Is the clock at the funding pub pointing to ‘last call’? (Updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2012/12/crystal-ball.jpg” thumb_width=”150″ /]And we were having such a good time! UPDATED Having ridden a few hype curves (in health tech and out–remember airline deregulation?) and with the bruises to prove it, this Editor believes that she can spot a Cracking Market at forty paces. The hands on the clock appear to be near closing time, even as we party on. After all, DTC telehealth is forecast to be $25 bn in the US by 2025 (GrandView Research), if we make it that far!

Where are the sharp noises coming from?

  • The continuing fail of unicorns like Theranos [TTA 4 May and prior], now resorting to bullying the Wall Street Journal and negotiating with the alphabet (SEC, DOJ, FDA, CMS…), and the troubles of Zenefits. 
  • Another notable unicorn, the doctor booking site ZocDoc, being called out at last on their customer churn, low margins, and high customer acquisition costs. (As well as an irritant to doctors and office managers) New York Business Journal
  • Extremely high and perhaps insane rounds of funding to young companies with a lot of competition or a questionable niche. Higi is an odd little kiosk + consumer engagement program located in primarily Rite Aid drugstores–odd enough to score $40 million in its first venture round. (Ed. note: I shop at Rite Aid–and have never seen one.)This is after the failure of HealthSpot Station, which burned through approximately $43 million through its entire short but showy life. The low-cost, largely exchange plan insurer Oscar Health raised $400 million this February  ($727 million total) while UnitedHealth and others are dropping money-losing plans in most states. Over 50 percent of exchange co-ops went out of business in 2015, leaving doctors, health systems and patients holding their baggage. Again, low margins, high cost and high customer acquisition costs.
  • We’ve previously noted that funders are seeking ‘validation in similarity’–that a few targeted niches are piling up funding, such as doctor appointment setting, sleep trackers and wellness engagement [TTA 30 Dec 15]
  • Tunstall’s continuing difficulty in a sale or additional financing, which influence the UK and EU markets.
  • NEW More patent fights with the aim of draining or knocking out competition. We’re presently seeing it with American Well litigating Teladoc over patent infringement starting last year, which is only now (March) reaching court. It didn’t stop Teladoc’s IPO, but it publicly revealed the cost: $5 million in previously unplanned lobbying and legal costs, which include their fight with the Texas Medical Board on practicing telemedicine–which is beneficial for the entire industry. (But I would not want to be the one in the legal department explaining this budget line.) Politico, scroll down. But these lawsuits have unintended consequences–just ask the no-longer-extant Bosch Healthcare about the price of losing one. (more…)

Dream team or dance of the dinosaurs? Another view of Legrand’s recent acquisition

The recent news of  Legrand’s acquisition of Jontek Ltd to join Tynetec in their Assisted Living & Healthcare Business Unit stirs many nice memories, as this editor has much to thank both Tynetec, and Jontek for.

Once Tynetec quality was a match for the other major player in the telecare market, their competition was truly appreciated in restraining the cost of delivering telecare. They were enormously helpful, particularly when this editor was working in Surrey. However at the end of the day, their systems, like the other major competitors in the market, were proprietary. Thus once a Tynetec dispersed alarm unit was installed, only Tynetec peripherals could be added.

Jontek on the other hand were able to receive alerts from all the major telecare players, so enabled mixed economies (as we had in Surrey) to be managed by the same call centre. Although “for legal reasons” there were problems with getting (more…)

10th Anniversary Article 2: The Decade that Laid the Foundations for Connected Care?

This year, on the 10th Anniversary of Telehealth and Telecare Aware, we invited industry leaders to reflect on the past ten years and, if they wish, to speculate about the next ten. We are pleased to publish the following item from Steve Sadler, who has been Chief Technology Officer for the Tunstall Group since 1996.

My reflections on the last decade describe a laying of the foundations for ‘connected care’.

The decade has seen continued and huge pressures on health, care and housing, driven by our living longer and with increasing prevalence of long-term conditions.

We have also seen major disruptions to economies worldwide, affecting their ability to continue funding traditional models of care. The resulting public sector budget constraints are daunting, pushing us to explore technology-enabled transformation of services.

