Hilferty paralleled the new ventures at Independence to the work of the great innovator, Thomas Edison. Not only did Edison invent the light bulb, but his work is evidenced in the scalability of electricity that changed the world and how we now live.

In what directions is Independence Blue Cross converging? (more…)

AdhereTech’s smart pill bottle gets a new retro design

click to enlarge My visit to CEWEEK in NY at the end of June was, in contrast to the 2014 edition, light on compelling health tech. One that stood out, for all the modesty of their display, was NYC-based AdhereTech. It’s a med reminder system pushed to the max: a pill bottle that dispenses normally, but collects and sends adherence data in real-time, with a system that analyzes and records the data. If a dose is missed, they send out customizable alerts and interventions to patients, using automated phone calls, text messages and other reminders. It also uniquely measures the level in the bottleso it can automatically notify the patient, provider and pharmacy about a refill.

When last we saw them, they had just won a spot in the inaugural (2013) Pilot Health Tech NYC program. They have redesigned the bottle to have a more compact, retro med bottle-like shape along with a brighter light and chime. (more…)

Health Datapalooza 2015: more data, better health

Guest columnist and data analytics whiz Sarianne Gruber (@subtleimpact) sat in on the Health Data Consortium’s 2015 edition of Health Datapalooza last week in Washington, DC. It was all about the data that Medicare has been diligently harvesting. Also see the US-UK connection on obesity.

Health Datapalooza 2015, now in its sixth year, welcomed more than 2,000 innovators, healthcare industry executives, policymakers, venture capitalists, startups, developers, researchers, providers, consumers and patient advocates. Health Datapalooza brings together stakeholders to discuss how best to work the advance health and healthcare,” said Susan Dentzer, senior policy adviser to the Robert Wood Johnson Foundation and a member of the Health Data Consortium. The Consortium promotes health data best practices and information sharing; and works with businesses, entrepreneurs, and academia to help them understand how to use data to develop new products, services, apps and research insights. This year’s conference was held on May 31 through June 3 in Washington, DC. And how best to celebrate is with the gift of more data!

New Medicare Data Means More Transparency
The Centers of Medicare and Medicaid Services (CMS) released its third annual update to the Medicare hospital inpatient and outpatient charge data on June 1, 2013. (more…)

ATA’s hottest trend: advancing to Healthcare 2.0 via personalized healthcare

Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 earlier this month. This is the third of three articles on his observations on trends and companies to watch.

For those who attended the American Telemedicine Association‘s meeting in Los Angeles, the overarching trend was how a personal healthcare system is taking shape. The three pillars include: care anywhere, care networking and care customization.

The ATA stage opened with a keynote speech by Dr Sanjay Gupta about celebrating new innovation and technology advancements. This is the year where healthcare models are being built around patients in the home to support patient autonomy.These three pillars of personalized healthcare are being made possible by disruptive technologies, wearables/implantables, social networks and analytic technologies to automate remote care. Wearables and biosensors allow patients to move anywhere without interfering with day to day schedules while allowing for optimized data collection.

Access to care anywhere has been a challenge and is becoming realized through providing cheaper wireless tools that takes it to far corners. Dr Gupta focused on the use of telemedicine for delivery of care and its utility for improving access. He endorsed it as a tool for providing care for those with limited healthcare accessibility and locally for more a mainstream solution to a larger healthcare problem. We have seen telemedicine become mainstream (more…)

The Future of Medicine – Technology & the Role of the Doctor in 2025 – a brief summary

The following is a brief summary of a joint Royal Society of Medicine/Institute of Engineering & Technology event held at the Academy of Medical Sciences on 6th May. The event was organised, extremely professionally, by the IET events team. The last ticket was sold half an hour before the start, so it was a genuine sell-out.

The speakers for the event were jointly chosen by this editor and by Prof Bill Nailon, who leads the Radiotherapy Physics, Image Analysis and Cancer Informatics Group at the Department of Oncology Physics, Edinburgh and is also a practising radiological consultant. As more of those invited by Prof Nailon were available than those invited by this editor, the day naturally ended up with a strong focus on advances in the many aspects of radiology as applied to imaging & treating cancer, as a surrogate for the wider examination of how medicine is changing.

