Tyto Care partners with Avera eCARE for telehealth delivered to medically underserved populations

Following on last week’s announcement of Tyto Care‘s partnership with Novant Health, Sioux Falls SD-based telemedicine provider Avera eCARE will be introducing Tyto Care’s professional version, TytoPro, into its telemedicine service using high-definition video for virtual consults. What TytoPro will add is remote diagnostic capability and collection via the TytoVisit platform, using the TytoApp and Clinician dashboard. Avera will use TytoPro’s hand-held device with exam camera, thermometer, otoscope, stethoscope (with volume, bell, and diaphragm filters), and tongue depressor adaptors.

In a test of Avera eCARE plus Tyto Care in an assisted living community, the pairing of the two systems reduced emergency department transfers by 20 percent, with 93% of residents treated in place.

Avera eCARE, a part of Avera Health, provides telemedicine services to medically underserved populations via local healthcare systems, rural hospitals, outpatient clinics, skilled nursing facilities, assisted living communities, schools, and correctional facilities. It has over 400 providers in its comprehensive virtual health network across the US. A ‘white paper’ on the Avera/Tyto Care partnership is here. Release 

Call for abstracts extended: ISG’s 12th World Conference of Gerontechnology (Norway)

ISG’s 12th World Conference of Gerontechnology, to be held on 18-20 May 2020 in Trondheim, Norway, has extended its call for conference abstracts to Friday 15 November. There are two types of abstracts:

  • Format No.1 – Free Paper, Poster, or an individual presentation as part of a symposium
  • Format No.2 – ONLY if you are the Convener of a Symposium

The link to the call for abstracts is here on their site. 

The conference will be held at the Clarion Hotel & Congress, located at Brattørkaia 1 in historic Trondheim. The conference theme is “Measures to achieve better quality of life and active healthy aging”. From the website, the conference “addresses the potential power of technology to both enhance quality of life older people and prevent age-related disabilities through health promotion. Technological solutions can also support independence and meaningful activities, and they can prevent loneliness, boredom and helplessness. This aligns with the main goals of gerontechnology which is divided into seven achievements: Satisfaction and enjoyment; Prevention; Support; Compensation; Caring; Care support; and Care organization.” More information is here. To register, see this page. Hat tip to Professor Anthea Tinker of the Institute of Gerontology, King’s College London.

News, moves and M&A roundup: Appello acquires RedAssure, Shaw departs NHS Digital, NHS App goes biometric, GP at Hand in Manchester, Verita Singapore’s three startup buys, Novant Health and Tyto Care partner

Appello telecare acquires RedAssure Independent Living from Worthing Homes. A 20-year provider of telecare services to about 700 homes in the Worthing area in West Sussex, the acquisition by Appello closed on 1 October. Previously, Appello provided monitoring services for RedAssure since 2010. Terms were not disclosed. Release.

Another NHS Digital departure is Rob Shaw, deputy CEO. He will be leaving to pursue a consulting career advising foreign governments on national health and care infrastructure. He is credited with moving the NHS Spine in-house and establishing NHS Digital’s cybersecurity function. The Digital Health article times it for around Christmas. Mr. Shaw’s departure follows other high-profile executives this year such as former chief digital officer Juliet Bauer who controversially moved to Kry/LIVI after penning a glowing article about them [TTA 24 Jan], Will Smart, Matthew Swindells, and Richard Corbridge.

One initiative that NHS Digital has lately implemented is passwordless, biometric facial or fingerprint-based log in for the NHS App, based on the FIDO (Fast-Identity Online) UAF (Universal Authentication Framework) protocol (whew!). NHS Digital’s most recent related announcement is the release of two pieces of code under open-source that will allow developers to include biometric verification for log in into their products.

