Mid-week roundup: Teladoc gets BetterHelp to boost Q4 ’22 revenue; fundings for Array, Paytient, Telesair, three others; layoffs hit at Alphabet’s Verily, Cue Health

January 12, 2023 | by

Teladoc may finish 2022 better than expected, at least in revenue. At the JPMorgan (JPM) annual healthcare conference, CEO Jason Gorevic shared a revised but still preliminary projection that Q4 would finish up a tick higher than expected–between $633 million and $640 million in revenue, versus their projection during Q3 that the low side would be $625 million. FY2022 revenue was updated to be the $2.403 billion to $2.41 billion range. The big contributor? Their mental health app BetterHelp. Their growth, according to Mr. Gorevic, is “staggering’. Silicon Valley Bank (SVP) analyst Stephanie Davis calculated a growth rate of 43% for the business, up from previous management targets. Teladoc’s optimism is tempered by the no/slow growth economy projected for this year, both direct to consumer and corporate. To help boost the latter, it is launching a new app for health plan members and company employees access to all of Teladoc’s clinical programs. Healthcare Dive, Becker’s

Despite the uncertain economy, funding continues in various rounds, especially in still-hot areas such as remote/virtual behavioral therapy and payments, but nowhere near the bubbly level of 2021:

CVS Health’s open piggybank helped to fund NJ-based Array Behavioral Care’s $25 million Series C. Other investors included HLM Venture Partners, OSF Healthcare System, Wells Fargo, and three others. Array will use the funds to scale its virtual behavioral therapy platform.  Mobihealthnews, Crunchbase

In that interesting area called healthcare fintech, the cleverly-named Paytient now has an additional $40.5 million in Series B funding, bringing their total to $63 million. Paytient provides corporate employees, health plan members, and health system patients with a card-based Health Payment Account (HPA) that includes a line of credit. Release, Mobihealthnews 

In hospital-to-home respiratory care, still in stealth Telesair raised $22 million in Series A funding, led by Pasaca Capital with participation from existing and new investors such as Honeywell Investors, ZhenCheng Capital, Shangbay Capital plus three others. According to the release, funding will be used for the commercialization of the Bonhawa Respiratory Humidifier for use in the ICU and the development of a second-generation, revolutionary product for hospital-to-home. Mobihealthnews   

Also highlighted in Mobihealthnews‘ article is a $10 million Series B for ModifyHealth, which delivers prepared, medically tailored meals and provides advice from dieticians. ModifyHealth provides certified low FODMAP meals for those with irritable bowel syndrome or small intestinal bacterial overgrowth (SIBO), as well as Mediterranean, low-sodium, and gluten-free (celiac disease) diet meals. Censinet, a developer of healthcare cybersecurity software, also landed $9 million in a funding round led by MemorialCare Innovation Fund, Rex Health Ventures, and Ballad Ventures plus five others for a total of over $22 million.  Release  CARI Health, a San Diego startup developing a wearable sensor for medication management, gained $2.3 million in seed funding from the San Diego Angel Conference plus four other funds. Release

The pace of layoffs may have slowed, but the numbers have not.

Alphabet’s Verily health tech development unit is discharging 15% of current staff, estimated at 240 people.  This is part of a reorganization designed to move to financial independence from Alphabet/Google. It’s categorized among Google units as ‘Other Bets’ which is appropriate given that so far, their bets haven’t hit any jackpots. An example we covered back in 2015-16 was a glucose monitoring contact lens developed with Alcon, an on-the-face of it Preposterous Idea that died about that time. Current discontinued areas include remote patient monitoring for heart failure and micro needles for drug delivery. Employees were told to leave the office for the remainder of the week; further information including separation would be sent to them via email. Since 2017, it has raised over $2 billion. You wonder where it went. CNBC

Cue Health, a home diagnostics company, is cutting 388 employees, about 26% of its workforce, effective March. This is in addition to an 170-person manufacturing worker layoff during the summer. Cue bet heavily on growth of its at-home molecular Covid testing packs sold direct on a membership plan [TTA 12 Nov 2021], plus to pharmacies and to businesses. It expanded from about 100 workers in 2020 to more than 1,500. That growth has cratered along with the entire testing market for a pandemic that is no longer there. According to Mobihealthnews, they have submitted to the FDA for new test such as an EUA for a combination flu and COVID-19 diagnostic as well as de novo clearances for its flu and COVID-19 standalone tests. 

