AI and machine learning ‘will transform clinical imaging practice over the next decade’

The great challenges in radiology are accuracy of diagnosis and speed. Yet for radiology, machine learning and AI systems are still in early stages. Last August, a National Institutes of Health (NIH)-organized workshop with the Radiological Society of North America (RSNA), the American College of Radiology (ACR) and The Academy for Radiology and Biomedical Imaging Research (The Academy) kickstarted work towards AI. Their goal was to collaborate in machine learning/AI applications for diagnostic medical imaging, identify knowledge gaps, and to roadmap research needs for academic research laboratories, funding agencies, professional societies, and industry.

The report of this roadmap was published in the past few days in Radiology, the RSNA journal. Research priorities in the report included:

  • new image reconstruction methods that efficiently produce images suitable for human interpretation from source data
  • automated image labeling and annotation methods, including information extraction from the imaging report, electronic phenotyping, and prospective structured image reporting
  • new machine learning methods for clinical imaging data, such as tailored, pre-trained model architectures, and distributed machine learning methods
  • machine learning methods that can explain the advice they provide to human users (so-called explainable artificial intelligence)
  • validated methods for image de-identification and data sharing to facilitate wide availability of clinical imaging data sets.

Another aim is to reduce clinically important errors, estimated at 3 to 6 percent of image interpretations by radiologists. Diagnostic errors play a role in up to 10 percent of patient deaths, according to this report.

It is interesting that machine learning, more than AI, is mentioned in the RSNA materials, for instance in stating that “Machine learning algorithms will transform clinical imaging practice over the next decade. Yet, machine learning research is still in its early stages.” Radiology actually pioneered store-and-forward technology, to where radiology interpretation has been farmed out nationally and globally for many years. This countered a decline in US radiologists as a percentage of the physician workforce that started in the late 1990s and continues to today with some positive trends (Radiology 2015). Perhaps this distribution model postponed development of machine learning technologies. Also Healthcare Dive, RSNA press release  

TTA’s Spring Hop: China’s AI health crunching, Babylon Health in Asia and Africa, Tyto Care/Best Buy, ATA, Spry’s COPD wearable, NHSX, more!

 

Spring Fever continues as we hop like a bunny to Easter and Passover. This week has a distinctly international focus, with Babylon Health and Merck in Africa, a digital health funding competition in Helsinki, and Israel’s Tyto Care DTC-ing with Best Buy. We take a critical look at China’s massive data reaping through private healthcare companies for AI diagnostics, with little regard to patient consent or privacy. Closer to home, there’s ATA, Spry Health’s wearable for COPD, and NHSX’s establishment.

22 May is just over a month away! Scroll below for news of The King’s Fund’s Digital Health and Care Congress in London, including Matt Hancock as keynote speaker on day 2. Plus 10% off registration for our Readers!

International news roundup: ATA dispatches, compete for funding in Helsinki, Spry FDA-cleared for COPD, Merck acquires ConnectMed Kenya 
Babylon Health’s expansion plans in Asia-Pacific, Africa spotlighted (We extract the highlights including the new NHSX for good measure)
Tyto Care inks deal with Best Buy for retail sales of remote diagnostic device (Tyto finally moves into DTC with a retailer apparently set on digital health)
China’s getting set to be the healthcare AI leader–on the backs of sick, rural citizens’ data privacy (Damn ethics and privacy rights, full speed ahead!)

With a touch of spring fever, we round up events from a two-week digital health festival in Leeds to ATA in New Orleans. CVS-Aetna’s merger continues to linger in a Federal court. And the NHS App report is overall positive for its rollout later this year–but Microsoft’s HealthVault is rolling into history.

NHS App’s pilot results: renewing prescriptions good, making appointments…not so much (Plus the demise of Microsoft HealthVault)
Leeds Digital Festival 2019: a two-week showcase of digital health and care (Quite an annual show across town!)
Spring is here, so are some events to enjoy–and broaden your horizons (From New York to New Orleans) 
Drawn-out decision on the CVS-Aetna merger held up again in Federal court (Examined up, down, and sideways in a Federal court–since October)

Fortune and Kaiser Health News take down EHRs and the havoc they wreak on doctors and patients. Our weekly news roundup looks at diabetic VR training in Wessex, telemental health in Australia, GreatCall’s health ambitions–and prescribing apps is baaack!

EHRs: The Bridge to Nowhere–other than despair. An investigative Must Read on ‘an unholy mess’. (The reality settles in, and it’s worse than you thought, whether you’re a doctor or patient)
News roundup from all over: prescribing apps is back! Plus telemental health Down Under, GreatCall’s health tech strategy, Wessex’s diabetic sim, telehealth growth outpaces urgent care

It was a busy week for acquisitions and investments–perhaps the health tech bubble is staying at a reasonable size–for now. The post-Nokia Withings is definitely wide awake with sleep tracking.

News roundup: Teladoc acquires MédecinDirect, Blue Cedar closes $17M Series B, Hill-Rom buys Voalte, Withings bolsters sleep tracking (Real but not crazy money on the line here. And Withings isn’t snoozing.)

