News roundup: docs dim on AI without purpose, ‘medtail’ a mall trend, CVS goes SDH, Kvedar to ATA, Biden ‘moonshot’ shorts out, and Short Takes

Docs not crazy about AI. And Dog Bites Man. In Medscape‘s survey of 1,500 doctors in the US, Europe, and Latin America, they are skeptical (49 percent-US) and uncomfortable (35 percent-Europe, 30 percent-Latin America). Only 20 percent fess up to actually using an AI application, and aren’t crazy about voice tech even at home. Two-thirds are willing to take a look at AI-powered tech if it proves to be better than humans at diagnosis, but only 44 percent actually believe that will happen. FierceHealthcare

This dim view, in the estimation of a chief analytics and information officer in healthcare, Vikas Chowdhry, is not the fault of AI nor of the doctors. There’s a disconnect between the tech and the larger purpose. “Without a national urgency to focus on health instead of medical care, and without scalable patient person-centered reforms, no technology will make a meaningful impact, especially in a hybrid public goods area like health.” The analogy is to power of computing–that somehow when we focused behind a goal, we were able to have multiple moon missions with computing equivalent to a really old smartphone, but now we send out funny cat videos instead of being on Mars. (And this Editor growing up in NJ thought the space program was there to market Tang orange drink.) HIStalk.

Those vacant stores at malls? Fill ’em with healthcare clinics! And go out for Jamba Juice after! CNN finally caught up with the trend, apparent on suburbia’s Boulevards and Main Streets, that clinics can fill those mall spots which have been vacated by retail. No longer confined to ‘medical buildings’, outpatient care is popping up everywhere. In your Editor’s metro area, you see CityMDs next to Walmarts, Northwell Health next to a burger spot, a Kessler Health rehab clinic replacing a dance studio, and so on. The clever name for it is ‘medtail’, and landlords love them because they sign long leases and pay for premium spots, brighten up dim concourses, and perhaps stimulate food court and other shopping traffic. Of course, CVS and Aetna spotted this about years ago in their merger but are working expansion in the other direction with expanding CVS locations and on the healthcare side, testing the addition of social determinants of health (SDH) services via a pilot partnership, Destination: Health with non-profit Unite Us to connect better with community services. This is in addition to previous affordable housing investments and a five-year community health initiative. Forbes, Mobihealthnews

ATA announces Joseph Kvedar, MD, as President-Elect. Dr. Kvedar was previously president in 2004-5 and replaces John Glaser, PhD, Executive Senior Advisor, Cerner. He will remain as Vice President of Connected Health at Partners HealthCare and Professor of Dermatology at Harvard Medical School. A question mark for those of us in the industry is his extensive engagement with October’s Connected Health Conference in Boston, one of the earliest and now a HIMSS event. ATA’s next event is ATA2020 3-5 May 2020 in Phoenix–apparently no Fall Forum this year.

The Biden Cancer Initiative has shut down after two years in operation. This spinoff of the White House-sponsored ‘moonshot’ initiative was founded after the death of Beau Biden, son of Democrat presidential candidate Joe Biden. Both Mr. Biden and wife Jill Biden withdrew due to ethics concerns in April. According to Fortune, the nonprofit had trouble maintaining momentum without their presence. However, the setup invited conflict of interest concerns. The Initiative engaged and was funded by pharmas and other health tech companies, directly for Initiative support but mainly for indirect pledges to fund research. Most of these organizations do business with Federal, state and local governments. Shortly after the formal announcement, Mr. Biden the Candidate announced a rural health plan to expand a federal grant program to include rural telehealth for mental health and specialized services. Politico   But isn’t that already underway with the FCC’s Connected Care Pilot Program, coming to a vote soon? [TTA 20 June]

And…Short Takes

  • Philips Healthcare bought Boston-based patient engagement/management start-up Medumo. Terms not disclosed. CNBC
  • London’s Medopad launched with Royal Wolverhampton NHS Trust (RWT) in a three-year RPM deal. DigitalHealthNews
  • Parks Associates’ Connected Health Summit will be again in San Diego 27-29 August with an outstanding lineup of speakers. More information and registration here.

And in other news, Matt Hancock holds tight to his portfolio as UK Secretary of State for Health and Social Care in the newly formed Government under new PM Boris Johnson. Luckier than the other 50 percent!

