TTA’s Week: Google predicts outcomes, RPM wins €$, CVS-Aetna hurdles, Amazon looms, Japan copes

 

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)

Amazon as Healthcare’s Scary Monster, Robots on Parade (when they’re not fainting), fall prevention and apps get protective, and NHS plays catchup with the 21st Century’s Digital Times

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)

Of continued interest….

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)

Fall prevention: the technology–and Dutch–cures (Falling tech keeps seniors mobile…and learning to fall right)

Advances in 2017 which may set the digital health stage for 2018 (Alzheimer’s, Huntington’s treatments; All of Us, DeepMind Streams, and Telehealth in Outer Space!)
Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty (Dancing to the M&As, canaries, Babylon, KardiaBands on Apple Watches…)
The Theranos Story, ch. 45: a ‘Christmas present’ $100 million loan from Fortress averts bankruptcy (updated) (A Trojan Horse?)
2017 wrapup: state telehealth reimbursement policies and progress made (Center for Connected Health Policy tracks 63 legislative actions in 34 states)

 


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

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Rounding up what’s news: LindaCare, TytoCare funding; Medicare telehealth parity, Norway’s big cyberhack, Virta reversing diabetes, DARPA’s 60th birthday

click to enlargeYour Editor’s been away and then largely out of pocket over the past two weeks. Here’s our roundup/catchup beyond the bombshells:

In remote patient monitoring for chronic disease, Philips, PMV, and other investors invested €7 million ($8.6 million) in Belgium’s/Hartford CT’s LindaCare. The Series B funding will accelerate its US expansion of OnePulse for remote monitoring of chronic heart failure and cardiac arrhythmia patients with Cardiac Implanted Electronic Devices (CIED). It is in use in major European hospitals and in US trials, though there is no mention in the release or on their website on CE Marking or FDA clearance/clinical trials. Previously from its 2013 founding, it had €1.6 million in funding. Also Mobihealthnews.

TytoCare, a remote monitoring telehealth/video consult platform which integrates peripherals for a virtual physical exam, raised $25 million in a Series C round led by large Chinese insurer Ping An via their Global Voyager Fund plus Walgreens, Fosun Group, OrbiMed, LionBird, and Cambia Health Solutions. Release. Their total raise is $45.6 million since 2012 (Crunchbase). Their most current partnership is with Long Island-based Allied Physicians Group which is featuring at-home telehealth visits at its pediatric practice in Plainview.

More favorable Medicare reimbursement for telehealth is the subject of four US Congressional bills. The one furthest along is the ‘Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017’ (S.870), which aims to improve at-home care, increases Medicare Advantage flexibility, gives ACOs more options and expands telehealth capabilities for stroke and dialysis patients. It passed the Senate in September and now goes to the House Subcommittee on Health of the Committee on Energy and Commerce. The effect of all four is on Medicare payment parity with in-office visits, which does not currently exist and is not affected by the various state parity bills on insurance for those below 65. American Well touts a 10-fold growth in revenue, but the likelihood of any of these four bills being signed into law is small, particularly with a pending report from the Medicare Payment Advisory Commission. Becker’s Hospital Review

Norway released at end of January news on an “advanced and persistent” 8 January cyberattack on Health South East RHF. This has both a health breach and military twist.

(more…)

Behave, Robot! DARPA researchers teaching them some manners.

click to enlargeWeekend Reading While AI is hotly debated and the Drudge Report features daily the eeriest pictures of humanoid robots, the hard work on determining social norms and programming them into robots continues. DARPA-funded researchers at Brown and Tufts Universities are, in their words, working “to understand and formalize human normative systems and how they guide human behavior, so that we can set guidelines for how to design next-generation AI machines that are able to help and interact effectively with humans,” said Reza Ghanadan, DARPA program manager. ‘Normal’ people determine ‘norm violations’ quickly (they must not live in NYC), so to prevent robots from crashing into walls or behaving towards humans in an unethical manner (see Isaac Asimov’s Three Laws of Robotics), the higher levels of robots will eventually have the capacity to learn, represent, activate, and apply a large number of norms to situational behavior. Armed with Science

