TTA’s week: CVS-Aetna–does it make sense? The Rivers of Babylon (Health). Tender alerts gift wrapped!

More on the ground-breaking CVS-Aetna merger–does it make sense? We wade into the rivers of Babylon Health’s pilots and present you with a large box of Tender Alerts for our UK companies.

And a reminder that you have just two more days to 15 Dec to submit your project for The King’s Fund 2018 Digital Health Congress.


Tender Alert: NHS England, London South Bank, Univ. of Leeds, NHS Digital, Halifax, Healthy New Towns (The last is big…really big)
Babylon Health: correcting earlier NW London CCG report; other concerns raised by CQC report (A deeper dive into The Rivers of Babylon and lessons to learn)
CVS-Aetna: the canary says that DOJ likely to review merger–plus further analysis and developments (It faces legal headwinds, may not make the most business sense–and has international repercussions affecting Walgreens Boots)

Is the CVS-Aetna merger heralding a new era, or an executional disaster in waiting? A lively #MedMo17 awards six startups. And Australia tries Health Care Homes for coordinated care.

Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both? (Are US healthcare execs in shock?)
#MedMo17: the conference, winning startups, Bayer, blockchain, and more (A lively conference report!)
Health Care Homes – treating chronic diseases in Australia (Coordinating care Down Under)

Does telemental care work?–the VA record. Secretary Shulkin moves forward on private care, Mayo’s Dr. Montori on care fitting into life. And HeyDoctor is Text 4 Doc.

OnePerspective: VA shows how technology can improve mental health care (Telemental health’s expansion chronicled in our new section)
VA’s Secretary Shulkin wants more private care options for veterans as part of reforms (Telehealth, private care coverage leading to better care)
Mayo Clinic’s Victor Montori MD calls for a ‘patient revolt’ for ‘careful and kind care’ (Expanding minimally disruptive medicine concept)
HeyDoctor! Come and get your diagnosis via text here! (Intriguing, but we see the downside)

Plenty of news before (US) Thanksgiving: NHS/Babylon Health’s London tests, Tunstall, Caribbean telemedicine. 

Rollout of second planned Babylon Health GP pilot for North West London scuttled (More unsettling news for Babylon’s model)
NHS, Public Health England testing multiple digital health devices for obesity, diabetes (Taking a year to do so with five suppliers)
NHS ‘GP at hand’ via Babylon Health tests in London–and generates controversy (Hits a GP brick wall)
Tunstall partners with voice AI in EU, home health in Canada, update on Ripple alerter in US (Changing their model, hopefully to profit)
Telemedicine comes to Saint Lucia–and the Caribbean (Seeking warmer climes doesn’t mean you leave telemedicine behind)

FDA’s approval of the first digital drug tracker. Reports on CES 2018, Aging 2.0.  Roundups on telehealth and companies. And Editor Charles cheerfully points out the difference between doers and advisors. 

Breaking: FDA approves the first drug with a digital ingestion tracking system (Proteus only took 16 years)
Telehealth roundups: Cuyahoga County (OH), BMJ systematic review, AAFP Forum (Telehealth results, PCP challenges)
Tender/Prior Information Alerts: North Yorkshire, North Ayrshire (Closing early 2018)
CES Unveiled’s preview of health tech at CES 2018 (5G, AI, VR, Extreme Tech, more)
BU CTE Center post-mortem presentation on Aaron Hernandez: stage 3 CTE (Can health tech even help?)
Some quick, cheerful updates from Welbeing, CarePredict, Tunstall, Tynetec, Hasbro, Fitbit
Themes and trends at Aging2.0 OPTIMIZE 2017 (Reinventing aging to thrive, not just survive)
A blogger’s lot is not a happy one (Editor Charles opines on the increasing disproportion between doers and advisers in the NHS) 

Of continued interest….

Fall risk in older adults may be higher during warm weather–indoors (A counterintuitive surprise marks need for gait detection/analytics)
How does the NHS get funded and work? The King’s Fund pulls it together for you. (Graphics and video)
Public Health England: we’re hiring to expand digital initiatives (A hiring blitz of 9 openings, more to come)
A few short topical items: NHS Digital, DHACA, IET, more (Editor Charles’ update)

CareRooms: the perils of “Silicon Valley hype” when your customer is the NHS (Discretion is the better part of valor)
Tender Alert: advance notice for NHS England ACS-STP Innovation Framework (Another big part of this NHS initiative)
Will Japan’s hard lessons on an aging population include those with dementia? (Japan’s bellwether rings again)

Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: http://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


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

Subscribe here to receive this Alert as an email on Wednesdays with occasional Weekend Updates. It’s free–and we don’t lend out or sell our list–no spam here!