The event began with a talk by Prof Ian Kunkler, Consultant Clinical Oncologist & Professor in Clinical Oncology at the Edinburgh Cancer research Centre. Prof Kunkler began by evidencing his statement that radiotherapy delivers a 50% reduction in breast cancer reappearance, compared with surgery alone. He stressed the importance of careful targeting of tumours with radiotherapy – not an easy task, especially if the patient is unavoidably moving (eg breathing) – Cyberknife enables much more precise targeting of tumours as it compensates for such movement. Apparently studies have shown that 55% of cancer patients will require radiotherapy at some point in their illness.

This was followed by Prof Joachim Gross, Chair of Systems Neuroscience, Acting Director of the Centre for Cognitive Neuroimaging & Wellcome Trust Senior Investigator, University of Glasgow, talking about magnetoencephalopathy (MEG), which enables excellent spatial & temporal resolution of the brain. However it currently uses superconducting magnets that in turn require liquid helium, so is very expensive to run. He then showed an atomic magnetometer which apparently is developing fast and will be a much cheaper alternative to MEG – he expects people will be able to wear sensors embedded in a cap soon. He then went on to show truly excellent graphics on decoding brain signals with incredible precision; he explained that the 2025 challenge is understanding how the different brain areas interact. Finally he described neurostimulation, using an alternating magnetic field with the same frequency as brain waves to change behaviour; whence the emergence of neuromodulation as a new therapy. Both exciting, and just a little scary.

Dr David Clifton, Lecturer, Dept of Engineering Science & Computational Informatics Group, University of Oxford, followed with a talk on real-time patient monitoring. He began by explaining the challenges that clinicians face with this wall of patient data coming towards them: only “big data in healthcare” enables all the data generated by patients to be analysed to identify the early warning signals that are so important to minimise death and maximise recovery. (more…)

“Mainstreaming medical apps; reducing NHS costs; improving patient outcomes” – a brief summary

What follows is a brief summary of the presentations given at the Royal Society of Medicine’s third “Appday”, held on 9th April 2015. All three events have been sell-outs.

Anne Hayes, Head of Market Development at BSI, opened the event with an excellent presentation on the then shortly-to-be-finalised PAS 277 on mHealth apps (now available, free, here). She particularly welcomed the opportunity to present to clinicians, as too often her audience was primarily technologists. The presentation was especially impressive because Anne had only agreed to do the presentation the previous Friday, following realisation by both MHRA & NICE that proximity to the election meant neither could present. Anne explained that PAS 277, as a Publicly Available Specification, is not mandatory – it is essentially a checklist for developers and purchasers of medical apps to consider.

Julie Bretland, CEO of OurMobileHealth, then presented on the preliminary conclusions of the NIB Workstream 1.2 on how best to approve medical apps. (more…)

ATA trend #2: is this the ‘second generation’ of remote patient monitoring?

Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 last week. This is the second of three articles on his observations on trends and companies to watch.

During the course of the ATA conference, I was inundated with the concept of “dumb” data whereby biosensors track patient clinical data and will alarm to clinical staff if outside designated parameters. However, the call center filter between the patient’s data and physician is often a primary cause of increased unnecessary admissions. The Sentrian Remote Patient Intelligence Platform (Sentrian RPI) received recognition for its advancement in utilization of sensors, enabling healthcare providers to utilize this “dumb” data and make it “smart”. For clinicians like myself, this was a new way of looking at an age old problem: “How do we safely and comprehensively support physician decision making at a standard high enough to detect pathologies earlier and more accurately?”

Sentrian has used machine learning to support the work of a dedicated clinical team by monitoring patient data 24/7 to detect subtle signs that warn a family member or care provider of future problems through biometric patterns of thousands of patients, comparing their medical histories, vitals and health information. This novel approach to remote monitoring won Sentrian the ATA President’s Innovation Award. (more…)

ATA trend #1: Is a sustainable RPM infrastructure fact or fiction?

Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 last week. This is the first of three articles on his observations on trends and companies to watch.

The advancement of remote patient monitoring is a visible trend from the American Telemedicine Association’s 2015 meeting, with care moving from the doctor’s office and being shifted to the patient’s home. A more diverse range of data is being collected for patients to facilitate more informed decision making at the patient visit and after the patient is away from the practice. As information is being collected and monitored on a more comprehensive basis, we have seen creative modalities to view a broad array of data points that would typically have been collected in a doctor’s office with the hopes of early diagnosis and preventive care, versus reactive care.

Patient autonomy has now come to the forefront and network infrastructure is being built to support that shift. Wearables, implantables and home based lab/ urine diagnostic kits are becoming smaller, cheaper, less invasive, wireless and cloud-based so that patients can be monitored without interfering in day to day living. (more…)

ELabNYC Pitch Day 2015

Thursday 3 April, Microsoft’s NY Technology Center, Times Square NYC

click to enlargeThe third annual Pitch Day for the now 20 startup/early-stage life science, biotech and healthcare technology companies in the ELabNYC (Entrepreneurship Lab Bio and Health Tech NYC) is a culmination of their year-long program participation in this NY Economic Development Corporation (NYCEDC)-supported program. The entrepreneurs in the ELabNYC program primarily come from from the doctoral and post-doc programs from New York’s many universities, from CUNY to Columbia, from many parts of the world, and most have experience within the city’s multitude of major health research institutions from The Bronx to Brooklyn. New York is also a center of funding for life science and health tech ventures; it’s #2 with NIH awards totaling $1.4 billion. For the past few years, NYEDC has also supported these companies with finding access to capital, specialized space (e.g. wet labs such as the million square feet at Alexandria Center alone, plus Harlem Biospace and SUNY Downstate in Brooklyn) and partnerships with major companies such as Celgene, Eli Lilly, Pfizer and GE Ventures.

This Editor will concentrate on health tech companies–eight, up from five last year [TTA 17 Apr 14]. Each company pitched for five minutes on its concept, its current state of advancement (including pilots/customers), its team and a funding timeline. It was a very different mix from last year’s class, which focused on compliance, diagnosis, dementia and concussion. These companies focused on niches which are either not being served well or to substantially reduce costs. Nearly half the entrepreneurs were women, a substantially greater number than one usually sees in the biotech/health tech area. Short impressions on our eight, with links to their Executive Summaries on the 2014-15 ‘class page’: (more…)

Qualcomm (Second) Life: a conversation with Jim Mault

One of the surprises for this Editor, and for others attending the mHealth Summit, was to see the sizable presence of Qualcomm Life on both the exposition floor and during the sessions. From a near-nil presence at ATA 2014 and gone dark on news, the floodlights snapped on last week with new partners and a new emphasis: coordination of chronic and transitional (hospital to home) care management (CCM/TCM).

On the show floor, the spotlight was on the partner companies which mixed the established with (mostly) the early and mid-stage. Readers will recognize names such as AliveCor, Telcare, OMRON, Nonin and Airstrip; not so well known are Vaica, Orion Health, Monitored Therapeutics, IMPak Health, Vital Connect, Care Connectors, toSense (CoVa), Dexcom, InteliChart, TruClinic, ForaCare, VOXX, vitaphone (outside of Europe), Propeller Health and Noom Health (a NYeC Digital Health Accelerator 2014 graduate). The partners occupy different parts of the management continuum, integrating communications, record sharing, population health management, sensor-based monitoring, traditional and non-traditional vital signs monitoring, medication management, behavioral change methodologies and PHRs. The 2net Hub is still present for data transmission, sharing and storage, but more prominent is Qualcomm Life’s HealthyCircles platform which provides the clinical management ‘glue’: secure communications, record sharing and care team coordination. HealthyCircles was purchased in mid-2013. Founder James Mault, MD, FACS joined Qualcomm Life as VP/Chief Medical Officer.

