HIMSS17 dispatch: developing a telehealth IT team in health system and multi-site networks

Reader Bill Oravecz of Stone Health Innovations is attending HIMSS17 in Orlando, and was kind enough to forward a ‘hot off the presses’ link to this presentation deck given by Jay Weems of Avera eCARE (downloadable as PDF). The subject is ‘Telehealth Workforce Offers Unique Competencies & Opportunities’ and covers how telehealth/telemedicine IT is developed in a health system, mentoring rural originating sites in building proficiencies, and Avera’s experience in supporting a 13-state, multi-system, multi-specialty network. This is more about telemedicine (virtual consults) but offers lessons in developing both in a B2B model.

Material is (c) HIMSS. Session handouts for most presentations are publicly available via the Schedule page; click on individual sessions for further information.

NY’s Northwell Health Home Care partners with HRS for telehealth tablets

click to enlargeNew York State’s largest health system, Northwell Health, is partnering with Hoboken, New Jersey-based (and Blueprint Health grad) telehealth provider Health Recovery Systems (HRS) on introducing their tablets into their Home Care Network. The picture at left is of Bernard Feinstein, a 100-year-old Queens-resident Northwell Health patient, who seems to be easily using and handling the touchscreen tablet. HRS tablets are video-enabled for consults and monitor vital signs, connecting via Bluetooth to devices: stethoscope (heart and lung), pulse oximeter , blood pressure, and weight scale. If one enjoys examples of pretzel logic, the release states that Northwell’s telehealth implementation is one of the first–of Bluetooth-enabled monitoring in NY State home care and the first on Long Island. (Cable-connected telehealth systems have been commonplace since 2003, including Northwell’s home care.) The HRS partnership follows on Northwell Ventures’ $1 million Series A investment in Virginia-based telemedicine provider Avizia. Innovate LI,

Humana-Omada Health diabetes prevention program could cut $3 bn in Medicare expense: study

A study performed by insurer Humana using the Omada Health program for diabetes prevention effectively lowered weight, improved cholesterol, blood glucose and mood. 500 volunteer subjects from Humana’s Medicare Advantage program, enrolled during 2015, lost an average of 13 to 14 pounds over a year (7.5 to 8 percent). They also saw improvements in cholesterol levels, blood glucose levels and subjective measures of moods and self-care. Individuals were chosen from administrative medical claims based on metabolic syndrome diagnosis or a combination of three of four of the following diagnoses: prediabetes, hypertension, dyslipidemia, and obesity. Based on the researchers’ calculations, this type of prevention program among this group if widely implemented among overweight adults could reduce Medicare costs by $3 bn over 10 years, not only for diabetes but also heart disease and high blood pressure.

Omada Health’s program included an online small group support, personalized health coaching, digital tracking tools, and a weekly behavior change curriculum. These one-hour lessons focused on a single topic were delivered via laptop, tablet, or smartphone, and included interactive games or exercises, written reflections, and goal-setting activities. The content was approved by the CDC Diabetes Prevention Recognition Program. Data was gathered via wireless scale, pedometer for physical activity, online food intake logging and standard lab results. “In conclusion, this study demonstrated that older adults who agreed to participate in this program were able to engage meaningfully and gain important health and wellness benefits during a relatively short time frame.”

While the cost reduction estimate is exactly that, other studies directionally confirm health improvement and savings: the National Diabetes Prevention Program (NDPP) which is the model for the Omada program, the BMJ/Noom Health study, and the Fruit Street/VSee telehealth program being used by St. Jude Children’s Research Hospital, University of South Florida and University of Michigan. mHealth Intelligence, study (full text in Journal of Aging and Health/Sage Journals)

TytoCare remote diagnostics comparable to in-person exam results: study

click to enlargeA study of the Tyto Care remote diagnostic device, conducted by Schneider Children’s Medical Center and the Sackler School of Medicine, found that the quality of readings by Tyto Care was ‘on par’ with in-person medical exams using conventional otoscopes and stethoscopes. Ears, heart, lungs and throats of 137 children aged 2-18 seeking care from the emergency department of a tertiary care facility were examined first conventionally and then again by a second remote physician using exam data captured by the TytoCare all-in-one device and attachments. Using standard statistical methods, the results were compared and the study reported “good to excellent agreement for all exams conducted using TytoCare and conventional exam tools, with a p-value <.001.” The study also recorded a separate five-point measure of patient experience and results averaged 4.4 and 4.5 out of 5 (excellent). No adverse events were recorded.