 

 

International news roundup: ATA dispatches, compete for funding in Helsinki, Spry FDA-cleared for COPD, Merck acquires ConnectMed Kenya

There’s not much news so far from the just-wrapped ATA 2019 conference in New Orleans, but POLITICO Morning eHealth highlighted a drop-by by Sen. Bill Cassidy from Louisiana, urging attendees to demonstrate to their local politicos that telemedicine is safe and effective–and be ready to answer questions about fraud or misuse. Louisiana’s Ochsner Health System is branching into retail with the O Bar, cleverly designed to look like an Apple Store to merchandise wearables and other health tech devices. For Ochsner patients, they can enroll into RPM programs and have their data directly input into their Epic EHR. American Well released a survey of 800 doctors, with the unsurprising finding that 22 percent have used telehealth to treat patients, but this is up 340 percent since 2015; also that the doctors finding telehealth most attractive to practice are also reporting high levels of burnout. Looking for more substantiative news from NOLA.

It’s Helsinki for pitching your digital health idea in June. The 11th edition of the interestingly named EC2VC Investors Forum and Pitch Competition is now part of HIMSS/ Health 2.0 Europe 2019. Healthcare startups and SMEs looking for funding can apply, with 12 companies to be selected to present before a jury panel of digital health investors. The format is a four-minute pitch, followed by six minutes of Q&A. More information and to apply by 6 May, with finalists selected by 13 May. The event is 11 June from 13:00 to 16:00 at Messukeskus Helsinki Expo & Convention Centre. 

Spry Health’s Loop wearable device gained FDA clearance. Spry is a RPM device company with a wrist-wearable device that measures pulse oximetry, respiration, heart rate, and blood pressure (research only) through optical sensors. While users can receive reports on the display and alerts, it is primarily meant for clinical monitoring by physicians in healthcare systems. The RPM is meant to detect signs of patient deterioration and exacerbations early so that actions can be taken. For the present time, the company is focusing on the device’s use in COPD patients. Certainly there is a large market in the US–there are 12 million diagnosed patients, with COPD the third leading cause of death with over 120,000 deaths per year. Mobihealthnews, BusinessWire, MDDIOnline

Merck acquires Kenyan digital health startup ConnectMed. The pharma company is purchasing ConnectMed’s telehealth applications in Kenya serving about 8,000 consumers, as well as related management systems. Merck will use the platform in conjunction with its Curafa point of care clinical and pharmaceutical services. Started in September of last year, these are run by local independent pharmaceutical technologists, clinical officers and nurses for underserved populations in Kenya. ConnectMed will cease operations. During its lifetime, it developed three DTC digital health services in Kenya and South Africa. WT/Startup Africa

Spring is here, so are some events to enjoy–and broaden your horizons

AI in healthcare: hope or hype? MedStartr, Rent24NYC, Thursday 18 April, 6 – 9pm

Our colleagues at MedStartr are hosting a panel discussing a hot topic: AI in healthcare. Panel and speakers include Melissa Honour, IBM Watson, Artificial Intelligence Portfolio Lead; Joseph Gough, EVP Innovation, Remedy Health;  Samantha Nazareth, MD, Gastroenterologist, writer, broadcast commentator, and healthcare analyst. More to come! Cost is $20 but there are drinks and snacks throughout. Register on Meetup. TTA is a media partner of Health 2.0 NYC and MedStartr.

Validating Your Digital Health Solution: Why, When and How. Partners HealthCare Pivot Labs, Liberty Hotel, Boston, Monday 22 April, 6-9pm

On the journey to commercializing your health tech product, there are multiple ways to test it. It can be difficult to determine where to start, how to do it and what to evaluate. During this free session, Partners HealthCare Labs will address why validating your digital health solution – whether for clinical or economic outcomes – can benefit your product. RSVP at this link.

Two coming up very soon via Aging 2.0 NYC:

Thursday-Friday 11-12 April: The Center for Research and Education on Aging and Technology Enhancement (CREATE) will hold a two-day workshop on Design For Older Adults at Weill Cornell’s Division of Geriatrics. If you are designing technology, consumer or health products, or living environments for older adults, this is a unique opportunity to network with colleagues and glean advice from leading experts in aging and design. Because of the highly interactive nature of this workshop, attendance is limited to 35 attendees. Aging2.0 members receive a discount. Email Adrienne Jaret at adj2012@med.cornell.edu or call 646-962-7153 (mention Aging2.0).

