News roundup UK, AU, NZ: BMA England’s concerns on digital medical records; Australia and NZ’s health connectivity initiatives advance

November 3, 2022 | by

The British Medical Association (BMA) has expressed several concerns on NHS England’s ‘Data Saves Lives’ patient record access that is part of the NHS Long Term Plan and ‘Data Saves Lives’ Data Strategy. Data Saves Lives requires practices to offer, effective 1 November, patients aged 16+ access to their health records at their GP. Practices were notified back in April of the access available to them starting with care as of 1 November. The information includes consultations, documents (sent and received), problem headings, lab results, immunizations, and free text entries made by GPs plus secondary care, community services, and mental health services that go into the GP record. Patient access is currently working for practices with TPP and EMIS systems, with Cegedim (previously Vision) in progress.

The concerns in the BMA letter to GP practices center around protecting and redacting information from patients. This may sound contrary to the intent of Data Saves Lives, but in certain circumstances, such as risky situations with harm to the patient (example, a coercive situation or domestic violence) or to another individual. Practices are obligated to identify patients who could be at risk of serious harm.

The workaround identified is to add a specific SNOMED code to the patient’s full record before 1 November.  Practices will then need to 1) monitor if the patient requests access and 2) can schedule reviews on a case-by-case basis at a future date to identify if access can be provided. If third parties are mentioned without permission, this is also inappropriate to view and that information has to be redacted. 

The BMA also considered the Law of Unintended Consequences in these areas:

  • Specific consults can also be redacted, but there are clinical safety concerns that the current software apparently does not function well and hides too much.
  • Redaction does not remain in place following a GP2GP transfer
  • There has been no public campaign that warns patients that the NHS app now can become a portal to their detailed health records. Users have passwords saved in their smartphones, and their family members who know the patient’s phone PIN can have easy access to health records. 
  • Some practices may not be ready for opening their patient records
  • Workload will at least for a time increase

BMA letter to practices, HISTalk 28 Oct, GP practice letter from Dr Ursula Montgomery at NHS Digital

Take a look back at the convoluted history of Data Saves Lives going back to June 2021.

Forming a “centre of excellence” for Australian healthcare connectivity is the Australian Digital Health Agency (ADHA) and the Australian e-Health Research Centre under the Commonwealth Scientific and Industrial Research Organisation (CSIRO). Terminology and interoperability are central to connectivity and governance. A third agency, the National Clinical Terminology Service (NCTS), will provide terminology services and tools, including an online browser, a mapping and authoring platform, and CSIRO’s national syndication server Ontoserver. According to the release, “under the new partnership, ADHA will retain responsibility for governance and the strategic role of end-to-end management, SNOMED CT licensing and the relationship with SNOMED International, while CSIRO will deliver the services and functions required to manage the NCTS, as well as content authoring and tooling” over the next five years. Healthcare IT News

And over in New Zealand, Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority have developed the 2022 interim national health plan. Te Pae Tata New Zealand Health Plan identifies greater use of digital services as part of their six critical areas. Actions to be taken in the NZ$600 million (US$400 million) data and digital budget include:

  • Create and implement actions to deliver national consistency in data and digital capability and solutions across Te Whatu Ora including streamlining duplicate legacy systems
  • Implement Hira, a user-friendly, integrated national electronic health record, to the agreed level
  • Scale and adapt population health digital services developed to support the COVID-19 response to serve other key population health priorities
  • Improve the interoperability of data and digital systems across the hospital network, and between primary, community and secondary care settings
  • Improve digital access to primary care as an option to improve access and choice, including virtual after-hours and telehealth, with a focus on rural areas

Healthcare IT News

Perspectives: How joined-up communications can enable connected patient care across healthcare Trusts

October 12, 2022 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today, we have a contribution from Dave O’Shaughnessy, Avaya’s Healthcare Practice Leader for EMEA and APAC. The subject is NHS England’s transition to an integrated care system and where a cloud-based communications system helps in patient engagement and care team coordination.

Interested in being a Perspectives contributor? Contact Editor Donna. 

