TTA’s Week: Albertson’s Amazon Effect, Hidden Signals, partnering right, three telehealth/telecare studies, print your own smartphone microscope!

 

Retail health convergence, the bumpy Road to Utopia in three telehealth/telecare studies, DHS’ epidemiology challenge, partnership challenges, snap on that microscope, and a newsy week in the health tech biz.

Retail health convergence and ‘Amazon Effect’ continues with Albertsons and Rite Aid (And Albertsons goes public to boot)
Telehealth alternatives to in-person consultation found lacking in effectiveness: Alt-Con Study (UK) (GPs reluctant despite NHS encouragement. It needs work.)
CNBP develops a 3D printed microscope to clip on to your smartphone (AU) (A really useful and inexpensive breakthrough from Down Under using iPhone flash) 
Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?
How do digital health partnerships happen? Where do you go with them? Views from a developer and an app security provider. (Keep your connections warm and current–and look ahead)
DHS’ Hidden Signals Challenge to improve tracking of biological and epidemiological threats (Applicable for both health and security)
Telemedicine’s still-sluggish adoption in health systems revealed in survey of health system executives (So far to go on starvation budgets)
The UTOPIA Project evaluation of telecare in social care report published (UK) (Where it fits in social care and how it’s delivered)

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

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

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

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

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

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

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

Of continued interest….

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

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


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Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?

click to enlargeHere’s our roundup for the week of 12 February:

VA wins on the budget, but the Secretary’s in a spot of bother. Updated. Last week started off as a good week for Secretary Shulkin with a White House budget proposal that increased their $83.1 billion budget by 11.7 percent, including $1.2 billion for Year 1 of the Cerner EHR implementation in addition to the agency’s $4.2 billion IT budget which includes $204 million to modernize VistA and other VA legacy IT systems in the interim. While the Cerner contract went on hold in December while record-sharing is clarified, the freeze is expected to be lifted within a month. POLITICO  Where the trouble started for Dr. Shulkin was in the findings of a spending audit by the VA’s Inspector General’s Office of an official European trip to Copenhagen and London which included unreimbursed travel by Mrs. Shulkin and free tickets to Wimbledon, at least partly justified by a doctored email. This has led to the early retirement of the VA Chief of Staff Vivieca Wright Simpson and also an investigation of hacking into Wright Simpson’s email. It also appears that some political appointees in the VA are being investigated for misconduct. CNBC, FierceHealthcare.

Updated: POLITICO doesn’t feel the love for Dr. Shulkin in today’s Morning eHealth, linking to articles about the supposed ‘internal war’ at the VA, with veterans’ groups, with the Trump Administration, and within the VA. It’s the usual governmental infighting which within the 16 Feb article is being whipped by POLITICO and co-author ProPublica to a fevered pitch. Dr. Shulkin comes across as doctor/tech geek who underestimated the politicization of and challenges within an agency with the mission to care for our veterans. It’s also an agency having a hard time facing the current demands of a dispersed, younger and demanding veteran group plus aging, bureaucratic infrastructure. As usual the ‘privatization’ issue is being flogged as an either/or choice whereas a blend may serve veterans so much better.

Digital health entrepreneur named CEO of the American Telemedicine Association. A first for ATA is a chief from the health tech area who is also one of the all-too-rare executive women in the field. Ann Mond Johnson, who will be starting on 5 March, was previously head of Zest Health, board chair and advisor to Chicago start-up ConnectedHealth (now part of Connecture), and had sold her first start-up company Subimo to WebMD in 2006. She began her career in healthcare data and information with The Sachs Group (now part of Truven/IBM Watson). Ms. Johnson replaces founding CEO Jonathan Linkous, who remained for 24 years before resigning last August and is now a consultant. ATA release, mHealth Intelligence. ATA relocated in January from Washington DC to nearby Arlington Virginia. And a reminder that ATA2018 is 29 April – 1 May in Chicago and open for registration.