Telemedicine Has Two Faces: the good in expanding mental health and preventing rehospitalizations in long-term care–and the very bad in delivering end-of-life news to an elderly patient.

Suddenly hot, redux: mental health telemedicine in long term care, analytics to help predict rehospitalizations in skilled nursing facilities (A traditional provider adds telemedicine, three new SNF tech companies preventing rehospitalizations)
A telemedicine ‘robot’ delivers end of life news to patient: is there an ethical problem here, Kaiser Permanente? (An insensitive use of good technology gets bad press for both)

A government study on tech to enable aging independence that actually may be useful. Meanwhile, the FBI is warning that Hackermania is running wild over healthcare. AliveCor’s KardiaMobile succeeds in UK’s EDs. And that music you have on to concentrate may be doing exactly the opposite.

A useful White House study released: ‘Emerging Technologies to Support an Aging Population’ (Big topics and tech approaches without the fluff)
Hackermania ‘bigger than government itself’–and 25% of healthcare organizations report mobile breaches (We ought to be doing better by now)
Smartphone-based ECG urged for EDs to screen for heart rhythm problems: UK study (Give the patients mobile ECG monitors to take home)
Listening to music impairs verbal creativity: UK/Sweden university study (Those headphones are not helpful if you’re trying to think)


The King’s Fund’s annual Digital Health and Care Congress is back on 22-23 May. Just announced–Secretary Matt Hancock keynoting Day 2. Meet leading NHS and social care professionals and learn how data and technology can improve the health and well-being of patients plus the quality and effectiveness of the services that they use. Our Readers are eligible for a 10% discount using the link in the advert or here, plus the code Telehealth_10.


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

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Babylon Health’s expansion plans in Asia-Pacific, Africa spotlighted

Mobihealthnews’ interview with Ali Parsa of Babylon Health illuminates what hasn’t been obvious about the company’s global plans, in our recent focus on their dealings with the NHS. For its basic smartphone app (video consults, appointments, medical records), Babylon last year announced a partnership with one of Asia’s largest health insurers, Prudential [TTA 18 Sept 18], licensing Babylon’s software for its own health apps across 12 countries in Asia for an estimated $100 million over several years. Babylon has also been active in Rwanda and now reaches, according to their information, nearly 30 percent of the population. There’s also a nod to developments with the NHS.

Parsing the highlights in Dr. Parsa’s rather wordy quest towards less ‘sick care’, more ‘prevention over cure’, and making healthcare affordable and accessible to everyone ’round the clock:

  • Asia-Pacific: Working with Tencent, Samsung and Prudential Asia through licensing software is a key component of their business. By adding more users, they refine and add more quality to their services. (Presumably they have more restrictions on the data they send to Tencent than what they obtain in China.)
  • Africa: How do you offer health apps in an economically poor country where only 5 percent of the population has a smartphone? Have an app that works for the 75 percent who have a feature phone. Babyl Rwanda has 2 million users–30 percent of Rwanda’s population–and completes 2,000 consultations a day. Babyl also works with over 450 health clinics and pharmacies. The service may also be expanded across East Africa, and may serve as a model for similar countries in other regions.
  • UK and NHSX: About the new NHS-formed joint organization for digital services, tech, and clinical care, Dr. Parsa believes it is ‘fantastic’ and that “it is trying to bring the benefits of modern technology to every patient and clinician, and aims to combine the best talent from government, the NHS and industry. Its aim, just like ours, is to create the most advanced health and care service in the world, to free up staff time and empower patients.” (Editor’s note:  NHSX will bring together the Department of Health and Social Care, NHS England and NHS Improvement, overseeing NHS Digital. More in Digital Health, Computer Weekly.)

China’s getting set to be the healthcare AI leader–on the backs of sick, rural citizens’ data privacy

Picture this: a mobile rural health clinic arrives at a rural village in Jia County, in China’s Henan province. The clinic staff check the villagers, many of them elderly and infirm from their hard-working lives. The staff collect vital signs, take blood, urine, ECGs, and other tests. It’s all free, versus going to the hospital 30 miles away.

The catch: the data collected is uploaded to WeDoctor, a private healthcare company specializing in online medical diagnostics and related services that is part of Tencent, the Chinese technology conglomerate which is also devoted to AI. All that data is uploaded to WeDoctor’s AI-powered cloud. The good part: the agreement with the local government that permits this also provides medical services, health insurance, pharmaceuticals and healthcare education to the local people. In addition, it creates a “auxiliary treatment system for general practice” database that Jia County doctors can access for local patients. According to the WIRED article on this, it’s impressive at an IBM Watson level: 

Doctors simply have to input a patient’s symptoms and the system provides them with suggested diagnoses and treatments, calculated from a database of over 5,000 symptoms and 2,000 diseases. WeDoctor claims that the system has an accuracy rate of 90 per cent.

and 

Dr Zhang Qiaofen, in nearby Ren Zhuang village, says the system it has made her life easier. “Since WeDoctor came to my clinic, I feel more comfortable and have more confidence,” she says. “I’m thankful to the device for helping me make decisions.”

