News Roundup: Doctor on Demand’s $75M Series D, Google’s Fitbit buy scrutinized, $5.4 bn digital health funding breaks record

More evidence that telehealth has advanced 10 years in Pandemic Time. Doctor on Demand, estimated to be the #3 telemedicine provider behind Teladoc and Amwell, announced a Series D raise of $75 million, led by VC General Atlantic plus their prior investors. This increases their total funding to $240 million.

Unlike the latter two, DOD actively courts individual users in addition to companies and health plans. In May, they announced that they were the first to be covered under Medicare Part B as part of the CMS expansion of telehealth services in response to the pandemic (and for the duration, which is likely to be extended past July), which would reach 33 million beneficiaries. Other recent partnerships include a pilot with Walmart for Virtual Primary Care in three states (Colorado, Minnesota, Wisconsin) in conjunction with Grand Rounds and HEALTHScope Benefits as well as with Humana for On Hand Virtual Primary Care (regrettably only a video clip on the DOD press site with the noisome Jim Cramer). DOD covers urgent, chronic, preventative care, and behavioral health and claims about 98 million users, doubled the number of covered lives in 1st half 2020, and passed 3 million visits. Crunchbase NewsMobihealthnews

Google’s Fitbit acquisition scrutinized by EU and Australia regulators, beaten up by consumer groups in US, EU, Canada, Australia, and Brazil. None too happy about this acquisition is a swath of powerful opponents.

  • EU regulators have sent 60-page questionnaires to both Google and Fitbit competitors asking re the effect the $2.1 bn acquisition will have on the wearables space, whether it will present disadvantages to competitors in Google’s Play store, and how Google will use the data in their advertising and targeting businesses. While #2 and 3 are no-brainers (of course it will present a competitive disadvantage! of course, they’ll use the data!), it signals further investigation. The next waypost is 20 July where EU regulators will present their decision.
  • The Australian Competition and Consumer Commission (ACCC) announced in mid-June their concerns in a preliminary decision, though they don’t have the jurisdiction to block it. “Buying Fitbit will allow Google to build an even more comprehensive set of user data, further cementing its position and raising barriers to entry to potential rivals,” according to ACCC Chairman Rod Sims. This adds to the controversy Down Under on how Google and other internet companies use personal information. Final statement is 13 August. Reuters
  • The US Department of Justice is also evaluating it, as is the Federal Trade Commission. But an acquisition like this doesn’t easily fall under antitrust regulation as Google and Fitbit aren’t direct competitors. Fitbit has only about 5 percent of the fitness wearable market. However, this plays into another related investigation by DOJ — Google’s abuse of advertising data and its dominance of the market in tech tools such as Google Ad Manager in the US. DOJ asked competitors for information at the end of June. There are separate investigations by state attorneys general and also by Congress of Google and Apple. Reuters
  • The consumer group opposition rounds up the usual suspects like Open Markets Institute, Omidyar Network, Center for Digital Democracy, Open Knowledge and Public Citizen in the US, and in the EU Open Society European Policy Institute and Access Now. Their grounds expressed in a letter to regulators in the above countries are the usual dire-sounding collection of “exceptionally valuable health and location datasets, and data collection capabilities.” Sound and fury….

It will keep Google’s attorneys in DC, Brussels, and elsewhere quite busy for a lot longer than perhaps Google anticipated. Meanwhile, Fitbit is in the Twilight Zone. The Verge, Android Authority, FierceHealthcare 

US digital health companies smash funding records in 1st half 2020. Despite–or because of–the pandemic, US digital health investment funding tracked by Rock Health is at a torrid pace of $5.4 bn–$1.2 bn above the record first half posted in 2019.  That is despite a pullback in 1st Q + April.

Investors came roaring back in May and June, spurred by telehealth success and a rallying market, closing 2nd Q with $2.4 bn in investment. That was 33 percent higher than the $1.8 bn quarterly average for the prior three years. And the deals were big: on average $25.1 million, with the big boosts in Series C and bridge financing. M&A is still cloudy, but what isn’t? Notably, Rock Health is not projecting a final year number, a good move after they stubbed their collective toe on last year’s final investment total, down from both forecast and 2018. [TTA 7 Feb]

The big moves of 1st half in real digital health (not fitness) were Teladoc-InTouch Health (just closed at $600 million stock and cash) and Optum-AbleTo (at a staggering $470 million, which has apparently not moved past the ‘advanced talks’ state). Two of last year’s Big IPOs–Phreesia and Livongo— are doing just fine; Health Catalyst not so much. The bubble bath we predicted turned out to be a cleansing one–but there’s six months more to go. Also Mobihealthnews

Breaking: NHSX COVID contact tracing app exits stage left. Enter the Apple and Google dance team.