This directly relates to self-driving cars, which are supposed to solve all sorts of problems from road rage to traffic jams. It turns out that they cannot live up to the breathless hype of Elon Musk, Google, and their ilk, even taking the longer term. Sequencing on roadways? We don’t have the high-accuracy GPS like the Galileo system yet. Rerouting? Eminently hackable and spoofable as WAZE has been. Does it see obstacles, traffic signals, and people clearly? Can it make split-second decisions? Can it anticipate the behavior of other drivers? Can it cope with mechanical failure? No more so, and often less, at present than humans. And self-drivers will be a bonanza for trial lawyers, as added to the list will be car companies and dealers to insurers and owners. While it will give mobility to the older, vision impaired, and disabled, it could also be used to restrict freedom of movement. Why not simply incorporate many of these assistive features into cars, as some have been already? An intelligent analysis–and read the comments (click by comments at bottom to open). Problems and Pitfalls in Self-Driving Cars (American Thinker)

Robot-assisted ‘smart homes’ and AI: the boundary between supportive and intrusive?

click to enlargeSomething that has been bothersome to Deep Thinkers (and Not Such Deep Thinkers like this Editor) is the almost-forced loss of control inherent in discussion of AI-powered technology. There is a elitist Wagging of Fingers that generally accompanies the Inevitable Questions and Qualms.

  • If you don’t think 100 percent self-driving cars are an Unalloyed Wonder, like Elon Musk and Google tells you, you’re a Luddite
  • If you have concerns about nanny tech or smart homes which can spy on you, you’re paranoid
  • If you are concerned that robots will take the ‘social’ out of ‘social care’, likely replace human carers for people, or lose your neighbor their job, you are not with the program

I have likely led with the reason why: loss of control. Control does not motivate just Control Freaks. Think about the decisions you like versus the ones you don’t. Think about how helpless you felt as a child or teenager when big decisions were made without any of your input. It goes that deep.

In the smart home, robotic/AI world then, who has the control? Someone unknown, faceless, well meaning but with their own rationale? (Yes, those metrics–quality, cost, savings) Recall ‘Uninvited Guests’, the video which demonstrated that Dad Ain’t Gonna Take Nannying and is good at sabotage.

Let’s stop and consider: what are we doing? Where are we going? What fills the need for assistance and care, yet retains that person’s human autonomy and that old term…dignity? Maybe they might even like it? For your consideration:

How a robot could be grandma’s new carer (plastic dogs to the contrary in The Guardian)

AI Is Not out to Get Us (Scientific American)

Hat tip on both to reader Malcolm Fisk, Senior Research Fellow (CCSR) at De Montfort University via LinkedIn

Samsung’s $8bn Harman buy: what’s the digital health implications? (UPDATED)

UPDATED Monday’s big news (other than the Dow Jones post-US election climb, China getting shirty on trade and the severe 7.8 magnitude quakes near Christchurch NZ where we hope our Readers are OK) is the $8bn acquisition of Harman International by Samsung Electronics. Those of us who are most familiar with Connecticut-based Harman in the audio area (in cars and Harman/Kardon speakers on this Editor’s bookshelf) will be surprised at their powerhouse status in the automotive industry as a technology hardware and software supplier to GM, BMW and Volkswagen. Its technology is in 30 million vehicles and is tidily profitable. It is also unusual for Samsung as they have tended to grown internally and organically, versus by acquisition. Harman will be operated as a standalone company. (Articles also point out the change at Samsung’s top, with a new generation ascending to control this family-controlled company.)

It diversifies Samsung well past the uncertainties and the maturity of the smartphone business not only into a direct supplier relationship with car makers, but also in how the relationship between man and car transportation is changing. Beyond the obvious like self-driving (piloted driving) cars where Tesla, Ford, Uber, Apple and Alphabet are playing (and the more near-term area like partial assistance in driving), there is a chicken-egg dynamic on cabin enhancements–what can be done versus what should be done. (Designer Raymond Loewy’s MAYA–most advanced yet acceptable.)

