Breaking: NHSX COVID contact tracing app exits stage left. Enter the Apple and Google dance team.

Breaking News: The NHS finally abandoned the NHSX-designed COVID contact tracing app in favor of the app based on the Apple and Google API.

The NHSX version had issues, seemingly intractable, on the BTE features on distancing and contact duration between devices, as well as the app being inaccurate on the iPhone.

The “Gapple” app is already in use in Italy, Switzerland, Denmark, Latvia, and Poland. As this Editor noted on Tuesday, Austria is in test, Germany just launched their ‘Corona Warning App’ and reported 6.5 million downloads in the first 24 hours. 

The BBC reported that the lead on the NHSX app, Matthew Gould and Geraint Lewis, are “stepping back” and former Apple executive Simon Thompson is joining NHSX to manage it

Depending on reports, the NHS either rejected the Gapple app in April or were working on it in tandem from May. More likely, they revived the latter with the NHSX problems. The Gapple version is decentralized in storing information about user contacts on individual phone handsets because of issues over user privacy, versus the NHSX centralized app.

According to the FT and TechCrunch, the government is de-emphasizing the utility of the app, and relying on its small army of contact tracers. 

But what about all those folks on the Isle of Wight?

More on this: Digitalhealth.net, TechCrunch, Financial Times     Hat tip to Steve Hards for alerting this Editor at the end of a busy day!

TTA’s Almost Summertime Blues: $30M to Higi from Babylon, NHS contact traces old school, Propeller’s 510(k) OK, and 7 reasons why to spare that mask most of the time

 

Gasping under our fabric masks, we are wheezing the Almost Summertime Blues. Is NHS a little blue with its unready contact tracing app and having to do things the Old Fashioned Way? Higi is not at all blue with a $30 million Series B infusion led by–Babylon Health–nor Propeller Health, 34 EU health tech startups, and Amazon. Google’s attorneys will roast in an Arizona summer. And finally, BMJ discovers that masks might make your breathing a lot more difficult–and concentrate whatever virus you’re exhaling.

Babylon Health leads a $30 million Series B for Higi health kiosks (An interesting series–of mutual interests in the US of A)
News roundup: LabCorp CRO boosts Medable, Propeller Health gains 510(k), EU’s 34 medtech startups, Amazon’s healthcare moves, Google’s Arizona privacy lawsuit
NHS’ COVID contact tracing service started today–but where’s the app? Australia?
(Looks like the old fashioned un-digital way)
Why ‘masking up’ isn’t such a great idea–more than a false sense of security (And 6 other reasons why)

Sloooowly emerging from our homes into the sunshine, and maybe back into our offices soon, we have a first-person participant view of TechForce19. Back in the office, there will be a whole lot of app tracking and separation going on, if we return. In other news, Optum continues its buying spree, Amwell raises a few dollars, and DHACA has a #WebinarWednesday coming up in June. 

Reflections of a TechForce19 Participant (What it’s like to be in the center of a tornado!)
Optum buys naviHealth for reported $1 billion; Amwell raises $194 million in Series C (More $ in analytics, telehealth)
DHACA home testing webinar 20th May 10am–next one 3 June (DHACA’s #WebinarWednesday)
Post-COVID back to work: for workplace screening, testing, contact tracing, there’s an app for that (You’ll be in a very different looking office with plenty of new rules–if you return there)

Even in Lockdown Lands, it is still Spring. Springing back is Curve Health, repurposing Call9’s telehealth and system. Theranos’ prosecutors had a spring in their step with 12 new charges. And maybe springing the UK free to recover is on the government’s mind with reopening guidance on the post-pandemic workplace.

Founder of Call9 springing back with Curve Health for nursing home telemedicine (Timely with corona’s unfortunate spotlight on SNFs)
The Theranos Story, ch. 63: 12 new wire fraud, conspiracy, forfeiture charges for Holmes, Balwani (The Feds Strike Back)
Important UK government guidance on safer workplaces during and after the COVID-19 pandemic (Kudos to the government–it’s time to revive the economy)

Babylon Health debuts in the US, contact tracing nears rollout in the UK, as an ‘immunity passport’ is contemplated, COVID and telehealth in three countries compared, and a lighter look at technology’s generation gap ‘all in the family’. And..this weekend, we commemorated V-E Day at 75!