Monday, April 29: Aging2.0 and CaringKind will host the third annual Technology for Caregivers showcase from 1:30pm-7:30pm at CaringKind’s headquarters at 360 Lexington Avenue. This one-day event will give caregivers and the Aging2.0 community the opportunity to try the latest technology for caregiving and dementia, and provide startups the opportunity to showcase their products. Last year’s event was featured on CBS and saw more than 300 caregivers interact with 25 innovative startups. If you would like to have your company featured contact us at newyork@aging2.com. Register here.

And finally, we’d be remiss in not mentioning next week’s ATA19 which will be held 14 – 16 April in New Orleans at the Convention Center. Less and less referring to itself as the American Telemedicine Association, the conference is also less significant than it once was due to the specialization of health tech, the rise of HIMSS earlier in the year, as well as early fall’s Health 2.0 and the Connected Health Conference. Nevertheless, for many companies in the field it is still a must-attend if not a must-exhibit. Registration is still open here.

Two more events for the calendar: ATA’s EDGE18 (Austin TX), SEHTA/Brunel MedTech Connects (London)

EDGE18, American Telemedicine Association, 26-28 September, Fairmont Austin, Austin TX

The revamped fall meeting of the ATA is being held in Austin, Texas this year as EDGE18.  The conference will highlight emerging best practices in telemedicine and virtual care, which are accelerating delivery model innovation, program design, and technology implementation. Speakers will include industry thought-leaders from WalMart, Aetna, Blue Cross Blue Shield, Ascension Healthcare, Babylon Health, AHIP, and NY Presbyterian Hospital. There will also be interactive workshops and immersion tours (space limited) offering “hands-on” previews of new technologies and programs at the Austin offices of Fjord Austin, Dell Medical School, and others. For more information and registration, see their website 

MedTech Connects: SMEs to Universities – Brunel University Showcase, 10 October, Darwin Room, Hamilton Centre, Brunel University, London UB8 3PH, 09:30 – 15:00

Brunel University, SEHTA and the GLA are hosting a free conference to highlight research, teaching and commercial collaborations through the Co-Innovate programme, a Brunel initiative supported by the EU through the European Regional Development Fund (ERDF). This major event is designed to start partnerships leading to collaborations with Brunel’s Design, Computer Science and Business schools, and collaborative research bids including current opportunities from InnovateUK, UKRI, SBRI and the Industry Challenge Fund. More information and registration is here.

VA’s ‘Anywhere to Anywhere’ telehealth initiative finalizes

VA Secretaries may come and go (or never get there), but their initiatives stay. With much fanfare last year, then-Secretary David Shulkin announced the ‘Anywhere to Anywhere’ telehealth and telemedicine program [TTA 3 Aug]. This program will use VA practitioners to provide virtual patient care across state lines when a veteran cannot make it to a VA hospital or clinic. The Department of Veterans Affairs published the proposed rule last October [TTA 3 Oct 17] with the Final Rule published in the Federal Register on 11 May.

Technically, it preempts state and local regulations around telehealth. “VA is exercising Federal preemption of conflicting State laws relating to the practice of healthcare providers; laws, rules, regulations, or other requirements are preempted to the extent such State laws conflict with the ability of VA health care providers to engage in the practice of telehealth while acting within the scope of their VA employment.”

It was widely supported by ATA, the American Association of Family Physicians, American Medical Informatics Association, Federal Trade Commission, the College of Healthcare Information Management Executives (CHIME), and many other industry organizations. It also enjoys wide Congressional support.

There is plenty of room for growth. Only 1 percent of VA’s veterans used Home Telehealth, while 12 percent used other forms of telehealth. They will be doing so with few suppliers: Medtronic, 1Vision/AMC Health, and Care Innovations. Iron Bow/Vivify Health was found to not have tablets which met the US production qualification. This Editor wonders how the current three suppliers will fare.