Allscripts’ ‘Such a Deal’! Following up on Allscripts’ acquisitions of Practice Fusion for $100 million (a loss to investors) and earlier McKesson’s HIT business for $185 million [TTA 9 Jan], it hasn’t quite paid for itself, but came very close with the sale of McKesson’s OneContent, a healthcare document-management system, for a tidy $260 million. Net price: $25 million. Their CEO is some horse trader! Some of the savings will undoubtedly go to remedying the cyberattack in January that affected two data centers in North Carolina, shutting down EHR and billing applications for approximately 1,500 physician practices, which have launched a class action lawsuit. FierceHealthcare 

Flatiron Health acquired by Roche. Flatiron founders Nat Turner and Zach Weinberg undoubtedly are feeling quite affluent as Roche buys out the company for $1.9 billion (corrected). Roche previously had a 12.6 percent interest, creating a new valuation of $2.1 billion according to CNBC. The company specializes in data analytics for cancer and has also developed an oncology EMR for cancer clinics. The company will be operated as an independent entity under Roche and retain both the founders and employees. Reportedly McKesson was also interested in the company. Exiting will be earlier investors Google Ventures (Alphabet), First Round Capital, and LabCorpCNBC, MedCityNews  Updated: David Shaywitz’s excellent analysis of why Roche paid a premium price for Flatiron–a cup of coffee read. Flatiron’s data analytics mines via humans (oh, the shock!) those unstructured data fields (e.g. free text fields of pathology reports and clinical notes) in EHRs aided by technology tools. This willingness of the founders and the advocate of this approach, Amy Abernethy MD, their chief medical officer, to capture this valuable and elusive information on cancer set them apart from the usual structured data analytics–and sets them in the right place for the evolving field of clinical trial validation which is Roche’s interest. Did Pfizer, a Flatiron partner, lose a march on this? Forbes.

click to enlargeNokia looking at options for its digital health business–updated. A terse Nokia release announced that they initiated a review of strategic options for its Digital Health business, part of Nokia Technologies. They are also cutting 425 of 6,300 jobs in Finland. Nokia is a company that came back from the near-dead starting in 2015 [TTA 13 Aug 15], concentrating on networking (Alcatel-Lucent/Bell Labs) but also making acquisitions in healthcare such as Withings [TTA 27 Apr 16] with the Nokia Growth Fund reporting a $350 million piggybank for IoT investment. They are a late entrant in a crowded and shaking-out wearables segment–not a good position. An ill sign was Nokia’s write-down of €141 million of Withings goodwill in 3rd Quarter 2017. Looking at the Nokia chart at left (from BI Intelligence–Digital Health Briefing 2/16), digital health is insignificant and not growing at 2-3 percent of their quarterly revenue. The books aren’t balancing here. Watch for an exit. Reuters

One last must-read for the weekend is Roy Lilley’s take on Carillion. His view that the NHS is “doing a Carillion”, meaning using every ‘dodge and wheeze’ (US=trick) to stay afloat, and how many Trusts are heading down Carillion Street.

How do digital health partnerships happen? Where do you go with them? Views from a developer and an app security provider.

This Editor recently covered a partnership between Doncaster UK’s MediBioSense Ltd.and San Francisco-based Blue Cedar, where Blue Cedar’s app security system will protect information from MediBioSense’s app through to the provider database. I was curious how two physically distant small companies, even in this global healthcare business, found each other, as well as how MediBioSense (MBS) adopted a US-developed sensor from VitalConnect. To find out more, I spoke with the company CEOs, Simon Beniston of MBS and John Aisien of Blue Cedar. Their respective experiences led me to three takeaways which are applicable to early-stage companies–wherever they are located.

Past business dealings of the principals and keeping connections ‘warm’ matter a great deal–when the time is right to partner. Both companies had a combination of people and past experience in common. “I had some interaction with Simon during my time at Mocana, the company from which Blue Cedar spun out.” Mr. Aisien noted. “Our sales leadership in the UK continued to be in touch with Simon, and as we continued to execute on our business plan and focused on healthcare, the relationship strengthened. Simon’s role as a healthcare global app developer made him even more attractive as a partner.” For Mr. Beniston considering Blue Cedar as a security partner, it was a combination of contacts and people he knew already, “driven by the realization that while our data was fairly secure by design, I was cognizant of the fact that data protection requirements were growing in the European market with GDPR (General Data Protection Regulation). As a forward-thinking company, we wanted to get to this early on. Given this, the partnership between MediBioSense and Blue Cedar was a perfect fit.”