Mount Sinai Health Partners (NY) launches Babylon Health telehealth app (Babylon’s app debut to millions competes against established virtual visits)
Is a COVID-19 ‘immunity passport’ next for the UK to get back to work? (Needs reliable antibody testing, as well as a much flatter curve)
Contact tracing in the UK: the biggest digital health test yet? (It’s not the insecurity of data that may hold it back)
Telehealth and the response to COVID-19 in Australia, UK, and US: video (The Malcolm Fisk interview on another view of the ‘genie out of the bottle’)
Has the ‘river of knowledge’ reversed its natural course? A lighter look at technology’s other effects. (Falling into the generation gap)
Contact tracing app ready for Isle of Wight trial this week: Hancock. But is it ready for rollout? (updated) (Needs 80% uptake to work)

Now that the COVID-19 threat may be receding, what’s the future? The view from our telescope or our genie bottle, both good and not so good. We have good news from The TeleDentists, AliveCor, and AbleTo that are upvotes for pioneers. And clinical trials are a fresh pivot for digital health.

10 years in 2 months: prognosticating the longer-term effect of COVID-19 on telehealth, practices, and hospitals (Is the genie out of the bottle? What do you see?)
Anthem Blue Cross Blue Shield adds virtual dental care with The TeleDentists in 9 states (Another vote for remote dentistry)
AliveCor, OMRON announce cardiac monitoring strategic alliance, equity investment (Good news for a pioneer in cardiac monitoring)
The Future of Clinical Trials in the Post-Pandemic Era: HITLAB Seminar Series 6 May (Ongoing series, how CROs may be part of the future for digital health)
Optum rumored on the digital health acquisition hunt again with AbleTo virtual behavioral health (AbleTo a pioneer with traction; a trend further discussed in the lead article)

Alerts on Saturday? Thanks for the feedback–and we’ll try these for awhile.

A full spectrum of news this week. NHSX has made 18 companies very happy in the TechForce19 challenge. We find out more about Tunstall’s ownership change/refinancing. DHACA’s second webinar is coming up on Wednesday 29 April. In the middle, NHSX’s COVID-19 contact tracing app raises privacy questions. And sad news for the industry in the loss of Doug Miles of UKTelehealthcare.

NHSX announces TechForce19 challenge awards, COVID-19 contact tracing app in test for mid-May launch (UK) (Good and not so good news, if you care about privacy)
CEO to CEO: TSA’s Alyson Scurfield interview with Tunstall CEO Gordon Sutherland (updated) (More hot gen on Tunstall’s ownership and financing)
RIP Doug Miles, founder of UKTelehealthcare (A sad loss of a telecare influencer)
Doing more for less in primary care – DHACA’s Wednesday webinars on 22 and 29 April (2nd one coming up on Wed!)

We’ve either flattened or flattered the curve with this week’s news. Flattening the curve is Vayyar’s sensor biomonitoring in Israel, Legrand’s care home support, the FCC, and dental telehealth including The TeleDentists. But flattering that curve is Medopad’s pivoting to Huma and more.

Medopad rebrands, pivots as Huma, acquires BioBeats and TLT, names Alan Milburn as chairman (UK) (Moving from diseases to wellbeing with a splash)
Beyond telehealth: sensor-based vital signs monitoring for early coronavirus symptoms being tested in Israel (Advanced sensor tech)
Legrand launches care home support fund, adds to hospital staff and caregiver support initiatives (Wide-ranging support for multiple worthy efforts at this viral time)
FCC opens application window for $200 million telehealth cost reimbursement program (Financial help for providers, but a lot of hoops to jump)
Cigna launches dental telehealth with Dental Virtual Care–including The TeleDentists (Payer support for dental telehealth, finally)

It was easy to forget that it was Easter and Passover Week as the days blur when you’re sheltering and working at home. But some reasons for cheer are present. There’s an injection of telehealth optimism from Dr. Topol, money for Tunstall and Tyto Care, and Care Innovations’ going to CRO Land. Even Ms. Holmes enjoyed good news, with the Theranos trial charges shrinking like the Wicked Witch of the West. And giving thanks to our healthcare workers–better than banging pots as in the US–is Thank And Praise’s Healthcare Thanking Wall.

A ‘digital wall’ gives thanks and praise to UK healthcare workers (An appropriate message for this week)
After the COVID Deluge: a Topol-esque view of what (tele)medicine will look like (The good doctor administers a dose of future cheer during these Bad News Weeks)
Tunstall Healthcare secures funding from Barings, M&G (A lifeline?)
Care Innovations sold to PRA Health Sciences; launches COVID-19 patient monitoring program (News we missed)
Tyto Care telehealth diagnostics raises $50 million in venture round (Big vote for remote monitoring)
The Theranos Story, ch. 62: Holmes’ attorneys request breaking ‘shelter in place’ orders for trial prep–and a coronavirus testing patent twist (Prosecution charges also deteriorating bit by bit?)

