Tender Alert: Scotland CAN DO Challenge, Bootle needs assistive tech

This Editor thought it would be quiet for the rest of the month, but our Eye on Tenders, Susanne Woodman, has alerted us to two freshly posted–and the first is major:

  • Scotland: The tender for the CAN DO Innovation Challenge Fund – Health & Social Care Challenges is so large it is in 10 lots which offer an initial market test, an evaluation by the fund, then a decision made on whether to pursue the potential project further with the public body. There are eight that directly involve healthcare technology:
    • Point of care lab testing
    • Adopting technology for care in the north of Scotland
    • Transforming nursing care processes for the 21st century
    • Creating and driving a clinically and cost effective pathway to improve recovery after critical illness enabled by data from hospital information systems
    • An IT system for care workers and patients for adherence to stroke management plans to enable real time monitoring
    • Transforming management of people with severe COPD to improve patient outcomes and quality of life and reduce healthcare costs
    • Glasgow TECS development to support care and digital cutover
    • Develop and integrate digital services that allow for consent-driven data sharing from patient records

There is no deadline listed. More information and required document links here on Public Contracts Scotland

  • Bootle (Merseyside) and Sovini Ltd are seeking assistive technology for about 1,000 residents of its local One Vision Housing with retirement and dispersed housing. Estimated value £180,000 over 24 months. Deadline is 18 Sept at noon. More information at Delta e-Sourcing and Tenders Electronic Daily.

Tender Alert: Torbay and South Devon NHS Foundation Trust for TECS

One more from our Eye on Tenders, Susanne Woodman, is from NHS South West which is reviewing their currently in-house delivery of TECS, including monitoring, in Torbay. The Torbay and South Devon NHS Foundation Trust is seeking a fresh look at innovative services from providers who are interested and able to provide the full service from equipment, installation and monitoring, as well as bench-marking information. To review their current services and equipment (Tunstall), they helpfully provided this linkThis was posted today (15 Aug) and closes 1 September, so there’s only a short window. Refer to the Gov.UK Contracts Finder page for contact information and (importantly) document attachments.

VA’s Shulkin: Cerner rollout start by mid-2019?

An interesting short (free) article on POLITICO Morning eHealth today was an interview with VA Secretary David Shulkin, MD on the Cerner transition, stating that if all went well with negotiations later this year, VA clinicians could be using the Cerner system by mid-2019. “There’s a lot of understandable concern about whether the Cerner EHR will have the same functionality as VistA, which has evolved to the physician’s needs over the past 35 years.” One of the problems with VistA was that it wasn’t one system, it was 130 systems, which is echoed in many EHRs. POLITICO goes on to quote Dr. Shulkin: “I don’t hear as many concerns about that as I do relief about finally making a decision because people felt this was the slow death of a system that they have poured their hearts and souls into. Knowing we’re committed to doing a transition as well as we can is reassuring to people.” Sadly, the rest of the interview is paywalled on POLITICO PRO. Earlier analysis: VA says goodbye to VistA, hello to Cerner. We wonder what the involvement and engagement of the four Home Telehealth winners of the 5-year contract will be.

Weekend Big Read: will telemedicine do to retail healthcare what Amazon did to retail?

Updated. Our past contributor and TelehealthWorks’ Bruce Judson (ATA 2017 coverage) has penned this weekend’s Big Read in the HuffPost. His hypothesis is that telemedicine specifically will disrupt location-based care, followed by other digitally based care–and that executives at health systems and payers are in denial. More and more states are recognizing both parity of treatment and (usually) payment. Telemedicine also appeals to three major needs: care at home or on the go, with a minimal wait; maldistribution of care, especially specialized care; and follow-up/post-acute care. His main points in the article:

  • Healthcare executives are being taken by surprise because present digital capabilities will not be future capabilities, and the shift to virtual will be a gradual process
  • Telemedicine will address doctor shortages and grow into coordinated care platforms embedding expertise (via connected diagnostics, analytics, machine learning, AI) and care teams
  • Telemedicine will eventually go up-market and directly compete with large providers in urban areas, displacing a significant amount of in-person care with virtual care
  • Telemedicine will start to incorporate continuous feedback loops to further optimize their services and move into virtual health coaching and chronic care management
  • Telemedicine platforms are also sub-specializing into stroke response, pediatrics, and neurology
  • Centers of expertise and expert platforms will become larger and fewer–centralizing into repositories of ‘the best’
  • Platforms will be successful if they are trusted through positive patient experiences. This is a consumer satisfaction model.

