TTA’s Week: Google predicts outcomes, RPM wins €$, CVS-Aetna hurdles, Amazon looms, Japan copes

 

Big steps forward? Google’s predictive health, Virta’s diabetes reversal, remote patient monitoring’s €$. Baby steps for Medicare telehealth parity, Japan’s social care. Scary Monsters scare less in the morning but the cyberhacks continue. And Happy 60th DARPA!

Google ‘deep learning’ model more accurately predicts in-hospital mortality, readmissions, length of stay in seven-year study (Predictive health’s possible giant step)
Scary Monsters, Take 4: further investor thoughts on CVS-Aetna, the Amazon Threat–and Aetna’s skeleton in the closet? (CVS may be the smarter partner in the merger)
Rounding up what’s news: LindaCare, TytoCare funding; Medicare telehealth parity, Norway’s big cyberhack, Virta reversing diabetes, DARPA’s 60th birthday
Japan as aging bellwether: experiential VR, claim that robots increase activity by 50 percent (Coping with an aging population develops)

Will the Amazon/Berkshire/JPMC venture really be a ‘meaningful disruptor’? And as expected, CVS-Aetna bears more merger scrutiny by DOJ. 

Scary Monsters, Take 3: one week later, JPMorgan Chase takes heat, Amazon speculation, industry skepticism (Boo Again! There’s fallout with this disruption.)
CVS-Aetna: DOJ requests additional information at deadline (updated for CVS earnings)
(As predicted, DOJ takes the lead. And CVS is quite healthy and nimble.)

When Giants decide to transform healthcare, it puts advertising that didn’t deliver masquerading as ‘behavior change technology’ in the unshuddery shade. Continuing the debate on the efficacy of health apps. Are we getting to the tricorder on the back of a smartphone? And are we getting to collaborative virtual care through the vendor door? 

Scary Monsters, Take 2: Amazon, Berkshire Hathaway, JPMorgan Chase’s addressing employee healthcare (Boo! Seriously, there are issues)

Another unicorn loses its horn–Outcome Health finally loses the CEO and president (Just what healthcare needs–another ‘transformer’ which didn’t deliver)
Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots (Set goals, pay money, dear patient)
5 vital signs, one ‘heavyweight’ device on the back of your Moto X smartphone (Are we getting to tricorders through smartphone mods?)
InTouch Health launches a three-way collaboration on virtual acute care with Jefferson Health, Mission Health (Finally, information sharing–and it took a vendor to do it)

Amazon as Healthcare’s Scary Monster, Robots on Parade (when they’re not fainting), fall prevention and apps get protective, and NHS plays catchup with the 21st Century’s Digital Times

What’s up with Amazon in healthcare? Follow the money. (The Scary Monster parsed away from the hype)
MediBioSense and Blue Cedar take a new approach to secure medical wearable data (UK/US) (Protect the app, protect the data)
Hip-protective airbags get another entrant from France. And fall prediction steps forward. (Oui and sí for airbags to cushion the blow, tech to determine fall risk)
Robots, robots at CES: ElliQ, Sophia the ‘humanoid’, companions, pets, butlers, maids…and at a supermarket near you? (The Parade of Cute–And Not Working)
Robots, robots, everywhere…even when they’re NHS 111 online algorithms (NHS’ continued difficulty with Digital Times)

Of continued interest….

Iron Bow’s uncertain future with $258 million VA Home Telehealth contract (A Federal ruling against partner Vivify Health stops the program–can Iron Bow save it?)
Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? (Is there ‘Life on Mars’? Is there?)
CVS-Aetna: It’s not integrated healthcare, it’s experiential retail! (A different look at a complicated merger proposing another reason why it may set the pace)
Babylon’s ‘GP at hand’ has thousands of London patients in hand (A hit with Londoners indicates pent-up demand for virtual care)

Fall prevention: the technology–and Dutch–cures (Falling tech keeps seniors mobile…and learning to fall right)

Advances in 2017 which may set the digital health stage for 2018 (Alzheimer’s, Huntington’s treatments; All of Us, DeepMind Streams, and Telehealth in Outer Space!)
Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty (Dancing to the M&As, canaries, Babylon, KardiaBands on Apple Watches…)
The Theranos Story, ch. 45: a ‘Christmas present’ $100 million loan from Fortress averts bankruptcy (updated) (A Trojan Horse?)
2017 wrapup: state telehealth reimbursement policies and progress made (Center for Connected Health Policy tracks 63 legislative actions in 34 states)