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

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TTA’s week: CVS-Aetna’s implications, #MedMo17 report, Aussie Health Care Homes test

Is the CVS-Aetna merger heralding a new era, or an executional disaster in waiting? A lively #MedMo17 awards six startups. And Australia tries Health Care Homes for coordinated care.

Special to Alerts Readers: One free place at The King’s Fund Leeds meeting on 13 December. Last week! See offer below. And a reminder that you have one more week to 15 Dec to submit your project for the 2018 Digital Health Congress.


For our UK Readers: The King’s Fund has been kind enough to offer to our Readers one complimentary spot to their Wednesday 13 December ‘Sharing health and care records’ conference at the Horizon Leeds. If you would like to attend, email us by end of day Thursday 7 December at Extras@telecareaware.com with your name, title, and organization. Put in subject line of the email “KF-Leeds Ticket”. The winner will be chosen from best responses and notified by Friday 8 December.


Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both? (Are US healthcare execs in shock?)
#MedMo17: the conference, winning startups, Bayer, blockchain, and more (A lively conference report!)
Health Care Homes – treating chronic diseases in Australia (Coordinating care Down Under)

Does telemental care work?–the VA record. Secretary Shulkin moves forward on private care, Mayo’s Dr. Montori on care fitting into life. And HeyDoctor is Text 4 Doc.

OnePerspective: VA shows how technology can improve mental health care (Telemental health’s expansion chronicled in our new section)
VA’s Secretary Shulkin wants more private care options for veterans as part of reforms (Telehealth, private care coverage leading to better care)
Mayo Clinic’s Victor Montori MD calls for a ‘patient revolt’ for ‘careful and kind care’ (Expanding minimally disruptive medicine concept)
HeyDoctor! Come and get your diagnosis via text here! (Intriguing, but we see the downside)

Plenty of news before (US) Thanksgiving: NHS/Babylon Health’s London tests, Tunstall, Caribbean telemedicine. 

Rollout of second planned Babylon Health GP pilot for North West London scuttled (More unsettling news for Babylon’s model)
NHS, Public Health England testing multiple digital health devices for obesity, diabetes (Taking a year to do so with five suppliers)
NHS ‘GP at hand’ via Babylon Health tests in London–and generates controversy (Hits a GP brick wall)
Tunstall partners with voice AI in EU, home health in Canada, update on Ripple alerter in US (Changing their model, hopefully to profit)
A fistful of topical events (London Health Technology, NICE briefings, Planetary Health, RSM, DHACA, with a splash of Club Soda!)
Telemedicine comes to Saint Lucia–and the Caribbean (Seeking warmer climes doesn’t mean you leave telemedicine behind)

FDA’s approval of the first digital drug tracker. Reports on CES 2018, Aging 2.0. Looking forward to four conferences in NYC at end of November. Roundups on telehealth and companies. And Editor Charles cheerfully points out the difference between doers and advisors. 

Breaking: FDA approves the first drug with a digital ingestion tracking system (Proteus only took 16 years)
Telehealth roundups: Cuyahoga County (OH), BMJ systematic review, AAFP Forum (Telehealth results, PCP challenges)
Tender/Prior Information Alerts: North Yorkshire, North Ayrshire (Closing early 2018)
CES Unveiled’s preview of health tech at CES 2018 (5G, AI, VR, Extreme Tech, more)
BU CTE Center post-mortem presentation on Aaron Hernandez: stage 3 CTE (Can health tech even help?)
Some quick, cheerful updates from Welbeing, CarePredict, Tunstall, Tynetec, Hasbro, Fitbit
Themes and trends at Aging2.0 OPTIMIZE 2017 (Reinventing aging to thrive, not just survive)
A blogger’s lot is not a happy one (Editor Charles opines on the increasing disproportion between doers and advisers in the NHS) 


Having the ability to share health and care records digitally is essential to offering better, more co-ordinated care for local populations. But delivering the key benefits requires three things: the appropriate technology, the right governance structure and a culture of adoption. Learn about this at The King’s Fund’s 13 Dec full day conference at Horizon Leeds, where you will explore the different models that have been developed over the past few years and learn how local areas are overcoming these challenges. Click on the advert to register or here


Of continued interest….