Breaking News: The NHS finally abandoned the NHSX-designed COVID contact tracing app in favor of the app based on the Apple and Google API.

The NHSX version had issues, seemingly intractable, on the BTE features on distancing and contact duration between devices, as well as the app being inaccurate on the iPhone.

The “Gapple” app is already in use in Italy, Switzerland, Denmark, Latvia, and Poland. As this Editor noted on Tuesday, Austria is in test, Germany just launched their ‘Corona Warning App’ and reported 6.5 million downloads in the first 24 hours. 

The BBC reported that the lead on the NHSX app, Matthew Gould and Geraint Lewis, are “stepping back” and former Apple executive Simon Thompson is joining NHSX to manage it

Depending on reports, the NHS either rejected the Gapple app in April or were working on it in tandem from May. More likely, they revived the latter with the NHSX problems. The Gapple version is decentralized in storing information about user contacts on individual phone handsets because of issues over user privacy, versus the NHSX centralized app.

According to the FT and TechCrunch, the government is de-emphasizing the utility of the app, and relying on its small army of contact tracers. 

But what about all those folks on the Isle of Wight?

More on this: Digitalhealth.net, TechCrunch, Financial Times     Hat tip to Steve Hards for alerting this Editor at the end of a busy day!

News roundup: LabCorp CRO boosts Medable, Propeller Health gains 510(k), EU’s 34 medtech startups, Amazon’s healthcare moves, Google’s Arizona privacy lawsuit

It does seem ages since our last one! One major winning category for digital health is clinical trials. LabCorp has one of the largest CROs (contract research organization), Covance. LabCorp has partnered with startup Medable, a Palo Alto-based company that decentralizes the gathering and analysis of clinical trial data from recruited participants through apps and telemedicine. Mobihealthnews  Confirming this trend: earlier this month, Medable cleared a $25 million venture round from GSR Ventures. Crunchbase  This does make rival CRO PRA Health Science’s pickup of Care Innovations from Intel late last year, for an undisclosed amount, look like a prescient (and likely a bargain) purchase.

Propeller Health, which specializes in digital respiratory health with sensors connected to inhalers and apps, gained 510(k) FDA clearance for a sensor/app for use with AstraZeneca’s Symbicort inhaler. This medication is used for asthma and COPD. It does not seem that long ago (2014) that the startup was at trade shows like NYeC and mHealth Summit with an exceedingly modest display of popups and brochures. Their 2019 acquisition by ResMed for the stunningly premium price of $225 million made news in late 2018. Mobihealthnews

In Europe, COVID-19 has boosted at least 34 medtech startups, including 11 in UK alone, followed by Switzerland and Sweden. This is based on a study by Oxford University data visualization spin-out Zegami. One of them happens to be Zegami on a project in using a limited dataset to distinguish between x-rays of COVID-19 infections and infections caused by viral or bacterial pneumonia, as well as images of healthy lungs. On the list are (naturally) Babylon Health and the slightly mysterious Medopad. Sweden’s Kry (LIVI in the UK) is also on the list. Kry/LIVI last made some news when Juliet Bauer of NHS Digital ankled to Kry in early 2019, Med-techInnovationNews, Mobihealthnews

Amazon’s latest stretches into healthcare are noted in a brief Becker’s Health IT article which notes AWS’ deals with Cerner and addition of healthcare-specific features with hospitals using AWS. Mayo Clinic has partnered with Alexa for voice responsive ‘Mayo Answers’. Some Amazon employees now have access to telehealth benefits (this Editor wonders why not all, beyond those Seattle warehouse workers). Industry research company CB Insights is projecting that Amazon’s next move will be a benefits marketplace for employers and payers. Meanwhile, their partnership with JP Morgan Chase and Berkshire Hathaway, Haven, has stumbled with its CEO Atul Gawande, MD, leaving the post to return to practice after less than two years. Executive turnover has been high, and the company has yet to announce a major initiative. FierceHealthcare 

Meanwhile, Arizona’s attorney general has sued Google for violating state privacy laws. Seems like Android users are trackable, even if they turn off location on their phones, through Google apps like Maps and Weather. The lawsuit also charges that Google changed its default tracking settings without informing users, using data for targeted ads. Becker’s Health IT 

News roundup: Kompaï debuts, Aging Tech 2020 study, Project Nightingale may sing to the Senate, Amwell, b.well, Lyft’s SDOH, more on telehealth for COVID-19

Believe it or not, there IS news beyond a virus!