The bad part: The patients have no consent or control over the data, nor any privacy restrictions on its use by WeDoctor, Tencent, or the Chinese government. Regional government officials are next pictured in the article reviewing data on Jia County’s citizens: village, gender, age, ailment and whether or not a person has registered with a village health check. Yes, attending these health checks is mandatory for the villagers. 

What is happening is that China is building the world’s largest medical database, free of those pesky Western democracy privacy restrictions, and using AI/machine learning to create a massive set of diagnostic tools. The immediate application is to supplement their paucity of doctors and medical facilities (1.5 doctors per 1,000 people compared to almost double in the UK). All this is being built by an estimated 130 private companies as part of the “Made in China 2025” plan. Long term, the Chinese government gets to know even more intimate details about their 1.3 billion citizens. And these private companies can make money off the data. Such a deal! The difference between China’s attitude towards privacy and Western concerns on same could not be greater.  More on WeDoctor’s ambitions to be the Amazon of healthcare and yes, profit from this data, from Bloomberg. WeDoctor is valued at an incredible $5.5 billion. Hat tip to HISTalk’s Monday morning update.

TTA’s Week: Eric Topol does the NHS’ future, robotic therapy for autistic children, telehealth’s wind at back, and Editor Charles’ roundup

 

The Topol Review’s relationship to reality explored by Roy Lilley. Robotics effects in therapy for children with autism and CP. The wind’s even more at the back of telehealth–but there are caveats. Plus Editor Charles is back with a UK digital health roundup.

And scroll below for news of The King’s Fund’s Digital Health and Care Congress–plus 10% off registration for our Readers!

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS (This week’s Must Read)
Robots’ largely positive, somewhat equivocal role in therapy for children with autism and cerebral palsy (HIMSS)
The wind may be even stronger at the back of telehealth this year–but not without a bit of chill (VA, Virginia as indicators–and the hurdles when you get there )
A selection of short digital health items of potential interest (Editor Charles is back with views on AI and events)

The telehealth entrepreneur and the $5 million fraud = 15 years in prison. Scotland’s Current Health wins FDA clearance, Latin America telemedicine’s uncertain state, women in eHealth, and studies on digital health in health systems.

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems
Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH) (Reviving the terminology discussion)
The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta (And 15 years in the Federal pen. Tell your mum or uncle to be wary of good stories)

Our lead this week is the sale of Tunstall’s US operation. Unicorns need to hype less and publish studies more. The King’s Fund’s two events in March and May, Bayer’s accelerator winners, and news from Apple to teledermatology for São’s spotted!

Short takes: Livongo buys myStrength, Apple Watch cozies with insurers, Lively hears telehealth and $16 million
Tunstall Americas sold to Connect America
(Tunstall conceding their business is outside the US)
Where’s the evidence? Healthcare unicorns lack the proof and credibility of peer-reviewed studies. (Unicorns need to add substance to the sparkle)
News roundup: Virginia includes RPM in telehealth, Chichester Careline changes, Sensyne AI allies with Oxford, Tunstall partners in Scotland, teledermatology in São Paolo
The King’s Fund ‘Digital Health and Care Explained’ 27 March
(Readers also get a 10% discount at the 22-23 May Congress)
Bayer’s G4A accelerator awards agreements with KinAptic, Agamon, Cyclica (DE) (A truly international accelerator program)

Latest through the revolving door is NHS’ chief digital officer, digital health may be more ‘bubbly’ than you would like, telemedicine and telehealth gain important consumer and Medicare facing ground, and fill your calendar some more!

NHS England digital head Bauer exits for Swedish medical app Kry, but not without controversy (The revolving door reveals a self-made cloud over her head)
Events, Dear Friends, Events: UK Telehealthcare, Mad*Pow HXD, dHealth Summit (Get out the calendars–and the checkbooks/app)
Telemedicine virtual visits preferred by majority in Massachusetts General Hospital survey (Over 94% loved the convenience alone)
Medicare Advantage model covering telehealth for certain in-person visits starting in 2020 (The needle moves–slowly)
It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding. (‘Bubbly’ factors that may influence this year–not for the better)

We round up the Official Healthcare Circus of CES, Verily rolls along with $1 bn in investment, and Walgreens Boots finally makes an alliance splash with Microsoft

It’s Official: CES is now a health tech event (updated) (And still a circus! We round up the top coverage so you don’t have to)
News roundup: Walgreens Boots-Microsoft, TytoCare, CVS-Aetna moves along, Care Innovations exits Louisville
Verily, Google’s life sciences arm, gathers in another billion to go…where? (Updated for Study Watch clearance) (Still a mystery)

Our first full week in January is full of news and events, from CES to RSM, plus lots of healthcare acceleration!

