You know it’s a step towards a more normal state of affairs when this Editor can cheerfully announce something which has really nothing to do with a virus, pandemic, or something ending in 19, although there’s the expected COVID spin. Almost getting lost in All That was the announcement last week of a global strategic alliance between AliveCor, the developer of KardiaMobile, and OMRON Healthcare, the Kyoto-based cardiac health and wellness company. Cardiac monitoring was around well before this virus and with a focus on mobile monitoring, is a major up-vote for an innovative company like AliveCor. What’s in the release is the announcement of a global alliance, technology integration, and at the very end of the release, closing of an undisclosed equity investment by OMRON Corporation (OMRON Healthcare’s parent). This is actually the second equity investment which OMRON has made in AliveCor, with the first being in March 2017 with the Mayo Clinic. Hat tip to co-founder and ever-dapper Dave Albert, MD via Twitter
Wednesday 6 May, 11am to 12 noon Eastern Daylight Time
How can virtual trials improve patient enrollment, retention, and engagement in a clinical trial? How much of the future CRO model will be defined by digital solutions? These are two questions key for many digital health companies as they expand and/or pivot their business model. Answering these questions will be the task of the panel discussing “Clinical Trials in the Post-Pandemic Era”, a free virtual midday seminar hosted by HITLAB in New York.
Panelists are: Joris van Dam, Head of Digital Therapeutics at Novartis, Natalia Kotchie, Vice President R&DS Applied Data Science Center at IQVIA, Bill Taranto, President & General Partner at Merck Global Health Innovation Fund, and Jeff Ventimiglia, Senior Vice President, Medidata Solutions (sponsor). The panel will be moderated by Professor Stan Kachnowski, Director of the Digital Health Strategy program at Columbia Business School.
Seats are limited to 1,000. Registration is necessary through Eventbrite here. Registrants will receive a follow-on email with instructions on how to access the webinar.
Optum, the part of UnitedHealthGroup that runs engagement, technology, and financial services for UHG, is in advanced negotiations to acquire AbleTo, a New York City-based behavioral health and virtual therapy provider, according to CNBC. Unusually, there is also a number attached: $470 million, about 10 times their forward revenue.
AbleTo is already well acquainted with Optum, as their Ventures arm provided financing in January 2019 in a corporate round. Over the past 12 years, the company has raised close to $47 million through a Series D. Interestingly, one of the early investors was Aetna, pre-CVS. Crunchbase
Optum of late has been on an acquisition tear, with first dialysis provider DaVita for $5 billion and then telehealth/remote patient monitoring company Vivify Health for an undisclosed but certainly far less amount. AbleTo is attractive not only in the context of telehealth (at last the belle of the ball!) but also for the underserved behavioral health market. Confirmation of its attractiveness? A fresh crop of competitors such as Quartet Health, Lyra, and ‘traditional’ telemedicine providers such as Doctor on Demand.
AbleTo was founded by Michael Laskoff, at one time quite the ‘face’ in the NYC digital health scene, who went on some years back to found another behavioral health company, Annum Health, focusing on alcohol addiction. AbleTo is one of the pioneers of virtual therapy, both telephonic and audio/video, using care teams of coaches and LCSWs to provide short-term cognitive therapy sessions. It is certainly an underserved market with over 50 percent of those researched citing cost and stigma to not obtain treatments, with about 2/3rds surprisingly under age 50, but not surprisingly about half with one or more chronic conditions. Most of its business is with payers and self-funded companies, although it still offers individual therapy plans. Mobihealthnews
NHSX announces TechForce19 challenge awards (updated), COVID-19 contact tracing app in test for mid-May launch (UK)
NHSX, the group within the NHS responsible for digital technology and data/data sharing, made two significant announcements yesterday.
TechForce19 Challenge Awarded
NHSX, with the Department of Health and Social Care (DHSC) and the Ministry for Housing Communities and Local Government (MHCLG), yesterday announced the 18 finalists in the TechForce19 challenge. This challenge was set up quickly to support the problem of vulnerable, elderly, and self-isolating people during this COVID-19 quarantine to reduce actual and feelings of loneliness and lack of safety.