France’s Kompaï assistance robot is finally for sale to health organizations, primarily nursing homes and hospitals. Its objective, according to its announcement release, is to help health professionals in repetitive daily tasks, and to help patients. It’s interesting that the discussion of appearance was to achieve a ‘slightly humanoid’ look, but not too human. The development process took over 10 years. (Here at TTA, Steve’s first ‘in person’ with the developers was in May 2011!) Kompaï usage mentioned is in mobility assistance and facility ‘tours’ and public guidance. Here’s Kompai in action on what looks like a tour. Press release (French/English)

Not much on robotics here. Laurie Orlov has issued her 2020 Market Overview Technology for Aging Market Overview on her Aging and Health Technology Watch, and everyone in the industry should download. Key points:

  • In 2020, aging technologies finally nudged into the mainstream
  • The older adult tech market has been recognized as an opportunity by such companies as Best Buy, Samsung, and Amazon. Medicare Advantage payers now cover some tech.
  • Advances plus smart marketing in hearing tech–one of the top needs in even younger demographics–is disrupting a formerly staid (and expensive)
  • The White House report “Emerging Technologies to Support an Aging Population” [TTA 7 March] first was an acknowledgment of its importance and two, would also serve as a great source document for entrepreneurs and developers.

The study covers the demographics of the older adult market, where they are living, caregiving, the effect of data breaches, optimizing design for this market, the impacts of voice-driven assistants, wearables, and hearables.

Project Nightingale may be singing to some US Senators. The 10 million Ascension Health identified patient records that were transferred in a BAA deal to Google [TTA 14 Nov 19], intended to build a search engine for Ascension’s EHR, continue to be looked into. They went to Google without patient or physician consent or knowledge, with major questions around its security and who had access to the data. A bipartisan group of senators is (finally) looking at this ‘maybe breach’, according to Becker’s. (Also WSJ, paywalled)

Short takes:  b.well scored a $16 million Series A for its software that integrates digital health applications for payers, providers, and employers. The round was led by UnityPoint Health Ventures….Lyft is partnering with Unite Us to provide non-emergency patient transportation to referred health appointments. Unite Us is a social determinants of health (SDOH) company which connects health and community-based social care providers….What happens if you’re a quarantined physician due to exposure to the COVID-19 virus? Use telehealth to connect to patients in EDs or in direct clinic or practice care, freeing up other doctors for hands-on care. 11 March New England Journal of Medicine….American Well is finally no more, long live Amwell. Complete with a little heart-check logo, American Well completed its long journey to a new name, to absolutely no one’s surprise. It was set to be a big reveal at HIMSS, but we know what happened there. Amwell blog, accompanied with the usual long-winded ‘marketing’ rationale They are also reporting a 10 to 20 percent increase in telehealth consults by patients (Becker’s)….Hospitals and health systems such as Spectrum Health (MI), Indiana University Health, Mount Sinai NY, St. Lukes in Bethlehem PA, and MUSC Health, are experimenting with COVID-19 virtual screenings and developing COVID-19 databases in their EHRs. The oddest: Hartford (CT) Healthcare’s drive-through screening center and virtual visit program. Is there an opportunity to cross-market with Wendy’s or Mickey D’s? After all, a burger and fries would be nice for a hungry, maybe sick, patient before they self-quarantine.

Considering 2019’s digital health investment picture: leveling off may be a Good Thing

2019 proved to be a leveling-off year for digital health investment. The bath may prove to be more cleansing than bubbly.

We noted that the always-fizzy Rock Health engaged in some revisionist history on its forecasts when the final numbers came in–$7.4bn in total investment and 359 deals, a 10 percent drop versus 2018. When we looked back at our 2019 mid-year article on Rock Health’s forecast [TTA 25 July], they projected that the year would end at $8.4 bn and 360 deals versus 2018’s $8.2 bn and 376 deals. That is a full $1bn under forecast and $0.8 below 2018. Ouch!

In their account, the 10 percent dip versus 2018 is due to average deal size–decreasing to $19.8M in 2019–and a drop in late-stage deals. Their analysts attribute this to wobbliness around some high-profile IPOs, citing Uber, Lyft, and Slack, as well as the near-collapse of WeWork right before its IPO towards the end of 2019.

