International news roundup: Verily ‘eyes’ India, Oxford VR trials in Hong Kong, Israel-Finland collaborate, Blue Cedar-Blackberry partner, NuvoAir inhales $3M

Verily rolls along in India with eye health research. Spending its fresh $1bn in funding [TTA 17 Jan], Verily and Alphabet sibling Google are researching machine learning in screening for diabetic retinopathy and diabetic macular edema. The retinal diagnostic program is at Aravind Eye Hospital, a network of eye hospitals headquartered in Tamil Nadu. Early research at Madurai has demonstrated that the algorithm performs on par with general ophthalmologists and retinal specialists assessing the images for disease. The estimated shortage of eye doctors in India is estimated at over 100,000. The stated objective of the research is to detect retinal disease earlier and expand access to screening. Further testing is verifying safety and effectiveness. Verily has received the CE Mark for the algorithm. Verily blog

Oxford VR in pilot to manage mental health in Hong Kong. Oxford VR, AXA Hong Kong and The Chinese University of Hong Kong (CUHK) have partnered for an “immersive therapy” trial using VR. This will focus on managing common mental health issues, such as social avoidance, anxiety and depressive symptoms. The scenarios will be in both English and Cantonese. Details will be announced in June. Mobihealthnews, Oxford VR press release

Israel and Finland are launching a joint collaboration announced last December, led by the Israel Innovation Authority (IIA) and the Helsinki Business Hub. The pilot program is starting with a Call for Proposals for joint projects. The two countries will co-develop, test, improve and pilot technologies, products and services in digital health, smart mobility and information and communication technologies. According to Mobihealthnews, the countries both have strong commonalities in public health systems with coordinated data sets, digital health, genomic projects, and advanced interoperability. Also The Jewish Voice

App security innovator Blue Cedar partners with Blackberry. Blue Cedar’s securing data from the app to the provider location will work with BlackBerry Dynamics-enabled mobile apps so that development teams will not be required to manually change source code or add libraries. Both Blue Cedar and Blackberry target international high-security fields such as healthcare, government, and financial. Blue Cedar blog

Swedish respiratory device/app NuvoAir inhales $3M in new funding. NuvoAir targets those managing asthma, COPD, and cystic fibrosis who need to monitor their breathing and lung health in conjunction with their overall health. Last year, the company developed the Air Next system, a portable device that connects via Bluetooth LE to users’ smartphones or tablets. Air Next has a CE Mark. NuvoAir plans to expand into Europe, North America, and Asia. The digital respiratory therapy area is booming, with an estimated 210 million asthma and COPD patients with smartphones worldwide a strong factor. One sign: Propeller Health’s premium acquisition by ResMed.  Mobihealthnews

It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding.

The doors were blown off funding last quarter, so whither the year? Our first take 10 January on Rock Health’s 2018 report was that digital health was a cheery, seltzery fizzy, not bubbly as in economic bubbles.  Total funding came in at $8.1 billion–a full $2.3 bn or 42 percent–over 2017’s $5.7 bn, as projected in Q3 [TTA 11 Oct]–which indicates confidence and movement in the right direction.

What’s of concern? A continued concentration in funding–and lack of exiting.

  • From Q3, the full year total added $1.3 bn ($6.8 bn YTD Q3, full year $8.1 bn) 
  • The deals continue to be bigger and fewer–368 versus 359 for 2017, barely a rounding error
  • Seed funding declined; A, B, C rounds grew healthily–and D+ ballooned to $59M from $28M in 2017, nearly twice as much as C rounds
  • Length of time between funding rounds is declining at all levels

Exits continue to be anemic, with no IPOs (none since 2016!) and only 110 acquisitions by Rock Health’s count. (Rock only counts US only deals over $2 million, so this does not reflect a global picture.)