 


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Google ‘deep learning’ model more accurately predicts in-hospital mortality, readmissions, length of stay in seven-year study

A Google/Stanford/University of California San Francisco/University of Chicago Medicine study has developed a better predictive model for in-hospital admissions using ‘deep learning’ a/k/a machine learning or AI. Using a single data structure and the FHIR standard (Fast Healthcare Interoperability Resources) for each patient’s EHR record, they used de-identified EHR derived data from over 216,000 patients hospitalized for over 24 hours from 2009 to 2016 at UCSF and UCM. Over 47bn data points were utilized.

The researchers then looked at four areas to develop predictive models for mortality, unplanned readmissions (quality of care), length of stay (resource utilization), and diagnoses (understanding of a patient’s problems). The models outperformed traditional predictive models in all cases and because they used a single data structure, are projected to be highly scalable. For instance, the accuracy of the model for mortality was achieved 24-48 hours earlier (page 11). The second part of the study concerned a neural-network attribution system where clinicians can gain transparency into the predictions. Available through Cornell University Library. AbstractPDF.

The MarketWatch article rhapsodizes about these models and neural networks’ potential for cutting healthcare costs but also illustrates the drawbacks of large-scale machine learning and AI: what’s in the EHR including those troublesome clinical notes (the study used three additional deep neural networks to discern which bits of the clinical data within the notes were relevant), lack of uniformity in the data sets, and most patient data not being static (e.g. temperature). 

And Google will make the chips which will get you there. Google’s Tensor Processing Units (TPUs), developed for its own services like Google Assistant and Translate, as well as powering identification systems for driverless cars, can now be accessed through their own cloud computing services. Kind of like Amazon Web Services, but even more powerful. New York Times

EHR action: Allscripts acquires Practice Fusion, expands footprint in small/ambulatory practices

A significant EHR acquisition kicks off an action-packed week. Announced today by leading EHR Allscripts is their acquisition for $100 million of independent practice EHR Practice Fusion. Allscripts, which has been usually in the top five US EHRs (Kalorama April 2017 survey), vastly expanded its hospital market share with August’s acquisition of #2 McKesson‘s health IT business and with this would be ranked just behind EHR leader Cerner. In acute care settings, Epic and Cerner dominate with 25 percent of the market each with Allscripts/McKesson far behind #3 Meditech (KLAS April 2017). 

Practice Fusion, one of the pioneers in the small practice/ambulatory EHR starting with a basic free, ad-paid model in 2005, has 30,000 ambulatory sites serving about 5 million patients each month. In the Allscripts view, they will now be able to offer “last mile” reach to the under-served clinicians in small and individual practices” and close gaps in care. Allscripts President Rick Poulton noted in the statement that “We believe this transaction will directly benefit Practice Fusion clients, who will now have access to Allscripts solutions and services. We look forward to welcoming Practice Fusion team members to our family.” which leads one to believe that the Practice Fusion name will be sunsetted. Allscripts release and Healthcare IT News

From being the leader in small practice EHRs, Practice Fusion found the last few years difficult as competition expanded into their segment, from eClinical Works, drchrono, athenahealth, and NextGen to small practice packages from Epic and Cerner.

It should be noted that Practice Fusion in 12 years went through 13 funding rounds, raising almost $158 million from a long list of VC luminaries such as Kleiner Perkins, Artis Ventures, Founders Fund, and Qualcomm Ventures (Crunchbase). However, it disappointed its investors and Wall Street, which expected two years ago a $1.5 billion IPO. The $100 million from Allscripts is all cash and the price is “subject to adjustment for working capital and net debt”–an exit which was surely not the sugarplum in the eyes of its 2014 and prior  investors. CNBC

Now EHR data entry 50% of primary care doctors’ workday: AMA, University of WI report

click to enlargeWhere’s the doctor? Typing away! A fact of life doctors have agonized on over the past ten years–even great advocates like Robert Wachter, MD above at NYeC last year–is the clerical burden of EHRs and patient data entry. A late 2016 time and motion study in the ACP Annals of Internal Medicine (AMA, Dartmouth-Hitchcock, Australian Institute of Health Innovation) noted a mere 49.2 percent of ambulatory physicians’ time spent on EHR and desk work. Mayo Clinic (above) has been tracking both the burnout and the burden as 50 percent (above).