This telehealth program will be located in the apparently newly named Veterans Health Administration Office of Connected Care. mHealthIntelligence.com

Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Here’s our roundup for the week of 12 February:

VA wins on the budget, but the Secretary’s in a spot of bother. Updated. Last week started off as a good week for Secretary Shulkin with a White House budget proposal that increased their $83.1 billion budget by 11.7 percent, including $1.2 billion for Year 1 of the Cerner EHR implementation in addition to the agency’s $4.2 billion IT budget which includes $204 million to modernize VistA and other VA legacy IT systems in the interim. While the Cerner contract went on hold in December while record-sharing is clarified, the freeze is expected to be lifted within a month. POLITICO  Where the trouble started for Dr. Shulkin was in the findings of a spending audit by the VA’s Inspector General’s Office of an official European trip to Copenhagen and London which included unreimbursed travel by Mrs. Shulkin and free tickets to Wimbledon, at least partly justified by a doctored email. This has led to the early retirement of the VA Chief of Staff Vivieca Wright Simpson and also an investigation of hacking into Wright Simpson’s email. It also appears that some political appointees in the VA are being investigated for misconduct. CNBC, FierceHealthcare.

Updated: POLITICO doesn’t feel the love for Dr. Shulkin in today’s Morning eHealth, linking to articles about the supposed ‘internal war’ at the VA, with veterans’ groups, with the Trump Administration, and within the VA. It’s the usual governmental infighting which within the 16 Feb article is being whipped by POLITICO and co-author ProPublica to a fevered pitch. Dr. Shulkin comes across as doctor/tech geek who underestimated the politicization of and challenges within an agency with the mission to care for our veterans. It’s also an agency having a hard time facing the current demands of a dispersed, younger and demanding veteran group plus aging, bureaucratic infrastructure. As usual the ‘privatization’ issue is being flogged as an either/or choice whereas a blend may serve veterans so much better.

Digital health entrepreneur named CEO of the American Telemedicine Association. A first for ATA is a chief from the health tech area who is also one of the all-too-rare executive women in the field. Ann Mond Johnson, who will be starting on 5 March, was previously head of Zest Health, board chair and advisor to Chicago start-up ConnectedHealth (now part of Connecture), and had sold her first start-up company Subimo to WebMD in 2006. She began her career in healthcare data and information with The Sachs Group (now part of Truven/IBM Watson). Ms. Johnson replaces founding CEO Jonathan Linkous, who remained for 24 years before resigning last August and is now a consultant. ATA release, mHealth Intelligence. ATA relocated in January from Washington DC to nearby Arlington Virginia. And a reminder that ATA2018 is 29 April – 1 May in Chicago and open for registration.

Allscripts’ ‘Such a Deal’! Following up on Allscripts’ acquisitions of Practice Fusion for $100 million (a loss to investors) and earlier McKesson’s HIT business for $185 million [TTA 9 Jan], it hasn’t quite paid for itself, but came very close with the sale of McKesson’s OneContent, a healthcare document-management system, for a tidy $260 million. Net price: $25 million. Their CEO is some horse trader! Some of the savings will undoubtedly go to remedying the cyberattack in January that affected two data centers in North Carolina, shutting down EHR and billing applications for approximately 1,500 physician practices, which have launched a class action lawsuit. FierceHealthcare 

Flatiron Health acquired by Roche. (more…)

Telemedicine for all creatures great and small? Veterinarians debate.

Will veterinarians be covered by ongoing telemedicine legislation? This surprisingly became an issue with the New Jersey telemedicine bill [TTA 11 Aug] S.291 prior to signature by Governor Christie. The debate was whether “health care providers” covered under the licensing statutes in Title 45 of NJ’s Revised Statutes also included veterinarians in the “including but not limited to” language as well as the nature of the “proper provider-patient relationship” and “patient request”. Reportedly the Governor held his signature in order to sort this out, meeting with healthcare and veterinary representatives. The final bill does not appear to specifically address veterinary practice.

For its part, the American Veterinary Medical Association (AVMA) Practice Advisory Panel (AP) came out solidly in favor of non-inclusion in human laws like New Jersey’s in their January report. Their view of the patient-physician relationship is logically different because the animal patient cannot give consent, but an owner/client can, and that difference is not specified in human medicine laws. In the AP’s view, “telemedicine shall only be conducted within an existing VCPR [veterinarian client patient relationship], with the exception for advice given in an emergency care situation until that patient(s) can be seen by or transported to a veterinarian” which is increasingly not true of human telemedicine. Law firm Fox Rothschild’s animal law practice blog cited instances such as when a Texas veterinarian was found to have violated the state practice act by offering advice over the internet. 

