TTA’s Week: Albertson’s Amazon Effect, Hidden Signals, partnering right, three telehealth/telecare studies, print your own smartphone microscope!

 

Retail health convergence, the bumpy Road to Utopia in three telehealth/telecare studies, DHS’ epidemiology challenge, partnership challenges, snap on that microscope, and a newsy week in the health tech biz.

Retail health convergence and ‘Amazon Effect’ continues with Albertsons and Rite Aid (And Albertsons goes public to boot)
Telehealth alternatives to in-person consultation found lacking in effectiveness: Alt-Con Study (UK) (GPs reluctant despite NHS encouragement. It needs work.)
CNBP develops a 3D printed microscope to clip on to your smartphone (AU) (A really useful and inexpensive breakthrough from Down Under using iPhone flash) 
Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?
How do digital health partnerships happen? Where do you go with them? Views from a developer and an app security provider. (Keep your connections warm and current–and look ahead)
DHS’ Hidden Signals Challenge to improve tracking of biological and epidemiological threats (Applicable for both health and security)
Telemedicine’s still-sluggish adoption in health systems revealed in survey of health system executives (So far to go on starvation budgets)
The UTOPIA Project evaluation of telecare in social care report published (UK) (Where it fits in social care and how it’s delivered)

Big steps forward? Google’s predictive health, Virta’s diabetes reversal, remote patient monitoring’s €$. Baby steps for Medicare telehealth parity, Japan’s social care. Scary Monsters scare less in the morning but the cyberhacks continue. And Happy 60th DARPA!

Google ‘deep learning’ model more accurately predicts in-hospital mortality, readmissions, length of stay in seven-year study (Predictive health’s possible giant step)
Scary Monsters, Take 4: further investor thoughts on CVS-Aetna, the Amazon Threat–and Aetna’s skeleton in the closet? (CVS may be the smarter partner in the merger)
Rounding up what’s news: LindaCare, TytoCare funding; Medicare telehealth parity, Norway’s big cyberhack, Virta reversing diabetes, DARPA’s 60th birthday
Japan as aging bellwether: experiential VR, claim that robots increase activity by 50 percent (Coping with an aging population develops)

Will the Amazon/Berkshire/JPMC venture really be a ‘meaningful disruptor’? And as expected, CVS-Aetna bears more merger scrutiny by DOJ. 

Scary Monsters, Take 3: one week later, JPMorgan Chase takes heat, Amazon speculation, industry skepticism (Boo Again! There’s fallout with this disruption.)
CVS-Aetna: DOJ requests additional information at deadline (updated for CVS earnings)
(As predicted, DOJ takes the lead. And CVS is quite healthy and nimble.)

When Giants decide to transform healthcare, it puts advertising that didn’t deliver masquerading as ‘behavior change technology’ in the unshuddery shade. Continuing the debate on the efficacy of health apps. Are we getting to the tricorder on the back of a smartphone? And are we getting to collaborative virtual care through the vendor door? 

Scary Monsters, Take 2: Amazon, Berkshire Hathaway, JPMorgan Chase’s addressing employee healthcare (Boo! Seriously, there are issues)

Another unicorn loses its horn–Outcome Health finally loses the CEO and president (Just what healthcare needs–another ‘transformer’ which didn’t deliver)
Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots (Set goals, pay money, dear patient)
5 vital signs, one ‘heavyweight’ device on the back of your Moto X smartphone (Are we getting to tricorders through smartphone mods?)
InTouch Health launches a three-way collaboration on virtual acute care with Jefferson Health, Mission Health (Finally, information sharing–and it took a vendor to do it)

Of continued interest….

What’s up with Amazon in healthcare? Follow the money. (The Scary Monster parsed away from the hype)
MediBioSense and Blue Cedar take a new approach to secure medical wearable data (UK/US) (Protect the app, protect the data)
Hip-protective airbags get another entrant from France. And fall prediction steps forward. (Oui and sí for airbags to cushion the blow, tech to determine fall risk)
Robots, robots at CES: ElliQ, Sophia the ‘humanoid’, companions, pets, butlers, maids…and at a supermarket near you? (The Parade of Cute–And Not Working)
Robots, robots, everywhere…even when they’re NHS 111 online algorithms (NHS’ continued difficulty with Digital Times)