Now we have a new three-year study published in the Annals of Family Medicine led by the University of Wisconsin Medical School tracking EHR data entry as 52 percent: 5.9 hours of an 11.4 hour workday. This includes allied clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounting for 2.6 hours, close to 50 percent of the 5.9 hours daily.

Is there a way out? The study’s recommendations were:

  • Proactive planned care
  • Team-based care that includes expanded rooming protocols, standing orders and panel management
  • Sharing of clerical tasks including documentation, order entry and prescription management
  • Verbal communication and shared inbox work
  • Improved team function.

Much of this sounds like burden shifting to deal with the EHR, not a redesign of the EHR itself, but the commentary in AMA Wire makes it clear that it was shifted in the first place by the EHR designers from other staff to the doctor for direct entry. Other time savings could be realized through moving to single sign-on (versus dual entry passwords) to advanced voice-recognition software. (UW release)

The earlier ACP study excerpt in NJEM Journal Watch has physician comments below the article and they blast away: (more…)

VA EHR award to Cerner contested by CliniComp (updated)

See update below. CliniComp International, a current specialized EHR vendor to some Department of Veterans Affairs locations and to the Department of Defense for clinical documentation since 2009, has filed a bid protest in the US Court of Federal Claims on Friday 18 Aug, saying that VA improperly awarded a contract to Cerner in June [TTA 7 June] without a competitive bidding process.

At the time, VA Secretary David Shulkin moved the award via a “Determination and Findings” (D&F) which provides for a public health exception to the bidding process. Without this, competitive bidding could take six to eight months, as Dr. Shulkin stated to a Congressional committee after the award–or two years, as DoD’s did–and would have further slowed down the already slow adoption process. Even if all goes well, the transition from VistA to Cerner will not begin at earliest until mid-2019 [TTA 14 Aug]. The Cerner MHS Genesis choice was also logical, given the Federal demand for interoperability with DoD. In June, the House Appropriations Committee approved $65 million for the transition, provided that VA provides detailed reports to Congress on the transition process and its interoperability not only with DoD’s but also private healthcare systems.

CliniComp objected to all that, saying in the protest that VA had enough time for an open bidding procedure, that the failure to do so was “predicated on a lack of advance planning,” and that awarding it to Cerner without it was “unreasonable”. “As shown by the nine counts set forth below, the VA’s decision to award a sole-source contract to Cerner is arbitrary, capricious, an abuse of discretion and violates the CICA and Federal Acquisition Regulations,” according to the suit.

According to Healthcare IT News, “CliniComp said it filed an agency-level protest to contest the sole source award shortly after the announcement, according to the complaint. But the VA Deputy Assistant Secretary for Acquisition denied the protest on Aug. 7. In doing so, the VA violated the Competition in Contracting Act of 1978, the company claims.”

This is not CliniComp’s first bid protest. Before one dismisses the bid protest as sour grapes picked by a minor vendor, this Editor discovered via Law360 that CliniComp was successful in a VA bid protest in August 2014. In this case, VA had a $4.5 million contract for computer systems at several intensive care units for saving patient waveform biometrics. The VA’s award to Picis in October 2013 was overturned because the Court of Federal Claims found that in clarifying the CliniComp bid, VA never had official discussions with CliniComp, only informal requests for clarifications. The court found that the two bids were not evaluated the same way–and that likely both were acceptable, with CliniComp’s bid preferable because it was lower. (More on CliniComp and its 30-year history here)

Update. Arthur Allen in POLITICO Morning e-Health also did his homework and found the same Law360 article on CliniComp’s 2014 bid protest win, adding the following:

  • DoD and VA officials have complained that CliniComp’s software is not compatible with legacy systems. However, some IT experts have noted that neither DoD nor VA can provide platforms which can be interoperable with Cerner. (Circular firing squad?)
  • Oral arguments are set for 2 October, if necessary, after motions are filed next month. Cerner joined in the defense against the protest as of Monday. 