Mr. Judson draws an analogy of healthcare with internet services, an area where he has decades of expertise: “A general phenomenon associated with Internet services is that they break activities into their component parts, and then reconnect them in a digital chain.” Healthcare will undergo a similar deconstruction and reconstruction with a “new set of competitive dynamics.”

It’s certainly a provocative POV that at least gives a rationale for the sheer messiness and stop-n-start that this Editor has observed in Big Health since the early 2000s. A caution: the internet, communications, and retail do not endure the sheer volume of regulatory force imposed on healthcare, which tends to make the retail analogy inexact. Governments monitor and regulate health outcomes, not search results or video downloads (except when it comes to net neutrality). It’s hard to find an industry so regulated other than financial/banking and utilities. FierceHealthcare also found the premise intriguing, noting the VA’s ‘Anywhere’ programs [TTA 9 Aug] and citing two studies indicating 96 percent of large employers plan to make telemedicine, also with behavioral health services, available, and that 20 percent of employers are seeing over 8 percent employee utilization. (Under 10 percent utilization gave RAND the vapors earlier this year with both this Editor and Mr. Judson stinging RAND’s findings with separate analyses.)

Analyses of New Jersey’s new telemedicine regulations

click to enlargeWith New Jersey’s telemedicine regulations now signed into law by Governor Christie to be effective 21 July, both providers and payers are adjusting to what the expansion means for those covered by Medicaid, Medicaid managed care, commercial health plans, and NJ state-funded health insurance. Our 27 June article reviews key points, and they are largely positive for expanding telemedicine in the (now official) Garden State. However, the payment parity part was diluted in the final version, with the in-person reimbursement rate set as the maximum ceiling for telemedicine and telehealth reimbursement rates.

Unique parts of the NJ bill require:

  • Telemedicine or telehealth organizations operating in NJ to annually register with the Department of Health
  • Submit annual reports on activity and encounter data, which will include patient race and ethnicity, diagnostic and evaluation management codes, and the source of payment for the consult (final details determined by succeeding legislation)
  • A seven-member New Jersey Telemedicine and Telehealth Review Commission
  • Mental health screeners, screening services, and screening psychiatrists are not required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes

Full reviews of the legislation are available from law firms Foley & Lardner and in the National Law Review by an attorney from NJ firm Giordano, Halleran & Ciesla.

VA unveils several ‘anywhere’ new telehealth services for veterans

The new Veterans Affairs Secretary, David Shulkin, has wasted no time since his appointment in introducing several technology and mobile-based services at the VA, all of which are long overdue in this Editor’s estimation:

  • Anywhere to Anywhere VA Health Care will authorize telehealth consults and cross-state care for veterans no matter their location and regardless of local telehealth restrictions. VA is already the largest provider of telemedicine services (called VA Telehealth) in 50 specialties to 700,000 veterans annually. This new regulation will enable VA to hire primary care and specialist doctors in metro areas to cover veterans in rural or underserved areas. 
  • Rolling out nationally over the next year is the VA Video Connect app where veterans can use their smartphones or home computers with video connections to consult with VA providers. At present 300 VA providers at 67 hospitals are using it.
  • The Veteran Appointment Request (VAR) app will also roll out from its test. It will enable veterans to use their smartphone, tablet or computer to schedule or modify appointments at VA facilities nationwide.

Dr. Shulkin advocated these programs while undersecretary, especially ‘Anywhere to Anywhere’, which required advice from the Justice Department. VA’s technology is also being supported by the American Office of Innovation to improve care transitions between the Defense Department and VA. 