Iron Bow’s uncertain future with $258 million VA Home Telehealth contract (A Federal ruling against partner Vivify Health stops the program–can Iron Bow save it?)
Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? (Is there ‘Life on Mars’? Is there?)
CVS-Aetna: It’s not integrated healthcare, it’s experiential retail! (A different look at a complicated merger proposing another reason why it may set the pace)
Babylon’s ‘GP at hand’ has thousands of London patients in hand (A hit with Londoners indicates pent-up demand for virtual care)


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

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

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Telemedicine’s still-sluggish adoption in health systems revealed in survey of health system executives

Sage Growth Partners, a Baltimore Maryland-based healthcare research and strategy firm, released a study surveying US C-level executives and service line leaders at a variety of larger health systems (integrated delivery networks (IDNs), academic medical centers (AMCs), community hospitals, and specialty hospitals) on their telemedicine use. It combined initial/exploratory qualitative interviews (total N=65) with online quantitative surveys (completed N=98) taken 2nd Quarter 2017.

Have we reached a tipping point? The findings indicated that just over 50 percent (56 percent) had developed in-house telemedicine systems or were already working with vendor/s on implementing telemedicine in their organizations. The study’s definition of telemedicine was broad, inclusive of any technology and programs that connect providers and patients not physically at the same location when care is provided. 

But many of the findings are dismaying:

  • Budgets–limited at best. Most (66 percent) had budgets under $250,000 per year 34 percent committed over $250,000 with most under $100,000, but three-quarters believe those budgets will increase next year. 
  • What it’s used for: Emergency use (29 percent), remote patient home monitoring (21 percent, and non-emergency cases (20 percent). 
  • How many vendors do they want to deal with?: One is quite enough–54 percent prefer a single telemedicine solution across the continuum of care (however defined), with 31 percent accepting two solutions. 
  • Has it changed the ‘standard of care’?: Yes for stroke, according to 70 percent surveyed. 75 percent believe it will potentially change the standard of care for behavioral health/psychiatry, followed by neurology (53 percent), primary care (52 percent), and cardiology (48 percent).
  • What about direct-to-consumer telemedicine?: The top must-haves are EMR integration, appointment scheduling, and store-and-forward messaging (60+ percent). What’s surprisingly not so desired: store-and-forward of images (47.9 percent–so much for home wound management) and vitals capture (45.9 percent–so much for connecting devices to telemedicine).

Perhaps it’s this Editor looking at the ‘glass half-full’ with a ‘Gimlet Eye’, but here we are in February 2018 still having this discussion at the executive and service line levels. The progress has been glacial at best on starvation budgets, yet telemedicine vendors are multiplying. What is also not promising: these executives’ preference for enterprise solutions which preclude small, innovative companies from getting past the pilot or trial phase. Another barrier: the insistence upon EMR (EHR) integration, which sounds appropriate except that Cerner and EPIC are ‘walled gardens’. Defining Telemedicine’s Role: The View from the C-Suite (PDF, free download from Sage). Also Clinical Innovation + Technology and Global Healthcare 

InTouch Health launches a three-way collaboration on virtual acute care with Jefferson Health, Mission Health

Telehealth provider InTouch Health announced a five-year joint partnership with Asheville, North Carolina-based Mission Health and Philadelphia-based Jefferson Health to develop 10 new models in virtual acute and outpatient care. These use cases are not “typical telehealth” and include stroke, sepsis, and acute heart failure.

It’s an interesting expansion of the telemedicine/telehealth acute care model, especially if it extends to outpatient care. InTouch is building upon several years of separate work with each health system. In this joint development arrangement, the health systems will share information and with InTouch Health. What is also interesting that working with both systems allows InTouch to test virtual care access and whether it increases care coordination in diverse settings. Jefferson is an urban university hospital based in Center City Philadelphia, while Mission serves an economically mixed suburban and rural area. According to the release, this is to “ensure the care pathways and supporting technologies improve patient access and quality of care and are applicable across markets and geographies.”

Jefferson Health has worked with InTouch for nearly a decade, using the InTouch telestroke program for its 30 hospitals in the Jefferson Neuroscience Network. Mission Health is using their telestroke, telepsychiatric, tele-hospitalist, and tele-neonatology programs. The InTouch programs include virtual platforms, clinical workflow solutions, and software.

