Connected Health Conference highlights (so far): FCC’s $100 million telehealth pilot, NIH’s ‘All of Us’, MIT’s social robots integrating AI

Expanding FCC connected health programs. FCC Chairman Ajit Pai in his keynote reinforced the agency’s interest and support of connected health initiatives, from rural to opioids. Most of the programs have a rural focus to bring broadband and telehealth/RPM to the ‘end of the line’ in underserved communities, something close to Mr. Pai’s heart as his parents were both rural physicians in Kansas..

  • This summer, the Connected Care Pilot Program was proposed and approved unanimously in August [TTA 9 Aug]. Funding for this is proposed at $100 million.
  • The spending cap for the rural healthcare program, which has been around since 1997’s dial-up days and now includes telemedicine and remote monitoring, was increased for 2017-2018 from  $400 million to $571 million, a 43 percent increase. The FCC has pledged to fully fund 2018 programs.
  • New initiatives were announced covering new uses for telehealth and remote patient monitoring:
    • Connected care at home via RPM as part of the Connected Care Pilot Program
    • Cancer care in partnership with the National Cancer Institute. The Launch program for rural and underserved communities aims to bring high-quality cancer care to where patients work and live through bringing together government, academia and community health providers.
    • For opioids, there are two programs. One is expanding the mapping broadband health platform to include critical drug use data. This will allow users to rapidly visualize, overlay, and analyze broadband and opioid data together at the national, state, and county level. The second is to launch a chronic pain management and opioid use challenge as part of the pilot program.  Mobihealthnews

A status report on NIH’s All of Us. Back in January as part of setting the stage for 2018, this Editor briefly mentioned the National Institute of Health’s massive All of Us program, part of the Federal Precision Medicine Initiative (PMI). All of Us needs almost all of us–their goal is to collect data on at least one million Americans for a major leap forward on data supporting population health. Dr. Dara Richardson-Heron, All of Us’ chief engagement officer, confirmed that over 100,000 participants have registered since the launch in May, with over 65,000 completing the full protocol. She mentioned that 75 percent of signups are from groups often underrepresented in modern medical research, with 50 percent from racial and ethnic minorities. The Mobihealthnews article ends on a ‘Debbie Downer’ note of doubting whether the program will reach enrollment goals, the cost will be justified, and whether the data will be kept private as promised.

MIT’s social robots may be the future of emotional support for wellbeing. MIT associate professor Cynthia Breazeal heads up the Personal Robots Group and is working on how to integrate AI into emotional robots for pediatric patients at Boston Children’s Hospital. The robots serve as a go-between child life specialists and the patient. The initial results were positive, with higher verbal scores (as a measure of engagement) than with stuffed bears or digital avatars. Professor Breazeal wants to extend the technology to older adults for wellbeing and engagement. Running against the conventional wisdom, their research found that older adults were more open to technology than the children. Following MIT’s work are companies like Hasbro and Embodied. Mobihealthnews.

Tender Alert: advance notice for NHS England ACS-STP Innovation Framework

Susanne Woodman, our Eye on Tenders, has located another NHS England prior information notice for healthcare technology services. This is for Sustainability and Transformation Partnerships (STPs) and Accountable Care Systems (ACS) for building services around population needs, improving outcomes and quality of care. NHS is seeking “a ‘one stop shop’ framework and contracting vehicle to allow STP and ACS partners to more easily source a range of transformation support.” A description is under VI.3) Additional information. Interested suppliers must register via the NHS Bravo portal at https://nhsengland.bravosolution.co.uk/web/login.html–Bravo will be used to issue further information to interested suppliers. Estimated date of publication of contract notice is 8 December. Tenders Electronic Daily-TED.

Higi and Interpreta’s data mix partnership–questions on consent, data security

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/08/Interpreta-Higi.jpg” thumb_width=”150″ /]Higi (also higi), which has placed health monitoring kiosks in over 11,000 US retail locations and a 5.5 million signup base, and data cruncher Interpreta announced that they are partnering to blend Higi’s vital signs data with Interpreta’s claims, clinical and genomics data analytics. Based on Mobihealthnews’ article and the joint release, an individual’s health information taken at higi retail stations will be “prioritized within Interpreta in real time”. They also claim that for the first time, insurance payers and providers will be able to leverage biometrics data, clinical, claims and additional genomic information a person may obtain from genetic testing services into a ‘personalized care roadmap’ that closes gaps in care. This is positioned as a big advance in population health and it all sounds great.