President Trump participated in the announcement with Dr. Shulkin and sat in on between Albert Amescua, a 26-year Coast Guard veteran at a VA clinic in Grants Pass, Ore., and Brook Woods, a VA internist in Cleveland. VA announcement with videos, POLITICO Morning eHealth, HealthcareITNews

Charterhouse lost half its equity in Tunstall debt refinancing–Sunday Times report (updated)

click to enlargeBreaking News, even though it happened in March! See updates below. The Sunday Times (UK–sign up for limited access) broke news over the weekend that Charterhouse Capital Partners, the main investor in Tunstall Healthcare, along with other shareholders, have been forced to relinquish nearly half the equity in the company to senior lenders and management. According to their annual report on page 65, section 31**, this happened on 17 March after the close of the FY, but only now has come to light through the Sunday Times report.

The article is light on details, but our Readers who’ve followed Tunstall’s history since the Charterhouse purchase in 2008 for £530 million will not be surprised, only that this development took so long. The cold facts are that the company has been wrestling with a stunning debt burden that grew from £1.2bn in 2015 [TTA 15 Apr 16] to the Times report of £1.7bn at the end of last September, with £300m owed to lenders and £1.2bn to investors. Debt service drove their financials to a £391m pre-tax loss last year. 

The highlights of the deal as reported in the Sunday Times:

  • Senior lenders (not disclosed) received 24.9 percent of Tunstall’s shares. Management received 25 percent.
  • Charterhouse with other shareholders now have a razor-thin controlling balance of 50.1 percent. Prior to this, Charterhouse alone had 61 percent of Tunstall’s shares.
  • In return, the lenders agreed to relax covenants on their debt, termed a ‘covenant reset’.
  • Tunstall also spent £18.5m last year on an abortive attempt to sell itself for up to £700m. We noted reports in April 2016 that they rejected a £300 million (US$425 million at the time) buyout offer from private equity investment firm Triton Partners.

**For those who wish to dig deeper, Tunstall’s hard-to-find annual report through last September (but not filed until 29 March 2017)  is available through Companies House. Go to their index here and select the “Group of companies’ accounts made up to 30 September 2016” which currently is the first listing.

This will be updated as other sourced reports come in, if they do–for now, it appears that the Sunday Times has the exclusive ‘dig’. It is unfortunate since Tunstall is responsible for millions of customers and employs thousands worldwide, and has been aggressively investing in the company and technology while having a fair amount of churn in executive and director positions. Regrettably, they never capitalized on a established position in a big market when they bought AMAC in 2011, then estimated as the US’ third largest PERS company. But as this Editor closed her 2016 article, the whole category of healthcare tech, while becoming more accepted and with a few exceptions, regrettably is still mired in ‘too many players, too many segments with too many names, all chasing not enough money whether private or government.’ I will add to that equation ‘too few users’–still true among older adults and the disabled–and ‘technology that moves too fast’ to make it even more confusing and unsettled for potential buyers (obsolescence on steroids!). And ‘gadgets’, to use the Times’ wording, are among the worst culprits and victims of these factors.

Updated: Equity capital. A cautionary tale was Editor Emeritus and Founder Steve Hards’ prescient analysis of the risks that Tunstall and Charterhouse undertook in acquiring so much debt. After you read it, note the year it was published. More recent commentary on Tunstall’s financial deteriorata dating back to 2013 can be found here.

Tunstall pairing with Inhealthcare digital health for NHS remote monitoring

click to enlargeA digital link of hope for Tunstall’s future? Announced at The King’s Fund Digital Health & Care Conference but oddly not receiving much notice was the UK collaboration of Tunstall Healthcare and Inhealthcare. Inhealthcare builds infrastructure for digital health services, and currently works extensively with multiple NHS regions and programs, such as the North of England Regional Back Pain Programme, NHS England’s Sheffield City Region Test Bed and the Darlington Healthy New Town project. Their services include telehealth monitoring for INR, COPD, medication reminders, a smartphone app platform, chronic pain management, and a surprising one that addresses undernutrition in older adults. The Tunstall-Inhealthcare objective is to integrate health and social care with clinical care systems in six areas: LTC home monitoring, identifying vulnerable patients, involving family members, 24/7 clinical care coordination centers, post-discharge management, and digital health at home innovation. Also noted is that Inhealthcare has programming technology that can reduce the time to build out services and apps.