 

Outcome Health founders Shah, Agarwal plead not guilty in Federal court

December 17, 2019 | by

As expected, the co-founders of in-office health information/advertising firm Outcome Health today (Monday) pleaded not guilty in the Northern District of Illinois Federal Court in Chicago. Of a total of 26 counts in the Federal indictment, Rishi Shah, the company’s former CEO, has been charged with six counts of mail fraud, 12 counts of wire fraud and two counts each of bank fraud and money laundering. Shradha Agarwal, the former president, has a somewhat lighter charge count of six counts of mail fraud, nine counts of wire fraud and two counts of bank fraud. Both were released on bond: $20 million for Mr. Shah, $10 million for Ms. Agarwal. Crain’s Chicago Business, may require free registration.

The charges relate to deception layered around company performance as detailed in our 3 December article–overstatement of advertising placement and delivery, manipulating third-party data on patient engagement on Outcome’s tablets, and fraudulently stating results to auditors. This was used to leverage nearly half a billion of a total $1 bn raise by major firms such as Goldman Sachs, Alphabet, and the Pritzker fund.

Last week, we covered the pleas of Ashik Desai, former EVP of business operations/chief growth officer (guilty) and Brad Purdy, former COO/CFO (not guilty). Mr. Desai, interrupted from his graduate studies at Wharton, is cooperating with the prosecutors; Mr. Purdy is blaming Mr. Desai.

A podcasted discussion on Crain’s Daily Gist has expressed the opinion that some in tech and healthcare, especially in Chicago, believe the list of charges and heavy penalties are ‘unusual’ and ‘extreme’ for a startup, considering that the revelations started four years ago, the accused stepped down two years ago. and restitution has been made to the defrauded companies. Moreover, the business and the model was not far fetched or pie-in-sky–it was a reasonable model, according to report John Pletz. The company continues in business, albeit scaled down. Mr. Pletz believes that the outcome of Outcome Health will be far more due diligence on investors’ part (accentuated by the WeWork/Softbank crash in the same car) on startups. “Failure is expected–fraud is not.” The resolution of the charges will also be far in the future, perhaps years, due to this being an extraordinarily complicated case. There will be further hearings in January, but do expect it to drag on. A mini-surprise in his commentary was stating that the analysts may turn their plea to guilty. 

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

October 9, 2019 | by

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

International news roundup: Verily ‘eyes’ India, Oxford VR trials in Hong Kong, Israel-Finland collaborate, Blue Cedar-Blackberry partner, NuvoAir inhales $3M

May 2, 2019 | by

Verily rolls along in India with eye health research. Spending its fresh $1bn in funding [TTA 17 Jan], Verily and Alphabet sibling Google are researching machine learning in screening for diabetic retinopathy and diabetic macular edema. The retinal diagnostic program is at Aravind Eye Hospital, a network of eye hospitals headquartered in Tamil Nadu. Early research at Madurai has demonstrated that the algorithm performs on par with general ophthalmologists and retinal specialists assessing the images for disease. The estimated shortage of eye doctors in India is estimated at over 100,000. The stated objective of the research is to detect retinal disease earlier and expand access to screening. Further testing is verifying safety and effectiveness. Verily has received the CE Mark for the algorithm. Verily blog

Oxford VR in pilot to manage mental health in Hong Kong. Oxford VR, AXA Hong Kong and The Chinese University of Hong Kong (CUHK) have partnered for an “immersive therapy” trial using VR. This will focus on managing common mental health issues, such as social avoidance, anxiety and depressive symptoms. The scenarios will be in both English and Cantonese. Details will be announced in June. Mobihealthnews, Oxford VR press release

