TTA’s scorching week: events, tenders, app experts, diabetes telehealth, and When We’re 64!

 We enter Summer–and some scorching temps on both sides of the Atlantic. How to scorch your company during an EHR/HIT transition. A not-so-scorching diabetes telehealth study result. Events, tenders, app experts are hot, and We Sing A Song of Telemedicine When We’re 64–and still hot!

R2G’s annual mHealth App Survey is closing–and register now for The King’s Fund Digital Health meeting on July 11!

Tender Alert: Scotland Excel, Leeds, London/Manchester, Thurrock (Four from our Eye on Tenders–and most close 17 July)
Study doubts benefit of basic blood glucose self-monitoring for non-insulin T2 diabetes (Not encouraging for the Diabetes Monitoring Gold Rush)
Some London events and an opportunity to monetise your expertise (Editor Charles invites app reviewers, and three events are up)
Mismanaging a healthcare IT transition: what’s the cost? (Expensive by any metric, especially the customer and long term ones)
Singing a song–-of telemedicine (after you, McCartney!) (Congratulations to Paul on his 75th, not his 64th!, from a contributor)

June is all about change again at GE and GreatCall. A Nightingale is singing that tenders are up. Ericsson’s big study on 5G closing the gap. Telemedicine grows ever-larger and more accepted, even for bad news. Misbehaving robots and self-driving cars. And more!

Telemedicine may be appropriate for delivering ‘bad news’: study (More research needed)
UK Telehealthcare TECS MarketPlace event 4 July in Yorkshire, plus (Telehealthcare Awareness Week is end of June)
GE’s change at the top puts a healthcare head first (Many changes coming to The Blue Meatball)
Ericsson report: will 5G close the healthcare gap from hospitals into the home? (Major study from unexpected source)
Tenders closing quickly: Cornwall/Isles of Scilly, Blackpool (Blackpool is still open)
76% of health systems to adopt consumer telemedicine by 2018: Teladoc survey (But its use is changing)
The Nightingale-H2020 project for wireless acute care (UK/EU) (Major initiative, get on it before tender)
Behave, Robot! DARPA researchers teaching them some manners. (Rules for those Overrunning Robots and those Self-Driving Cars)
GreatCall’s acquisition: a big vote for older adult-centered healthcare tech (Private equity sees gold in the old)
Tech that assists those with speech impairments, telemedicine for mapping public health (Solving specific, important problems)
Wearable haptic/Braille guidance system for the visually impaired (MIT CSAIL innovation)

It’s all about change: the big EHR change at VA, change at the top at Tunstall Americas, and state telemedicine policy.

VA says goodbye to VistA, hello to Cerner for new EHR–and possible impacts (Big changes will take years)
Tunstall Americas has a new president/CEO (updated) (More details on this quiet change)
Texas gets its telemedicine on: governor signs off on full direct-to-consumer access (A change that leads the way for other states)

Previous articles of continued interest

Add hospital-acquired infections to your list, Google Ventures! (What kills 450,000 or more annually–in US alone)
DNA ‘Snapshot’ facial modeling–and predicting future Alzheimer’s risk (Out of Law & Order)
The King’s Fund Digital Health & Care Congress coming up fast! (London) (Register now for July!)

Breathe, exhale: a future bracelet that may predict asthma attacks through breath (Real research vs. the fakes)

In-home video monitoring acceptable to 90 percent of dementia carers: Age NI study (Feelings change in the Selfie Age)
Want to attract Google Ventures to your health tech? Look to these seven areas. (Won’t be easy)
Winston Churchill Memorial Trust – 2018 Travelling Fellowships (Global research grants for UK citizens)
International Conference on Rural and Elderly Health Informatics (Togo, W. Africa) (IREHI, 14-17 December–workshop papers due 25 July)

Successful Aging 2030: how far we haven’t come, how far we have to go (Over a coffee, Editor Donna’s full report from d.health Summit 2017)

The stop-start of health tech in the NHS continues (UK) (Hurry up and wait)

Thinking about a location for your health tech startup? Consider…’virtual’ Estonia! (A Baltic welcome to business–and you don’t have to leave home)

Blue Cedar releases new security for health apps, built into the app (A way around a roadblock)


 

 

Make your plans, if you have not already, to attend The King’s Fund’s annual Digital Health meeting in London. NHS England’s “Next steps on the five year forward view” outlines the plan to harness technology and innovation over the next two years. But what’s really happening on the ground? Find out in two full days of conference, networking, and exhibition. For more information and to register, click on the advert above or here


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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We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, HIMSS, MedStartr, HealthIMPACT, and Parks Associates.

