TTA’s Holiday Runup 2: Outcome Health exec pleads guilty, Proteus runs out of road, malware-ridden 2020 forecast, HHS execs fight, Leeds leads, DOJ looks at Fitbit, more

 

 

Barely two weeks to Christmas, but a blue one for Proteus Digital Health employees and six former Outcome Health execs. HHS leadership mixes it up in public, malware bites Hackensack, but it’s lovely in Leeds–and if you have a new job.

News roundup: Proteus may be no-teous, DOJ leads on Google-Fitbit, HHS’ mud fight, Leeds leading in health tech, malware miseries, comings and goings (Proteus runs out of road for 300, DOJ looking at Fitbit acquisition, HHS execs no lika each other, malware 2020, and it’s Leeds leading)
“There were practices going on there that were wrong”: Outcome Health’s Desai pleads guilty, cooperates with DOJ. (One pleads guilty, three not guilty, with the major players pleading on Monday)

Snow falls, what’s left of freeze-dried leaves clog the gutters, and we’re revving up the charge cards in our run up to the Christmas holidays. Dr. Halamka follows the AI Star to Mayo. But already there’s coal in the stocking for six former Outcome Health-ers.

News roundup: Philips allies with Humana for pop health, Dexcom’s outage outrage, Halamka ankles Lahey for Mayo, Google and NHS Wales changes, Agfa’s health sale, Victrix/WhatsApp, more

SEC, DOJ charges Outcome Health founders Shah and Agarwal, others, with $487 million fraud, 26 counts of indictment (Club Fed looms for decades)

BRRR! Winter’s preview has hit the US East Coast. Walgreens Boots Alliance and Google’s Project Nightingale may be feeling the chill. And NHS tries to find a workaround for app vetting.

Walgreens Boots going private in the largest ever leveraged buyout: reports (Maybe too big for the market?)
Google’s ‘Project Nightingale’–a de facto breach of 10 million health records, on a bridge too far? (Is there no end to Google intrusion?)
A change of vetting for the NHS Apps Library by spring 2020 (Outsourcing the accreditation problem)

Leaves are turning–and falling–as fall gets on. Getting on, many face the care gap that happens after a hospital discharge. Teladoc looks healthier, but Walgreens is rethinking its clinic strategy. Outcome Health avoids a reckoning with the DOJ. 

Short takes: Outcome Health pays up, Teladoc’s up in double-digits, Walgreens closing 40% of clinics, a health kiosk for hospital employees?
The biggest care gap: the fear of going home after discharge (What do you do–when you can’t do for yourself? The British Red Cross is applying some answers.)

Autumn’s more pleasant this week. As leaves fall, questions on age tech rise. Dissatisfaction with healthcare continues despite digital health’s rise. Cleveland Clinic’s telehealth tieup with American Well, Amazon’s buy of Health Navigator, and more. And get away to a digital health conference in historic Trondheim.

Short Takes: Amazon buys symptom checker Health Navigator; Ettain Group acquires EHR consultant Leidos Health (Amazon’s new foray into Amazon Care)
Is ‘age-tech’ a stereotype that misses the larger mark–and market? (A pernicious belief that helps no one)
Over half of Americans of all ages use digital health tools, self-diagnose after internet search: ResMed/Edelman survey (High levels of dissatisfaction with healthcare despite digital tools)
Cleveland Clinic, American Well extend partnership to high-acuity telehealth services with ‘The Clinic’ (Health system growth pinned to telehealth–and virtual visits specializing in complex conditions)
Tyto Care partners with Avera eCARE for telehealth delivered to medically underserved populations (Tyto Care obviously building a use case)
Call for abstracts extended: ISG’s 12th World Conference of Gerontechnology (Norway) (A chance to visit Trondheim)

Autumn’s rainy days set the stage for much M&A, departures, and company moves from Appello, NHS Digital, Babylon Health, Verita, Tyto Care, and more. And slow gait=fast aging in Duke University five-decade study. 