New investors and repeat investors increased to 627 from 585 in 2018, with no real change in composition.

The headliners of 2019 were:

  • Amazon’s acquisition of Health Navigator adding symptom-checking tools to its health offerings
  • Google’s buy of Fitbit
  • Optum’s purchase of Vivify Health, which gives it a full remote patient monitoring (RPM) suite (right when CMS is setting reimbursement codes for RPM in Medicare)
  • Best Buy’s addition of Critical Signal Technologies for RPM
  • Phreesia, Livongo’s and Health Catalyst’s IPOs. For Livongo and Health Catalyst, current share prices are off from their IPOs and shortly after: past $25 for LVGO and $31 for HCAT. Phreesia closed today at a healthy $33, substantially up from PHR’s debut at $15. (Change Healthcare, on the other hand, is up a little from its IPO at $16, which isn’t bad considering their circumstances on their financing.)

Rock Health only counts US deals in excess of $2 million, which excludes the global picture, but includes some questionable (in this Editor’s estimation) ‘digital health’ players like Peloton, explained in the 25 July article.

Rock Health’s analysts close (and justify their revisions) through discussions with VCs expecting further headwinds in the market–then turn around and positively note the Federal backing of further developments in building the foundation for connected health as tailwinds. No bubbly forecasts for 2020–we’ll have to wait.

Is this necessarily bad? This Editor likes an occasional dose of reason and is not displeased at Rock Health’s absence of kvelling.

Confirming the picture is Mercom Capital’s analysis which also recorded a 6 percent dip 2019/2018: $8.9bn with 615 deals, dropping from the $9.5bn and 698 deals in 2018. Their ‘catchment’ is more global than Rock Health, and encompasses consumer-centric and patient-centric technologies and sub-technologies. Total corporate funding reached $10.1bn.

News roundup: Proteus may be no-teous, DOJ leads on Google-Fitbit, HHS’ mud fight, Leeds leading in health tech, malware miseries, comings and goings

Proteus stumbles hard, cuts back. The original ‘tattle-tale pill’ company, Proteus Digital Health, plans to lay off 292 people in the San Francisco Bay Area and to permanently close its three Redwood City and Hayward locations, starting 18 January, according to notices sent to California state and local offices, including the state employment development department. It is unclear where Proteus will be located after the closures.

This followed after Proteus failed to launch a twelfth funding round of $100 million. According to reports, they furloughed most of their employees for two weeks in November and are reorganizing. This is after a substantial number of investors have put in about $487M in funding through a Series H (Crunchbase), including a game-changing investment by Novartis dating back to 2010.  Proteus achieved unicorn status about three years ago, but its high-priced pill tracking technology with a pill sensor tracked by a skin-worn monitor reporting into a smartphone has a built-in limited market to expensive medication. Otsuka Pharmaceutical in 2017 partnered with Proteus for an FDA-cleared digital medicine system called Abilify MyCite that basically put an off-patent behavioral drug back into a more expensive tracking methodology. But Proteus remains a great idea on tracking compliance in search of a real market, and may not have much of a future. San Jose Mercury News, CNBC

But ingestible detectable pills are still being tested. On Monday, as Proteus’ bad news broke, eTectRx announced its FDA clearance of the ID-Cap System and its testing at Brigham and Women’s Hospital and Fenway Health, focusing on HIV medication when used for treatment and prevention. Release, HISTalk

Department of Justice taking the lead on scrutinizing Google’s Fitbit acquisition. The Federal Trade Commission also sought jurisdiction over the transaction. According to the New York Post, “both agencies are concerned that a Google-owned Fitbit would give the search giant an even bigger window into people’s private data, including sensitive health information, sources said. Under the Hart-Scott-Rodino Act, all large mergers must file proposals with both the DOJ and the FTC, but only one antitrust agency reviews the merger.”