Fall risk in older adults may be higher during warm weather–indoors (A counterintuitive surprise marks need for gait detection/analytics)
How does the NHS get funded and work? The King’s Fund pulls it together for you. (Graphics and video)
Public Health England: we’re hiring to expand digital initiatives (A hiring blitz of 9 openings, more to come)
A few short topical items: NHS Digital, DHACA, IET, more (Editor Charles’ update)

CareRooms: the perils of “Silicon Valley hype” when your customer is the NHS (Discretion is the better part of valor)
Tender Alert: advance notice for NHS England ACS-STP Innovation Framework (Another big part of this NHS initiative)
Will Japan’s hard lessons on an aging population include those with dementia? (Japan’s bellwether rings again)
CVS’ bid for Aetna–will it happen, and kick off a trend? (updated) (Where do payers, retailers go to expand?)


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: http://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


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

Subscribe here to receive this Alert as an email on Wednesdays with occasional Weekend Updates. It’s free–and we don’t lend out or sell our list–no spam here!

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

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

OnePerspective: VA shows how technology can improve mental health care

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

click to enlargeBy: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

(more…)

VA’s Secretary Shulkin wants more private care options for veterans as part of reforms

Released days before our Thanksgiving turkey (or steak, or lasagne), the Department of Veterans Affairs Secretary David Shulkin, in an interview with The Wall Street Journal (paywalled), stated his aims to increase veteran access to private care without having to rely on the VA to approve or coordinate it. This is in the direction of the recently signed bill with $2.1 bn in funding for the Veterans Choice program that targets veterans living in areas without ready access to VA facilities, or who are told they cannot get an appointment within VA within 30 days.

“The direction I’m taking this is to give veterans more choice in their care and be the decision maker for their care, which I fundamentally believe is a concept that has to be implemented,” Shulkin said. He admitted that opening the VA to private care programs will be gradual. Mentioned in the article were commodity, non-urgent services like podiatry and audiology.

For instance, the Veterans Choice program started in 2014 after wait times exploded in multiple regions, delaying care past 30 days for over half a million veterans for years well into 2015. Veterans died after waiting for care or follow up for months, notably at the Phoenix VA, creating a massive and rightfully political problem. 

Dr. Shulkin’s drive for reform and speed of care is also increasing the pace telehealth expansion with programs such as Anywhere to Anywhere which would allow cross-state consults and care that published their Federal proposed rule last month, and the rollout of VA Video Connect [TTA 9 Aug]. Earlier this year, four companies were awarded a total of over $1 bn to provide Home Telehealth over five years, reviving a fading program and updating it to not only smaller in-home tablets, but also to mobile and laptop devices. As noted in our OnePerspective article on telemental health deployment, the VA has the largest program in the US, dating back to the early 2000s.

While some veterans organizations, such as the Veterans of Foreign Wars, have been critical of moves towards integrating private care, this Editor cannot see where the problem truly is. Healthcare Dive, The Hill 

Tunstall partners with voice AI in EU, home health in Canada, update on Ripple alerter in US

Tunstall Healthcare seems to be a recent convert to the virtues of partnership and not trying to do it all in-house. Here’s a roundup of their recent activity in three countries with advanced technology developers. 

Perhaps the most advanced is conversational computing, which with Siri and Alexa is the 2017-2018 ‘IT Girl’, albeit prone to a few gaffes.  The European Commission is incentivizing the development of the next generation of interactive conversational artificial intelligence to assist older adults to live independently within their home. The largest award of €4m is going to Intelligent Voice, a speech recognition company based in London. The EMPATHIC project will develop a conversational ‘Personalized Virtual Coach’ with partners including Tunstall and the University of Bilbao, as well as several other companies and academic organizations in seven European nations. Digital Journal

