Next DHACA Day 9th July, London – seeking new members (psst–it’s free)

DHACA, the Digital Health and Care Alliance, with some 850 members currently, is having a new membership drive among SMEs working in the UK’s digital health & care space, following the kind offering of new sponsorship by Kent Surrey and Sussex AHSN and UCL Partners. 

The organisation’s objective is to help members develop their innovative products and services commercially, to achieve successful sales to the NHS. DHACA works right across the UK.

If you aren’t a member, you can sign up here to ensure you are kept aware of important news and of DHACA events. Membership is entirely free and members’ details will of course never be passed on to any other organisation.

Whether or not you are currently a member, booking is now open for the next DHACA Day. This event is primarily aimed at informing members working in the digital health & care sector of the major recent changes they need to be aware of, and how best to navigate them to make greater sales to the NHS and other health & care organisations. There is a small charge of £30+VAT to provide lunch, otherwise all other costs will kindly be covered by the event Sponsors, Baker Botts, in whose premises at 41 Lothbury (the opposite side of the Bank of England to the Bank Tube) it will be held.

The draft agenda includes talks by Luke Pratsides, Clinical Lead, Digital Development, NHS England about NHSX, Sam Shah, Director of Digital Development at NHS England and James Maguire, Clinical Advisor in Digital Innovation & AI at NHSX on NHS England’s digital development strategy, Mark Salmon, Programme Director, NICE on their HealthTech Connect and Evidence Standards, Neil Foster, Partner, Baker Botts on Finance for digital health start-ups, Neil Coulson, Partner, Baker Botts, on IP protection and the GDPR, Rob Berry, Commercial Director, UCL Partners on how the AHSNs can help SMEs and much more. Neil McGuire, Clinical Director of Devices, MHRA, has also been invited to update attendees on MDR implementation – a most important topic.

DHACA is keen to get members’ views on how they’d like it to be organised and governed in order to deliver what members want, so there will be time in the middle of the day for this too.

Should be a great day!

(Disclosure: this Editor is also DHACA CEO) 

 

Events, dear friends, events in London from painting to leadership

‘Framing the Future’, Paintings in Hospitals 60th Anniversary. Monday 13 May at 6pm, Royal College of Physicians

What is the past, present and future role of arts in health? Considering the past pioneers and future innovations of visual arts in health and social care is a panel including Edmund de Waal OBE (artist and author), Dr Errol Francis (CEO of Culture&), Dr Val Huet (CEO of the British Association of Art Therapists), Prof. Victoria Tischler (Professor of Arts and Health at the University of West London) and Ed Vaizey MP (Chair of the All-Party Parliamentary Group on Arts, Health and Wellbeing). This event is waitlisted, but was fascinating enough to warrant a mention.

HealthChat with Ruth May, Chief Nursing Officer for England, Thursday 23 May at 5.30pm, The King’s Fund

Organized by UK Health Gateway, this evening with Ms. May will delve into issues such as workforce, her priorities, and how she will unite nurses in planning for the future? Tickets through Eventbrite are £19.95 – £39.95.

HealthChat with Rashik Parmar MBE. Monday 10 June at 5.30pm, The King’s Fund

Organized by UK Health Gateway, this evening with Mr. Parmar who is a Fellow of IBM, the leader of IBM’s European technical community and an IBM Distinguished Engineer will be about technology, data mapping, and AI. Tickets through Eventbrite are  £19.95 – £39.95.

Hat tip to Roy Lilley and his NHSManagers.net newsletter for the above three events

Ninth annual leadership and management summit. Wednesday 10 July starting 8am for the full day. The King’s Fund

The King’s Fund’s annual leadership event is for senior leaders in health and care organizations across the public, private and third sectors. Topics will be centered on leadership capabilities and cultures that enable teams to deliver better patient care and value for money, while also delivering continuous improvements to population health. Speakers include the Rt Hon Matt Hancock MP and Simon Stevens, CEO of NHS England. More information and registration here.