Photo courtesy of Avaya

The new NHS’ integrated care system (ICS) aims to support patients across England with health and care that is ‘joined-up’ in its delivery from local councils, the NHS, and other partners. The aim is to remove the existing silos that separate hospitals, GPs, physical health, mental health, and council services from each other.

As each ICS region starts to prepare their 5-year plan, there is an opportunity for modern communications and collaboration technology solutions to play an important role in helping to address healthcare Trusts’ challenges as they work to deliver joined-up services across their ICS.

Connected Challenge

As part of a successful ICS, a Trust will need to deepen its relationship with a number of other stakeholders, including local councils, the voluntary community and social enterprise sector. This can be greatly facilitated by leveraging communications and collaboration services to improve experiences at both a local level as well as scaling the solution across the region. In this way, what were previously isolated pain points can be solved across the whole ICS.

Four Areas for Improvement

There are four key practice areas where cloud-based communications and collaboration solutions can help maximise the positive transformation of the patient and key worker experience – patient access to care, patient experience, team member experience, and collaboration across an ICS. Let’s add some details to these four areas:

  1. Improving patient access to care includes managing healthcare appointments, prescriptions, payments, and other everyday administrative tasks in a way that works effortlessly for all parties, constructive access to healthcare specialists where control of access is maintained by support staff, enabling more complex remote treatments and monitoring whilst maintaining a high quality of care; and effective, non-repetitive, digital data capture and organisation to reduce the administrative burden on both patients and staff.
  2. Creating an engaging patient experience includes integrating digital therapeutics to enhance and modernise traditional care, creating scalable, even automated on-demand patient health services to help avoid overwhelming hospital staff; ensuring these digital services are intuitive, easy to learn, and practically accessible to all patients and staff; creating more personalised and therefore meaningful care experiences cost-effectively and rooted in scientific and behavioural understanding.
  3. Enabling beneficial care-team coordination, to help staff focus on delivering healthcare services, will include being able to contact and communicate with the required staff resources (e.g. on-call specialists, hospital orderlies) with the minimum of effort or time-wasting steps; making best use of scarce specialist resources to tackle the elective backlog without adding to burnout, and leveraging the best features from communications and collaboration services to help remove frustrating siloes and operational complexities.
  4. Collaboration with healthcare providers across the ICS includes creating consistent, beneficial experiences across regions despite variations in age and quality of infrastructures; removing duplication or confusing patient treatments across Trusts and other care providers; maintaining compliant data governance and security to create ‘joined-up’ care without adding to staff burnout, reduction in hospital alarm notifications and messaging fatigue, and maintaining clear roles and responsibilities for transformation projects to prevent delays.

When collaboration and communications services are connected across the entire patient journey from before a visit, during a visit, and then after a visit, they become integral to the improvement of the total experience for patients, clinical staff, and back-office staff. It can be a good idea to start off by using a benchmarking tool to measure against industry standards, and so get a good idea of a healthcare provider’s innovation readiness.

NHS Digital trialling Wireless Center of Excellence–in face of ‘crisis’ level staffing shortages

August 4, 2022 | by

NHS Digital has just closed a solicitation for organizations to demonstrate how wireless technologies can improve health and care services. This trial series, the Wireless Centre of Excellence, is in the process of being reviewed by NHS Digital and interviews will be set up with qualifying organizations. The trials fund wireless technologies that improve connectivity in health and care settings.

The Wireless Centre of Excellence appears to be the latest trial in a NHS Digital series. The current trial is University College London Hospitals’ Find & Treat service using 5G and low Earth orbit satellites to enable front-line screening services for tuberculosis, HIV and hepatitis B and C to homeless people, individuals with drug or alcohol dependencies, vulnerable migrants and people who have been in prison. Another trial made South London and Maudsley NHS Foundation Trust the first 5G-connected hospital in the UK. NHS Digital hopes that these wireless products can be a UK export adopted by other healthcare systems. There is more on NHS Digital’s efforts in wireless tech in Healthcare IT News, along with additional UK/NHS news (below)