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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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Ericsson report: will 5G close the healthcare gap from hospitals into the home?

Ericsson, one of Europe’s leading telecom companies, earlier this month published its latest ConsumerLab report, “From Healthcare to Homecare” on the next generation of healthcare enabled by the greater speed and security of 5G–the fifth generation of wireless mobile. Their key findings among consumers and industry decision makers contained surprises:

  • Growing frustration with hospital wait times. 39 percent prefer an online consult with a doctor versus waiting for the face-to-face.
  • Wearables are perceived as better ways to monitor and even administer medication for chronic conditions–nearly two in three consumers want them. But medical grade wearables will be required.
    • Yet the current state doesn’t lend itself to these wishes. “55 percent of healthcare decision makers from regulatory bodies say these devices are not sufficiently accurate or reliable for diagnosis. In addition, for liability reasons it will be very difficult to rely on patients’ smartphones for connectivity….medical-grade wearables will be required. Such devices could also automatically dispense medicine and offer convenience to those recovering from surgery.”
  • +/- 60 percent of surveyed consumers believe that wearables will improve lifestyles, provide personalized care, and put people in control of their own health.
  • There’s real security concerns that 5G is expected to access: “61 percent of consumers say remote robotic surgery is risky as it relies on the internet….47 percent of telecom decision makers say that secure access to an online central repository [of medical records] is a key challenge and expect 5G to address this.” Surprisingly, only 46 percent of cross-industry decision makers consider data security to be an issue. Battery power is also a significant concern for over half in wearables, a problem that over 40 percent will be helped by 5G.
  • Even more surprising is the lack of desire for consumer access to their medical records–only 35 percent of consumers believe that it will help them easily manage the quality and efficiency of their care. In contrast, 45 percent of cross-industry experts consider the central repository as a breakthrough in healthcare provisioning.

Decentralizing care into the home is seen as worthwhile by a majority of industry decision makers 

click to enlarge (more…)

The Nightingale-H2020 project for wireless acute care (UK/EU)

click to enlargeSusanne Woodman of BRE, our Eye on Tenders, is following the Nightingale-H2020 project for acute care–and if you are in the wireless or wearable remote monitoring business, you should be too. It is a pre-commercial procurement project (PCP) that invites the European healthcare industry to develop wireless solutions for patient in-hospital and home monitoring. Deriving from the European Commission’s Horizon 2020 grant, the process started last year with a €5 million award and in the spring had two Open Market Consultation meetings. Q&As from these meetings were recently released. The official tender will be released this November on the EU website Tenders Electronic Daily (TED). For more information, consult the Nightingale PCP website and their useful PDF on the process. @Nightingale_EU

Wearable haptic/Braille guidance system for the visually impaired

MIT researchers from their CSAIL (Computer Science and Artificial Intelligence Laboratory) unit have developed a system that is designed to aid the visually impaired in accurately navigating a room, with or without the assistance of a cane. It consists of a 3-D camera worn on the abdomen, a belt that has vibrational (haptic) motors, and an electronically controlled Braille interface worn on the side of the belt. The camera is worn on the chest as the optimum and least interfering body location. The pictures taken are analyzed by algorithms that quickly identify surfaces and their orientations from the planes in the photo, including whether or not a chair is unoccupied. The belt sends different frequency, intensity, and duration tactile vibrations to the wearer to help identify nearness to obstacles or to find a chair. The Braille interface also confirms the object and location through key initials (‘c’ for chair, ‘t’ for table) and directional arrows. According to the MIT study, “In tests, the chair-finding system reduced subjects’ contacts with objects other than the chairs they sought by 80 percent, and the navigation system reduced the number of cane collisions with people loitering around a hallway by 86 percent.” MIT News, Mashable, ‘Wearable Blind Navigation’ paper Hat tip to Toni Bunting of TASK Ltd.