 

It’s NICE to HealthTech Connect with the NHS

The National Institute for Health and Care Excellence (NICE) launched last week a resource for a wide range of health care technologies to gain traction in the UK. NICE’s HealthTech Connect is a free portal for companies and developers that enables “companies to understand what information is needed by decision makers in the UK health and care system, and clarify possible routes to market access.” It centralizes information on companies who enter their information for consideration by organizations which are seeking technologies or offering support such as funding, market access, and evaluation.

For this ‘single point’ initiative, NICE has brought on an impressive roster of partners and funders in England, Scotland, and Wales including NHS England, NHS Supply Chain, the NIHR Innovation Observatory, the AHSN Network, Office for Life Sciences, MHRA, and NHS Clinical Commissioners. Over 100 companies registered on the site, with 13 technologies submitted, since a soft launch in January. Already one company, Sonata System/Gynesonics, has been selected for a Medtech Innovation Briefing. HealthTech Connect will also facilitating fast tracking within the Accelerated Access Collaborative. NICE release, Mobihealthnews

Smartphone-based ECG urged for EDs to screen for heart rhythm problems: UK study

A UK study of patients reporting heart palpitations at Emergency Departments (EDs) compared the use of standard care at the ED versus standard care plus the use of a smartphone-based ECG (EKG) event recorder (the AliveCor KardiaMobile) to determine whether symptomatic heart rhythms were present. Often heart palpitations are transitory and triggered by stress or too much coffee, but may indicate a larger problem such as atrial fibrillation which can cause stroke, or other types of cardiac disease.

Researchers from the University of Edinburgh and NHS Lothian conducted the trial over 18 months in 10 UK hospital EDs, with a total patient group of 243. The intervention group was given a KardiaMobile and told to activate it if palpitations were felt, with results sent to a doctor. 69 of 124 reported symptomatic rhythm using the AliveCor device over 90 days versus 11 in the control group of 116. Reporting was over four times faster: the mean detection time was 9.5  days in the intervention group versus 42.9 days in the control group.

The study was funded by research awards from Chest, Heart and Stroke Scotland (CHSS) and British Heart Foundation (BHF) which included funding for purchasing the AliveCor devices. NHS England has issued statements included in the BBC News article on how they have issued AliveCor devices to “GP practices across the country as part of the Long Term Plan commitment to prevent 15,000 heart attacks, strokes and cases of dementia.” Retail pricing is US $99 and UK £99. EClinical Medicine (study) Hat tip to the always dapper David Albert, MD of AliveCor

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

WannaCry’s anniversary: have we learned our malware and cybersecurity lessons?

Hard to believe that WannaCry, and the damage this malware wreaked worldwide, was but a year ago. Two months later, there was Petya/NotPetya. We’ve had hacking and ransomware eruptions regularly, the latest being the slo-mo malware devised by the Orangeworm hackers. What WannaCry and Petya/NotPetya had in common, besides cyberdamage, was they were developed by state actors or hackers with state support (North Korea and–suspected–Russia and/or Ukraine).

The NHS managed to evade Petya, which was fortunate as they were still repairing damage from WannaCry, which initially was reported to affect 20 percent of NHS England trusts. The final count was 34 percent of trusts–at least 80 out of 236 hospital trusts in England, as well as 603 primary care practices and affiliates. 

Has the NHS learned its lesson, or is it still vulnerable? A National Audit Office report concluded in late October that the Department of Health and the NHS were warned at least a year in advance of the risk.  “It was a relatively unsophisticated attack and could have been prevented by the NHS following basic IT security best practice.” There was no mechanism in place for ensuring migration of Windows XP systems and old software, requested by April 2015, actually happened. Another basic–firewalls facing the internet–weren’t actively managed. Worse, there was no test or rehearsal for a cyberdisruption. “As the NHS had not rehearsed for a national cyber attack it was not immediately clear who should lead the response and there were problems with communications.” NHS Digital was especially sluggish in response, receiving first reports around noon but not issuing an alert till 5pm. It was fortunate that WannaCry had a kill switch, and it was found as quickly as it was by a British security specialist with the handle Malware Tech. 