MediBioSense’s relationship with VitalConnect is also unusual in that MediBioSense developed their platform that monitors data for the VitalPatch. Mr. Beniston founded the company because he believed that healthcare was where mobile technologies, his prior field, could make a real difference and be joined to the use of biosensors and wearables. His knowledge of the platform and app were thus from the ground up. “We then went on to ensure that their [Blue Cedar’s] technology fit with our technology and the testing was successful. We could then go to healthcare companies and tell them that we have data protection covered. It gives us a competitive edge.”

The right partnerships build use cases, look forward to where their businesses can go in meeting customer needs, and are a step ahead of their clients. Mr. Aisien: “What Simon is doing is a wonderful example of using digital channels to improve healthcare outcomes and reduce costs. We think it’s a great proof point of the value of our app-centric approach as it relates to security in healthcare. MediBioSense’s app will be running on devices which are outside of the control of the entity using VitalPatch to capture [the patient’s] data. It’s not practical or economic for that entity to manage the device.”

When asked about whether healthcare users and developers are finally seeing the light about app security, Mr. Aisien acknowledged that it is developing. “The knowledge of the criticality of protecting oneself against security threats is unquestionably there and has been for awhile. With the increased use of digital channels–mobile, IoT, wearables–to improve business and reduce risks, the growth, the understanding, and most importantly, the funding are there. App-centric security continues to evolve because while other approaches like securing the whole device or containerization are technically sound, they are not necessarily economic or practical for all use cases. What makes universal sense is to download the app that already has the requisite levels of security in it.”

This is what attracted Mr. Beniston to use an app-based security approach for MediBioSense. “Historically it’s always been a device approach such as MDM [mobile device management]. One of our key USPs, when we approach our clients, is that one of the big expenses, aside from the VitalPatch, is hardware. One of our strengths is that our platform and interface can work on a consumer mobile device. We can utilize what your clinicians and patients already have in their pockets. They can use what they have, and to date, we haven’t seen any interference with mobile devices.”

He added, “We were surprised that even today, some are saying about GDPR that ‘we’ll wait until it happens’. That’s hiding your heads in the sand! (more…)

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’s ‘GP at hand’ has thousands of London patients in hand

click to enlargeApparently Babylon Health’s ‘GP at hand’ is a hit with Londoners, despite the requirement to shift GP practices. The Evening Standard reports that the Lillie Road Surgery in Hammersmith, one of the five London practices in the program (plus Victoria, Poplar, Euston, and Fulham), increased its patient list by nearly 7,000 (4,970 in November to 11,867 last month). (Was it the Tube adverts?–Ed.) No information is available on increases at the other surgeries. 

Helping matters may be the UK flu epidemic, where the incentive to stay at home and have a video consult would be great (and helpful in stemming the spread). These consults on average are available 2 1/2 hours after booking, which to us Yanks used to independent services seems a great delay. One-third are reportedly out of office hours. Duration of the visit is about 10 minutes, which is standard for in-person. What is suspected is that many do not realize that the GP at hand signup also changes your GP to the program. The GP partner quoted in the article claims that homeless people, those with mental health and multiple chronic conditions–not just the young and mobile-savvy–have signed up. 

This Editor will concur with others that it’s time for telehealth to be integrated into the NHS, but the tying of it to specific practices which alters capitation is a large wrinkle which needs ironing out. Our earlier coverage here. Hat tip to Roy Lilley.

Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty

click to enlargeOur Editors will be lassoing our thoughts for what happened in 2017 and looking forward to 2018 in several articles. So let’s get started! Happy Trails!

2017’s digital health M&A is well-covered by Jonah Comstock’s Mobihealthnews overview. In this aggregation, the M&A trends to be seen are 1) merging of services that are rather alike (e.g. two diabetes app/education or telehealth/telemedicine providers) to buy market share, 2) services that complement each other by being similar but with strengths in different markets or broaden capabilities (Teladoc and Best Doctors, GlobalMed and TreatMD), 3) fill a gap in a portfolio (Philips‘ various acquisitions), or 4) payers trying yet again to cement themselves into digital health, which has had a checkered record indeed. This consolidation is to be expected in a fluid and relatively early stage environment.