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
Slow gait speed at age 45 as an accelerated aging predictor–and result: Duke University study (A Must-Read if you are interested in aging and its causes)


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, DHACA, 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

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

News roundup: Proteus may be no-teous, DOJ leads on Google-Fitbit, HHS’ mud fight, Leeds leading in health tech, malware miseries, comings and goings

Proteus stumbles hard, cuts back. The original ‘tattle-tale pill’ company, Proteus Digital Health, plans to lay off 292 people in the San Francisco Bay Area and to permanently close its three Redwood City and Hayward locations, starting 18 January, according to notices sent to California state and local offices, including the state employment development department. It is unclear where Proteus will be located after the closures.

This followed after Proteus failed to launch a twelfth funding round of $100 million. According to reports, they furloughed most of their employees for two weeks in November and are reorganizing. This is after a substantial number of investors have put in about $487M in funding through a Series H (Crunchbase), including a game-changing investment by Novartis dating back to 2010.  Proteus achieved unicorn status about three years ago, but its high-priced pill tracking technology with a pill sensor tracked by a skin-worn monitor reporting into a smartphone has a built-in limited market to expensive medication. Otsuka Pharmaceutical in 2017 partnered with Proteus for an FDA-cleared digital medicine system called Abilify MyCite that basically put an off-patent behavioral drug back into a more expensive tracking methodology. But Proteus remains a great idea on tracking compliance in search of a real market, and may not have much of a future. San Jose Mercury News, CNBC

But ingestible detectable pills are still being tested. On Monday, as Proteus’ bad news broke, eTectRx announced its FDA clearance of the ID-Cap System and its testing at Brigham and Women’s Hospital and Fenway Health, focusing on HIV medication when used for treatment and prevention. Release, HISTalk

Department of Justice taking the lead on scrutinizing Google’s Fitbit acquisition. The Federal Trade Commission also sought jurisdiction over the transaction. According to the New York Post, “both agencies are concerned that a Google-owned Fitbit would give the search giant an even bigger window into people’s private data, including sensitive health information, sources said. Under the Hart-Scott-Rodino Act, all large mergers must file proposals with both the DOJ and the FTC, but only one antitrust agency reviews the merger.”

Coal from stockings being thrown about at HHS. According to POLITICO and the New York Times, the disagreements between Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), and the Cabinet-level Secretary of Health and Human Services (HHS), Alex Azar, have boiled over, enough to have to be settled by the President’s acting chief of staff, Mick Mulvaney. According to the Times, both President Trump and VP Mike Pence have told them to find a way to work together. Both are administration appointees, but President Trump has not been reluctant to cut a mis-performing or overly contrary appointee loose. The latest salvo from those obviously not on Ms. Verma’s side was the revelation that she requested compensation for jewelry stolen on a business trip, contrary to government policy of course. She was compensated for other items which is standard. (Isn’t that what homeowners’ insurance is for? And what sensible person actually travels with valuable jewelry?) Under Ms. Verma, CMS has been quite progressive in developing new business models in Medicare fee-for-service, moving providers to two-sided risk, and innovating in both Medicare and Medicaid. It will either be settled, or one or both will be gone. Pass the popcorn.

Leeds picks up another health tech company. Mindwave Ventures is opening an office there, as well as appointing Dr Victoria Betton and Dr Janak Gunatilleke to the roles of chief innovation officer and chief operating officer. Mindwave develops technologies around digital products and services in healthcare and health research. Leeds reportedly is home to over 250 health tech companies and holds an annual Leeds Digital Festival in the spring [TTA 11 April].

Ransomware attack hits Hackensack Meridian. Systems were down for about a week. While this large New Jersey health system hasn’t admitted it, sources told the Asbury Park Press that it was ransomware. And if it’s not ransomware, its Emotet and Trickbot. Read ZDNet and be very apprehensive for 2020, indeed, as apparently healthcare is just one big target.