On the other side of the Atlantic, Tunstall is partnering with TELUS Health in Toronto. TELUS will use Tunstall’s ICP Integrated Care Platform with remote patient monitoring and videoconference telehealth capabilities to monitor patients in their network. Apparently, this is the first use of the ICP in the Americas, as previous deployments have been in Europe, Australasia, and China. It is also additive to TELUS’ own capabilities. TELUS itself is a conglomerate of healthcare tech, with EHRs, analytics, consumer health, claims/benefits management, and pharmacy management. TELUS release.

click to enlargeThis Editor also followed up with the CEO of Ripple, the smart-looking compact alerter targeted to a younger demographic that would dial 911 in emergency situations through a smartphone app or for a subscription fee, connect to Tunstall’s call center network. It was Americas’ CEO Casey Pittock’s last move of note back in February. In June, with his departure, a check of Kickstarter and social media indicated that Ripple also disappeared. Last month, after reaching out to their founder/CEO Tim O’Neil, it was good to hear that this was quite wrong. Ripple was featured on HSN on 23 September (release) and joined that month with Michigan Governor Rick Snyder and first lady Susan Snyder at the End Campus Sexual Assault Summit. On the new website, it’s priced as an affordable safety device: $19 for one unit connecting to an app to push notifications, plus $10 monthly for 24/7 live monitoring through Tunstall. A discreet alert device that has a jewelry-type look, pares safety down to the essentials, and extends safety coverage to the young does have something on the ball.

 

Telemedicine comes to Saint Lucia–and the Caribbean

click to enlargeThe wide world of telemedicine! It’s hard to get away from the internet (see The Telegraph’s digital detox list of countries and areas with little to none, like North Korea), but your Editors have found that telemedicine is reaching far away places like the small, volcanic Windward Island of Saint Lucia. For those who are considering a winter holiday or are resident in this eastern Caribbean Commonwealth-member island with a dual French and British history, you can take advantage of Bois d’Orange’s Easycare Clinic‘s telemedicine services. These include real-time video consults, answers to healthcare questions, creation and maintenance of PHRs, vital signs tracking, and full access to a health network. Registration is free at www.easycare-stlucia.com along with the app. St. Lucia Times

Elsewhere in the Caribbean, a report from the Bahamas tells us that that the Princess Elizabeth Hospital A&E department is now covering Fresh Creek Community Clinic in Andros and Marsh Harbour in Abaco (the ‘family islands’). According to Edward Stephenson, a healthcare consultant in the Caribbean, telemedicine has been established privately in Turks & Caicos, Haiti, Dominican Republic and St. Vincent. The VA’s Home Telehealth program was established in Puerto Rico and the USVI, although in what present condition after two hurricanes is unknown. The University of the West Indies has had a telehealth program for Trinidad and Tobago since 2004 and works with The Hospital for Sick Children (SickKids) in Toronto in a program that includes that country as well as the Bahamas, Barbados, Jamaica, St. Lucia, St. Vincent and the Grenadines.

ATA has had a long-standing Latin America and Caribbean Chapter (ATALACC) which also is affiliated with the University of Arizona’s well-known Arizona Telemedicine Program–which in turn is affiliated with Panama’s Proyecto Nacional de Telemedicina y Telesalud. Readers’ updates welcome on this subject!

Telehealth roundups: Cuyahoga County (OH), BMJ systematic review, AAFP Forum

click to enlargeTelehealth/telemedicine case studies are many, but those of us in the field are always on the hunt for fresh results. And the results seem to be fairly successful.

Cuyahoga County in Ohio instituted a telehealth program for its 569-person Educational Service Center this past July. In the first 90 days, 45 telemedicine consultations were completed with an average savings of $342 for each visit. Median wait time to the doctor consult was 2 minutes, 23 seconds. This amounted to a 130 percent return on investment, or $48,000. This is over the summer, when many employees were on leave, and does not calculate productivity gains, e.g. less sick time. The ESC goal is 80 percent utilization. This last would boggle the Big Minds over at the RAND Corporation which criticized the 88 percent rise in utilization when CalPERS members used Teladoc. TTA 8 Mar, 25 Mar  The provider of telehealth services is First Stop Health. Healthcare IT News.

