Philips awarded by VA 10-year, $100 million remote ICU, telehealth contract; partners with BioIntelliSense for RPM

The US Department of Veterans Affairs (VA) awarded Philips a ten-year contract to build out their remote intensive care (ICU) service infrastructure to make it accessible to veterans from any location in the US. The VA currently manages 1,800 ICU beds nationwide in its approximately 1,700 sites. Based on the release, the Philips engagement in VA Tele-Critical Care will expand the VA’s current capabilities to encompass telehealth, tele-critical care (eICU), diagnostic imaging, sleep solutions, and patient monitoring. The agreement may total $100 million over the 10-year contract duration.

Philips has about 20 percent of the adult eICU market. They claim that 1 in 8 adult ICU patients are monitored 24/7 by their eICU Program, which combines audio/visual technology, predictive analytics, data visualization, and advanced reporting capabilities. Their proprietary research points to shorter ICU visits by eICU patients plus better outcomes. Healthcare IT News, Philips release (Photo: Philips)

By this Editor’s calculation, VA remains the single largest user of telehealth in the US. In their FY 2019, the first year of the ‘Anywhere to Anywhere’ initiative [TTA 24 May 2018], VA delivered more than 2.6 million telehealth episodes to 900,000 veterans. During the early part of the pandemic, they grew virtual home visits from an average of 10,000 to 120,000 per week. By the end of FY 2020, their goal is to deliver all primary care and mental health provider services, both in-person and via a mobile or web-based device. The VA release from November 2019 does not break out the different types of VA telehealth and usage.

Philips and BioIntelliSense have also inked a partnership deal to integrate BioIntelliSense’s BioSticker sensors into their post-acute remote patient monitoring (RPM) systems. The BioSticker is a wearable FDA-cleared 510(k) Class II sensor that transmits passive monitoring of key vital signs, physiological biometrics, and symptomatic events up to 30 days. The first announced user of the RPM+BioSticker systems will be Healthcare Highways of Frisco, Texas, a provider of health plans, employer self-funded health plans,  pharmacy benefit management, population health management, and benefit plan administration. Healthcare Highways is participating in seven patient monitoring programs to assess patient health status with providers: COVID-19, CHF, hypertension, diabetes, total joint replacement, cancer, and asthma. Release (Photo: Philips)

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.

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.

ReWalk powered exoskeleton now covered by the VA (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/12/rewalk.jpg” thumb_width=”200″ /]The advancement of robotic assistance in movement and walking took a sizable step forward (so to speak) with the Veterans Administration now covering the cost of and transition to the ReWalk powered exoskeleton on a national basis. It will be supplied to qualifying veterans with spinal cord injuries, but that qualification is a substantial hurdle in itself. According to the AP article, height and weight requirements are specific, and the paraplegic veteran has to be capable of wearing the supportive belt around the waist to keep the suit in place and carrying a backpack which holds the computer and rechargeable battery. Crutches still must be used for stability and the FDA as part of its clearance requires an assistant be nearby. It also cannot be worn for a full day, but even minimal use was proven to be beneficial; in VA pilot studies, the paraplegics who wore the ReWalk as little as four hours a week for three to five months experienced better bowel and bladder function, reduced back pain, improved sleep and less fatigue.

ReWalk has identified 45 paralyzed veterans who qualify, (more…)

Senate Veterans Affairs Committee takes evidence on VETS Act (US)

Further to our report in October on the introduction of the Veterans E-Health & Telemedicine [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/10/Dept-of-VA-logo.jpg” thumb_width=”150″ /]Support Act (“Veterans eHealth & Telemedicine”, 10 October 2015), Sen. Joni Ernst’s website reports that Sen. Ernst was the first witness to testify in front of the Senate Veterans Affairs Committee on Wednesday (19 November 2015) about the proposed legislation.

“The VA has been practicing telemedicine since 2001, and they are largely cited as leaders and innovators in the field. Their efforts in telemedicine have saved money and veterans’ time by eliminating often an hour or more long drives to the VA, and reducing bed days at the VA” Ernst is reported to have said.

“For example: According to the VA, in Fiscal Year 2014, telehealth reduced bed days of care by 54%, reduced hospital admissions by 32%, and saved $34 in travel savings per  consultation. (more…)

VA Department data breaches soar (US)

If after the Healthcare.gov debacle, there’s still any confidence that centralized Federal systems are secure and trustworthy, please read this HealthcareITNews tally of the multiple data breaches and HIPAA violations taking place at the US Department of Veterans Affairs (VA).

From 2010 through May 2013, VA department employees or contractors were responsible for 14,215 privacy breaches affecting more than 101,000 veterans across 167 VA facilities, including incidences of identity theft, stealing veteran prescriptions, Facebook posts concerning veterans’ body parts, and failing to encrypt data, a Pittsburgh Tribune-Review investigation revealed.

The two-month investigation by the Pittsburgh Tribune-Review published this weekend found that the VA led the way in HIPAA violations–17 in the past few years–for reasons centering on lack of accountability, shoddy safeguards, sloppiness in handling data and failure to encrypt data even after the 2006 theft of a laptop put records of 26.5 million veterans in danger. There are few firings, disciplinary actions or HHS fines.

This should put telehealth and telemedicine providers on notice that their encryption will have to be ‘stronger than the VA’, as both they and Department of Defense (DOD) are the single largest users of telehealth in the US.