VA, DoD aren’t collaborating on EHR: GAO

Your ‘Dog Bites Man’ item for the weekend (no, it’s not in reverse!) is that the Government Accountability Office (GAO) has determined that Veterans Affairs (VA) and the Department of Defense (DoD) have not yet proved that their current two-system path, having rejected a single EHR, actually will be workable. In February 2013, both agencies abandoned a joint system after $1 billion in spend, and $4 billion in fixes/upgrades to their separate VistA and AHLTA systems. [TTA 15 Dec] By the two agencies going their separate ways, the GAO is mystified on what is going on with interoperability. The answer: not much. And as mentioned in our 15 December article, there was a 31 January deadline for an interoperability plan (or single system) to be implemented by 2016, mandated by the 2014 National Defense Authorization Act (NDAA). Obviously, this deadline has come and gone. FierceEMR article, GAO recommendation (full text PDF)

One way to overcome the interoperability problem and too much in the EHR? Get rid of those pesky backlogged patient records! The Daily Caller uncovered a VA whistleblower’s complaint to the VA’s Inspector General and their office of special counsel, plus Congress, that VA officials in Los Angeles intentionally canceled backlogged patient exam requests going back more than one year–and that the delay on exams went back 6-9 months. The deletions started in 2009. There is a wrongful dismissal (of said whistleblower) suit and other joy. Article, audio (02:21) Updates 3-4 March:  according to Under Secretary for Health Robert Petzel, the Daily Caller report was ‘scurrilous’. He stated that about 300 records were closed but not deleted after administrative review, generally for old imaging requests, and there was no effort to delete records to boost performance.  According to FierceHealthIT, the backlog is about 400,000. Also Military Times. According to EHR Intelligence, both DoD and the VA agree with the GAO recommendations; GAO will update its findings once the agencies have taken action. Also iHealthBeat.

Inquiry into telehealth services in Queensland

“A statewide healthcare system with new capacity, co-operation, transparent reporting systems, [grow_thumb image=”” thumb_width=”150″ /]financial accountability and with patients the focus of attention—this is a vision all Queenslanders want to see.” So opened the message from Campbell Newman, Premier of Queensland, Australia, in Blueprint for better healthcare in Queensland in February last year. Turning to telehealth Mr Newman said “In remote communities, this government will work to provide 24-hour access to safe and sustainable care through a revised network of Telehealth facilities for the very first time. This is a 21st century solution to a problem long-regarded as impossible. Our plan will provide reliable health services in places where they were never previously available.”

A year on, the Health and Community Services Committee of the Queensland Parliament has opened an inquiry into telehealth services in the public sector health services in Queensland. The inquiry will consider the implementation of telehealth by the Department of Health and Hospital and Health Services, including the Rural Telehealth Service that was announced in the Blueprint for better healthcare in Queensland.

The committee will examine trials, pilots and other sites, consider the value for money of the delivery of telehealth services, examine the factors that support successful implementation of telehealth services, identify any barriers to successful implementation and consider strategies to address such barriers. The committee intends to visit some rural and regional telehealth sites and hold public hearings in Brisbane and other locations.

The committee will receive an initial public briefing from the Department of Health on Wednesday 5 March at 11.00am in Brisbane. The briefing program is available here. This public briefing will be broadcast live via the link, and a transcript of the briefing will be published here when available.

Changes afoot at Aetna’s Healthagen?