BMJ reviewed 44 studies (of over 2,100 studies surveyed in the last five years) to identify factors around telehealth effectiveness and efficiency. “The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences.” Patient satisfaction was achieved when providers delivered healthcare via videoconference or any other telehealth method. Telehealth and patient satisfaction: a systematic review and narrative analysis (PDF)

The American Academy of Family Physicians (AAFP) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care hosted a Capitol Hill meeting on telehealth in primary care 9 November. The conundrum that PCPs face: telehealth is well-suited to primary care, the CPT codes are there, physician time can be easily recorded, and patients now are comfortable with it–but connectivity, health plans, and expansion of the referral network beyond the local are still not there. Regina Holliday, a well-known patient advocate who will be speaking at MedMo17, spoke about telehealth’s great advantages in mental health, especially to younger patients who want anonymous counseling and those in rural areas where it’s hundreds of miles to a mental health clinic or a psychiatrist. AAFP Forum Report

Tender/Prior Information Alerts: North Yorkshire, North Ayrshire

Susanne Woodman, our Eye on Tenders, has located more complete information on a North Yorkshire tender we listed on 7 Nov and a prior information notice by North Ayrshire for a contract to be published next month.

  • North Yorkshire: The North Yorkshire County Council has listed full information on the tender for Assistive Technology services for North Yorkshire. It is for technology, monitoring and support to extend healthier independent living in the home and reduce demand on social care services. It is a three-year contract (extension up to 24 additional months) valued at £4.85 m. Bids close on 17 January 2018. TED–Tenders Electronic Daily 
  • North Ayrshire (Scotland): This Prior Information Request by North Ayrshire Council is for a 24/7/365 call handling system which is fully compatible with alarm equipment and telecare peripherals installed or provided by the Council in the full North Ayrshire Council area which includes the islands of Arran and Cumbrae. There are about 4,200 services users of primarily Tunstall equipment with a volume of 21,000 to 28,500 calls per month. The contract will be from 01 September 2018 to 31 August 2019. The contract will be published on 4 Dec. Public Contracts Scotland and TED

Distance concierge medicine: telemedicine connects US doctors to Chinese patients

Another ‘burden shift’ in medical care. As we in the US wrestle with the issues of telemedicine, cross-state consults, and payment parity, companies are finding a niche in cross-border international virtual consults. A startup in NYC, Docflight, now connects Chinese patients to a claimed several hundred US doctors from prestigious medical centers: Dana-Farber Cancer Center, NYU Langone, Brigham and Women’s Hospital, Massachusetts General, New York-Presbyterian, and others. Founded by Sally Wang, an attorney with a MPH, she developed the idea after negotiating the US healthcare system for her mother with breast cancer and considering how difficult it would be in China to do the same.

The patients pay an upfront fee of about $2,000 in what is essentially long-distance concierge medicine. Docflight first screens the patient, then recommends an appropriate specialist. Once matched, Docflight collects the patient’s medical records (machine translated then human reviewed) and schedules the consult time. The US doctor then advises their Chinese patient on health issues and performs a virtual visit, often with an attending Chinese doctor, and offers recommendations for treatment in an average 45 minute session. The doctors cannot prescribe, perform treatments or procedures. 

China has a burgeoning middle class and an aging population, which in combination with the hospital-based system of care in China means that individual patients receive little time with a physician, don’t have a personal relationship with one or more doctors, and don’t expect much of a personal relationship with their doctor. Their government is trying to swing the balance to a primary care model, but with 1.4 bn people that will take awhile. Telehealth and remote patient monitoring is one avenue being explored [TTA 12 Oct 16] but for acute care, a different model is needed. For the Chinese middle class, Docflight is an alternative to medical tourism, a time-tested safety valve for the affluent commonplace for patients from Canada, Latin America, the Middle East, and Asia to international medical centers, though Docflight will arrange such trips to the US.

It’s reasonable that healthcare crosses borders to increase access and overcome language barriers. We’ve previously profiled Mexico’s Salud Interactiva, which provides telephonic consults within the country plus select services through partners ConsejoSano (US) and Konsulta MD (Philippines) [TTA 16 Aug]. Dictum Health, an early-stage health tech company dual-headquartered in Dubai and Oakland, Calif., provides telehealth/telemedicine services long-distance to clinics in Costa Rica, refugee camps in Jordan, and oil rigs [TTA 19 Sep]. Crossing borders to burden-shift care and using technology to facilitate it is a trend to watch for in 2018. NBC News (video)Bold Global Media (video)Crunchbase  Hat tip to reader Jeanmarie Tenuto of Healthcare Technical Solutions.