Coal from stockings being thrown about at HHS. According to POLITICO and the New York Times, the disagreements between Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), and the Cabinet-level Secretary of Health and Human Services (HHS), Alex Azar, have boiled over, enough to have to be settled by the President’s acting chief of staff, Mick Mulvaney. According to the Times, both President Trump and VP Mike Pence have told them to find a way to work together. Both are administration appointees, but President Trump has not been reluctant to cut a mis-performing or overly contrary appointee loose. The latest salvo from those obviously not on Ms. Verma’s side was the revelation that she requested compensation for jewelry stolen on a business trip, contrary to government policy of course. She was compensated for other items which is standard. (Isn’t that what homeowners’ insurance is for? And what sensible person actually travels with valuable jewelry?) Under Ms. Verma, CMS has been quite progressive in developing new business models in Medicare fee-for-service, moving providers to two-sided risk, and innovating in both Medicare and Medicaid. It will either be settled, or one or both will be gone. Pass the popcorn.

Leeds picks up another health tech company. Mindwave Ventures is opening an office there, as well as appointing Dr Victoria Betton and Dr Janak Gunatilleke to the roles of chief innovation officer and chief operating officer. Mindwave develops technologies around digital products and services in healthcare and health research. Leeds reportedly is home to over 250 health tech companies and holds an annual Leeds Digital Festival in the spring [TTA 11 April].

Ransomware attack hits Hackensack Meridian. Systems were down for about a week. While this large New Jersey health system hasn’t admitted it, sources told the Asbury Park Press that it was ransomware. And if it’s not ransomware, its Emotet and Trickbot. Read ZDNet and be very apprehensive for 2020, indeed, as apparently healthcare is just one big target.

Comings and Goings: There may be some end of year bombshells, but after last week’s big news about John Halamka, it’s been fairly quiet. Paul Walker, whom this Editor knew at New York eHealth Collaborative, has joined CommonWell Health Alliance as executive director. Mr. Walker was most recently Philips Interoperability Solutions’ vice president of strategy and business development. CommonWell’s goal is improving healthcare interoperability and its services are used by more than 15,000 care provider sites nationwide. Blog release, Healthcare Innovation ….Dr. Jacqueline Shreibati, the chief medical officer for AliveCor, is joining Google Health in the health research area. Mum’s the word when it comes to Fitbit (see above). CNBC ….Peter Knight has pleaded guilty to falsifying educational credentials to gain his position as chief information and digital office at Oxford University Hospitals NHS Foundation Trust. He held that position from August 2016 until September 2018. BBC News

News roundup: Philips allies with Humana for pop health, Dexcom’s outage outrage, Halamka ankles Lahey for Mayo, Google and NHS Wales changes, Agfa’s health sale, Victrix/WhatsApp, more

Insurer Humana is identifying high-acuity and chronic CHF Medicare Advantage members and deploying two support programs utilizing Philips PERS and remote patient monitoring (RPM) systems. The first program identifies at-risk older people with chronic conditions and offering them Philips Lifeline with AutoAlert, Lifeline’s fall detection technology, and their CareSage predictive analytics. Philips Lifeline is already offered in select Humana Medicare Advantage plans. The second is a pilot with telehealth RPM to monitor a select group of CHF patients. This will use a Philips interactive tablet and connected measurement devices for care teams to actively monitor congestive heart failure patients. The rationale in the press release is centered on population health management, quality of care, and positively influencing patient outcomes, with “more efficient resource utilization” a/k/a lowering cost of care. Philips release.

Health tech is great, when it works–and Dexcom found out how serious it can get when it doesn’t. Dexcom, a continuous glucose monitoring system, experienced a server outage over the US Thanksgiving holiday weekend into Monday. It knocked out its updates in the Follow feature, frequently used by parents to monitor Type 1 diabetic children, and those with artificial pancreas devices that adjust insulin based on monitored BG levels. Dexcom was not only blasted by users on the server outage, which they attributed to ‘overload’, but also on its communications of the problem to users which depended on Facebook postings and not on real-time direct contacts or messaging. It was a ‘big surprise’ to their CEO, who also dismissed the possibility of a data breach, which seems a bit premature. Both Google and Microsoft provide cloud and tech services to Dexcom. CNBC 12/2, 12/3

