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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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


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

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

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Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS

Well, it’s a blockbuster–at least in length. Over 100 pages long, and in the PDF form double-paged, which will be a tough slog for laptop and tablet readers. It’s Eric Topol’s view of the digital future of the NHS and it’s…expansive. In fact, you may not recognize it as the healthcare world you deal with every day.

Our UK readers may not be so familiar with Dr. Topol, but here you can get a good strong dose of his vision for the NHS’ future as delivered (electronic thunk) to Secretary Hancock. I haven’t read this, but Roy Lilley has. You should read his 12 February e-letter if you haven’t already.

Here is a choice quote: It’s a mixture of science faction, future-now-ism and away-with-the fairies.

Here’s some background. The Vision’s been around for awhile. Dr. Topol thinks and talks Big Picture, in Meta and MegaTrends. His view is patient-driven, self-managed, with their genomic sequenced and at their fingertips, with the doctor empowered by their records, his/her own digital tools for physical examination, with AI to scan the records and empower a partnership model of decision-making.

Topol In Person is quite compelling. This Editor’s in-person take from the 2014 NY eHealth Collaborative meeting is a review of vintage Topol. His expansive, hopeful view was in contrast to the almost totalitarian view (and it is fully meant) of Ezekiel Emanuel, with his vision of the perfectly compliant, low choice patient, and squeezed like a lemon medical system. At that time, I concluded:

One must be wary of presenters and ‘big thinkers’–and these doctors define the latter, especially Dr Emanuel who looks in the mirror and sees an iconoclast staring back. Fitting evidence selectively into a Weltanschauung is an occupational hazard and we in the field are often taken with ‘big pictures’ at the expense of what can and needs to be done now. Both Drs Topol and Emanuel, in this Editor’s view, have gaps in vision.

A year later, I reviewed his article The Future of Medicine Is in Your Smartphone which came out at the time of ‘The Patient Is In.’ which was quite the succès d’estime among us health tech types. “The article is at once optimistic–yes, we love the picture–yet somewhat unreal.” It seemed to fly in the face of the 2015 reality of accelerating government control of medicine (Obamacare), of payments, outcomes-based medicine which is gated and can be formulaic, and in the Editor’s view, a complete miss on the complexities of mental health and psychiatry.

Back to Roy Lilley:

There is an etherial quality to this report, spiritual, dainty. The advisory panel is 70 strong.

Studies and citations galore, from the world’s top research organizations. The advisory board–I believe well over 70–there’s not a soul down in the trenches running a hospital. Government, academics, and a few vendors (Babylon Health, natch). A lot of emphasis on AI, genomics, and training for ‘collective intelligence’. After reading but a few dizzying, dense pages, I admire the vision as before, but wonder again how we get from here to there.

Roy’s essay is a must read to bring you back to reality. 

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems

Scottish startup gains FDA Class II clearance, pilots with Mount Sinai Brooklyn. Edinburgh’s Current Health has received FDA Class II clearance for its AI-enabled remote patient monitoring wearable monitors. The single arm-worn wearable sends data every two seconds on oxygen saturation, respiration rate, pulse rate, temperature, activity, and posture. Algorithms analyze the data and alert clinicians to patient status and deterioration. The Mount Sinai pilot follows on Dartford and Gravesham NHS Trust for a post-discharge monitoring program, with a 22 percent reduction in home visits plus fewer hospital readmissions and emergency department visits. Current Health is the renamed snap40. Mobihealthnews, BusinessWire release

Healthware, a Salerno, Italy-based consultancy group primarily concentrated in marketing and sales, has received a €10 million investment from Fondo Italiano d’Investimento SGR (FII Tech Growth). The investment will be used over the next two years has received to expand Healthware’s business transformation for life sciences companies and product development and services for digital health start-ups which improve health outcomes through new technologies. Release.  Hat tip to Healthware’s Antonietta Pannella

Telemedicine adoption in hospitals ranges from 65 to below 30 percent in Latin America. A study published this week in Health Affairs Global Health Policy (paywalled) looks at the different rates of hospital-based telemedicine adoption in nine Latin America countries. Leading is Chile with the aforementioned 65 percent; Argentina, Costa Rica, Mexico and Peru with less than a 30 percent. In the middle: Panama (35 percent), Uruguay and Guatemala in the 40 percent range. Despite supportive official policies in many of these countries, “Efforts to implement telemedicine are isolated and scattered, often left to the public sector or taking the form of insulated projects that are not sustained” or scaled up nationally and regionally. Mobihealthnews

