TTA’s week: pop health en español, ATA’s choice, VA’s Cerner, de-retailing healthcare, more

Will the doctor’s office go the way of the retail store, even in NJ? Can we improve population health through telephone call centers? Will the UK get its mojo back in digital health innovation? Can the VA implement Cerner by 2019? And will ATA appoint a new CEO before then?

Only two weeks to go to Connected Health Summit 2017 in San Diego–save 20%. See below.

Beyond crowdfunding–startup funding through blockchain cryptocurrency, smart contracts (The Next Big Funding Thing?)
Commonwealth Fund case study on Spanish-speaking telemedicine services (MX, PH, US) (Population health south–and north–of the border)
Tender Alert: Torbay and South Devon NHS Foundation Trust for TECS (Looking for innovative telehealth)
VA’s Shulkin: Cerner rollout start by mid-2019? (The decision was a relief)
Innovate UK’s £35m Digital Health Technology Catalyst competition opens–apply now! (Another opportunity in UK healthcare)
Weekend Big Read: will telemedicine do to retail healthcare what Amazon did to retail? (Except there’s regulation…)
Tender Alerts: NHS Wales, Southend-on-Sea (More for innovative companies in UK)
Analyses of New Jersey’s new telemedicine regulations (Not quite parity, but a forward leap)
Some reflections on ATA and a future CEO–your ‘nominations’ wanted! (Name that CEO!)

Winners and losers…VA implements more telehealth, Israel gets its first aging services venture fund. Charterhouse loses equity in Tunstall, ATA’s Linkous leaves, Siemens delays the Healthineers and Theranos plays for time.

VA unveils several ‘anywhere’ new telehealth services for veterans (VA tech moves fast under Dr. Shulkin)
First aging services tech investment fund debuts in Israel (3rd Age tech)
Change at the top at ATA: CEO Jon Linkous departs after 24 years (Didn’t give notice either)
Charterhouse lost half its equity in Tunstall debt refinancing–Sunday Times report (updated) (Not unexpected)
Siemens plans IPO of Healthineers during 2018, possibly in US: reports (Expectations delayed)
The Theranos Story, ch. 44: Walgreens settles lawsuit, cash box empties further (The spiral to Flat Brokedom continues)

It’s an IoT Black Hat hackfest, Facebook bots learn argot, AI is debated after a fashion by ‘giants’, and Tunstall gets a partner that opens doors.

It’s all hackable by Black Hats: pacemakers, Amazon Echo, trains, heart monitors, prison cells! (Increasingly easy pickings)
AI good, AI bad (part 2): the Facebook bot dialect scare (Not all that…)
AI good, AI bad. Perhaps a little of both? (Top six effects) 
Tunstall pairing with Inhealthcare digital health for NHS remote monitoring (A shot of digital high-octane for the Big T?)


Connected Health Summit: Engaging Consumers analyzes the roles of connected health technologies and innovations in driving changes in consumer behaviors and business models. Now in its fourth year in beautiful San Diego, this event is focused on data-driven, human-centric patient experience and engagement. Keynoters include executives from Aetna, UnitedHealth, ShareCare and Geisinger. Readers save 20 percent! For more information, click on the advert or here.


Confirming football CTE, thinking ‘digital therapeutics’. Glass reboots, Fitbit and social robotics back up, TSA changes guard. Mindful (or mind your?) drinking, and catch up with The King’s Fund.

CTE found in 99% of former, deceased NFL players’ brains: JAMA study (News in both health and sports sections)
Shouldn’t we be concentrating on digital therapeutics rather than ‘health apps’? (A different look at the future of digital health)
The King’s Fund 2017 Digital Health Congress: videos, presentations now posted (Catch up!)
Fitbit’s smartwatch on track; Intel exits the game (Were they ever in?)
Can Google Glass’ enterprise iteration solve the patient documentation crisis? (Hands off help for hands-on workers)
Toyota’s $14 million bet on Intuition Robotics’ social companion robot (JP/IL/US) (ElliQ’s growing up)
Come along to London’s first mindful drinking festival! (Hic!)
TSA appoints new chair (Paul Shead takes the helm)

Recent articles of continued interest….