 

A breakthrough wearable? Sweat analysis for cystic fibrosis and diabetes diagnosis.

click to enlargeResearchers at Stanford University School of Medicine and University of California-Berkeley have developed a wristband equipped with a sensor that can capture and analyze perspiration. The design stimulates the production of sweat, with the embedded sensors and microprocessors detecting the presence of different molecules and ions based on their electrical signals. In the abstract’s words, this is an “electrochemically enhanced iontophoresis interface, integrated in a wearable sweat analysis platform.” The wearable was tested in two separate studies for detecting a key indicator for cystic fibrosis (CF)–a high level of chloride ions–and in comparing levels of glucose in sweat to blood glucose for diabetes. The data is transmitted via smartphone to a server that analyzes the results in real time.

The potential for this wearable is considerable. First, for CF, it changes a 70-year-old protocol–that sweat is stimulated and collected in a 30-minute procedure, then sent to an outside lab to be analyzed with the usual delay. Children being screened for CF have trouble sitting still for the lengthy test. The second is that the test can be done anywhere with minimal training, making it suitable for underserved communities and developing areas of the world. The third is in CF drug development. CF genetics have multiple mutations, limiting drug usefulness. A test such of this in real time could speed drug clinical trials and human response.

The glucose testing was preliminary in comparing the glucose in sweat with standard blood glucose levels, but also proved that the platform could be used for other perspiration constituents, such as sodium and lactate. The ultimate intent of the researchers is to incorporate the technology into a smartwatch for continuous monitoring, but they recognize two challenges: reproducibility, to see whether measurements are consistent, and mapping all the constituents of sweat.

The report was published on 17 April in Proceedings of the National Academy of Sciences of the United States of America (PNAS). Abstract and full report (PDF, 6 pages). Stanford Medicine News Center

Wearables: it’s a journey, but is it really necessary?

click to enlargeIncreasingly, not in the opinion of many. We’ve covered earlier [TTA 21 Dec, 6 Feb] the wearables ‘bust’ and consumer disenchantment affecting fitness-oriented wearables. While projections are still $19 bn by 2018 (Juniper Research), Jawbone is nearly out of business with one last stab at the clinical segment, with Fitbit missing its 2016 earnings targets–and planning to target the same segment. So this Washington Post article on a glam presentation at SXSW of a Google/Levi’s smart jeans jacket for those who bicycle to work (‘bike’ and ‘bikers’ connote Leather ‘n’ Harleys). It will enable wearers to take phone calls, get directions and check the time by tapping and swiping their sleeves, with audio information delivered via headphone. As with every wearable blouse, muumuu, and toque she’s seen, this Editor’s skepticism is fueled by the fact that the cyclist depicted has to raise at least one hand to tap/swipe said sleeves and to wear headphones. He is also sans helmet on a street, not even a bike path or country lane. All are safety Bad Doo-Bees. Yes, the jacket is washable as the two-day power source is removable. But while it’s supposed to hit the market by Fall, the cost estimate is missing. A significant ‘who needs it?’ factor.

Remember the Quantified Selfer’s fascination with sleep tracking and all those sleep-specific devices that went away, taking their investors’ millions with them? Fitbit and many smartwatches work with apps to give the wearer feedback on their sleep hygiene, but the devices and apps themselves can deliver faulty information. This is according to a study published in the Journal of Clinical Sleep Medicine called “Orthosomnia: Are Some Patients Taking the Quantified Self Too Far?” (abstract) by Kelly Glazer Baron, MD with researchers from the Feinberg School of Medicine at Northwestern University. “The patients’ inferred correlation between sleep tracker data and daytime fatigue may become a perfectionistic quest for the ideal sleep in order to optimize daytime function. To the patients, sleep tracker data often feels more consistent with their experience of sleep than validated techniques, such as polysomnography or actigraphy.” (more…)

CES 2017

The Consumer Electronics Show is half a century old this year and it click to enlargeis promising to be the biggest show yet. Here are some items that may be of interest to TTA readers.

