VA’s REACH Vet uses algorithms and AI to predict critical mental health needs–including suicide risk

The Department of Veterans Affairs (VA) has been using artificial intelligence and patient data as part of a suicide prevention program for veterans–a top clinical priority for VA. The REACH Vet program, started in 2017, uses predictive algorithms to identify risk factors for suicide in millions of veteran patient records for medications, treatment, traumatic events, overall health, and other information. It then uses the information to determine the top 0.1 percent of veterans at any facility at the highest risk for suicide in the next year. Clinicians then call these veterans for about an hour’s conversation, offering to help them create a mental health care plan.

In its first year (2007-8), the program reached more than 30,000 veterans and identified about 6,700 active VA users a month. According to the short article on findings published by the Suicide Prevention Resource Center in 2018, “veterans who engaged with REACH Vet were less likely to be admitted to an inpatient mental health unit, and more likely to attend mental health and primary care appointments compared to those not in the program. REACH Vet infrastructure includes a coordinator at every VA facility and a national team of clinicians who provide overall program support.”

There are pros and cons to this proactive approach–the pros being a reduction in veteran suicides and evidence of higher suicide risk in the three-to-six months of starting–and ending–an opioid prescription; and the cons being that some of the algorithms may be inaccurate–a veteran could be inaccurately ‘dinged’ for risk or a traumatic involuntary hospitalization. VA is still refining its algorithms in areas such as changes in medication dosage (including opioids) and clinical notes for mention of negative personal issues. POLITICO Health Care

FCC’s $100M Connected Care Pilot Program for rural areas up for July vote

Finally, a big boost for rural telehealth comes to the ‘yea or nay’ stage. The Federal Communications Commission’s (FCC) Connected Care Pilot Program, which was approved to proceed last August [TTA 9 Aug 18] with comments on the creation of the program, now moves to the next stage with a formal FCC vote on 10 July on the program itself. The FCC vote was announced by FCC Commissioner Brendan Carr, the co-proposer of the program with Mississippi’s Senator Roger Wicker, during a visit on Tuesday to a rural health clinic in Laurel Fork, Virginia.

The three-year program increases support for telehealth efforts aimed at low-income Americans in underserved regions and who are veterans, to increase their access to health technologies. Providers would be assisted in securing both technology and broadband resources needed to launch remote patient monitoring and telehealth programs. 

Commissioner Carr quoted, in his rural health clinic visit, stats from multiple studies including the VA‘s long experience (since the early 2000s) with remote patient monitoring:

  • A study of 20 remote patient monitoring trials found reductions of 20 percent in all-cause mortality and 15 percent in heart failure-related hospitalizations.
  • A remote patient monitoring initiative (not attributed) reduced ER visits by 46 percent, hospital admissions by 53 percent, and in-patient stay length by 25 percent.
  • The Veterans Health Administration’s remote patient monitoring program had reductions of 25 percent in days of inpatient care and a 19 percent in hospital admissions.
  • In savings, a diabetes trial run by the University of Mississippi Medical Center (UMMC) saved nearly $700,000 annually in hospital readmissions. This extrapolated, based on 20 percent of Mississippi’s diabetic population, that Medicaid would save $189 million per year.

HealthLeaders Media also noted that at the July meeting, the FCC will vote on a notice of proposed rulemaking to seek comment on funding to defray the cost of healthcare providers joining the telehealth initiative and innovative pilot programs aimed at responding to critical health crises including diabetes management and opioids. Also mHealth Intelligence

TTA’s Week: Eric Topol does the NHS’ future, robotic therapy for autistic children, telehealth’s wind at back, and Editor Charles’ roundup

 

The Topol Review’s relationship to reality explored by Roy Lilley. Robotics effects in therapy for children with autism and CP. The wind’s even more at the back of telehealth–but there are caveats. Plus Editor Charles is back with a UK digital health roundup.

And scroll below for news of The King’s Fund’s Digital Health and Care Congress–plus 10% off registration for our Readers!

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS (This week’s Must Read)
Robots’ largely positive, somewhat equivocal role in therapy for children with autism and cerebral palsy (HIMSS)
The wind may be even stronger at the back of telehealth this year–but not without a bit of chill (VA, Virginia as indicators–and the hurdles when you get there )
A selection of short digital health items of potential interest (Editor Charles is back with views on AI and events)

The telehealth entrepreneur and the $5 million fraud = 15 years in prison. Scotland’s Current Health wins FDA clearance, Latin America telemedicine’s uncertain state, women in eHealth, and studies on digital health in health systems.