Israel and Finland are launching a joint collaboration announced last December, led by the Israel Innovation Authority (IIA) and the Helsinki Business Hub. The pilot program is starting with a Call for Proposals for joint projects. The two countries will co-develop, test, improve and pilot technologies, products and services in digital health, smart mobility and information and communication technologies. According to Mobihealthnews, the countries both have strong commonalities in public health systems with coordinated data sets, digital health, genomic projects, and advanced interoperability. Also The Jewish Voice

App security innovator Blue Cedar partners with Blackberry. Blue Cedar’s securing data from the app to the provider location will work with BlackBerry Dynamics-enabled mobile apps so that development teams will not be required to manually change source code or add libraries. Both Blue Cedar and Blackberry target international high-security fields such as healthcare, government, and financial. Blue Cedar blog

Swedish respiratory device/app NuvoAir inhales $3M in new funding. NuvoAir targets those managing asthma, COPD, and cystic fibrosis who need to monitor their breathing and lung health in conjunction with their overall health. Last year, the company developed the Air Next system, a portable device that connects via Bluetooth LE to users’ smartphones or tablets. Air Next has a CE Mark. NuvoAir plans to expand into Europe, North America, and Asia. The digital respiratory therapy area is booming, with an estimated 210 million asthma and COPD patients with smartphones worldwide a strong factor. One sign: Propeller Health’s premium acquisition by ResMed.  Mobihealthnews

Verily, Google’s life sciences arm, gathers in another billion to go…where? (updated for Study Watch FDA clearance)

January 17, 2019 | by

Biotech/device company Verily added to its 2016 $800 million stake from Singapore’s Temasek a fresh $1 bn from Silver Lake Partners. with reported participation from Ontario Teacher’s Pension Plan. Verily is majority-owned by Google parent Alphabet, which has added a new member to the Verily board, CFO Ruth Porat, and Egon Durbat from Silver Lake.

CEO Andrew Conrad, who is still there despite a brace of bad press two years ago [TTA 6 Apr 16], stated that “We are taking external funding to increase flexibility and optionality as we expand on our core strategic focus areas. Adding a well-rounded group of seasoned investors, led by Silver Lake, will further prepare us to execute as healthcare continues the shift towards evidence generation and value-based reimbursement models.”

One is tempted to say, ‘whatever that means’. They have had multiple ventures from contact lenses with Novartis’ subsidiary Alcon (reportedly discontinued but dating back with Google to 2014), diabetes with Sanofi, to sleep apnea with ResMed. VentureBeat reports they are cash-profitable and even venturing into areas such as small exploding needles that can extract blood through a wearable device–not precisely for the needle-phobic. There seem to be multiple projects in multiple directions that are primarily research. Certainly their finding at $1.8 bn is an outlier even at 2018’s big scale–but with Alphabet/Google as a parent and A-list partners, the risk is minimal. Mobihealthnews, Crunchbase

FDA clearance of Verily’s Study Watch. Late last week, Verily announced that their Study Watch was given a 510(k) FDA clearance. It records, stores, transfers and displays single-channel ECG. To date, there are no plans to use it beyond a handful of research studies primarily on cardiac disease. Mobihealthnews. Meanwhile, Google, not Verily, paid Fossil $40 million for a still under development smartwatch technology to fit into Google’s Ware OS area. It’s not known whether it is health related, but their CEO admitted that it was based on tech from the Misfit acquisition–and Misfit was focused on health tech. After the sale closing, it is predicted that some Fossil R&D staff will move over to Google. Back in 2015, Fossil paid $260 million for Misfit and their fitness tech but generally has stayed in the conventional smartwatch area. The story broke in Wareable. Also Mobihealthnews.

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

November 15, 2018 | by

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

The magic quadrant matrix strikes again for health tech and investment potential

May 24, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/05/Medical-social-quadrant-box.jpg” thumb_width=”150″ /]Deceptively simple, the quadrant matrix can make sense out of actions and decisions. As a management tool, it can help you prioritize what is most urgent and important, or how to vary your supervisory/coaching style based on the person’s skill and will levels.