Babylon Health’s GP at Hand plans Manchester expansion. The formal notification will likely be this month to commissioners of plans to open a Manchester clinic as a center for GP at Hand’s primarily virtual consults. This follows on their recent expansion into Birmingham via Hammersmith and Fulham CCG which will be notified. How it will work is that patients registering in Manchester would be added initially to a single patient list for GP at Hand located at Hammersmith and Fulham CCG. Babylon is now totalling 60,000 patients through GP at Hand.  GP Online

Singapore’s Verita Healthcare Group has acquired three digital health startups. The two from Singapore are nBuddy and CelliHealth, in addition to Germany’s Hanako. Verita has operations in Singapore, the US, Asia-Pacific and Europe, with 35 alliance partnerships with medical clinics and hospitals across Australia, Southeast Asia and Europe. Mobihealthnews APAC

Novant Health, a 640-location health system in North Carolina, is introducing Tyto Care’s TytoHome integrated telehealth diagnostic and consult device as part of its network service. Webpage, release

Slow gait speed at age 45 as an accelerated aging predictor–and result: Duke University study

Tracking gait not just for tracking acuity and functioning in older adults in care homes. A five-decade cohort study made of over 900 45 year-old adults in a single community–Dunedin, New Zealand–correlates slowness of gait with accelerated aging, including brain health measured as early as age 3. These markers include:

  • Decreased cortical thickness
  • Reduced brain volume
  • Poorer physical functions such as balance, hand grip, stepping, and physical-motor coordination
  • 19 biomarkers taken at ages 26, 32, 38, and 45 years including body mass index, waist-to-hip ratio, glycated hemoglobin level, leptin level, blood pressure, cholesterol, C-reactive protein level, white blood cell count, and dental health

Why this matters: the cohort study goes back to age 3. Assessed at that time by a pediatric neurologist were standardized tests of intelligence, receptive language, and motor skills; and examiner ratings of each child’s emotional and behavioral regulation. MRIs were not available for physical examination at that time and for many years after for children, but were used on the adult respondents to determine structural age-related features of the brain. 

At age 3 and later, poor scores on brain health judged from standardized tests were indicative of future slower gait and accelerated aging at 45, though the exact causality is not clear. In addition to the biomarkers and brain changes, their facial age was also older.

The study was conducted primarily by Duke University and New Zealand university researchers. The original cohort was 1037 participants (535 [51.6%] male). 997 were still alive at age 45 years, and 938 took part in the assessment at age 45 years between April 2017 and April 2019. Of the 997 still alive, 904 (90.7%; 455 [50.3%] male; 93% white) completed the gait test. Disabled (e.g. broken leg, amputation) were eliminated.

In looking back at this significant study, could a physical assessment of children’s health beyond the ordinary, with remedial work on motor skills and emotional state, stave off accelerated aging? Duke Today, JAMA Network Open, New Atlas

CB Insights names a Top 150 of digital health startups

Now the equivalent of Mrs. Astor’s Four Hundred? CB Insights has entered the list game with a brand new listing of digital health startups, the Digital Health 150, no ballroom needed–perhaps a convention hall? They are classified, sliced, and diced as follows:

Broad categories:

  • Digital therapeutics
  • Pharma supply chain
  • Insurance and benefits
  • Genomics
  • Consumer health and wellness
  • Providers: administrative tools, specialty care, primary care, clinical tools
  • Diagnostics: imaging, pathology, other diagnostics
  • Drug R&D: drug discovery and development, clinical trials, real-world evidence

Another slice is by deal stage from 2014 (the receding of seed funding and progression into Series B and C is notable), top well-funded companies, and ‘unicorn startups’. Unlike Rock Health, CB Insights also looks at where in the world the startups are from: 116 in the 150 from the US, 17 from Asia, 16 from Europe, and 1 from Canada (League employee health benefits).

Many of the usual suspects are here: 23andMe, Babylon Health (UK), American Well, Doctor on Demand, Proteus Digital Health, Iora Health, MDLive, Oscar, One Medical, the relentlessly advertised (in US) Noom, TytoCare, China’s WeDoctor and GoodRx (which last month acquired telemedicine provider HeyDoctor).  Others are surprising in various aspects: the new well-wired Medicare Advantage company Devoted Health, Let’s Get Checked (Ireland, though they list their HQ as NY on website), Protenus (breach tracking), Kry (Nordic/LIVI in UK), Zava (UK), Teckro (Ireland), AbleTo, Higi, ClearCare, and CarePredict. It’s nice to see nods to the un-sexy areas of senior telecare, home care, and cognitive health. CB Insights page

WOT with Proteus found equal to or better than DOT in TB medication adherence trial

Implications for administration of tuberculosis and other rigorous therapies. A test conducted by a California university team with tuberculosis (TB) patients comparing Wirelessly Observed Therapy (WOT) administered through Proteus Digital Health’s combination ingestible pill and sensor-based smartphone tracking, versus standard Directly Observed Therapy (DOT), found that WOT was equivalent to DOT in accuracy–and superior to DOT in supporting confirmed daily adherence to TB medications. It was also overwhelmingly preferred by participants. 