Perhaps not so great are the details. What about consent and data security? Aside from absolutely no mention of patient consent and HIPAA compliance in the above news, this Editor suspects that past, current and future Higi users may not be made aware that their vital signs data recorded with Higi will be 1) sent into a non-Higi database and 2) integrated with other information that appears in Interpreta’s database. How is this being done? Is consent obtained? What then happens? Is it used on an identified or de-identified basis? Where is it going? Who is doing what with it? Can it be sold, as 23andme’s genomic information is (with consent, but still…)? “Interpreta works in the realm of precision medicine, continuously interpreting and synchronizing clinical and genomics data in real time to create a personalized roadmap to enable the orchestration of timely care.” but they do this for providers and health plans who are then responsible for privacy and data integrity. Consent for Higi to keep a record of your blood pressure when you drop into your local RiteAid or ShopRite is not consent for Interpreta to use or manipulate it. These questions should have been addressed in the release or an accompanying fact sheet. We welcome a response from either Higi or Interpreta.

And one last and exceedingly ‘gimlety’ observation by this Editor: kiosks get hacked, and here we have not a price to a McDonald’s meal but a portal to deep PHI. Here’s a two-part article in an industry publication, Kiosk Marketplace, if you are skeptical. Part 1, Part 2 

Digital Epidemiology: on-demand public health

Guest Editor Sarianne Gruber (@subtleimpact) reviews the meta-trend of digital epidemiology, which gathers ‘digital exhaust’ information through social networks, chat rooms and other online media, analyzes it at the population level and tracks localized outbreaks of diseases like the Zika virus and flu. It even has inspired new models of vaccine delivery and patient transportation such as Uber Health and Circulation.

The Internet has a rather detailed picture of the health of the population, coming from digital sources through all of our connected devices, including smartphones. This is digital epidemiology: the idea that the health of a population can be assessed through digital traces, in real time. Digital Epidemiology: Tracking Diseases in the Mobile Age. M. Salathé, J. Brownstein et al.

As a Harvard Medical School Professor and the Boston Children’s Hospital Chief Innovation Officer, the plights of patients and the hurdles in care are Dr. John Brownstein’s starting points for questions and discovery. When the Community Transportation Association study reported “an estimated 3.6 million patients the United States miss at least one appointment due to lack of access to transportation”, Brownstein was determined to make this challenge his own. This fall, he launched the first customizable patient-centric digital transportation system – Circulation – a new vision for non-emergency medical transportation. As a Klick Health Muse attendee and having had the privilege to speak with John Brownstein, Ph.D., co-founder of Circulation, I would like to share what I learned about his journey as an epidemiologist, public health educator, and innovator.

Social Media’s Big Data: Preventing Epidemics and Tracking Drug Safety
Digital epidemiologists think in terms of “digital phenotype” to understanding the health of individuals. Uncovering critical information about what is happening at the population level is collectively called “digital exhaust”. These digital traces that are left behind, help track local outbreaks around the world. “In fact, you don’t need surveys, just mine what people are saying online. We combine social media to get real insights as to what is happening on the ground: facts and sentiment. The ability to understand risk and population health is fantastic with these emerging technologies,” opened Dr. John Brownstein at the 2016 New York City KlickMuse event.

Social media mixed with disparate sources of health data was how Brownstein began solving public health risks. (more…)

Population health is everywhere (US)

Last week, CMS published the ominously dubbed Final Rule on MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) which utterly changes how physicians are compensated by Medicare and the various monetary incentives they have in quality and patient-centered care. This Editor is not going to get into interpretation of 2,300+ pages, but her belief is that this will not be effective in 2017 as designed, as literally it is over-complex and not understood by those who implement patient care. The dizzying models include Merit-Based Incentive Payment System (MIPS) and for the daring, the Advanced Alternative Payment Model (APM). All great business for the 100 or so ‘value-based consultants’ ready to help those expensively organized ACOs which thought they’d be rich from Meaningful Use. Oh, and what about the patient and their well-being in the meantime?? Healthcare Dive, Healthcare IT News and here  Don’t hunt for CMS’ fact sheet–it’s here. Don’t look for much about telemedicine and remote monitoring, which apparently was included in the law but not in the Final Rule for MIPS but is a part of the Advanced APM. Congress may act to expand Medicare’s payment policy on telehealth, but don’t hold your breath for it happening this year. POLITICO Morning eHealth 19 Oct