For weekend reading. Intersecting with the Latin America story above is this. This Editor missed the October issue of Global Health: Science and Practice published out of Johns Hopkins, but here it is. The focus of the six articles is digital health integration into health systems in the US and internationally. Hat tip to Alain B. Labrique via Twitter

Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH)

Editor Donna (and Editor Steve before her) always likes a good dust-up about terminology. One of the former’s pet peeves is the imprecise usage of telemedicine (virtual visits) versus telehealth (remote patient monitoring of vital signs); she will concede that the differences have been so trampled on that telemedicine has nearly faded from use.

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) makes a grand attempt to parse the differing definitions of digital health and eHealth in their opening editorial of this month’s (24 Jan) issueeHealth has fallen so far from use that the few times one does see it is in associations such as ISfTeH and the New York eHealth Collaborative. Even the World Health Organization, which has always been a fair arbiter for the industry, defined eHealth back in the salad days of 2005 as “the use of Information and Communication Technologies (ICT) for health”–broad, but workable. After a witty aside in defining digital health as “an area of healthcare focused entirely on fingers and toes” (plus), and examining the overly broad definitions of Eric Topol and Paul Sonnier, the authors Richard E. Scott and Maurice Mars seem to settle on this: that while digital health is given a  much broader but nebulous definition (to the point of linguistic absurdity cited in Mesko et al.), and may incorporate related technologies like genomics (another poorly defined term) and ‘big data’, it would not work without that ICT. And that at least there’s a settled definition for eHealth, as stated above, for which this Editor assumes we should be happy. In the author’s closing, “Will we be sufficiently motivated to rise to such a challenge-globally agreed universal definitions? If not ……here we go again …..”

This month’s journal theme is also Women in eHealth, with articles on Brazilian eHealth distance education, digital technology in midwifery practice, and how online social networks can work for drug abuse treatment referral. There’s also a change in format, with article links opening to full PDFs of each article.

The King’s Fund ‘Digital Health and Care Explained’ 27 March

https://www.kingsfund.org.uk/events/digital-health-and-care-explained?utm_source=Telehealth&utm_campaign=J1083#topicsAs briefly mentioned earlier this month, The King’s Fund in London will be previewing digital health with ‘Digital Health and Care Explained: demystifying the tech revolution in health and care”, a full day meeting on Wednesday 27 March at The King’s Fund. The ‘demystification’ will include policy challenges, operational innovations, research breakthroughs–and the practical aspects of making a ‘radical transformation’ real. Registration and session information is at the link above and here. Follow the event on Twitter at #KFexplain

And put on your calendar the Digital Health and Care Congress Wednesday-Thursday 22-23 May in London. Our Readers are eligible for a 10% discount using the link above or in the sidebar, plus the code Telehealth_10.

NHS England digital head Bauer exits for Swedish medical app Kry, but not without controversy

Juliet Bauer, who is departing NHS England’s chief digital officer post after 2 1/2 years for the sunnier shores of Appdom, has apparently also taken a splash in hot water on her way there. She is joining Sweden’s Kry (Livi in the UK), a GP telemedicine app available in Europe and the UK in an undisclosed product executive role. Livi offers NHS and private services for video consults, including a current contract with GPs in Surrey. 

The event that has sparked the controversy was Ms. Bauer’s article on digital health in the Times (paywalled) on 14 Jan praising Kry/Livi without disclosing publicly that she is joining the company in April. She stated that data provided by Kry/Livi showed “higher levels of patient and GP satisfaction while at the same time delivering higher patient safety and medical quality as well as crucial improvements in lowering prescription of antibiotics.” To add to it, the claim was not backed up with details nor, in reports, did the article cite other medical companies.