In this roundup, we miss the telecom moves of prior years, most of which have misfired. WebMD, once an acquirer, once on the ropes, is being acquired into a fully corporate info provider structure with its pending acquisition by KKR’s Internet Brands, an information SaaS/web hoster in multiple verticals. This points to the commodification of healthcare information. 

click to enlargeLove that canary! We have a paradigm breaker in the pending CVS-Aetna merger into the very structure of how healthcare can be made more convenient, delivered, billed, and paid for–if it is approved and not challenged, which is a very real possibility. Over the next two years, if this works, look for supermarkets to get into the healthcare business. Payers, drug stores, and retailers have few places to go. The worldwide wild card: Walgreens Boots. Start with our article here and move to our previous articles linked at the end.

US telehealth and telemedicine’s march towards reimbursement and parity payment continues. See our article on the CCHP roundup and policy paper (for the most stalwart of wonks only). Another major change in the US is payment for more services under Medicare, issued in early November by the Centers for Medicare and Medicaid Services (CMS) in its Final Rule for the 2018 Medicare Physician Fee Schedule. This also increases payment to nearly $60 per month for remote patient monitoring, which will help struggling RPM providers. Not quite a stride, but less of a stumble for the Grizzled Survivors. MedCityNews

In the UK, our friends at The King’s Fund have rounded up their most popular content of 2017 here. Newer models of telehealth and telemedicine such as Babylon Health and PushDoctor continue to struggle to find a place in the national structure. (Babylon’s challenge to the CQC was dropped before Christmas at their cost of £11,000 in High Court costs.) Judging from our Tender Alerts, compared to the US, telecare integration into housing is far ahead for those most in need especially in support at home. Yet there are glaring disparities due to funding–witness the national scandal of NHS Kernow withdrawing telehealth from local residents earlier this year [TTA coverage here]. This Editor is pleased to report that as of 5 December, NHS Kernow’s Governing Body has approved plans to retain and reconfigure Telehealth services, working in partnership with the provider Cornwall Partnership NHS Foundation Trust (CFT). Their notice is here.

More UK roundups are available on Digital Health News: 2017 review, most read stories, and cybersecurity predictions for 2018. David Doherty’s compiled a group of the major international health tech events for 2018 over at 3G Doctor. Which reminds this Editor to tell him to list #MedMo18 November 29-30 in NYC and that he might want to consider updating the name to 5G Doctor to mark the transition over to 5G wireless service advancing in 2018.

Data breaches continue to be a worry. The Protenus/DataBreaches.net roundup for November continues the breach a day trend. The largest breach they detected was of over 16,000 patient records at the Hackensack Sleep and Pulmonary Center in New Jersey. The monthly total was almost 84,000 records, a low compared to the prior few months, but there may be some reporting shifting into December. Protenus blog, MedCityNews

And perhaps there’s a future for wearables, in the watch form. The Apple Watch’s disconnecting from the phone (and the slowness of older models) has led to companies like AliveCor’s KardiaBand EKG (ECG) providing add-ons to the watch. Apple is trying to develop its own non-invasive blood glucose monitor, with Alphabet’s (Google) Verily Study Watch in test having sensors that can collect data on heart rate, gait and skin temperature. More here from CNBC on Big Tech and healthcare, Apple’s wearables.

Telehealth saves lives, as an Australian nurse at an isolated Coral Bay clinic found out. He hooked himself up to the ECG machine and dialed into the Emergency Telehealth Service (ETS). With assistance from volunteers, he was able to medicate himself with clotbusters until the Royal Flying Doctor Service transferred him to a Perth hospital. Now if he had a KardiaBand….WAToday.com.au  Hat tip to Mike Clark

This Editor’s parting words for 2017 will be right down to the Real Nitty-Gritty, so read on!: (more…)

NHS ‘GP at hand’ via Babylon Health tests in London–and generates controversy

click to enlargeThe GP at hand (literally) service debuted recently in London. Developed by Babylon Health for the NHS, it is available 24/7, and doctors are available for video consults, most within two hours. It is a free (for now) service to NHS-eligible London residents who live and work in Zones One through Three, but requires that the user switch their practice to one of the five ‘GP at hand’ practices (map). Office visits can be scheduled as well, with prescriptions delivered to the patient’s pharmacy of choice.