Creepy data mining on medical conditions run wild: where’s the privacy? (Ethically dubious practices)
UDG Healthcare buys American, adds Vynamic, Cambridge BioMarketing for up to $67 million (Acquisition trend for healthcare consultancies and marketing)
“Crazy”: StartUp Health’s 2nd Q digital health funding breaks record (Another round of champs and roses! Can it last?)

‘Record-shattering’ Q2 for digital health deals: Rock Health’s volte-face (Suddenly it’s wine and roses!)
Conference & Tender Alert: Perth & Kinross TEC event, Flintshire (Wales) tender (UK) (TEC event Sept 26, tender Aug 4)
‘Let me die at home’. The human and financial cost of ending telehealth (Cornwall UK) (A familiar, no less wrenching story to those who’ve worked in telehealth–the books don’t balance)

The Nightingale-H2020 project for wireless acute care (UK/EU) (Major initiative, get on it before tender)


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


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

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

VA unveils several ‘anywhere’ new telehealth services for veterans

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

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

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

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

Cerner DoD deployment on time; Coast Guard EHR shopping; Air Force, VA sharing teleICU

The US Department of Defense announced that the deployment of Cerner’s EHR MHS Genesis at the Naval Hospital in Oak Harbor, Washington is on time for later this month. It’s a little unusual that anything this big and in the government is actually on time. It’s also meaningful for VA, as they are adopting MHS Genesis in an equally, if not longer, rollout [TTA 7 June]. Healthcare IT News

Less well known is the Coast Guard‘s dropping its costly six-year deployment of the Epic EHR last year and reverting to paper. They are not in the MHS Genesis rollout because the CG is part of the Department of Homeland Security, despite its service roots and structure similar to the US Navy. This has led to much speculation that their final choice will be DoD’s Cerner platform, although the OpenEMR Consortium has already answered their April RFI.

And even less noticed was the late June announcement that the US Air Force Medical Operations Agency and the VA are implementing a tele-ICU sharing arrangement, giving the USAF access to the VA’s capabilities at five AF locations: Las Vegas; Hampton, Virginia; Biloxi, Mississippi; Dayton, Ohio; and Anchorage, Alaska. The VA central tele-ICU facility is in Minneapolis. Doctors there can remotely consult, prescribe medications, order procedures and make diagnoses through live electronic monitoring. Becker’s Hospital Review, VA press release

VA says goodbye to VistA, hello to Cerner for new EHR–and possible impacts (updated)

The new sheriff just turned the town upside down. Veterans Affairs’ new Secretary, Dr. David J. Shulkin, as expected moved quickly on the VA’s EHR modernization before the July 1 deadline, and moved to the same vendor that the Department of Defense (DoD) chose in 2015 for the Military Health System, Cerner. VA will adapt MHS GENESIS, based on Cerner Millenium. The rationale is seamless interoperability both with DoD and with private sector community providers and vendors, which base their services on commercial EHRs. The goal is to have one record for a service member through his or her lifetime and to eliminate the transition gap after discharge or retirement. (Transition gaps are also repeated when reservists or National Guard are called up for active duty then returned to their former status.) Another priority for VA is preventing the high rate of suicide among vulnerable veterans.

Updates: VA confirmed that Epic and Leidos will keep the development of the online medical appointment scheduling program, awarded in 2015 and currently in pilot, to be completed in 18 months. The contract is worth $624 million over five years. Wisconsin State Journal  The House Appropriations subcommittee on Veterans Affairs likes the Cerner EHR change. The Senate Veterans Affairs Committee is meeting Wednesday to discuss the VA budget sans the EHR transition. The EHR numbers are expected to be sooner rather than later. POLITICO Morning eHealth 

Dr. Shulkin is well acquainted with the extreme need for a modernized, interoperable system serving the Veterans Health Administration (VHA), having been on the US Senate Hot Grill for some years as Undersecretary of Health for VA. The foundation for the move from homegrown VistA to Cerner was laid last year during the prior Administration through an August RFI for a COTS (commercial off the shelf) EHR [TTA 12 Aug 16] and in later hearings. “Software development is not a core competency of VA” and it has been obvious in system breakdowns like scheduling, maintaining cybersecurity and the complex interoperability between two different systems. To move to Cerner immediately without a competition, which took DoD over two years, Dr. Shulkin used his authority to sign a “Determination and Findings” (D&F) which provides for a public health exception to the bidding process. The value of the Cerner contract will not be determined for several months.