Comings and Goings: There may be some end of year bombshells, but after last week’s big news about John Halamka, it’s been fairly quiet. Paul Walker, whom this Editor knew at New York eHealth Collaborative, has joined CommonWell Health Alliance as executive director. Mr. Walker was most recently Philips Interoperability Solutions’ vice president of strategy and business development. CommonWell’s goal is improving healthcare interoperability and its services are used by more than 15,000 care provider sites nationwide. Blog release, Healthcare Innovation ….Dr. Jacqueline Shreibati, the chief medical officer for AliveCor, is joining Google Health in the health research area. Mum’s the word when it comes to Fitbit (see above). CNBC ….Peter Knight has pleaded guilty to falsifying educational credentials to gain his position as chief information and digital office at Oxford University Hospitals NHS Foundation Trust. He held that position from August 2016 until September 2018. BBC News

News, events roundup: FDA clears AliveCor’s first 6 lead ECG, Jawbone Health rises from ashes, Let’s Get Checked’s $30M check, Health Wildcatters’ $35M ‘how to’ breakfast

AliveCor receives FDA clearance for KardiaMobile 6L, the first FDA-cleared personal 6-lead device. From the AliveCor release, the description: “In addition to the two electrodes on the top of the device, there is one additional electrode on the bottom. The user places her thumbs on each of the two top electrodes, and places the bottom electrode on her left knee or ankle. This formation, known in cardiology as the Einthoven Triangle, allows cardiologists to view electrical activity in the heart from six perspectives or “leads.”” The information is sent to the mobile device’s software including KardiaAI bradycardia and tachycardia detection features cleared recently for the single-lead KardiaBand, as well as deeper information into arrhythmias. The single-lead ECG space that AliveCor pioneered with first their snap-on then the KardiaBand is now crowded with the Apple Watch, Withings, and numerous others. It’s a big step forward for the company. AliveCor has opened pre-orders now at $149, to be delivered starting in June. Hat tip to co-founder Dr. Dave Albert. 9to5Mac, Biospace (release), Mobihealthnews

Save Your Jawbones, the Founder Rises Again. Yes, Jawbone founder Hosain Rahman just raised $64.5 million for a new company. The new outfit, dubbed Jawbone Health, will offer a “personalized subscription service where we take all of this continuous health data about you and we combine that with a lot of machine intelligence . . .” to prevent avoidable diseases. After having burnt to a crisp $1 billion over 10 years on wireless speakers and fitness bands, again Mr. Rahman goes into territory which isn’t exactly unique with the footprints of the aforementioned Apple Watches, Withings, Spry Health’s Loop, EarlySense, etc. But hey,  SignalFire and Refactor Capital in the Bay Area, Polymath Ventures and Meraas in Dubai like his style. Even TechCrunch is arching an eyebrow.

Let’s Get Checked checks in with $30 million raise. This NYC-based direct-to-home supplier and manufacturer of in-home test kits raised a $30 million Series B from Leerink Transformation Partners, Qiming Venture Partners USA, and Optum Ventures after last year’s $10 million Series A. Customers can order in-state physician-approved laboratory tests via LetsGetChecked.com or through partner retailers, including CVS, Walmart, Pharmaca, and McKesson online stores, with delivery in 1-2 days. Tests covering wellness, men’s and women’s health are processed by CLIA-certified reference labs with results sent to a secure online account in 2-5 days, with the customer referred to in-state physicians for interpretation of results and further action if needed. PrivaPath Diagnostics markets in the US, Canada, Ireland, and Europe. Release

Speaking of raising money, how about $35 million for your med device startup? Health Wildcatters is hosting one of their Pulse Health Startup Education Series breakfasts (7.30-9am) in Dallas on Tuesday 21 May with main speaker Ken Nelson from Bardy Diagnostics, which just had a $35.5 million Series B, presumably letting everyone in on the secret. Registration and more information here.

Rounding up September’s start: AliveCor’s hyperkalemia detector, Apple’s ECG Watch, Tunstall Nordic’s EWII, steps towards a bionic eye, Philips licenses BATDOK, VistA’s international future

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”120″ /]AliveCor gets a fast track for its bloodless hyperkalemia (high blood potassium) detector through the FDA Breakthrough Device program. Working with doctors at the Mayo Clinic, they developed a way to read patterns in electrocardiograms (ECG/EKG) that track increasing potassium levels without drawing blood. While attributed in the CNBC article to AI, it seems closer to machine learning. Hyperkalemia is a condition that is seen in type 1 diabetes, chronic kidney disease, and other kidney related conditions. The device and software is at least one year away from approval including a clinical trial, even on this program which further speeds up the Expedited Access Pathways (EAP) program under the 21st Century Cures legislation. AliveCor currently markets the Kardia Band that reads ECGs.