Other attractive features of the service are replays of the consult, a free interactive symptom checker, and a health record for your test results, activity levels and health information. 

While the FAQs specify that the “practice boundary” area is south of Talgarth Road and Cromwell Road in Fulham, and north of the River Thames, it is being advertised on London Transport (see advert left and above taken on the Piccadilly Line) and on billboards.

Reviewing the website FAQs, as telemedicine it is positioned to take fairly routine GP cases of healthy people (e.g. colds, flu, rashes) and dispatch them quickly. On the ‘can anyone register’ page, it’s stated that “the service may however be less appropriate for people with the conditions and characteristics listed below”. It then lists ten categories, such as pregnancy, dementia, end of life care, and complex mental health conditions. If anyone is confused about these and other rule-outs, there is a support line. 

Babylon Health is well financed, with a fundraise of £50 million ($60 million of a total $85 million) in April for what we profiled then as an AI-powered chatbot that sorted through symptoms which tested in London earlier this year. This is a full-on telemedicine consult service with other services attached.

Now to the American view of telemedicine, this is all fairly routine, expected, and convenient, except that there’d be a user fee and a possible insurance co-pay, as more states are adopting parity for telemedicine services. We don’t have an expectation that a PCP on a telemedicine consult will take care of any of these issues which Babylon rules out, though telemental health is a burgeoning and specialized area for short and long-term support. But the issues with the NHS and GPs are different.

First, signing up to ‘GP at hand’ requires you to change your GP to one in that program. US systems are supplementary–a telehealth consult changes nothing about your other doctor choices. This is largely structural; the NHS pays GPs on a capitation basis.

mHealth Insight/3G Doctor and David Doherty provide a lengthy (and updated) analysis with a critical view which this Editor will only highlight for your reading. It starts with the Royal College of GPs objections to the existence of the service as ‘cherry-picking’ patients away from GPs and creating a two-track system via technology. According to the article, “NHS GPs are only paying them [Babylon] £50 a year of the £151 per year that the NHS GP Practice will be paid for every new Patient they get to register with them” which, as a financial model, leads to doubts about sustainability. Mr. Doherty advises the RCGPs that they are fighting a losing battle and they need to get with mHealth for their practices, quickly–and that the NHS needs to reform their payment mechanisms (GPs are compensated on capitation rather than quality metrics).

But there are plenty of other questions beyond cherry-picking: the video recordings are owned by Babylon (or any future entity owning Babylon), what happens to the patient’s GP assignment if (when?) the program ends, and patients’ long-term care.

Oh, and that chatbot’s accuracy? Read this tweet from @DrMurphy11 with a purported video of Babylon advising a potential heart attack victim that his radiating shoulder pain needs some ice. Scary. Also Digital Health.

A blogger’s lot is not a happy one

Who would want to be a digital health blogger? Seconds of inspiration lead to minutes of typing which lead to hours of making sure you have the right URL embedded, the right layout, put in the right tags, tipped your hat to everyone who has helped, not caused offence (well not too much anyway), and so on. And for what? Occasionally you run into someone at a show who says how much they like a post, and that’s it. Well not quite, because there’s a wonderful sense of release when you’ve got something burning inside you out in the open, even if nothing comes back to you.

This came to mind recently because another drawback of being a blogger is that people send you stuff they think is important and get quite irate if you don’t agree (and so don’t blog it). One such piece is the announcement last week that David Allison, Chief Executive at Wirral University Teaching Hospital NHS Foundation and former Chief Operating Officer for Newcastle Hospitals NHS Foundation Trust is joining Draper & Dash to add “to their stellar executive board team dedicated to enabling world-class digital analytics platforms”. I’ll say straight away that I don’t know why someone with such impeccable-looking credentials is taking essentially what used to be called a “desk job”, so I mean nothing personal by picking this example. It just happened to be the one that spurred me into action.

It does worry me though that (more…)

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?