Tests run since WannaCry have proven uneven at best. While there has been reported improvement, even head of IT audit and security services at West Midlands Ambulance Service NHS Trust and a penetration tester for NHS trusts, said that they were “still finding some real shockers out there still.” NHS Digital deputy CEO Rob Shaw told a Public Accounts Committee (PAC) in February that 200 NHS trusts tested against cyber security standards had failed. MPs criticized the NHS and the Department of Health for not implementing 22 recommendations laid out by NHS England’s CIO, Will Smart. Digital Health News

Think ‘cyber-resilience’. It’s not a matter of ‘if’, but ‘when’. Healthcare organizations are never going to fix all the legacy systems that run their world. Medical devices and IoT add-ons will continue to run on outdated or never-updated platforms. Passwords are shared, initial passwords not changed in EHRs. Add to firewalls, prevention measures, emphasizing compliance and best practices, security cyber-resilience–more than a recovery plan, planning to keep operations running with warm backups ready to go, contingency plans, a way to make quick decisions on the main functions that keep the business going. Are healthcare organizations–and the NHS–capable of thinking and acting this way? WannaBet? CSO, Healthcare IT News. Hat tip to Joseph Tomaino of Grassi Healthcare Advisors via LinkedIn.

Health tech for stroke prevention and rehab from Kardia Mobile, Watch BP, Northwestern U (UK/US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/02/Northwestern-stroke-patch.jpg” thumb_width=”150″ /]Is stroke avoidable? We know it is an expensive medical event at $20-23,000 for hospitalization alone (NIH), which does not count rehabilitation or the devastation to individuals and their families, including loss of ability and work. NHS England is testing two devices, the Kardia Mobile and Watch BP, with an eye to preventing stroke in those vulnerable to it. 6,000 devices are being distributed to GP practices in England in a program through 15 NHS and care innovation bodies known as Academic Health Science Networks (AHSNs). The Alivecor‘s Kardia Mobile is a smartphone add-on clip that captures a medical-grade ECG in 30 seconds, stores, and sends readings to physicians. The application to stroke is primarily in atrial fibrillation (AF) and irregular heart rhythms, which according to statistics, more than 420,000 people across England have. Watch BP is a blood pressure cuff device which is also equipped with an AF detection system. The goal of the project is to identify 130,000 new cases of AF over two years, to prevent at least 3,650 strokes and potentially save 900 lives. Savings to NHS are being estimated at £81 million annually. Digital Health News

Post-stroke rehabilitation treatment is also being boosted by a new device developed at Northwestern University and being tested at the Shirley Ryan AbilityLab, a Chicago research hospital. It is a Band-Aid® like device which can be applied to key areas such as the throat (left above, credit AbilityLab), chest, or limbs to send back information to doctors on how a patient in treatment post-discharge, especially at home, progresses. The sensors and platform measure heart activity, muscle movement, sleep quality, swallowing ability, and patterns of speech. Especially revolutionary is the monitoring of speech communication and swallowing, which are often impaired in stroke patients but hard to track once the patient is out of a facility. The team’s research was presented last week at the American Association for the Advancement of Science (AAAS) annual meeting. New Atlas. Hat tip to Toni Bunting.

Telehealth alternatives to in-person consultation found lacking in effectiveness: Alt-Con Study (UK)

It needs work and can’t be top down. That’s the conclusion of the Alt-Con Project and its researchers from several UK universities: Warwick, Bristol, Oxford (Nuffield) and Edinburgh. After examining the use of technological alternatives to GP consultations in eight general practices, they found that there were significant barriers to implementation, including insufficient training of non-clinical staff on these approaches’ benefits. The study includes recommendations to guide a more effective implementation.

Practices have been slow to adopt tech alternatives to F2F consults using telephone, email, e-consultation systems, and online video, despite NHS encouragement and programs such as the GP Access Fund. The paradox is that time devoted to non-F2F consults cuts into GPs time seeing live patients in the office.

