Rounding up mid-August: PCORI funds 16 projects with $85 million, InTouch’s Rite Aid deal, Suennen leaves GE Ventures, NHS lost 10K patient records last year

click to enlargeRounding up August as we wind down our last weeks of summer holidays. 

The Patient-Centered Outcomes Research Institute (PCORI) announced earlier this week that they are funding 16 studies which compare two or more approaches to improve care and outcomes for a range of conditions. Included in the $85 million funding are studies incorporating technology. One is a $13.3 million grant for a West Virginia University study utilizing telehealth to monitor patients with major depressive disorders comparing medication, cognitive behavior therapy (CBT), and medication plus remote CBT. PCORI Release

InTouch Health, an enterprise telehealth provider which most recently partnered with RPM developer Vivify Health [TTA 19 Dec] to move into in-home and post-acute settings, is now moving into retail with Rite Aid. The letter of intent is to help Rite Aid build up the technology in their existing health kiosks in pharmacies and ‘alternative care sites’. Rite Aid has had a long standing interest in kiosks, including as one of the last customers of HealthSpot. With their Albertsons merger scuttled, Rite Aid is seeking other business and interest. One of InTouch’s executives is EVP of Marketing and Consumer Solutions Steve Cashman, who founded and headed HealthSpot. InTouch is also participating in the World Telehealth Initiative, a nonprofit organization which seeks to bring telehealth expertise into worldwide communities in need. InTouch will donate devices, access to its virtual network, and access to doctors donating their time. Mobihealthnews.

Lisa Suennen, a fixture at many health tech conferences and one of the few women with both presence and clout in the funding sphere, has departed GE Ventures, GE’s VC arm. She was senior managing director focusing on healthcare companies, successfully exiting several in her portfolio to UnitedHealth and Aetna. No reason was given for her exit after a stint of under two years, other than the anodyne “find a new adventure.” GE is planning to spin off its healthcare businesses as part of its restructuring. CNBC

And the week would not be complete without a report about NHS losing nearly 10,000 patient records–paper and electronic–last year, according to information released under UK freedom of information laws. Without this information, doctors have trouble finding patient history sources and prior diagnostic records. There is also abundant opportunity for fraud, as Everything Winds Up Somewhere, and that somewhere could be criminal. Last year, Members of Parliament said the NHS had “badly failed patients” after a scandal in which at least 708,000 pieces of correspondence–including blood tests, cancer screening appointments, medication changes, and child protection notes–piled up in storerooms. Sunday Times. If paywalled, see the attached PDF.

Despite recruiting, Babylon Health’s GP at hand still on hold in Birmingham (UK); CEO steps down at rival Push Doctor

GP at hand, Babylon Health’s NHS app and service for scheduling patients with local GPs, was expected to roll out in Birmingham, but the Hammersmith and Fulham CCG, from which Babylon operates, continues to halt its the expansion since the beginning of this month on patient safety concerns.

The app, which schedules patients with GPs and requires registration that effectively changes what we in the US call ‘attribution’, was set to add GP surgeries in Birmingham starting this month and was setting up an HQ at Badger House, an out-of-hours GP services provider based in Birmingham’s inner city. GP recruitment had started, according to Pulse, in late July. Patients would register in Babylon’s host practice Dr. Jefferies and Partner in southwest London through NHS’ out-of-area registration scheme.

The objections to Babylon’s expansion came initially from Paul Jennings, the chief executive of Birmingham and Solihull CCG. According to Digital Health, “he wrote to Hammersmith and Fulham to lodge a formal objection to the expansion. He argued the digital service was “not yet robust or tested for a national service to be delivered from a single practice outside of Birmingham”. Hammersmith and Fulham then stated that “further information is required to provide assurance on the safety of patients” before the Birmingham roll-out could be approved. 

This is despite the release of a equality impact assessment by Verve Communications on behalf of Hammersmith and Fulham finding mainly positive results, such as GP at hand “more likely to address most barriers than traditional GP services” in 10 out of 11 protected groups” and that “carers may benefit from [the] use of GP at Hand as this will allow them to consult a primary care practitioner whilst continuing with their care responsibilities.” The new Health Secretary Matt Hancock, a major advocate of technology in care, is himself registered with Babylon. Mobihealthnews

(If you are in the UK, you can hear it straight from Babylon’s CEO Ali Parsa, interviewed by Roy Lilley of nhsmanagers.net, on 10 September at the RSM.)