There is no mention here of using new telehealth partner Vivify Health [TTA 19 Dec] for their Managed Kit and BYOD, but to this Editor the most likely place for their systems would be integration into outpatient care. Outpatient service could also be furnished by their new home-based video consult services acquired through their purchase earlier this month of TruClinic.

Since 2003, InTouch has rounded up over $26 million in funding through a 2010 $6 million Series D. The fact that their funding has been conservative (compared to the over $158 million Practice Fusion raised in a dozen years before their acquisition earlier this month by Allscripts) and have managed to make several acquisitions in that time either indicates excellent cash flow from existing business or undisclosed sources of private financing. Release. Mobihealthnews.

Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? Is Carillion’s collapse a spanner in the works?

NHS England won’t be rolling out the Babylon Health ‘GP at hand’ service anytime soon, despite some success in their London test with five GP practices [TTA 12 Jan]. Digital Health cites an October study by Hammersmith and Fulham CCG (Fulham being one of the test practices) that to this Editor expresses both excitement at an innovative approach but with the same easy-to-see drawback:

The GP at Hand service model represents an innovative approach to general practice that poses a number of challenges to existing NHS policy and legislation. The approach to patient registration – where a potentially large volume of patients are encouraged to register at a physical site that could be a significant distance from both their home and work address, arguably represents a distortion of the original intentions of the Choice of GP policy. (Page 12)

There are also concerns about complex needs plus other special needs patients (inequality of service), controlled drug policy, and the capacity of Babylon Health to expand the service. Since the October report, a Babylon spokesperson told Digital Health that “Commissioners have comprehensively signed off our roll-out plan and we look forward to working with them to expand GP at Hand across the country.” 

Re capitation, why ‘GP at hand’ use is tied into a mandatory change of GP practices has left this Editor puzzled. In the US, telemedicine visits, especially the ‘I’ve got the flu and can’t move’ type or to specialists (dermatology) are often (not always) separate from whomever your primary care physician is. Yes, centralizing the records winds up being mostly in the hands of US patients unless the PCP is copied or it is part of a payer/corporate health program, but this may be the only way that virtual visits can be rolled out in any volume. In the UK, is there a workaround where the patient’s electronic record can be accessed by a separate telemedicine doctor?

Another tech head-shaker: 45 percent of GPs want technology-enabled remote working. 48 percent expressed that flexible working and working from home would enable doctors to provide more personalized care. Allowing remote working to support out-of-hours care could not only free up time for thousands of patient appointments but also level out doctor capacity disparities between regions. The survey here of 100 GPs was conducted by a cloud-communications provider, Sesui. Digital Health. This is a special need that isn’t present in the US except in closed systems like the VA, which is finally addressing the problem. The wide use of clinical connectivity apps enables US doctors to split time from hospital to multiple practices–so much so on multiple devices, that app security is a concern. 

Another head-shaker. 48 percent of missed NHS hospital appointments are due to letter-related problems, such as the letter arriving too late (17 percent), not being received (17 percent) or being lost (8 percent). 68 percent prefer to manage their appointments online or via smartphone. This preference has real financial impact as the NHS estimates that 8 million appointments were missed in 2016-2017, at a cost of £1bn. Now this survey of 2,000 adults was sponsored by Healthcare Communications, a provider to 100 NHS trusts with patient communications technology, so there’s a dog in the hunt. However, they developed for Barnsley Hospital NHS Foundation Trust a digital letter technology that is claimed to reduce outpatient postal letters by 40 percent. Considering my dentist sends me three emails plus separate text messages before my twice-yearly exam…. Release (PDF).

Roy Lilley’s daily newsletter today also engages the Tech Question and the “IT desert” present in much of the daily life of the NHS. Trusts are addressing it, junior doctors are WhatsApping, and generally, clinicians are hot-wiring the system in order to get anything done. It is much like the US about five to seven years ago where US HHS had huge HIPAA concerns (more…)

Deals of the day: American Well partners with Philips for global telehealth apps, gains $59 million partnership with Allianz