Comings and goings: HIT pioneer, strategist, and general guru John Halamka is following the AI Star, leaving Boston’s Beth Israel Lahey Health to head up a machine learning/AI initiative at the Mayo Clinic in Minneapolis. Mayo this fall announced a 10-year high-level partnership with Google Cloud to store patient data and analysis. Modern Healthcare  According to the Healthcare IT News article, he’ll be returning on weekends to the Bay State to his 250-acre working farm….Also moving on to Google Health is Facebook’s Hema Budaraju, a product management director. Business Insider has annoyingly hid the news behind its paywall, leading to speculation in Mobihealthnews that she will be engaged in Google’s “social and environmental impact” efforts as she was at FB…And speaking of Google, founders Larry Page and Sergey Brin are stepping down at long last from active management. Google CEO Sundar Pichai will now be running Google and its corporate parent, Alphabet. See their letter on the GoogleBlog.DigitalHealth reports on changes at the NHS Wales Informatics Service. Helen Thomas is now interim director as NWIS director Andrew Griffiths is departing this month. NWIS is also transitioning to a new Special Health Authority….Agfa’s Healthcare Information Solutions and Integrated Care, plus their imaging division, are definitely going to Italy’s Dedalus Holdings S.p.A. for €975 million. It awaits approval from various authorities, their employee groups, and the usual closing conditions. Release, DigitalHealth.

UK healthcare analytics company Victrix Socsan has signed a licensing agreement last month with WhatsApp. Victrix will use Whats App for communications with beneficiaries as part of their furnishing proactive preventive care services and provide secure information. Release.

Google’s ‘Project Nightingale’–a de facto breach of 10 million health records, off a bridge too far?

Breaking News. Has this finally blown the lid off Google’s quest for data on everyone? This week’s uncovering, whistleblowing, and general backlash on Google’s agreement with Ascension Health, the largest non-profit health system in the US and the largest Catholic health system on the Planet Earth, revealed by the Wall Street Journal (paywalled) has put a bright light exactly where Google (and Apple, Facebook, and Amazon), do not want it.

Why do these giants want your health data? It’s all about where it can be used and sold. For instance, it can be used in research studies. It can be sold for use in EHR integration. But their services and predictive data is ‘where it’s at’. With enough accumulated data on both your health records and personal life (e.g. not enough exercise, food consumption), their AI and machine learning modeling can predict your health progression (or deterioration), along with probable diagnosis, outcomes, treatment options, and your cost curve. Advertising clicks and merchandising products (baby monitors, PERS, exercise equipment) are only the beginning–health systems and insurers are the main chance. In a worst-case and misuse scenario, the data modeling can make you look like a liability to an employer or an insurer, making you both unemployable and expensively/uninsurable in a private insurance system.

In Google’s latest, their Project Nightingale business associate agreement (BAA) with Ascension Health, permissible under HIPAA, allowed them apparently to access in the initial phase at least 10 million identified health records which were transmitted to Google without patient or physician consent or knowledge, including patient name, lab results, diagnoses, hospital records, patient names and dates of birth. This transfer and the Google agreement were announced by Ascension on 11 November. Ultimately, 50 million records are planned to be transferred from Ascension in 21 states. According to a whistleblower on the project quoted in The Guardian, there are real concerns about individuals handling identified data, the depth of the records, how it’s being handled, and how Google will be using the data. Ascension doesn’t seem to share that concern, stating that their goal is to “optimize the health and wellness of individuals and communities, and deliver a comprehensive portfolio of digital capabilities that enhance the experience of Ascension consumers, patients and clinical providers across the continuum of care” which is a bit of word salad that leads right to Google’s Cloud and G Suite capabilities.

This was enough to kick off an inquiry by Health and Human Services (HHS). A spokesperson confirmed to Healthcare Dive that “HHS’ Office of Civil Rights is opening an investigation into “Project Nightingale.” The agency “would like to learn more information about this mass collection of individuals’ medical records with respect to the implications for patient privacy under HIPAA,” OCR Director Roger Severino said in an emailed statement.”

Project Nightingale cannot help but aggravate existing antitrust concerns by Congress and state attorneys general on these companies and their safeguards on privacy. An example is the pushback around Google’s $2.1 bn acquisition of Fitbit, which one observer dubbed ‘extraordinary’ given Fitbit’s recent business challenges, and data analytics company Looker. DOJ’s antitrust division has been looking into how Google’s personalized advertising transactions work and increasingly there are calls from both ends of the US political spectrum to ‘break them up.’ Yahoo News

Google and Ascension Health may very well be the ‘bridge too far’ that curbs the relentless and largely hidden appetite for personal information by Google, Amazon, Apple, and Facebook that is making their very consumers very, very nervous. Transparency, which seems to be a theme in many of these articles, isn’t a solution. Scrutiny, oversight with teeth, and restrictions are.