For those sentimental about VistA, he acknowledged the pioneering role of the EHR back in the 1970s, but that calls for modernization started in 2000 with seven ‘blue ribbon’ commissions and innumerable Congressional hearings since. He understated the cost in the failed efforts on interoperability with DoD’s own AHLTA system, VA’s own effort at a new architecture, and modernizing the outpatient system. This Editor tallied these three alone at $3 billion in GAO’s reckoning [‘Pondering the Squandering’, TTA 27 July 13]. 

It is still going to take years to implement–no quick fixes in something this massive, despite the urgency.

  • Both MHS and VA will be running two systems at once for years (more…)

Iron Bow partners with Vivify Health for $258 million VA telehealth contract

One mystery solved! Iron Bow Technologies announced that its telehealth delivery partner for their award of $258 million in the Veterans Affairs Home Telehealth program is Plano, Texas-based Vivify Health. As noted in our original article [TTA 6 Feb] on the much-delayed VA remote patient monitoring award, Iron Bow was an existing contractor in other VA Telehealth services, Clinical Video Telehealth (video conferencing) and Store-and-Forward (clinical imaging review), but did not have vital signs RPM capability. The addition of Vivify with its mobile and tablet-based solutions and integrated peripherals adds that capability.

Vivify structures its main telehealth solutions based on escalating patient ‘risk’: 1) healthy and ‘at risk’ (may have early stage disease), 2) rising risk (has complex chronic disease) and 3) high risk (for hospitalization). The approaches are scaled up from engagement on BYOD mobile and web for (1), to vital signs monitoring and telemedicine clinician visits via mobile and tablet (2), to the highest level of an integrated kit with tablet and integrated peripherals (3). These further divide into five ‘pathways’ which are more product-oriented.

Cost is, of course, a factor, with VA a very demanding client in this regard as individual VISN (region) budgets are tight. Medtronic, the incumbent, has not only been using the venerable Cardiocom Commander Flex hub, but also provides VA with Interactive Voice Monitoring (IVR) which is an inexpensive patient management solution. (Ed. note: having worked with IVR in the past, it can work well if used with primarily lower-risk patients, is structured/implemented properly and integrated with live clinical check-ins.) Vivify’s system is all new–and not inexpensive, especially at the high-risk level. From their website, Vivify uses BYOD for the lower levels and the integrated kit for the highest and poorer outcome patients. This Editor notes they offer a voice telephony care solution which presumably is IVR. This gives them a welcome flexibility in price, but also a complexity which will be a training issue with VA care coordinators.

Other factors affect mobile-based solutions. Many at risk at-home veterans are older and thus don’t have smartphones or tablets. Reliable broadband connectivity is also an issue. Many don’t have Wi-Fi, which is a prerequisite for tablet use, and may live in areas with poor cellular reception.

The other work and labor-intensive parts for Vivify and Iron Bow are to integrate their reporting platform into VA’s complex and secure systems, which also involves a highly structured updating process: CPRS (computerized patient record systems), the VistA EHR and whatever replaces it (Epic is being trialed in Boise, Idaho–scroll down to ‘Big Decisions’ and Dr Shulkin).

Founded in 2009, Vivify has compiled an impressive track record with CHRISTUS Health (TX), RWJ Health (NJ), Trinity Health (MI), Centura Health (CO) and other large systems plus home care. It has also been conservative in its venture funding, with $23.4 million to date and its last big round from LabCorp and others in 2014 (CrunchBase).

Release. Hat tip to Vivify’s Bill Paschall via LinkedIn.  P.S. Stay tuned for an announcement of 1Vision’s partner. 

Editor’s clarification: The VA Home Telehealth contract is structured as a one-year base period, followed by four one-year optional periods, for five years total. The awarded amount over the five-year period is $258 million for Iron Bow/Vivify. It is the same amount/term for each of the three other awarded companies, totaling just over $1 billion for the five-year program. This is comparable to the 2011 five-year program value of $1.3 billion divided over six awardees. Thanks to Josie Smoot of Iron Bow Technologies’ press office.