Like most everything around coronavirus, this was fast tracked: the challenge announcement in late March, submissions closing on 1 April, and the selection announced on 24 April. Each finalist is being awarded up to £25,000 for further development of their technology systems.
The 18 finalists include a number of familiar names to our Readers (who also may be part of these organizations): Feebris, Neurolove, Peppy, Vinehealth, Beam, TeamKinetic, Alcuris MemoHub, Ampersand Health, Aparido, Birdie, Buddi Connect, Just Checking, Peopletoo/Novoville, RIX Research & Media (University of East London), SimplyDo, SureCert, VideoVisit, and Virti. Their systems include checking for the most vulnerable, volunteering apps, mental health support, remote monitoring, home care management, and in-home sensor-based behavioral tracking. Details on each are in the NHSX release on their website. NHSX partners with PUBLIC and the AHSN Network (15 academic health science networks). Hat tip to reader Adrian Scaife
Updated 29 April. Adrian was also kind enough to forward additional information to Readers on Alcuris MemoHub (left) as a finalist in the remote care category. Partners in the test are Clackmannanshire and Stirling Health and Social Care Partnership (HSCP), East Lothian HSCP, South Tyneside Council, and Stockton on Tees Borough Council and last for about two to three weeks. Release
COVID-19 contact tracing
NHSX announced the release, in coming weeks, of a contact tracing app to track your movements around people and if you become positive for coronavirus, “you can choose to allow the app to inform the NHS which, subject to sophisticated risk analysis, will trigger an anonymous alert to those other app users with whom you came into significant contact over the previous few days.” The app is being tested in ‘early alpha’ at RAF Leeming (Computer Weekly). The app will tell users that they are OK or if they need to self-isolate. Far more controversial, if one cares about privacy, despite all the caveats. Based on the articles, NHSX is targeting a release of the app by mid-May according to the BBC, which also broke the RAF test. It will presumably acquire a snappy name before then. ComputerWeekly 24 April (may require free business registration), Matt Hancock Commons statement 22 April
If you are following the changes at Tunstall Healthcare, TSA’s Alyson Scurfield’s talk with Gordon Sutherland has some significant news. The investment from Barings, M&G, and the lender group has been confirmed as a change of ownership. It could be inferred from the release, but was not explicit.
From Mr. Sutherland: “The change in ownership deal is now subject to several legal steps including a European Commission review regarding Competition Law. We expect to be able to address any issues and the deal to be signed in late June/July.” Checking back on the Charterhouse website, Tunstall is still categorized as an unexited portfolio company (or ‘unrealised’ in a more delicate term).
Another reveal in this conversation is a strategic statement that segments care and presumably the company’s direction into four parts, somewhat like Roman Gaul (which was three or five, depending on the history you’re reading):
- Reactive care: for instance an alarm bell or PERS press
- Proactive care: reactive plus social care and well checks
- Predictive care: sensor-based tracking in the home. Presumably this would be rules-based (i.e. time) on ADLs.
- Tunstall has added to this Cognitive Care or “Intelli-Care” which would combine presumably #2 and #3 along with other healthcare data from the user which would be analyzed to deliver social or health ‘nudges’. While in its ‘infancy’ according to Mr. Sutherland, this type of system would also detect changes in vital signs which require intervention.
#3 and especially #4 referred to as in ‘infancy’ leave this Editor puzzled. Back in 2006-9, the QuietCare system (still sold by Care Innovations) had changes in ADLs based on a normative model baselined over two weeks pretty much nailed down. There are more advanced systems such as CarePredict that take that motion and movement and have put it on a wrist-based sensor system that is now sold for individuals at home as well as in group living–with fall prediction and a PERS for good measure. Vital signs monitoring can also be done with other personal devices, watches, and smartphone/tablet reporting, but medical grade monitoring is another step further with far more complex integration.