Inhealthcare Ltd is part of Intechnology plc, owned by Peter Wilkinson, who has developed several UK internet and technology companies at scale–Planet Online, Freeserve, and Sports Internet (now Sky Betting and Gaming). Tunstall release

Can Google Glass’ enterprise iteration solve the patient documentation crisis?

click to enlarge“Glass is a hands-free device, for hands-on workers.” What a marketing position! Google Glass finally arrives at where it should have started–not a techie toy or a social snooper banned from bars, but a tool for specific work needs that solve specific but important problems. This is not only ‘on trend’, but also the ‘professional case’ is steak on the grill as a powerful way to lend legitimacy to a new product (the classic is Tang ‘orange drink’ going into space in the early ’60s). The recent announcement of Glass Enterprise Edition (EE) marking its emergence from stealth mode was a refreshingly low-key (for Google and parent Alphabet) surprise. Even the revamped look is sturdy and utilitarian in full glass mode (left) or in clip-on (and also serves as eye protection). 

Their on-trend position for healthcare is to reduce the amount of time that doctors spend charting and documenting patients. Augmedix, a Glass partner, built the documentation automation platform for Sutter Health and for Dignity Health that captures the information from the interaction between patient and doctor via a ‘remote scribe’. Jay Kothari, the Glass project lead, quotes data from Dignity that it reduces clinician daily documentation time from 33 percent to less than 10 percent,  The Sutter Health estimate is two hours per day. Out of the gate this is extremely valuable because it improves the clinician-patient face-to-face (and presumably virtual) visit in eye contact, reduces the break in taking notes, and reduces time pressure generated by post-visit review. Netherlands-based swyMed concentrates on facilitating virtual visits, and is testing a home visit pilot with Loyola University Health System practitioners in Maywood, Illinois. Others, like John Nosta, have been continuing to use Glass in business. Our Readers may want to check out these partners as that is how Google is making the Glass available, not directly. SF/Boston-based partner Brain Power wasn’t mentioned in Mr. Kothari’s blog, but their AI/VR applications for brain conditions such as autism and TBI, as well as other uses such as clinical trials and care for older adults. mHealthIntelligence interviewed Augmedix’s CEO Ian Shakil, who notes that Glass still needs improvements in battery life for the hard work of documenting patient visits.

Update: An interesting comment on this via Twitter. The paper is from 2015 but the regulatory and privacy questions around recording patients and information remain. Augmedix does state on its website that it is HIPAA compliant.

 
click to enlarge

Telemedicine, payment parity finally are ‘perfect together’ in New Jersey

The years-long telemedicine battle in the populous state of New Jersey–the ever-contradictory home of history, high taxes, ‘the Boss’, Newark Airport, and some of the world’s finest beaches and resorts–has finally concluded with a strong win. Last Thursday, the NJ Legislature unanimously passed two bills that set telemedicine practice and payment standards. The General Assembly passed A.1464 and then hours later, the State Senate passed its bill (S.291). Governor Chris Christie had already indicated his support and his signature is expected once both bills are formally reconciled. The new regulations will be effective immediately.

The bill defines telemedicine as doctor-patient two-way videoconferencing and store-and-forward technology, omitting audio-only, email, texting, and fax as usual on the consults. Telehealth is defined as communications technologies including remote patient monitoring and telephone to support clinical health care, provider consultations, and health-related education. No pre-qualifying in-person visits are required to establish a “proper provider-patient relationship” except for conditions requiring treatment with Schedule II controlled dangerous substances. Another exception is for unpaid consults in the wake of an emergency or disaster–something that NJ is experienced with, having been hit hard in the past by hurricanes.