VA awards over $1 billion in Home Telehealth contracts–at long last (updated)

Breaking News, Updated  The Department of Veterans Affairs (VA) on 1 Feb issued over $1 billion in awards to four companies to provide Home Telehealth vital signs monitoring technologies to veterans in home care and monitoring. The four companies are Medtronic, Care Innovations, Iron Bow Technologies, and 1Vision LLC. The $1 billion is split evenly between the four ($258 million for each company over the five-year duration). The contracts are for an initial year (31 Jan 2018 end date listed on GovTribe.com), renewable annually for five years total. The bid process started in 2015 and the award had originally been scheduled for early-to-mid 2016.

On the suppliers:

  • Medtronic is the incumbent as a supplier since 2011, dating back to Cardiocom’s 2011 award for its home monitoring units (Cardiocom was acquired in August 2013). Medtronic is a Dublin, Ireland HQ’d company with a US headquarters in Minnesota.
  • Care Innovations is well known to our Readers as the developer of Health Harmony and the acquirer of the QuietCare telecare/behavioral monitoring used in senior housing. Their parent is Intel.
  • Iron Bow Technologies is a supplier to VA in other healthcare areas (telemedicine and store-and-forward) and is a large, privately held IT company with multiple Federal contracts and deep Federal contractor roots. Their revenue has been reported at over $462 million (Washington Technology Top 100 2016).
  • 1Vision LLC is a new company formed as a joint venture between HMS Technologies, Inc. and MBL Technologies, Inc. Neither are previously engaged as home telehealth providers, but both are Federal contractors. According to their individual websites, HMS is an IT systems integrator and MBL is engaged primarily in cybersecurity.

The question for this Editor is how Iron Bow and 1Vision, which are not telehealth (vital signs) monitoring companies but telemedicine and IT service providers respectively, will execute Home Telehealth with the VA. Have they partnered with yet-to-be disclosed providers in providing home telehealth services to the VA? (Watch this space)

While the award is the largest in US telehealth, the VA is, by this Editor’s experience in her last position with Viterion Corporation, extremely demanding on its service providers and will be even more so in the future. The future reasons are clear: 1) President Trump has put a Klieg light on the VA and 2) he’s named a new VA secretary, Dr David Shulkin, who is currently VA Undersecretary for Health (confirmation hearing notes courtesy of POLITICO, nomination approved by the Senate committee Tuesday, and easily confirmed Monday night 13 Feb), who has been highly engaged with HIT issues, including both the VistA EHR modernization/replacement and initiatives such as the recently unveiled Digital Health Platform [TTA 12 Jan]. (more…)

VA Digital Health Platform proof-of-concept unveiled; new VA head nominated

Back in April 2016, the Department of Veterans Affairs (VA) in Congressional hearings hinted at an end of year preview of a ‘state-of-the-art’ digital health platform which would integrate veteran health information from multiple sources. That debut was revealed this week in analytics vendor Apervita‘s announcement that they are participating in a proof-of-concept of the VA Digital Health Platform (DHP). According to their release, in the first three weeks, they and the DHP partners demonstrated that they could organize and extract insights from veteran data originating from VA, military, and commercial electronic health records, plus e-prescribing, apps, devices, and wearables. The end outcome is to provide a unified view or dashboard that integrates data, implements a care plan, tracks clinical encounters, optimizes medications, responds to patient needs, and more. The prime contractor in DHP is Georgia Tech, which brought on board Apervita, Salesforce (workflow user engagement), and MuleSoft (API). Next steps are not disclosed. Mobihealthnews, Health Data Management

One of the sparkplugs behind the DHP and also interoperability of DOD’s and VA’s badly outdated VISTA EHR is current VA Undersecretary for Health David Shulkin, MD. Today, at an eventful press conference, President-Elect Donald J. Trump nominated him for the VA secretary position. Dr Shulkin was previously CEO of Beth Israel Medical Center in NYC and president of the Atlantic Health System ACO. He will also be, upon Senate approval, the first non-veteran head of the VA. What is apparent is that P-E Trump has not moved one iota from the promise he made during the campaign to move fast on modernizing, improving quality and speeding up veterans health services–and for that he needs an insider.  Health Data Management

VA’s moves spell the end of the homegrown EHR

The Veterans Health Administration (VHA) is formally reaching out to the private sector to explore switching from its current, pioneering EHR system, VistA (also referred to as CPRS, Computerized Patient Record System) to a commercial system. Their ‘feeler’ is an August 5 and 8 notice in FedBizOpps.gov titled 99–TAC-16-37877 * RFI – VHA supporting COTS EHR REQUEST FOR INFORMATION (RFI), Solicitation Number: VA11816N1486. This requests information on business support for transitioning to a commercial-off-the-shelf system (COTS–don’t governments love acronyms?–Ed.) and closes 26 August, which is not a lot of time even for an RFI.