Recent rumors predicted changes at Healthagen, the rebranded ‘Emerging Businesses’ unit of health payer giant Aetna, and that these would be apparent at HIMSS14. Mobihealthnews attempts to ‘Sovietologize’ Aetna chairman Mark Bertolini’s appearance (sponsored by Healthagen, not Aetna) and what products were included in the Healthagen (not Aetna) show floor display. First, the booth: only Accountable Care Solutions and health info exchange Medicity were featured.  Former star iTriage (the original Healthagen product) was relegated to a distant booth. The much-touted CarePass consumer wellness platform? Absent. InvolveCare, the Healthagen caregiver app introduced last fall? Announced to be discontinued 28 April. In the true tradition of Sovietology, omissions are as apparent as inclusions. Second, the keynote: oddly, there are no content points cited from Mr. Bertolini’s speech in Mobihealthnews. We turn then to the Dan Munro in Forbes article, where Mr. Bertolini calls for the ‘creative destruction of healthcare’, a stock rallying point since 2009 (Yes, it doesn’t work. No, it’s not sustainable. It’s an iron triangle. Etc.) The bottom line was his announcing that Aetna’s business going forward would be ACOs and “driving a consumer healthcare experience.” Hopefully that will mean access and quality for the rest of us. Will Healthagen CEO Charles Saunders be part of leading the charge? Not a mention. One could say that the Magic 8 Ball says ‘cloudy’ for the present situation at Healthagen. Perhaps more changes will be revealed in coming weeks. 

Verizon adds Telcare, Genesis to monitoring platform

Verizon received a second FDA clearance for its health management software platform, and added blood glucose management monitors Telcare and Genesis Health as part of it. The first clearance, according to Mobihealthnews, covered five telehealth devices from Ideal Life. Verizon’s intentions are to ‘white label’ market the system to providers who plan to use personally gathered telehealth as part of a patient management program in integrated delivery networks (IDNs), where it is currently in trial–plus health plans and self-insured employers. Verizon’s platform also has ‘gamified’ educational and motivational functions, including its own virtual currency for rewards. If this is proven in the US, will this be marketable in the UK and EU–and will Verizon go it alone or seek partners? Hat tip again on the story to reader Mike Short via Editor Charles.  

It’s iAwards time again!

As the US East Coast faces low temps (down to 12 degrees again tonight) and another dumping of snow Monday, a small sign of spring, like flash-frozen daffodils and crocuses (crocii?), is the annual application call for the Triple Tree iAwards for Connected Health to be presented at the Wireless-Life Sciences Association (WLSA) 9th Annual Convergence Summit 14-16 May at the Omni in San Diego, California. Twelve finalists will be selected from applicants based on

criteria including the uniqueness of their solution; marketplace traction; clinical, operational or consumer relevance; size of addressable market and international presence across three categories:

    • Operational Effectiveness: Solutions that address the financial, compliance or operational needs of a healthcare organization.
    • Clinical Effectiveness: Solutions that address the care delivery and clinical effectiveness for a patient.
    • Consumer Engagement: Solutions that empower consumers to make better healthcare decisions.

Finalists attend not only a dinner, but also for the first time this year a private business review session. Online applications can be accessed at the TripleTree and Wireless-Life Sciences Alliance websites along with a $195 fee. Registration for the conference is here. Hat tip to Editor Charles and reader Mike Short.

‘Grizzled pioneer’ VRI receives major investment from Pamlico Capital (US)

US telehealth monitoring and medical alert provider VRI (Valued Relationships, Inc.) of Franklin, Ohio earlier this month received a majority investment/recapitalization from Pamlico Capital, a Charlotte, North Carolina-based private equity firm. Terms of the transaction were not disclosed. Current lead executives CEO Chris Hendriksen and President Andy Schoonover will remain in active management and retain significant ownership in VRI, which they founded in 1989. Regarding the investment, Mr. Schoonover to this Editor stated that the funds will be used for expansion purposes. “It is another vote of confidence (alongside the Cardiocom acquisition) that telehealth is getting great results and is here to stay. The capital will support VRI’s growth objectives, particularly in executing a couple of large projects with health plans that VRI has booked for 2014, and the hiring of additional sales talent.” 

Despite being in a rather ‘non-buzzy’ area of telehealth, the investment attracted the interest of some major players. VRI was assisted in evaluating its options by well-known digital health financial advisor Triple Tree; legal counsels were McDermott Will & Emery for VRI and Alston & Bird LLP for Pamlico. Pamlico specializes in the ‘middle market’ and has previously invested selectively in mid-sized healthcare providers such as Greenway (EHR), Healthcare First (home health software) and Physicians Endoscopy (surgical centers). Overall, and interestingly, this appears to be a positive, long-term vote for telehealth and medication monitoring, as well as for the viability of traditional medical alerts and some of the patient engagement/hospital readmission reduction models VRI has been developing with major payers such as Humana. Pamlico Capital release, Triple Tree release.