‘Brazen,’ ‘jaw-droppingly inappropriate’, and a ‘puff piece’ was how the article was characterized by Meg Hillier, the Labour MP who chairs the Commons public accounts committee. Even Simon Eccles, her soon-to-be-former colleague who is CIO of health and care, chimed in that the article was a mistake by a colleague he called ‘fantastic’ in her advocacy for centering NHS around the individual. Ms. Bauer worked on the recently disclosed 10 year plan, but the key leaders were Dr. Eccles, NHS Digital boss Sarah Wilkinson, West Suffolk Hospitals Foundation Trust head Steve Dunn, and NHS England deputy chief exec Matthew Swindells. Dr. Eccles to the press dismissed any influence by her towards her future imployer.

Ms. Bauer was NHS England’s first chief digital officer, starting in July 2016. She was responsible for patient-focused digital dubbed Empower the Person, including NHS 111, the app library, and the NHS app. According to the internal memo obtained by HSJ revealing her departure, it is with ‘with immediate effect’. Replacing her from 4 February on an interim basis will be Tara Donnelly, the current chief executive of the Health Innovation Network.

The brazenly revolving door of civil servants to companies and vice versa is common on both sides of the Atlantic. Former senators, congressmen, and generals–and those well down the greasy pole–find new employment at lobbyists, companies and industries they used to oversee. Influence and connections, as well as expertise, count for a great deal in the real world. In the private sector, sometimes there are non-solicit or non-compete (the latter unenforceable in many states) agreements, with exceptions for highly regulated and conflict-prone businesses, such as insurers.

Conflict of interest? Too close for comfort to this Editor. In a publicly-funded, contract based healthcare system like the UK’s, the departure of Ms. Bauer for a company contracting with the NHS, without being specifically excluded from dealing with the NHS–in fact, in her departure statement saying quite the opposite–has raised the spectre of conflict of interest. This Editor would also question her judgment in accepting the position without said exclusion–but that was likely the reason she was hired! Will this go away soon? Probably not for at least a week! More in the Financial Times (may be paywalled), The Register 11 Jan and 22 Jan, iNews

Events, Dear Friends, Events: Hancock at the RSM, MedStartr NOLA Challenge, RSM and The King’s Fund

HealthChat with Secretary of State for Health Matt Hancock. Monday 28 Jan at the RSM (starts at 8 for 8.30am).

Roy Lilley of NHS Managers will be asking the questions, so they won’t be a parade of powderpuffs. What is the long term look at health policy when the Government is gripped by Brexit? Promoting digital health won’t have an argument here and fax machines may have had their day, but what’s the 10 year plan all about? What about that social media blitz targeting the obese, smokers, and those who like their drink? Intriguingly, who is the real Matt Hancock? Is he That Man In A Portfolio? Tickets are a moderate £19.95 – £39.95 and likely will sell out soon. Book via Eventbrite here. Hat tip to Roy Lilley via NHS Managers.

NOLA Health Innovators Challenge. Over here in the US, we have a very big event (no, not CES in Las Vegas or the JP Morgan invitational conference this week in SF). It’s down in one of the homes of Real Jazz, New Orleans (NOLA), in March (date to come). Back for its second year, MedStartr Ventures has been running the Health Innovators Challenge jointly with the New Orleans Business Alliance. It’s very late to apply for one of the four Challenges (it closes on Sunday 13 Jan) but if you work hard and fast, see the link to apply to a program that is raising its second round of funding and helping previous crowd challenge winners raise their next rounds–plus get a wealth of guidance on how to package your idea for presentation to key healthcare stakeholders to get to market much faster. They also sponsor the #HCLDR Tweetchat every Tuesday at 8:30 PM EST, 5:30 PST, Wednesday 1.30 AM GMT.

Speaking of the RSM, their Digital Health (Telemedicine & eHealth) section is sponsoring upcoming events on Recent Developments in AI and Digital Health on Tuesday 26 Feb and Medical Apps–Mainstreaming Innovation on Thursday 18 April featuring a return appearance by Matt Hancock. 

Over at The King’s Fund, they will be hosting a full day session on Digital Health Explained: demystifying the tech revolution in health and care on Wednesday 27 March. The annual two-day Digital Health and Care Congress will be a little earlier this year, on 22-23 May; preliminary information and registration including sponsor packages are here. Follow developments at #KFdigital19.

3rings assistive tech will be ringing off next March (UK) (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/02/3rings-logo-only.jpg” thumb_width=”150″ /]Another assistive technology/TECS company decides that they have reached the end of the road.