It’s not a bubble. Really! Or is it a developing one? Most of the article delivers on conclusions why Rock Health and its advisors do not believe there is a bubble in funding by examining six key attributes of bubbles. Yet even on their Bubble Meter, three out of the six are rated ‘Moderately Bubbly’–#2, #3, and #5–my brief comments follow. 

  1. Hype supersedes business fundamentals (well, we passed this fun cocktail party chatter point about 2013)
  2. High cash burn rates (not out of line for early stage companies)
  3. Unclear exit pathways (no IPOs since ’16 which bring market scrutiny into play. Oddly, Best Buy‘s August acquisition of GreatCall, and the latter’s earlier acquisitions of Lively and Healthsense didn’t rate a mention)
  4. Surge of cash from new investors (rising valuations per #5–and a more prosperous environment for investments of all types)
  5. High valuations decoupled from fundamentals (Rock Health didn’t consider Verily’s billion, which was after all in January)
  6. Fraud or misuse of funds (Theranos, Outcome dismissed by Rock as ‘outliers’, but no mention of Zenefits or HealthTap)

Having observed bubbles since 1980 in three industries– post-deregulation airlines in the 1980s, internet (dot.com) in the 1990s, and healthcare today (Theranos/Outcome), ‘moderately’ doesn’t diminish–it builds to a peak, then bursts. Dot.com’s bursting bubble led to a recession, hand in hand with an event called 9/11.

This Editor is most concerned with the #5 rating as it represents the largest divergence from reality and is the least fixable. While Verily has basically functioned as a ‘skunk works’ (or shell game–see here) for other areas of Google like Google Health, it hardly justifies a billion-dollar investment on that basis alone. $2 bn unicorn Zocdoc reportedly lives on boiler-room style sales to doctors with high churn, still has not fulfilled its long-promised international expansion, and has ceased its endless promises of transforming healthcare. Peleton is a health tech company that plumps out Rock Health’s expansive view of Health Tech Reality–it’s a tricked out internet connected fitness device. (One may as well include every fitness watch made.)

What is the largest divergence from reality? The longer term faltering of health tech/telecare/telehealth companies with real books of business. Two failures readily come to mind: Viterion (founded in 2003–disclosure, a former employer of this Editor) and 3rings (2015). Healthsense (2001) and Lively were bought by GreatCall for their IP, though Healthsense had a LTC business. Withings was bought back by the founder after Nokia failed to make a go of it. Canary Care was sold out of administration and reorganized. Even with larger companies, the well-publicized financial and management problems of publicly traded, highly valued, and dominant US telemed company Teladoc (since 2015 losing $239 million) and worldwide, Tunstall Healthcare’s doldrums (and lack of sale by Charterhouse) feed into this. 

All too many companies apparently cannot get funding or the fresh business guidance to develop. It is rare to see an RPM survivor of the early ’00s like GrandCare (2005). There are other long-term companies reportedly on the verge–names which this Editor cannot mention.

The reasons why are many. Some have lurched back and forth from the abyss or have made strategic errors a/k/a bad bets. Others like 3rings fall into the ‘running out of road and time’ category in a constrained NHS healthcare system. Beyond the Rock Health list and the eternal optimism of new companies, business duration correlates negatively with success. Perhaps it is that healthcare technology acceptance and profitability largely rests on stony, arid ground, no matter what side of the Atlantic. All that money moves on to the next shiny object.(Babylon Health?) There are of course some exceptions like Legrand which has bought several strong UK companies such as Tynetec (a long-time TTA supporter) and Jontek.

Debate welcomed in Comments.

Related: Becker’s Hospital Review has a list of seven highly valued early stage companies that failed in 2018–including the Theranos fraud. Bubble photo by Marc Sendra martorell on Unsplash

Verily, Google’s life sciences arm, gathers in another billion to go…where? (updated for Study Watch FDA clearance)

Biotech/device company Verily added to its 2016 $800 million stake from Singapore’s Temasek a fresh $1 bn from Silver Lake Partners. with reported participation from Ontario Teacher’s Pension Plan. Verily is majority-owned by Google parent Alphabet, which has added a new member to the Verily board, CFO Ruth Porat, and Egon Durbat from Silver Lake.