Here we see the magic box used by Krishna Yeshwant, MD, a doctor and investor with GV, Alphabet’s venture firm, to sort out all those Next Revolutions in Health Care. The factors that Dr. Yeshwant uses pertain to the end user’s medical and social needs, often called social determinants of health (SDH). Both are meshed, whether in an active older veteran who lives alone in a rural area but manages his diabetes well, or in a homeless substance user in a city with multiple medical conditions.

Most non-medical entrepreneurs prefer to develop tech and services for people like them with low medical/low social needs, such as virtual doctor apps, concierge primary care, and wellness apps. It’s a crowded quadrant and perhaps is over-served. Those with a medical background appear to gravitate to the diagonal quadrant–high medical/high social needs, such as those targeted to the ‘underserved’ with diabetes or high-need care model management, such as Aledade and Iora Health. Where does the investment money go? Their money goes to companies which have developed high medical need therapeutics such as expensive treatments for cancer, neatly avoiding those complex social factors.

What is missing: innovation in low medical/high social needs. This group is at high risk to move into high medical needs due to their lack of organization and access to/willingness for primary care. This Editor agrees, but if another factor is observed–profitability–this is likely the least potential of the four. So if you want to get Dr. Y’s attention and maybe some moolah from Alphabet…. From his presentation at the HLTH meeting last week in Las Vegas. CNBC.

Another unicorn loses its horn–Outcome Health finally loses the CEO and president

January 29, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/08/1107_unicorn_head_mask_inuse.jpg” thumb_width=”150″ /]Another Theranos? Outcome Health is a point of ‘sale’ advertising company that has wrapped itself in ‘behavior change technology’. It’s been a Chicago darling and closed a $500 million Series A led by Goldman Sachs and Alphabet only last May. Its business in ‘transforming healthcare’ is the prosaic but highly lucrative placement of monitors in doctors’ offices that provide relentless health educational content liberally laced with DTC sponsorship messages, free to the doctors but paid for by pharma companies. This also includes tablets, exam room demo wallboards, and Wi-Fi in offices. The Series A pushed up the company’s valuation to $5.5 bn and made its CEO a billionaire.

What it didn’t do, like Theranos, was deliver. Before October last year, advertisers, backed up by former employees’ testimony, realized that the data were inflated in several ways: number of screens in offices, verification of actual runs, match lists that didn’t match to the screens, made-up survey numbers, and puffed up third-party analyses of the ads’ effectiveness, e.g. for prescriptions written. A Wall Street Journal article in October last year exposed the practices. When advertisers are fleeced, they may get mad, but then they get even. There were reported refunds in the millions to Pfizer, plus millions in advertising make-goods to Sanofi SA and Biogen Inc. 250 ad campaigns are now in review across 40,000 doctors’ offices. A search for the guilty ensued, some culpable employees were suspended, the usual layoffs of 33 percent of the staff and belt-tightening ensued, and an outside person was hired to investigate and impose the usual ‘best practices’. Also MedCityNews

The mea culpas didn’t work because it’s real money and there were signs it was moving. In November, investors in that Series A, including Goldman Sachs, Alphabet, and Pritzker Group Venture Capital, attempted to claw back $225 million they gave to CEO Rishi Shah and President Shradha Agarwal held in a special fund. The investors accused them of moving the money. The court documents indicated they received subpoenas from the Justice Department (see Chicago Tribune below). The filing was in New York State Supreme Court, not in Illinois. Outcome’s response was to trumpet their integrity and that “the equity investors led by Goldman Sachs are misusing the court system to advance their own short-term, self-interest of winning an advantage over debt-holders — all to the detriment of the business, its employees and customers.” MedCityNews