Staff shortages power wireless innovation. A good part of the impetus for wireless technologies is contained in a recent cross-party MP report that states that NHS England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, in a ‘crisis’ not seen since, well, ever. Both threaten patient safety and aggravate wait times. NHS Digital is trying to present an alternative using wireless to cut time to treatment and to reach patients the way they want faster. While NHS England is drawing up long-term plans to recruit more staff, the current shortage comes from clinical burnout and pay that has not kept up with inflation–not that different than the US, particularly in primary care and psychiatry. According to BBC reports, half of nurses are being recruited ex-UK. Scotland, Wales and Northern Ireland have similar staffing pressures. BBC News

Additional UK news from Healthcare IT News:

  • Leeds Teaching Hospitals NHS Trust and Elsevier entered into a three-year partnership. Elsevier’s Care Planning solution will be integrated within the trust’s EHR.
  • The Medicines and Healthcare products Regulatory Agency (MHRA) published plans to strengthen the regulation of medical devices to improve patient safety and encourage innovation in five areas, taking advantage of Britain’s exit from the EU.
  • HelloSelf, a digital therapeutics startup, is partnering with Central and North West London NHS Foundation Trust to refer patients to its therapy and coaching platform.

Propel@YH digital health accelerator announces 2020 cohort of 10 companies

October 23, 2020 | by

Propel@YH, commissioned by the Yorkshire & Humber AHSN (Academic Health Science Networks) digital health accelerator, last week announced its 10-company 2020 cohort, to start on 26 October. They are:

  • Co-Opts ltd; a smart speaker for automated recording, transcription and summarisation of therapy sessions
  • CyberLiver Ltd; remote monitoring of at-risk cirrhosis patients using wearables and an app
  • I.M.M.E; a VR experience created to support Williams syndrome, supporting isolation, rehab mobility and mental health
  • Liria Digital Health; a technological solution addressing the health and wellbeing of perimenopausal, menopausal, and postmenopausal people
  • My Food 24; an online food diary system which automates the diet tracking and analysis process
  • SeeAI; a platform that supports early fracture diagnosis through x-ray images 
  • Ufonia Ltd; an AI-enabled accessible clinical assistant called Dora that can conduct an intelligent clinical conversation via a regular voice telephone call
  • Vastmindz; an AI face analysis app to measure real-time heart and respiration rates, oxygen saturation, stress level, blood pressure and atrial fibrillation risk
  • Warner Patch; a non-invasive, wearable wireless (using 2G network) sensor that predicts tissue health disease evolution using AI for clinicians to give preventive care, improve patient outcome and save care costs
  • Written Medicine; a pharmacy label and discharge summary translation system, that works across 11 different languages

Propel@YH is designed to attract international digital health companies to the Yorkshire/Leeds area. The AHSN is one of 15 innovation centers acting as the innovation arm of NHS England. Partners in the program include Nexus (University of Leeds’ academic research and tech development community), Barclays Eagle Labs (business incubation/networking/investment), Hill Dickinson (legal and strategic advice), and Leeds City Council. 

Neville Young, Director of Enterprise and Innovation for the Yorkshire & Humber AHSN, said: “This is the second time we’ve been able to offer this great opportunity for innovative digital and data-driven health companies and we were truly blown away by the innovation and talent presented by this year’s shortlist. Our panel had a tough choice choosing our finalists from this year’s entries but we think the mix of businesses and applications we will be working with this year really will play a part in supporting the NHS and healthcare providers throughout the pandemic and the ‘new normal’ ways of working.”  YHAHSN press release

Comings and goings, wins and losses: VA’s revolving door spins again, NHS sleep pods for staff, Aetna’s Bertolini booted, Stanford Med takes over Theranos office

February 6, 2020 | by

VA’s revolving door spins again with #2 person fired, but VistA replacement implementation moves on. James Byrne, deputy secretary, was fired on 3 Feb “due to loss of confidence in Mr. Byrne’s ability to carry out his duties” according to secretary Robert Wilkie. Mr. Byrne, a Naval Academy graduate and former Marine officer, had been VA general counsel, acting deputy secretary starting August 2018, then confirmed five months ago.

