The King’s Fund: ‘Sharing health and care records’ Leeds 13 Dec

Wed 13 December, 9.00am-4.30pm
Horizon Leeds, Kendall Street, Leeds 

The King’s Fund is hosting a December conference in Leeds on the digital sharing of health and care records. Delivering the key benefits of coordinated care requires three things: the appropriate technology, the right governance structure and a culture of adoption. Attendees will learn more at this full-day event about:

  • The direction of national programmes on interoperability and data sharing across and between local areas
  • Case studies from around England where teams have developed ways to share health and care records locally
  • The challenges involved in implementing data sharing across and between local areas and learn how others have overcome them

Keynote speakers include Will Smart (CIO, NHS England), Prof. Maureen Baker (Chair, Professional Record Standards Body), Andy Kinnear (Director of Digital Transformation, NHS South, Central and West Commissioning Support Unit and Chair, BCS Health), Nicola Quinn (Project Manager, Health Informatics Unit, Royal College of Physicians), and Jan Hoogewerf (Programme Manager, Health Informatics Unit, Royal College of Physicians).

For complete information, agenda, and to register, click on the sidebar advert or here. TTA is pleased to be a long-time supporter of The King’s Fund and a supporter of this event. Hat tip to Claire Taylor of The King’s Fund–if you are interested in supporting this conference, contact her here.

Counting down to the Connected Health Conference–readers save $100!

Connected Health Conference
25-27 October, Seaport World Trade Center, 200 Seaport Boulevard, Boston

The eighth annual Connected Health Conference, presented by the Personal Connected Health Alliance (PCHAlliance) in partnership with Partners Connected Health, is coming up in just a few days.

Wednesday is packed with special sessions that cover the state of the market in wearables, artificial intelligence (AI), voice-activated technologies, the smart home (hosted by Parks Associates) and the innovation economy.

  • The Life Sciences and MedTech Roundtable will explore the emerging category of digital therapeutics, the evolution of traditional pharma and med tech business models and the impact on relationships with patients, providers and other stakeholders in healthcare.
  • Europe Meets North America will exchange views and strategies on issues like interoperability and the free flow of data across borders in an all-day workshop hosted by the ECHAlliance. (For more on the PCHAlliance’s EU efforts to ensure consistent regulations governing digital health with the implementation of the General Data Protection Regulation (GDPR), see this release.)

Recent additions to the main conference on Thursday and Friday:

  • A new fifth track focusing on health system innovation projects, outcomes and processes with the leading partnerships that are disrupting and redesigning healthcare delivery, including Healthbox and Intermountain Healthcare, Brigham Digital Innovation Hub, Johns Hopkins Medicine Technology Innovation Center and MITRE sharing their work with Dana-Farber.
  • The new Innovation Lounge will showcase provider, industry and institutional innovation centers and novel collaborations. The Innovation Lounge stage will present groundbreaking initiatives from Intel, IBM, MDRevolution and Becton Dickinson, HHS Idea Lab, data from the IPSOS Digital Doctor Survey, and results of a recent connected health survey. Dr. Joseph Kvedar will share a preview of his new book, The New Mobile Age, How Technology Will Extend the Healthspan and Optimize the Lifespan. (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 

StartUp Health’s Q3 is an even crazier $9bn YTD

And you thought Q2 was ‘crazy’? There’s no cooling in StartUp Health’s reported digital health funding activity in Q3, which at $9bn is already past 2016’s $8.1bn and is poised to cross the $10bn bar by end of year.

