‘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

Fitbit reaching out to NHS–but new smartwatch ‘a giant mess’ (updated)

There have been sketchy reports of Fitbit’s CEO James Park meeting with the NHS last month to get Fitbits into the ‘big moves’ in wearables and apps promised by Health Secretary Jeremy Hunt. Mr. Park’s interview with the Sunday Times (limited access) indicated that Fitbit’s NHS project, should it happen, would be for exercise and activity monitoring, similar to the partnership with UnitedHealthcare which reduces premiums based on policyholder exercise monitoring. This move towards payers is in line with reports starting last year of Fitbit’s seeking clinical markets and moving away from the fickle B2C market. City AM

click to enlargeGiven this week’s leak/reveal and scuttlebutt on the new Fitbit smartwatch, Mr. Park needs to gin up a big payer, quickly. The advance buzz is not positive nor kind. It’s delayed from spring to end of year–in competition with the latest iteration of the Apple Watch. This advance photo of codenamed ‘Higgs’ from Yahoo!Finance indicates a certain clunkiness (and derivation from the panned semi-smartwatch Blaze). It’s pricey, rumored to be priced at around $300. Features include a 1,000nit, built-in GPS, heart-rate monitoring, contactless payments, Pandora and four days of battery life along with connectivity to new Bluetooth headphones. Yet TechCrunch notes “complaints about design, production delays, antenna issues and software problems.” in what they dub “a giant mess”. Forbes notes problems in waterproofing and GPS signal. There are other Android-based smartwatches that do the same for the same price or less. Will this save Fitbit? To be determined….

Update: CEO Park denies delays in the new smartwatch, saying “all new product introductions are on track”, but then again–it hasn’t been officially announced! On the earnings call Thursday, Fitbit stated that new products are now accounting for 84 percent of 1stQ revenue. The company also reported better-than-expected earnings for the first quarter of 2017, reporting an adjusted loss of 15 cents per share on revenue of $299 million. Full year projected at $1.5 – 1.7 bn. Marketwatch, The Verge

How to unblock that health data in your EHR? Blockchain. (UK)

The solution to that huge pile of patient-generated data, blocked and stymied in those non-interoperable EHRs [TTA 15 Mar], may be a system based on blockchain. DeepMind, Alphabet’s AI ‘skunk works’, is building a tool that it calls Verifiable Data Audit. It will be tested first in UK hospitals with which DeepMind is already working, including London’s Royal Free Hospital. What VDA will do is use cryptographic math to keep an accurate record of data used in the past to see exactly who is using health-care records, and for what purpose. When data is used, it generates a code based on all past activity. Any alteration to one part of the data alters the others and is quick to spot.

The UK test results will be interesting because, according to the MIT Technology Review article, patient records are considered to be highly fragmented. Another issue that DeepMind had in the UK was the NHS oversharing data with it for other projects, such as AI systems to diagnose eye disease, early warning signs of illness, and machine-learning approaches to guide cancer treatment. The VDA approach would, ironically, create an audit trail of that data. Another reason why we may be moving from Data Despare to Hope. Hat tip to contributor Sarianne Gruber of RCM Answers.

CHANGED DEADLINE Calling all diabetes prevention apps: may be your chance for greatness!

Our Mobile Health is seeking to identify the best digital behaviour change interventions aimed at helping people diagnosed as pre-diabetic to reduce their risk of onset of Type 2 Diabetes. They are working with NHS England and the Diabetes Prevention Programme to identify the best 4-5 of these that are suitable for deployment to around a total of 5000 people across England. The aim is to build up an evidence base for digital behaviour change interventions for people diagnosed as pre-diabetic.

Organisations with suitable digital behaviour change interventions are invited to submit their solutions for inclusion. These should be either actually deployed or will be ready to be deployed within three months. They should be suitable to be, or have been, localised for the UK market, and they should not be dependent on any further integration with the UK health system for deployment.  Shortlisted digital behaviour change interventions will be invited to participate in Our Mobile Health’s assessment process; the final selection will be made based on the results of that assessment.

The deadline for submissions, which can be made directly online is midday on Wednesday 15th March.  NOTE THIS IS A CHANGE FROM THAT PREVIOUSLY ADVISED. There is more about the programme on the NHS website.