At the same time we are experiencing helpful developments in technology, prompting questions as to how we can do more with IP-connectivity, health apps, internet of things, cloud and big data analytics, to help us to shape solutions that bridge the gap between our needs and our resources.

An Exciting Beginning: So what was so special about the last 10 years? (more…)

Xcertia takes another pass at app certification, but will it fly? (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/12/alp-mountains-peaks-in-winter.jpg” thumb_width=”150″ /]An app developer and a healthcare/digital health innovation lab get into the certification game. Can they fly over the treacherous peaks this time? Social Wellth made good on their promise (or threat?) to get into the app vetting business this past week through announcing a partnership with Columbia University-based HITLAB at the HITLAB Summit this week to develop a certification organization known as Xcertia. Last year, Social Wellth acquired the remains of Happtique from GNYHA Ventures [TTA 12 Dec 14]. The Xcertia principles center around privacy, security, operability and content–as Happtique’s did. The intent is to not only develop a program to certify apps based on established standards, but also form a Signature Steering Committee to ensure they maintain “their definitive set of criteria for evaluating mobile health apps.” MedCityNews, release

Possible conflict of interest. It all sounds positive, but the head of Xcertia, David Vinson, is also the CEO of Social Wellth, which despite its nonprofit-ish name makes its living by developing consumer apps and “dashboards” for insurance companies, a task grandly called (from their press release) “the curation of digital health experiences by leveraging mobile health technologies that allow for integration and aggregation of all digital assets.” Social Wellth also makes quite a bit of hay on its website about app curation for its clients. (more…)

Big home health win for telehealth confirms trend: must expand services, analytics

One of the most logical places for telehealth, remote care management (RCM) and transitional/chronic condition management (TCM/CCM) is with home health providers and post-acute care, yet perennially it has been on the ‘maybe next year’ list for most telehealth providers. That ‘next year’ may be getting a little closer with the news that Intel-GE Care Innovations has inked a multi-year deal (no pilot-itis here) with major (~400 facilities) home health provider Amedisys using their PC/tablet-based Health Harmony platform.

The initial focus is an ambitious one: reducing hospitalizations and ER/ED visits among patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, depression as well as patients who have two or more of these conditions (co-morbidities). The most interesting to this Editor is the parenthetical mention of analyzing ADLs (activities of daily living) with clinical data. Does this imply the engagement of their venerable ADL monitor QuietCare? (It’s something the founding company worked on circa 2006 while this Editor was there; one would think the analytics have advanced since then.) Another aspect is that Care Innovations will manage Amedisys’ complete RCM program from recruiting to logistics, data analytics and application integration services. Business Wire

What this means: Telehealth (and telecare) companies are now increasingly obliged in these big wins to provide a plethora of additional related services. Health care providers demand services beyond the monitoring technology. They want the turnkey package, from nurse evaluations, care coordination/management, to analytics and logistics.This ‘service creep’ implies alliances and mergers to add on to technological monitoring capabilities–and beaucoup financing. (more…)

2016: will telehealth catch on or stagnate, due to factors out of control?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/11/Robert-Graham-Center-logo.jpg” thumb_width=”150″ /]Updated. Reviewing the Robert Graham Center study summarized by Editor Chrys last week, René Quashie of Epstein Becker Green, perhaps the leading law firm in the health tech area, opines that despite the great progress made by telehealth (telemedicine/virtual consults, but also remote patient monitoring), “state legal and regulatory issues, reimbursement, and provider training and education continue to be serious barriers to wider adoption of telehealth. And until the landscape evolves to address these barriers, telehealth adoption is likely to stagnate despite the great promise of telehealth holds as a tool to improve quality and access.” Yes, that old FBQ* (actually the top two) continues to be as true now as five years ago. While in closing Mr Quashie puts his trust in the ‘pull’ factor of consumers and patients “who will continue to demand better access and more innovative delivery models outside the conventional office visit,” this Editor is far less sanguine, despite having used a virtual consult app recently. It was turned to more out of sheer frustration–time pressure (work, travel), being unable to secure a timely visit with a specialist (no one seems to be taking new patients!) despite good (non-Obamacare) medical coverage, and a condition which was eminently photographable (plus $40 at hand). National Law Review  * The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.