  • What connected technologies are helpful and valuable to the driver and passengers?
  • Which ones increase safety, autonomy and security?
  • Which ones add to the driver ‘load’ of distractions and increase danger to the driver and others?
    • Pilots term this a too-busy cockpit. Remember that drivers aren’t pilots and don’t go through checklists and walkarounds before and after driving. We want to turn the key, tune the radio and go.
    • Which ones can be made to be not distracting?
  • What happens when the technologies malfunction or break?
  • What happens to cost and affordability? (All the whiz-bang tech can put a vehicle out of reach for the many. It would be counter-productive and elitist to return driving to the early 20th Century decades where cars were owned by the few and wealthy–Henry Ford and Alfred Sloan had a different thought), though some would like that outcome.)
  • How seamless and secure can IoT be in a vehicle, as it is not secure at present?

All these are in the sub-text of five mega-trends noted at last week’s CES Unveiled New York by the Consumer Technology Association, notably as part of the cheerleading around ‘Transportation Transformation’ and ‘Connections and Computations’. (More about this separately in a later article on CES Unveiled.)

Let’s drill down into the nearer-term health tech aspects, where Samsung has been a leader in their phones and tablets, and what the Harman acquisition might mean there.

The first is the mobilization of what is presently in the home and phone.  (more…)

The security risks, and the promise of, the Internet of Things

Jason Hope, who back in September wrote on how one of the greatest impediments to the much-touted Internet of Things (IoT) was not security, but the lack of a standardized protocol that would enable devices to communicate, has continued to write on both this topic and IoT security. While The Gimlet Eye had great fun lampooning the very notion of Thingys Talking and Doing Things Against Their Will [TTA 22 Sept 15], and this Editor has warned of security risks in over-connectivity of home devices (see below), relentlessly we are moving towards it. The benefit in both healthcare monitoring/TECS and safely living at home for older adults is obvious, but these devices must work together easily, safely and securely. To bend the English language a bit, the goal is ‘commonplaceness’–no one thinks much about the ubiquitous ATM, yet two decades ago ‘cash machines’ were not in many banks and (in the US) divided into regional networks.

As Mr Hope put it as the fifth and final prediction in his recent article:

The IoT Will Stop Being a “Thing”
How many times in the past week have you said, “I am getting on to the World Wide Web?” Chances are, not very many. How many times have you thought about the wonder of switching on a switch and having light instantly? Probably never. Soon, the Internet of Things, and connectivity in general, is going to be so common place, we also won’t think about it. It will just be part of life and the benefits and technology that wow us right now will cease to be memorable.

This Editor continues to be concerned about how hackers can get into devices, (more…)

IoT’s biggest problem? Communication of Things.

click to enlargeThe Gimlet Eye joins us for a ‘blink’ from an undisclosed, low-tech dot on the map. The fave rave of 2015 is IoT, the annoying shorthand for Internet of Things. Well, can Aunt Madge go into a store and buy an Internet Thingy? But it seems fundamental that The Things Speak with each other, if only to compare football scores and conspire against their owner to drive him or her Stark Raving Mad by producing too many ice cubes in the fridge, turning lights on/off at the wrong times or sending out for a deli order of 20 pounds of Black Forest sliced ham. Our fear about The Things was in considering that they could be hacked in doing Things Against Their Will and Not In The Owner’s Manual. But never mind, it’s not this we should be concerned about, or whether Uncle Aloysius will go off-roading in his Google Galaxie after it’s hacked for fun by an eight-year-old Black Hat. It’s that practically all of these same or different brand TVs, parking meters, cars and health/activity monitoring devices to make life simple for Auntie and Oncle are built on different platforms without a communication protocol. The Eye is now relieved of the fear that IoT devices will be crawling out of the water onto her faraway from dull care beach anytime soon. But you may not be. The Biggest Problem with the Internet of Things? Hint: It’s Not Security (Tech.co) Hat tip to follower @ersiemens via Twitter

Ford disconnects research on heart attack-sensing car seat

click to enlargeThe Gimlet Eye returns and hopes that Ford has a better idea, because this wasn’t it. The automaker announced over the weekend that it is abandoning research on car seats that would detect cardiac anomalies such as a heart attack and then (presumably safely) bring the car to a halt (and also presumably, call for medical assistance). A corporate statement to the FT stated that Ford was ‘transitioning’ to other projects, based on advances in consumer wearables. No indication of spend out of a $5.5 billion budget. Undoubtedly, the potential for sensor problems in seats and the danger of shutting down a car while driving were insurmountable. No tears though…. (more…)