But population health and the data analytics that’s needed to get a handle on both large-scale patient health trends to allocate care where it is needed, and the financial metrics that organizations need, is hot. Verily Life Sciences (Alphabet-Google’s ever versatile healthcare tech arm) is allying itself with 3M Health Information Systems. (This Editor bets that you never thought that the Post-It Notes company was in health information!) According to the article, 3M’s part has to do with its business in coding, classification and risk-stratification methodologies. Verily will bring to the party data analytics, algorithms and software development. Healthcare IT News

This Editor also noted IHS Markit’s analysis of MACRA mixed with a bit from ATA’s Fall Forum. One insight: And now CMS plans to tie 90 percent of traditional Medicare fee-for-service payments to value-based payments in 2018. A lagninappe: “MACRA will help telemedicine to simply become another modality within healthcare delivery.” The wrapup is quite illuminating.

As identified during a recent consumer survey conducted by IHS Markit on digital health trends in the US, patients are interested now more than ever in sharing their healthcare data, and provider communication is at a low: (more…)

A deserved goring of whiz-bang unicorns Theranos and Zenefits (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/08/1107_unicorn_head_mask_inuse.jpg” thumb_width=”150″ /]A blog posting this Editor wish she had written. Fred Goldstein, who is a consultant to healthcare systems focused on building accountability and improving population health, has pressed a sharp point to the sparkly bubbles surrounding two Silicon Valley billion-dollar valuation darlings, Theranos and Zenefits, on their playing fast and loose with basic regulations.

Some background for our readers. It’s a pile-on with Theranos, which has been stepped on by FDA for their nanotainers [TTA 20 Nov 15], then whacked by the Centers for Medicare and Medicaid Services (CMS) last month for ‘deficient practices’ at their California testing lab (a remedial plan has been filed this week) and likely losing its lucrative Walgreens Boots deal if problems aren’t fixed in 30 days (having already lost its program with Capital Blue Cross in the Harrisburg area of Pennsylvania). According to Bloomberg, its proprietary testing is now used in only 1 of every 200 tests. Zenefits claims to be the ‘first modern benefits broker’ with cloud-based software designed to simplify and automate such HR tasks as health insurance signups for small businesses, but its software that facilitated skating around required licensure requirements by its staff got its CEO forced out by a key investor, Andreessen Horowitz. (And it gets worse…read on….)

It’s so…whiz-bang! (Updated) Your Editors, past and present, have made hash (corned beef and otherwise) of companies promising revolutions in healthcare since our inception. ‘Whiz bang’ (more…)

HIMSS Connected Health Conference/mHealth Summit starts Sunday–save $100

Time is short! This Editor will be attending the HIMSS Connected Health Conference this November 8-11 in Washington, DC (actually outside The Puzzle Palace in National Harbor, Maryland). Telehealth & Telecare Aware has been a media partner (disclosure) since the 2009 mHealth Summit. Changes this year include that it is three conferences in one: the original mHealth Summit with the Global mHealth Forum, the new PopHealth Summit (concentrating on health improvement on the community, regional and national level) and the much needed new CyberSecurity Summit.

Attend all three for one registration, including a large Exposition floor and three pavilions for Population Health, Cybersecurity and Games for Health. Also, there are extra co-located and add on events, mainly on Sunday the 8th. The Global mHealth Forum focuses on mobile and connected health in low and middle income countries (LMICs) and is on Wednesday.

The Summit organizers have been kind enough to offer an excellent discount to our readers of $100. When registering, click on the advert (above, right hand side) and use the promotional code TELEHEALTH100 to receive it. (more…)

Health IT serving population health

From the iHT2 Health IT Summit this Editor attended two weeks ago is this presentation by Jonathan Weiner, DrPH, Professor in the Department of Health Policy and Management, Director of the Center for Population Health IT (CPHIT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Telehealth is (or should be) implicit in the data feedback loop outlined in slide 3; in the population health assessment and performance loop on slide 5; the ‘digital health milieu’ on slide 9.

Harnessing EHRs and Health IT to Achieve Population Health    Interview with Dr. Weiner