Also STAT News , The Verge on Google’s real ambitions in healthcare, and a tart take on Google’s recent lack of success with acquisitions in ZDNet, ‘Why everything Google touches turns to garbage’. Healthcare IT News tries to be reassuring, but the devil may be in Google’s tools not being compliant with HIPAA standards.  Further down in the article, Readers will see that HIPAA states that the agreement covers access to the PHI of the covered entity (Ascension) only to have it carry out its healthcare functions, not for the business associate’s (Google’s) independent use or purposes. 

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

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

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

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

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

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

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

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

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

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

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

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

DeepMind loses its Health to Google. DeepMind, the London-based AI developer acquired by Alphabet (Google) in 2014, no longer has a Health division. This group will be absorbed by Google Health, now headed by ex-Geisinger CEO David Feinberg. The former DeepMind health team will continue to be headed by former NHS surgeon Dr Dominic King, who will remain in London along with about 100 reported staffers, at least for now.

DeepMind’s major health initiative is Streams, an AI-powered mobile app that analyzes potential deterioration in patients and alerts nurses and doctors, saving time. It also monitors vital signs and integrates different types of data and test results from existing hospital IT systems. Streams is currently deployed at Royal Free NHS Foundation Trust Hospital in north London for acute kidney injury. The rollout is expected to be made at Imperial College Healthcare NHS Trust, Taunton and Somerset NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust. It is expected that test partners will be found outside of the UK.

DeepMind’s other health initatives and research include fast eye disease detection, planning cancer radiotherapy treatment in seconds rather than hours; and detecting patient deterioration from electronic records.

Google Health is now expanding into products and research into digital technologies which was to be expected with Dr Feinberg on board. Currently, its revenue stream consists of advertising and search.

The remainder of DeepMind not engaged with health will remain independent. CNBC, DeepMind blog

News roundup: Walmart and Microsoft AI, are derm apps endangering public with 88% skin cancer diagnosis?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”150″ /]Walmart and Microsoft partner to change the retail experience via AI. The five-year agreement will switch over applications to the cloud and will affect shipping and supply chain. It’s projected in Healthcare Dive that the impact will be in healthcare as well. Microsoft announced last month that it is forming a unit to advance AI and cloud-based healthcare tools. The landscape is under extreme pressure in retail and healthcare delivery, and Walmart needs to ready for future moves which will certainly happen. Walmart is rumored to be interested in acquiring Humana and is currently working with Emory Healthcare in Atlanta. Then there is CVS-Aetna, Cigna-Express Scripts, Google, and (looming above all) Amazon. (Though you can tuck all the years of Amazon’s profits into one year of Walmart’s.)

The ITV News headline grabs attention — but are dermatology apps really endangering the public when teledermatology can help diagnose 88 percent of people with skin cancer and 97 percent of those with benign lesions? A University of Birmingham-led research team did a metastudy of the literature and found three failings: “a lack of rigorous published trials to show they work and are safe, a lack of input during the app development from specialists to identify which lesions are suspicious and flaws in how the technology analyses photos” particularly for scaly or non-pigmented melanomas. But did access to these apps encourage early diagnosis which can lead to up to 100 percent five-year survival? Of course review is required as recommended by the study, but this last factor was not really examined at the British Association of Dermatologists’ annual meeting in Edinburgh. University of Birmingham release with study abstract

Google’s ‘Medical Brain’ tests clinical speech recognition, patient outcome prediction, death risk

Google’s AI division is eager to break into healthcare, and with ‘Medical Brain’ they might be successful. First is harnessing the voice recognition used in their Home, Assistant, and Translate products. Last year they started to test a digital scribe with Stanford Medicine to help doctors automatically fill out EHRs from patient visits, which will conclude in August. Next up, and staffing up, is a “next gen clinical visit experience” which uses audio and touch technologies to improve the accuracy and availability of care.

The third is research Google published last month on using neural networks to predict how long people may stay in hospitals, their odds of re-admission and chances they will soon die. The neural net gathers up the previously ungatherable–old charts, PDF–and transforms it into useful information. They are currently working with the University of California, San Francisco, and the University of Chicago with 46 billion pieces of anonymous patient data. 

A successful test of the approach involved a woman with late-stage breast cancer. Based on her vital signs–for instance, her lungs were filling with fluid–the hospital’s own analytics indicated that there was a 9.3 percent chance she would die during her stay. Google used over 175,000 data points they saw about her and came up with a far higher risk: 19.9 percent. She died shortly after.