News roundup: CES’ early beat, CVS-Aetna pauses, digital health fizzes, Yorkshire & Humber Propels
Events, Dear Friends, Events part 2: Newcastle and Texas accelerate, Aging2.0 NYC gets happy, AutoBlock’s Meetup, Wearable Tech, HealthImpact East
Events, Dear Friends, Events: Hancock at the RSM, MedStartr NOLA Challenge, RSM and The King’s Fund

We start our 2019 first in West Africa with a health facility mapping initiative addressing epidemics and service distribution. On to the UK with Babylon Health’s chatbot problems revealing an increasingly fractious relationship with the business press–one of our most read articles ever. And 3rings may be exiting, but doing so with grace and consideration–another Top Read.

Healthsites, eHealth Africa mapping health facility locations in West Africa to improve emergency care (Fighting epidemics and improving disaster response using health tech)
Is Babylon Health the next Theranos? Or just being made out to be by the press? (Soapbox) (A few best practices might stop a growing pile-on–or a Big Problem)
3rings’ well-handled transition to their March shutdown (updated) (Referring their clients to other UK companies based on the customer’s needs) 


The King’s Fund’s annual Digital Health and Care Congress is back on 22-23 May. Meet leading NHS and social care professionals and learn how data and technology can improve the health and well-being of patients plus the quality and effectiveness of the services that they use. Our Readers are eligible for a 10% discount using the link in the advert or here, plus the code Telehealth_10.


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: http://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

A selection of short digital health items of potential interest

Editor Charles has taken time off recently from assessing mHealth apps to give us a selection of short news items and event notifications.

CE and FDA certification

This editor recently stumbled over the first list he’s ever seen of approved digital health medical devices. As of today there are some 151 products on there which is hugely impressive. One of the reasons for the relatively poor showing of CE certifications on the list is that there is no official list yet: latest forecasts for Eudamed, which will provide this, are Spring 2020 amid much uncertainty about whether enough Notified Bodies will be approved to certify to the MDR in time. Immediately spotted as a CE certification missing is Walk with Path’s Path Finder device for helping people with Parkinson’s to avoid a freezing of their gait (though CE certification is well hidden on their website) and doubtless there are others. Clearly the list points up potential benefits were it ever possible to harmonise the approval process across the Pond.

Longevity 

The first Longevity Leaders event took place on Monday, perhaps the first large event in the UK on that topic. Based on the enthusiasm of attendees, clearly it won’t be the last. Doubtless in due course it will fragment into a myriad of specialist topics though currently it is a fascinating combination of almost every medical/pharmaceutical and digital discipline, plus housing and a range of other considerations. Timescales varied widely too – for example I talked about the immediate benefits of digital health including keeping people in their own homes, thus minimising sarcopenia from being confined to a hospital bed and avoiding exacerbating dementia by a change of environment, whereas others spoke of how best to make DNA immortal and whether the first person destined to live to 1000 had already been born.

Clinical  Homecare

From the sublime (last item) to the The National Clinical Homecare Association‘s conference on 31st January, where this Editor also spoke on how digital health could help people to be treated in their own homes. Notable was the absence of any Twitter handle for the Association, no hashtag for the conference and just two people it seemed out of 250 using social media. Clearly there are huge opportunities here for digital health suppliers, particularly as so much of what was said by other speakers, and what was being shown in the exhibition was very much manually-intensive stuff: join the NCHA and start a revolution in clinical homecare! 

Recent developments in AI

Since this editor stopped active involvement in conference organisation for the Royal Society of Medicine it is encouraging to see that the younger generation has picked up the baton and is running even harder, such that the above event, on 26th February, has proved so popular that it has been moved to the largest (300 seater) lecture theatre at the Society, and on current sign-up rate will sell out.  Speakers from Babylon, Ada Health, DeepMind, Kheiron Medical, BenevolentAI, UCL Life Sciences & Alan Turing AI partnership, and many more will ensure that delegates gain a comprehensive understanding of how AI is being used across healthcare. Book here to experience the delights of the new RSM all-new website which makes signing up for an event so much easier than in the past. Fear not though: the RSM’s legendary low ticket costs are maintained!

Wayra and Novartis

A most exciting event this week was the announcement of the joint Wayra and Novartis health call now looking for their next cohort of remarkable start-ups to join their new programme called The Health Hub. This is built together with their new partner Novartis, one of the leading pharma companies. Their focus is on how healthtech can be used drastically to innovate long-term disease management. Apply here, by February 17th. Hat tip to Professor Mike Short for this item and other observations in this post .

Rewired Pitchfest

Early health tech entrepreneurs should consider taking part in the Rewired Pitchfest at the Digital Health Rewired Conference and Exhibition, Olympia London on 26 March. Sponsored by Silver Buck, this provides the opportunity for early stage digital health start-ups to showcase their disruptive ideas and prototypes to NHS IT leaders. Applicants will compete before a judging panel featuring investors and successful start-up founders. It’s a great way to gain significant exposure and make connections with a diverse range of UK digital health leaders…and the winner will be announced, and congratulated, by Matt Hancock himself! There is also the chance of winning a mentoring programme with the experts on the judging panel and PR features in Digital Health News. (Disclosure: this editor is on the Programme Committee of Rewired, as well as being a Pitch judge)

