Digital triage in health service – CQC’s initial recommendations

This is a brief alert to readers that the CQC has publicised its initial recommendations from its review of the use of digital triage services.

The CQC defines digital triage tools as software that tells a patient what to do or where to go next in their care pathway. It can be software that:

  • supports clinicians to make decisions
  • supports non-clinical staff to interact with patients
  • people interact with themselves

This is an important area requiring regulatory clarification as it sits at the interface between medical devices regulated by the MHRA and medical services regulated by the CQC…and patients are increasingly being impacted by it.

Key findings are:

  • care providers and local systems need better guidance and support from national bodies when they commission technology suppliers and set up contracts – a standard test of the effectiveness of triage algorithms would help providers and systems choose the best products
  • digital triage tools should help people to get care in the right place at the right time, and should not prevent this – clinicians should be able to override the recommendations from these tools when they think it is in a person’s best interest
  • people need to understand the difference between a digital triage tool that checks their symptoms and one that directs them to a regulated healthcare service – they also need clearer guidance on how to use them.
  • there is a need to understand how safeguarding can work when people are using digital interfaces instead of humans
  • technology suppliers that don’t need to register with CQC should meet all other relevant regulatory requirements when developing clinical pathways for triage tools – this area has limited assurance or regulation, reinstating the accreditation scheme from NICE or something similar would help
  • the insight and data from digital triage tools provide an excellent opportunity to improve care – there is a need to work collectively to understand how best to do this

The full report is here.

This is the first use by the CQC of the “regulatory sandbox” approach: a way of testing how best to regulate new types of services by working collaboratively to find out about them. As someone who was briefly engaged in the process, this Editor considers it to be potentially an extremely impressive way of coming up with practical regulations, and avoiding unworkable proposals.

The next step will be to develop the detailed proposals based on the above.

RCGP chair at The King’s Fund: destroy Babylon Health’s GP at Hand ‘amazing model’, the present financial model–or both

A whole lot of disrupting goin’ on. At The King’s Fund’s June conference on ‘Reimagining general practice’, Royal College of General Practitioners (RCGP) chair Professor Helen Stokes-Lampard at the opening plenary seemingly did the impossible–praising Babylon Health’s GP at Hand while wishing its destruction, along with the present UK practice payment method. First, health leaders had a ‘lot to learn’ from the GP at Hand model–and that NHS IT systems at present were inadequate in meeting patients’ needs. “‘Let’s have tech that works and use innovative ways of consulting. Because the reality is we’re looking foolish and people are looking for alternatives. The rise of the private GP health sector is not a coincidence – it’s an inevitable consequence of the NHS not keeping up.”

If you cannot beat them, join them–and figure out a new way of paying GPs. ‘[We] have to totally adopt that technology right throughout the NHS for everybody so it destroys [Babylon’s] business model and it is normal across the whole of general practice – tech tsunami stuff. Or we have to tear up the financial model by which we pay [practices]. And one of those things has to happen fast. I would suggest we need to do both.’   

Her remarks are in the face of GP at Hand cresting at over 30,000 patients, with over 3,000 signing up in May.

Both Professor Stokes-Lampard and following speaker Professor Steve Field, CQC chief inspector of general practice, pointed to a model such as GP at Hand ‘cherry picking’ primarily healthy patients rather than a broad population and destabilizing surgeries. Both agreed that the disruption had major implications for ‘the financial contracting model in general practice’.

Earlier, GPonline exclusively revealed that market research firm Ipsos Mori is investigating–at a cost of £250,000–the impact of GP at Hand, including its long-term implications for the sustainability of traditional general practice.

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…)

When is an app not an app? (When it’s a conundrum)

It all started so simply. In DHACA under the leadership of Rob Turpin (BSI) we produced the definitive guide to app regulation in the UK. Sure it was 44 pages long (and will shortly need updating) however we all knew that an app was standalone software and that none other than MEDDEV 2.1/6, the ultimate definitive guide to when an app is a medical device defined software as:

…a set of instructions that processes input data and creates output data.

However doubts began to creep into this editor’s mind when he heard that app developers in the US were avoiding (US/FDA) medical device classification as that would rule them out as service providers, which can reduce future  reimbursement benefits – as we quoted Ralph-Gordon Jahns of research2guidance in 2014 “profitable developers… rely on service sales as their primary source of revenue.”

Things got more complicated when it emerged at the UK Health Show this autumn that PHE was considering listing digital GP services as (more…)