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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

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NHS’ COVID contact tracing service started today–but where’s the app? Australia? (with comments)

To paraphrase the burger chain Wendy’s long-past spokeswoman, Clara Peller, ‘Where’s The App?’. The NHS debuted a contact tracing scheme for COVID, but it is a manual system dependent upon–people. If you test positive for the virus, you will receive a call from the NHS’ test and trace system. The person will ask for information about your recent contacts with others, and then asked to self-isolate for 14 days. Those names you provide will be contacted as well.

The NHSX-developed Bluetooth LE app remains in beta test on the Isle of Wight, which started on 5 May [TTA 5 May]. Reportedly there were 52,000 downloads in week one, which for an island with only 80,000 households is pretty impressive. 

The original rollout date set by Health Secretary Matt Hancock and NHSX chief Matthew Gould to the House of Commons’ science committee was mid-May, which has come and gone. The new date is now sometime in June. However, Baroness Dido Harding, the new director of NHS’s Test and Trace program, would not confirm that date–as we’d say, tap dancing quite hard. Digitalhealth.net, Telegraph

The US has been hiring contact tracers by state from Alaska to New York. A recent study in preprint in MedRxiv (PDF) by Farzid Mostashari of ACO management company Aledade and others found that in order to reduce the transmission rate by 10 percent, a contact tracing team would have to detect at least half of new symptomatic cases, and reach at least half the people with whom they were in close contact. MIT Technology Review 

Apps have been deployed in Australia (COVIDSafe) and Singapore (TraceTogether) and are in development in Switzerland and Germany. Most use BTE, but South Korea, India, Iceland, and some US states including North Dakota and Utah are using GPS phone location. China has been the most ruthless in using GPS data to monitor citizen locations and activity, to restrict their movements. Previously mentioned here [TTA 19 May] are UnitedHealth Group and Microsoft’s ProtectWell, PWC’s homegrown app–and Google and Apple announced in April a BTE app which hasn’t debuted yet. The Verge

Contact tracing in the UK: the biggest digital health test yet?

Is uncertainty over risk of data breaches and violation of data privacy in the NHS contract tracing app the real barrier to adoption? Or is the risk more complicated–the user perception of  app reliability for them to upend their life? A person might not want to have the government on record as telling them that they were “sufficiently near” a person diagnosed with coronavirus–and also believe that the app does not provide reliable information. The person receiving the alert very well may not be infected, but the risk is that they may be compelled to self-isolate and even test with repeated alerts that may or may not be accurate.

In other words, the ‘false positive’ alert syndrome. We go back to this syndrome to understand that the real test of confidence is the perception that the algorithms will, with a good deal of confidence, screen for the number and duration of contacts of other people with symptoms, and that the complex algorithms will create a correct evaluation.

With a system that relies on about 80 percent of adoption, according to a University of Oxford team, the real factor in a successful contract tracing app may be Human Behavior– how users with smartphones perceive the app as reliable in alerting them for enough risk to self-isolate, with privacy and security lesser concerns.  UKAuthority  Hat tip to reader Alistair Appleby

Contact tracing app ready for Isle of Wight trial this week: Hancock. But is it ready for rollout? (updated)

Announced today was what in normal times we’d call a beta test of the contact tracing app [TTA 25 April] developed by NHSX on the Isle of Wight. Transport Secretary Grant Shapps announced it Sunday to Sky News. BBC News detailed today that council and healthcare workers will be first to try the contact-tracing app starting Tuesday at 4pm, with the rest of the island able to download it starting Thursday. Gov.UK  The Isle of Wight has approximately 80,000 households.

Update: How the Isle of Wight residents reacted to the app. BBC News

How the app works: if someone reports COVID-19 symptoms through the app, that information goes to the NHS server and the server downloads that tracking information. The app then notifies the other app users that the person has been in contact with over the past few days, contact being defined as within 6 feet for 15 minutes. This can include someone a person has sat next to on public transport. The tracking in the app is via Bluetooth LE to other mobile phones. The app then alerts contacts with the app and gives advice, including how to get a test to confirm whether or not they do have COVID-19. Users will be able order tests through the app shortly.

Use of the app is voluntary and personal data is limited to postal code and what the user opts in to. So the intent of the app is to warn and test to reduce future outbreaks, as full lockdown is not and cannot be a permanent state. Mr. Shapps stated to Sky that the goal is 50 to 60 percent of the country using the app.

Unfortunately, many of the most vulnerable–older, sicker, and poorer adults–won’t have the smartphone, much less the app, and even with the smartphone, won’t be able to download the app or use it. It’s dependent on self-reporting, which may or may not be reliable. Phones can turn off Bluetooth LE. Another consideration, and one this Editor hopes has been tested, are extremes: extreme density in population and contact areas, and extreme distance, as in rural areas. Additional from BBC News, including a short Matt Hancock clip from the Monday briefing with an almost-touch of his nose or mouth right at the start (!)