Rival telemedicine service Push Doctor is also undergoing changes with CEO and co-founder Eren Ozagir’s departure. It appears that he and the board had a difference around company direction, with the board recommending a cut of 40 jobs (Sunday Times). Their COO, Wais Shaifta, became acting CEO in July. In June 2017, a report by the Care Quality Commission (CQC) found the service to be delivering unsafe care via antidepressant and blood thinner prescriptions being given without requisite blood tests and monitoring. Digital Health

Will Matt Hancock be a refreshing change for NHS? Or another promise unfulfilled? (updated)

click to enlargeMatt In A Binder? With the sudden departure of Jeremy Hunt from the Department of Health and Social Care in the Cabinet’s ‘change partners and dance’, the new Secretary of State Matt Hancock comes over from heading Digital, Culture, Media and Sport. A couple of weeks in, it can be determined that he is a big advocate of technology and looking forward, not back (which Mr. Hunt spent a great deal of time doing):

Technology has a proven ability to radically change the world for the better – be it in finance, in education and in transport. But nowhere does technology have greater potential to improve lives than in healthcare. (Statement on Gov.UK/Health Service Journal 12 July )

And he glows again about increasing the use of apps within the NHS, though Digital Health goes a little overboard in calling the Rt Hon Mr. Hancock ‘app-happy’ even though he’s built his own this year so that his West Suffolk constituents can keep track of his activities. 

In his maiden speech, Mr. Hancock promoted a drive to replace pagers with smartphone apps as part of a £487 million funding package and connecting Amazon Echo with the NHS Choices website. It was overshadowed by a seeming walking back of the 95 percent four-hour A&E treatment target. Telegraph

Much of the criticism comes from those who see his appointment as yet another step in the privatization and regional devolution of the NHS due to campaign donations from the chair of pro-market group the Institute of Economic Affairs (IEA). However, Mr. Hunt faced the realization that NHS trusts are $1.2bn in debt and sought workarounds such as adoption of an ACO-type model (which in the US has a strong element of public incentive) and increased use of private health insurance to cost-shift. He wasn’t a technophobe, having inked a deal with the UK Space Agency to repurpose space tech for health tech and funding innovators in this conversion up to £4 million–which can be said to be ‘out there’.

Mr. Hancock also announced this week the £37.5 million funding of three and five ‘Digital Innovation Hubs’ over the next three years. These will connect regional healthcare data with genetic and biomedical information for R&D purposes.

Will he last? Will there be positive changed fueled by technology? Will the May Government last? Only time will tell.

What are your thoughts? (If you’d like to post anonymously, write Editor Donna in confidence)

Here’s select opinion from across the spectrum:

Don’t be fooled, Matt Hancock will be no better for the NHS than Jeremy Hunt was (The Independent)

New health secretary Matt Hancock received £32,000 in donations from chair of think tank that wants NHS ‘abolished’ (The Independent)

Roy Lilley’s always tart take on things NHS extends to the new Secretary dubbed ‘No18’. A deft wielding of Occam’s Razor and a saber on reflexive phraseology such as ‘driving culture change’ (it can be cultivated not driven–this Editor agrees but the tone and structure need to be set from the top), dealing with suppliers, and the danger of creating an electronic Tower of Babel due to lack of interoperability. (Does this resonate in the US? You bet!) (See NHSManagers.net if the link does not work.)

Margaret McCartney: Health technology and the modern inverse care law (BMJ) — to paraphrase, that the greatest need for healthcare is by those least likely to have the right care at the right time available. She points to Babylon Health, which counts Mr. Hancock as a member, as not only unproven, but also not needed by those able to afford other options. (But didn’t we know that already?)