The large partners with the large, adding a global dimension. Telemedicine provider American Well and Philips announced today a global alliance to integrate American Well’s patient-doctor video consults with a range of Philips’ healthcare monitoring program. First up will be adding American Well consults to the Philips Avent uGrow parenting app. This is an Apple/Android app that presently tracks baby feeding, weight, and sleeping patterns, tying into Philips baby monitoring products such as an ear thermometer and babycam. The second stage with American Well involves their mobile telehealth software development kit (SDK) to integrate video consults into other Philips’ digital health solutions and the Philips HealthSuite Digital Platform. Philips also announced that uGrow will include voice activation with the ever-trendy Amazon Echo and the Philips Avent smart feeding kit to automatically monitor the time, volume and duration of a baby’s feeds. Philips release

American Well’s second global deal of the day is with insurer Allianz’s digital investment fund, Allianz X.  The latter, funded with a $59 million investment, creates another partnership dedicated to developing a digital product that combines wearable sensors, remote monitoring, and virtual visits. The goal is to widen patient access, lower cost and improve healthcare quality. As part of the deal, Allianz X will be joining American Well’s Board of Directors. Allianz is not well known as a health insurer in the US, but is active in the international health insurance area for individual expats and employers with international employees.  Release, Mobihealthnews

Far from a tipping point: only 18 percent of consumers using telemedicine. An expectation gap? (US)

When will we get there? And what needs to happen? Telemedicine provider Avizia surveyed both consumers and healthcare professionals earlier this year, and the results are not encouraging. For the huge investments made by telemedicine and telehealth companies, along with providers and payers, the key finding here is that only 18 percent of the 403 consumers surveyed in March had even used telehealth.

Of that 18 percent (N=72), it’s been a positive experience:

  • On a 1 to 10 scale, with 10 signifying a “great experience,” 62 percent of consumers who used telehealth ranked their experience a 10, 9, or 8.
  • Consumers who used telehealth appreciated time savings and convenience (59 percent), faster service and shorter wait times to see the doctor (55 percent), and cost savings due to less travel (43 percent)

Modern Healthcare also sponsored the outreach to healthcare professionals who are subscribers, locating 444 respondents whose organizations currently use telehealth or telemedicine.

  • They are most interested in telehealth’s ability to expand access or reach to patients (72 percent). Barriers are reimbursement (41 percent), program cost (40 percent), and clinician resistance (22 percent)
  • Their #1 use cases are for stroke and neurology (72 percent), followed by behavioral health (41 percent) and intensive care (20 percent).

What’s unsaid in this write-up? Consumers and clinicians clearly have differing expectations on how they want to use telemedicine. Consumers are largely using it as an alternative to an in-person visit for less serious medical needs. Clinicians use it for very serious situations–stroke, neurology, mental illness, ICU. Perhaps this is why the takeup of telehealth among consumers is low.

Mike Baird, CEO of Avizia, is quoted in the release as saying “Health systems are investing in telehealth, even as uptick is slow among consumers, because they understand the potential of the technology to impact patient care in a profound way.” But as a Grizzled Pioneer in this field said to this Editor in confidence, how many of these companies have the revenues and patient investors to enable them to stay alive till they get to the Promised Land–and how far is it? Closing the Telehealth Gap (white paper requires free registration and download)Becker’s Hospital Review

The ‘health kiosk’ idea is alive and kicking from New York to France

click to enlarge[Photo: NYP] The $40 million+ failure of HealthSpot Station last year [TTA 14 June 16] might have signaled the demise of the health kiosk (telemedicine + multiple vital measurement devices) concept. Basic stations with consumer engagement/mobile tie-ins such as Higi have been gaining traction at retail locations [TTA 30 Mar] such as RiteAid (which bought the assets and IP of HealthSpot) and Publix supermarkets. CVS MinuteClinics in northeast Ohio and Florida have allied over the past two years with Cleveland Clinic and American Well to integrate records and telemedicine. But the kiosk model is gaining a second life with these recent iterations.