Impact of IP telephony on UK telecare systems

The Telecare Services Association (TSA) in the UK has recently released a white paper addressing the impact of a fundamental change to the click to enlargeUK Public Switched Telephone Network (PSTN) that is now being contemplated. This change will eventually see the replacement of the current PSTN and Integrated Services Digital Network landline networks with IP telephony (the type of phone connectivity that has been commonly used in most modern office environments for some years).

Two years ago BT, who essentially owns practically the whole of the UK PSTN, proposed that the change of their network would be completed in 2025.

This has an impact on the telecare services to the extent that many telecare alarm devices in use connect to the call centres via the PSTN and hence such devices and/or the infrastructure used by suppliers of such services will need to be upgraded when the underlying network is changed. There are, according to the TSA paper, 1.7 million users of such devices in the UK.

The TSA is essentially the UK industry body for telecare and telehealth and as such it is understandably trying to raise awareness of the need for both the commissioners and suppliers of these services to prepare for the change. This paper is said to be a result of gathering views from “key stakeholders” related to this change.

The potential impact, however, seems to be somewhat exaggerated. It should be remembered that the UK very successfully underwent another major switch-over not that long ago in 2012 – from analogue to digital TV. It required every analogue TV in the country to be either fitted with a set top box or replaced with a digital TV.

TSA also suggest that this changeover be used as an opportunity to roll out more internet based digital health functionality to end users. Of course, such functionality is already widely appearing in the form of health monitors, exercise and medication reminders etc. and are not dependent on the switch over. So it is unfortunate that the paper flips between the two topics and asserts a dependence of internet based digital services on the PSTN switch-over.

The document feels more like marketing material than a white paper with about 1/3 of it taken up by irrelevant photographs of random happy smiling or laughing (mostly older) people. It reminded me of some of the material that came out the the 3 Million Lives project. If only our elderly people living alone or in our care homes were as happy as this!

The paper is available to download here.

Medtronic, American Well mega-partner for telehealth + telemedicine for chronic care

Boston-based American Well and Dublin-based Medtronic announced this week a partnership to integrate telemedicine and telehealth for chronic care management, targeting complex, chronic and co-morbid patients. Under the agreement, American Well’s telemedicine services will integrate into Medtronic Care Management Services (MCMS) video-enabled telehealth platforms for remote patient monitoring and video consults. The goal is to provide more information so that clinicians gain a more complete view of a patient’s health status when making care decisions, thus reducing the cost of care and improving patient outcomes. Care for patients with multiple chronic conditions accounts for over 70 percent of healthcare spending, according to an AHRQ study.

American Well is currently partnered with 250 healthcare partners in the US and more than 750 health systems and 975 hospitals, along with most major health plans. MCMS has two video telehealth platforms including the mobile NetResponse and the LinkView Wi-Fi tabletop. Their most recent activity is with the Midwest’s Mercy healthcare system for data sharing and analysis to gather clinical evidence for medical device innovation and patient access. MCMS platforms are also being integrated into the VA’s Home Telehealth program [TTA 6 Feb and 15 Feb]. It indicates that Medtronic is seeking to grow its telehealth device business, which has largely (except for VA) been a backwater in the immense Medtronic empire.

This is a very logical and in this Editor’s estimation, overdue type of partnership between a telehealth provider to enhance telehealth and RPM. (An easy bet: expect Teladoc to follow with another telehealth provider)

American Well/Medtronic release, Healthcare Informatics, MassDevice

Improvements in telehealth reimbursement, interstate coverage urged in Florida

Florida is one of the 34 states (plus the District of Columbia) to have legislated telehealth commercial insurance coverage, usually termed ‘parity’, for telehealth (telemedicine) virtual visits. It’s also the headquarters of many telehealth related companies, which makes it surprising that it took till 2016 for legislation to pass. In the law was the formation of a Telehealth Advisory Council within Florida’s Agency for Health Care Administration (AHCA) to report on the actual performance of insurers in paying for telehealth services. This Advisory Council recently met to review a draft copy of a 32-page report that will be sent to Florida’s Governor and Legislature later this month. That report contained some aggressive recommendations based on their provider survey, such as:

  • Establishing a practitioner/patient relationship through telehealth alone, without a prior in-person visit
  • Real parity in insurance company payment with in-person visits–in other words, payment at the same rate, which is explicitly stated in regulations in only three of the 34 states with telehealth ‘parity’ legislation
  • Amend Medicaid rules to give provider reimbursement for more telehealth services–currently, Medicaid provides for reimbursement of live video conferencing only
  • Authorize participation in interstate “compacts” that enable cross-state licensure for telehealth services. This was in the Florida House version of the bill in 2016 but dropped from the final version approved by both chambers.