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems
Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH) (Reviving the terminology discussion)
The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta (And 15 years in the Federal pen. Tell your mum or uncle to be wary of good stories)

Our lead this week is the sale of Tunstall’s US operation. Unicorns need to hype less and publish studies more. The King’s Fund’s two events in March and May, Bayer’s accelerator winners, and news from Apple to teledermatology for São’s spotted!

Short takes: Livongo buys myStrength, Apple Watch cozies with insurers, Lively hears telehealth and $16 million
Tunstall Americas sold to Connect America
(Tunstall conceding their business is outside the US)
Where’s the evidence? Healthcare unicorns lack the proof and credibility of peer-reviewed studies. (Unicorns need to add substance to the sparkle)
News roundup: Virginia includes RPM in telehealth, Chichester Careline changes, Sensyne AI allies with Oxford, Tunstall partners in Scotland, teledermatology in São Paolo
The King’s Fund ‘Digital Health and Care Explained’ 27 March
(Readers also get a 10% discount at the 22-23 May Congress)
Bayer’s G4A accelerator awards agreements with KinAptic, Agamon, Cyclica (DE) (A truly international accelerator program)

Latest through the revolving door is NHS’ chief digital officer, digital health may be more ‘bubbly’ than you would like, telemedicine and telehealth gain important consumer and Medicare facing ground, and fill your calendar some more!

NHS England digital head Bauer exits for Swedish medical app Kry, but not without controversy (The revolving door reveals a self-made cloud over her head)
Events, Dear Friends, Events: UK Telehealthcare, Mad*Pow HXD, dHealth Summit (Get out the calendars–and the checkbooks/app)
Telemedicine virtual visits preferred by majority in Massachusetts General Hospital survey (Over 94% loved the convenience alone)
Medicare Advantage model covering telehealth for certain in-person visits starting in 2020 (The needle moves–slowly)
It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding. (‘Bubbly’ factors that may influence this year–not for the better)

We round up the Official Healthcare Circus of CES, Verily rolls along with $1 bn in investment, and Walgreens Boots finally makes an alliance splash with Microsoft

It’s Official: CES is now a health tech event (updated) (And still a circus! We round up the top coverage so you don’t have to)
News roundup: Walgreens Boots-Microsoft, TytoCare, CVS-Aetna moves along, Care Innovations exits Louisville
Verily, Google’s life sciences arm, gathers in another billion to go…where? (Updated for Study Watch clearance) (Still a mystery)

Our first full week in January is full of news and events, from CES to RSM, plus lots of healthcare acceleration!

News roundup: CES’ early beat, CVS-Aetna pauses, digital health fizzes, Yorkshire & Humber Propels
Events, Dear Friends, Events part 2: Newcastle and Texas accelerate, Aging2.0 NYC gets happy, AutoBlock’s Meetup, Wearable Tech, HealthImpact East
Events, Dear Friends, Events: Hancock at the RSM, MedStartr NOLA Challenge, RSM and The King’s Fund

We start our 2019 first in West Africa with a health facility mapping initiative addressing epidemics and service distribution. On to the UK with Babylon Health’s chatbot problems revealing an increasingly fractious relationship with the business press–one of our most read articles ever. And 3rings may be exiting, but doing so with grace and consideration–another Top Read.

Healthsites, eHealth Africa mapping health facility locations in West Africa to improve emergency care (Fighting epidemics and improving disaster response using health tech)
Is Babylon Health the next Theranos? Or just being made out to be by the press? (Soapbox) (A few best practices might stop a growing pile-on–or a Big Problem)
3rings’ well-handled transition to their March shutdown (updated) (Referring their clients to other UK companies based on the customer’s needs) 


The King’s Fund’s annual Digital Health and Care Congress is back on 22-23 May. Meet leading NHS and social care professionals and learn how data and technology can improve the health and well-being of patients plus the quality and effectiveness of the services that they use. Our Readers are eligible for a 10% discount using the link in the advert or here, plus the code Telehealth_10.