CEO Andrew Conrad, who is still there despite a brace of bad press two years ago [TTA 6 Apr 16], stated that “We are taking external funding to increase flexibility and optionality as we expand on our core strategic focus areas. Adding a well-rounded group of seasoned investors, led by Silver Lake, will further prepare us to execute as healthcare continues the shift towards evidence generation and value-based reimbursement models.”

One is tempted to say, ‘whatever that means’. They have had multiple ventures from contact lenses with Novartis’ subsidiary Alcon (reportedly discontinued but dating back with Google to 2014), diabetes with Sanofi, to sleep apnea with ResMed. VentureBeat reports they are cash-profitable and even venturing into areas such as small exploding needles that can extract blood through a wearable device–not precisely for the needle-phobic. There seem to be multiple projects in multiple directions that are primarily research. Certainly their finding at $1.8 bn is an outlier even at 2018’s big scale–but with Alphabet/Google as a parent and A-list partners, the risk is minimal. Mobihealthnews, Crunchbase

FDA clearance of Verily’s Study Watch. Late last week, Verily announced that their Study Watch was given a 510(k) FDA clearance. It records, stores, transfers and displays single-channel ECG. To date, there are no plans to use it beyond a handful of research studies primarily on cardiac disease. Mobihealthnews. Meanwhile, Google, not Verily, paid Fossil $40 million for a still under development smartwatch technology to fit into Google’s Ware OS area. It’s not known whether it is health related, but their CEO admitted that it was based on tech from the Misfit acquisition–and Misfit was focused on health tech. After the sale closing, it is predicted that some Fossil R&D staff will move over to Google. Back in 2015, Fossil paid $260 million for Misfit and their fitness tech but generally has stayed in the conventional smartwatch area. The story broke in Wareable. Also Mobihealthnews.

Will there ever be a medical ‘tricorder’?

ZDNet teases us that ‘the race is on’, but is it? It’s a great clickbait headline, but the substance of the article illustrates the distance between today’s tech reality versus the picture of Star Trek’s Bones pointing a Tricorder at a patient and immediately pronouncing that your malady was Sakuro’s Disease or some strange Vulcan malady.

Was it that long ago that the Scanadu Scout was the odds-on bet to be the Tricorder? The hype began in 2012 [TTA 23 May 2013] with Indiegogo funding, competing for the XPRIZE, and breathless pronouncements at nearly every healthcare conference. By 2016, it missed the Qualcomm Tricorder XPRIZE finals (with Northern Ireland’s Intelesens), bricked all sold units to date to comply with FDA regulations on investigational devices, and with Chinese money in hand, moved into other testing devices. Those looking for Scanadu today will be disappointed as their website is unreachable. The DeBrowers and medical director Alan Greene, all of whom were fêted on the healthcare scene, are engaged over at Doc.ai with a new mission of decentralizing precision medicine onto the blockchain using AI, using your medical data gathered on an app (of course).

Google X was up next as Scanadu was fading. There were various devices they were hyping and testing as Google’s life sciences skunk works morphed into Verily, but to date they have all petered out, with some questions raised about people and project churn at the Alphabet unit [TTA 6 April 2016] .

Basil Leaf Technologies (as Final Frontier Medical Devices) wound up winning last year’s final Qualcomm XPRIZE with DxtER, which could diagnose and interpret a defined set of 13 health conditions to various degrees, while continuously monitoring five vital health metrics, using a mix of sensors and an AI-powered diagnostic engine. What they are planning to market first is not DxtER, but a single-disease device to monitor congestive cardiac failure (CCF) since FDA approval for DxtER “would take aeons to be approved.”

Urine tests are also a ‘wet’ way into a tricorder state, with both Basil Leaf and the University of Glasgow working on devices which could quickly scan for metabolites in urine that indicate particular diseases.