Meanwhile, the Series 4 iteration of the Apple Watch moves further into the medical device area–and AliveCor’s ECG niche–with a built-in atrial fibrillation-detecting algorithm and an ECG, along with fall detection via the new accelerometer and gyroscope. The Apple Watch will start shipping September 21. Mobihealthnews.

Danish energy and broadband provider EWII has sold its subsidiary EWII Telecare A/S to Tunstall Nordic. EWII Telecare provides telemedicine and telehealth services on a tablet platform dubbed Netcare (video here). The EWII Telecare website is already down. Telecompaper, Tunstall Nordic release

Foundational technology for a bionic eye? The University of Minnesota has developed a method using 3D printing to create light receptors on a hemispherical surface. Printing a base of silver ink, the next layer was photodiodes of a semiconducting polymer which convert light into electricity. ZDNet

Philips Healthcare is licensing the Battlefield Airmen Trauma Distributed Observation Kit (BATDOK) technology for remote monitoring of vital signs by combat paramedics. Terms were not disclosed. BATDOK was developed by the US Air Force Research Laboratory, which sought commercialization. [TTA 6 Sept 17]  Mobihealthnews

What is generally not known about the VA’s eventually departing EHR is that it has for some years an open source version called OSEHRA VistA. Plan VI will expand VistA capability by making it compatible with different languages using Unicode and creating a reference implementation for global use. Working with non-profit OSEHRA are research groups in South Korea, China, and the Kingdom of Jordan. Release

Health tech for stroke prevention and rehab from Kardia Mobile, Watch BP, Northwestern U (UK/US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/02/Northwestern-stroke-patch.jpg” thumb_width=”150″ /]Is stroke avoidable? We know it is an expensive medical event at $20-23,000 for hospitalization alone (NIH), which does not count rehabilitation or the devastation to individuals and their families, including loss of ability and work. NHS England is testing two devices, the Kardia Mobile and Watch BP, with an eye to preventing stroke in those vulnerable to it. 6,000 devices are being distributed to GP practices in England in a program through 15 NHS and care innovation bodies known as Academic Health Science Networks (AHSNs). The Alivecor‘s Kardia Mobile is a smartphone add-on clip that captures a medical-grade ECG in 30 seconds, stores, and sends readings to physicians. The application to stroke is primarily in atrial fibrillation (AF) and irregular heart rhythms, which according to statistics, more than 420,000 people across England have. Watch BP is a blood pressure cuff device which is also equipped with an AF detection system. The goal of the project is to identify 130,000 new cases of AF over two years, to prevent at least 3,650 strokes and potentially save 900 lives. Savings to NHS are being estimated at £81 million annually. Digital Health News

Post-stroke rehabilitation treatment is also being boosted by a new device developed at Northwestern University and being tested at the Shirley Ryan AbilityLab, a Chicago research hospital. It is a Band-Aid® like device which can be applied to key areas such as the throat (left above, credit AbilityLab), chest, or limbs to send back information to doctors on how a patient in treatment post-discharge, especially at home, progresses. The sensors and platform measure heart activity, muscle movement, sleep quality, swallowing ability, and patterns of speech. Especially revolutionary is the monitoring of speech communication and swallowing, which are often impaired in stroke patients but hard to track once the patient is out of a facility. The team’s research was presented last week at the American Association for the Advancement of Science (AAAS) annual meeting. New Atlas. Hat tip to Toni Bunting.

5 vital signs, one ‘heavyweight’ device on the back of your Moto X smartphone

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/01/Vitals-product.jpg” thumb_width=”150″ /]Are we getting to the ‘tricorder’ through the smartphone mod back door? Smartphone clip-ons to measure a vital sign are nothing new–the early 2010s AliveCor device was a snap-on case for the iPhone containing EKG electrodes, now replaced with the Kardia Mobile and KardiaBand for the Apple Watch. But the Vital USA Moto Mod has to be the heavyweight champ of clip-on ‘mods’. It is for the Motorola Moto Z only, and the reveal at CES was by Lenovo, the official global distributor. Release (PDF).