What is lacking in the release are the diagnoses of the young patients, but presumably those results will be presented with the final study. Formal presentations will be at the Israel Society for Clinical Pediatrics (HIPAK) meeting on 8 February in Tel Aviv and at the American Telemedicine Association (ATA) conference 23-25 April in Orlando, Florida. This positive report on efficacy will also aid their rollout with American Well, announced at the end of 2016 [TTA 2 Dec]. Harry Wang at Parks Associates in their blog also named TytoCare one of the two standouts of CES 2017–and the other, Partron (Croise) is not yet on the market.

Tender up: NHS Shared Business Services (SBS) (UK)

Susanne Woodman, our Reader who is our Eye on Tenders, has found this on the Gov.UK contracts finder site:

Lease of telehealth equipment and peripherals by NHS Shared Business Services. Tender # is RA212802. Location is listed as postal code M50 2UW which is Salford, Lancashire. No value assigned. The RFQ expires on Monday 20th February at 12pm. Questions accepted until Wednesday 15th February 2017 at 12:00 with responses returned by Friday the 17th. Quote procedure and more information is via Multiquote.

British Journal of Cardiology (BJC) Digital Healthcare Forum’s inaugural meeting

28 April, 9:30am-5pm, Royal College of Obstetricians and Gynaecologists, London 

Henry Purcell of the BJC was kind enough to post us with information on the first-ever BJC Digital Healthcare Forum. Organized by the BJC in association with the NHS, the Digital Health and Care Alliance (DHACA), and the Telehealth Quality Group, it is a novel ‘hands on’ meeting to assess if digital medicine can fill gaps in healthcare provision throughout the NHS. It is also in response to the massive pressures which winter has wrought on NHS health and social services. The Forum was designed by clinicians and leaders in healthcare informatics for UK commissioners, doctors and other HCPs involved in the management of long-term conditions (cardiovascular, obstructive pulmonary disease, diabetes etc.), as well as those engaged in health informatics, IT, and Trust CEOs. Speakers include Dr Malcolm Fisk of De Montfort University, our own Charles Lowe of DHACA, Professor Tony Young, National Clinical Director for Innovation (NHS England) and many more experts in digital health and care. For the latest information and to register, see the event website or the attached PDF.

What are the impacts of NHS CCGs forcing disabled and LTC patients into care homes? (UK)

click to enlargeCare for elderly and disabled goes off the tracks again. A report in the Health Service Journal (subscription required), covered in an opinion piece in the Guardian, indicates that thousands of patients who are disabled and also those who require long-term care may be forcibly put into care homes (US=nursing homes) rather than being treated and maintained in home care. According to the HSJ, “Freedom of Information (FOI) requests from campaign group Disability United found that 37 NHS clinical commissioning groups (CCGs) in England were introducing rules about ongoing care that could force up to 13,000 people with health conditions into care homes.” CCGs due to NHS cuts have been setting limits on financing home care, between 10 and 40 percent above the care home option. In other words, where a care home is cheaper, the CCG will withdraw payment for home care, and unless the individual can self-pay or has an advocate who can organize a care plan, that person may be involuntarily moved.

The word ‘institutionalization’ deservedly strikes fear on both sides of the Atlantic as a recipe for patient decline, physical and verbal abuse, theft and generally bad care. It’s a blunderbuss solution to ‘bed-blocking’ which we discussed here [TTA 7 Sep 16]–the care plan becomes ‘move ’em out’. By going this way in policy, NHS England is going counter-trend, against more personalized care delivered in home settings, and setting an unfortunate trend for other countries like the US.

Outside the scope of the article, but in this Editor’s thoughts, is the knock-on effect it will have on the UK’s developers and providers of telehealth and telecare services/TECS designed to support home care. Many of these technologies are in a transition period to the greater capabilities (and freedom from land line) of digital from analogue care, which was discussed in TTA here. Cutting domestic demand may not only be critical not only to companies’ survival, but also to their expansion in the (now far more open to the UK) US market. Readers’ thoughts?

Assistive technology tender open for North Yorkshire County Council (UK)

There’s an open assistive technology tender issued by the North Yorkshire County Council closing on 31 March. It doesn’t say ‘telehealth’ but describes needs for a patient-monitoring system, emergency and security equipment, surveillance and security systems, sensors, GPS, health/social work and community health services which are in the aggregate quite close. Award appears to be shortly thereafter but listed as 1 April. Duration is one year out to 31 March 2018. Registration is required on the YORtender website for DN198838 (Historical Ref: CONTRACT-A8SL-W8IAL7) and the contact is Matt Clothier of NYCC. Hat tip to Susanne Woodman, our eye in the sky for tender opportunities.