Punning headlines

It’s rare that a single item is worthy of its own paragraph on TTA these days however an exception must surely be made for one of the few punning headlines to be found in digital health, especially as it’s for such an old – and until now undelivered – idea: “Smart toilet seat is flush with possibilities to monitor patients’ health”

News roundup: Virginia includes RPM in telehealth, Chichester Careline changes, Sensyne AI allies with Oxford, Tunstall partners in Scotland, teledermatology in São Paolo

Virginia closes in on including remote patient monitoring in telehealth law. Two bills in the Virginia legislature, House Bill 1970 and Senate Bill 1221, include remote patient monitoring (RPM) within their present telehealth and telemedicine guidelines and payment in state commercial insurance and the commonwealth’s Medicaid program. It is currently moving forward in House and Senate committees with amendments and. RPM is defined as “the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including monitoring of clinical patient data….” Both were filed on 9 January. Virginia was an early adopter of parity payment of telemedicine with in-person visits. The University of Virginia has been a pioneer in telehealth research and is the home for the Mid-Atlantic Telehealth Resource Center. mHealth Intelligence

Chichester Careline switches to PPP Taking Care. Chichester Careline is currently a 24/7 care line services provided by Chichester District Council. Starting 1 March, PPP Taking Care, part of AXA PPP Healthcare, will manage the service. According to the Chichester release, costs will remain the same, technology will be upgraded, and telecare services will be added. Over the past 35 years, Chichester Careline has assisted over 1 million people across Britain. 

Sensyne collaborates with University of Oxford’s Big Data Institute (BDI) on chronic disease. The three-year program will use Sensyne’s artificial intelligence for research on chronic kidney disease and cardiovascular disease. Sensyne analyzes large databases of anonymized patient data in collaboration with NHS Trusts. BDI’s expertise is in population health, clinical informatics and machine learning. Their joint research will concentrate on two major elements within long-term chronic disease to derive new datasets: automating physician notes into a structure which can be analyzed by AI and integrating it into remote patient monitoring.  Release.

Tunstall partners with Digital Health & Care Institute Scotland. The partnership is in the Next Generation Solutions for Healthy Ageing cluster. Digital Health & Care supports the Scottish Government’s TEC Programme and the Digital Telecare Workstream. The program’s goals are to help Scots live longer, healthier lives and also create jobs.  Building Better Healthcare UK

Teledermatology powered by machine learning helps to solve a specialist shortage in São Paolo. Brazil has nationalized healthcare which has nowhere near enough specialists. São is a city with 20 million inhabitants, so large and spread out that when the aircraft crew announces that they are on approach to the airport, it takes two hours to touch the runway. The dermatology waitlist was up to 60,000 patients, each waiting 18 months to see a doctor. The solution: call every patient and instruct them to go to a doctor or nurse to take a picture of the skin condition. The photo is then analyzed and prioritized by an algorithm, with a check by dermatologists, to determine level of treatment. Thirty percent needed to see a dermatologist, only 3 percent needed a biopsy. Accuracy level is about 80 percent, and plans are in progress to scale it to the rest of Brazil. Mobihealthnews.

UK’s DeepMind loses Streams, health projects to Google Health

DeepMind loses its Health to Google. DeepMind, the London-based AI developer acquired by Alphabet (Google) in 2014, no longer has a Health division. This group will be absorbed by Google Health, now headed by ex-Geisinger CEO David Feinberg. The former DeepMind health team will continue to be headed by former NHS surgeon Dr Dominic King, who will remain in London along with about 100 reported staffers, at least for now.

DeepMind’s major health initiative is Streams, an AI-powered mobile app that analyzes potential deterioration in patients and alerts nurses and doctors, saving time. It also monitors vital signs and integrates different types of data and test results from existing hospital IT systems. Streams is currently deployed at Royal Free NHS Foundation Trust Hospital in north London for acute kidney injury. The rollout is expected to be made at Imperial College Healthcare NHS Trust, Taunton and Somerset NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust. It is expected that test partners will be found outside of the UK.

DeepMind’s other health initatives and research include fast eye disease detection, planning cancer radiotherapy treatment in seconds rather than hours; and detecting patient deterioration from electronic records.

Google Health is now expanding into products and research into digital technologies which was to be expected with Dr Feinberg on board. Currently, its revenue stream consists of advertising and search.

The remainder of DeepMind not engaged with health will remain independent. CNBC, DeepMind blog

Is Babylon Health’s AI on par with a human diagnostician? Claim questioned in ‘The Lancet’.

In July, Babylon Health released the results of their testing against the MRCGP (Member of the Royal College of General Practitioners) exam based on publicly available questions. As we reported at the time, its AI system passed the exam with a score of 81 percent. A separate test where Babylon worked with the Royal College of Physicians, Stanford University and Yale New Haven Health subjected Babylon and seven primary care physicians to 100 independently-devised symptom sets. Babylon passed with an 80 score.