Then again, if you read Health Populi and believe Gallup’s polling (based on a slightly skewed question), a majority of Americans aren’t thinking about delivery models or telehealth at all. They’re unhappy, and would like to hand the whole hot mess over to the government when asked if “government is responsible for ensuring that people have health insurance.” Yet the Affordable Care Act, now two years in, was supposed to do exactly that by forcing everyone to pay for a healthcare policy or else pay a punitive tax. Too many did the math; the tax penalty was cheaper, especially for those Young ‘n’ Healthy Invincibles with slim purses and other things to spend on. They were the ones who were expected to pony up premiums, use few services and generally prop up the system.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/11/shockedshocked.jpg” thumb_width=”150″ /]Now the American populace are shocked, shocked to find that out-of-pocket costs are way up and access is down. The same Health Populi article cites Fair Health’s spring 2015 consumer survey, finding that 33 percent of American patients felt that their out-of-pocket costs were ‘much more than expected’, with an additional 17 percent in the ‘somewhat’ category–a total of 50 percent. The contradiction of government control versus spending (and actuarial) reality is, in this Editor’s opinion, not going to be solved easily or well.

As to the wisdom of government involvement, there’s another developing and embarrassing ACA Big Fail(more…)

Are we in the midst of healthcare disruption–or not at all?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]If you believe we are in the midst of a slow, tidal disruption of healthcare and the ascendancy of patient-centered care–to the point of Topolesque patient ownership–then you will be upset to tears by the contrarian assertions of Dan Munro in Forbes. He maintains that disruption isn’t what we think it is, but (and we cut to the chase here) it’s more like ‘process improvement’ and that it has to be driven by ‘K Street’ (translation: the street in Washington DC where Lobbyists Rule). Technology–patches on the flawed system. Doctors–desperately seeking to pay back their educational loans by picking the most lucrative specialties. (If they survive the internship and residency system without killing a patient or themselves; see The Misery of a Doctor’s First Days)

But..there’s more. (more…)

Soapbox: The burning technological platform for person-centred care

Rising demands of an aging population are putting increasing pressure on care providers across health and social care. But the technology and thinking that can help alleviate some of those pressures is analogue in a digital world, argues Tom Morton of Communicare247.

Analogue thinking in a digital world
Integrated, person-centred care is seen as a driving force for building public services around individual needs. It aims to bring care out of the hospital and into the community and home to cope with the growing burden of the 3 million people who will have over three long-term conditions by 2018. It will also help acute hospitals to address the ever increasing costs associated with our aging population.

Meanwhile life in our homes and communities is becoming fragmented. One in four (2.9 million) people aged 65 and over feel they have no one to go to for help and support, according to a 2015 report from Age UK and The Campaign to End Loneliness(1). With research indicating that social isolation leads to higher mortality, what point is there keeping people out of hospital, if only they are left home alone, and without the necessary support?

Person-centred care will have minimal success if we do not recognise this fact; people need someone to look out for them. And current approaches are not building the foundations that society needs to help grasp the nettle of providing round-the-clock personal care. (more…)

A day in the life of a blind business man (guest blog)

Chris Lewis, the world-renowned telecoms expert and regular presenter on disability issues has kindly offered to share some thoughts with readers prior to his presentation at the Royal Society of Medicine event on the Medical Benefits of Wearables on 23rd November. This is the second of two he has written specially for TTA.

You’re blind: How do you ‘read’, join in social media and find your way around, let alone run a business?

Picture the scene: a blind man walking down the street moving white stick to and fro. He is muttering to himself while clicking a small black thing in his left hand. What is he doing? Actually, he is running his business, doing email, messaging, reading documents, checking-in for his flight and working out the best route using bus and tube to get to the airport. The black device is a mini keyboard, controlling the iPhone in his pocket and it is talking to him via his in-ear Bluetooth device….

Having been registered blind for over 30 years, I am accustomed to the regular question about how the hell do you run a business? I thought it worth while to put this down in writing both as a record of how things stand in 2015, but also as evidence of how my world has changed since the days of cumbersome magnifiers, papers being sent off to be recorded, and very clunky interfaces with early PCs.