Using AI to crunch massive amounts of data is an approach that has been tried by IBM Watson in healthcare with limited success. Augmedix, Microsoft, and Amazon are also attempting AI-assisted systems for scribing and voice recognition in offices. CNBC, Bloomberg

Contact lenses as a drug delivery system take home MIT Sloan Healthcare prize

This Editor has been covering contact lenses in health tech since at least 2013–contact lenses that detect glucose for diabetics (Google/Novartis/Alcon), eye pressure (Sensimed), and even detect multiple diseases (Oregon State University). None to date have made it into commercial release.

Here’s another try, this time from this year’s winner of the MIT Sloan Healthcare Innovation Prize competition. Theraoptix won the $25,000 grand prize, sponsored by Optum. The lenses are designed to deliver eye medication on a time release basis using a thin polymer film formed into a tiny circular strip sandwiched into the lens material. They can be worn for up to two weeks to slowly but constantly deliver drugs in the treatment of diseases like glaucoma or after surgery. It can also deliver drugs effectively for back of the eye treatment of macular degeneration, diabetic retinopathy, retinal vein occlusion, and similar diseases that today require in-office injections.

Theraoptix was developed by Lokendra Bengani Ph.D. of the Schepens Eye Research Institute of the Massachusetts Eye and Ear Infirmary. It was based on core technology by ophthalmologist Joseph B. Ciolino MD, who is Dr. Bengani’s mentor. We wrote about Dr. Ciolino’s research previously [TTA 7 Sept 16] including a look back at contact lens research. There were seven other finalists, of which the most interesting to this Editor was Kinematics shoe insole sensors for gait detection analysis (and fall prevention).  MIT News

Is Uber fit to deliver healthcare transport? Healthcare organizations may want to check.

Healthcare-related organizations have codes of conduct pertaining to suppliers. Does Uber meet compliance standards? As we reported a few days ago in our article on the burgeoning area of non-emergency medical transport (NEMT) [TTA 9 Mar], Uber Health’s debut with a reputed 100 healthcare organizations has led this Editor to a further examination of Uber, the organization. Uber has had a hard time staying out of the headlines–and the courts–in the past two years, in matters which might give healthcare partners pause.

  • On 21 Nov, Uber reported that the personal data of 57 million users, including 600,000 US drivers, were breached and stolen in October 2016–a full year prior. Not only was the breach announcement delayed by over a year, but also in that year it was made to go away by Uber’s paying off the hacker. Reuters on 6 December: “A 20-year-old Florida man was responsible for the large data breach at Uber Technologies Inc [UBER.UL] last year and was paid by Uber to destroy the data through a so-called “bug bounty” program normally used to identify small code vulnerabilities, three people familiar with the events have told Reuters.” The payment was an extraordinary $100,000. “The sources said then-CEO Travis Kalanick was aware of the breach and bug bounty payment in November of last year.” The Reuters article goes further into the mechanism of the hack. It eventually led to the resignation of their chief security officer, former Facebook/eBay/PayPal security head Joe Sullivan, who ‘investigated’ it using encrypted, disappearing messaging apps. Atlantic.
  • CEO and co-founder Travis Kalanick was forced to resign last June after losing the confidence of the company’s investors, in contrails of financial mismanagement, sexual harassment, driver harassment, and ‘bro culture’. This included legal action over Uber’s 2016 acquisition of self-driving truck startup Otto, started by former Googlers who may or may not have lifted proprietary tech from Google before ankling. These are lavishly outlined in Bloomberg and in an over-the-top article in Engadget (with the usual slams at libertarianism). Mr. Kalanick remains on the board and is now a private investor.
  • The plain fact is that Uber is still burning through funds (2017: $1bn) after raising $21.1bn and its valuation has suffered. The new CEO Dara Khosrowshahi, who earlier righted travel site Expedia, has a tough pull with investors such as SoftBank and Saudi Arabia’s Public Investment Fund. Also Mashable.

Healthcare and NEMT, as noted in our earlier article, are a strong source of potential steady revenue through reimbursement in Medicare Advantage and state Medicaid programs, which is why both Uber and Lyft are targeting it. The benefits for all sides–patients, practices, these companies, sub-contractors, and drivers–can be substantial and positive in this social determinant of health (SDOH).  

Healthcare organizations, especially payers, have strict codes of compliance not only for employees and business practices but also for their suppliers’ practices. Payers in Medicare Advantage and Medicaid are Federal and state contractors. While Uber under its new CEO has shown contriteness in acknowledging an organization in need of righting its moral compass (CNBC), there remains the track record and the aftermath. Both deserve a closer look and review.

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