The conference programme includes a Digital Health Summit and a Wearable Tech Summit (the organisers obviously haven’t been reading the TTA view on wearables so recently produced by Editor Donna). In the Digital Health Summit the top topics are going to be advances in genomics and precision medicine (not sure why this is digital health), Digital medicine and current trends such as “tele-everything”, wearables, aging, digital therapies (what’s that?) and VR. The wearable Summit top topics are the science of wearables, hottest wearable tech thus far and interactive jewelry.

There is a new “Sleep Tech Marketplace” presented by the National Sleep Foundation (no, really, I am not making this up) with 10 companies exhibiting everything from sleep tracking devices (Beddit), a system to mask noise during sleep (Cambridge Sound Systems), ultra thin earphones to wear in bed (Dubs Labs), a water mattress-topper to keep you cool while you sleep, an app to record your dream talking and snoring (Snail App) and a stress reducer.

If you are not attending between tomorrow and the 8th, then you could do worse than follow it on the official CES website or on engadget

Seeing into 2017: Fitness trackers’ chill, clinical and specialized wearables warm up

click to enlargeThe first in a series of brief projections for 2017. Fitness wearables aren’t even lukewarm anymore, and it’s visible in consolidation and the nay-saying articles. In late November, Fitbit bought one of the pioneers, Pebble, for a cut price of $40 million (TechCrunch). Fitbit shares are also cut price at below $7.50, whereas the 2015 IPO debuted at $50. Editor Charles’ favorite, Jawbone, is moribund; the springtime rumors of company sale and shutdown of the fitness band line have not been contradicted since [TTA 27 July]. Research/analytics company CB Insights calculated that 2015 wearable computing (a broader category) investment funding fell 63 percent from 2014 to a level comparable to 2012-13, in large part due to the cooling of the fitness segment.

A sure sign that fitness bands have chilled is negative play in the consumer press. ‘My fitness band has made me fat’, spun off the JAMA article [TTA 28 Sep], is now the theme of hilarious ‘dieters gone wild’ articles like this from the New York Post (warning, eye bleach photos!). But The Sun (UK) waves a warning flag that the information could be sold, sent to your employer or insurance company to profile and/or discriminate against you, or cyberhacked. All this can knock a pricey band off the Christmas shopping list. And no, it hasn’t shifted to smartwatches as most insiders predicted, as smartwatch sales have leveled off–as expected–until their functionality and appearance improve to justify their high price.

What’s in our crystal ball? Clinical-quality and specialized wearables will rise from these ashes.

  • Doctors are simply not interested in the current poor quality of data generated by current wearables–‘it’s worthless, Jim!’ ZDNet’s much-discussed article on this subject paradoxically stresses this, then focuses in on the clinical quality data generated by startup VivaLnk’s eSkin for temperature and stress. Clinical quality data is what is required for a health and wellness research partnership like the one recently announced by RTI and Validic.
  • Industry buzz is that Fitbit bought Pebble for its better IP, apps and stable of developers, not its smartwatch hardware, and that IP includes clinical quality measurement.  Other biosensor companies on the rise according to CB Insights are Thync, Thalmic Labs, YBrain and mCube.
  • In specialty wearables, there’s the recent funding success of Owlet, the High Cute Factor baby monitor sock. Lifebeam transfers multiple sensing technology to helmets and hats for richer data.

And if sensor patches develop with speed, in two to three years they may eliminate all of these!

Asia-Pacific telehealth set to grow to 75% to $1.79 billion in 2020: Frost study

Frost & Sullivan’s Asia-Pacific Telehealth Outlook 2016-2020 is projecting that telehealth (broadly defined as telemedicine, remote patient monitoring (RPM) and mobile health), will be growing from US $1.02 bn in 2015 to $1.79 bn by 2020. Driving growth in the region are an aging population, governments building out 3G/4G mobile networks and developing favorable policies and roadmaps. However, the study found that impediments included a familiar tune of poor clinician adoption, unfavorable regulations, lagging technology and (ta-da) payment models. What’s improved? Wearables in the region have made great strides, and payment models, according to F&S, are concentrated on patient and provider pay. Not so familiar is that many Asia-Pac nations are building a Smart Cities and Smart Nation infrastructure; telehealth is a key area almost always included in a Smart City plan. The study will set you back a smart $4,950. Marketwatch release. F&S feature page.