The Guardian brings up privacy concerns as well as a Health Service Journal (HSJ) report that the app was ‘wobbly’ and had cybersecurity concerns which would exclude it from the NHS’ own app store. The HSJ story quoted their source stating that the government is “going about it in a kind of a hamfisted way. They haven’t got clear versions, so it’s been impossible to get fixed code base from them for NHS Digital to test. They keep changing it all over the place”.  The reporting data also will reside on NHS servers, not individual phones, but pushes out the alert from the server.

Worldometer gives the current UK statistic as total of 190,584 with 28,734 deaths. While case diagnosis continues to increase, fatalities have been steeply declining. There is concern that COVID is yet to spike in rural areas, as cases have concentrated in Greater London, the Midlands, and the North West. New York and New Jersey alone in the US have over 456,000 cases with just under 32,900 fatalities attributed to COVID-19, 3/4 of which have been in NY–almost as much as the entire UK. (However, the fatality statistic is widely questioned as not screened for contributing causes, since there are certain incentives for attribution.)

In other NHS news, NHS Digital, the information and tech side of NHS (not the innovation unit) has named a new deputy chief executive. Pete Rose will also take on the role of chief information security officer for the Health and Care System, including live services, cybersecurity, solutions assurance, infrastructure, and sustainability.

NHSX announces TechForce19 challenge awards (updated), COVID-19 contact tracing app in test for mid-May launch (UK)

NHSX, the group within the NHS responsible for digital technology and data/data sharing, made two significant announcements yesterday.

TechForce19 Challenge Awarded

NHSX, with the Department of Health and Social Care (DHSC) and the Ministry for Housing Communities and Local Government (MHCLG), yesterday announced the 18 finalists in the TechForce19 challenge. This challenge was set up quickly to support the problem of vulnerable, elderly, and self-isolating people during this COVID-19 quarantine to reduce actual and feelings of loneliness and lack of safety.

Like most everything around coronavirus, this was fast tracked: the challenge announcement in late March, submissions closing on 1 April, and the selection announced on 24 April. Each finalist is being awarded up to £25,000 for further development of their technology systems.

The 18 finalists include a number of familiar names to our Readers (who also may be part of these organizations): Feebris, Neurolove, Peppy, Vinehealth, Beam, TeamKinetic, Alcuris MemoHub, Ampersand Health, Aparido, Birdie, Buddi Connect, Just Checking, Peopletoo/Novoville, RIX Research & Media (University of East London), SimplyDo, SureCert, VideoVisit, and Virti. Their systems include checking for the most vulnerable, volunteering apps, mental health support, remote monitoring, home care management, and in-home sensor-based behavioral tracking. Details on each are in the NHSX release on their website. NHSX partners with PUBLIC and the AHSN Network (15 academic health science networks). Hat tip to reader Adrian Scaife

Updated 29 April. Adrian was also kind enough to forward additional information to Readers on Alcuris MemoHub (left) as a finalist in the remote care category. Partners in the test are Clackmannanshire and Stirling Health and Social Care Partnership (HSCP), East Lothian HSCP, South Tyneside Council, and Stockton on Tees Borough Council and last for about two to three weeks. Release

COVID-19 contact tracing

NHSX announced the release, in coming weeks, of a contact tracing app to track your movements around people and if you become positive for coronavirus, “you can choose to allow the app to inform the NHS which, subject to sophisticated risk analysis, will trigger an anonymous alert to those other app users with whom you came into significant contact over the previous few days.” The app is being tested in ‘early alpha’ at RAF Leeming (Computer Weekly). The app will tell users that they are OK or if they need to self-isolate. Far more controversial, if one cares about privacy, despite all the caveats. Based on the articles, NHSX is targeting a release of the app by mid-May according to the BBC, which also broke the RAF test. It will presumably acquire a snappy name before then. ComputerWeekly 24 April (may require free business registration), Matt Hancock Commons statement 22 April

A ‘digital wall’ gives thanks and praise to UK healthcare workers (updated)

In a deluge of press releases to TTA linking every app, service, virtual event, or device to the coronavirus, no matter the stretch, putting this Editor into ocular overload, a message from James McLoughlin at a small company based in Ascot called Thank And Praise Ltd. (TAP)  was a refreshing change. TAP’s social Healthcare “Thanking Wall’ lets individuals thank NHS workers–individuals, groups, or in general–for their work. TAP is primarily focused on both healthcare and education in the UK, including Northern Ireland. Their objective is to be ‘the global platform of thanks.’

I’ll let James, who is their commercial director, take it from here.