Will the brakes be put on Cerner’s work while the protest wends its weary way through the Federal Claims Court? The bid protest is high-profile embarrassing for VA, though the D&F is completely legal. Stay tuned. Also Modern Healthcare, KCUR, Healthcare Dive

VA’s Shulkin: Cerner rollout start by mid-2019?

An interesting short (free) article on POLITICO Morning eHealth today was an interview with VA Secretary David Shulkin, MD on the Cerner transition, stating that if all went well with negotiations later this year, VA clinicians could be using the Cerner system by mid-2019. “There’s a lot of understandable concern about whether the Cerner EHR will have the same functionality as VistA, which has evolved to the physician’s needs over the past 35 years.” One of the problems with VistA was that it wasn’t one system, it was 130 systems, which is echoed in many EHRs. POLITICO goes on to quote Dr. Shulkin: “I don’t hear as many concerns about that as I do relief about finally making a decision because people felt this was the slow death of a system that they have poured their hearts and souls into. Knowing we’re committed to doing a transition as well as we can is reassuring to people.” Sadly, the rest of the interview is paywalled on POLITICO PRO. Earlier analysis: VA says goodbye to VistA, hello to Cerner. We wonder what the involvement and engagement of the four Home Telehealth winners of the 5-year contract will be.

Cerner DoD deployment on time; Coast Guard EHR shopping; Air Force, VA sharing teleICU

The US Department of Defense announced that the deployment of Cerner’s EHR MHS Genesis at the Naval Hospital in Oak Harbor, Washington is on time for later this month. It’s a little unusual that anything this big and in the government is actually on time. It’s also meaningful for VA, as they are adopting MHS Genesis in an equally, if not longer, rollout [TTA 7 June]. Healthcare IT News

Less well known is the Coast Guard‘s dropping its costly six-year deployment of the Epic EHR last year and reverting to paper. They are not in the MHS Genesis rollout because the CG is part of the Department of Homeland Security, despite its service roots and structure similar to the US Navy. This has led to much speculation that their final choice will be DoD’s Cerner platform, although the OpenEMR Consortium has already answered their April RFI.

And even less noticed was the late June announcement that the US Air Force Medical Operations Agency and the VA are implementing a tele-ICU sharing arrangement, giving the USAF access to the VA’s capabilities at five AF locations: Las Vegas; Hampton, Virginia; Biloxi, Mississippi; Dayton, Ohio; and Anchorage, Alaska. The VA central tele-ICU facility is in Minneapolis. Doctors there can remotely consult, prescribe medications, order procedures and make diagnoses through live electronic monitoring. Becker’s Hospital Review, VA press release

Mismanaging a healthcare IT transition: what’s the cost?

Many of our Readers may consult HIStalk on occasion, especially the provocative weekly columns by a physician known as Dr. Jayne. She has a great deal to do with HIT for her practice, was a CMIO, and her Monday Curbside Consult is about the high cost of changing EHR platforms in a healthcare organization–an event that’s happening a lot lately (think DoD and VA). It’s the story of her friend who worked in IT for a health system that migrated to a single vendor platform and practice management system. The friend was given the option to remain with the legacy platforms support team for the transition, with the employer promising that those people would move to the new platform team following the migration. Routine, correct?

Not so routine when the cutover completion resulted in two weeks notice for those perhaps two dozen people. It wasn’t about headcount, because the organization posted jobs, but all new hires are required to be certified on the new system which the transition staff were not. And this health system, a non-profit, spent half a billion dollars for an EHR migration.

What’s the cost, in Dr. Jayne’s book?

  • The health system jettisoned a group of its most experienced people, with 15-20 years experience on average, with long-standing customer relationships (customers being doctors, practices, and health facilities). The knowledge base and track record they have in handling ‘Dr. Frazzled’s high maintenance billing team’, now wrestling with a new system, walked out the door.
  • These people, due to age, may never work, or find positions at the same level, ever again–and may very well wind up in the uncompensated healthcare system.
  • The health system may, through getting rid of experienced people, evaded the hard work on its own legacy of people and process. She points out that they “treated this migration simply as a technology swap-out” versus an “opportunity for further standardization and clinical transformation”. New people can freshen an organization, but will they be allowed to, or be fitted into the same stale setup?