Charterhouse lost half its equity in Tunstall debt refinancing–Sunday Times report (updated)

click to enlargeBreaking News, even though it happened in March! See updates below. The Sunday Times (UK–sign up for limited access) broke news over the weekend that Charterhouse Capital Partners, the main investor in Tunstall Healthcare, along with other shareholders, have been forced to relinquish nearly half the equity in the company to senior lenders and management. According to their annual report on page 65, section 31**, this happened on 17 March after the close of the FY, but only now has come to light through the Sunday Times report.

The article is light on details, but our Readers who’ve followed Tunstall’s history since the Charterhouse purchase in 2008 for £530 million will not be surprised, only that this development took so long. The cold facts are that the company has been wrestling with a stunning debt burden that grew from £1.2bn in 2015 [TTA 15 Apr 16] to the Times report of £1.7bn at the end of last September, with £300m owed to lenders and £1.2bn to investors. Debt service drove their financials to a £391m pre-tax loss last year. 

The highlights of the deal as reported in the Sunday Times:

  • Senior lenders (not disclosed) received 24.9 percent of Tunstall’s shares. Management received 25 percent.
  • Charterhouse with other shareholders now have a razor-thin controlling balance of 50.1 percent. Prior to this, Charterhouse alone had 61 percent of Tunstall’s shares.
  • In return, the lenders agreed to relax covenants on their debt, termed a ‘covenant reset’.
  • Tunstall also spent £18.5m last year on an abortive attempt to sell itself for up to £700m. We noted reports in April 2016 that they rejected a £300 million (US$425 million at the time) buyout offer from private equity investment firm Triton Partners.

**For those who wish to dig deeper, Tunstall’s hard-to-find annual report through last September (but not filed until 29 March 2017)  is available through Companies House. Go to their index here and select the “Group of companies’ accounts made up to 30 September 2016” which currently is the first listing.

This will be updated as other sourced reports come in, if they do–for now, it appears that the Sunday Times has the exclusive ‘dig’. It is unfortunate since Tunstall is responsible for millions of customers and employs thousands worldwide, and has been aggressively investing in the company and technology while having a fair amount of churn in executive and director positions. Regrettably, they never capitalized on a established position in a big market when they bought AMAC in 2011, then estimated as the US’ third largest PERS company. But as this Editor closed her 2016 article, the whole category of healthcare tech, while becoming more accepted and with a few exceptions, regrettably is still mired in ‘too many players, too many segments with too many names, all chasing not enough money whether private or government.’ I will add to that equation ‘too few users’–still true among older adults and the disabled–and ‘technology that moves too fast’ to make it even more confusing and unsettled for potential buyers (obsolescence on steroids!). And ‘gadgets’, to use the Times’ wording, are among the worst culprits and victims of these factors.

Updated: Equity capital. A cautionary tale was Editor Emeritus and Founder Steve Hards’ prescient analysis of the risks that Tunstall and Charterhouse undertook in acquiring so much debt. After you read it, note the year it was published. More recent commentary on Tunstall’s financial deteriorata dating back to 2013 can be found here.

Tunstall pairing with Inhealthcare digital health for NHS remote monitoring

click to enlargeA digital link of hope for Tunstall’s future? Announced at The King’s Fund Digital Health & Care Conference but oddly not receiving much notice was the UK collaboration of Tunstall Healthcare and Inhealthcare. Inhealthcare builds infrastructure for digital health services, and currently works extensively with multiple NHS regions and programs, such as the North of England Regional Back Pain Programme, NHS England’s Sheffield City Region Test Bed and the Darlington Healthy New Town project. Their services include telehealth monitoring for INR, COPD, medication reminders, a smartphone app platform, chronic pain management, and a surprising one that addresses undernutrition in older adults. The Tunstall-Inhealthcare objective is to integrate health and social care with clinical care systems in six areas: LTC home monitoring, identifying vulnerable patients, involving family members, 24/7 clinical care coordination centers, post-discharge management, and digital health at home innovation. Also noted is that Inhealthcare has programming technology that can reduce the time to build out services and apps.