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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

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

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

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The wind may be even stronger at the back of telehealth this year–but not without a bit of chill

Late last year, this Editor noted that ‘the wind may finally be at the back of telehealth distribution and payment’. The expansion of telehealth access for privately issued Medicare Advantage (MA) plans, state-run Medicaid and CHIP (Children’s Health Insurance Plan) plan members, and this year’s Medicare Physician Fee Schedule, along with a limited expansion of telemedicine in the Value-Based Insurance Design (VBID) model for MA announced earlier this year by CMS, is a leading indicator that government is encouraging private insurers to pay doctors for these services, who in term will pay vendors for providing them.

The Veterans Health Administration (VA) has historically been the largest user in the US of telehealth services (home telehealth, clinical video telehealth, store-and-forward). They are also a closed and relatively inflexible system (disclosure–this Editor worked for Viterion, a former RPM supplier to the VA). In 2017, under then Secretary David Shulkin (who left under a cloud, and not an IT one), there were hopes raised through the Anywhere to Anywhere VA Health Care Initiative. So the news released at the start of HIMSS’ annual meeting that veterans will be able to access their health data through Apple’s Health Records app on the iPhone, perhaps as early as this summer, was certainly an encouraging development. According to mHealth Intelligence, the key in enabling this integration and with other apps in the future is the Veterans Health Application Programming Interface (API), unveiled last year.

Anywhere to Anywhere is also making headway in veteran telemedicine usage. Of their 2.3 million telehealth episodes in their FY 2018, over 1 million were video telehealth visits with veterans, up 19 percent from 2017. 105,000 of those video visits were through VA Video Connect to veterans’ personal devices. The remainder were real-time interactive video conferences at a VA clinic. The other half were assessment of data between VA facilities or data sent from home (the underused Home Telehealth).  Health Data Management

Virginia also moved to make remote patient monitoring part of covered telehealth services for commercial health plans and the state Medicaid program. The combined bills HB 1970 and SB 1221 will be sent for signature to Governor Ralph Northam, to whom the adjective ‘beleaguered’ certainly applies. National Law Review

But service providers face compliance hurdles when dealing with governmental entities, and they’re complex. There are Federal fraud, waste, and abuse statutes such as on referrals (Anti-Kickback, Stark Law on self-referral), state Corporate Practice of Medicine Doctrine statutes, and medical licensure requirements for telehealth practices. Telehealth: The Beginner’s Guide to Legal Pitfalls is a short essay on what can face a medical practice in telehealth.

VA expands telehealth services again with T-Mobile’s 70,000 lines

The US Department of Veterans Affairs and T-Mobile announced on Monday that T-Mobile would be adding 70,000 lines of wireless service to increase telehealth services in the VA network and expand services to veterans, especially those in rural areas. The expanding network will connect veterans at home and at VA facilities, such as community-based outpatient clinics (CBOCs), with VA clinicians within the VA network.

This adds to VA’s push this year to extend telehealth to distant veterans in rural areas through initiatives such as with T-Mobile and the Spok Health – Standard Communications partnership to expand the Spok Care Connect messaging service to more VA healthcare systems. The VHA (Veterans Health Administration) has long been the largest user of telehealth services in the US. Until recently, their emphasis has been on store-and-forward and clinic-based patient consults, but finally Home Telehealth (HT) is being supported. Reportedly, only 1 percent veterans used Home Telehealth, while 12 percent used other forms of telehealth [TTA 24 May]. Yet the VA was among the earliest users of remote patient monitoring/home telehealth, dating back to 2003 and even earlier, with companies such as Viterion and Cardiocom.

While most of the news about VA has been about their leadership changes and their difficulties around EHRs, their ‘Anywhere to Anywhere’ program was finalized in May. This allows VA practitioners to provide virtual care across state lines to veterans, regardless of local telehealth regulations.

T-Mobile is already the lead wireless provider to the VA. The 70K line addition is part of the carrier’s $993.5 million five year contract with the US Navy.  Business Wire, Mobihealthnews

News roundup: NeuroPace’s brain study, Welbeing’s Liverpool win, VA’s Apple talks, Medtronic’s diabetes move

imageNeuroPace, which developed an implanted brain-responsive neuromodulation system for patients with refractory and drug-resistant epilepsy, announced the result of their nine-year long-term treatment study.