Now these results are being questioned in a letter to The Lancet. The authors–a medical doctor and two medical informatics academics–argue that the methodology used was questionable. ‘Safety of patient-facing digital symptom checkers’  shows there ‘is a possibility that it [Babylon’s service] might perform significantly worse’. The symptom checking methodology was questioned for not being real world–that the data in the latter test was entered by doctors only, not by patients or other clinicians. While the authors commended Babylon for being open about their research, they felt there was an “urgent need” for improvements in evaluation methods. “Such guidelines should form the basis of a regulatory framework, as there is currently minimal regulatory oversight of these technologies.” Babylon promises a response and additional improvements, presumably from its $100 million investment in AI announced in SeptemberDigitalHealth (UK), Mobihealthnews

Pepper pays a first-ever robot visit to Commons on the future of AI and robotics on education, older adult care (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/10/103886629_mediaitem103886628.jpg” thumb_width=”150″ /]Pepper paid a visit to a House of Commons select committee on education and became the very first robot to meet with MPs. Accompanied by students from Middlesex University, where Pepper is part of an initiative on teaching primary school-level children, he made a short presentation about the future of artificial intelligence in education and older adult care.

Certainly his introduction has some historic value. Pepper bowed and then said in his rather high-pitched and somewhat Japanese-inflected voice: “Good morning, chair [Robert Halfon]. Thank you for inviting me to give evidence today. My name is Pepper and I am a resident robot at Middlesex University.”

Pepper used voice, gesture, and his embedded front tablet to explain about the role robots like him will play in education and healthcare. At Middlesex, final year students in robotics, education, psychology, and biomedicine like Joana Miranda, one of his two escorts, work with Pepper on projects such as developing numeracy skills in primary school students. According to BBC News, Tory MP Lucy Allan dryly noted that Pepper was “better than some of the ministers we have had before us”.

In healthcare for older adults, the Pepper robot developed by Softbank is part of a major research project funded by the EU, the Japanese Government and UK’s Horizon 2020. The objective of the three-year CARESSES program is to develop a culturally aware robot to provide care suited to a wide variety of individuals and reduce loneliness. Another desired outcome is to relieve pressure in hospitals and care homes by promoting independent living at home with a care robot.

The education committee is examining the “fourth industrial revolution” which impacts STEM education, school curriculum, and workforce skills (and reskilling). Videos on BBC News and Gevul News (YouTube) A tart take on Pepper versus PM Theresa May from The Guardian. (And no fainting, as Pepper did at CES earlier this year.) Hat tip to The King’s Fund weekly newsletter.

Connected Health Conference highlights (so far): FCC’s $100 million telehealth pilot, NIH’s ‘All of Us’, MIT’s social robots integrating AI

Expanding FCC connected health programs. FCC Chairman Ajit Pai in his keynote reinforced the agency’s interest and support of connected health initiatives, from rural to opioids. Most of the programs have a rural focus to bring broadband and telehealth/RPM to the ‘end of the line’ in underserved communities, something close to Mr. Pai’s heart as his parents were both rural physicians in Kansas..

  • This summer, the Connected Care Pilot Program was proposed and approved unanimously in August [TTA 9 Aug]. Funding for this is proposed at $100 million.
  • The spending cap for the rural healthcare program, which has been around since 1997’s dial-up days and now includes telemedicine and remote monitoring, was increased for 2017-2018 from  $400 million to $571 million, a 43 percent increase. The FCC has pledged to fully fund 2018 programs.
  • New initiatives were announced covering new uses for telehealth and remote patient monitoring:
    • Connected care at home via RPM as part of the Connected Care Pilot Program
    • Cancer care in partnership with the National Cancer Institute. The Launch program for rural and underserved communities aims to bring high-quality cancer care to where patients work and live through bringing together government, academia and community health providers.
    • For opioids, there are two programs. One is expanding the mapping broadband health platform to include critical drug use data. This will allow users to rapidly visualize, overlay, and analyze broadband and opioid data together at the national, state, and county level. The second is to launch a chronic pain management and opioid use challenge as part of the pilot program.  Mobihealthnews

A status report on NIH’s All of Us. Back in January as part of setting the stage for 2018, this Editor briefly mentioned the National Institute of Health’s massive All of Us program, part of the Federal Precision Medicine Initiative (PMI). All of Us needs almost all of us–their goal is to collect data on at least one million Americans for a major leap forward on data supporting population health. Dr. Dara Richardson-Heron, All of Us’ chief engagement officer, confirmed that over 100,000 participants have registered since the launch in May, with over 65,000 completing the full protocol. She mentioned that 75 percent of signups are from groups often underrepresented in modern medical research, with 50 percent from racial and ethnic minorities. The Mobihealthnews article ends on a ‘Debbie Downer’ note of doubting whether the program will reach enrollment goals, the cost will be justified, and whether the data will be kept private as promised.

MIT’s social robots may be the future of emotional support for wellbeing. MIT associate professor Cynthia Breazeal heads up the Personal Robots Group and is working on how to integrate AI into emotional robots for pediatric patients at Boston Children’s Hospital. The robots serve as a go-between child life specialists and the patient. The initial results were positive, with higher verbal scores (as a measure of engagement) than with stuffed bears or digital avatars. Professor Breazeal wants to extend the technology to older adults for wellbeing and engagement. Running against the conventional wisdom, their research found that older adults were more open to technology than the children. Following MIT’s work are companies like Hasbro and Embodied. Mobihealthnews.