The King’s Fund Digital Health & Care Congress next week on 10-11 July

Time has flown by since this Editor first mentioned this event and now it’s next week. This year’s meeting features case studies in creating the right culture for large scale digital change, using digital technology to improve quality of care, prevention and changing behaviors, population health informatics, tools for self-management, reducing clinical variation, mobile working in community services, and much more. Featured speakers include Matthew Swindells of NHS England, the Rt Hon Paul Burstow of TSA, Ruth Rankine of the Care Quality Commission, and more. See the agenda here for Day 1 and Day 2. (TTA’s own Charles Lowe will be chairing Breakout T2B: Quality improvement 11:45am on Tuesday 10 July.) Two very full days 10-11 July, Tuesday and Wednesday, at The King’s Fund’s London location. For more information, click the advert in the right sidebar or here

Instant GP, don’t even add water; Babylon Health taps into the corporate market via insurer Bupa (UK)

click to enlargeIs digital health gaining some traction in the UK? One insurer is making the bet. Earlier this week, Babylon Health announced a UK partnership with Bupa’s corporate insurance area to open Babylon’s digital health services to corporate employees insured by Bupa.  Bupa’s Instant GP app offers these employees Babylon services, such as the ability to book virtual appointments with GPs, be transferred to specialists, and receive prescriptions. The app is free to download through the Apple App Store or Google Play for Bupa-covered employees.

Bupa and Babylon have been working together in a limited way since 2015–see this Bupa press release.

Some extras for employees in the program: unlimited 24/7 online GP consultations; Babylon’s clinical triage service, and access to the Babylon’s new “digital twin” service. This medical assessment method works with a smartphone tapping key parts of their body. It’s being previewed by Bupa and is scheduled to be released nationwide later this year.

Reportedly Bupa is seeking to provide Babylon services to their UK SME business (micro, small and medium-sized enterprises) later this year. Telegraph (paid access for full article), Digital Health News

For Babylon, it’s been an extraordinarily busy time. They have a new agreement with Samsung to be included in Samsung Health on smartphones [TTA 14 June], and China’s Tencent offering of Babylon through their WeChat platform. Babylon also recently announced passing the 26,500 patient mark with London NHS GP at Hand.

Building Better Healthcare Awards 2018 open for entries (UK)

Our former Eye on Tenders, Susanne Woodman of BRE, has informed us that this year’s BBH Awards is seeking organizations which are implementing healthcare technologies and software. These can be either process-centered (e.g. information or workflow systems) or patient-centered (e.g. medication compliance, smoking cessation). The organizer, HPCI Media, is accepting entries until 30 June. 

There will be 27 awards across five classes: Building Design, Technology, Estates and Facilities, Staff and Patient Experience, and Special Awards. Last year’s awardees are here. Another theme is the 70th Anniversary of the NHS. 

This year’s awards will be on 31 October at The Brewery in Chiswell Street, London.

Our very best to Susanne as she sets out on new horizons!

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

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

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

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

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

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

UK roundup: CCIO Simon Eccles warns against ‘shiny objects’, NHS Liverpool CCG award to Docobo, 87% concerned with NHS info security

click to enlargeNHS Digital CCIO doesn’t like ‘shiny objects’. Dr. Simon Eccles used his first NHS Digital board meeting as national CCIO to encourage delivering the current agenda first and not getting distracted by the ‘shiny objects’ of new innovations which also divert funding. “It is our collective challenge to make sure that doesn’t happen to things that are valued by the NHS – to do what we said we’d do and not be too distracted by new and shiny things.” This seems to be at odds with non-executive director Daniel Benton, who “suggested that NHS Digital needed to become more flexible as an organisation so that it was in a better position to roll with the punches in future.” Digital Health News

Docobo announced their win of the NHS Liverpool Clinical Commissioning Group‘s scale up of telehealth as part of the Healthy Liverpool program. The three to five-year contract has a maximum value of £11.5 million. The current Mi Programme (More Independent) partly funded by the Innovate UK dallas initiative and using Philips equipment is at 900 patients with 5,300 total patients since 2013. The plan is to scale up the program to 4-5,000 patients a year and support new clinical pathways and conditions including lung conditions, heart failure, and diabetes. Docobo’s platform is Doc@Home which uses patient information from the CarePortal device or their own digital devices. Docobo release. NHS Innovation Accelerator, Digital Health News

A survey of 500 British adults conducted by UK IT VAR Proband found that perceptions of public sector information security are poor. 87 percent were concerned about the security of their information with the NHS. Of that 87 percent, 34 percent were ‘very concerned’ about their cybersecurity. Taking this with a grain of salt, 80 percent distrusted security at the Driver and Vehicle Licensing Agency (DVLA) and 78 percent on data held by the police. The General Data Protection Regulation (GDPR) can’t come too soon [TTA 17 Feb] — but are you ready? More in Proband’s Online Security Audit (PDF).

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. (more…)

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?