Is *less* regulation the answer for mHealth? (US)

What if the solution to the mHealth/digital health logjam of approvals at the US Food and Drug Administration (FDA) is to take clinical and health software completely out of their approval purview–and hand it to the National Institute of Standards and Technology (NIST), which is not a regulatory body but a standards-development organization. That is the solution proposed by the PROTECT Act of 2014 (Preventing Regulatory Overreach to Enhance Care Technology), proposed by Senators Angus King (I-Maine) and Deb Fischer (R-Nebraska). It’s put some of the better known organizations into a swivet, along with high profile attorney and mHealth legal expert Bradley Merrill Thompson with Epstein, Becker & Green. Possibly little to no regulation would be applied to EMRs, clinical support software and wearables/fitness apps–which is promptly being conflated by the usual suspects to heavy-duty equipment such as CT scanners.  FDA also finalized its guidance last September on telehealth and telemedicine applications, which this would render irrelevant. The Washington betting is that this Senate bill will go exactly nowhere, but it’s indicative of the jockeying for position this Editor is seeing within the present government and now with advocates/lobbyists [TTA 13 Feb]. MedCityNews, FierceMobileHealthcare

Another ‘bionic pancreas’ in test

Another possible weapon against the Continuing Battle of Stalingrad faced by diabetics is in test in the Boston area. A system developed by associate professor of biomedical engineering at Boston University Dr. Edward Damiano (whose son has Type 1 diabetes), and assistant professor at Harvard Medical School Dr. Steven Russell has a sensor inserted under the skin that relays hormone level data to a monitoring device which sends data to an app on the user’s smartphone every five minutes. The app calculates required dosages of insulin or glucagon to maintain optimal blood sugar levels, and communicates the information to two corresponding hormone infusion pumps worn by the patient. Their target for FDA approval and rollout is 2017. Gizmag. Previously Editor Charles and this Editor have written about Diabetes Assistant and two other systems in clinical trials, which also are bringing this to a closer reality [TTA 20 Aug, 5 Aug]

Eric Dishman’s ‘view from the top’ on genomics

Eric Dishman of Intel’s Health & Life Sciences Group credits genomics with changing the course of treatment for his life-threatening cancer about two years ago. With new treatment based on his genomic sequencing, he became cancer-free in three months and eligible for a kidney transplant, which he received in early 2013 from, as it turned out, a fellow Intel-er [TTA 12 Apr]. His keynote at HIMSS14 was about what he calls ‘N=1″ personalized medicine, which is based on three Bs plus one: body, biology and behavior, plus beliefs. Dishman also recounted a story around the original Intel Health Guide of a woman caregiving for a mother with Alzheimer’s whose diabetes worsened because she could not make clinic visits; with the addition of remote monitoring to the care plan this was reversed. No mention of Care Innovations (the Intel-GE JV), but he presented the Sotera Wireless ViSi Mobile wireless patient monitor as an ‘ICU on a wrist’ (Intel is an investor). Neil Versel reports in MedCityNews.

More on the data analytics and integration behind genomics from an unexpected source–the chief medical officer of Northrop Grumman. If like Editor Donna, you had no idea that this company had a footprint in healthcare, prepare to be surprised. Thanks to our friends at HITECH Answers.

European Knowledge Tree Technology Group 2014 Conference (UK)

The European Knowledge Tree Technology Group (EKTG) has met periodically since the Ambient Assisted Living Forum in Odense in 2010. Recent meetings include sessions at AAL 2013 in Sweden. It is an ad hoc high level group drawn from across technology, finance, service, policy and innovation sectors. It has drilled into the barriers and drivers around mainstream market uptake of independent living services.