  • Approximately 3 out of 4 patients responded to therapy, achieving at least 50% seizure reduction
  • 1 in 3 patients achieved at least 90% seizure reduction
  • 28% of patients experienced seizure-free periods of six months or longer; 18% experienced seizure-free periods of one year or longer
  • Median seizure reduction across all patients was 75% at 9 years
  • Quality of life improvements (including cognition) were sustained through 9 years, with no chronic stimulation-related side effects.

The study included 256 patients across 33 epilepsy centers with nearly 1,900 patient implant years of follow-up on the RNS System. Release.

Liverpool Mutual Homes (LMH) sheltered housing awarded its emergency alarm contract to Welbeing, a Doro Group company. Welbeing has added 1,200 LMH residents to their alarm services. Release (PDF)Hat tip to Welbeing’s Charlene Saunders.

It appears that the VA is talking with Apple about a mobile EHR. VA patients would be able to transfer their records to their iPhone — likely through Apple’s Health Records app. No time frame is mentioned and it’s hard to expect a quick turnaround given the VA’s stringent IT and security requirements. Another factor is that VA is making the long transition from VistA to Cerner’s MHS Genesis, bumpily. Mobihealthnews picking up a paywalled Wall Street Journal article.

Medtronic, otherwise known as the 9,000 lb Elephant that Sits Where It Wants, will acquire long-time diabetes partner Nutrino, an AI powered personalized nutrition platform. In June, Medtronic integrated Nutrino’s FoodPrint Report technology that connects meal and glucose variability into Medtronic’s iPro2 myLog app. Terms and timing were not disclosed. It fits in Medtronic’s recent strategy of smaller acquisitions and beefing up its diabetes business. Mobihealthnews.

Rounding up the news: Babylon’s Samsung Health UK deal, smartphone urine test debuts, a VA Home Telehealth ‘announcement’, Aging 2.0’s NY Happy Hour

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”125″ /]Huge or Ho-Hum? Babylon’s ‘Ask an Expert’ feature is now available within the Samsung Health app as of the start of June. It will need to be activated at a cost of £50 per year, or £25 for a single consultation. Babylon’s service with over 200 GPs is now available on millions of Samsung Galaxy devices in the UK. Babylon now claims half a million users of its private GP services and 26,500 registered in London with its NHS-funded and controversial GP at Hand app.

Is it as our Editor Charles, quoting Niccolo Machiavelli writing in The Prince, “Nothing is more difficult to undertake, more perilous to conduct or more uncertain in its outcome than to take the lead in introducing a new order of things. For the innovator has for enemies all those who have done well under the old and lukewarm defenders who may do well under the new”. The debate rages–see the comments below the Pulse Today article. 

Healthy.io is introducing a test of its urinalysis by smartphone test with Salford Royal NHS Foundation Trust’s new Virtual Renal Clinic. 50 patients will received the Dip.io kit to test their urine. Dip.io uses the standard urine dipstick test combined with a smartphone application that guides the user through scanning in the results with a smartphone camera and sends the result to their doctor. Healthy.io claims this is a first-of-kind technology and system. According to Salford Royal, chronic kidney disease (CKD) costs the NHS £1.45 billion in England alone. The company is part of the NHS Innovation Accelerator Programme. Digital Health News

In what has been the worst kept secret in US telehealth, 1Vision LLC and AMC Health finally announced they were partners in 1Vision’s over $258 million Home Telehealth award by the Department of Veterans Affairs (VA) [TTA 6 Feb 17]. The news here is that the AMCH release states that they have an “Authority to Operate (ATO)”, which means they can provide Home Telehealth services using AMC Health’s CareConsole to VA-enrolled veterans and their families. This last step is very important because it is a common post-award point of failure for new awardees. Earlier this year, the Iron Bow/Vivify Health award failed on the country of origin of Vivify’s kit, dooming the implementation [TTA 16 Jan] and Iron Bow’s award. (Vivify Health has gone on.) Medtronic, as a long-term incumbent, has few worries in this regard, though any new equipment has to be cleared. The mystery is if Intel-GE Care Innovations, the last new awardee, has passed the ATO bar. AMC Health/1Vision release. 

And on the social front for New Yorkers, raise a Pint 2.0 at Aging 2.0’s NYC Happy Hour, Tuesday 18 July at 310 Bowery Bar, 6pm. Aging 2.0 website, where you can check for a chapter and events near you.