Mark Smith, one of our Readers and Business Development Director of 3rings, which has been featured more than a few times in these pages over the past six years from Kickstarter days, this morning passed along the sad news that 3rings is closing. From Steve Purdham, the founder and chairman (and updated by him today 19 September):

It is with great regret and sadness that we have to inform you that we will be bringing the 3rings Care plug and Internet of Things sensor service to a close. 

After a journey of 6 years we have taken this decision because the technology adoption within the Social care market is extremely slow moving, which means that we are not able to attain a sustainable business model that would give the quality, and daily operational support that we believe is the minimum we would expect to deliver, to look after you, our customers.

Our customers including individuals, regional council’s and housing association’s that use 3rings as a safety net of care, are very important to us and this is the reason why we haven’t waited until the last moment to notify you of our decision.

With this in mind, we will be maintaining support for the 3rings care service, including the Plug and IOT sensors platform until Friday 1st March 2019.

Given the extended notice period we feel that this provides enough time for you to make alternative arrangements.

The 3rings team strongly believe in the world of IoT sensors and true digital solutions to provide a safety net of care, 3rings has always evangelised this as our goal, we know that digital safety nets of care will change the face of social care in the future. With that in mind we are still exploring alternatives and should anything change we will inform you at the earliest opportunity.

We are truly sorry to have to deliver this message, but can I personally thank you for your support, we are immensely proud to have helped so many families and vulnerable people, and to have saved lives through the 3rings service.

Your support for the 3rings product range made a massive difference, and we thank you for your understanding and commitment to providing to the safety net of care for your loved ones or clients.

Should you wish to clarify anything or have any comments then please don’t hesitate to contact me directly either by email on steve@3rings.co.uk or call me on 01260-222853 or my mobile 07899 803555.

Yours sadly
Steve
Steve Purdham · Chairman

Steve, in his separate note to this Editor, explained that they chose this four-month-plus winding down in order to responsibly look after their customers so that they have enough time to transition to other monitoring systems. Individual users of 3rings will be separately notified as well.

It was, as Mark said, a shock, but as this Editor noted in the Canary Care article from earlier today, in many ways the TECS/AT/telehealth business has not progressed much since 2006. The funding, technology, and consumer acceptance are all better since the early 2000s, but there is a lot more competition with not enough market takeup to warrant it. Even 3rings’ integration with the very trendy Amazon Echo and the IoT space showed innovation, but not the reward.

The social care area is more developed in the UK than the US as a concept. In the US, we speak more about ‘social determinants of care’, with one determinant–transportation–getting most of the action and the money. When you look at the truly disproportionate amounts of investment in certain hot companies with sexy tech, for instance a few ‘unicorns’–the now expired Theranos being the Poster Child–where far smaller amounts funding tech that works in real companies with real customers would do immediate good and would change things in the long term (longer than 18 months, which is the usual VC horizon), one wonders if we haven’t gone a little bonkers.

Yet those of us in the industry remain hopeful. As Steve Purdham said to me in a separate note, “the market has all the tools to change face of social care but the families and the existing structures are so glacial in the acceptance of this change. It will come and it will make a massive difference when it does.” We’re all trying.

We wish Steve, Mark, and the 3rings team all the best–and perhaps a White Knight will Save the Plug. Hat tip to Gerry Allmark of UK Telehealthcare as well for the information.

Apply to pitch your older adult health solution at the SOMPO Digital Lab Pitch Event at Aging2.0

SOMPO Digital Lab Pitch Event, 14 November, Aging2.0 Optimize Conference, San Francisco

SOMPO Digital Lab, in partnership with California senior care communities Front Porch and Carlton Senior Living, will host a pitch event for high potential startups at the Aging2.0 OPTIMIZE Conference on 14 November in San Francisco. Startups focused on Brain Health, Caregiving and Daily Living and Lifestyle are invited to present. The grand prize is $5,000 and a pilot opportunity in the U.S. or Japan. Your startup must have raised a minimum of $100,000 up to a maximum of $5 million.

SOMPO Digital Lab is the innovation group of Sompo Holdings, one of the largest insurance and senior care conglomerates in Japan. Please view this document to see the eligibility requirements for this event: http://bit.ly/SOMPOapplication

Deadline is 28 September.

We should also mention Aging2.0 OPTIMIZE 14-15 November. For more information and to register, click here. For a list of their other local and international events (oddly, none in NYC for the foreseeable future), click here.