  • They were adopted without a clear rationale or clearly thinking through cost-benefit for patients and practice staff.
  • Professor Sue Ziebland from Nuffield found that “…practices introduced alternative consultation methods for very different reasons and to solve problems that the practice had identified. These included a failure to be modern, to work more efficiently, to better serve commuters or dispersed populations, and to ensure appointments were available to those who needed them most.”
  • Other reasons: “the acknowledgment that the previous system was broken and unethical in providing a first-come, first-served system that left patients without appointments that they needed, and “the recognition that reception staff and phone lines were overwhelmed.”
  • Noted by other researchers were that ‘one-size-fits-all’, policy and financial incentive driven approaches were “not the best way forward”.

The study looked at GP practices of different sizes (1,938 to 18,353) covering over 85,000 patients, located in different geographic areas of England (6) and Scotland (2) including urban and rural areas, and with a mixture of patients’ socioeconomic status. 45 staff members and 39 patients were interviewed over eight months.

The University of Bristol Centre for Academic Primary Care has published a web page based on the Alt-Con research, offering guidance for GP practices. 

NHS England’s rejoinder: ‘This is a tiny study based on data that is almost two years old. Online consultations offer a convenient alternative to face-to-face appointments and patients are already seeing the benefits.’ Nuffield Department of Primary Care release, British Journal of General Practice, Daily Mail  Hat tip to former TTA Ireland editor Toni Bunting

Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots

Do they really work to change behavior? Studies for the past seven or so years have debated efficacy; a quick search online will show you a wealth of articles with findings on both sides. We know healthcare-related (consumer behavior and professional apps) are growing like weeds after rain– over 320,000 mobile, wearable, and IoT health apps were available for use in 2017, with 200 added daily (Research2Guidance, IQVIA estimates). But qualitatively, the jury is out.

Three studies published in the last two months come somewhere in the middle.

Obesity and weight loss: A telemedicine-based 12 week study from California State University found that the combination of a secure mobile phone-based platform for data tracking and video conferencing with the research team, plus meeting with the medical doctor once per month, and weekly with a registered dietitian worked to clinical standards, ≥5% of initial body weight loss over six months, for 69 percent of the telemedicine participants (n=13) versus 8 percent in the control group (n=12). Note the substantial hands-on human support each of the 13 participants received. Journal of Telemedicine and Telecare, Clinical Innovation & Technology

Activity monitoring not effective unless users set goals: A 400-person study performed by researchers from the Oregon Health & Science University (OHSU) School of Medicine and their Knight Cardiovascular Institute found that when people used such monitors and apps without a specific goal in mind, their physical activity declined and their heart health did not improve, even if 57 percent thought it did. The subjects, primarily office workers at one site, wore a Basis Peak band for about five months. To gauge heart health, the researchers also tracked multiple indicators of cardiac risk: body mass index, cholesterol, blood pressure and HbA1C. Cardiac risk factors did not change. However, the corresponding author, Luke Burchill MD PhD, told EurekAlert (AAAS) that when paired with specific goals, the trackers could be powerful tools for increasing physical activity. The original study published in the British Journal of Sports Medicine doesn’t go quite that far. 

But it’s great for your morale, especially if you pay for it: A Brigham Young University study published in JMIR MHealth and UHealth (August) confirmed that physical activity app usage in the past 6 months resulted in a change in respondents attitudes, beliefs, perceptions, and motivation. This study’s purpose was to track engagement factors such as likeability, ease of engagement, push prompts, and surprisingly, price–that higher-priced apps had greater potential for behavior change. Possible reasons were that the apps provide additional features or have higher quality programming and functionality. (And user investment?)