The Advisory Council’s survey prior to the draft report showed lower than the national usage of telehealth: 6 percent of practitioners versus nationally 16 percent. 45 percent of Florida hospitals used telehealth, below the 52 percent of hospitals (with another 10 percent in the process) found in a 2013 national poll. For practitioners, the key barrier was financial in three areas: required investment, adequate reimbursement for services, and a financial return.

By law, the Advisory Council must complete its report by December 1, 2018, but it appears they are well ahead of schedule. Health News Florida (WUSF). Background from law firm Foley on the original legislation 14 March 2016

Proposed rule issued for ‘VA Anywhere to Anywhere’ telehealth cross-state care

The Department of Veterans Affairs ‘Anywhere to Anywhere’ program, which would enable VA doctors to treat VA patients across state lines via telehealth and telemedicine, yesterday (2 October) published in the Federal Register the required Federal proposed rule. There is a mandated 30-day comment period (to 1 Nov). In the Federal government, these rules move faster than any legislation. From the rule: “VA has developed a telehealth program as a modern, beneficiary- and family-centered health care delivery model that leverages information and telecommunication technologies to connect beneficiaries with health care providers, irrespective of the State or location within a State where the health care provider or the beneficiary is physically located at the time the health care is provided.” PDF of rule.

VA Home Telehealth has both doctor-to-patient telemedicine and vital signs remote monitoring components. While VA is fully able to waive state licensing requirements if both the physician and the patient are in a VA clinic, because of state telemedicine laws they have not been able to provide the same care for veterans at home. VA also has a care distribution problem, with many veterans living in rural areas, at great distances from VA facilities, or with limited mobility. What this will enable is VA hiring in metro areas primary care and specialist doctors to cover veterans in rural or underserved areas and the expansion of mental health care. It also will facilitate the rollout of the VA Video Connect app for smartphones and video-equipped computers now in use by over 300 VA providers [TTA 9 Aug].

The VETS Act (Veterans E-Health and Telemedicine Support Act of 2017, S. 925) would permanently legislate this, but in the US system this type of Federal rule, in this circumstance, moves faster.  Fierce Healthcare, Healthcare Finance, mHealth Intelligence 

NHS Kernow forced to postpone telehealth end by patient legal action (updated)

Your opinion counts. Use it! (Also see below for another cut to be made) NHS Kernow, which back in July snap announced an end to telehealth monitoring for budgetary and ‘outcome proof’ reasons, has been forced to back down on ending the program by a patient’s legal action. Ian Wyness, a 55-year-old patient with a severe heart condition, took up the fight with NHS Kernow CCG, first with letters, then in the local court. NHS Kernow is now maintaining the service to over 900 patients and on 19 Sept opened up for a six-week public consultation.

According to Cornwall Live, local people will be able to share their views about the service to 7am on Wednesday 1 November through a survey distributed online at www.surveymonkey.co.uk/r/KCCG-TelehealthSC or returning a printed copy. Cornwall Live also lists times and locations for four public hearings, inviting users and caregivers, on 24 and 26 October. The service will be continued until a final decision is reached by the CCG–according to them, in December.

International headlines were made in July when the plight of Bodmin resident Jill Diggett, who has five serious medical conditions that have hospitalized her multiple times, but has stayed out of hospital with telehealth, went viral via Cornwall Live, many publications like TTA, and an ITV interview where she begged the CCG to ‘Let me die at home’ [TTA 7 July]. Ending her service would not only affect her and her husband’s quality of life, but also made no sense financially with the daily cost of her long hospital stays. The promise of transitioning her care to a distant Cornwall location also hadn’t been kept.