TAP (Thank And Praise), a unique social thanking platform, was created in January 2019 to enable the general public to show their appreciation for the unsung heroes in healthcare and education. In response to the COVID-19 crisis, TAP launched a free-to-use Digital Thanking Wall to enable members of the public to post messages of thanks to the courageous and selfless people working in healthcare/NHS and education at this time. Our campaign has resulted in 1000s of visitors to our website to read the hundreds of heart-felt messages, mainly for healthcare workers.

Readers, do drop in and leave a message on the Healthcare Thanking Wall and follow their LinkedIn page. At this Easter and Passover time, I cannot think of anything more appropriate. Hat tip to James McLaughlin. And thanks.

Release

Babylon Health fires back at critic @DrMurphy11; Dr. Watkins–and Newsnight–return fire (UK)

Last month, this Editor took note of the Twitterstorm around Babylon Health on the issues raised surrounding diagnosis of women’s cardiac symptoms. @DrMurphy11, who has been raising performance issues with the Babylon chatbot for the past three years, ran a test on the app. First using a male patient, then a woman, with identical cardiac symptoms, the app returned two different diagnoses: the man was advised to go to an ED on an emergency basis and given information on a heart attack, the woman to her GP in six hours and given information on a panic attack.

@DrMurphy11 came out earlier this week to BBC Two’s Newsnight’s Emma Barnett on a profile of ‘healthcare juggernaut’ Babylon as Dr. David Watkins, a consultant oncologist. You can see him on YouTube here (at the 1 minute and 3 min. 30 mark). He demonstrates the response of the chatbot, using as the patient an older male smoker with chest pains. The chatbot advises him that he might have either gastritis or ‘sickle cell crisis in chest’–and to go to his GP in 6 hours. What is far more likely than sickle cell with this history is, of course, a heart attack, as a consultant cardiologist, Dr. Amitava Banerjee confirmed on the program. Dr. Banerjee has also been critical of Babylon’s chatbot on cardiac diagnosis and Health Secretary Matt Hancock in his visible advocacy of Babylon in the NHS alone (at 6 min.) According to Dr. Watkins, he has been documenting chatbot problems to the MHRA and the CQC since 2017, and the problems haven’t been fixed.

Timed with the Newsnight piece, Babylon fired back with a press release labeling Dr. Watkins a “troll” and stating that only 100 of his 2,400 tests demonstrated any concerns with the chatbot. According to the release, Babylon’s staff “have attempted to start a positive conversation with this anonymous person. We have invited him in to start a dialogue, to test our AI, and to meet with the senior doctors who build our products” without response. Babylon has also cited that all of Dr. Watkins’ trials were theoretical tests and cites millions of real uses without a single report of harm, that it meets regulatory standards in five countries including use in the NHS, and that its real life users are highly satisfied (85 percent at 5 stars).

At 6:48 to 12:40 in the video, Newsnight’s Emily Maitlis grills both Babylon’s Dr. Keith Grimes and Dr. Watkins. She brings up that Babylon’s former head of regulatory affairs, Hugh Harvey, had stated that no one has assessed how well the app works. Dr. Watkins also counters Babylon’s non-contact claim that he contacted one of the Babylon leadership members back in 2018 on chatbot problems. Dr. Grimes responded to Ms. Maitlis’ remark that founder Ali Parsa is not a doctor that over 600 doctors work for Babylon. This Editor will leave it to Readers to decide what side won, or if it was a draw. Also Mobihealthnews global edition. (For US Readers, Newsnight and Ms. Maitlis conducted the exclusive, disastrous–for Prince Andrew–interview on his relationship with the late Jeffrey Epstein.)

Propel@YH opens again for 2020 accelerator candidates

Yorkshire & Humber AHSN (Academic Health Science Network) today opened applications for the second year of its Propel@YH digital health accelerator. The accelerator is aimed at helping digital health innovators of startup and scale-up size navigate the NHS in the Yorkshire and Humber region and who are already there or are willing to establish an operation there.

10 companies will have access to expert partners such as NHS providers, commissioners and academic institutions. The program this year is being supported by the University of Leeds’ innovation hub, Nexus; Barclays Eagle Labs national incubator network, leading health law firm Hill Dickinson, and Leeds City Council.

Last year, their six finalists were DigiBete, Healthcare Engineering, HeteroGenius, Medicsen, Medicspot and Scaled Insights. 