VHA has been under extreme pressure from Congress to modernize its EHR, lately in July hearings before the Senate Appropriations Committee. EHR replacement is also in line with the Congressionally-mandated, now concluded Commission on Care’s recently published recommendations on a total, top-down reorganization of VHA, including a sweeping reorg of their HIT management. The VHA strategy appears to be that while they are walking down the road to replace VistA and have already spent to assess where they are with KLAS and other EHR consultancies (spending $160,000+ on surveys), they are essentially ‘kicking the can down the road’ to the next administration (POLITICO’s Morning eHealth, 14 July).

Current state is to continue to upgrade VistA through late 2018, though the closely related Department of Defense’s Military Health System is in the long process of cutting its homegrown AHLTA over to Cerner-Leidos as MHS Genesis, awarded last August, with a first trial in the Pacific Northwest later this year (HealthcareITNews, Ed. emphasis). Of course, it will take the VHA years to roll it out; there are close to 9 million veterans enrolled in the closed system that is the VHA.  FCW, Morning eHealth 10 August

Love EHRs or hate them, the sheer size of the VHA and its growing concession that VistA won’t do in caring for American veterans makes it clear that the future of EHRs is in private systems from major developers–a field which is winnowing out to The Few (take that, GE).  (more…)

A weekend potpourri of health tech news: mergers, cyber-ransom, Obama as VC?

As we approach what we in these less-than-United States think of as the quarter-mile of the summer (our Independence Day holiday), and while vacations and picnics are top of mind, there’s a lot of news from all over which this Editor will touch on, gently (well, maybe not so gently). Grab that hot dog and soda, and read on….

Split decision probable for US insurer mergers. The Aetna-Humana and Anthem-Cigna mergers will reduce the Big 5 to the Big 3, leading to much controversy on both the Federal and state levels. While state department of insurance opposition cannot scupper the deals, smaller states such as Missouri and the recent split decision from California on Aetna-Humana (the insurance commissioner said no, the managed care department said OK) plus the no on the smaller Anthem-Cigna merger are influential. There’s an already reluctant Department of Justice anti-trust division and a US Senate antitrust subcommittee heavily influenced by a liberal think tank’s (Center for American Progress) report back in March. Divestment may not solve all their problems. Doctors don’t like it. Anthem-Cigna have also had public disagreements concerning their merged future management and governance, but the betting line indicates they will be the sacrificial lamb anyway. Healthcare Dive today,  Healthcare Dive, CT Mirror, WSJ (may be paywalled) Editor’s prediction: an even tougher reimbursement road for most of RPM and other health tech as four companies will be in Musical Chairs-ville for years.

‘thedarkoverlord’ allegedly holding 9.3 million insurance records for cyber-ransom. 750 bitcoins, or about $485,000 is the reputed price in the DeepDotWeb report. Allegedly the names, DOBs and SSNs were lifted from a major insurance company in plain text. This appears to be in addition to 655,000 patient records from healthcare organizations in Georgia and the Midwest for sale for 151 – 607 bitcoins or $100,000 – $395,000. The hacker promises ‘we’re just getting started’ and recommends that these organizations ‘take the offer’. Leave the gun, take the cannoli.  HealthcareITNews  It makes the 4,300 record breach at Massachusetts General via the typical unauthorized access at a third party, once something noteworthy, look like small potatoes in comparison. HealthcareITNews  Further reading on hardening systems by focusing on removing admin rights, whitelisting and endpoint security. HealthcareDataManagement

Should VistA stay or go? It looks like this granddaddy of all EHRs used by the US Veterans Health Administration will be sunsetted around 2018, but even their undersecretary for health and their CIO seem to be ambivalent in last week’s Congressional hearings. According to POLITICO’s Morning eHealth newsletter, “The agency will be sticking with its homegrown software through 2018, at which point the VA will start creating a cloud-based platform that may include VistA elements at its core, an agency spokesman explained.” Supposedly even VA insiders are puzzled as to what that means, and some key Senators are losing patience. VistA covers 365 data centers, 130 separate VistA systems, and 834 custom installations, and is also the core of many foreign government systems and the private Medsphere OpenVista. 6/23 and 6/24

click to enlargeDr Eric Topol grooves on ‘The Fourth Industrial Revolution’ of robotics and AI. (more…)

Can expanding telehealth help VA solve veteran access crisis?