Can Best Buy have an effective older adult strategy when they can’t sell a TV?

We noted last month that the acquisition of GreatCall by big box retailer Best Buy was the next step in a strategy targeting an older adult market niche, with goods and services promoting digital health and wellness, ‘solving technology problems and addressing key human needs across a range of areas.’ GreatCall will be managed as a separate division because, as their CEO admitted, ‘it is a different business’, presumably continuing to do what they do best–direct marketing. Longer term, what GreatCall was purchased for is to enable what they have touted to investors as “Best Buy 2020 that includes Assured Living, a program aimed at using the mobile web, sensors and other digital or smart-home healthcare technology to help adult children or caregivers remotely check in on the health and safety of aging residents at home.” The acquisition is expected to close this fall.  Digital Commerce 360/Internet Health Management  

But will this strategy, which requires a bit of personal service and problem solving, work in the field? The result of a simple search and transaction for a common electronic product wasn’t a promising predictor. This Editor went to a Best Buy in search of a new TV set to replace her aged and fritzing Panasonic (the kind with a cathode ray tube). It was a rainy Saturday night in Paramus NJ, the kind of night on which only Those Determined To Buy brave the traffic to shop. After a sweep of the aisles looking for that senior-oriented healthcare technology, finding none, she hit the TV displays, adjacent to the laundry dryers.

With space measurements and a tape measure in hand, she looked at smaller TVs. Having already determined that a 28″ would likely be best, but with no 28″ on display, she measured 32″ sets which maybe, maybe could fit the TV spot in the wall unit. Smart? Roku? What do these mean, and do I need them? 720 px? 1080 px?  This went on for about 30-40 minutes. In that time, not one blue-shirted salesperson stopped to assist a willing buyer who just needed a little help. So she went in search of one, finding exactly…none. Other shoppers looking at larger sets? Also non-assisted. After a few more sweeps of the aisles, stopping to marvel at an QLED’s resolution, feeling a bit ghostly and ghosted, she tapped out and left, vowing to buy a Samsung online–anywhere other than Best Buy.

If this can happen with a straight-forward electronic product with a relatively willing buyer…what will happen to a more complex sale with a lower level of understanding? Without a better level of customer service, all the corporate strategy talk will simply…flop.

Oh yes, that live link to Assured Living? It goes to a page that says “We’re sorry, something went wrong.” 

Highlights of The King’s Fund Digital Health and Care Congress 2018

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/06/kf-digital-health-2018-300×145.jpg” thumb_width=”150″ /]As The King’s Fund itself pointed to these two Digital Health articles, this Editor (who did not attend) will summarize their findings on the two days. Surely more to come!

Day One: digital transformation was not just about patient and clinician tools, but also about culture and partnerships

  • The King’s Fund’s researchers presented findings from their recently released report, ‘Digital change in health and social care’ where local organizations can speed change faster than nationally (more detail here)
    • Tight collaboration is necessary to bring change, not only within organizations, but also with providers and suppliers
    • The culture gap is significant between technology and clinical and must be overcome
    • Technology may be the only way “by which the NHS would be able to face “long-term pressures” facing the healthcare system”
  • What are lessons learned from national and regional NHS digital transformation projects?
    • How do you bring data together on a large scale?
    • Primary care practice is the obvious place to engage people with technology
  • No ‘post code lottery’–All patients should have access to digital services (the standard criticism of Babylon Health)

Day Two: build the technology around the patient

  • Put the patient first–some technology does not
  • The paramount importance of safeguarding the patient
  • Patients should be involved continuously with technology–and patients inspire technology

TTA is a media partner of The King’s Fund digital health conferences and was pleased to be a supporter this year.

The health tech events of summer: The King’s Fund (London) and Parks Associates (San Diego) (Updated)

Summer is coming, even if it’s difficult to believe that April Showers (or Snow) bring May Flowers. Here’s a preview of two health tech events to put on your calendar later on this year in mid and late summer.

The King’s Fund Digital Health and Care Congress 10-11 July, at their location in London. Content and case studies include creating the right culture for large-scale digital change, using digital technology to improve quality of care, prevention and changing behaviors, population health informatics, tools for self-management, and much more. Speakers include Matthew Swindell of NHS England and the Rt. Hon. Paul Burstow of the TSA. Information and registration are now available here. (Updated this week!) Follow The King’s Fund on Twitter here: #KFdigital18. TTA is a media partner of the Digital Health Congress.