TB is a disease where treatment requires strict adherence to medication protocols over a lengthy treatment course and usually requires a period of direct observation of patient dosage. In the first part of the test examining accuracy under direct observation, the researchers reported a 99.3 percent rate of positive detection accuracy (95% CI, 98.1% to 100%) among 77 TB patients under treatment with IS-Rifamate. The second part of the study among 66 patients took place in a randomized control test. The Proteus WOT system was found superior to DOT in supporting confirmed daily adherence to TB medications during the continuation phase of TB treatment by 93 percent to 63 percent. The treatment course was as long as 29 weeks. Participants rated preference for a WOT system at 100 percent.

The study was performed by researchers from the University of California, San Diego, Stanford University, HHS and Orange County Health Care Agency and published in PLOS Medicine on 4 October. The team recommended that a WOT system like Proteus be used within high-burden TB settings in low and middle-income countries, especially as it can be monitored seven days a week versus a standard five days.  Mobihealthnews

The Theranos Story, ch. 61: Elizabeth Holmes as legal deadbeat

Did her lawyers expect otherwise? This weekend’s news of Elizabeth Holmes’ legal team at Cooley LLP withdrawing their representation services due to non-payment should not have caused much surprise. Cooley’s attorney team petitioned the court to withdraw from the case, stating that “Ms. Holmes has not paid Cooley for any of its work as her counsel of record in this action for more than a year.”

Cooley was representing Ms. Holmes in a class-action civil suit in Phoenix brought against her, former Theranos president Sunny Balwani, and Walgreens, charging fraud and medical battery. (When they withdraw, will she seek public representation based on poverty?)

Perhaps Ms. Holmes is the one who’s setting priorities, as the civil suit would be for monetary damages, and no money means there will be none for the plaintiffs to collect. The DOJ charges are a different story. She is on the hook for nine counts of wire fraud and two counts of conspiracy related to her actions at Theranos. Conviction on these could send her to Club Fed for 20 years plus a fine of $250,000 plus restitution for each charge. [TTA 16 June]

Last Wednesday, both Ms. Holmes and lawyers for her and Mr. Balwani were in Federal court in San Jose on the wire fraud and conspiracy charges, demanding that the government release documents from the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) that allegedly would clear them. After an hour, Judge Davila set 4 November as the next hearing date. 

Defending oneself does not come cheap, but after your company’s value crashes to $0 from $9bn, one might be looking for change in your Roche-Bobois couch and wondering if your little black Silicon Valley-entrepreneur formal pantsuit/white shirt ensembles will last through the trial. CNBC 2 Oct, CNBC 4 OctFox Business, Business Insider

Health tech bubble watch: Alphabet-backed One Medical reportedly prepping for 2020 IPO

Another health tech company tests the IPO waters. One Medical, a primary care medical clinic group that digitizes the office experience by offering mobile apps with online scheduling, virtual consults, and same-day appointments–for an annual fee of $200 plus your insurance–is prepping for an IPO filing early next year. The sure sign is that it’s hired banks including J.P. Morgan and Morgan Stanley.

One Medical, backed by Alphabet, has 72 primary care practices in nine major US cities. It currently has a valuation of $1.5 to $2 bn based on private share sales and investment firm estimates. In 2008 it raised $220 million in a 2018 round led by The Carlyle Group for a total raise since 2007 of $408 million, backed by Alphabet’s GV venture arm and VC firm Benchmark. From an initial emphasis on individual enrollment and a ‘lite’ version of concierge medicine, it recently has concentrated on self-insured employers, corporate health plans, and service areas such as mental health and pediatrics. A big question for investors will be its valuation–tech or healthcare?