The Theranos Story, ch. 57: was it Silicon Valley and Startup Culture bad practices pushed to the max?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/07/Rock-1-crop-2.jpg” thumb_width=”125″ /]Theranos is now formally in California insolvency proceedings (note on their website). Creditors may have enough awarded to them to go down to the local pizzeria to buy a slice or two. Hard lessons indeed for creditors and shareholders. But aside from the drama yet to come in the trial of Elizabeth Holmes and Sunny now Shady Balwani, a/k/a the Silicon Valley Trial of the Century, are there any further lessons to be learned?

For those of us who have not been closely following The Theranos Story, David Shaywitz’s kind-of-review of John Carreyrou’s Bad Blood coupled with a thought piece in Forbes is especially appealing. Even if you’ve been tracking it closely like your Editor, it’s a good read. He posits that in three key areas, Theranos exhibited Startup Culture and Silicon Valley Ethics (or lack thereof) at the very extreme in these areas:

  • Secrecy: extreme compartmentalization, siloing, stratification, and rigid definition of roles that prevent information sharing. No outsiders in, or peer-reviewed research out.
  • Promises, promises, promises: a rosy picture to the point of delusion that masks real flaws
  • I Want To Believe: for various personal reasons, investors, press, and supports need to believe

Secrecy can and should work for companies in keeping proprietary information and competitive advantage intact. All startup and early-stage companies have to paint a positive picture in the midst of pitched struggle. The glass is always half full not empty even when the bank account is, but when the old ‘fake it till you make it’ becomes too strong, papering over the truth is the thing and the institutional absence of tough self-scrutiny (or a professional kicker-of-holes) prevents companies from fixing obvious problems–you get a delusional organization like Theranos edging gradually, then very quickly, into outright fraud. Finally, Theranos’ supporters had their own reasons for wanting to believe the technology worked. 

He goes on to state that the fraud that Theranos perpetrated was not only financial and in harm to health, but also in the hope that change is possible in healthcare delivery, we can challenge the way it’s always been done and win, and that technology can be empowering.

Will we, as a result, in Mr. Shaywitz’s words, take the ‘hit to hope’ to heart and become ‘excessively chastened and overcautious”? This Editor tends to be on the overcautious side when it comes to technologies such as IoT and AI because the potential for hacking and bad use is proven despite the hype, but far less so in challenging incumbents–even it it resembles tilting at windmills till they buy you.   

Will l’affaire Theranos change the Silicon Valley and Startup Culture for the better? Here is my ‘hit to hope’–that this excessively aggressive, conformist, borderline irresponsible, and secretive culture could change. This Editor doubts it’s even entered their leaders’ ‘deep’ thoughts, despite this best-selling book.

A more typical review of ‘Bad Blood’ is by Eric Topol, MD (!) in Nature–who certainly borrowed ‘The Theranos Story’ from this series of articles!

A sobering, mercifully hype-free view of AI in healthcare

Way up there on the Peak of Inflated Expectations in the Gartner Hype Cycle is that two-letter creature, AI. Artificial Intelligence has been invoked in multiple tech fields, and Microsoft in the US currently is running 30 second commercials about how AI is “making tomorrow today” but without much explanation as to how.

If AI’s current puffery makes you dizzy, long-time observer of the Healthcare Scene Anne Ziegler’s article in Hospital EMR and EHR might stabilize the whirlies. In direct and brief terms, she classifies the realities of healthcare AI adoption in three areas:

  1. Lack of Transparency. How does AI reach its conclusions in making ‘good decisions’? Sometimes the logic of the conclusion is obvious, but often it is not, and what you get is physician and clinician bypass–and suspicion.
  2. That Old Monkey Wrench Tossed into Existing Processes. It’s taken a long time for organizations to fully integrate their EHR inputs and documentation. Throwing in an AI implementation even in a limited sense may require more adjustments than the outcomes are worth.
  3. It’s Too, Tooooo Much Data. Healthcare organizations do not suffer from a paucity of data. AI feeds on data. Sounds like a good match, doesn’t it. Except that a lot of this data isn’t usable without filtering and mining, and that takes a lot of processing. The future may have more advanced data processing and indexing tech to do that, but right now even natural language processing to identify useful information is rare in the field.