Part 2 of the conversation will discuss what are the anticipated changes to health and social care service sectors and the proposed strategic direction of TSA. Hat tip to one of our Readers
Updated 25 April: A further snippet on how the new investment will play out at Tunstall is found on healthcare business intel provider Laing Buisson’s Care Markets website. In their view, the Barings/M&G investment will be “supporting the restructure, which will see the business recapitalised and debt reduced to £180m….” The rest is unfortunately only available to Care Markets newsletter subscribers, of which we are not. Again, no mention of Charterhouse.
We are sad to let our readers know that Doug Miles, the founder and former Chairman of UKTelehealthcare, passed away on the 28 March 2020 a year after being diagnosed with pancreatic cancer.
Doug had worked in the TECS sector for over twenty-five years, initially as the manager of MASCOT Telecare in Merton, South London, before founding London Telecare in 2005. Doug and co-founder John Chambers relaunched the company as UKTelehealthcare in 2013 and he continued to chair the organisation until retiring in December 2017.
Gerry Allmark (UKTHC MD) said “Doug was a true gentleman of the TECS industry and will be greatly missed by me and the UKTHC team who he continued to support after his retirement. He will also be missed by his many colleagues and friends in the telecare sector.”
Our thoughts and prayers go out to his wife and family at this particularly difficult time for them.
DHACA restarts our webinar series after Easter Week with a panel of three contrasting suppliers of GP process improvement (aka “total triage”) software and the NHS England expert on the topic, at 10am on Wednesday. In our first Webinar, huge potential benefits were identified from use of this software, which is particularly well suited to the requirement of the current pandemic that face:face consultations be avoided where possible.
However the benefits don’t stop there. Patients, clinicians and practice managers all benefit hugely…and I can speak from personal experience as my local surgery converted recently and has never looked back! We’ll be exploring these benefits in more detail the following Wednesday 29th April in the following webinar when users – both professionals and patients – describe their experiences of the software, and the challenges implementing it.
We have more exciting webinars coming up, including self-testing to reduce face:face GP consultations further so keep an eye on DHACA’s Webinar listing for when they are published.
Medopad, a London-based software developer for healthcare specializing in digital biomarkers generated by wearables and apps, has rebranded as Huma and, with the brand splash, announced the acquisition of two companies:
- BioBeats, a London-based mental health monitoring app and wearable combination that tracksheart rate, activity, sleep, mood, and cognitive function to create a wellbeing model.
- Tarilian Laser Technologies (TLT), based in Welwyn Garden City, is a developer of continuous blood pressure and cardiovascular non-invasive measurement technologies. Their assets include patents, software, and hardware awaiting US FDA approval.
Purchase details were not disclosed, but TechCrunch’s sources indicate a $10 million deal for BioBeats.
Joining Huma is former UK Health Minister The Right Honourable Alan Milburn as chairman of its board of directors.
Medopad announced last November a Series B raise of $25 million led by Leaps by Bayer, Bayer AG’s venture capital arm which also participated in their earlier Series A (CityAM/Crunchbase). Medopad’s focus to date has been primarily with life sciences companies to predict disease risk, condition progression, and diagnosis for chronic diseases including Parkinson’s (based on monitoring finger movements, in partnership with China’s Tencent), Alzheimer’s and diabetes. Which does make the pivot surprising, given the financing origin.
The Huma rebranding is accompanied by the usual quotes from the founder/CEO to explain the pivot from disease states to the ‘wellbeing’ sphere and Huma being reflective of humanity (see the daVinci-esque logo). The release quotes are also in Mobihealthnews Europe/UK (along with an unexplained doubling of their Series B raise; their total funding is $50 million). The release also lists offices in New York at the Genome Center on lower 6th Avenue and Shanghai. Hat tip to reader Paul Costello
Beyond telehealth: sensor-based vital signs monitoring for early coronavirus symptoms being tested in Israel
Now that the US, as well as other countries like Austria and Germany, are planning to emerge from full quarantine and lockdown (before we all go stir crazy and broke), can digital health move beyond telehealth consults to proactive detection of possible cases of coronavirus and other communicable diseases, which would be valuable in early-stage detection and mapping outbreaks?