One Medical would join IPO brethren such as Health Catalyst, Livongo, Phreesia, and Change Healthcare, all of which had fairly strong openings and initial growth but have rollercoastered since then. Still, smaller IPOs such as Progyny, a company that manages fertility benefits for employees at large firms, have filed to IPO by the end of the year. Fierce Healthcare, CNBC, Business Insider

Does healthcare need a new EHR system? A major health system thinks so. (Updated)

An interesting pairing to work on a ‘next generation EHR’. EHR and HIT giant Allscripts and Northwell Health, the largest health system in New York State, are partnering to develop an EHR that is AI and cloud-based and–what’s different–voice-enabled. Allscripts will, according to the release, provide development and systems integration expertise; Northwell will provide the clinician input, testbed, and also support the project with IT and administrative staff. The goal is an optimized patient and clinician experience, which is about as specific as the release gets. According to POLITICO’s Morning eHealth, the foundation for the system will be Avenel, the company’s stripped-down, cloud-based EHR platform, There’s no further information on timing, cost, what the AI might do, or whether the focus will be on acute care or outpatient/specialty practices.

Allscripts and Northwell will continue with their Allscripts EHRs in use since 2009, Allscripts Sunrise at the 19 Northwell hospitals and Allscripts Touchworks EHR used at Northwell’s 750 owned and operated outpatient practices in the metro New York area. Additional articles at Northwell’s newsroom.

Update 16 Oct: Northwell announced that it was extending its contract with Allscripts through December 2027. Read on in HISTalk for a tart take on the odds that the next-gen EHR will actually be a viable, competitive new product.

The confusion within TEC/telehealth between machine learning and AI-powered systems

Defining AI and machine learning terminology isn’t academic, but can influence your business. In reading a straightforward interview about the CarePredict wearable sensor for behavioral modeling and monitoring in an AI-titled publication, this Editor realized that AI–artificial intelligence–as a descriptor is creeping into all sorts of predictive systems which are actually based on machine learning. As TTA has written about previously [TTA 21 Aug], there are many considerations around AI, including the quality of the data being fed into the system, the control over the systems, and the ability to judge the output. Using the AI term sounds so much more ‘techie’–but it’s not accurate.

Artificial intelligence is defined as the broader application of machines being able to carry out tasks in a ‘smart’ way. Machine learning is tactical. It’s an application that assumes that we give the machine access to data and let the machine ‘learn’ on its own. Neural networks in computer design have made this possible. “Essentially it works on a system of probability – based on data fed to it, it is able to make statements, decisions or predictions with a degree of certainty.”, as stated in this Forbes article by Bernard Marr.

CarePredict has been incorporating many aspects of machine learning, particularly in its interface with the wrist-worn wearable and its interaction with sensors in a residence. It gathers more over time than older systems like QuietCare (this Editor was marketing head) and with more data, CarePredict does more and progressed beyond the relatively simple algorithms that created baselines in QuietCare. They now claim effective fall detection, patterns of grooming and feeding, and environment. (Disclosure: this Editor did freelance writing for the company in 2017)

In wishing CEO Satish Movva much success, this Editor believes that using AI to describe his system should be used cautiously. It makes it sound more complicated than it is to a primarily non-techie, senior community administrative and clinical audience. Say what you do in plain language, and you won’t go wrong. AI for Healthcare: Interview with Satish Movva, Founder & CEO of CarePredict

 

If the market’s expanding, where’s the telecare and TEC boom?

A question this Editor’s been asking since 2007, wondering why the rising tide of the market isn’t lifting the business boats. Adrian Scaife’s brief article on the TSA blog rhetorically asks the question and speculates on some answers. Mr. Scaife starts with the Care Technology Landscape Review’s [TTA 18 July] simple fact that growth in the UK has been flat for the past decade at 1.7m users nationally. Yet the demographics, social care dynamics, and the desire to live independently at home, enabled by more accessible and usable technology, should mean otherwise. 

Some of the reasons why are addressed in the Care Technology report: the industry’s focus on bright shiny tech, what sells to organizations versus emerging needs–and not focusing on benefits to the end users or ‘design and delight in the way the solutions look’ (the Apple paradigm). As Mr. Scaife put it, “It is perhaps not surprising consumers are currently voting with their feet!”

What might get the feet going in the other direction?  A “new generation of telecare that builds on existing services” that “delivers proactive, preventative, consumer friendly services with positive reassurance”. The difference is that this can be enabled by both “interoperable devices” (that shiny tech) but integrated with data that can provide that proactive insight. But those insights must be supported by a health and social care structure, more in place in the UK than in the US, for instance–and that may require the transformation first versus later. Why Isn’t Our TEC Industry Booming?