  • NewYork-Presbyterian, Walgreens (Duane Reade) and American Well: Kiosks located in private rooms at select Duane Reade drugstores (left above) connect to NYP OnDemand using American Well telemedicine and Weill Cornell Medicine emergency medicine physicians. In addition to the live consult, the patient can send select vital signs information to the doctor using a forehead thermometer, a blood pressure cuff, a pulse oximeter, and a dermascope for a high-resolution view of skin conditions. Pediatric emergency physicians are available through NYP OnDemand weekdays between 6 – 9pm. Prescriptions are e-prescribed to the patient’s preferred pharmacy. The first kiosk opened this week at 40 Wall Street with additional locations to open in 2018. NYP OnDemand telemedicine consults are also available to NY area residents through the Walgreens website. American Well release, Healthcare IT News, MedCityNews
  • H4D (Health for Development): French doctor Franck Baudino wanted to reach those who live in what the French term ‘health deserts’ in their rural areas. Over the past nine years, he developed a booth-type kiosk connecting to a live doctor and with vitals instrumentation. The Consult Station is fully equipped with a wide range of vitals instrumentation, including vision, audio, eye, and blood glucose, functioning almost as a remote doctor’s office. In France, to gain access, all users need do is pop in their carte vitale. Reportedly the kiosks can treat 90 percent of common illnesses. Prescriptions are printed out in the booth. Consult Stations are now in France, Italy, Portugal, Philippines, Canada, Belgium, UAE and were recently cleared by FDA as a Class II device. ZDNet  

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…)

NHS ‘GP at hand’ via Babylon Health tests in London–and generates controversy

click to enlargeThe GP at hand (literally) service debuted recently in London. Developed by Babylon Health for the NHS, it is available 24/7, and doctors are available for video consults, most within two hours. It is a free (for now) service to NHS-eligible London residents who live and work in Zones One through Three, but requires that the user switch their practice to one of the five ‘GP at hand’ practices (map). Office visits can be scheduled as well, with prescriptions delivered to the patient’s pharmacy of choice.

Other attractive features of the service are replays of the consult, a free interactive symptom checker, and a health record for your test results, activity levels and health information. 

While the FAQs specify that the “practice boundary” area is south of Talgarth Road and Cromwell Road in Fulham, and north of the River Thames, it is being advertised on London Transport (see advert left and above taken on the Piccadilly Line) and on billboards.

Reviewing the website FAQs, as telemedicine it is positioned to take fairly routine GP cases of healthy people (e.g. colds, flu, rashes) and dispatch them quickly. On the ‘can anyone register’ page, it’s stated that “the service may however be less appropriate for people with the conditions and characteristics listed below”. It then lists ten categories, such as pregnancy, dementia, end of life care, and complex mental health conditions. If anyone is confused about these and other rule-outs, there is a support line. 

Babylon Health is well financed, with a fundraise of £50 million ($60 million of a total $85 million) in April for what we profiled then as an AI-powered chatbot that sorted through symptoms which tested in London earlier this year. This is a full-on telemedicine consult service with other services attached.

Now to the American view of telemedicine, this is all fairly routine, expected, and convenient, except that there’d be a user fee and a possible insurance co-pay, as more states are adopting parity for telemedicine services. We don’t have an expectation that a PCP on a telemedicine consult will take care of any of these issues which Babylon rules out, though telemental health is a burgeoning and specialized area for short and long-term support. But the issues with the NHS and GPs are different.

First, signing up to ‘GP at hand’ requires you to change your GP to one in that program. US systems are supplementary–a telehealth consult changes nothing about your other doctor choices. This is largely structural; the NHS pays GPs on a capitation basis.

mHealth Insight/3G Doctor and David Doherty provide a lengthy (and updated) analysis with a critical view which this Editor will only highlight for your reading. It starts with the Royal College of GPs objections to the existence of the service as ‘cherry-picking’ patients away from GPs and creating a two-track system via technology. According to the article, “NHS GPs are only paying them [Babylon] £50 a year of the £151 per year that the NHS GP Practice will be paid for every new Patient they get to register with them” which, as a financial model, leads to doubts about sustainability. Mr. Doherty advises the RCGPs that they are fighting a losing battle and they need to get with mHealth for their practices, quickly–and that the NHS needs to reform their payment mechanisms (GPs are compensated on capitation rather than quality metrics).

But there are plenty of other questions beyond cherry-picking: the video recordings are owned by Babylon (or any future entity owning Babylon), what happens to the patient’s GP assignment if (when?) the program ends, and patients’ long-term care.

Oh, and that chatbot’s accuracy? Read this tweet from @DrMurphy11 with a purported video of Babylon advising a potential heart attack victim that his radiating shoulder pain needs some ice. Scary. Also Digital Health.

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!

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.

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 

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