VA’s ‘Anywhere to Anywhere’ telehealth initiative finalizes

VA Secretaries may come and go (or never get there), but their initiatives stay. With much fanfare last year, then-Secretary David Shulkin announced the ‘Anywhere to Anywhere’ telehealth and telemedicine program [TTA 3 Aug]. This program will use VA practitioners to provide virtual patient care across state lines when a veteran cannot make it to a VA hospital or clinic. The Department of Veterans Affairs published the proposed rule last October [TTA 3 Oct 17] with the Final Rule published in the Federal Register on 11 May.

Technically, it preempts state and local regulations around telehealth. “VA is exercising Federal preemption of conflicting State laws relating to the practice of healthcare providers; laws, rules, regulations, or other requirements are preempted to the extent such State laws conflict with the ability of VA health care providers to engage in the practice of telehealth while acting within the scope of their VA employment.”

It was widely supported by ATA, the American Association of Family Physicians, American Medical Informatics Association, Federal Trade Commission, the College of Healthcare Information Management Executives (CHIME), and many other industry organizations. It also enjoys wide Congressional support.

There is plenty of room for growth. Only 1 percent of VA’s veterans used Home Telehealth, while 12 percent used other forms of telehealth. They will be doing so with few suppliers: Medtronic, 1Vision/AMC Health, and Care Innovations. Iron Bow/Vivify Health was found to not have tablets which met the US production qualification. This Editor wonders how the current three suppliers will fare.

This telehealth program will be located in the apparently newly named Veterans Health Administration Office of Connected Care. mHealthIntelligence.com

Shulkin out, Admiral Ronny Jackson MD nominated for VA head

You’re Fired! Dr. David Shulkin is out the door as VA Secretary as of Wednesday evening. US Navy Rear Admiral Ronny Jackson, MD has been nominated for the position. In the interim, while confirmation takes place, Robert Wilkie, currently the Undersecretary of Defense for personnel and readiness, will move to VA as Acting Secretary.

Dr. Shulkin’s downfall was an Inspector General report last month that criticized his personal actions on a recent Europe trip (e.g. gratis Wimbledon tickets), actions (too much time spent on personal travel/personal time for the funding of the trip), and the poor way he handled the publicity around the report. Other issues centered on internal turmoil as he attempted to reform VA practices. As late as Tuesday, things were looking up based on White House statements, though Chris Ruddy of Newsmax was far less sanguine last Sunday on ABC. Our extensive coverage on Dr. Shulkin’s tenure at the VA is here. Our Readers who are engaged with US telehealth knew him as an IT ‘maven’, but from this Editor’s perspective, the rocky process of contracting in the Home Telehealth area and the downgrading of the program in recent years was dismaying.

Dr. Shulkin’s subsequent appearances in the pages of the NY Times and on TV were also less than stellar, overly personal, and to this Editor, ill-considered, blaming privatization and stating he did not resign. 

The announcement was made yesterday evening from President Trump’s Twitter account. An (unnamed) White House official said the embattled Shulkin was no longer effective in his role, saying his “distractions were getting in the way of carrying out the President’s agenda.” according to CNN. 

Rear Adm. Ronny L. Jackson moves from being personal physician to both President Trump and previously for President Obama. It is a White House tradition that personal physicians are from the Navy. He has combat medicine experience, having been deployed during Operation Iraqi Freedom in charge of resuscitative medicine for a forward deployed Surgical Shock Trauma Platoon in Taqaddum, Iraq. In 2006, during President G.W. Bush’s administration, he joined the White House Medical Unit. (more…)

News roundup for Tuesday: room at the top at VA? (updated), Philips integrates teleradiology. 3rings Care premieres Amazon Echo service

Updated. Who’s the Leader? At the Veterans Administration, the soap opera plot accelerated on the continued tenure of Secretary David Shulkin who, after a strong start (and coming from within VA’s tech area), has stumbled over charges of inappropriate spending and staff turmoil since the beginning of the year. Journalist Christopher Ruddy, CEO of Newsmax, who speaks regularly with President Trump, indicated in an interview on ABC’s This Week on Sunday that Dr. Shulkin will likely be the next Cabinet departure. The fact that VA Choice 2.0 did not make it into the huge ‘omnibus’ budget bill indicated a disillusion with him on Capitol Hill. The lack of closure on replacing VistA with Cerner is also not in favor of a longer stay. The replacement may come from the VA House committee, the defense contractor community, or DoD. Why it’s important? VA is the largest purchaser of telemedicine and telehealth in the US, and has set the pace for everything from EHRs to info security. And there are those 9 million veterans they serve. Stay tuned. POLITICO Morning eHealth…..