The Vital Moto Mod measures five vital signs–heart rate, respiratory rate, blood oxygen saturation (SpO2), non-contact core body temperature, and systolic/diastolic blood pressure–through primarily a finger cuff and sensors. For BP, the cuff uses sensors and a novel inflatable bladder. Vital USA claims that running through all five readings takes between two to three minutes. The results download to the HIPAA-compliant Vital app which will be available through the Google App Store. The app also guides the user through how to take one or more of the vital signs. The Vital Moto Mod is not yet FDA cleared or CE Marked. 

As CNet remarked, the mod is huge and not exactly something you slip into your back pocket. They didn’t have the opportunity to check it for accuracy against other standard medical devices. It will be available after April 8 for $395 (£290).

One questionable aspect of the website is the consistent usage and demonstration of ‘vital signs monitoring’ and confirmation of its accuracy when in the FAQs, under “Is the product FDA approved”, it states that “this is a health and general wellness product. The Vital Moto Mod is not a medical device and therefore not currently regulated by the FDA.” 

However, announced on the 24th was their partnership with Partners Connected Health of Boston to validate the readings in a clinical trial that will compare the Vital Moto Mod to predicate medical devices, which is preliminary to FDA approval. Release

It appears that the US company, HQ’d in Boca Raton, FL, has an Irish parent, ARC Connected Health.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/01/sensoscan.jpg” thumb_width=”150″ /]An earlier, less clunky entrant, which this Editor first saw at Connected Health 2015 is the Sensogram SensoSCAN finger cover monitor which is a 4-in-1, measuring blood pressure, heart rate, blood oxygen saturation (SPO2), and respiration rate (but not temperature). Measurements are viewable on a screen readout. It is currently available for $499 through their website and is in the process of FDA clearance. In development is the VitalBand, which adds fall detection, medication reminders, goal notifications, and pre-programmed contacts to the SensoSCAN’s four vital signs. Data is stored on both devices and uploaded to their app via Bluetooth.

This Editor is impressed with the idea of consumers not having to work with multiple devices but sees two definite drawbacks: size of the Vital Moto Mod and the cost of both up to $499. They are most useful to those who have to monitor multiple vitals for chronic conditions, yet they are both, at this time, stand-alone, not reimbursable, and not integrated with any major telehealth system. It’s yet to be seen if they will be accepted by telehealth companies (which kit their tablets or hubs with multiple devices), payers, and patients.

Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Our Editors will be lassoing our thoughts for what happened in 2017 and looking forward to 2018 in several articles. So let’s get started! Happy Trails!

2017’s digital health M&A is well-covered by Jonah Comstock’s Mobihealthnews overview. In this aggregation, the M&A trends to be seen are 1) merging of services that are rather alike (e.g. two diabetes app/education or telehealth/telemedicine providers) to buy market share, 2) services that complement each other by being similar but with strengths in different markets or broaden capabilities (Teladoc and Best Doctors, GlobalMed and TreatMD), 3) fill a gap in a portfolio (Philips‘ various acquisitions), or 4) payers trying yet again to cement themselves into digital health, which has had a checkered record indeed. This consolidation is to be expected in a fluid and relatively early stage environment.

In this roundup, we miss the telecom moves of prior years, most of which have misfired. WebMD, once an acquirer, once on the ropes, is being acquired into a fully corporate info provider structure with its pending acquisition by KKR’s Internet Brands, an information SaaS/web hoster in multiple verticals. This points to the commodification of healthcare information. 

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]Love that canary! We have a paradigm breaker in the pending CVS-Aetna merger into the very structure of how healthcare can be made more convenient, delivered, billed, and paid for–if it is approved and not challenged, which is a very real possibility. Over the next two years, if this works, look for supermarkets to get into the healthcare business. Payers, drug stores, and retailers have few places to go. The worldwide wild card: Walgreens Boots. Start with our article here and move to our previous articles linked at the end.