But hurry–applications close on 12th March. Release, Propel@YH website, application

News roundup for the New Year: NHS £40m diet on login times, Germany’s ‘cheesy’ health ID security, Livongo and Higi partner, MTBC picks up CareCloud

NHS investing £40 million to cut health service login times, £4.5 million on digital assists for independent living. Announced by secretary Matt Hancock, the objective is to move to reduce the time to log in over the 15 systems NHS clinicians and staff may have to use with a patient. The test of a single sign-on system at Alder Hey hospital in Liverpool reduced it from 105 seconds to 10. The Department of Health and Social Care is also providing £4.5m to local authorities to fund digital programs aimed at aiding independent living for recipients of adult social care. Guardian

Germany’s health data network security is ‘swiss cheesy’. Germany’s physicians are in the process of being networked into the national health system through an electronic doctor’s card and practice ID card which identify and sign them in. Similarly, patients will have their own chipped ID card. A special research project by NDR, Der Spiegel, and  IT security experts belonging to the Chaos Computer Club (CCC), found that they could send all three to a cheese monger’s shop in Lüneburg. Looks like their security has a few ‘holes’ in it. Tagesschau.de

Livongo’s diabetes/chronic condition management platform and health kiosk Higi are partnering in 500 retail pharmacies in Michigan for a Livongo-branded health screening and tracking program, using Higi’s measurement, tracking, and Livongo’s wellness programs. Mobihealthnews

CareCloud acquired by MTBC for $17 million cash and about $41 million in total consideration such as warrants and perpetual preferred stock. Both companies are in similar businesses related to medical practice management, EHR integration, and patient communications. It reflects the deep falloff of value in the absurdly overcrowded field of EHR and practice management businesses since Meaningful Use wound up: Allscripts’ acquisition of Practice Fusion for $100 million in January 2018 [TTA 14 Aug 19] and reduced prospects for other HIT players such as Athenahealth, Watson Health and Waystar [TTA 25 Apr 19]. Total investment in CareCloud was north of $150 million in ten funding rounds (Crunchbase) which makes the price a knockdown for the investors like Norwest, Intel Capital, First Data and PNC. Seeking Alpha, MTBC release, commentary on HISTalk.

LIVI telemedicine app expands availability to 1.85 million patients with GPs in Birmingham, Shropshire, Northamptonshire, Southeast

The LIVI telemedicine app, which made news last year with UK partnerships in Surrey and Northwest England last year, has expanded to GP practices in Birmingham, Shropshire, Northamptonshire, and locations in the Southeast, as well as additional practices in Surrey. The Northampton General Practice Alliance and the Alliance for Better Care are among the federations partnering with LIVI.

LIVI offers NHS and private services for video consults with a GP. Patients can also access medical advice, referrals, and prescriptions. Unlike Babylon Health, the patient can use LIVI without having to register with a new, Babylon Health-linked practice and deregistering from the former GP practice. It is now available to 1.85 million UK patients. Known as Kry in the Nordic countries, LIVI also has a presence in France. 

In January, LIVI also acquired some notoriety when their current VP of product, Juliet Bauer, departed her chief digital officer spot with NHS England after an all-too-glowing article about LIVI’s Surrey pilot in The Times–without disclosing that she was joining the company in April [TTA 24 Jan] leading to charges of the ‘brazenly revolving door’ et al.

‘Ask Alexa’ if you’re sick, says the NHS

The latest in the NHS’ ‘digital first’ effort in the Long Term Plan is to add Amazon Alexa’s voice search capability to the NHS’ online advice service. Using Amazon’s search algorithm, UK users will be able to ask Alexa about their scratchy throat, sneezing, flu symptoms, or headache with information sourced from the NHS website. In the announcement, Secretary of State for Health and Social Care Matt Hancock said that “We want to empower every patient to take better control of their healthcare and technology like this is a great example of how people can access reliable, world-leading NHS advice from the comfort of their home, reducing the pressure on our hardworking GPs and pharmacists.” 50 million GP consultations each year are estimated to be unnecessary; the NHS is actively campaigning for patient awareness on self-care to reduce the patient load on practices (GP). NHSX is also planning of making more NHS services available to all patients through digital technology. 

Physicians have expressed concern that what seems to be a minor symptom could be the start of something big, like an underlying illness. For instance, heart rate monitors which are present in smartwatches and gym equipment have driven many to their doctor because of normal heart rate fluctuations, but that visit could be also picking up the early symptoms of atrial fibrillation.

The Alexa voice assistant adoption by the NHS makes search information more accessible for those with limited mobility or sight, which can help them feel more connected and enhance safety. It also assumes that internet is both available, affordable, and understandable by these users.

This Editor wonders if Alexa will have an emergency feature which calls for assistance or to a GP if the user indicates a worsening condition or is in distress. Voice recognition, as Readers know, is imperfect; Alexa may be puzzled by regional accents, phrasing, or speech impediments.

Current estimates on voice search fluctuate. The oft-repeated ’50 percent by 2020′ assumes an accuracy in digital voice recognition and Alexa/Echo/Android/Siri usage and sales that at this stage are simply not there. An excellent discussion of the voice search market that cuts through the hyped-up predictions is by Rebecca Sentance on the eConsultancy website.