Last week, they settled. Both Mr. Shah and Ms. Agarwal announced they are ‘stepping down’ from direct operations to become chairman and vice chair of the now seven-person board of directors, now including three independent directors and two representing investors. The investors, lenders, and founders are funneling $159 million to reduce the company’s debt by $77 million and buttress their operations. The COO is taking on interim CEO duties while the board searches for a new head. The release trumpets ‘reinvestment in the future’. And that HQ move to an ‘Outcome Tower’? Nixed. Illinois also pulled away two tax credit deals. Chicago Tribune, MedCityNews

How three major investors didn’t do their ‘due diligence’ before writing big checks is beyond this Editor’s ken. This tale won’t be as drastic or lead to moral questions as Theranos did. There are no malfunctioning tests, misled patients and doctors– after all, it’s just advertising in offices paid by everyone’s favorite pharmas. But as yet another blot on healthcare transformation, like Theranos it’s turned into a corporate saga of posturing–ah, here’s a fig leaf to cover, a shoe to drop, and here’s your large feathered fan.

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

December 29, 2017 | by | 2 Comments

[grow_thumb image=”https://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=”https://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…)

Verily’s million points of BYO health data to take to your next doctor visit

October 11, 2017 | by

Verily‘s visit to last week’s Health 2.0 conference had an odd-but-fun tack, comparing the data received from human bodies to the billions of data points generated by an average late-model automobile in normal operations. We generate a lot less (ten orders of magnitude difference, according to Verily Chief Technology Officer Brian Otis), but Verily wants to maximize the output by wiring us to multiple sensors and to use the data in a predictive health model. Some of the Verily devices this Editor predicts will be non-starters (the sensor contact lens developed with Alcon) but others like the Dexcom partnership to develop a smaller, cheaper continuous blood glucose monitor and Liftware, the tremor-canceling silverware company Google acquired in 2014, appear promising. Key to predictive health is the Study Watch, which is a wearable that collects a lot of data but is easy to wear for a long time. Mobihealthnews

But what to do with this All That Data? Where this differs from a car is that the operational data goes into feedback loops that tune the engine’s performance, perform long-term monitoring, electrical system, braking, and more. (When the sensors go south or the battery’s low, watch out!) It’s not clear from the talk where this overwhelming amount of healthcare data generated goes to and how it becomes useful to a person or a doctor. This has its own feedback loop this Editor dubbed a few years ago as the Five Big Questions (FBQs): who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records. That’s not answered, but presumably these technologies will incorporate machine learning and AI to Crunch That Data into bite-sized parts.

Which leads us back to Verily’s parent, Alphabet a/k/a Google. All that data into Verily devices could be monitored by Google and fed into other Google programs like their search engines and Adwords. Another privacy problem? 

Perhaps health systems are arriving at the realization that they have to crunch the data, not avoid it. For the first time, this Editor has observed that a CMIO of a small health system in Illinois and Sanford Health‘s executive director of analytics are actually welcoming patient data and research. Startups in this area such as PreventScripts labor on that “last mile” of clinical decision support, preventative medicine. EHRs are also into the act. Epic launched Share Everywhere, where patients can grant access to their data and clinicians can send updates into the patient portal (MyChart). What’s needed, CMIO Goel admits, is software that combines natural language processing and algorithms to track by disease and specialty–once again, machine learning. Healthcare IT News 

Can Google Glass’ enterprise iteration solve the patient documentation crisis?

July 24, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/Glass-EE.jpg” thumb_width=”200″ /]”Glass is a hands-free device, for hands-on workers.” What a marketing position! Google Glass finally arrives at where it should have started–not a techie toy or a social snooper banned from bars, but a tool for specific work needs that solve specific but important problems. This is not only ‘on trend’, but also the ‘professional case’ is steak on the grill as a powerful way to lend legitimacy to a new product (the classic is Tang ‘orange drink’ going into space in the early ’60s). The recent announcement of Glass Enterprise Edition (EE) marking its emergence from stealth mode was a refreshingly low-key (for Google and parent Alphabet) surprise. Even the revamped look is sturdy and utilitarian in full glass mode (left) or in clip-on (and also serves as eye protection). 