Parks Associates’ 2018 Connected Health Summit: Engaging Consumers will be held 28-30 August at the Manchester Grand Hyatt in San Diego, California. This year will analyze the role of innovative connected health solutions in driving changes in consumer behaviors as well as how healthcare systems, insurers, and hospital networks interact with consumers. Updated: Confirmed keynotes are Deborah DiSanzo, General Manager, IBM Watson Health and–just added–Christopher Weber, General Manager of Uber Health [see this Editor’s thoughts on Uber from last month]. Speaker submissions are open until 1 June–more information is here. Early registration is now open. TTA is a media partner of the Connected Health Summit.

2017’s transition in digital health funding: is it maturity or a reconsideration?

Rock Health’s topline for 2017 digital health funding is impressively upbeat, casting it as “the end of the beginning in digital health, the start of a new era with new challenges”. Digging into it, there is a continued slowing that Rock Health itself predicted back in their 3rd Quarter report [TTA 3 Oct 17]. It seems that the big did get bigger, but if you weren’t on the train in 2016 or prior, 2017 wasn’t the year you left the station. Their findings bear this out, keeping in mind that their tracking is for US companies with deals over $2 million in value, which excludes much of the action from young and international companies:

  • No digital health IPOs this year, in a weak year in general for IPOs
  • For the companies already in public markets, they outperformed the S&P 500 31 percent to 19 percent
  • Average deals hit an all-time high of $16.7M ($5.8 bn over 345 deals) 
  • Big money went to better-developed, more mature companies like Outcome Health and Peloton exercise equipment at $500 million and $325 million. Rock Health duly notes Outcome Health’s troubles since. (To this Editor, Peloton is not a digital health company despite its glitzy overlay of video and exercise community.)  
  • Seven $100 million + mega-deals front-loaded in the first half of the year. Second half’s sole big deal was genetic testing and data marketer 23andme. The dominant category of business? Consumer health information represented by Outcome, 23andme, PatientPoint, PatientsLikeMe, and ShareCare, most with a B2B2C model.
  • Looking at deals by stage, not surprisingly the funding at D and later rounds soared to an average size of $74 million (from 2016’s $46 million). Seed and A rounds’ average funding at $7 million, while the majority, hasn’t varied much since 2011. Series B funding was also flat at $17 million on average.
  • Exits continued to be weak, indicating the reality of healthcare investing being long haul. M&A deals declined for the second straight year to 119–18 percent fewer than 2016 and 36 percent fewer than 2015

Also Modern Healthcare.

This Editor’s opinion? One damper on 2017 was the $900 million credulously blown on Theranos. Call it the Theranos Effect.

As usual we will look at StartUp Health‘s always numerically bigger report after release, but this Editor’s bet is that it won’t be ‘crazy’ like earlier in 2017. 

Digital health is not here. Or it is. Or it’s still “the future” and we’re waiting for the ship to come in.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/long-windy-road.jpg” thumb_width=”150″ /]Another bit of convergence this week and last is the appearance of several articles, closely together, about digital health a/k/a health tech or ‘Dr. Robot’. It seems like that for every pundit, writer, and guru who believes “We’ve Arrived”, there’s some discouraging study or contra-news saying “We’re Nowhere Near The New Jerusalem”. This Editor’s been on the train since 2006 (making her a Pioneer but not as Grizzled as some), and wonders if we will ever Get There. 

Nearing Arrival is the POV of Naomi Fried’s article in Mobihealthnews giving her readers the keys to unlock digital health. “Digital health will be the dominant form of non-acute care.” It has value in chopping through the thicket of the low clinical impact technologies that dominate the current scene (Research2Guidance counted only 325,000 health apps and 3.6bn downloads in 2017). Where the value lies:

  1. Diagnosis and evaluation–devices that generate analyzable data
  2. Virtual patient care–telehealth and remote patient monitoring
  3. Digiceuticals–digital therapeutics delivered via apps
  4. Medication compliance–apps, sensors, games, ingestibles (e.g. Proteus) 