We had some post-mHealth Summit reflection time by telephone this Wednesday while Dr Mault was in Boston. (more…)

Breaking news out of the mHealth Summit

mHealth Summit this year had an abundance of digital health company news announcements, not only from the conference but also timed to coincide with the heightened interest around it. Your Editor looks over the most interesting of them, briefly. Thanks to Ashley Gold of Politico’s Morning eHealth (@ashleygold, daily reports archived here), Stephanie Baum of MedCityNews (@stephlbaum) and Anne Zieger of Healthcare Dive for their coverage and their company in the press room!

Partners HealthCare researches, Validic expands, AliveCor and Omron ally, Happtique sells out, Doctor on Demand is telemental, Orange goes dental, VA Innovation Rocks

  • Partners HealthCare/Center for Connected Health’s cHealth Compass will use panel and other research to help companies, device manufacturers, startups and investors determine what end users–consumer and provider–want out of personal health tech. Focus groups, interviews and usability testing will help to determine product design, evaluation, assess applications and feasibility as well as interim/final product testing. Partners is already organizing in Massachusetts a 2,000-patient database which rewards participants $50 on registration and $110 annually to be in a monthly survey panel. cHealth Compass website, BetaBoston (Boston Globe)
  • Health data connector/aggregator Validic demonstrates the attractiveness of Anything Big Data on with new clients including the Everyday Health consumer/professional website and the adidas Group’s sport and fitness apps. Recently they added WebMD, Pfizer, University of Pittsburgh Medical Center (UPMC), NexJ Health and MedHost to their client list. The company claims that their ‘ecosystem’–probably the most popular buzzword at this year’s conference–of healthcare companies and tech developers now reaches over 100 million people with devices such as Omron, Alere, Qardio, Telcare, Jawbone and Withings. Release
  • AliveCor accentuates the retail with Omron. AliveCor, which developed the first FDA-cleared ECG for smartphones and gained clearance for an atrial fibrillation algorithm in August, is collaborating with Japanese device manufacturer Omron on developing its retail presence. Omron’s devices are available in major drugstores such as Walgreens, RiteAid and Walmart so certainly AliveCor is due to benefit. AliveCor is also part of a revived QualcommLife (more on this in an upcoming article)  ReleaseMobihealthnews (Your Editor had the pleasure of meeting at last AliveCor’s CMO and founder Dr. Dave Albert.)
  • Happtique sold to SocialWellth. Last year’s floor talk was about Happtique’s first class of certified apps and a security expert’s untimely discovery of major flaws (more…)

NYeC Digital Health: two diverging visions of a connected future (Part 1)

The New York eHealth Collaborative’s fourth annual Digital Health Conference is increasingly notable for combining both local concerns (NYeC is one of the key coordinators of health IT for the state) and nationally significant content. A major focus of the individual sessions was data in all flavors: big, international, private, shared and ethically used. Another was using this data in coordinating care and empowering patients. Your Editor will focus on this as reflected in sessions she attended, along with thoughts by our two guest contributors, in Part 2 of this roundup.

click to enlargeThe NYeC Conference was unique in presenting two divergent views of ‘Future IT’ and how it will affect healthcare delivery. One is a heady, optimistic one of powerful patients taking control of their healthcare, personalized ‘democratized medicine” and innovative, genetically-powered ‘on demand medicine’. The other is a future of top-down, regulated, cost-controlled, analyzed and constrained healthcare from top to bottom, with emphasis on standardizing procedures for doctors and hospitals, plus patient compliance.

 

click to enlargeFirst to Dr Topol in Monday’s keynote. The good side of people ‘wired’ to their phones is that it is symptomatic, not of Short Attention Span Theatre, but of Moore’s Law–the time technology is now taking for adoption by at least 25 percent of the US population is declining by about 50 percent. That means comfort with the eight drivers he itemizes for democratizing medicine and empowering the patient: sensors, labs, imaging, physical examination, records, costs, meds and ‘Uber Doc’.

(more…)