The Group will meet again in London on 24 & 25 March, 2014 at the London School of Economics to to consider a range of interconnected care-related topics:

  • How does technology and care procurement take place?
  • How do we educate the people who need it?
  • Making the media work for you.
  • How do we pay for what’s needed?
  • What are the costs and systems of care?
  • What can technology do for: Heart Disease, Mental Health, Sensory Deficits?
  • How can we transfer technology from field to field, nano to macro technologies?
  • Legal, ethical, and regulatory issues – do you meet them?
  • Communicating in emergencies
  • If the power goes off, do services work?

The Group aims to bring together key players from user groups, industry, finance, public and private stakeholders, policy makers (and, as they say in their blurb, YOU…). To join those key players, click here.


Digital Health and Care Alliance opens for business; free membership available (UK)

As the dallas programme approaches its halfway point, one of its four projects, i-focus, has formed an organisation to continue the promotion of interoperability across the health & care sector beyond the end of dallas. The Alliance, with the acronym DHACA, will help NHS organisations, local authorities and third-sector providers collaborate and share information about new digital services.  This will significantly help members reduce costs, remove duplication of effort and improve support for independent living and self-management projects, resulting in much-improved patient outcomes. DHACA will operate across the full health and social care spectrum. Targeted at forward-thinking, engaged, health and care professionals as well as technology suppliers, DHACA will provide experienced assistance, trusted processes and in-depth knowledge to:

  • Define and share best practice services, technologies and business models
  • Define and share business requirements for future procurement and roadmapping
  • Better use existing investments, assets and infrastructure
  • Ensure quality, interoperability with other systems and future-proofing

Membership is currently free – more information and joining arrangements here. (Disclosure editor Charles Lowe has been recruited by ADI, as interim director of DHACA, to establish it – the medical apps work previously published on TTA will now be taken forwards in DHACA)

Samsung’s mHealthy S5, Gear–and potential

[grow_thumb image=”×554.jpg” thumb_width=”150″ /]Is there an untapped mHealth business model here?

Samsung’s dual announcements in New York and at Barcelona’s annual GSMA Mobile World Congress (MWC) of the Galaxy S5 smartphone and the latest iterations of their smartwatch (left), the Gear 2/Neo, confirm what this Editor believes will be a major 2014 trend: the matter-of-fact integration of vital signs sensors into easy-to-adopt form factors. Reported by ZDNet:

  • Galaxy S5:It’s so small and unnoticeable, you would be forgiven for not giving it a second thought. Next to the flash is a heart-rate sensor that can — prepare yourself for a hearty dose of real-life sci-fi — see the blood pumping through your finger. It works when you gently push your finger over the flash on the rear of the handset. This ties in with the smartphone’s pre-installed health apps, such as the S Health, which includes a fitness tracker and pedometer.” The phone also connects to the Gear 2 software. (This is in addition to the fingerprint scanner.) Article
  • Gear 2 and Gear 2 Neo specification: Bluetooth 4 low energy, Infrared, heart rate sensor, accelerometer, gyroscope  Article

Easy to use tools for health–and fall detection–baked into a mainstream phone and a fairly attractive smartwatch. There’s plenty of health and safety functionality for all ages built into both.  What’s the missing link? Here’s a thought. A manufacturer/wireless JV or subsidiary which targets the health monitoring potential of these devices to create a separate revenue stream. The ‘risk’ could be spread to resellers allowed to creatively adapt devices like the Gear for older adults in independent and assisted living environments, or for autistic/at-risk children. This is not an inconsistently supported AT&T ForHealth [TTA 5 Feb] or a failed Lifecomm [TTA 14 Oct 13], but an entirely different business model. Reader thoughts?  

More on MWC: Washington Post

Update 28 February: The Galaxy S5’s heart rate sensor may make it a medical device in the eyes of South Korea’s health agency, forcing the phone to be regulated and reviewed in the ROK before its 11 April worldwide release. FierceMedicalDevices. Hat tip to @DrDave01 (Dr. David Albert of AliveCor) and David Doherty of @mhealthinsight via Twitter.