At the Arrival Platform and changing the timetable is machine learning. Already algorithms have grown into artificial neural networks that mimic animal learning behavior. Though the descriptions seem like trial and error, they are fast cycling through cheap, fast cloud computing. Machine learning already can accurately diagnose skin cancer, lung cancer, seizure risk, and in-hospital events like mortality [TTA 14 Feb]. It’s being debated on how to regulate them which according to Editor Charles Lowe will be quite difficult [TTA 25 Oct 17]. Returning to machine learning, its effect on diagnosis, prognosis, and prediction may be seismic. Grab a coffee for The Training Of Dr. Robot: Data Wave Hits Medical Care (Kaiser Health News). Hat tip to EIC Emeritus Steve Hards.

The (necessary?) bucket of Cold Water comes from KQED Science which looked at two studies and more, and deduced that the Future Wasn’t Here. Yet.:

  1. NPJ Digital Medicine’s 15 Jan meta-analysis of 16 remote patient monitoring (RPM) studies using biosensors (from an initial scan of 777) and found little evidence that RPM improves outcomes. The researchers found that many patients are not yet interested in or willing to share RPM data with their physicians. The fact that only 16 randomized controlled trials (RCTs) made the cut is indicative of the lack of maturity (or priority on research) for RPM. 
  2. In JMIR 18 Jan, a systematic review of 23 systematic reviews of 371 studies found that efficacy of mobile health interventions was limited, but there was moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. 

Even a cute tabletop socially assistive robot given to COPD patients that increases inhaler medication adherence by 20 points doesn’t seem to cut hospital readmissions. The iRobot Yujin Robot helping patients manage their condition through medication and exercise adherence lets patients admit that they are feeling unwell so that a clinician could check on them either through text or phone and if needed to see their regular doctor. The University of Auckland researchers recommended improvements to the robot, integration to the healthcare system, and comparisons to other remote monitoring technology. JMIR (18 Feb), Mobihealthnews.

As Dr. Robert Wachter of UCSF put it to the KQED reporter, we’re somewhere on the Gartner Hype Cycle past the Peak of Inflated Expectations. But this uneven picture may actually be progress. Perhaps we are moving somewhere between the Slough (ok, Trough) of Disillusionment and the Slope of Enlightment, which is why it’s so confusing?

Robots, robots, everywhere…even when they’re NHS 111 online algorithms

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/Overrun-by-Robots1-183×108.jpg” thumb_width=”150″ /]The NHS continues to grope its way towards technology adoption, gets slammed–but is it justified? The Daily Telegraph (paywalled–see The Sun) revealed a draft December NHS report that recommended that the NHS 111 urgent non-emergency care line’s “enquiries will be handled by robots within two years.” Moreover, “The evaluation by NHS England says smartphones could become “the primary method of accessing health services,” with almost 16 million inquiries dealt with by algorithms, rather than over the telephone, by 2020.” (That is one-third of demand, with one-quarter by 2019.)

Let’s unpack these reported statements.

  • An algorithm is not a ‘robot’. This is a robot.[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/robottoy-1.jpg” thumb_width=”100″ /]
  • What is so surprising about using algorithmically based questions for quick screening? Zipnosis in the US has been using this method for years as a pre-screener in major health systems. They call it an ‘online adaptive interview’ guiding the patient through branching logic of relevant questions; a provider can review the provided clinical note and make a diagnosis and treatment recommendation in 2 minutes. It also captures significant data before moving to an in-person or telemedicine visit if needed. Babylon Health uses a similar methodology in its chatbot-AI assisted service [TTA 26 Apr 17].
  • Smartphones as a primary means of accessing health services? How is this surprising when the Office of National Statistics says that 73 percent of adults use the internet from their mobiles? 51 percent go online for health information.
  • Based on the above, 66 percent would still be using telephonic 111 services.

It seems like when the NHS tries to move forward technologically, it’s criticized heavily, which is hardly an incentive. Over New Year’s, NHS 111 had a 20 percent unanswered call rate on its busiest day when the flu epidemic raged (Sun). Would an online 111 be more effective? Based on the four-location six-month test, for those under 35, absolutely. Yes, older people are far less likely to use it, as undoubtedly (but unreported) the disabled, sight-impaired, the internet-less, and those who don’t communicate in English well–but the NHS estimates that the majority of 111 users would still use the phone. This also assumes that the online site doesn’t crash with demand, and that the algorithms are constructed well.