Equipment & technology

(more…)

Accessibility arriving at the Top Table (guest blog)

Chris Lewis, a world-renowned telecoms expert and regular presenter on disability issues has kindly offered to share some thoughts with readers prior to his presentation at the Royal Society of Medicine event on the Medical Benefits of Wearables on 23rd November. This is the first of two he has written specially for TTA.

At this year’s Mobile World Congress (MWC) in Barcelona accessibility I took to one of the main stages for the first time. IBM, Microsoft, Google and the Mobile Manufacturers Forum (MMF) joined me to present perspectives on how accessibility is going mainstream.

I introduced the session with some of the key findings from the second Telefonica accessibility report “Digitising the Billion Disabled: Accessibility Gets Personal“. In summary, the billion disabled people represent a major spending group, combining earnings of some $2.3 Trillion and state support of $1.3 Trillion. Disabled people on average earn only 60% of their able-bodied peers and, of course, many disabled people don’t get the opportunity to work at all. 4% of children and 10% of the working population are disabled, but perhaps most striking, over three quarters of the elderly. Combine this dynamic with Douglas Adams’s theory of adopting technology getting harder as we get older and you can see the ticking time bomb of disability and age. (more…)

10th Anniversary Article 1: The Next Ten Years of Telecare

This year, on the 10th Anniversary of Telehealth and Telecare Aware, we have invited industry leaders nominated by our readers to reflect on the past ten years and, if they wish, to speculate about the next ten. Here is the first article, with a UK focus, by Dr Kevin Doughty.

Many of us are frustrated at how little progress there has been in the deployment and acceptability of telecare during the past decade. Yet, despite warnings that an ageing population was about to bankrupt the NHS (and health insurance schemes elsewhere in the world), and that access to social care for older people was being withdrawn at such a rate that it could only be afforded by the wealthiest in society, our health and social care systems have just about survived.

But this can’t go on, and in England over the past 12 months: (more…)

Radiation from smartwatches, wearables: real, alarmist, or the NY Times?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye has that certain half-baked radioactive ‘glow’. The healtherati are all aTwitter over a New York Times Style (!) section article that does the unthinkable–it dares to raise the question of the possible harm of radiation that wearables, including smartwatches as well as smartphones, might present to both adults and children. The writer, Nick Bilton, is a regular tech columnist.

After an unfortunate baiting for attention at the start, making an analogy of cellphone/wearable radiation to 1930s adverts with doctors ‘endorsing’ cigarettes, he for the most part tries to take a balanced approach. By the end, he lines it up like this. Bluetooth LE and Wi-Fi–no evidence of harm in adults. 3G/4G cellphone radiation–you may want to be careful. He points out that studies aren’t definitive. Older studies, such as the WHO’s, a Swedish and some European studies point to harmful (carcinogenic) effects from phones held extensively too close to the head, but nothing is definitive in causality as the CDC pointed out and additional studies have proven no conclusive evidence of harm. Conclusion–use anything 3G/4G with caution, away from the head, limit exposure by children or pregnant women. Cautious enough?

Oddly, he advocates Bluetooth headsets but doesn’t mention using speakerphone settings–and then, for the smashing windup, won’t put the Bluetoothed Apple Watch near his head. It’s a weirdly sourced (an alternative doctor the only one cited? Old studies?) and half-baked, partially tossed salad article. Consider: most wearables are–surprise, Bluetooth or Wi-Fi connected. But it does bring up the inconvenient question, only partially answered, of All Those Rads and What (If Anything) Are They Doing To Us.

What’s really interesting? The immediate, twitchy and prolonged press response. As they say in New Jersey, they are ‘jumping ugly’. (more…)

The NHS, tech, and the next 10 years – soapbox, event & call for posters

As a distraction from the things that, before the advent of handheld technology, little boys used to do in the school playground when this editor was young, once in a while we would engage in the pointless debate of what would happen if an irresistible force met an immovable object.

Those debates came to mind when Graham De’Ath kindly drew this editor’s attention to the recently published Labour Ten Year Plan for Health & Care. Now Telehealth & TelecareAware knows better than to indulge in politics, however the document was notable in that it did not make any significant reference either to the demographic reality of the next ten years, or the likely role of ‘technology’ in assisting with the resultant increase in care required (the word is mentioned just once, in the commitment to: “Set up a wide–ranging review of NICE which will look at reforming the  NICE technology  appraisal process…” [actually already underway by the NIB]).  The Labour Party is far from being alone in this – readers with long memories will recall our amusement as the RCGP’s ten year forecast of the changes in GP practice where the biggest role technology was expected to play in 2022 was in remote delivery of test results.