Many veterinarians are calling for AVMA to seek guidance from organizations like the ATA to better codify animal telemedicine practice. ATA, for its part, has stayed apart from state debates while remaining generally supportive. The gap in veterinary practice is especially acute with a declining number of practitioners caring for food animals (livestock) and in rural veterinary practice. But who will care for the unicorns? Seriously, here is a gap that needs to be filled. mHealth Intelligence

Some reflections on ATA and a future CEO–your ‘nominations’ wanted!

This Editor and publication have had relationships at different levels with the American Telemedicine Association (ATA) since at least 2006. Our Readers know of TTA’s long-standing support of ATA’s annual meeting as a media partner. As a marketer, I’ve negotiated booths, sponsorships, and sent staff (including myself) to meetings, which makes this experience like many of our Readers.

It is worth reflecting that in 1993, when Jon Linkous took the ATA helm, few of us other than academics had email or used the Internet except in limited ways like IBMMail or Minitel. Once telemedicine, video consults, and vital signs data capture were the future and mostly theory. We went through the whiz-bang gadget phase, where every new one was going to change healthcare as we know it. Now we are past the buzzy cocktail party hangover into trying to make it work. We are in 2.0 and 3.0 where it’s all about integration of telemedicine and telehealth into patient engagement, behavior change, data analytics, predictive care, genomics, improving life for the aging and chronically ill population, managing the tsunami of patient data for better outcomes, smart pills, hacking and data security, EHRs, ACOs, meeting standards such as MACRA…and heavy engagement with national (Federal) and local entities. And always–getting paid enough to stay afloat!

As an organization, ATA faces an ever-expanding HIMSS, which has expanded far beyond its health information/IT/data analytics raison d’être to media properties, multiple health tech conferences, and now presence with early-stage companies through acquiring Health 2.0.

Dizzying changes, and more to come.

Who do you want to see at the helm of ATA? What will be the new CEO’s problems to solve? List your choices and thoughts in Comments below! (If you wish to be anonymous, email Editor Donna in confidence.)

Change at the top at ATA: CEO Jon Linkous departs after 24 years

The American Telemedicine Association’s CEO, Jonathan Linkous, has left ATA after 24 years as CEO. An ATA spokesperson cited personal reasons, according to MedCityNews. Sources told POLITICO Morning eHealth that Mr. Linkous “simply told the organization he was leaving the job effective immediately before its board meeting this week.” It was certainly an unusual departure, without the standard transitional period of months or even a year. The ATA release was short and concentrated on the ‘transitional period’.

Acting as interim CEO will be Dr. Sabrina Smith, who joined last January as COO after senior VP/COO-level positions with the Regulatory Affairs Professionals Society (RAPS) and the American Academy of Physician Assistants (AAPA) after 12 years with MedStar Health, the largest health system in the Washington DC metro. MedCityNews quoted ATA board president Peter Yellowlees, MD that the search is expected to take about six months. This will take the search through ATA’s Fall Forum in October and well into the ramp-up for ATA 2018 in April. ATA is seeking “a vision for the future of healthcare” and “extensive knowledge of telemedicine”, so if you have it, step up! 

Jon Linkous, from the formation of ATA to yesterday, gained much recognition for telemedicine and telehealth, to where ATA presently has 10,000 members and 450 health system and industry partners, a leading annual conference, multiple events and educational programs. They have concentrated much (and successful) effort in gaining parity of payment for telemedicine, a state by state battle, though the POLITICO report (using a quote from a former HIMSS executive director now consulting for ATA!) did not think much of ATA’s influence in the Washington DC swamps. Another major change apparent over the past five years: as an association, healthcare technology has developed way outside ‘telemedicine’. Organizations like HIMSS have exploded in size through redrawing their definitional lines plus aggressive acquisitions in media and of competitors such as Health 2.0. The next chapters won’t be simple or easy for the new CEO. Also FierceHealthcare(Disclosure: TTA has been for many years a media partner of the ATA annual conference.)

ATA 2017 dispatch: The future is about business models and the consumer

Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the first of several articles this week. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].

