A fistful of topical events

The London Health Technology Forum has just announced the details of its Christmas evening meeting on 13th December. Star turn will be the seasonally-appropriate Andrew Nowell, CEO of Pitpatpet who has a brilliant story to tell of how an activity tracker can unlock so many revenue sources. Attendees will also unlock mince pies, courtesy of longstanding host Baker Botts, and a roundup of key digital health changes in 2017 from this editor.

NICE Health App Briefings: NICE has finally published the end result of its review of three health apps on their Guidance & Advice list. Given that digital health is so much faster moving than pharma, it is disappointing that these apps appear to be being judged to a very high level of evidence requirement.

For example Sleepio, whose evidence for  effectiveness “is based on 5 well-designed and well-reported randomised controlled trials and 1 large prospective unpublished audit” is still judged, in terms of clinical effectiveness, as “has potential to have a positive impact for adults with poor sleep compared with standard care. There is good quality evidence that Sleepio improves sleep but the effect size varies between studies, and none of the studies compared Sleepio with face-to-face cognitive behavioural therapy for insomnia (CBT‑I).”

This editor is unaware of any other app that has five good RCTs under its belt so (more…)

Sleepio and Alivecor enhance digital health credibility

This has proved to be a great week for digital health credibility.

Firstly Sleepio picked up two honours – one was scoring the highest mark on the first Ranked Health output. The second was getting the American College of Physicians to come out and say that CBT-I should be the treatment of choice for insomnia (above hypnotics).

Meanwhile a study has shown that “A Smart Phone-based ECG Recorder Is Non-inferior to an Ambulatory Event Monitor for Diagnosis of Palpitations”. In layman’s language, the Alivecor/Kardia smartphone peripheral and app are as good as the awkward to wear & cumbersome Holter monitor.

Well done both!

Those who have heard Dr Sophie Bostok, the indefatigable Sleepio Sleep Evangelist, explain (more…)

The NHS fail at encouraging digital health startups

While Minister of Life Sciences George Freeman MP speaks very highly of the need for innovation and digital health in an NHS integrated health system, the reality is less encouraging for UK startups and their growth. The story of Big Health’s Sleepio and its move from the UK, told by Bloomberg, illustrates the difficulty that new companies and technologies have in fitting into a national framework, then selling into the 209 NHS regions plus related healthcare spenders. The long cycle and the narrowness of the frameworks are disincentives for many digital health technologies and their funders. Even if you win clients as part of being on the framework, when it expires after a few years, the business can be lost.

It’s hard to crack the code, and small companies are dependent on partners. A personal anecdote from this Editor’s time at Living Independently: the company achieved getting on a national framework with the QuietCare telecare product (2007) through partnerships with several larger telecare providers. We relied on them to offer QuietCare to the regions and councils. This had limited success and the US business far outstripped that in the UK.

Ten years ago, the situation was reversed. NHS, Government and council funding helped the earliest development and acceptance of telehealth and telecare, much as the Veterans Health Administration (VA) did with home telehealth and telemedicine in the US.  Other European markets and Canada have established private spending in this area, but these smaller markets–and funders– don’t have the potential that is possible in the US private market, even without reimbursement. The trend is reflected in investment: $4 bn in the US, less than €100 million in Europe. US developers now have a bonus in the potential of Asia, with China having the greatest interest and now funding. [TTA 23 July].  How the NHS Is Locking Out Britain’s Digital-Health Startups