The Department of Veterans Affairs (VA) has been both one of the largest US users of telehealth in various forms–and widely criticized for practices including veteran patient wait lists for care, a lack of accountability, a scheduling system full of problems, an ancient EHR (VistA), and an inability to meet interoperability and modernization goals set over years. Telehealth is, in fact, one of VA’s bright spots with store-and-forward imaging, clinical video telemedicine and home telehealth.

At the American Telemedicine Association ATA 2016 meeting Monday, Under Secretary for Health and VA Chief Executive Dr. David Shulkin noted that the crisis has pushed VA into other options for achieving the goals set for the end of year: every VA medical center provides same day primary care services and same day mental health services. One area of focus is telemental health. Dr Shulkin announced in his plenary speech the opening of five new Mental Health Telehealth Clinical Resource Centers this summer, located in Charleston, Salt Lake City, Pittsburgh, and a consortium of facilities in Boise, Seattle, and Portland, Oregon. West Haven, Connecticut is already open as a specialty hub focused on the most severe and complex mental health issues, such as chronic depression and bipolar disorder. Other VA telemedicine initiatives include kiosks and text messaging to help with medication adherence and chronic condition management. (We’ve reported on their partnering with nhssimple to develop ANNIE, a sister of NHS’ Flo in text messaging to encourage patients in their health monitoring, TTA 2 Dec 15.)

VA delivered 2.1 million episodes of telehealth care last year (FY 2015), in 45 specialty areas of care, including 400,000 telemental health visits. They also reduced bed days by 56 percent, reduced readmissions by 32 percent, and decreased total psychiatric admissions by 35 percent, maintaining high user satisfaction scores at 89 percent.

Dr Shulkin also noted that four generations of veterans are served by VA–WWII, Korea, Vietnam and Desert Shield through current Iraq/Afghanistan–and all four have different delivery requirements. He closed with what is, for VA which has been very proud of their ‘home grown’ solutions from the time of Dr Adam Darkins in the early 2000s on, something unusual: “We’re looking to learn, we’re looking to work with all of you who are innovating to help take better care of veterans.” (Next on tap: the award of the next five-year round of home telehealth providers, which is presently down to two Grizzled Pioneers, Medtronic (Cardiocom) and Viterion.) MobihealthnewsVA press release

Flo and ANNIE: text messaging with a personality to improve health (UK/US)

Flo–the Florence Simple Telehealth text messaging system–is well known to our UK Readers as a successful initiative of the NHS. Over the past five years, starting from a test with NHS Stoke on Trent, it has been used by more than 30,000 people in over 70 health and social care organizations to help them monitor their health in areas as diverse as managing diabetes, living with COPD and managing breast feeding. Flo is customized by the clinician for the individual patient on questions, information, and speaks to the patient with a sometimes sassy ‘voice’ to help keep him or her on track. The Health Foundation has spotlighted Flo (named after Florence Nightingale) in ‘The Power of People’ with an overview page here and the video ‘Telehealth with a human touch’.

click to enlargenhssimple, a Social Enterprise is now tasked with developing the Flo program and since 2013 has partnered with the Veterans Health Administration in the US to develop a counterpart. Named ANNIE after Lt. Annie G. Fox, Army Nurse Corps, who was the first woman awarded the Purple Heart for her actions at Pearl Harbor, the VA is shortly testing it at four sites with intent to roll out nationally in 2016. This Editor has seen two presentations by Neil Evans, co-director of VHA connected health, in 2014 and this year at mHealth Summit (HIMSS Connected Health–see left). The Health Foundation video also includes an interview with Dr Wyatt Smith, prior Deputy CIO of the US Military Health System, and mentions the VHA. Hat tip to Phil O’Connell, Global Lead of nhssimple, for the update.