The reality, TTA believes, will be very different: (more…)

Hackermania running wild, 2015 edition

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”300″ /]

Do we need the Hulkster Running Wild against Hacking? It’s so heartwarming to see the mainstream press catch up to what your Editors have been whinging on for the past few years: that healthcare data is the Emperor With No Clothes. Here we have Reuters and the New York Times with a case of the vapors, seeking a fainting couch. Reuters dubs 2015 ‘The year of the healthcare hack’. The FBI is investigating the AnthemHealth breach, while their counterparts UnitedHealth, Cigna and Aetna are in full, breathless damage control mode. The Times at least delves into the possibility that it was at least partially instigated by China and the People’s Liberation Army (PLA) unit that trolls for intellectual property.

Our Readers, savvy to your Editors’ warnings since at least 2010, were aware that the drumbeat accelerated this past summer. (more…)

Can the NHS be in crisis when they want to waste money like this?

The Guardian had a headline yesterday: “GPs to be offered £1bn in new funds if they improve access and elderly care” Upon reading further it transpires that £250m pa is to be offered for the next four years. A clue to the rationale and preferred direction of the monies is:

“NHS England believes using the £1bn to transform existing GP surgeries and build some new premises will help reduce the pressure on hospitals buckling under the strain of unprecedented demand.”

Telehealth & Telecare Aware believes that this is totally the wrong approach. Given the huge increases in the popularity of remote consultation as we covered in our review of our 2014 predictions, surely the right focus for additional funding is to provide substantial incentives to get GPs using existing technology to consult with patients remotely? This should be allied with an advertising campaign to point out the benefits to patients of not having to visit a surgery or exchange germs with others in the waiting room plus offer reassurance that face to face appointments will always be available if the doctor thinks one is necessary.

One way to start might be for the NHS to do deals with organisations like GP Access to offer technology like their askmygp to all GP surgeries for free and give large financial incentives to GPs conducting remote consultations with more than an agreed percentage of the patients on their books by year end…then raise that percentage every year for the next four years. That has got to be far cheaper than building works that will anyway become redundant soon because attitudes are changing and people will be preferring remote consultation shortly anyway! It would be much quicker to implement too.

In mitigation, the article also mentions that surgeries, apparently also “will also be expected to make much better use of technology to monitor patients’ health as a way of reducing their need to seek direct care from a doctor.” However that sounds more like a tepid endorsement of telehealth than encouragement to be radical.

Hat tip to Mike Clark

Soapbox: Why an app isn’t like a book

The suggestion has been made recently at a couple of events that this editor attended that there is an unnecessary fuss over regulation of medical apps because they are just like medical books; as there is no regulation of books, why the need to regulate medical apps? . In order to try to move to a consensus, this post puts the opposite point of view, to stimulate debate. In summary the arguments of why they are different are:

  • We are familiar with books and have worked out how to deal with them;
  • Books give formulae and leave users to compute; apps do it all, often without showing their working;
  • Tablets and, especially, smartphones have screens that are smaller than books so require a different design.

This issue of course only relates to serious medical apps – something like 99.5% of all health apps available are very unlikely to do serious harm, helping people as they do record things like their fitness and their weight, and so do not require such detailed scrutiny. It is the ones that get close to, or meet, the test of being a medical device that are of particular interest here. The goal is that once clinicians are comfortable prescribing medical apps, and patients are comfortable using them, the NHS will save substantial sums by, for example replacing drugs with apps for a range of diseases where both are effective and apps are far cheaper. There are also huge benefits for clinician-facing apps – properly certified medical apps like Mersey Burns and Mersey Micro are already massively improving patient outcomes and significantly reducing NHS costs.

In more detail, books have been with us for many centuries so we are familiar with their structure, with the processes for their removal from publication if they give dangerous advice, and with the idea of specialist publications accessible by appropriate experts only – the same is not true of apps. In the event that advice in a book was dangerously wrong, (more…)