US telehealth and telemedicine’s march towards reimbursement and parity payment continues. See our article on the CCHP roundup and policy paper (for the most stalwart of wonks only). Another major change in the US is payment for more services under Medicare, issued in early November by the Centers for Medicare and Medicaid Services (CMS) in its Final Rule for the 2018 Medicare Physician Fee Schedule. This also increases payment to nearly $60 per month for remote patient monitoring, which will help struggling RPM providers. Not quite a stride, but less of a stumble for the Grizzled Survivors. MedCityNews

In the UK, our friends at The King’s Fund have rounded up their most popular content of 2017 here. Newer models of telehealth and telemedicine such as Babylon Health and PushDoctor continue to struggle to find a place in the national structure. (Babylon’s challenge to the CQC was dropped before Christmas at their cost of £11,000 in High Court costs.) Judging from our Tender Alerts, compared to the US, telecare integration into housing is far ahead for those most in need especially in support at home. Yet there are glaring disparities due to funding–witness the national scandal of NHS Kernow withdrawing telehealth from local residents earlier this year [TTA coverage here]. This Editor is pleased to report that as of 5 December, NHS Kernow’s Governing Body has approved plans to retain and reconfigure Telehealth services, working in partnership with the provider Cornwall Partnership NHS Foundation Trust (CFT). Their notice is here.

More UK roundups are available on Digital Health News: 2017 review, most read stories, and cybersecurity predictions for 2018. David Doherty’s compiled a group of the major international health tech events for 2018 over at 3G Doctor. Which reminds this Editor to tell him to list #MedMo18 November 29-30 in NYC and that he might want to consider updating the name to 5G Doctor to mark the transition over to 5G wireless service advancing in 2018.

Data breaches continue to be a worry. The Protenus/DataBreaches.net roundup for November continues the breach a day trend. The largest breach they detected was of over 16,000 patient records at the Hackensack Sleep and Pulmonary Center in New Jersey. The monthly total was almost 84,000 records, a low compared to the prior few months, but there may be some reporting shifting into December. Protenus blog, MedCityNews

And perhaps there’s a future for wearables, in the watch form. The Apple Watch’s disconnecting from the phone (and the slowness of older models) has led to companies like AliveCor’s KardiaBand EKG (ECG) providing add-ons to the watch. Apple is trying to develop its own non-invasive blood glucose monitor, with Alphabet’s (Google) Verily Study Watch in test having sensors that can collect data on heart rate, gait and skin temperature. More here from CNBC on Big Tech and healthcare, Apple’s wearables.

Telehealth saves lives, as an Australian nurse at an isolated Coral Bay clinic found out. He hooked himself up to the ECG machine and dialed into the Emergency Telehealth Service (ETS). With assistance from volunteers, he was able to medicate himself with clotbusters until the Royal Flying Doctor Service transferred him to a Perth hospital. Now if he had a KardiaBand….WAToday.com.au  Hat tip to Mike Clark

This Editor’s parting words for 2017 will be right down to the Real Nitty-Gritty, so read on!: (more…)

Babylon as AI diagnostician that is ’10 times more precise than a doctor’

The NHS announced at the top of this month that it would test Babylon Health‘s ‘chatbot’ app for the next six months to 1.2 million people in north London. During the call to the 111 medical hotline number, they will be prompted to try the app, which invites the user to text their symptoms. The app decides through the series of texts, through artificial intelligence, in minutes how urgent the situation is and will recommend action to the patient up to an appointment with their GP, or if acute to go to Accident & Emergency (US=emergency room or department) if the situation warrants. It will launch this month in NHS services covering Barnet, Camden, Enfield, Haringey, and Islington, London. TechCrunch.

The NHS’ reasons for “digitising” services through a pilot like Babylon’s app is to save money by reducing unnecessary doctor appointments and pressure on A&Es. It provides a quick diagnosis that usually directs the patient to self-care until the health situation resolves. If not resolved or obviously acute, it will direct to a GP or A&E. The numbers are fairly convincing: £45 for the visit to a GP, £13 to a nurse and £0 for the app use. According to The Telegraph, the trial is facing opposition by groups like Patient Concern, the British Medical Association’s GP committee, and Action Against Medical Accidents. There is little mention of wrong diagnoses here (see below). The NHS’ app track record, however, has not been good–the NHS Choices misstep on applying urgency classifications to a ‘symptom checker’ app–and there have been incidents on 111 response.