(Disclosure: this editor has been asked to assist with the assessment process referred to above)

Tender up: NHS Shared Business Services (SBS) (UK)

Susanne Woodman, our Reader who is our Eye on Tenders, has found this on the Gov.UK contracts finder site:

Lease of telehealth equipment and peripherals by NHS Shared Business Services. Tender # is RA212802. Location is listed as postal code M50 2UW which is Salford, Lancashire. No value assigned. The RFQ expires on Monday 20th February at 12pm. Questions accepted until Wednesday 15th February 2017 at 12:00 with responses returned by Friday the 17th. Quote procedure and more information is via Multiquote.

British Journal of Cardiology (BJC) Digital Healthcare Forum’s inaugural meeting

28 April, 9:30am-5pm, Royal College of Obstetricians and Gynaecologists, London 

Henry Purcell of the BJC was kind enough to post us with information on the first-ever BJC Digital Healthcare Forum. Organized by the BJC in association with the NHS, the Digital Health and Care Alliance (DHACA), and the Telehealth Quality Group, it is a novel ‘hands on’ meeting to assess if digital medicine can fill gaps in healthcare provision throughout the NHS. It is also in response to the massive pressures which winter has wrought on NHS health and social services. The Forum was designed by clinicians and leaders in healthcare informatics for UK commissioners, doctors and other HCPs involved in the management of long-term conditions (cardiovascular, obstructive pulmonary disease, diabetes etc.), as well as those engaged in health informatics, IT, and Trust CEOs. Speakers include Dr Malcolm Fisk of De Montfort University, our own Charles Lowe of DHACA, Professor Tony Young, National Clinical Director for Innovation (NHS England) and many more experts in digital health and care. For the latest information and to register, see the event website or the attached PDF.

Two tenders up in Scotland and Wales (UK)

Susanne Woodman, our Reader who keeps an eye on telecare procurement tenders, has alerted our UK readers to two current postings:

Telecare IT Platform for East Lothian Council (Scotland).  This is for the purchase an integrated call handling facility and telecare asset management system to respond to alerts from telecare equipment in the homes of vulnerable people. Contract duration 60 months. Deadline 1 March. (Public Contracts Scotland)

NHS Wales Informatics Service–Velindre NHS Trust. The NHS in Cardiff, Wales is looking to appoint partners to develop solutions to engage citizens digitally in the proactive management of their health. It is anticipated that this could encompass a wide range of services from existing applications (Apps) to innovative joint developments. Contract notice will be published 4 April, but the notice as published does not have a deadline. (Tenders Electronic Daily)  See the Sell2Wales website for documentation.

Babylon as AI diagnostician that is ’10 times more precise than a doctor’

The NHS announced at the top of this month that it would test Babylon Health‘s ‘chatbot’ app for the next six months to 1.2 million people in north London. During the call to the 111 medical hotline number, they will be prompted to try the app, which invites the user to text their symptoms. The app decides through the series of texts, through artificial intelligence, in minutes how urgent the situation is and will recommend action to the patient up to an appointment with their GP, or if acute to go to Accident & Emergency (US=emergency room or department) if the situation warrants. It will launch this month in NHS services covering Barnet, Camden, Enfield, Haringey, and Islington, London. TechCrunch.

The NHS’ reasons for “digitising” services through a pilot like Babylon’s app is to save money by reducing unnecessary doctor appointments and pressure on A&Es. It provides a quick diagnosis that usually directs the patient to self-care until the health situation resolves. If not resolved or obviously acute, it will direct to a GP or A&E. The numbers are fairly convincing: £45 for the visit to a GP, £13 to a nurse and £0 for the app use. According to The Telegraph, the trial is facing opposition by groups like Patient Concern, the British Medical Association’s GP committee, and Action Against Medical Accidents. There is little mention of wrong diagnoses here (see below). The NHS’ app track record, however, has not been good–the NHS Choices misstep on applying urgency classifications to a ‘symptom checker’ app–and there have been incidents on 111 response.

Babylon’s founder Ali Barsa, of course, is bullish on his app and what it can do. (more…)

The King’s Fund Digital Health and Care Congress ’17–update

The latest from The King’s Fund on the upcoming Digital Health and Care Congress, 11-12 July (only six months from now!) is in this video now available on Vimeo. It gives a great overview of how digital health has to be integrated to improve care in the NHS and also in other countries, and the scope of its effects on clinicians, HIT, and patients. This Editor has also received word that the successful projects submitted in the meeting’s call for papers will be announced on Friday 20 January, and that the full programme will be announced at the end of this month.

The King’s Fund’s event page; 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.  