More on NHS and Alexa: Telegraph, Wired UK

First they came for the fax machines….now NHS is coming for the pagers

Bloop, Bleep. The NHS has officially announced the phasing out of pagers in hospitals by the end of 2021, with all hospitals required to have their plans and infrastructure in place by September 2020. Replacing pagers will be mobile phones, and smartphones with health communication apps, which facilitate two-way communications and coverage.

According to Digital Health, the pager-less pilot was at West Suffolk NHS Foundation Trust (WSFT), which is one of the Global Digital Exemplar (GDE) sites. The 2017 test resulted in junior doctors saving 48 minutes per shift and nurses 21 minutes on average. The platform  used was Medic Bleep, which integrates audio, text, image and file sharing on web, iOS, and Android. 

NHS is estimated to use about 10 percent of all pagers in use worldwide. The cost, according to this report in Bloomberg, is also stunning. Its 130,000 pagers cost £6.6 million ($8.6 million). A single device can cost as much as £400 pounds, which came as a great surprise to this Editor. Only one UK company, Capita Plc’s PageOne, even supports pagers. So this ‘War On Pagers’ as Digital Health dubs it, has some rationale. Supposedly, the NHS can keep some pagers for emergencies, when Wi-Fi fails or when other forms of communication are unavailable, but even that is doubtful as PageOne will likely go out of the pager business by then.

Mr. Hancock is quoted extensively in both reports. “We have to get the basics right, like having computers that work and getting rid of archaic technology like pagers and fax machines. Email and mobile phones are a more secure, quicker and cheaper way to communicate which allow doctors and nurses to spend more time caring for patients rather than having to work round outdated kit.”

In the US, pagers have largely been replaced by smartphones with advanced communication and file sharing/monitoring except in one specialty–psychiatry. Many psychiatrists in private practice retain their pagers and answering services as a needed triage between themselves and patients. (Over 55 percent of psychiatrists are also aged 55+.)

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS

Well, it’s a blockbuster–at least in length. Over 100 pages long, and in the PDF form double-paged, which will be a tough slog for laptop and tablet readers. It’s Eric Topol’s view of the digital future of the NHS and it’s…expansive. In fact, you may not recognize it as the healthcare world you deal with every day.

Our UK readers may not be so familiar with Dr. Topol, but here you can get a good strong dose of his vision for the NHS’ future as delivered (electronic thunk) to Secretary Hancock. I haven’t read this, but Roy Lilley has. You should read his 12 February e-letter if you haven’t already.

Here is a choice quote: It’s a mixture of science faction, future-now-ism and away-with-the fairies.

Here’s some background. The Vision’s been around for awhile. Dr. Topol thinks and talks Big Picture, in Meta and MegaTrends. His view is patient-driven, self-managed, with their genomic sequenced and at their fingertips, with the doctor empowered by their records, his/her own digital tools for physical examination, with AI to scan the records and empower a partnership model of decision-making.

Topol In Person is quite compelling. This Editor’s in-person take from the 2014 NY eHealth Collaborative meeting is a review of vintage Topol. His expansive, hopeful view was in contrast to the almost totalitarian view (and it is fully meant) of Ezekiel Emanuel, with his vision of the perfectly compliant, low choice patient, and squeezed like a lemon medical system. At that time, I concluded:

One must be wary of presenters and ‘big thinkers’–and these doctors define the latter, especially Dr Emanuel who looks in the mirror and sees an iconoclast staring back. Fitting evidence selectively into a Weltanschauung is an occupational hazard and we in the field are often taken with ‘big pictures’ at the expense of what can and needs to be done now. Both Drs Topol and Emanuel, in this Editor’s view, have gaps in vision.

A year later, I reviewed his article The Future of Medicine Is in Your Smartphone which came out at the time of ‘The Patient Is In.’ which was quite the succès d’estime among us health tech types. “The article is at once optimistic–yes, we love the picture–yet somewhat unreal.” It seemed to fly in the face of the 2015 reality of accelerating government control of medicine (Obamacare), of payments, outcomes-based medicine which is gated and can be formulaic, and in the Editor’s view, a complete miss on the complexities of mental health and psychiatry.

Back to Roy Lilley:

There is an etherial quality to this report, spiritual, dainty. The advisory panel is 70 strong.

Studies and citations galore, from the world’s top research organizations. The advisory board–I believe well over 70–there’s not a soul down in the trenches running a hospital. Government, academics, and a few vendors (Babylon Health, natch). A lot of emphasis on AI, genomics, and training for ‘collective intelligence’. After reading but a few dizzying, dense pages, I admire the vision as before, but wonder again how we get from here to there.