QuantuMDx’s Q-POC, from Newcastle UK, is expected to launch in 2019 with handheld diagnostics for bacterial and viral infections. In addition to quick diagnostics for outbreaks in less developed countries, they are also developing diagnostics to prescribe the right antibiotic the first time. This is critical in treatment superbugs such as MRSA and MSSA, as well as more garden variety infections which can go wrong quickly. TTA profiled their crowdfunding launch in 2014.

The ZDNet article wraps up with a bit of romance about how a tricorder is needed for Mars, but down here on Earth, the reality is that a tricorder will likely be a combination of devices and analytics, stitched together by machine learning and AI.

Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Our Editors will be lassoing our thoughts for what happened in 2017 and looking forward to 2018 in several articles. So let’s get started! Happy Trails!

2017’s digital health M&A is well-covered by Jonah Comstock’s Mobihealthnews overview. In this aggregation, the M&A trends to be seen are 1) merging of services that are rather alike (e.g. two diabetes app/education or telehealth/telemedicine providers) to buy market share, 2) services that complement each other by being similar but with strengths in different markets or broaden capabilities (Teladoc and Best Doctors, GlobalMed and TreatMD), 3) fill a gap in a portfolio (Philips‘ various acquisitions), or 4) payers trying yet again to cement themselves into digital health, which has had a checkered record indeed. This consolidation is to be expected in a fluid and relatively early stage environment.

In this roundup, we miss the telecom moves of prior years, most of which have misfired. WebMD, once an acquirer, once on the ropes, is being acquired into a fully corporate info provider structure with its pending acquisition by KKR’s Internet Brands, an information SaaS/web hoster in multiple verticals. This points to the commodification of healthcare information. 

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]Love that canary! We have a paradigm breaker in the pending CVS-Aetna merger into the very structure of how healthcare can be made more convenient, delivered, billed, and paid for–if it is approved and not challenged, which is a very real possibility. Over the next two years, if this works, look for supermarkets to get into the healthcare business. Payers, drug stores, and retailers have few places to go. The worldwide wild card: Walgreens Boots. Start with our article here and move to our previous articles linked at the end.

US telehealth and telemedicine’s march towards reimbursement and parity payment continues. See our article on the CCHP roundup and policy paper (for the most stalwart of wonks only). Another major change in the US is payment for more services under Medicare, issued in early November by the Centers for Medicare and Medicaid Services (CMS) in its Final Rule for the 2018 Medicare Physician Fee Schedule. This also increases payment to nearly $60 per month for remote patient monitoring, which will help struggling RPM providers. Not quite a stride, but less of a stumble for the Grizzled Survivors. MedCityNews

In the UK, our friends at The King’s Fund have rounded up their most popular content of 2017 here. Newer models of telehealth and telemedicine such as Babylon Health and PushDoctor continue to struggle to find a place in the national structure. (Babylon’s challenge to the CQC was dropped before Christmas at their cost of £11,000 in High Court costs.) Judging from our Tender Alerts, compared to the US, telecare integration into housing is far ahead for those most in need especially in support at home. Yet there are glaring disparities due to funding–witness the national scandal of NHS Kernow withdrawing telehealth from local residents earlier this year [TTA coverage here]. This Editor is pleased to report that as of 5 December, NHS Kernow’s Governing Body has approved plans to retain and reconfigure Telehealth services, working in partnership with the provider Cornwall Partnership NHS Foundation Trust (CFT). Their notice is here.

More UK roundups are available on Digital Health News: 2017 review, most read stories, and cybersecurity predictions for 2018. David Doherty’s compiled a group of the major international health tech events for 2018 over at 3G Doctor. Which reminds this Editor to tell him to list #MedMo18 November 29-30 in NYC and that he might want to consider updating the name to 5G Doctor to mark the transition over to 5G wireless service advancing in 2018.