One growing area for apps is mental health, where the metrics are solidly behavioral and the condition is chronic. The UK’s National Institute for Health and Care Excellence (NICE) has moved forward in favor of piloting them with NHS England. The latest is one from Germany, Deprexis, that uses texts, emails, questionnaires, and cognitive behavioral therapy to give feedback to users. It also has tools to relax users through audio and visual programs. NICE recommends therapist guidance for the trial. According to Digital Health News, NICE is recommending it should be trialed for up to two years in at least two of the specialist services that were set up to improve access to psychological therapies. Again, cost is a factor in rolling out but others are access to care and freeing up therapist time. The organization also plans to review up to 14 digital programs to treat anxiety and depression over the next three years.

Hat tip to Toni Bunting for much of the above

For further reference: The 2017 R2G mHealth App Developer Economics 2017 study has been released and is available for free download here. The 2017 study surveyed 2,400 mHealth developers and practitioners. (Disclosure: TTA was a media sponsor for the study.)

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’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? Is Carillion’s collapse a spanner in the works?

NHS England won’t be rolling out the Babylon Health ‘GP at hand’ service anytime soon, despite some success in their London test with five GP practices [TTA 12 Jan]. Digital Health cites an October study by Hammersmith and Fulham CCG (Fulham being one of the test practices) that to this Editor expresses both excitement at an innovative approach but with the same easy-to-see drawback:

The GP at Hand service model represents an innovative approach to general practice that poses a number of challenges to existing NHS policy and legislation. The approach to patient registration – where a potentially large volume of patients are encouraged to register at a physical site that could be a significant distance from both their home and work address, arguably represents a distortion of the original intentions of the Choice of GP policy. (Page 12)

There are also concerns about complex needs plus other special needs patients (inequality of service), controlled drug policy, and the capacity of Babylon Health to expand the service. Since the October report, a Babylon spokesperson told Digital Health that “Commissioners have comprehensively signed off our roll-out plan and we look forward to working with them to expand GP at Hand across the country.” 

Re capitation, why ‘GP at hand’ use is tied into a mandatory change of GP practices has left this Editor puzzled. In the US, telemedicine visits, especially the ‘I’ve got the flu and can’t move’ type or to specialists (dermatology) are often (not always) separate from whomever your primary care physician is. Yes, centralizing the records winds up being mostly in the hands of US patients unless the PCP is copied or it is part of a payer/corporate health program, but this may be the only way that virtual visits can be rolled out in any volume. In the UK, is there a workaround where the patient’s electronic record can be accessed by a separate telemedicine doctor?

Another tech head-shaker: 45 percent of GPs want technology-enabled remote working. 48 percent expressed that flexible working and working from home would enable doctors to provide more personalized care. Allowing remote working to support out-of-hours care could not only free up time for thousands of patient appointments but also level out doctor capacity disparities between regions. The survey here of 100 GPs was conducted by a cloud-communications provider, Sesui. Digital Health. This is a special need that isn’t present in the US except in closed systems like the VA, which is finally addressing the problem. The wide use of clinical connectivity apps enables US doctors to split time from hospital to multiple practices–so much so on multiple devices, that app security is a concern. 

Another head-shaker. 48 percent of missed NHS hospital appointments are due to letter-related problems, such as the letter arriving too late (17 percent), not being received (17 percent) or being lost (8 percent). 68 percent prefer to manage their appointments online or via smartphone. This preference has real financial impact as the NHS estimates that 8 million appointments were missed in 2016-2017, at a cost of £1bn. Now this survey of 2,000 adults was sponsored by Healthcare Communications, a provider to 100 NHS trusts with patient communications technology, so there’s a dog in the hunt. However, they developed for Barnsley Hospital NHS Foundation Trust a digital letter technology that is claimed to reduce outpatient postal letters by 40 percent. Considering my dentist sends me three emails plus separate text messages before my twice-yearly exam…. Release (PDF).

Roy Lilley’s daily newsletter today also engages the Tech Question and the “IT desert” present in much of the daily life of the NHS. Trusts are addressing it, junior doctors are WhatsApping, and generally, clinicians are hot-wiring the system in order to get anything done. It is much like the US about five to seven years ago where US HHS had huge HIPAA concerns (more…)

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. 