Babylon’s founder Ali Barsa, of course, is bullish on his app and what it can do. (more…)

Silicon Valley’s mantras don’t work in healthcare: AliveCor’s CEO

Betas, ‘moving fast and breaking things’ don’t work in our territory. That is the POV of Vic Gundotra, the CEO of AliveCor, which has successfully introduced and marketed its smartphone snap-on ECG globally. Witness the up vote from the NHS on technology (Daily Mirror), while the American Medical Association (AMA) in the US wants better vetting of both clinical and DTC health tech and refers to much of it as ‘quackery’ (Forbes). According to Mr Gundotra, who was in engineering at Google and Microsoft prior to AliveCor, “Healthcare is not a market that can be hacked.” and “When a product directly relates to human health, following regulatory requirements needs to be a core part of the strategy from day one. What has been seen as a burden needs to be seen as a benefit. It’s time that we stop viewing regulatory bodies as obstacles and start viewing them as valuable partners. This is a mindset that should be adopted across a company’s entire team — from board to CEO to VC to developer.” And the incompatible expectation of Silicon Valley VCs, “18 months tapping our feet, then exit” as well.  Recode

Sleepio and Alivecor enhance digital health credibility

This has proved to be a great week for digital health credibility.

Firstly Sleepio picked up two honours – one was scoring the highest mark on the first Ranked Health output. The second was getting the American College of Physicians to come out and say that CBT-I should be the treatment of choice for insomnia (above hypnotics).

Meanwhile a study has shown that “A Smart Phone-based ECG Recorder Is Non-inferior to an Ambulatory Event Monitor for Diagnosis of Palpitations”. In layman’s language, the Alivecor/Kardia smartphone peripheral and app are as good as the awkward to wear & cumbersome Holter monitor.

Well done both!

Those who have heard Dr Sophie Bostok, the indefatigable Sleepio Sleep Evangelist, explain (more…)

Breaking news: AliveCor’s integration with Apple Watch – hugely impressive!

Kardia bandAliveCor have today announced the Kardia Band which replaces the ordinary strap on an Apple Watch. Touch the band with your other hand and it records a one-lead ECG (EKG=US) that communicates with the Watch app, Kardia by AliveCor. The Atrial Fibrillation (AF) Detector then uses an algorithm to instantly detect and inform the wearer of the presence of AF, the most common cardiac arrhythmia and a leading cause of stroke. Other ‘detectors’ look at the ECG to determine normal heart rate and rhythm or if you should retake an ECG so physicians receive only the highest quality recordings.

Users can also record voice memos on their Apple Watch to accompany each ECG that give doctors and caregivers a clearer picture of what was happening at the time of the recording — describing symptoms such as palpitations or external factors like caffeine intake. Kardia also integrates seamlessly with Apple’s Health app to include ECG data with steps and calorie intake to provide richer, personal analysis over time.

A short note at the end indicates that the FDA-cleared AliveCor Mobile ECG, best known for snapping on to an iPhone but works on Android smartphones as well, has been rebranded as Kardia Mobile to establish a product family.

Most impressive.

In the US, the Kardia Band is pending 510k clearance and is not currently for sale. Plans for the UK have not been formally announced but anticipated soon.  AliveCor release.

Technology for Aging in Place 2016

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/03/elderly-smartphone.jpg” thumb_width=”150″ /]Laurie Orlov’s updated view of technologies that assist home caregiving/living, and her observations on trends for both boomers and those well over 65, is hot off the (virtual) presses and available here on her website. It is US-market oriented, but the trends explored here will be of interest internationally. The focus in this study is home-based systems for safety, alerts, activity/location tracking (telecare), home care/caregiving tools and what this Editor would call ‘health monitoring light’–med minders and logging apps versus medically-oriented telehealth (vital signs, save for AliveCor) and telemedicine (virtual visits/consults).