Dr. Jayne is optimistic about her friend finding a new position. This Editor will let her write the conclusion which applies beyond HIT in how healthcare is being managed today, from small to giant organizations:

Too often, however, that mission is keeping up with the proverbial Joneses rather than being good stewards. It reminds me of when I was in the hospital this winter, when I didn’t get scheduled medications on time due to a staffing shortage. Is it really cheaper to risk a poor outcome? When did people become less valuable of an asset than mammoth IT systems or another outpatient imaging facility or ambulatory surgery center? And do we really need another glass and marble temple to healing when the actual patient care suffers?

From despair to hope? New study charts future of patient-generated data in care delivery

click to enlargeA frustration of everyone in healthcare and technology is the unfulfilled promise of Big Data. A study conducted by a team for NEJM Catalyst (New England Journal of Medicine) of 682 health care executives, clinical leaders, and clinicians indicates that at present, very few (<20 percent) believe that their healthcare organizations extremely or very effectively use data for direct patient care; 40 percent believe it is not very effective or not at all effective.

The hope comes in a trend over the next five years (NJEM chart at left above, click to enlarge). Presently, the most useful sources of data are clinical (95 percent), cost (56 percent), and claims (56 percent). In five years, they project that the top four will be clinical (82 percent) and cost (58 percent) joined by patient-generated and genomic data (both at 40 percent). How that patient-generated data will be compiled to be useful is not described, but the hope is that “With patient-generated data and genomic data, we will be able to create true “n of 1” medicine with options specific to each patient’s needs, giving a boost to priorities such as care coordination and improved clinical decision support.”

A possible roadblock is the lack of interoperability of EHRs. Less than 10 years ago, the EHR was touted as The Solution to patient records and a repository of Everything. 51 percent indicate that interoperability is weak. One-third believe that ease of use and training for EHRs are also weak.

Other findings indicated strong support for greater patient access to personal medical records (93 percent), fee/price information for comparison shopping (80 percent), and outcomes information listed by hospital (73 percent)–but not by doctor (55 percent).

The full report is available for download at the NEJM Catalyst link here. Also Mobihealthnews.

VA Digital Health Platform proof-of-concept unveiled; new VA head nominated

Back in April 2016, the Department of Veterans Affairs (VA) in Congressional hearings hinted at an end of year preview of a ‘state-of-the-art’ digital health platform which would integrate veteran health information from multiple sources. That debut was revealed this week in analytics vendor Apervita‘s announcement that they are participating in a proof-of-concept of the VA Digital Health Platform (DHP). According to their release, in the first three weeks, they and the DHP partners demonstrated that they could organize and extract insights from veteran data originating from VA, military, and commercial electronic health records, plus e-prescribing, apps, devices, and wearables. The end outcome is to provide a unified view or dashboard that integrates data, implements a care plan, tracks clinical encounters, optimizes medications, responds to patient needs, and more. The prime contractor in DHP is Georgia Tech, which brought on board Apervita, Salesforce (workflow user engagement), and MuleSoft (API). Next steps are not disclosed. Mobihealthnews, Health Data Management

One of the sparkplugs behind the DHP and also interoperability of DOD’s and VA’s badly outdated VISTA EHR is current VA Undersecretary for Health David Shulkin, MD. Today, at an eventful press conference, President-Elect Donald J. Trump nominated him for the VA secretary position. Dr Shulkin was previously CEO of Beth Israel Medical Center in NYC and president of the Atlantic Health System ACO. He will also be, upon Senate approval, the first non-veteran head of the VA. What is apparent is that P-E Trump has not moved one iota from the promise he made during the campaign to move fast on modernizing, improving quality and speeding up veterans health services–and for that he needs an insider.  Health Data Management

Friday’s cyberattack is a shot-over-bow for healthcare (updated)

click to enlargeFriday’s multiple distributed denial-of-service (DDoS) attacks on Dyn, the domain name system provider for hundreds of major websites, also hit close to home. Both Athenahealth and Allscripts went down briefly during the attack period. Athenahealth reported that only their patient-facing website was affected, not their EHRs, according to Modern Healthcare. However, a security expert from CynergisTek, CEO Mac McMillan, said that Athenahealth EHRs were affected, albeit only a few–all small hospitals.