By the next morning, a press secretary was saying “At this point in time though, he [President Trump] does have confidence in Dr. Shulkin. He is a secretary and he has done some great things at the VA. As you know, the president wants to put the right people in the right place at the right time and that could change.” But one of Dr. Shulkin’s biggest thorns-in-side at the VA, Darin Selnick, shuffled off last year to the Domestic Policy Council, will return to a post at the VA.

HIMSS continued to support VA’s and Dr. Shulkin’s efforts to increase veteran patient record sharing through changing the consent requirements authorizing the VA to release a patient’s confidential VA medical record to a Health Information Exchange (HIE) community partner. Letter.

Philips has entered the integrated teleradiology field by combining Philips’ Lumify portable ultrasound system and Innovative Imaging Technologies‘ (IIT) Reacts collaborative platform. It combines a compatible smart device that enables a two-way video consult with live ultrasound streaming. How it works: “clinicians can begin their Reacts session with a face-to-face conversation on their Lumify ultrasound system. Users can switch to the front-facing camera on their smart device to show the position of the probe. They can then share the Lumify ultrasound stream, so both parties are simultaneously viewing the live ultrasound image and probe positioning, while discussing and interacting at the same time.” Release

Following up on 3rings and their integration into the Amazon Echo virtual assistant system [TTA 18 Oct], Mark Smith from their business development area has told us that they have formally launched this platform earlier this month. The person cared for at home can simply ask Alexa to alert family and caregivers that they need help via voice message, text or email. Care staff or family can also use Echo to check through the 3rings platform by simply asking Alexa if that person is safe and OK. 3rings is now actively seeking to partner with innovative health, housing, and social care organizations. Overview/release.

VA moves closer to doing Cerner EHR deal, real Choice for veterans (updated)

The Cerner EHR deal with the VA edges closer to closing. Another VA contractor, MITRE, reviewed the agreement and recommended 50 changes that, according to POLITICO Morning eHealth’s source, address many of the interoperability-related usability features “that irritate EHR users” such as reconciling data coming from outside sources (Home Telehealth, perhaps?–Ed.). VA officially updated the status with Congressional Veterans Affairs staff on Tuesday. The deal could be inked as early as next week, but never bet on this when the Secretary seems doubtful of the agreement date. In any case, it will be a decade before VA is fully transitioned from VistA. Speaking of the Secretary, Dr. Shulkin’s crisis of last week seems to have passed with a White House vote of confidence. He can ‘cashier’ his critics and according to him, everyone’s on board with a clear direction. We’ll see. 

Updated. Well, it’s 2 March and still no word on closing the Cerner contract. Meanwhile, the VA ‘revolt’ continues, with either true or false reports of demands for Dr. Shulkin’s resignation. It’s exhausting, and meanwhile who pays? Staff and veterans. See POLITICO from 1 March here.

Modern Healthcare reported that important reforms in the VA Choice legislation are closer to reality with the Senate Veterans Affairs committee. They are proposing changes, supported by the White House, that would open up VA Choice eligibility to nearly all veterans by “making VA facilities responsible for meeting access standards set by the VA secretary. If a facility can’t, the patient can seek out a community provider if both patient and a VA provider or an authorized provider in the community working closely with VA deem that a better option than a VA facility.” This is a step beyond the earlier proposed access standards which would have given the VA Secretary discretion to relax restrictions to community care provision. Currently the VA Choice program is used by only 1 million veterans who have to prove that they are facing wait times of 30 days or more, or 40-mile travel time to a VA clinic. While the tone in the article is slightly disparaging, firm standards and opening the VA to limited market pressures to this Editor is a good thing–and getting effective care faster to veterans, many of whom live in exurban or rural areas, is beyond all considerations, absolutely necessary. How this affects veterans monitored by telehealth programs–and interoperability of their records–are open questions.