Their on-trend position for healthcare is to reduce the amount of time that doctors spend charting and documenting patients. Augmedix, a Glass partner, built the documentation automation platform for Sutter Health and for Dignity Health that captures the information from the interaction between patient and doctor via a ‘remote scribe’. Jay Kothari, the Glass project lead, quotes data from Dignity that it reduces clinician daily documentation time from 33 percent to less than 10 percent,  The Sutter Health estimate is two hours per day. Out of the gate this is extremely valuable because it improves the clinician-patient face-to-face (and presumably virtual) visit in eye contact, reduces the break in taking notes, and reduces time pressure generated by post-visit review. Netherlands-based swyMed concentrates on facilitating virtual visits, and is testing a home visit pilot with Loyola University Health System practitioners in Maywood, Illinois. Others, like John Nosta, have been continuing to use Glass in business. Our Readers may want to check out these partners as that is how Google is making the Glass available, not directly. SF/Boston-based partner Brain Power wasn’t mentioned in Mr. Kothari’s blog, but their AI/VR applications for brain conditions such as autism and TBI, as well as other uses such as clinical trials and care for older adults. mHealthIntelligence interviewed Augmedix’s CEO Ian Shakil, who notes that Glass still needs improvements in battery life for the hard work of documenting patient visits.

Update: An interesting comment on this via Twitter. The paper is from 2015 but the regulatory and privacy questions around recording patients and information remain. Augmedix does state on its website that it is HIPAA compliant.

 
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/Glass-Twitter.jpg” thumb_width=”250″ /]

How to unblock that health data in your EHR? Blockchain. (UK)

April 5, 2017 | by

The solution to that huge pile of patient-generated data, blocked and stymied in those non-interoperable EHRs [TTA 15 Mar], may be a system based on blockchain. DeepMind, Alphabet’s AI ‘skunk works’, is building a tool that it calls Verifiable Data Audit. It will be tested first in UK hospitals with which DeepMind is already working, including London’s Royal Free Hospital. What VDA will do is use cryptographic math to keep an accurate record of data used in the past to see exactly who is using health-care records, and for what purpose. When data is used, it generates a code based on all past activity. Any alteration to one part of the data alters the others and is quick to spot.

The UK test results will be interesting because, according to the MIT Technology Review article, patient records are considered to be highly fragmented. Another issue that DeepMind had in the UK was the NHS oversharing data with it for other projects, such as AI systems to diagnose eye disease, early warning signs of illness, and machine-learning approaches to guide cancer treatment. The VDA approach would, ironically, create an audit trail of that data. Another reason why we may be moving from Data Despare to Hope. Hat tip to contributor Sarianne Gruber of RCM Answers.

Contact lenses as sight-saving drug delivery system

September 7, 2016 | by

A drug-dispensing contact lens has shown success in effectively lowering eye pressure in monkeys with induced glaucoma. In what is termed a ‘pre-clinical model’, the study found that the medication, latanoprost, usually administered by the patient in conventional eye drops, in the contact lens form had equal or better intraocular pressure reduction. To quote the study’s first author, “We found that a lower-dose contact lens delivered the same amount of pressure reduction as the latanoprost drops, and a higher-dose lens, interestingly enough, had better pressure reduction than the drops in our small study,” said Joseph B. Ciolino, M.D., an ophthalmologist at Massachusetts Eye and Ear and an Assistant Professor of Ophthalmology at Harvard Medical School. The design of the lens does double duty: the periphery contains the thin film of drug-encapsulated polymers that slowly releases the drug; the center of the lens is clear and breathable, thus usable for standard vision correction.