Mr. Wyness is a former RAF service member from Davidstow who had his own dramatic medical experience leading to telehealth monitoring. In one day in 2012, he had been resuscitated 14 times in three locations due to his heart condition. Telehealth now monitors his blood pressure. When monitoring staff noted a drop, he was taken to hospital ‘just in time’. When the closing was announced, Mr. Wyness went to court with the assistance of the Leigh Day firm. They made and won a legal argument that closing telehealth services without consulting with members of the public was illegal. “I decided to fight for everyone because many patients who use the service who may have dementia or may be old are unable to take on that fight.” Bravo! Hat tip and thanks to Suzanne Woodman for the follow up.

Tender Alerts: Staffordshire’s £70m contract, Yorkshire and The Humber test

Susanne Woodman, our Eye on Tenders, alerts us to two tenders, the first which will definitely pique our UK Readers’ attention with its size and duration. The second is for a proposal using TECS and telemedicine as an alternative to emergency services.

  • Staffordshire: This is a huge seven-year contract to create the Support For Independent Living In Staffordshire (SILIS) Service to enable older and disabled adults to age in place in their current homes. “A key aim of the Service is to help Individuals to make changes to their home environment that will prevent the need for more costly interventions, such as admission to hospital or residential care, following life crises.” The Service will improve upon existing services in Assistive Technology (AT) including referral to telecare providers.

There are six borough and district councils involved, with the potential for use by nine more. The contract is valued at £70 million to start April 2018 with renewal points, ending in March 2025. Deadline is Wednesday 1 November at noon. Much more information (you’ll need it) on TED EU-Tenders Electronic Daily

  • NHS Greater Huddersfield & North Kirklees CCG: This tender is for the provision of a technology-assisted, rapid access service offering an alternative to hospital-based A&E services. Market test site is in Kirklees for residents of a care home. Requirements are:
    • A 24/7 clinical teleconsultation service delivered via secure video link into residential/ nursing homes, that is utilized instead of patients having to be taken to the local A&E department.
    • A service that provides clinical consultation not a logarithm based approach like 111.
    • A fully managed technical service utilizing bespoke laptops with HD cameras and with 4G SIM or broadband.

The CCG may also commission an accountable care organization (ACO) for this care in future, to which this contract would transfer. Deadline is 5pm on Friday 20 October to brenda.powell@greaterhuddersfieldccg.nhs.uk. More information on Gov.UK.

Want to know effectiveness of telehealth, interoperability? NQF reports take their measure.

There’s been an increase in doubt about the efficacy of telemedicine (virtual visits) and telehealth (vital signs monitoring) as a result of the publication of two recent long-term studies, one conducted by the University of Wisconsin and the other by CCHSC for Telemonitoring NI [TTA 13 Sep]. These follow studies that were directionally positive, and in a few cases like the VA studies conducted by Adam Darkins, very much so, but mostly flawed or incomplete (low N, short term, differing metrics). What’s missing is a framework for assessing the results of both. In an exceptionally well-timed announcement, the National Quality Forum (NQF) announced their development of a framework for assessing the quality and impact of telehealth services. 

In a wonder of clarity, the NQF defines telehealth’s scope as telemedicine (live patient-provider video), store-and-forward (e.g. radiology), remote patient monitoring (telehealth), and mobile health (smartphone apps). Measurement covers four categories: patients’ access to care, financial impact to patients and their care team, patient and clinician experience, and effectiveness of clinical and operational systems. Within these categories, NQF identified six areas as having the highest priority for measurement: travel, timeliness of care, actionable information, added value of telehealth to provide evidence-based practices, patient empowerment, and care coordination. Finally, the developing committee identified 16 measures that can be used to measure telehealth quality.

The NQF also issued a similar framework for interoperability, a bête noire that has led many a clinician and developer to the consumption of adult beverages. Again there are four categories: the exchange of electronic health information, its usability, its application, and its impact—on patient safety, costs, productivity, care coordination, processes and outcomes, and patients’ and caregivers’ experience and engagement. And it kept the committee very busy indeed with, from the release, “53 ideas for measures that would be useful in the short term (0-3 years), in the mid-term (3-5 years) and in the long-term (5+ years). It also identified 36 existing measures that serve as representative examples of these measure ideas (sic) and how they could be affected by interoperability.”

Both reports were commissioned and funded a year ago by the US Health & Human Services Department (HHS). We will see if these frameworks are extensively used by researchers.

NQF release, Creating a Framework-Telehealth (download link), Creating a Framework-Interoperability (download link), Mobihealthnews