Health execs’ wish list for 2017: security, analytics, pop health…and telehealth (US)

click to enlargeHealthcare IT News published the results of their October survey of 95 healthcare executives as to their forward plans (resolutions?) for 2017. It’s unsurprisingly centered on upgrades to the following areas:

  • Data security (52 percent)–definitely making up for lost time and spending due to the obvious threats from hacking and data breaches. In November alone, nearly two incidents a day (57) and over 458,000 records were reported by healthcare entities to HHS. (Protenus Breach Barometer)
  • Data analytics (51 percent)–figuring out what to do with all that patient data generated by….
  • Patient engagement and population health (44 percent each)–demanded by quality standards in CMS’ MACRA Quality Payment Program (QPP), including the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs)
click to enlargeThe surprises come here–the technologies they expect to introduce or investigate. Analytics and workflow correspond to the last two points above, but what is compelling is an apparent tipping point for technology which links the patient to care monitoring and access: telehealth (44 percent), smart medical devices (41 percent) and remote patient monitoring (34 percent). These overlap (as in telehealth and RPM require smart medical devices), yet these are strong numbers if they accurately reflect these execs’ actual (or eventual) spending. (Does it point to more clinically validated use of trackers like Fitbit? The Magic 8 Ball does not tell here….)

The presence of 2016-17’s ‘It Girl’, precision medicine (21 percent), which applies both data analytics and genomics to improve patient outcomes, isn’t surprising with the emphasis on quality care.

One can quibble that the sample size is small N, and the report doesn’t confirm the selection details like title, location, and type of organization, but the direction has to be cheering on many fronts. HITN’s overview, survey results (16 slides)

The growth of telehealth, and the confusion of terminology (US)

Becker’s Health IT and CIO Review has written up a US-centric review of recent advances in telehealth and telemedicine but kicks it off with the confusion level between the two terms. Internationally, and in these pages, they are separate terms; telehealth referring primarily to vital signs remote monitoring, and telemedicine the ‘virtual visit’ between doctor and patient, between two clinical sites, or ‘store and forward’ asynchronous exchange (e.g. teleradiology). Somehow, in US usage, they have been conflated or made interchangeable, with the American Telemedicine Association (ATA) admitting to same, and American Well simply ‘just doing it’ in relabeling what they provide. On top of it, the two are incorporating elements of each into the other. Examples: TytoCare vital signs measurement/recording into American Well’s video visit; Care Innovations Health Harmony also providing video capability.

Of particular interest to our international readers would be the high rate of US growth in telemedicine utilization from 7 to 22 percent (Rock Health survey). Teladoc, the largest and publicly traded provider, passed the milestone of 100,000 monthly visits in November and the ATA estimates 1.25 million from all providers for 2016 (Teladoc release). Other US competitors include the aforementioned American Well, MDLive, and Doctor on Demand, the latter two also selling direct to consumer. They also compete against doctor-on-house call services like Pager and Heal. Reimbursement remains an issue both privately and publicly (Medicare and Medicaid) on a state-by-state level, with telehealth experiencing significant difficulties, as well as internet access, speed, and usage by older adults.

GreatCall enlarges remote monitoring profile with Healthsense acquisition (US) (Updated)

Updated. GreatCall, the older adult-targeted mobile phone/PERS company, on 20 December announced the acquisition of telecare/RPM developer Healthsense. Terms were not disclosed. Healthsense was one of the earliest developers (close after Living Independently Group’s, now Intel Care Innovations’, QuietCare) of a sensor-based residential system, eNeighbor, to monitor ADLs for activity and safety. It has been primarily marketed to senior living communities after an early start in home sales, and currently monitors 20,000 lives according to the press release. Healthsense acquired a similar system, WellAWARE, in 2013.

GreatCall is best known for its older adult-targeted mobile phone line, but in recent years they have expanded into mPERS services on phone and devices, including an emergency call center. The San Diego-based company acquired the remnants of the Lively in-home monitoring system a year ago and incorporated its watch-wearables into its medical alert product line.

This Editor speculates that one direction GreatCall may take is to expand into the senior community monitoring and home care business beyond mPERS. To date, GreatCall has been a highly successful, direct-to-consumer driven company which has popularized not only products to make technology simpler and more usable for older adults, but also led in a non-condescending approach to them. If the company decides to enter senior housing and home care, it presents a different and new marketing challenge, as both have been to date late technology adopters. Another concern is the cost/financial model, usability and reliability of Healthsense’s remote monitoring system.

The other direction is more conventional–GreatCall could incorporate the Healthsense technology and ADL algorithms into home monitoring, with a design resembling Lively’s original self-installed, attractively designed in-home telecare system.