Contact lenses for drug delivery have been for decades intriguing to researchers, but the embedded drug delivery has been too rapid to be effective in most cases; thus the polymers and the design are critical in slowing delivery. (more…)

It’s Alive! Augmedix’s $17 million raise raises Google Glass in medicine

May 4, 2016 | by

Just when we thought that Google Glass was going to be a tax writeoff for Alphabet (the Google parent company), along comes Augmedix, a Google Developers/Glass At Work enterprise partner which has raised, without a lot of fanfare, a tidy $17 million in venture capital funding. The round was funded primarily from customers–in this case Sutter Health, Dignity Health, Catholic Health Initiatives (CHI), TriHealth Inc. and an anonymous funder, plus traditional VCs Redmile Group, Emergence Capital and DCM Ventures, the last two which were also in the $16 million Series A. Augmedix’s Google Glass is used during the visit by the doctor to connect to a remote scribe who enters patient data into the EHR instead of the doctor. Our Readers familiar with a typical doctor’s office can readily see this as a useful function, though the Glass itself might put off some patients. No word of the dramatic surgery/telesurgery consults this Editor has seen demonstrated. It also appears that Augmedix is the only enterprise developer of Glass that has stayed with medical use, shifting its focus to large healthcare organizations. Mobihealthnews. CrunchBase

Google’s Verily rolls along. Bumpily? (updated)

April 6, 2016 | by

Several articles of late have reported on the Google Alphabet life sciences company Verily. By fall last year, they had developed partnerships with Novartis-Alcon on development of a smart contact lens (for measuring glucose), plus Dexcom, Abbvie and Biogen. STAT, a health/medicine news website owned by Boston Globe Media which is still in beta, has a well-researched article that details, seemingly with a lot of inside scoop, its current turmoil. 12 top engineering and science executives have taken a powder. Some of the execs date back to the Google X days; most have fled back to Mother Google, others to Amazon or to life sciences competitors. STAT: “No similar brain drain has occurred at Calico, another ambitious Google spinoff, which is focused on increasing the human lifespan.” The reasons are the apparently abrasive CEO Andrew Conrad, depicted as ambitious, fickle and moody–and the constant shifting of support from approved projects to short-term initiatives ‘that show little promise’. Google’s bold bid to transform medicine hits turbulence.

Update: STAT published today information on a possible conflict of interest in Verily awarding a short-term research contract to a luxury health clinic, California Health & Longevity Institute, where Dr Conrad holds a majority ownership. According to the publication, it has no documented experience with this kind of work. The clinic will gather, in a 200-person ‘feasibility study’ for the larger Baseline study, genetic, molecular, clinical, and other data. According to Dr Conrad, it was done “Because I think it’s cool. Because it’s super efficient to have everything in one spot.” What may not be cool to the participants is that Baseline is already planning to sell the data to pharmaceutical companies–with patient consent, of course, in a document not yet public. Google’s biotech venture hit by ethical concerns

Alphabet action versus diabetes with Life Sciences’ contact lens and Sanofi

September 1, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/03/google-contacts_1401174_616.jpg” thumb_width=”150″ /] Monday’s Big Story. As previously reported [TTA 25 Aug], the new Google holding company Alphabet is bringing the Life Sciences group formerly under Google X into its own company, with a new name TBD. On Monday, Life Sciences and Paris-based pharma Sanofi announced a partnership on projects related to diabetes monitoring and treatment. According to BioSpace, “at least part of the partnership will be focusing on helping Life Sciences create small, Internet-based devices that either automatically adjust insulin levels, or make suggestions based on real-time monitoring. ”

Clearly Life Sciences’ raison d’etre includes a focus on this disease, others that may relate to it, and in developing devices that others may market. Your Editors have been tracking their research for well over a year. A roundup of Life Sciences’ partnerships include more than diabetes:

**Novartis division Alcon for the glucose sensing contact lens [TTA 17 July 14, patent report 27 Mar 15 ]

** DexCom to develop a Band-Aid sized wearable for glucose monitoring, announced 15 August

**A 10 year deal with Abbvie for age-related disease exploration (which relates to the accelerated aging associated with diabetes)

**Biogen for multiple sclerosis (MS) treatments

We continue to have doubts about the practicality of the contact lens and the viability of embedded sensors in lenses, as the eyes are extremely sensitive and especially vulnerable for those with diabetes. But directionally on this disease, which is expanding almost uncontrollably worldwide, the research and devices which Life Sciences can develop for a variety of companies looks promising. Business Insider, Re/Code, Digital Trends