Veterans eHealth & Telemedicine

Currently in the US, the Department of Veteran Affairs may waive click to enlargethe state license requirements for telemedicine services if both the healthcare professional and the patient are located at facilities owned by the Federal Government, according to Sen Joni Ernst from Iowa (see Ernst pushes for expansion of telehealth care for veterans). She is introducing the Veterans E-Health & Telemedicine Support Act in the Senate which, if enacted, would permit VA to allow the use of any location, such as a patient’s home. This, it is argued, will give better access to elderly, disabled and rural veterans. Ernst says that with 21 million veterans nationwide and 12% of veterans receiving some form of telehealth care in 2014 this could reduce costs for the VA. It is. however, not clear how many of the veterans receiving telemedicine care necessarily need out-of-state healthcare professionals to provide that care.

A similar Act is being introduced (or rather, re-introduced) in the House of Representatives by Rep Charles Rangel, a Democrat from New York with 18 co-sponsors (see E-Health Legislative Summary: The Veterans E-Health & Telemedicine Support Act of 2015). That act has previously been introduced in the House in 2012 and 2013 according Govtrack and its chances of being enacted this time round are considered very low (1%).

Personal health ‘big data’ exchange is all good, right? Perhaps wrong.

Many of our recent stories have touched on ‘big (health) data’ as Achieving the Holy Grail–how it can be shared, how it can work with the Internet of Things and how poorly implemented personal health record (PHI) databases can derail national health systems (and careers) [TTA 22 Sep]. They are, after all, 1) extremely difficult to design to preserve privacy and 2) must satisfy patients’ requirements for easy use as well as privacy including opting out. But when despite all good intentions, data goes awry, the consequences can be severe.

  • A daughter applies for health insurance from Aetna, and her mother’s medications, about which she had no knowledge, are attributed to her. How? Data mining off Milliman’s IntelliScript data service which mixed up the records.
  • EHR exchange can spread errors such as a dropped critical health or medication record. One led to the death of an 84 year old woman. VA also had a problem with its EHR (not cited but likely VistA) slotting medication histories into the wrong patients’ files. An Australian hospital mixed up discharge files in electronically sending them to doctors. The more records are exchanged, the more possibility there is for propagation of errors.
  • More information is shared with third-party suppliers; survey companies are increasingly tapping into these databases to send annoying, potentially privacy-invading treatment questionnaires to individuals.

Bloomberg Business’ conclusion is that this could be a problem, but much beyond the tut-tutting doesn’t get into solutions. The Pitfalls of Health-Care Companies’ Addiction to Big Data

Is ‘pure’ robotic telesurgery nearing reality?

click to enlargeMoving beyond robot-assisted surgery (e.g. the well-accepted use of the daVinci system with prostate surgery), controlled by a surgeon present in the operating room, is telesurgery, where a remote surgeon uses a robot to fully perform surgery at a distant location. The Nicholson Center at Florida Hospital in Celebration, Florida, which specializes in training surgeons and technicians in leading (bleeding?-Ed.) edge techniques, is studying how internet latency (lag time to the non-techie) affects surgical effectiveness. Latency is defined in this case as “the amount of delay a surgeon can experience between the moment they perform an action to the moment video of the action being carried out at the surgery site reaches their eyes.” Their testing so far is that internet latency for surgery between hospitals has a threshold of 200-500 milliseconds before dexterity drops off dramatically (not desirable)–and that given the current state of the internet, it is achievable even at a mid-range distance tested (Florida to Texas). Making this a reality is highly desirable to military services worldwide, where expertise may be in, for example, Germany, and the casualty is in Afghanistan. It would also be a boon for organizations such as the Veterans Health Administration (VA) where resources are stretched thin, rural health and for relief agencies’ disaster recovery. ZDNet

Defense, VA EHR interoperability off the tracks again: GAO

click to enlarge According to the US Congress’ Government Accountability Office (GAO), the birddog of All Things Budget, the Department of Defense (DOD) and Veterans Affairs (VA) missed the 1 Oct 2014 deadline established in the Fiscal Year 2014 National Defense Authorization Act (NDAA) to certify that all health data in their systems met national standards and were interoperable. Modernization of software–a new Cerner EHR for DOD, modernization of VistA– is also behind the curve with a due date now beyond the 31 Dec 2016 deadline until after 2018. Finally the DOD-VA Interagency Program Office (IPO), which shares health data between the departments, has not yet produced or created a time frame nor “specified outcome-oriented metrics and established related goals that are important to gauging the impact that interoperability capabilities have on improving health care services for shared patients.” iHealthBeat, GAO report