AliveCor links with Practice Fusion

Breathlessly noted in today’s mHealth blogosphere is AliveCor’s partnership announcement with EHR giant Practice Fusion to integrate their patient-generated ECG information. According to the release, the 100,000 physician base of Practice Fusion will have the option to import AliveCor ECG data into patient records. This is a major breakthrough for AliveCor, which just gained FDA over-the-counter clearance for its snap-on case [TTA 11 Feb]. The AliveECG app also enables physicians to obtain an expert review of the ECG data, annotate and electronically transfer this data into the EHR within seconds. Is this the confirmation that AliveCor is the ‘product of the year’ as the Forbes article puts it? Or just an indicator where mHealth with clinical quality could be going?  (Let’s see if other EHRs like Athenahealth join the trend.) Release

$3,300 annual savings from diabetes monitoring: study

A study published in this month’s Endocrinology (US) demonstrated a $3,300 per person annual reduction in employee healthcare costs in a trial of the Telcare mHealthmonitoring system in conjunction with ActiveCare data analytics used for an employee diabetes management program (N=143). The amount was the average decrease in 12 month claims between 2011 and 2012 for those who enrolled and used the program, versus those who enrolled but did not use the program demonstrated a $282 per person increase. Telcare press release, (abstract/text) Hat tip to Editor Toni

New paper in the Practical aspects of Telehealth series

Establishing Telehealth in an institution, published this month in the Internal Medicine Journal, is the title of the fifth and latest in the Practical aspects of telehealth series of papers. According to the abstract the paper describes the development of a large teleoncology network over a vast geographical area in North Queensland, Australia.

The authors propose that the workforce, funding and infrastructure at rural sites, as well as the traditional mindset of healthcare professionals are key barriers to successful implementation of telehealth programmes. In the case of the Queensland teleoncology network, the rural hospital at Mt Isa, 900 km away from the central site, has been continually enhanced over a 5- to 6-year period. The success of the scheme is credited to these helping to overcome usual barriers.

Previous papers in this series are Practical aspects of telehealth: doctor patient relationship and communication, Practical aspects of telehealth: financial considerations (Journal in Internal Medicine), Practical aspects of telehealth: Are my patients suited to telehealth? and Practical aspects of telehealth: set-up and preparation for video consultations


National Health Summit Ireland–Special Report

Reader Andrew Macfarlane, Commercialisation & Centre Manager, CASALA at The Netwell Centre of the Dundalk Institute of Technology, stepped forward to report on this past Wednesday’s Summit. (Please note the excellent cross-references for those who may not be familiar with Ireland-specific programs.) Many thanks Andrew from Editors Toni and Donna!

From an Industrial Age to Information Age Healthcare – National Health Summit, Ireland

The 10th National Health Summit, which took place in Dublin, Ireland, saw a good attendance and an impressive range of speakers. The event is primarily targeted at decision-makers involved in leading and managing the delivery of healthcare services in Ireland.

The morning session outlined the changing landscapes of healthcare delivery both in an Irish and International context. Next up, separate tracks covering Health Insurance (as the Irish government seeks to introduce Universal Health Insurance), Hospital Management & Digital Healthcare (the primary topic covered by this post). The final session covered helping patients stay healthy at home and an insightful panel discussion on reform of the health service.

Tony O’Brien, Director General of the Health Services Executive (HSE) provided the opening address, entitled “Choices for our health service”. The HSE is a large organisation of over 100,000 people, whose job is to run all of the public health services in Ireland. He highlighted that like most health care systems, they are facing rising demand and costs (current budget €13.6bn), and that at the same time has endured significant health budget cuts, 26% since 2008, with €600+m planned savings in 2014. The annual National Service Plan sets out key priorities.

Key takeaway from a digital health point of view is the policy aim of A New Model of Care Treatment at the Lowest Level of Complexity that is Safe, Timely, Efficient and as Close to Home As Possible. The HSE envisages transforming from an industrial age healthcare to information age healthcare, with cost-effective use of ICT. Challenging perhaps with a historical under-investment in ICT at 0.85% of budget vs EU average of 2-3%, a number of speakers referenced the “Ghost of PPARS” as reason for under investment.

Professor Aidan Halligan, Director of Education, University College London & Principal, NHS Staff College, England in a lively storytelling highlighted that the Cathedrals to Disease  (more…)