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

 

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

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

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

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

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

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

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

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

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

Of continued interest….

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

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


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Donna Cusano, Editor In Chief, donna.cusano@telecareaware.com, @deetelecare

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

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

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

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

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

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

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

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

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

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…)

September-Autumn Events: The King’s Fund, Aging2.0 London, Health 2.0 NYC, RSM, ATA

Summer is evaporating before our eyes. Fill your calendars to shake off the blues! Here are some events that depending on where you are, should go on it:

At The King’s Fund, London:

Monday 4 September, 5:30-8:30pm: HealthChat with Claire Murdoch and Roy Lilley. Ms. Murdoch is Chief Executive of Central & North West London NHS Trust and NHSE’s new National Mental Health Director. Tickets are £39.95 through Eventbrite here. (Note: this is a private event organized by UK HealthGateway, the publisher of the nhsManagers.net newsletter.)

We thank Roy Lilley for the top-of-the-letter mention of our recent article on telemedicine and retail healthcare. Until today, this Editor was not aware that the NHS was the largest purchaser in the UK of fax machines. Will Sarah Wilkinson’s appointment as the head of NHS Digital change that?)

Friday 6 October, 12.00pm-7.00pm: Ideas that change health care–a festival of ideas to inspire and challenge the future of health care. Free, but tickets are limited. Sponsorships available. More information here. #kfIdeas17

Wednesday 29 – Thursday 30 November, 8.30am – 5.15pm both days: The King’s Fund Annual Conference 2017. Day 1 concentrates on population health, Day 2 on modernizing the health and care system. More information here. #kfAnnual2017

Aging2.0 London at Innovation Warehouse

Thursday 7 September, 6-9pm: Aging2.0 London 2-Pint-0 presents Chris Sawyer from Innovate UK on the Digital Health Technology Catalyst 2017 – Round 1 [TTA 14 Aug]. More information here.

Health 2.0 NYC/MedStartr, midtown NYC

Wednesday 27 September, 6-9pm: Mental Health Innovations 2017. The rising need for and increased scarcity of mental health care calls for new approaches in technology and innovation. The usual lively panel of speakers, company presenters, and engaged audience. More information on their Meetup page here. (more…)

‘We carry on’ this Memorial Day

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

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

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

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

TSA chair selection critiqued

Today’s Must Read  Published today in Roy Lilley’s influential NHSManagers.net newsletter (by free subscription, click on link) is Paul Harper’s commentary on the appointment of TSA Chair Andrew Gardner. Mr Harper’s view is informed by considerable experience in the UK health services concentrating on telehealth and telemedicine. His key point is that an ‘independent chair’ should be exactly that. Moreover, standards of public governance should apply (the Nolan Principles of Public Life), as these private companies are largely doing public sector business. Your Editor will let Mr Harper state the rest; a PDF of his article is attached.

In the US, where your Editor is from, it is commonplace to have an association chair from ‘inside the industry’ whether healthcare or in other areas where I’ve worked, (more…)