  • Q3 charted $2.5bn in funding, less than Q2 ($3.8bn) but above Q3 2016 ($2.2bn).
  • Series C and D deals led the funding charge at 15 percent of deals, with Series D on average $113 million. It’s an indicator of market maturity, though A rounds were still in the lead at 35 percent and 21 percent in Series B.
  • Deals are bigger than ever at an average $18 million versus $14 million in 2016
  • Half the deals they tracked were in personalized health and patient/consumer experience, a distinct difference from Rock Health’s shift to B2B. Population health held its own.
  • They tracked more mega-deals YTD due to broader category and ex-US. Rock Health’s lead this quarter of 23andMe was only #6 on the list, surpassed by Auris, Peloton, Guardant Health, Outcome Health, and Grail.
  • The Bay Area leads for deals substantially YTD, with NYC, Boston, and Chicago combined still trailing

Remember that StartUp Health takes a wider sample than Rock Health [TTA 3 Oct], tracking over 500 international company deals, including those below $2 million as well as both service and biotech/diagnostic companies. StartUp Health on Slideshare.

Tender Alerts: Wigan, Salford, NICE (Manchester), Kirklees

Susanne Woodman, our Eye on Tenders, has four for your consideration, three of which are high value:

  • Wigan Council: “Delivery of Support at Home and Mobile Response Service”. Wigan is seeking TECS to support Borough residents in home-based independent living and in Managed Accommodation developments. The objective is to reduce the local burden of unnecessary hospital admissions, on emergency services, and to reassure families and carers about the person’s wellbeing. The contract is for 60 months and is valued at £2,375,000. Closing is 27 October at 10:15am. More information on TED.
  • Salford Royal NHS Foundation Trust: “Provision of a Digital Control Centre”. Salford Royal will be the test bed for this Control Centre to potentially scale to the rest of the NHS. The Control Centre will use the latest advances in “data analytics and digital health to achieve a world-leading organisation which has operational excellence, the best quality healthcare and patient experience across the entire organization which also includes social care.” The five-year agreement starts August 2018 and is budgeted at £2.0m – £3.0m. More information on Gov.UK.
  • National Institute for Health and Care Excellence (NICE) in Manchester: This is for the NICE External Assessment Centre Framework, to provide a range of health technology assessment services to support its technology evaluation programmes and related activities. It is in four lots: secondary data analysis, primary data analysis, technical and regulatory support, decision support. The contract is for 33 months from award and total value is in the range of £1-6m. Deadline is 20 November at 5pm. More information on TED
  • And a reminder that NHS Greater Huddersfield & North Kirklees’ tender deadline is 20 October.  This tender is open early engagement for the provision of a technology-assisted, rapid access service offering an alternative to hospital-based A&E services. Market test site is in Kirklees for residents of a care home. Requirements are:
    • A 24/7 clinical teleconsultation service delivered via secure video link into residential/ nursing homes, that is utilized instead of patients having to be taken to the local A&E department.
    • A service that provides clinical consultation not a logarithm based approach like 111.
    • A fully managed technical service utilizing bespoke laptops with HD cameras and with 4G SIM or broadband.
    • Deadline is 5pm on Friday 20 OctoberMore information on Gov.UK.

Rock Health’s Q3 report: funding and mega-deals cool down

Too hot not to cool down? This year’s digital health funding, as reported by Rock Health, may be ‘just one of those things’ depending on what happens next quarter. After a torrid Q2 which brought first half 2017 to an explosive $3.5 bn [TTA 11 July], Q3 added only $1.2 bn for a total $4.7 bn. Bear in mind that this is larger than the full years of 2014-2016, and that Rock Health tracks only US deals over $2 million in value from venture capital, excluding government and grant funding. Rock Health’s report concentrates on deal sizes, trends, and types of companies. Here’s what this Editor found to be interesting:

Here’s what this Editor found to be interesting:

  • Number of deals is at a record: 268 digital health funding deals across 261 companies. In 2016, 240 digital health venture deals had closed by the end of Q3 in 2016.
  • Few mega-deals this quarter: The only ones are 23andMe with a $250 million round in September followed by cancer data company Tempus’ $70M Series C round. Average deal size dropped to $14.6 million. The cooling is great enough for Rock Health to predict that there may not be any IPOs this year–23andMe was considered the leading candidate but instead went for another round.
  • 16 percent of companies funded in Q3 are led by women CEOs, up from 11 percent. Of course, this is influenced by 23andMe’s founder/CEO Anne Wojcicki. But almost more importantly, there’s been a breakthrough in that women’s and reproductive health companies continue to gain funding traction, and most are led by women.
  • The two top categories for funding through Q3 are consumer: health information and personal health and tracking tools.
  • Yet companies are shifting to a B2B business model from B2C, with 23andMe in the lead targeting drug discovery via the Genentech deal they have had for a long time. 61 percent of digital health startups that Rock Health tracks converted from B2C to B2B. No surprise to this Editor as consumer adoption is a slow and costly road.
  • Exits are also cooling down as long-cycle reality hits. The ‘nine-inning ball game’ stated by an investor is, given healthcare’s long cycles, regulation, and slow adoption, is more like 15. 
  • Some recovery in public companies making money in earnings per share (EPS). Teladoc‘s recovered, while NantHealth continues in the doldrums. (Perhaps it’s Cher suing Patrick Soon-Shiong?)

Awaiting StartUp Health‘s always numerically bigger report, but this Editor’s bet is that it won’t be ‘crazy’ like Q2 [TTA 15 July]. Rock Health Q3 report.

Proposed rule issued for ‘VA Anywhere to Anywhere’ telehealth cross-state care

The Department of Veterans Affairs ‘Anywhere to Anywhere’ program, which would enable VA doctors to treat VA patients across state lines via telehealth and telemedicine, yesterday (2 October) published in the Federal Register the required Federal proposed rule. There is a mandated 30-day comment period (to 1 Nov). In the Federal government, these rules move faster than any legislation. From the rule: “VA has developed a telehealth program as a modern, beneficiary- and family-centered health care delivery model that leverages information and telecommunication technologies to connect beneficiaries with health care providers, irrespective of the State or location within a State where the health care provider or the beneficiary is physically located at the time the health care is provided.” PDF of rule.

VA Home Telehealth has both doctor-to-patient telemedicine and vital signs remote monitoring components. While VA is fully able to waive state licensing requirements if both the physician and the patient are in a VA clinic, because of state telemedicine laws they have not been able to provide the same care for veterans at home. VA also has a care distribution problem, with many veterans living in rural areas, at great distances from VA facilities, or with limited mobility. What this will enable is VA hiring in metro areas primary care and specialist doctors to cover veterans in rural or underserved areas and the expansion of mental health care. It also will facilitate the rollout of the VA Video Connect app for smartphones and video-equipped computers now in use by over 300 VA providers [TTA 9 Aug].

The VETS Act (Veterans E-Health and Telemedicine Support Act of 2017, S. 925) would permanently legislate this, but in the US system this type of Federal rule, in this circumstance, moves faster.  Fierce Healthcare, Healthcare Finance, mHealth Intelligence 

NHS Kernow forced to postpone telehealth end by patient legal action (updated)

Your opinion counts. Use it! (Also see below for another cut to be made) NHS Kernow, which back in July snap announced an end to telehealth monitoring for budgetary and ‘outcome proof’ reasons, has been forced to back down on ending the program by a patient’s legal action. Ian Wyness, a 55-year-old patient with a severe heart condition, took up the fight with NHS Kernow CCG, first with letters, then in the local court. NHS Kernow is now maintaining the service to over 900 patients and on 19 Sept opened up for a six-week public consultation.

According to Cornwall Live, local people will be able to share their views about the service to 7am on Wednesday 1 November through a survey distributed online at www.surveymonkey.co.uk/r/KCCG-TelehealthSC or returning a printed copy. Cornwall Live also lists times and locations for four public hearings, inviting users and caregivers, on 24 and 26 October. The service will be continued until a final decision is reached by the CCG–according to them, in December.

International headlines were made in July when the plight of Bodmin resident Jill Diggett, who has five serious medical conditions that have hospitalized her multiple times, but has stayed out of hospital with telehealth, went viral via Cornwall Live, many publications like TTA, and an ITV interview where she begged the CCG to ‘Let me die at home’ [TTA 7 July]. Ending her service would not only affect her and her husband’s quality of life, but also made no sense financially with the daily cost of her long hospital stays. The promise of transitioning her care to a distant Cornwall location also hadn’t been kept.