Orlando, April 24. Yesterday, the annual convention of the American Telemedicine Association (ATA) moved into full swing. At noon, Jonathan Linkous, ATA’s CEO, took a few minutes to talk with me. During our wide-ranging discussion, three notable themes emerged:

First and perhaps most important, Mr. Linkous believes that the future development of telehealth now stands with establishing viable business models. In his view, the speed of growth of the industry now depends on how the many participants in the healthcare system develop business models that lead to appropriate investments. He noted that this contrasts with the general focus on the evolving technology. Of course, the technology will continue to evolve and major advancements will occur for the foreseeable future. But, Mr. Linkous strongly believes that “the technology is here today.” In short, it’s now about how the technology is used and deployed. New advances will be incorporated into services and infrastructure as they occur. But, the past, telehealth is now moving into mainstream investment discussions. In his view, the leaders of every health organization are now assessing the role telehealth will play in the services they offer, and the investments they need to make now.  Now, it’s about making it work. We are no longer waiting for the technology to be viable.

Second, Mr. Linkous commented on the hype surrounding the industry. He was frank in recognizing that, as with all exciting, transformative industries, the hype cycle is in full swing. One telling comment: “Unlike the past, the industry now has real revenues,” with rapidly growing businesses. In short, we may not be past the hype, but the industry is quickly moving to fulfill realistic expectations.

Finally, Mr. Linkous concluded that the future growth of the telehealth industry would largely depend on the consumer. He cited a variety of factors: the growth of value-based care, the emerging influence of millennials who are comfortable with technology, and the overall consumerization of medicine.

Many industry participants have described themselves to me as B2B businesses. Undoubtedly, they are. It’s hard to refute Linkous’s conclusion: Ultimately, the growth of the industry, like the evolution of healthcare itself, will depend on consumer choices.

TytoCare remote diagnostics comparable to in-person exam results: study

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/Mom_using_on_child_ear.jpg” thumb_width=”150″ /]A study of the Tyto Care remote diagnostic device, conducted by Schneider Children’s Medical Center and the Sackler School of Medicine, found that the quality of readings by Tyto Care was ‘on par’ with in-person medical exams using conventional otoscopes and stethoscopes. Ears, heart, lungs and throats of 137 children aged 2-18 seeking care from the emergency department of a tertiary care facility were examined first conventionally and then again by a second remote physician using exam data captured by the TytoCare all-in-one device and attachments. Using standard statistical methods, the results were compared and the study reported “good to excellent agreement for all exams conducted using TytoCare and conventional exam tools, with a p-value <.001.” The study also recorded a separate five-point measure of patient experience and results averaged 4.4 and 4.5 out of 5 (excellent). No adverse events were recorded.

What is lacking in the release are the diagnoses of the young patients, but presumably those results will be presented with the final study. Formal presentations will be at the Israel Society for Clinical Pediatrics (HIPAK) meeting on 8 February in Tel Aviv and at the American Telemedicine Association (ATA) conference 23-25 April in Orlando, Florida. This positive report on efficacy will also aid their rollout with American Well, announced at the end of 2016 [TTA 2 Dec]. Harry Wang at Parks Associates in their blog also named TytoCare one of the two standouts of CES 2017–and the other, Partron (Croise) is not yet on the market.

The growth of telehealth, and the confusion of terminology (US)

Becker’s Health IT and CIO Review has written up a US-centric review of recent advances in telehealth and telemedicine but kicks it off with the confusion level between the two terms. Internationally, and in these pages, they are separate terms; telehealth referring primarily to vital signs remote monitoring, and telemedicine the ‘virtual visit’ between doctor and patient, between two clinical sites, or ‘store and forward’ asynchronous exchange (e.g. teleradiology). Somehow, in US usage, they have been conflated or made interchangeable, with the American Telemedicine Association (ATA) admitting to same, and American Well simply ‘just doing it’ in relabeling what they provide. On top of it, the two are incorporating elements of each into the other. Examples: TytoCare vital signs measurement/recording into American Well’s video visit; Care Innovations Health Harmony also providing video capability.

Of particular interest to our international readers would be the high rate of US growth in telemedicine utilization from 7 to 22 percent (Rock Health survey). Teladoc, the largest and publicly traded provider, passed the milestone of 100,000 monthly visits in November and the ATA estimates 1.25 million from all providers for 2016 (Teladoc release). Other US competitors include the aforementioned American Well, MDLive, and Doctor on Demand, the latter two also selling direct to consumer. They also compete against doctor-on-house call services like Pager and Heal. Reimbursement remains an issue both privately and publicly (Medicare and Medicaid) on a state-by-state level, with telehealth experiencing significant difficulties, as well as internet access, speed, and usage by older adults.