Healthcare providers (inclusive of doctors, nurses and other healthcare professionals) must be licensed in the state and telemedicine/telehealth organizations must register with and submit reports to the Department of Health. A seven-member Telemedicine and Telehealth Review Commission will be set up within six months and will review DOH reports that contain de-identified data on usage, diagnostic code, and payment. These public reports could provide valuable insights on the efficacy of telemedicine and telehealth treatment.

The bill includes full parity of telemedicine payment with in-person visits for both public (Medicaid, state benefit plans) and private insurance plans. There is also parity of a different type affecting mental health providers, with mental health screeners, screening services, and screening psychiatrists not being required to obtain a prior authorization or a waiver prior to engaging in telemedicine and telehealth. (more…)

Tender Alert: Scotland Excel, Leeds, London/Manchester, Thurrock

Our Eye on Tenders, Susanne Woodman of BRE, has a new batch for your telehealth business consideration. (Thank you, Susanne!)

  • Scotland Excel: A Prior Information Notice (PIN) for suppliers of “digital dispersed alarm units that communicate information digitally between alarm unit and alarm centre”. They are invited to note interest to Scotland Excel and to demonstrate what digital equipment they can currently offer, including any relevant peripherals, such as alarm triggers. The estimated date for the contract notice is February 2018. More information on Public Contracts Scotland.
  • Leeds City Council: A £400k contract for telecare equipment is on offer for North East, Yorkshire and The Humber. This includes alarm units, fall detection, pendants, multiple sensors, and more. It is a 12 month framework with approval obtained to re-procure for the following two subsequent years, expiring 31st March 2020. Submit by 17 July. More information on Gov.UK.
  • General Medical Council, North West (Manchester) and London: An unusual tender for research comparing UK health regulators to counterparts in overseas countries (i.e. Canada, US, Australia, New Zealand or European member states). This covers the regulation of doctors, other healthcare providers (e.g. pharmacists) and healthcare services. Submit by 17 July. More information on Gov.UK.
  • Thurrock Council: This is for community alarm telecare monitoring and administration platforms, with all associated hardware required. Value stated is £100k – £500k, and contract ends 31 July 2021. Submit by 17 July. More information on Gov.UK.

Telemedicine may be appropriate for delivering ‘bad news’: study

A study of a pilot telemedicine program, JeffConnect, administered by Thomas Jefferson University in Philadelphia during 2015 with 32 patients who received free primary care services via doctor-patient video consults (called telehealth here) has some interesting directional findings. The first was high overall satisfaction among the 19 respondents interviewed, including caregivers, with minimal wait times and far more convenience from home or work, aside from some difficulty in connecting. The second, and the most surprising, was this:

Patients had different perspectives on whether they prefer to hear bad news in a video call. Some said they preferred it, thinking that they could get the news earlier and be in a comfortable location with supportive people. One participant explained, “If it was something earth-shattering, you could cry in your own bedroom and not have to worry, I mean driving from downtown and you’re upset or what-not…” Others preferred to receive serious news in person, explaining, “If the doctor were telling me I have a fatal disease or a disease that could be fatal, and I have to go into immediate serious care, probably better in-person.” Several patients stated no clear preference between the 2 options.

This subject warrants more investigation with a larger cohort. Annals of Family Medicine. Also mHealth Intelligence.

76% of health systems to adopt consumer telemedicine by 2018: Teladoc survey

We normally don’t feature corporate or sponsored surveys, but are making an exception here as it demonstrates two trends: that hospital systems can’t fight consumer telehealth** anymore, and that the future mix of usage is starting to change. Teladoc’s/Becker’s Healthcare Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey projects that by 2018, 76 percent of health systems will adopt consumer telehealth (vs. site-to-site), double from 2016, and that most who have it will be expanding offerings. As a benchmark survey, it tracks services offered or plan to offer, organizational priorities, and goals.