Mr. Wyness is a former RAF service member from Davidstow who had his own dramatic medical experience leading to telehealth monitoring. In one day in 2012, he had been resuscitated 14 times in three locations due to his heart condition. Telehealth now monitors his blood pressure. When monitoring staff noted a drop, he was taken to hospital ‘just in time’. When the closing was announced, Mr. Wyness went to court with the assistance of the Leigh Day firm. They made and won a legal argument that closing telehealth services without consulting with members of the public was illegal. “I decided to fight for everyone because many patients who use the service who may have dementia or may be old are unable to take on that fight.” Bravo! Hat tip and thanks to Suzanne Woodman for the follow up.

Tender Alerts: Staffordshire’s £70m contract, Yorkshire and The Humber test

Susanne Woodman, our Eye on Tenders, alerts us to two tenders, the first which will definitely pique our UK Readers’ attention with its size and duration. The second is for a proposal using TECS and telemedicine as an alternative to emergency services.

  • Staffordshire: This is a huge seven-year contract to create the Support For Independent Living In Staffordshire (SILIS) Service to enable older and disabled adults to age in place in their current homes. “A key aim of the Service is to help Individuals to make changes to their home environment that will prevent the need for more costly interventions, such as admission to hospital or residential care, following life crises.” The Service will improve upon existing services in Assistive Technology (AT) including referral to telecare providers.

There are six borough and district councils involved, with the potential for use by nine more. The contract is valued at £70 million to start April 2018 with renewal points, ending in March 2025. Deadline is Wednesday 1 November at noon. Much more information (you’ll need it) on TED EU-Tenders Electronic Daily

  • NHS Greater Huddersfield & North Kirklees CCG: This tender is for the provision of a technology-assisted, rapid access service offering an alternative to hospital-based A&E services. Market test site is in Kirklees for residents of a care home. Requirements are:
    • A 24/7 clinical teleconsultation service delivered via secure video link into residential/ nursing homes, that is utilized instead of patients having to be taken to the local A&E department.
    • A service that provides clinical consultation not a logarithm based approach like 111.
    • A fully managed technical service utilizing bespoke laptops with HD cameras and with 4G SIM or broadband.

The CCG may also commission an accountable care organization (ACO) for this care in future, to which this contract would transfer. Deadline is 5pm on Friday 20 October to brenda.powell@greaterhuddersfieldccg.nhs.uk. More information on Gov.UK.

Regulation, safety and sustainable development: three short important updates

Erik Vollebregt has just released a blog that should be read by anyone with a medical device or whose technology is likely to be classified as a medical device under the new Medical Devices Regulation (MDR – Regulation 2017/745/EU) which replaces the MDD in early 2020. It makes scary reading as to what will need doing to comply with the new regulations as approval under the MDD will no longer apply (no ‘grandfathering’). MedTech Europe has helpfully produced a flowchart describing the necessary steps. Advice from official sources given to this editor is that, as the MDR already applies in the EU, its continued application in the UK after Brexit is not in serious doubt, so UK companies should not delay.

The Digital Health & Care Alliance (disclosure; that this editor manages) and DigitalHealth.London are jointly running a digital health safety conference on 7th November. Key players in the UK are on the agenda (including the CQC, MHRA, HSIB, NHS Digital/England, Datix, Vitalpac etc.). This is a topic that requires the attention of all developers and providers of digital health, as new technology, being unfamiliar, is inherently risky. It is therefore really key for everyone involved to share experiences, understand the risks and carefully plan avoidance and mitigation.  The draft agenda and booking details are here (there is a small charge for lunch).

For those who have doubts about the benefits that mobile communications can bring at times, a read of the GSMA’s 2017 report on mobile’s contribution to the UN’s sustainable development goals will fill you full of optimism of what technology can do, for health and many other aspects of life. Beautifully presented and full of interesting facts: recommended! (If you’ve not enough time, the summary is here.) Hat tip to Prof Mike Short.