Telecare – time to sweat the analogue assets, not dump them

Veteran Editor Charles climbs on his soapbox, one more time.

There must have been a moment, somewhere, when a bronze age warrior realised that iron really cut the mustard (and other things) better. Unfortunately, that resulting genetic preference for new over old has left us open to the blandishments of salespeople through the ages, encouraging us to take every opportunity to buy new and cast out old.

And it costs! A current example is the drive by many telecare companies to use the digitalisation of the telecoms network in the UK to encourage users to ditch their analogue equipment in favour of their new shiny digital kit…when there’s no need. The telecare world has of course an honourable tradition of encouraging box shifting – back when I ran a telecare programme at LB Newham, in 2007 the government was encouraged to offer a Preventive Technology Grant to all local authorities. Perhaps the most memorable campaign though was Three Million Lives which, from the outside, appeared to have that one aim. Indeed there must be few telecare consultants who have not at some point in their career opened a cupboard to find the shelves heaving with unused – and sadly in a few cases unusable – kit.

Wise telecare providers will resist the current pressures though – both BT and Virgin have been provided with a wide range of old analogue telecare kit to test in their digital simulators alongside the appropriate digital/analogue converters and, I am reliably informed, it has worked well every time. Some companies, I am told, may not have taken full advantage of these facilities and only tested their new digital offerings, whilst ignoring analogue; I’ll leave the reader to work out why they might have done that. This is important because telecare kit is built to last and whilst some service users will benefit from the latest tech wizardry, most will be completely happy with the older kit – indeed those with dementia may find it impossible to get used to any new kit, providing one more incentive not to change. The original cost of that analogue kit must conservatively be well over £500 million, so it would seem to be a crying shame just to dump it whilst it still works well – indeed with local authority budgets as they are, it effectively would hugely reduce their ability to provide a service for all who want it.

There is of course one potential issue, as no power comes down the fibre telecoms lines, unlike with copper, so the service could fail in a blackout. However I understand that both BT and Virgin are working on solutions to this. GSM alarms, supposedly the future, are also vulnerable; indeed apparently this already happened a a few weeks back when the country suffered widespread power outages, when mobile networks failed in some areas. I understand that many masts don’t currently have a power back-up for such occasions and those that do only last 30 minutes.

So, if you are responsible for a telecare provision budget and a nice salesperson pops by to encourage you to switch out your old, ask them how their old kit behaved in the network simulations when paired with an appropriate converter.

If they tell you anything other than that it went really well, look askance. If they say they haven’t tested their old kit, ask them why not.

News and event roundup: Amazon PillPack, Humana joins CTA, NH’s telemedicine go, Fitbit Lives Healthy in Singapore, supporting Helsinki’s older adults, events

Now that we are past the unofficial end of summer, it’s time to spin that lasso and rope us some news.

Amazon’s PillPack loses a critical data partner. Electronic prescriptions clearinghouse Surescripts terminated their data contract with ReMy Health, which supplied PillPack with information on patients’ prescriptions. Surescripts found fraud in several areas of their relationship with ReMy Health including medication history, drug pricing, and insurance billing. Now PillPack has to obtain it the old-fashioned way–by asking the patient. This can lead to errors and inaccuracies in things like dosages and whether a drug is brand-name or generic. Now PillPack, in the lurch, is seeking a direct relationship with Surescripts. Seeking Alpha, CNBC

Health plan Humana is the first payer to join the Consumer Technology Association (CTA). Humana has been building up his data analytics and digital health capabilities with new ‘studios’ in Boston and hiring USAA’s CTO.  It’s piloting an app for Medicare Advantage patients to connect them with pharmacists and medication management via Aspen RxHealth plus working on a virtual digital primary model with telemedicine provider Doctor on Demand. Fierce Healthcare

New Hampshire is joining the telemedicine reimbursement bandwagon, with its legislature and Gov. Sununu approving primary care providers and pediatricians to bill Medicaid and private insurance for telemedicine visits starting in January 2020. This also ties into rural telehealth. AP, Mobihealthnews