Minnesota-based Healthsense in 15 years of operation raised what some would term a paltry $46 million of equity and debt financing in ten rounds (Crunchbase). Over this time, Healthsense’s investors were a small group, including New York-based Radius Ventures, Mansa Capital, West Health and Fallon Community Health Plan. After the $10 million venture round in 2014, the last investment was a small $2.6 million in February. Early investor Ziegler HealthVest Management, which purchased a significant interest in 2007, is not listed in Crunchbase’s roster, though one of their senior financial managers is on their board. This Editor senses (sic) that the investors were seeking to exit after a long time in.

The release has a summary of an earlier Healthsense study of interest to marketers of telehealth and telecare as a reference:

An independent 12-month study with Fallon Health (an investor–Ed.) found that using Healthsense remote monitoring in connection with Fallon’s model of care for seniors reduced total medical expenses by $687 per member per month — a nearly 16 percent reduction for pilot members as compared to a control group. The Fallon population using Healthsense demonstrated a 32.2 percent reduction in fees for inpatient hospital visits, a 39.4 percent reduction in emergency department costs and a 67.7 percent reduction in expenses for long term care vs. the control during the year-long study.

More in Mobihealthnews, MedCityNews, Minneapolis-St Paul Business Journal

(Updated with further information on early investor Ziegler and the senior housing market; hat tip to reader Andrea Swayne)

21st Century Cures and Telehealth (US)

Just before the signing ceremony of the 21st Century Cures Act in click to enlargethe South Court Auditorium of the Eisenhower Executive Office Building President Obama made special mention of his Vice President Joe Biden and his wife Jill who had spoken of the death of their son due to cancer. Obama also mentioned his own mother who had also died of cancer when she was two and a half years younger than he was himself now. The Act provides $1.8 billion for cancer research according to the Washington Post although the allocation is for biomedical research and is not specifically for cancer research.

What was unsaid at the ceremony was that the Act also has a section on telehealth. The telehealth section of the act requires the Centers for Medicare and Medicaid Services (CMS) to report within one year to Congress on populations of Medicare beneficiaries whose care may be improved by expansion of telehealth services. CMS is also asked to report on the telehealth related work already funded by CMS Innovation, make suggestions on the type of services which might be suitable for telehealth and indicate barriers to expansion. The Medicare Payment Advisory Commission (MedPAC) is asked to identify, by March next year, services for which payment is available through private health insurance plans but not under Medicare. MedPAC is then asked to recommend how to incorporate these into Medicare.

These measures look to expanding the role of and accessibility to telehealth for Medicare beneficiaries. Further, a note entitled “Sense of Congress” states that “It is the sense of Congress that eligible originating sites should be expanded …”. However, unlike the key elements of the 21st Century Cures Act, such as biomedical research, no specific funding has been allocated for the implementation of any telehealth related recommendations. Although some optimism has been expressed about the expansion of telehealth as a result of this Act (see, for example, comments from URAC in HIT Consultant and Healthcare IT News.), with the lower priority on health that is possible from the incoming Trump administration, only time will tell if such optimism is justified.

NHS Scotland launches Attend Anywhere video consult trial

click to enlargeAnnounced earlier this month by Shona Robison, Cabinet Secretary for Health and Sport, Scottish Government at the Scottish Digital Health & Care Week and Conference is the pilot of the Attend Anywhere virtual doctor visits. The consults are through a patient’s computer, smartphone or tablet using a Google Chrome web browser. The patient logs in to the website, waits in a private video room, the provider is notified that the patient is in the queue, and when the doctor is available, the video visit will start. (See illustration at left)

Initially, the service will target video call access to up to 50 health care providers including primary care, specialist services, speech and language therapy as well as pharmacy prescription reviews. According to Attend Anywhere, the service is available now to Scots in both rural and metropolitan areas. The service was developed as part of a collaboration between NHS Scotland’s Technology Enabled Care (TEC) Programme, Melbourne Australia-based video consulting specialists Attend Anywhere, and Healthdirect Australia, supported by NHS 24 Scottish Centre for Telehealth and Telecare. The press release links to a video of the consults in use in western New South Wales, including a care home. Scottish Centre demonstration site, Scottish Digital Health Week page.  Hat tip to Chris Ryan of Attend Anywhere Australia for the original articles and corrections. His LinkedIn post here shows the Scottish Centre’s table at the conference.

Europe: how to keep elderly in their own homes longer

A new project to produce smart technical solutions to increase possibilities for the elderly to live at home click to enlargewithout being dependent on children or in-home care has been launched in Europe. The collaborative project named FRONT-VL is led by the Swedish mobile phone operator TeliaSonera and has 21 contributing organisations working within the industry-driven European research initiative “Celtic Plus”.