Widespread AI use in healthcare is, despite the IBM Watson Health hype, a long way off. In healthcare, the rubber must meet the road of patient care and clinical practicality to be useful to us with Non-Artificial Intelligence. Problems We Need To Address Before Healthcare AI Becomes A Thing

Coffee break reading: a ‘thumbs down’ on IBM Watson Health from IEEE Spectrum and ‘Der Spiegel’

In a few short years (2012 to now), IBM Watson Health has gone from being a 9,000 lb Harbinger of the Future to a Flopping Flounder. It was first MD Anderson Cancer Center at the University of Texas last year [TTA 22 Feb 17] kicking Watson to the curb after spending $62 million, then all these machine learning, blockchain, and AI upstarts doing most of what Watson was going to do, but cheaper and faster, which this Editor observed early on [TTA 3 Feb 17]. At the end of May, IBM laid off hundreds of workers primarily at three recently acquired data analytics companies. All came on board as market leaders with significant books of business: Phytel, Explorys, and Truven. Clients have evaporated; Phytel, before the acquisition ranked #1 by KLAS in analytics for its patient communication system, reportedly went from 150 to 80 clients. IBM denies the layoffs were anything but much-needed post-acquisition restructuring and refocusing on high-value segments of the IT market.

IEEE Spectrum rated the causes as corporate mismanagement (mashing Phytel and Explorys; IBM’s ‘bluewashing’ acquired companies; the inept ‘offering management’ product development process; the crushed innovation) plus inroads made by competition (those upstarts again!). What’s unusual is the sourcing from former engineers–IEEE is the trade group for tech and engineering professionals. The former IBM-ers were willing to talk in detail and depth, albeit anonymously. 

Der Spiegel takes the German and clinical perspective of what IBM Watson Health has gone wrong, starting with the well-documented failures of Watson at hospitals in Marburg and Giessen. The CEO of Rhön-Klinikum AG, which owns the university hospital at Marburg, reviewed it in action in February. “The performance was unacceptable — the medical understanding at IBM just wasn’t there.” It stumbled over and past diagnoses even a first-year resident would have considered. The test at Marburg ended before a single patient was treated.

The article also outlines several reasons why, including that Watson, after all this time, still has trouble crunching real doctor and physical data. It does not comprehend physician shorthand and negation language, which this Editor imagines is multiplied in languages other than American English. “Some are even questioning whether Watson is more of a marketing bluff by IBM than a crowning achievement in the world of artificial intelligence.” More scathingly, the Rhön-Klinikum AG CEO: “IBM acted as if it had reinvented medicine from scratch. In reality, they were all gloss and didn’t have a plan. Our experts had to take them by the hand.”

Hardly The Blue Wave of the Future. Perhaps the analogy is Dr. Watson as The Great Oz.

News roundup: Walmart and Microsoft AI, are derm apps endangering public with 88% skin cancer diagnosis?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”150″ /]Walmart and Microsoft partner to change the retail experience via AI. The five-year agreement will switch over applications to the cloud and will affect shipping and supply chain. It’s projected in Healthcare Dive that the impact will be in healthcare as well. Microsoft announced last month that it is forming a unit to advance AI and cloud-based healthcare tools. The landscape is under extreme pressure in retail and healthcare delivery, and Walmart needs to ready for future moves which will certainly happen. Walmart is rumored to be interested in acquiring Humana and is currently working with Emory Healthcare in Atlanta. Then there is CVS-Aetna, Cigna-Express Scripts, Google, and (looming above all) Amazon. (Though you can tuck all the years of Amazon’s profits into one year of Walmart’s.)

The ITV News headline grabs attention — but are dermatology apps really endangering the public when teledermatology can help diagnose 88 percent of people with skin cancer and 97 percent of those with benign lesions? A University of Birmingham-led research team did a metastudy of the literature and found three failings: “a lack of rigorous published trials to show they work and are safe, a lack of input during the app development from specialists to identify which lesions are suspicious and flaws in how the technology analyses photos” particularly for scaly or non-pigmented melanomas. But did access to these apps encourage early diagnosis which can lead to up to 100 percent five-year survival? Of course review is required as recommended by the study, but this last factor was not really examined at the British Association of Dermatologists’ annual meeting in Edinburgh. University of Birmingham release with study abstract

Google’s ‘Medical Brain’ tests clinical speech recognition, patient outcome prediction, death risk

Google’s AI division is eager to break into healthcare, and with ‘Medical Brain’ they might be successful. First is harnessing the voice recognition used in their Home, Assistant, and Translate products. Last year they started to test a digital scribe with Stanford Medicine to help doctors automatically fill out EHRs from patient visits, which will conclude in August. Next up, and staffing up, is a “next gen clinical visit experience” which uses audio and touch technologies to improve the accuracy and availability of care.

The third is research Google published last month on using neural networks to predict how long people may stay in hospitals, their odds of re-admission and chances they will soon die. The neural net gathers up the previously ungatherable–old charts, PDF–and transforms it into useful information. They are currently working with the University of California, San Francisco, and the University of Chicago with 46 billion pieces of anonymous patient data. 

A successful test of the approach involved a woman with late-stage breast cancer. Based on her vital signs–for instance, her lungs were filling with fluid–the hospital’s own analytics indicated that there was a 9.3 percent chance she would die during her stay. Google used over 175,000 data points they saw about her and came up with a far higher risk: 19.9 percent. She died shortly after.

Using AI to crunch massive amounts of data is an approach that has been tried by IBM Watson in healthcare with limited success. Augmedix, Microsoft, and Amazon are also attempting AI-assisted systems for scribing and voice recognition in offices. CNBC, Bloomberg