Inhealthcare Ltd is part of Intechnology plc, owned by Peter Wilkinson, who has developed several UK internet and technology companies at scale–Planet Online, Freeserve, and Sports Internet (now Sky Betting and Gaming). Tunstall release

The King’s Fund 2017 Digital Health Congress: videos, presentations now posted

click to enlargeThe King’s Fund’s annual two-day Digital Health and Care Congress now has videos and presentation decks posted on the event page.  If you missed it, or want to see the sessions you could not attend, here’s your opportunity to review and share with staff. All the plenaries and keynotes have both video and presentations. Selected workshops/breakouts have video along with PowerPoints on nearly all, including posters. Attendance this year was between 400 and 500. On Twitter: #kfdigital17, @TheKingsFund TTA was pleased to be a marketing supporter of the 2017 conference as we have for several years. Many thanks to events coordinator Claire Taylor.

For planning ahead, The King’s Fund Annual Conference will be two days this year, 29-30 November. Early bird registration is available until 1 September and sponsorships/exhibit opportunities are open.

‘We carry on’ this Memorial Day

As our Readers and Editors make our getaways for this holiday weekend (on Monday, in the UK the Spring Bank Holiday, in the US Memorial Day), it cannot help be on our minds the terrorist bombing this week killing concertgoers in Manchester and the extreme likelihood of further terror attacks. NHS trauma centers are already on highest alert specifically for this weekend, and there are reports that there may be another or even more devices in the hands of terrorists, ready for further slaughter, based on the remains of the home bomb factory. Here in New York, it is also Fleet Week, where many of our Navy’s and Coast Guard’s ships, along with sailors and Marines, visit the city. There are multiple, well-publicized events all over the metropolitan area. Evidence of increased security is everywhere.

On this US Memorial Day, where we remember and honor our fallen soldiers, sailors, airmen, Marines, Coast Guard, Merchant Marine and civilians in military service, we also include in our thoughts and prayers the innocent Manchester children and adults killed for simply enjoying themselves at a concert. We also remember that there are 18 adults and 14 children still in hospital, and that NHS emergency and trauma staff, under extreme pressure, performed magnificently.

Hundreds, perhaps thousands, of lives are forever changed. What really hits the heart, more so than at Bataclan, are that most of the dead and survivors, are children and adults waiting to take them home. Innocent lives snapped out in a few seconds. Holes in the heart that will never close.

What also hit the heart was Roy Lilley’s Friday newsletter, which says it better and more than this Editor can express. We carry on because we have to, until we can do better. We are pleased to link to it here.

Dry the tears: WannaCry stymied, North Korea hackers suspect. Is this a poke for a worse attack?

Breaking News This morning’s (Tuesday 16 May) news is about reputable security organizations–Kaspersky Lab and Symantec–connecting the dots that lead for now to a North Korea-linked hacking organization, the Lazarus Group. This group has been identified in previous hack attacks and is based upon WannaCry code appearing in Lazarus programs. US Homeland Security has admitted seeing the same similarities, but all are working to gain more information.

Lazarus has been previously identified as the source of the 2014 Sony attack and the theft of $81 million from the Bangladesh central bank, again linked to fundraising for North Korea for its missiles, army, EMP and nuclear arming while its terrorized people starve. However, this attack was a flop; according to US Homeland Security, about $70,000 was raised in ransom. The Homeland Security spokesman also distanced the NSA from the original information which targeted weaknesses in Microsoft’s systems.

According to reports, WannaCry disproportionately affected Russia, Taiwan, Ukraine and India, according to Czech security firm Avast. No US Federal government systems were affected. China on Monday reported that it attacked traffic police and school systems.

The Telegraph has posted a speculative list of 34 NHS organizations which suffered IT failure during the WannaCry attack. The article includes a map produced by MalwareTech that geographically spots the infection locations; the Boston to Washington corridor is a sea of blue dots. And…Marcus Hutchins has been identified as the young UK tech working for Kryptos Logic who redirected the attacks by buying a domain embedded in the WannaCry code. How it worked, according to PC World, is that if the malware can’t connect to the unregistered domain, it infects the system. By registering the domain and creating a page for the malware to connect to, he stopped the malware spread. (Video in Telegraph article)  Also FoxNews