Mr. Byrne’s responsibilities included the Cerner implementation replacing VistA and other IT projects (HISTalk), of which Mr. Wilkie stated in a press conference today (5 Feb) “will not impact it at all” (FedScoop). The termination comes in the wake of a House staff member on the House Veterans Affairs committee, herself a Naval Reserve officer, stating that she was sexually assaulted at the VA Medical Center in Washington (NY Times). Axios claims that the White House was disappointed in the way the VA handled the investigation. At today’s presser, Mr. Wilkie denied any connection but attributed the dismissal to ‘not gelling’ with other team members. The launch of Cerner’s EHR is still on track for late March. The turnover at the VA’s top has been stunning: four different secretaries and four more acting secretaries in the last five years. Also CNBC, Military Times.

NHS’ sleep pods for staff to catch a few ZZZZs. A dozen NHS England hospitals are trialing futuristic-looking ‘sleep pods’ for staff to power nap during their long shifts and reduce the possibility of errors and harm by tired clinicians. Most of the locations are in the A&E unit, doctors’ mess, and maternity department. They are available to doctors, nurses, midwives, radiographers, physiotherapists, and medics in training. The pods are made by an American company, MetroNaps, and consist of a bed with a lid which can be lowered along with soothing light and music to aid relaxation. The pods may cost about £5,500 each but are being well-used. Other hospitals are fitting areas out with camp beds and recliner chairs. The sleep breaks take place both during and end of shifts before returning home and average about 17-24 minutes. Everything old is new again, of course–dorm areas were once part of most hospitals some decades back and doctors’ lounges with sofas were popular snooze-gathering areas. Guardian (photo and article)

Mark Bertolini bumped off CVS-Aetna Board of Directors. The former Aetna CEO, who was the engineer of the sale to CVS Health two years ago, isn’t going quietly out the door with his $500 million either. The high-profile long-time healthcare leader told the Wall Street Journal that he was forced off the BOD. He maintains the integration of the Aetna insurance business is incomplete, contradicting CVS’ statement that it’s done. Mr. Bertolini and two other directors are being invited out as CVS-Aetna reduces its board following, it says, best practices in corporate governance. Looking back at our coverage, Mr. Bertolini had hits, bunts (ActiveHealth Management) and quite a few misses (Healthagen, CarePass, iTriage). According to the WSJ, the contentious nature of the statement plus the departure of the company’s president of pharmacy is raising a few eyebrows. And recently, an activist shareholder, Starboard Value LP, has taken a stake in the company. CVS is demonstrating some innovation with rolling out 1,500 HealthHubs in retail locations as MinuteClinics on steroids, so to speak.  Hartford Courant (Aetna’s hometown news outlet) adds a focus on how many jobs will be remaining in the city with a certain skeptical context on CEO Larry Merlo’s promises. 

Stanford taking over Theranos Palo Alto HQ space. HISTalk’s Weekender had this amusing note (scroll down to ‘Watercooler Talk’) that the 116,000-square-foot office building in Stanford Research Park will now house the Stanford medical school. Theranos had been paying over $1 million per month in rent for the facility. The writer dryly notes that Elizabeth Holmes’ bulletproof glass office remains. This Editor humbly suggests the floor-to-ceiling application of industrial-strength bleach wipes and disinfectant, not only in the lab facility but also in that office where her wolf-dog used to mess.

The LA Times reports that Ms. Holmes is also defending herself without counsel in the Phoenix civil class-action lawsuit against Theranos. On 23 January, she dialed in to the court hearing’s audio feed and spoke for herself during that hour. One has to guess that she doesn’t have much to do other than read legal briefs. (Perhaps she sees herself as a cross between Saint Joan and Perry Mason?) Last fall, Ms. Holmes was dropped by Cooley LLP for non-payment of fees [TTA 9 Oct 19]. Williams & Connolly continues to represent her in the criminal DOJ suit, where prison time looms. 

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

May 16, 2019 | by

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

May 10, 2019 | by

‘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

May 8, 2019 | by

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

March 6, 2019 | by

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

January 24, 2019 | by | 1 Comment

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?

May 16, 2018 | by

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)

February 23, 2018 | by
[grow_thumb image=”https://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)

February 20, 2018 | by

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

January 29, 2018 | by

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

January 23, 2018 | by | 1 Comment
[grow_thumb image=”https://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=”https://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?

January 16, 2018 | by

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…)