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?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Here’s our roundup for the week of 12 February:

VA wins on the budget, but the Secretary’s in a spot of bother. Updated. Last week started off as a good week for Secretary Shulkin with a White House budget proposal that increased their $83.1 billion budget by 11.7 percent, including $1.2 billion for Year 1 of the Cerner EHR implementation in addition to the agency’s $4.2 billion IT budget which includes $204 million to modernize VistA and other VA legacy IT systems in the interim. While the Cerner contract went on hold in December while record-sharing is clarified, the freeze is expected to be lifted within a month. POLITICO  Where the trouble started for Dr. Shulkin was in the findings of a spending audit by the VA’s Inspector General’s Office of an official European trip to Copenhagen and London which included unreimbursed travel by Mrs. Shulkin and free tickets to Wimbledon, at least partly justified by a doctored email. This has led to the early retirement of the VA Chief of Staff Vivieca Wright Simpson and also an investigation of hacking into Wright Simpson’s email. It also appears that some political appointees in the VA are being investigated for misconduct. CNBC, FierceHealthcare.

Updated: POLITICO doesn’t feel the love for Dr. Shulkin in today’s Morning eHealth, linking to articles about the supposed ‘internal war’ at the VA, with veterans’ groups, with the Trump Administration, and within the VA. It’s the usual governmental infighting which within the 16 Feb article is being whipped by POLITICO and co-author ProPublica to a fevered pitch. Dr. Shulkin comes across as doctor/tech geek who underestimated the politicization of and challenges within an agency with the mission to care for our veterans. It’s also an agency having a hard time facing the current demands of a dispersed, younger and demanding veteran group plus aging, bureaucratic infrastructure. As usual the ‘privatization’ issue is being flogged as an either/or choice whereas a blend may serve veterans so much better.

Digital health entrepreneur named CEO of the American Telemedicine Association. A first for ATA is a chief from the health tech area who is also one of the all-too-rare executive women in the field. Ann Mond Johnson, who will be starting on 5 March, was previously head of Zest Health, board chair and advisor to Chicago start-up ConnectedHealth (now part of Connecture), and had sold her first start-up company Subimo to WebMD in 2006. She began her career in healthcare data and information with The Sachs Group (now part of Truven/IBM Watson). Ms. Johnson replaces founding CEO Jonathan Linkous, who remained for 24 years before resigning last August and is now a consultant. ATA release, mHealth Intelligence. ATA relocated in January from Washington DC to nearby Arlington Virginia. And a reminder that ATA2018 is 29 April – 1 May in Chicago and open for registration.

Allscripts’ ‘Such a Deal’! Following up on Allscripts’ acquisitions of Practice Fusion for $100 million (a loss to investors) and earlier McKesson’s HIT business for $185 million [TTA 9 Jan], it hasn’t quite paid for itself, but came very close with the sale of McKesson’s OneContent, a healthcare document-management system, for a tidy $260 million. Net price: $25 million. Their CEO is some horse trader! Some of the savings will undoubtedly go to remedying the cyberattack in January that affected two data centers in North Carolina, shutting down EHR and billing applications for approximately 1,500 physician practices, which have launched a class action lawsuit. FierceHealthcare 

Flatiron Health acquired by Roche. (more…)

What’s up with Amazon in healthcare? Follow the money. (updated)

Updated–click to see full page. Amazon is the Scary Monster of the healthcare space, a veritable Godzilla unleashed in Tokyo, if one listens to the many rumors, placed and otherwise, picked up in mainstream media which then are seized on by our healthcare compatriots.

According to CNBC’s breathless reporting, they have set up a skunk works HQ’d in Seattle. When they posted job listings, they were under keyword “a1.492” or as “The Amazon Grand Challenge a.k.a. ‘Special Projects’ team.” In late July, these ads for people like a UX Design Manager and a machine learning director with experience in healthcare IT and analytics plus a knowledge of electronic medical records were deleted. Amazon has separate initiatives on selling pharmaceuticals and building health applications to be compatible with Echo/Alexa and other smart home tech. Both have come up in the context of the CVS-Aetna merger, where buying up state pharmacy licenses cannot be kept secret (see end of our 8 Dec article) and that efforts to extend Alexa and Echo’s capabilities aren’t particularly secret.

A quick look at Bezos Expeditions, Amazon supremo’s Jeff Bezos’ personal fund, on Crunchbase reveals several healthcare investments, such as GRAIL (cancer), Unity Biotechnology (aging), Rethink Robotics, and Juno Therapeutics (cancer). Not really things easy to sell on Amazon.