An interesting part is how the mix of services under telehealth is evolving. Presently, the top three among current users are urgent care, primary care, and psychiatry/mental health. For new users, their priorities are ED/urgent care (45 percent), readmission prevention (42 percent), primary care, including internal medicine and pediatrics (42 percent), chronic condition management (41 percent). Nearly one in five (18 percent) plan to include cardiology services.

As implemented by health systems, telehealth has run into problems that were totally predictable and will provoke the ‘Duh?’ response from our Readers. From the report:

  1. They didn’t measure patient or physician satisfaction with their telehealth programs, even though improving patient satisfaction is a leading motivator for offering telehealth services.
  2. Gaining physician buy-in was cited by 78 percent of respondents, and rated as the #1 lesson learned
  3. The second most important? The importance of aligning telehealth initiatives with organizational goals (75 percent). (more…)

CBO finds as budget neutral telehealth in Senate CHRONIC Care Act

Sneaking under the holiday week wire, when Congress high-tails it for home, the Congressional Budget Office (CBO) reviewed the telemedicine and telehealth provisions in the US Senate’s pending CHRONIC Care Act and found last week that they do not increase or decrease Medicare spending overall. Formally S.870 – Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017–and sponsored by Sen. Orrin Hatch of Utah, this means that this bill developed by the Senate Finance Committee’s bipartisan Chronic Care Working Group has passed a key spending acceptability test, and is another step further towards passage. CHRONIC removes many of the qualifiers that Medicare hedged around telehealth and telemedicine, with most restricting reimbursement to rural areas. There are four areas where the Act removes barriers:

  1. Nationwide coverage for Telestroke
  2. Home remote patient monitoring for Dialysis Therapy
  3. Enhanced telehealth coverage for ACOs–this expands the provisions in the Next Generation ACO program to ACOs participating in the Medicare Shared Savings Program (MSSP) Stages II, III and the few left in Pioneer, so that telehealth will be reimbursed regardless of geographic location and in the home.
  4. Increased flexibility for telehealth coverage under Medicare Advantage plans

There’s a long way to go, but this is an important step forward to an equal playing field for telehealth services. National Law Review’s summary

International Conference on Rural and Elderly Health Informatics (Togo, W. Africa)

click to enlarge14-17 December, University of Lomé, Togo, West Africa

The IREHI conference is an annual international conference organized by IEEE International and the University of Lomé. The first meeting will be in Togo and will concentrate on the crisis of care delivery in developing countries, particularly acute in rural areas. The conference will look at how information and communication technologies (ICT), including telehealth and distance care, can improve healthcare. These solutions could significantly contribute to the improvement of health education, diagnosis of diseases, the effectiveness of treatment and monitoring of the elderly, both in urban and rural areas where specialized services are still limited or sometimes non-existent. (more…)

Tender Alerts: Nottingham NHS telestroke, Scotland remote health and care

Our Eye on Tenders, Susanne Woodman of BRE, brings to our attention two from UK.Gov’s Contracts Finder and TED, with full information at the links:

  •  Telemedicine Solution for Stroke Services from Nottingham University Hospitals NHS Trust. Nottingham City Hospital requires an immediate replacement for a stroke Telecart which deals with out of hours (OOH) stroke emergencies. This system allows the consultants to remotely interact with patients and staff on the stroke unit. The patient is seen in real time video and audio. Future plans, not in this contract, are for a replacement system in multiple locations. Contact is Niall Fowler of the NUH NHS Trust. Closing 26 May.
  • NHS National Services Scotland Remote Health and Care Monitoring and Communication System. The procurement is intended to support the delivery of home/mobile health monitoring and video conferencing enhanced care. At a later date, this will expand to incorporate future digital telecare or wellbeing solutions. A registration of interest is required for more information, available at the Public Contracts Scotland website. Value is £ 2 million. Note: this listing is a Prior Information Notice with estimated publication 21 June. These are generally released for high-value contracts with usually a compressed application period since information has been previously published.