(more…)

NHS, Public Health England testing multiple digital health devices for obesity, diabetes

NHS England, Public Health England, and Diabetes UK launched a pilot, announced on World Diabetes Day on 14 November, to test various digital health approaches to controlling obesity and Type 2 diabetes. Approximately 5,000 patients will be recruited for a test period of up to one year. Multiple apps, gadgets, wristbands, and other digital devices to measure their results against goals will be tested,  combined with health coaching and online support groups. NHS is also offering to some wearable devices which record activity levels and receive motivational messages and prompts. 

The test will use products and services from five companies and the patients will be recruited from eight areas of the country. The companies, programs, and tools are:

  • Hitachi – Smart Digital Diabetes Prevention program combines an online portal + coaching
  • Buddi Nujjer – a wristband which monitors the user’s activity, sleep patterns and eating frequency, paired with a smartphone application
  • Liva Healthcare – 12 months of a dedicated coach starting with a personal face-to-face meeting. The Liva platform and patient app supports the patient with smart goal setting and plans, lifestyle tracking, video communication, and online peer to peer support.
  • Oviva – An eight-week intensive lifestyle intervention with an experienced dietitian providing personalized advice and support.
  • OurPath – A six-week mobile and desktop digital program with structured education on healthy eating, sleep, exercise and stress management.

The pilot builds on Healthier You: The NHS Diabetes Prevention Programme, launched last year to support people who are at high risk of developing Type 2 diabetes. This adds digital tools to a coaching-intensive, educational, and activity-oriented program. Public Health England also has the Active 10 app, which encourages at least 10 minutes of daily brisk walking. NHS press release, Digital Health

How *does* the NHS get funded and work? The King’s Fund pulls it together for you.

Confused on how a CCG (clinical commissioning group) is funded? Mystified about the relationship between local authorities and the NHS? Updated last month, The King’s Fund’s handy organograms (US=org chart) explain the formal organization of the NHS, how it is funded by Parliament, and the relationships between entities. The slides are downloadable. There are also two six-minute videos that tackle how NHS and NHS England work. See this page also for links to content on local service design, governance, and regulation, plus NHS finances. How is the NHS structured?

Tender Alert: advance notice for NHS England ACS-STP Innovation Framework

Susanne Woodman, our Eye on Tenders, has located another NHS England prior information notice for healthcare technology services. This is for Sustainability and Transformation Partnerships (STPs) and Accountable Care Systems (ACS) for building services around population needs, improving outcomes and quality of care. NHS is seeking “a ‘one stop shop’ framework and contracting vehicle to allow STP and ACS partners to more easily source a range of transformation support.” A description is under VI.3) Additional information. Interested suppliers must register via the NHS Bravo portal at https://nhsengland.bravosolution.co.uk/web/login.html–Bravo will be used to issue further information to interested suppliers. Estimated date of publication of contract notice is 8 December. Tenders Electronic Daily-TED.

Tender Alert: advance notice for NHS England/Leeds online consultation system

Susanne Woodman, our Eye on Tenders, has offered Readers a ‘heads up’ on a future tender for NHS England in Leeds. This is for the establishment of a national dynamic purchasing system (DPS) for the procurement of online consultation systems. According to the listing on Tenders Electronic Daily–TED, the DPS will allow NHS contracting bodies (e.g. CCGs and GPs) to procure online consultation systems in a robust and compliant way on a regional/local basis. “Online consultation is also increasingly a key part of patient pathways in urgent care, and the 111 Online programme seeks to connect patients to urgent care settings following a digital triage….to bring together a seamless experience for patients bridging primary and urgent care needs.”

This initial expression of interest is to gather information on the opportunity and to give interested parties the opportunity to ask clarification questions about the process. Deadline is 19 November for this information gathering exercise. Download any associated documentation via the In-Tend e-procurement system via the following link: https://in-tendhost.co.uk/scwcsu/aspx/Home. This may be part of an eventual investment of £45 million towards the purchase of online consultation systems.