Highlights:

  • In communication, internet non-usage among 75+ has declined to 50 percent over the past 15 years.
  • The tablet form factor is losing ground as smartphones get bigger. Older adults and smartphones are beginning to ‘get along’ partly as they grow larger, but also that feature and simple phones are becoming less available.
  • Also losing ground is senior housing–residents are delaying entry to assisted living until they are mid 80s and frailer. Savings and debt in the boomer group is low and high, respectively.
  • Investors are caring more about home care, with large investments ($80 million) in three regional home care worker startups: Honor (San Francisco), Home Hero (Los Angeles), and Hometeam (New York/New Jersey), caregiving apps and chronic care management (CareSync, with an $18 million raise).
  • Dementia care support tools are (finally) developing into its own category.

Surprising conclusions: PERS alerting stays strong, but changes to be mobile-enabled and more cosmetic; a lot of convergence of categories and forms; and the term ‘health tech’ will replace ‘digital health’. Oh my!

Apps and wearables – developments over the summer

Trying at least temporarily to distract this editor’s attention from his recent unfortunate experience with Jawbone technology, here are some interesting app and wearables snippets received over the summer.

We begin with news of the first CE certified mole checking app, SkinVision which rates moles using a simple traffic light system (using a red, orange or green risk rating). The app lets users store photos in multiple folders so they can track different moles over time. It aims to detect changing moles (color, size, symmetry etc.) that are a clear sign that something is wrong and that the person should visit a doctor immediately.

This contrasts with the findings of a paper published in June examining 46 insulin calculator apps, 45 of which were found to contain material problems, resulting in the conclusion that :”The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control.”, which to say the least of matters is worrying. (more…)

Important: DHACA’s response to the RCP advice on medical apps

The Royal College of Physicians has just published app guidance that, according to EHI “doctors should only use medical apps with an official CE mark”. EHI goes on to clarify that the guidance “applies to medical apps that can be classed as medical devices, which are bound by EU law to carry the mark.”

The Digital Health & Care Alliance (DHACA), of which this reviewer is Managing Director, is extremely concerned that this advice may seriously impact on the beneficial use of medical apps in the UK as it places the onus of deciding whether an app is a medical device on individual clinicians, a decision that at times even experienced MHRA personnel can equivocate on.

As the original research done by this editor on the topic of medical app take-up demonstrated, clinicians (more…)

HIMSS’ last full day highlights company partnerships

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/himss_chicago_2015-588×337.jpg” thumb_width=”150″ /]It’s almost time to Say Goodbye to Sinatra’s ‘My Kind of Town’, but there’s still news: Samsung+Partners Healthcare, IMS Health, AliveCor, Interoperability≠Humana, Panasonic+Cisco

  • Samsung and Partners HealthCare announced a direct-to-mobile partnership to develop chronic care management mobile software that monitors vital signs such as blood pressure, blood glucose and weight, as well as delivers mobile patient engagement, medication adherence and wellness self-management. Clinical trial is scheduled for June. Partners has always been a pioneer in the mHealth area, but playing with Samsung, Partners is flying at a slightly higher level than with Wellocracy and certainly the late Healthrageous. Partners release, Mobihealthnews (more…)

Dr Topol’s prescription for The Future of Medicine, analyzed

The Future of Medicine Is in Your Smartphone sounds like a preface to his latest book, ‘The Patient Will See You Now’, but it is quite consistent with Dr Topol’s talks of late [TTA 5 Dec]. The article is at once optimistic–yes, we love the picture–yet somewhat unreal. When we walk around and kick the tires…

First, it flies in the face of the increasing control of healthcare providers by government as to outcomes and the shift for good or ill to ‘outcomes-based medicine’. Second, ‘doctorless patients’ may need fewer services, not more, and why should these individuals, who represent the high-info elite at least initially, be penalized by having to pay the extremely high premiums dictated by government-approved health insurance (in the US, ACA-compliant insurance a/k/a Obamacare)–or face the US tax penalties for not enrolling in same? Third, those liberating mass market smartwatches and fitness trackers aren’t clinical quality yet–fine directionally, but real clinical diagnosis (more…)