The project is based on the premise that by enabling elderly people to live at home for as long as possible a good quality of life can be maintained while at the same time reducing care costs. The project proposes to develop predictive health related end-user services in fall prevention, mental health, rehabilitation and palliative care using machine learning and “big data” analysis together with IoT based data acquisition.

FRONT-VL has a budget of 7.2 million Euros and is due to run for 3 years beginning next month. The funding caters for just over 55 person-years of effort over the three year period.

The key innovations of the project will be in two areas. First will be to create a common service delivery framework able to provide Information Computing and Telecommunications based home care and health services to end-users and care professionals. Second is automated data collection to enable peer-to-peer learning and knowledge transfer.

The Celtic Plus initiative defines, performs and finances research projects in telecommunications, new media, future internet and applications and services. It is part of the wider Eureka Network that facilitates R&D projects across Europe.

#MedMo16: finalists, winners, and what they tell us about the state of health tech

click to enlargeHaving attended two conferences in the past two weeks, and squinting to read the tea leaves in the cup, there are some trends that this Editor is picking up. They are quite different from what has been seen over the past year or two. They’ll be expanded on in articles to follow. From the top:

  • Successful companies fit into a bigger picture. Startups into early-stage companies, which were the focus at #MedMo16, are now playing the niches like genetics, patient-focused discovery, condition management and cost-effective specialized clinical innovations.
  • Anything that simplifies a process and saves money is attractive. Complex ‘big data’, analytics and ‘population health/integration’ solutions aren’t in the lead anymore because there are a lot of them and they all look alike.
  • Nothing is revolutionary. The idea that an app, device or software will ‘revolutionize healthcare as we know it’ is now recognized as absurd. (The cocktail/drinks party is ovah!) Cases must be proved first, usually on your self-funded or FFF (families, friends and fools) dime, if you want to partner with the Big Dogs.
  • Value-based care, this year’s darling, is already being seen as a vague ‘catch-all’ in a way that Triple Aim and ‘outcomes/evidence-based care’ were eventually found to be. As a meme, it’s turning out to have the life of a fruit fly.
  • It has to be easy to access, preferably on something the average patient or clinician already has or can acquire easily, like a laptop, tablet or smartphone. The idea of having to place a special purpose-built device in, let’s say, a home, is looking more and more ‘analogue’ indeed, a trend we are seeing in the traditional hub-based telehealth market and even slowly in telecare and traditional PERS.
  • Funding models are changing, with more bootstrapping, self-funding, expand you go and less emphasis on big investment and selling out fast. As funders on a NYeC DHC panel pointed out last Wednesday, don’t raise more – or less – than you need.

At #MedMo16, Crowd Challenge participants were judged by a combination of the interested MedStartr/Health 2.0 NYC community through the MedStartr funding platform, and then by a panel of judges who have leading clinical, technological, patient advocate and funding experience. In short, a group that has seen a lot over the past decade plus, has been up and down the Hype Cycle, and is down to Brass Tacks.

The innovations that bubbled up through the finalists (more…)

Optum’s Utopia of proactive patient care–without telehealth

click to enlargeAnd we wonder why telehealth patient monitoring is floundering and telemedicine is only starting to take off? In this Editor’s reading today, up came this rather glossy, beautifully designed advertorial web page in The Atlantic sponsored by healthcare services provider/holding company Optum. It describes a proactive, highly supportive care process that starts with the diagnosis of a chronic condition (in this case developing CHF) through a ‘health scare’ handled at an urgent care versus a hospital ED, then to care at home (from a highly engaged nurse-practitioner no less) and a patient who, suitably engaged, is “responsibly managing her condition through a wellness approach” and has an improved lifestyle.

Other than an EMR (integrated between provider and urgent care–but EHR is the more current term), no other technology other than telephonic is mentioned in this rosy picture. Where’s the telehealth app that touches our patient, letting her chart her weight, breathing and general wellness, sending it to her EHR and alerting that nurse so she can truly be proactive in seeing changes in her patient’s health? Where’s the telemedicine virtual visit capability, especially if our patient’s out of breath outside of normal office hours, or there’s a blizzard and that nurse can’t visit? Here’s all the infrastructure built up for integrated care, but where’s the technology assistance and savings on home health visits and transportation for the patient?

It can’t be that Optum doesn’t know about what telehealth/telemedicine can do and the role it already plays in care? It can’t be that it doesn’t fit in the integrated care infrastructure? Or does it have to do with reimbursement? (Optum is the parent of giant insurer United HealthcareReaders’ thoughts?