Last week, Amazon reportedly hired Dr. Martin Levine, who ran integrated primary health Iora Health’s Seattle-based clinics, according to CNBC and Becker’s. They met with Iora, Kaiser, and the now-defunct Qliance about a year ago on innovative healthcare models. More breathless reporting: they are hiring a “HIPAA compliance lead.” 

What does this all mean? It may be more–or less–than what the speculation is. Here’s what this Editor believes as some options:

  • Alexa and Echo are data collectors as well as assistants–information that has monetary value to healthcare providers and pharma. To this Editor, this is the most likely and soonest option–the monetization of this data and the delivery of third-party services as well as monitoring.
  • Amazon now employs a lot of people. It is large enough to create its own self-funded health system. It’s already had major problems in the UK, Italy, and even in the US with healthcare and working conditions in its warehouses. Whole Foods’ non-union workers are prime for unionization since the acquisition (and also if, as rumored, robots and automation start replacing people).
  • A self-funded health system may also be plausible to sell  (more…)

Iron Bow’s uncertain future with $258 million VA Home Telehealth contract

Iron Bow Technologies’s setback with their VA contract confirmed. Iron Bow, which partnered last year with Vivify Health to provide telehealth services to the US Department of Veterans Affairs, received an unfavorable ruling on the US country of origin of the Vivify Health system that essentially stops the contract implementation.

Under Title III of the Trade Agreements Act of 1979, Federal suppliers must produce their products in the US or substantially transform the components in such a way that it becomes a product of the US. US Customs and Border Protection (CBP), Department of Homeland Security (DHS), makes this determination. Vivify Health contended that their Vietnam-produced tablet, because of their US-produced Vivify Health Pathways software and further US-based modifications to convert it into an FDA-regulated medical device, was transformed into a US product. In August, the CBP determined that the end product did not meet the transformation standard based on decades of precedent and the country of origin remained Vietnam. Transformation, yes, but not enough or the right kind for the CBP. Federal Register 8/22/17

An interesting Federal regulatory disconnect is that the FDA considers the Vivify tablet a regulated medical device. CBP considers it a communications device as the tablet transmits data from other medical devices but does not take those measurements itself. 

Vivify Health has publicly used in implementations with health organizations Samsung tablets. It is not known if the tablet reviewed by the CBP is manufactured by Samsung.

Both Iron Bow and Vivify Health were asked by this Editor for comments. Iron Bow’s response:

We have received an unfavorable ruling from United States Customs and Border Protection (“Customs”) regarding our proposed solution for the Home Telehealth contract. We respectfully disagree with the findings by Customs and have appealed the matter to the United States Court of International Trade. We are currently in discussions with our customer regarding the possible options for a path forward.

Vivify has not responded to date. 

Certainly, this is a sizable financial loss to both Iron Bow and Vivify if they cannot go forward with the VA, whether through a court decision or a different procurement process for the tablet to qualify it as US origin. Last February, we reported that the VA awarded the billion-dollar five-year Veterans Health Administration (VHA) Home Telehealth contract to four providers: incumbent Medtronic, Iron Bow, Intel Care Innovations, and service-disabled veteran-owned small business 1Vision. The award amount for each was $258 million over a five-year period, re-establishing the VHA as the largest telehealth customer in the US. All four awardees had in common that they were prior Federal contractors, either with the VA or with other Federal areas [TTA 1 Feb 17].

Medtronic and Care Innovations had long-established integrated telehealth systems but Iron Bow and 1Vision, as telemedicine and IT service providers respectively, did not have vital signs remote monitoring capability. In the solicitation, Iron Bow partnered with Vivify [TTA 15 Feb 17]. For 1Vision, it took nearly one year to announce that their telehealth partner was New York-based AMC Health, an existing provider of VA health services. It was also, for those in the field, a Poorly Kept Secret, as AMC Health had been staffing with VA telehealth veterans from the time of the award. (The joint release is on AMC Health’s site here.) The reason for the announcement delay is not known. AMC Health does not use a tablet system, instead transmitting data directly from devices or a mobile hub to a care management platform. They also provide IVR services.

Vivify has moved forward with other commercial partnerships, with the most significant being InTouch Health, which itself is on a tear with acquisitions such as TruClinic [TTA 19 Dec 17].

Hat tip to two alert Readers who assisted in the development of this article but who wish to remain anonymous.

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.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/11/Gigi-Sorenson-GlobalMed.jpg” thumb_width=”150″ /]By: 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