Telemedicine, telehealth and ‘Healthy India’

While we in the West and much of Asia/Pacific can parse the differences in wearables, tablets vs. smartphones and debate the accuracy of EHRs, far simpler issues dominate the application of health tech in places like India. Some are familiar–connectivity and preconceived notions of staff acceptance–and others are familiar to those of us who work in developing countries, such as interrupted power and a lack of trained people. Telemedicine and the reading of vital signs in telehealth has been part of the Indian scene for years–16 according to the article–but only in the past three years have remote consults been used more frequently. In the past year, over 100 patients have been saved by telehealth centers at two locations operated by Apollo TeleHealth in Himachal Pradesh, a province where the average patient travels up to 50 km for primary care and 250 km for secondary care. It is state-subsidized in a public-private partnership, but Apollo is already tracking over 15 months 3,000 teleconsults, providing emergency care to at least 200 people and saving Rs 15 lakh ($22,400 or £17,100).

The greatest impediment, according to the joint managing director of Apollo Hospitals Enterprise Limited (and the author), is the resistance to change–a familiar one. Telehealth services: A prescription of technology that saves lives, saves costs (Hindustan Times)

Aarogya Bharat, or Healthy India, is a ‘roadmap’ to enable India’s growth and prosperity by improving health for India’s population. Most Indians pay out of pocket, (more…)

Wearables for diabetes, more get thinner on a ‘smart skin’ diet

click to enlargeA team from the Seoul (South Korea) National University, University of Texas-Austin and wearable health sensor developer MC10 [TTA previous articles] have developed a translucent, thin graphene ‘cuff’ with sensors for blood glucose and a not-quite-complete metformin delivery mechanism for those with Type 2 diabetes. The graphene is ‘doped’ with gold to have it transmit blood glucose readings inferred on mechanical strain, skin temperature, and chemical composition of sweat. The mobile app calculates the metformin medication dose needed and the wristband administers it through an array of microneedles. This would not be a semi closed-loop system (dubbed here a ‘robopancreas’) which Type 1 diabetics now can use for insulin delivery, as there’s a delay in sensing and delivery. It also cannot in present form correct for excessively low blood glucose. IEEE Spectrum, Nature (abstract) Hat tip to former TTA Ireland Editor Toni Bunting

click to enlargeAnother wearable sensor bracelet with a distinctly ‘home-brewed’ feel is out of academia, from the Abdullah University of Science and Technology’s Integrated Nanotechnology Laboratory in Thuwal, Saudi Arabia. The research team pulled together office supplies–no, you are not misreading this: (more…)

Health tech innovations are doing little for baby boomers

click to enlargeWonder why the duck is upside down and sinking? Maybe it’s looking for all that transformative tech! Versus The King’s Fund sunny article above is Laurie Orlov in Boomer Health Tech Watch. Her POV is that as of right now, health tech innovations are not moving the needle for obese (39 percent) and chronically diseased US baby boomers. They aren’t downloading health apps and wearing wearables. Workplace wellness programs? Au contraire, they make us feel less well (Harvard Business Review) and anxious that we’re getting spied on by the company. Maybe we realize that All That Data isn’t secure (healthcare being a Hacker’s Holiday Camp), so we’re not playing the game. And the cost of care that the ACA was supposed to level off? Not if you’re a self-insured Boomer struggling to pay an ever-higher monthly premium, or even in a corporate high-deductible plan, paying increased deductibles, restricted networks, ever-higher treatment costs and fighting your insurer at nearly every turn. Add to that safety risks of procedures, mistakes compounded by EHRs [Dr Robert Wachter, TTA 16 April]  and (not mentioned) hospital-acquired infections. No wonder investment has cooled. Health and tech innovations do little for baby boomers

NHS England announces 7 “Test Beds”

NHS England has announced a series of “Innovation Test Beds” that will be used to “harness technology to address some of the most complex issues facing patients and the health service”.