But is this a prelude to more and worse? Is this testing our preparedness? If so, we’ve been found wanting on an enterprise level with vulnerable systems and administrators not updating their software and OS. George Avetisov, the CEO of HYPR, a biometric authentication company, in The Hill, summarized it neatly today: “We’ve also learned the hard way that, simply through a coordinated phishing attack on unsuspecting users, hackers can disrupt the day-to-day activities of enterprises that provide communications, travel, freight and healthcare administration simply by remotely deploying malware.” He then goes on to praise President Trump’s executive order (EO), “Strengthening the Cybersecurity of Federal Networks and Critical Infrastructure,” which he signed on Thursday–right before all this began. As if in confirmation…ShadowBrokers, the group that hacked the NSA files, today announced the availability of a subscription to a ‘members only data dump’ like a Wine of the Month Club. Watch out, banks and healthcare, it’s open season! NHS, better pay attention to another kind of hygiene–cyberhygiene. Without it, plans for patient apps and data sharing will go sideways–and deserved fodder for Dame Fiona [TTA 10 May]. The Hill  Earlier coverage here

Updated 15 May: 20% of NHS organizations hit by WannaCry, spread halted, hackers hunted

Updated 15 May: According to the Independent, 1 of 5 or 20 percent of NHS trusts, or ‘dozens’, have been hit by the WannaCry malware, with six still down 24 hours later. NHS is not referring to numbers, but here is their updated bulletin and if you are an NHS organization, yesterday’s guidance is a mandatory read. If you have been following this, over the weekend a British specialist known by his/her handle MalwareTech, tweeting as @malwaretechblog, registered a nonsensical domain name which he found was the stop button for the malware as designed into the program, with the help of Proofpoint’s Darien Huss.

It looks as if the Pac-Man march is over. Over the weekend, a British specialist known as MalwareTech, tweeting as @malwaretechblog, registered a nonsensical domain name which he found was the stop button for the malware, with the help of Proofpoint’s Darien Huss. It was a kill switch designed into the program. The Guardian tagged as MalwareTech a “22-year-old from southwest England who works for Kryptos logic, an LA-based threat intelligence company.”

Political fallout: The Home Secretary Amber Rudd is being scored for an apparent cluelessness and ‘wild complacency’ over cybersecurity. There are no reported statements from Health Secretary Jeremy Hunt. From the Independent: “Patrick French, a consultant physician and chairman of the Holborn and St Pancras Constituency Labour Party in London, tweeted: “Amber Rudd is wildly complacent and there’s silence from Jeremy Hunt. Perhaps an NHS with no money can’t prioritise cyber security!” Pass the Panadol!

Previously: NHS Digital on its website reported (12 May) that 16 NHS organizations have been hacked and attacked by ransomware. Preliminary investigation indicates that it is Wanna Decryptor a/k/a WannaCry. In its statement, ‘NHS Digital is working closely with the National Cyber Security Centre, the Department of Health and NHS England to support affected organisations and ensure patient safety is protected.’ Healthcare IT News

According to cybersecurity site Krebs on Security, (more…)

The stop-start of health tech in the NHS continues (UK)

Continuing their critique of the state of technology within the NHS [TTA 17 Feb], The King’s Fund’s Harry Evans examines the current state of incipient ‘rigor mortis’ (his term). Due to the upcoming election, the Department of Health is delaying its response to Dame Fiona Caldicott, the National Data Guardian for Health and Care (NDG), on her review of data security, consent and opt-outs (Gov.UK publications).

People have significant trust and privacy concerns about their data, which led to NHS England suspending care.data over three years ago. But with safeguards in place, public polling supports the sharing of health data for uses such as research and direct care. But…there’s more. Now there is ‘algorithmic accountability’, which may single out individuals and influence their care, much as algorithms dictate what online ads we’re served. What of the patient data being served to Google DeepMind, IBM Watson Health, and Vitalpac for AI development? Have people adjusted their concerns, and have systems evolved to better store, secure, and share data? And how can this be implemented at the local NHS level? The NHS and technology: turn it off and on again Hat tip to Susanne Woodman of BRE.

A reminder that The King’s Fund’s Digital Health and Care Congress is on 11-12 July. Click on the sidebar to go directly to information and to register. Preview video; the Digital Health Congress fact sheet includes information on sponsoring or exhibiting. To make the event more accessible, there are new reduced rates for groups and students, plus bursary spots available for patients and carers. TTA is again a media partner of the Digital Health and Care Congress 2017. Updates on Twitter @kfdigital17