Roy’s essay is a must read to bring you back to reality. 

Is Babylon Health the next Theranos? Or just being made out to be by the press? (Soapbox)

There, it’s said. A recent investigative article by a Forbes staff writer, European-based Parmy Olson (as opposed to their innumerable guest writers), that dropped a week before Christmas Eve raised some uncomfortable questions about Babylon Health, certainly the star health tech company on the UK scene. These uncomfortable bits are not unknown to our Readers from these pages and for those in the UK independently following the company in their engagement with the NHS.

Most of the skepticism is around their chatbot symptom checker, which has been improved over time and tested, but even the testing has been doubted. The Royal College of Physicians, Stanford University and Yale New Haven Health subjected Babylon and seven primary care physicians to 100 independently-devised symptom sets in the MRCGP, with Babylon achieving a much-publicized 80 test score. A letter published in the Lancet (correspondence) questioned the study’s methodology and the results: the data was entered by doctors, not by the typical user of Babylon Health; there was no statistical significance testing and the letter claims that the poor performance of one doctor in the sample skewed results in Babylon’s favor.  [TTA 8 Nov]. 

The real questions raised by the Lancet correspondence and the article are around establishing standards, testing the app around existing standards, and accurate follow up–in other words, if Babylon were a drug or a medical device, close to a clinical trial:

  • Real-world evaluation is not being done, following a gradual escalation of steps testing usability, effectiveness, and safety.
  • How does the checker balance the probability of a disease with the risk of missing a critical diagnosis?
  • How do users interact with these symptom checkers? What do they do afterwards? What are the outcomes?

Former Babylon staffers, according to the Forbes article, claim there is no follow up. The article also states that “Babylon says its GP at Hand app sends a message to its users 24 hours after they engage with its chatbot. The notification asks about further symptoms, according to one user.” Where is the research on that followup?

Rectifying this is where Babylon gets sketchy and less than transparent. None of their testing or results have been published in peer-reviewed journals. Moreover, they are not helped by, in this Editor’s view, their chief medical officer stating that they will publish in journals when “when Babylon produces medical research.” This is a sad statement, given the crying need for triaging symptoms within the UK medical system to lessen wait times at GPs and hospitals. But even then, Babylon is referring patients to the ED 30 percent of the time, compared to NHS’ 111 line at 20 percent. Is no one there or at the NHS curious about the difference?

And the chatbot is evidently still missing things. (more…)

Just the Fax. Or Matt Hancock versus the Fax Machines (UK) (Updated)

Updated. Add fax machines to the Endangered Device list. The news that Health Secretary Matt Hancock has banned the NHS from purchasing new fax machines starting in January 2019, with a full phaseout of use by 31 March 2020, was this past weekend’s Big News in the UK health sector. This is to help force adoption of paperless methods such as apps and email, which is a noble intention indeed.

The remaining prevalence of fax machines in the NHS became a cause célèbre after the Royal College of Surgeons in July estimated that over 8,000 fax machines were still in use. The RCS takes credit for nudging trusts to ‘Ax The Fax’. Guardian

This Editor presumes that Secretary Hancock does not possess a printer, or find the need to print his records even for convenience–or posterity. (One wonders what he’s carrying in that folder or brief…) I also presume that he has never heard of electrical outages, data breaches, malware or ransomware which may make print records suddenly quite needed.

The Road to Perdition is Paved With Good Intentions. A wonderfully tart take on Mr. Hancock’s Fax Obsession is contained in Monday’s NHSManagers.net newsletter from Roy Lilley. He looks at why NHS offices and practices have stayed with fax machines–and the absurdity of such a ban when trusts and practices are attempting to squeeze every penny in a cash-strapped, failing environment:

  • It’s point to point and legally binding not only in medicine, but in law and finance–even in the US
  • They are on the desk, easy to use–requiring only plug in to power and a phone line, fax toner, and paper
  • They don’t need IT support
  • Compared to computers, printers, and internet service, they are wonderfully cheap

And paper-free isn’t a reality even in the US with EHR, tablets and smartphones widely used. Even HHS and CMS in the US require some paper records. Confidentiality and hacking–especially when tied to computer networks–are problems with fax, but the same can be said for computer networksOh, and if your systems are attacked by ransomware, it’s awfully handy to refer back to printed records and to be able to communicate outside of computer networks.

Mr. Lilley also points out that ‘No 18’, as he dubs the Secretary of State for Health, actually has no power to enforce his edict with trusts or GPs.

This Editor predicts a thriving market in used and bootleg fax machines–“check it out”, as the street hustlers say!

Other articles on this: Fortune, Forbes