“Front-line health and care workers in seven areas will pioneer and evaluate the use of novel combinations of interconnected devices such as wearable monitors, data analysis and ways of working which will help patients stay well and monitor their conditions themselves at home”, according to the NHS press release. (more…)

Blood biomarkers to diagnose mild TBI; more studies on TBI, concussion

An abundance of studies pointing the way to digital health opportunity. A surprise on the early morning radio news in NYC was mention of a report on a blood biomarker that could confirm a diagnosis of concussion, published in the Journal of Neurotrauma. Once found, it wasn’t exactly as advertised but the research is worth reviewing. First, it applies to mild TBI. The biomarker is the extensively studied glial fibrillary acidic protein (GFAP) versus another biomarker, S100β. The key finding by the central Florida-based team is that in a general trauma population, GFAP out-performed S100β in detecting intracranial lesions as diagnosed in CT scans. Scrolling down in the article is a link to the abstract of a meta-study of 11 biomarkers in concussion, by the same lead researcher and another team. The current featured articles in Neurotrauma are a stunning review of studies around concussion and TBI, including two very interesting articles on why air evacuation can do more harm than good (unless absolutely necessary) for TBI patients (altitude lowers oxygen levels) and how mild TBI suffered by retired NFL players has long-term negative metabolic and pituitary effects. All paywalled unless you have library access or a friend with subscription access; however some of the citation articles are open access. But for health tech developers looking for problems to solve better, cheaper and faster, here it is–a lot more promising than yet another me-too wearable. 

Telegraph takes a quick look at CES 2016 trends, including wearables (updated)

click to enlargeIt’s hard to believe that with the end of the year, the Next Big Event for many is the Consumer Technology’s Association‘s CES 2016 in Las Vegas 6-9 January. The Telegraph notes six trends in this breezy overview of what’s going to be The Next Big Things at the show: connected cars (lots of automaker concepts including the hush-hush Faraday electric), cybersecurity (especially irking this year with healthcare taking three of the top seven-Healthcare IT News), drones (buzzing at a location near you, despite the FAA), wearables (most impacting digital health), virtual/augmented reality (with utility in rehabilitation not mentioned here), and the ever-annoying, ever-cloying Internet of Things. On wearables, the show floor has apparently tripled in size since last year, and the article highlights the Mimo baby sleep monitor and the Qardio ECG monitor. (Unfortunately this Editor missed the November New York CES preview as she was attending HIMSS Connected Health, and due to other commitments won’t be going to Vegas, Baby.) Six predictions for CES 2016: drones, cybersecurity, wearables and more (Telegraph)

Update. During CES, Parks Associates will hosting their 7th annual CONNECTIONS Summit on 6-7  January (Wednesday – Thursday). The most health tech related session is ‘Wearables: Healthcare, IoT, and Smart Home Use Cases’ on Wednesday 10:30am-11:45am, with a panel including executives from Honeywell Life Care, Care Innovations, Qualcomm, Independa, IFTTT and Lumo Body Tech, hosted by director Harry Wang of Parks whom this Editor counts as a Grizzled Pioneer, Research Division. Separate registration required. Information and full agenda here.

To our Readers: Are you attending CES? Interested in contributing some insights? Contact Editor Donna.

47% of UK adults prefer virtual visits: Aviva Health Check study

Insurer Aviva’s latest Health Check study headlined the following findings about UK adults’ growing preference for digital health options, including a growth in acceptance of wearable monitors:

  • 47% are willing to be diagnosed digitally instead of face-to-face with their GP
  • 67% would use wearable technology to monitor long-term medical conditions such as diabetes or heart failure–especially those who are overweight (68%) or obese (71%)
  • The majority already using healthcare technology report improved health–63% of all age groups using a physical activity monitor say it has improved their health, rising to 66% of those with a heart rate monitor
  • Three in five (60%) non-users would use a physical activity or heart rate monitor in the future, while 52% would consider using a sleep pattern monitor
  • 55% agree the NHS should provide free technology to help people play an active role in improving their health
  • Younger age groups are most open (of course) to use of monitoring. 15% of those 25-34 use a physical activity monitor (compared to 8% overall) while 9% of 25-34s use a sleep pattern monitor (vs. 4% overall)

Aviva has an interest in digital health through its recently established customer partnership with babylon‘s UK-based telemedicine app [TTA 26 May]. The study was conducted by ICM Research for Aviva UK Health in August 2015. Respondents were invited from ICM’s online panel and 2,004 interviews were conducted amongst a nationally representative sample of the UK adult population.

The full study is available here to our Readers. Aviva release.