A researcher/spokesman from Dyn had hours before the attack presented a talk on DDoS attacks at a meeting of the North American Network Operators Group (NANOG)

The culprit is a bit of malware called Mirai that targets IoT–Internet of Things–devices. It also took down the (Brian)KrebsOnSecurity.com blog which had been working with Dyn on information around DDoS attacks and some of those promoting ‘cures’. According to Krebs, the malware first looks through millions of poorly secured internet-connected devices (those innocent looking DVRs, smart home devices and even security devices that look out on your front door) and servers, then pounces via using botnets to convert a huge number of them to send tsunamis of traffic to the target to crash it. According to the Krebs website, it’s also entwined with extortion–read, ransomware demands. (Click ‘read more’ for additional analysis on the attack)

Here we have another warning for healthcare, if ransomware wasn’t enough. According to MH, “even for those hospitals with so-called “legacy” EHRs that run on the hospital’s own computers, an average of about 30 percent of their information technology infrastructure is hosted (more…)

VA’s moves spell the end of the homegrown EHR

The Veterans Health Administration (VHA) is formally reaching out to the private sector to explore switching from its current, pioneering EHR system, VistA (also referred to as CPRS, Computerized Patient Record System) to a commercial system. Their ‘feeler’ is an August 5 and 8 notice in FedBizOpps.gov titled 99–TAC-16-37877 * RFI – VHA supporting COTS EHR REQUEST FOR INFORMATION (RFI), Solicitation Number: VA11816N1486. This requests information on business support for transitioning to a commercial-off-the-shelf system (COTS–don’t governments love acronyms?–Ed.) and closes 26 August, which is not a lot of time even for an RFI.

VHA has been under extreme pressure from Congress to modernize its EHR, lately in July hearings before the Senate Appropriations Committee. EHR replacement is also in line with the Congressionally-mandated, now concluded Commission on Care’s recently published recommendations on a total, top-down reorganization of VHA, including a sweeping reorg of their HIT management. The VHA strategy appears to be that while they are walking down the road to replace VistA and have already spent to assess where they are with KLAS and other EHR consultancies (spending $160,000+ on surveys), they are essentially ‘kicking the can down the road’ to the next administration (POLITICO’s Morning eHealth, 14 July).

Current state is to continue to upgrade VistA through late 2018, though the closely related Department of Defense’s Military Health System is in the long process of cutting its homegrown AHLTA over to Cerner-Leidos as MHS Genesis, awarded last August, with a first trial in the Pacific Northwest later this year (HealthcareITNews, Ed. emphasis). Of course, it will take the VHA years to roll it out; there are close to 9 million veterans enrolled in the closed system that is the VHA.  FCW, Morning eHealth 10 August

Love EHRs or hate them, the sheer size of the VHA and its growing concession that VistA won’t do in caring for American veterans makes it clear that the future of EHRs is in private systems from major developers–a field which is winnowing out to The Few (take that, GE).  (more…)

Paper beats the EHR rock, docs in British Columbia conclude

“Moving to an electronic system should enhance the care we provide, rather than jeopardize it.” “We do not want a catastrophic event to occur in order to have our concerns heard.” “We do not feel that it is ethical to put patients at risk using a system that makes it difficult to ‘do the right thing’ and much easier to make a significant error.”

Nine weeks into the launch of a C$174 million Cerner EHR in March, emergency room and intensive care unit doctors Nanaimo Regional General Hospital in British Columbia, Canada reverted to paper orders and instructions out of concern for patient safety. Internists and others wanted to do the same. They formed a 250-member Medical Staff Association, which had enough concerns to go on the record with a report that included the above. One example: the lack of confidence in the electronic ordering system module for diagnostic tests, drugs and patient instructions was enough for sixty-one Association members to vote unanimously on a  “no confidence” motion in the system and a return to paper orders. The report also detailed “a multitude of physician-reported major safety issues from every department that deals with acute patient care.”