Data breaches continue to be a worry. The Protenus/DataBreaches.net roundup for November continues the breach a day trend. The largest breach they detected was of over 16,000 patient records at the Hackensack Sleep and Pulmonary Center in New Jersey. The monthly total was almost 84,000 records, a low compared to the prior few months, but there may be some reporting shifting into December. Protenus blog, MedCityNews

And perhaps there’s a future for wearables, in the watch form. The Apple Watch’s disconnecting from the phone (and the slowness of older models) has led to companies like AliveCor’s KardiaBand EKG (ECG) providing add-ons to the watch. Apple is trying to develop its own non-invasive blood glucose monitor, with Alphabet’s (Google) Verily Study Watch in test having sensors that can collect data on heart rate, gait and skin temperature. More here from CNBC on Big Tech and healthcare, Apple’s wearables.

Telehealth saves lives, as an Australian nurse at an isolated Coral Bay clinic found out. He hooked himself up to the ECG machine and dialed into the Emergency Telehealth Service (ETS). With assistance from volunteers, he was able to medicate himself with clotbusters until the Royal Flying Doctor Service transferred him to a Perth hospital. Now if he had a KardiaBand….WAToday.com.au  Hat tip to Mike Clark

This Editor’s parting words for 2017 will be right down to the Real Nitty-Gritty, so read on!: (more…)

Verily’s million points of BYO health data to take to your next doctor visit

Verily‘s visit to last week’s Health 2.0 conference had an odd-but-fun tack, comparing the data received from human bodies to the billions of data points generated by an average late-model automobile in normal operations. We generate a lot less (ten orders of magnitude difference, according to Verily Chief Technology Officer Brian Otis), but Verily wants to maximize the output by wiring us to multiple sensors and to use the data in a predictive health model. Some of the Verily devices this Editor predicts will be non-starters (the sensor contact lens developed with Alcon) but others like the Dexcom partnership to develop a smaller, cheaper continuous blood glucose monitor and Liftware, the tremor-canceling silverware company Google acquired in 2014, appear promising. Key to predictive health is the Study Watch, which is a wearable that collects a lot of data but is easy to wear for a long time. Mobihealthnews

But what to do with this All That Data? Where this differs from a car is that the operational data goes into feedback loops that tune the engine’s performance, perform long-term monitoring, electrical system, braking, and more. (When the sensors go south or the battery’s low, watch out!) It’s not clear from the talk where this overwhelming amount of healthcare data generated goes to and how it becomes useful to a person or a doctor. This has its own feedback loop this Editor dubbed a few years ago as the Five Big Questions (FBQs): who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records. That’s not answered, but presumably these technologies will incorporate machine learning and AI to Crunch That Data into bite-sized parts.

Which leads us back to Verily’s parent, Alphabet a/k/a Google. All that data into Verily devices could be monitored by Google and fed into other Google programs like their search engines and Adwords. Another privacy problem? 

Perhaps health systems are arriving at the realization that they have to crunch the data, not avoid it. For the first time, this Editor has observed that a CMIO of a small health system in Illinois and Sanford Health‘s executive director of analytics are actually welcoming patient data and research. Startups in this area such as PreventScripts labor on that “last mile” of clinical decision support, preventative medicine. EHRs are also into the act. Epic launched Share Everywhere, where patients can grant access to their data and clinicians can send updates into the patient portal (MyChart). What’s needed, CMIO Goel admits, is software that combines natural language processing and algorithms to track by disease and specialty–once again, machine learning. Healthcare IT News 

Diabetes management: the Next Big Health Tech Thing?