Not that the present service has been long-term satisfactory. David Doherty at mHealth Insight/3G Doctor takes a 4G scalpel to its performance and offers up some alternatives, starting with scrapping 111.

Babylon Health: correcting our NW London CCG report; objects to concerns raised by CQC report (latest updates)

Correcting and commenting on our earlier report. This Editor had earlier published on 11 Dec, as follow up to the extensive coverage on Babylon Health’s ‘GP at hand’ pilot activity in London, summarizing a report in Digital Health stating that the North West London Collaboration of Clinical Commissioning Groups (CCG) ended plans for expanding a test of the Babylon video consult/symptom checker app for GP practices in that area and that the app could be ‘manipulated’ to secure GP appointments faster and would not reduce demands on GPs. The original article was first corrected at an NHS England‘s representative’s request to reinforce that this was a local CCG project and that NHS England was not involved. The second request we received last Friday was from Babylon Health’s PR representative, Giles Kenningham, principal at Trafalgar Strategy. It was certainly strong and quoted here, edited as indicated to remove the link to the original article and Mr. Kenningham’s signature:

Your recent article on Babylon is factually wrong and misleading (link removed):
You claim the babylon app was dropped after being manipulated by patients. The term ‘manipualtion’ has been removed from the board papers and is wrong. Similarly the planned pilot had never begun so there so nothing to roll out.
This story is based on incorrect board papers which have now been corrected.

Please find a spokesman quote below. (closing signature removed)

A spokesperson for Babylon said:

“No pilot was ever carried out, nor any agreement signed with Babylon for such a pilot.

“Discussions were held after Babylon was selected in a competitive procurement exercise as the best technology to trial in GP practices across North West London. Subsequently, a decision was taken not to fund the pilot.”

This Editor then checked on the Digital Health article and found it had been removed without any follow-up or correction. Thus on Friday 8 Dec, this Editor removed the article, thanked Mr. Kenningham for bringing it to attention, and added that our report cited Digital Health as the source. I also requested a reference or third-party confirmation of his corrections. (This last request was not received as of the time of this writing.)

Wanting to get to the bottom of this for our Readers–and as a marketer who’s corrected more than a few inaccurate reports, your Editor has located the CCG’s report which is here published 22 November. It corresponds with Mr. Kenningham’s full note. The CCG report appears to have been revised (the URL indicates a v3), there never was a Babylon pilot, this version does not use the word ‘manipulation’, and the end result was that the CCG decided not to proceed to the pilot stage. In short, it appears to this Editor that the Digital Health report was based on an earlier and incorrect version of the report (perhaps as early as 25 Oct) and we are of course happy to correct. My fault and apology to our Readers and to Babylon in that I should have located the 22 Nov revised report prior to publishing the article and essentially provided a correction to Digital Health‘s report.

However, the CCG’s report on their Babylon evaluation contains two findings that were included in Digital Health‘s now-deleted article and give some pause. The CCG used focus groups of potential users, which surfaced that, in the CCG’s words, “The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment. The insights gathered therefore revealed that the symptom checker in particular was unlikely to reduce demand for GP services.”

Our Editor Chrys has pointed out the Pulse article which also comments on this and was corrected for the CCG’s revised report. The comments here by practicing GPs are worth reading. Scroll down and you’ll see that  ‘gaming the system’ has happened using direct triage in practices using personal phone consults–no app required. Can this even work?

Focus groups are highly subjective, but they are great ways of surfacing the flaws that developers and companies have gone blind to.

We hope that Babylon Health does take this feedback seriously. This Editor makes no secret of her advocacy of technology that can speed the obtaining of care, but based on her experience with early-stage companies, every critique, every hole that can be kicked in a service, delivery, and logistics, exposing a weakness should be appreciated–and ruthlessly scrutinized for flaws that need solutions. This becomes harder to do when you’ve achieved Big Funding. Babylon is typically burning a hole through it (The Times, 1 Oct–hat tip to Chrys). The pressure on now to find The Road to Breakeven must be stunning.

Important updates: Speaking of finding solutions, Babylon differs strongly with the findings of the Care Quality Commission (CQC)(not to be confused with the CCG), in the CQC report on their service published on Friday 8 December. 

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