The difficulty in differentiating telemedicine and telehealth

Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.

Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence

Payer reimbursement for telehealth, telemedicine gains in Delaware, Connecticut (US)

Two states–Connecticut and Delaware–are now requiring private commercial insurers to cover telemedicine and telehealth services at parity with in-person visits. Connecticut was first, signed into law on 22 June but not starting till 1 January 2016. It covers not only video consults but distance care delivered both synchronously and asynchronously, such as store and forward transfers, and covers remote patient monitoring. It specifically omits audio-only consults, email, texting and fax (!). The Connecticut law also requires parity of payment with in-person visits to prevent lower reimbursements. Delaware’s law was signed 7 July to take effect immediately, and based on the summary is similar in breadth to Connecticut’s. Delaware is now the 29th state to enact telehealth/telemedicine reimbursement legislation. Articles written by members of the Foley & Lardner law firm. JD Supra, Lexology

On the Federal front, Representative Mike Thompson (D-CA) and three other members of the House of Representatives introduced H.R. 2948, the Medicare Telehealth Parity Act of 2015. It would remove the current geographic restrictions for telehealth (in the Federal definition including telemedicine), expand services, expand telehealth/RPM for additional chronic conditions and expand home care service into hospice and dialysis. It is a rework of last session’s H.R. 5380 and is at very early days having gone to a Congressional committee. Unfortunately its passage has a snowball-in-July chance with Govtrack.us giving it zero chance of enactment. Rep. Thompson’s website, FierceHealthIT, ATA-Jonathan Linkous support statement.

Previously in TTA: Telehealth reimbursement makes legislative progress in Texas, US House

Home telehealth now focused on the ‘superusers’ of healthcare

A noticeable trend in telehealth has to do with focusing less on the generic virtues of at-home vital signs monitoring for routine patient care and more on managing specific high-cost populations to avoid or reduce costs. Some of the impetus in the US has come from new regulations by CMS (Center for Medicare and Medicaid Services) intended to move Medicare fee-for-service (FFS) patients into a reimbursed chronic care management (CCM) model. Banner Health is Arizona’s largest private employer (which does say something about Arizona as a retirement haven) and since 2006 has been experimenting with remote monitoring since 2006. Starting in 2013 Banner piloted Philips‘ post-discharge program now called ‘Hospital to Home’ as Banner iCare, combined with Philips Lifeline PERS, but made it available to those only with a stunning five+ chronic conditions–the top 5 percent that is reputed to account for 50 percent of healthcare spend. Banner combined the tech with intense support by a multi-layered care team. At ATA they announced the following results with the initial cohort of 135 patients, now up to 500:

  • 27% reduction in cost of care
  • 32% reduction in acute and long term care costs
  • 45% reduction in hospitalizations

The article in Forbes is a bit breathless in profiling the program and the ‘superusers’ of healthcare (with a windy but false analogy from John Sculley) but provides a level of detail in the program that most articles do not. One wonders how Philips makes money on supplying what is at least $2,500 worth of kit, with peripherals that must all be Bluetooth LE. It’s also not stated, but the TeleICU and TeleAcute programs also appear to be Philips’. Video

ATA trend #1: Is a sustainable RPM infrastructure fact or fiction?

Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 last week. This is the first of three articles on his observations on trends and companies to watch.

The advancement of remote patient monitoring is a visible trend from the American Telemedicine Association’s 2015 meeting, with care moving from the doctor’s office and being shifted to the patient’s home. A more diverse range of data is being collected for patients to facilitate more informed decision making at the patient visit and after the patient is away from the practice. As information is being collected and monitored on a more comprehensive basis, we have seen creative modalities to view a broad array of data points that would typically have been collected in a doctor’s office with the hopes of early diagnosis and preventive care, versus reactive care.

Patient autonomy has now come to the forefront and network infrastructure is being built to support that shift. Wearables, implantables and home based lab/ urine diagnostic kits are becoming smaller, cheaper, less invasive, wireless and cloud-based so that patients can be monitored without interfering in day to day living. (more…)