Big Data? Passé. Health IT security and hacking? At a peak. So what’s the Next Big Thing? If you’re tracking where the money’s going, it’s diabetes management. This week saw the joint venture Onduo formed by the controversial [TTA 6 Apr] life sciences-focused Verily (Google Alphabet) and Big Pharma Sanofi with a nest egg of $500 million. Onduo will be combining devices with services to help Type II diabetics. Based upon CEO Joshua Riff’s statements to MedCityNews, their platforms are yet to be developed, but “will be a digital platform that will involve software, hardware, and very importantly service” to change patient behaviors. Partnerships with Sutter Health in Northern California and Allegheny Health Network of western Pennsylvania will test their approaches in a clinical setting. Xconomy, Reuters

Verily’s other diabetes project include the £540 million bioelectronics partnership announced in August with UK-based GSK in Galvani Electronics [TTA 3 Aug] with a focus on inflammatory, metabolic and endocrine disorders, including Type II diabetes. With Dexcom, Verily is also building an inexpensive, smaller next-gen continuous glucose monitoring sensor; Mr Riff was coy about whether this sensor would be used but allowed that sensors might be used in Onduo’s approaches. Verily is also developing the well-known glucose-reading contact lens with Novartis [TTA 1 Sep 15].

Also this week, Glooko and Sweden’s Diasend announced their merger (more…)

Google’s Verily joint ventures with GSK into bioelectronics (UK/US)

Verily, the Alphabet (Google) life sciences research group, and GlaxoSmithKline are partnering in a joint venture that may replace drugs for disease with micro-electronic implantable devices. GSK will own 55 percent of Galvani Bioelectronics, with Verily owning 45 percent. They have pledged an investment of £540 million in the new UK-based business over 7 years, as well as contributing intellectual property rights to Galvani. Most of the staff will be at GSK in Stevenage with some at Verily’s HQ in South San Francisco, and led by Kris Famm, formerly GSK’s vice president of bioelectronics R&D. The deal is expected to close by end of year.

According to Business Insider UK, GSK has been involved with bioelectronics for four years. It’s defined as “a relatively new scientific field that aims to tackle a wide range of chronic diseases using miniaturised, implantable devices that can modify electrical signals that pass along nerves in the body, including irregular or altered impulses that occur in many illnesses.” The diseases that are being targeted are inflammatory, metabolic and endocrine disorders, including type 2 diabetes. According to the MedCityNews interview of Verily’s CTO Brian Otis, the systems will be closed loop where the devices listen to the nerve signals, do real-time signal processing and send the optimized signal back to the nerve to restore healthy function. GSK has the diagnostic and biologic expertise, Verily has the device smarts. Also Mobihealthnews, Recode

Google’s Verily rolls along. Bumpily? (updated)

Several articles of late have reported on the Google Alphabet life sciences company Verily. By fall last year, they had developed partnerships with Novartis-Alcon on development of a smart contact lens (for measuring glucose), plus Dexcom, Abbvie and Biogen. STAT, a health/medicine news website owned by Boston Globe Media which is still in beta, has a well-researched article that details, seemingly with a lot of inside scoop, its current turmoil. 12 top engineering and science executives have taken a powder. Some of the execs date back to the Google X days; most have fled back to Mother Google, others to Amazon or to life sciences competitors. STAT: “No similar brain drain has occurred at Calico, another ambitious Google spinoff, which is focused on increasing the human lifespan.” The reasons are the apparently abrasive CEO Andrew Conrad, depicted as ambitious, fickle and moody–and the constant shifting of support from approved projects to short-term initiatives ‘that show little promise’. Google’s bold bid to transform medicine hits turbulence.

Update: STAT published today information on a possible conflict of interest in Verily awarding a short-term research contract to a luxury health clinic, California Health & Longevity Institute, where Dr Conrad holds a majority ownership. According to the publication, it has no documented experience with this kind of work. The clinic will gather, in a 200-person ‘feasibility study’ for the larger Baseline study, genetic, molecular, clinical, and other data. According to Dr Conrad, it was done “Because I think it’s cool. Because it’s super efficient to have everything in one spot.” What may not be cool to the participants is that Baseline is already planning to sell the data to pharmaceutical companies–with patient consent, of course, in a document not yet public. Google’s biotech venture hit by ethical concerns