The B.C. provincial health authority, which in Canada’s system can overrule doctors and parent companies (Island Health), won’t remove the offending module, but is concerned enough to order additional resources and ongoing refinements, based on physician concerns and recommendations from a recent internal investigation. Island Health’s board also asked the health authority to: address fatigue in clinical staff and medical professionals; adjust resources to alleviate workload burden; Improve trust in the electronic health record and associated clinical care processes; work collaboratively with clinicians and medical staff to evaluate improvements in the electronic health record for quality and safe patient care. Times Colonist (BC)

Rock Health: 1st Q funding deals up nearly 50%, approaches $1bn (US)

click to enlargeFunding’s up, but the digital darlings have changed. The stock market and tech sector may have been uncertain kicking off 2016, but digital health wasn’t. Rock Health’s first report for 2016 exudes optimism. Compared to the same quarter in 2015, funding increased nearly 50 percent to $981.3 million, the highest amount since 2011. But the devil may be in the details:

  • Five deals accounted for 56 percent of the volume (in descending order: Flatiron Health (clinical intel for cancer care), Jawbone, HealthLine (consumer health info), Health Catalyst (data warehousing) and Higi, an odd little kiosk + consumer engagement program nationally placed in Rite Aid stores–odd enough to gain $40 million in its first venture round
  • Seed and Series A raises were still well over half–54 percent, over the 50 percent in 2015
  • Later stage deals (Series D and above) shrank to 13 percent in 2016 from 35 percent
  • Top categories also demonstrated the fickleness of funding favorites. Only two categories in the top six were carry-overs from 2015: wearables (driven by Jawbone) and consumer engagement. New favorites: analytics/big data, population health management, consumer health information and EHR/clinical workflow.
  • There were no venture-backed IPOs in the quarter, and public company performance was down (9 percent y/y)

The new picture favors what to do with the data–finding trends and putting them to use both consumer and clinical sides. And exits were popular as well: 187 was the Rock Health count, with fitness wear Asics‘ acquisition of the Runkeeper fitness wearable and provider One Medical acquiring the Rise app. Will the trend continue in 2nd quarter? Stay tuned….Rock Health Q1 Update

A gallimaufry of short digital health items to start the day with

The WHO has produced an excellent report on the state of eHealth in the European region, including a review of telehealth readiness. Ericsson have produced a very interesting report confirming what I guess anyone will have realised if they’ve traveled by public transport or have children: young people downloading video content are driving a surge in data usage: there’s much detail here though. Both are well worth the read.

Mentioning Ericsson reminds that the Telegraph recently produced a summary of the 20 best-selling mobile phones of all time – takes you back, with the substantial number once produced by Nokia.

The Royal Society of Medicine has it’s fifth annual medical app conference on April 7th – numbers booked have already well exceeded last year’s sellout so they are expecting to fill this year’s much larger conference venue. The focus this year is on the many legislative, regulatory and voluntary measures being introduced that will impact medical apps – there’s still room for old favourites though, such as Richard Brady’s always-topical (more…)

‘VC tourism’ in Health Tech Land is over (updated)

The ‘silly money’ is packing its bags and taking the next flight from the Coast. An exceedingly tart take out of Fast Company confirms what your Editors have noticed in Rock Health and other year-end reports. Funding for digital health may have surpassed $4.2 billion in 2015, but it barely eked over 2014’s total of $2.3 billion despite rising geometrically since 2011 [TTA 16 Dec 15, revised by Rock Health since then]. Since then, we’ve had the Trouble Every Day of ‘unicorns’ (overreaching) Theranos and (ludicrously) Zenefits [TTA 17 Feb]; EHR Practice Fusion stalled out and cutting 25 percent of its staff, hoping to be acquired by athenahealth–or anyone (Healthcare Dive); shaky Fitbit shares [TTA 20 Feb]. Perhaps the high point was last year’s ‘Corvette Summer’ with yet another big round to a company yet to fulfill its promise, ZocDoc [TTA 15 Aug 15]. Even Castlight Health with decent revenue (still at a loss) has been dubbed an ‘absolute horror show’ when it comes to its share prices, if you were foolish enough to buy it at or near its IPO.

Fortunately a large dose of sanity may prevail among VCs with a sobering realization–no different than five or ten years ago–that investment has to be strategic and far longer than the usual 18 month-and-out time frame. Too many companies have systems which work the same niche–you don’t need 50 companies doing these things: data analytics for care management, patient engagement platforms, med reminders or diabetes management. [We’ve already noted the ‘sameness’ in companies getting funded in 2015, almost as if investors were seeking reassurance in similarity, a sure sign of a coming fail–TTA 30 Dec 15.]

Developers must fill a need–uniquely. And have a superb business plan, squeeze the nickels till they squeak and forget about the party culture. Investors: Dumb Money For Digital Health Will Vanish As Quickly As It Came In