Internationally….Fitbit is partnering with Singapore’s Health Promotion Board (HPB) for the Live Healthy SG behavioral change program, based on the Fitbit Premium program, starting in late October. Mobihealthnews A-P   In Finland, Digital Service Center Helsinki is creating digital tools and virtual care systems to enable older adults to safely and independently live at home, including socialization to prevent loneliness. It’s a significant challenge as over 22 percent of Finland’s population is over 65. Mobihealthnews Europe-UK

Events:

The 9th International Digital Public Health Conference series (#DPH2019), 20-23 November, Marseille, France. This conference is billed as the digital health partner of the 12th European Public Health Conference and brings together the areas of public health, computer and data science, medtech, and NGOs. Conference information here.

Aging 2.0 New York Global Innovation Showcase 4 December, NYC. One of a series of global Aging 2.o events, startups will present aging-focused innovations. Want to pitch? It’s still open–apply here. Register to attend here. Additional information on this and on CREATE’s Design for Older Adults Workshop on 21-22 October at Weill Cornell is here.

 

Shock news: the CVS-Aetna merger officially approved after 9 months

Go away on holiday, Judge Leon finally jumps into the hole. It took two months from the last hearings in mid-July, and nine months in total (delivered after last year’s Thanksgiving turkey) but Judge Richard Leon of the Federal District Court finally–and somewhat unexpectedly–ruled that the CVS-Aetna merger could be at last a Done Deal.

The Final Judgment goes into extensive detail about the Medicare Part D divestiture by Aetna to WellCare, complete with a Monitoring Trustee. On the very last page, Judge Leon admits that the merger is in the Public Interest.

The entire process, which is chronicled here, was unprecedented in the annals of Federally approved mergers. Usually a District Court Tunney Act review of a merger already through the wringer of the DOJ and the states is brief. Judges don’t make headlines, save when their rulings are the coup de grace (see: Aetna-Humana, Anthem-Cigna). Instead, Judge Leon called hearing after hearing, witness after witness from the AMA to PIRG, opining all the way, even turning away five supporting states petitioning (in vain) to be heard.

This high-profile precedent doesn’t bode well for future mergers, especially for healthcare. Fierce Healthcare, Columbus Dispatch

Doro AB acquires Invicta Telecare from Clarion Housing, increasing to nearly 200,000 users (UK)

While this Editor was on holiday, Sweden’s Doro AB increased its presence in the UK with the acquisition of Invicta Telecare, parent of Centra Pulse and Connect. Invicta’s products will join the Welbeing PERS service. which at the time of their acquisition last June had about 75-80,000 users [TTA 7 June 18].

Invicta was sold by Clarion Housing Group, the UK’s largest social housing association, which includes a property development company and a charitable foundation. Invicta’s 2018 revenue was £6.3 million. Like Welbeing, Centra Pulse offers basic and mobile PERS, but also has multi-sensor in-home connected home capability. It is also one of the top three UK monitoring services and is a major provider of after-hours contact services for telecare providers, such as housing associations and local authorities. The sale was effective on 1 September.

The UK remains the largest telecare market in the European region with an estimated 1.8 million telecare connections. It faces a transition to digital from analog systems which affects social care spending and residential service capabilities. Doro operates in the UK and about 40 countries, with a core business in mobile phones specially designed for older adults. Doro announcement, press release

Digital Mental Health for Adults – a one day conference at the RSM on 23 September 2019 in London

The next event run by the Royal Society of Medicine’s Digital Health Council, on 23rd September, focuses on digital mental health for people over 18. There are two main sides in the high level discussion around this topic. There is an increasingly active (and commercially burgeoning) group of companies and individuals who believe that there are a digital tools that can help to screen, manage and in some cases treat people with mental health issues (or who suspect they may have one). Some of these are simply ways of digitally enabling remote conversations between mental health care providers and those that require advice or care. Some are AI driven tools that to some degree replace the human element of care and support. The event will discuss whether this not only addresses workforce issues but also delivers clinical efficacy.

On the other hand, many believe that the use of digital technologies can adversely affect the mental health of people who use them, often to excess. Do the potential benefits outweigh these negative factors, or is a digital detox something that your GP may soon be prescribing?

Come along and get involved! Booking is here – tickets start at £20 (RSM student rate) for the day including a delightful lunch.