Hat tip to KF’s Claire Taylor for the information and the update. TTA will be a media partner of the Digital Health Congress 2017. Updates on Twitter @kfdigital17

Virtual care stops germs dead in their tracks! (Who would have thought it?)

Here at TTA we do receive and read a lot of press releases, and most are pretty meh. (We work very hard to avoid subjecting our readers to meh, as we don’t much like it either.) Now this one takes a different tack. It backs up telemedicine and telehealth technology that enables the patient to avoid the germ-filled doctor’s office and ED. According to Zipnosis citing the Infection Control and Hospital Epidemiology journal, after the standard well-child visit, there is a 3.17 percent increase in influenza-like illnesses among children and their family members within two weeks. Extrapolated, this results in more than 766,000 additional office visits for flu-like symptoms each year and nearly $492 million in annual costs. Now here is a simple, proactive improvement in outcomes that achieves savings (hear that, HHS and NHS?) facilitated by healthcare technology. (See previous article on ‘A tricorder one step closer‘)

The remainder of the release concentrates on what a bad idea it is to subject the rest of the world to your germs when down with a cold or flu. Even the CDC wants patients to stay home from work, school and errands. (That is, if you can.) The point is made that virtual care can unjam doctor offices and EDs for those less dangerous who need hands on care. The light touch of the product message is that Zipnosis provides a white-labeled virtual care platform to health systems that first uses an online adaptive interview with a patient to document the condition, provides a diagnosis and treatment plan within an hour, directing the patient to an appropriate level of care. Release.

A couple more grant opportunities for SMEs

This editor was recently rendered temporarily speechless by an entrepreneur who complained that there was no money available any more to help him start his business. Upon recovering my power of speech I suggested he read Telehealth & Telecare Aware more avidly as we publicise many grants, awards, accelerators and other types of assistance. Here are two more:

mHabitat

mHabitat are launching a Digital Development Lab to accelerate the adoption of digital technologies in mental health.

They anticipate working with around six to eight Digital Development Lab participants over approximately seven months who will have access to a share of a £400k grant to accelerate their technology towards endorsement and adoption by NHS services and service users.

The Lab is open to applications from innovators (more…)

Events last week beyond Brexit: London Technology Week, CE Week NYC

The world may have turned upside down (and around) with Brexit, but London Technology Week happened nevertheless. It’s exploded into 400 events and 43,000 attendees, with 300 attending an event at London City Hall on health tech within the NHS. (Attendees invited to contribute in Comments.) Designer Brooke Roberts, an ex-NHS radiographer who advocates the fusion of fashion and tech, debuted her brain scan-inspired knitwear, accomplished by translating scans into digital files capable of programming industrial knitting machines. According to GP Bullhound in their annual European Unicorns report, 18 of Europe’s 47 billion-dollar digital startups are now based in the UK. So who needs the EU?  TechCityNews, CNN, Yahoo Tech

click to enlargeOn the other side of the Atlantic, there was a disappointing absence of wearables and health tech at the Consumer Electronics Association’s NYC summer event, CE Week. It’s been a major feature since 2009 at International CES in January; the NYC summer show and the November CES preview had always featured a mostly local exhibitor contingent and conference content. None this year–a representative cited a mystifying ‘change in direction’. There was one lone wearable way back in the exhibit hall–MonBaby, which came in from 16 blocks uptown. The snap-on button monitor works with any garment (unlike the Mimo onesie and the Owlet sock) (more…)

Philips publishes new report on connected tech

click to enlargeA report published by Philips today claims that 78% of healthcare professionals believe their patients need to take a more active role in managing their health while 20% of UK patients admit to not managing their health, according to a press release. The report suggests that the result of people not paying attention to their health is increased illnesses (or “lifestyle related conditions” as the report calls them) such as heart failure and type 2 diabetes. The report then goes on to suggest that the use of “connected technology” to help manage their health should be made mandatory for some patients. Connected technology is defined as technology that enables sharing of information throughout all parts of the health system (e.g. doctors, nurses, community nurses, patients, hospitals, specialists, insurers and government) that can range from computer software that allows secure communication between doctors and hospitals, to a watch that tracks a person’s heartbeat. However, the connected technology in a case study highlighted in the press release is home based monitoring systems supplied by Philips for a classic UK telehealth trial for COPD, diabetes and heart failure.

Philips say they commissioned the Future Health Index (FHI) report to globally gauge (more…)