The answer: possibly. An intriguing use of sensor-based diagnostic monitoring is being tested in Israel. A Tel Aviv-based company, Vayyar Imaging, is using its 4D radar imaging system to capture data without contact, such as pulse, heart rate variability, and respiratory rate. This extends the kind of contact testing with forehead thermometers which are often used in South Korea and Japan for airport arrival testing and, with other tests, during the Ebola event in the US.
The dedicated sensors can operate through walls and objects, are not line-of-sight, and are not influenced by lighting. They can map environments and track movements in real-time.
The tests are being run with MAFAT (Israel’s Defense Research & Development Directorate) and Israel’s Naval Medical Institute to run real-time monitoring with their personnel to detect early signs of the COVID-19 virus. The Israel National Emergency Team completed an earlier test in which two Vayyar sensor systems were adapted to remotely analyze patient data. Vayyar release.
Most stories during the COVID-19 public health emergency (PHE) have been about infection counts, overstressed hospital ERs/EDs, numerators/denominators, drugs, vaccines, and when can we get back to normal–if we can get back to normal. Thus some different and good news is more than welcome.
Today it comes from Legrand. During the crisis, Legrand has already provided equipment and staff support in several countries for field hospitals, long-term care facilities, and caregivers. A sample:
- In the UK, the Aid Call Touchsafe Pro emergency nurse call system was installed into several Nightingale field hospitals plus other hospitals where areas had been re-purposed for new wards. Tynetec Reach IP and Touch 2 pendants were deployed as a plug and play option to support hospital discharge.
- In the US, Legrand helped New York State field hospitals with a cable management solution to supply power to 2,000 beds–completed in four days. In Indiana, a production line for display screens was converted to making cloth masks which are in short supply in hospitals and for civilians.
- In hard-hit Milan and Bergamo, Italy, temporary hospitals were furnished with emergency solutions (bedhead units, nurse call devices, and VDI cabling systems).
- And in India, a university hospital in Kolkata was converted for treatment of coronavirus patients and equipped with the Group’s uninterruptible power supplies.
Legrand’s newest initiative, announced today, is the establishment of a ‘solidarity fund’ dedicated to care and nursing for the elderly. This fund will provide tangible support to staff who work in specialized facilities such as care and nursing homes. The fund will be administered through the Legrand Foundation, created in 2014 to combat “exclusion related to a loss of independence and electrical poverty, and promoting education and employment in the electrical sector.” An example of tangible support is to finance staff hotel accommodations near their work, to decrease stress, fatigue, and also protect their families. Legrand is also inviting contributions from both businesses and individuals wishing to join this solidarity initiative. TTA is pleased to feature these initiatives from Legrand/Tynetec, a long-time supporter. Release.
In more COVID related news, the Federal Communications Commission (FCC) will be administering the $200 million allocated by the CARES Act to fund telehealth related expenses for providers to furnish connected care for patients. The program will fully fund practices and health systems in telecommunications services, information services, and devices necessary to provide critical connected care services. Funding will continue through the national health emergency or until the program funds have been fully spent out.
The application period opened on Monday 13 April. Applicants can download a fillable PDF form linked to the FCC’s program web page, but before they do that, there’s several pre-requirements typical of any Federal program:
- Obtain an FCC Registration Number (FRN) from the Commission Registration System (CORES), as well as a CORES username and password at that link. An FRN is a 10-digit number that is assigned to a business or individual registering with the FCC and is used to identify the registrant’s business dealings with the FCC.
- Obtain an eligibility determination from the Universal Service Administrative Company (USAC) by filing FCC Form 460 through My Portal on USAC’s webpage. (Filers do not need to be rural health care providers in order to file Form 460 for this program.)
- Register with the federal System for Award Management (SAM)
When approved, the program operates as a reimbursement program where approved providers will have to submit invoices and supporting documentation which are also subject to audit.
In the US, most insurance payers have been responding to the COVID-19 pandemic by waiving cost-sharing, such as deductibles and co-pays, for coronavirus treatment–and also waiving co-pays for medical telemedicine/telehealth visits for any reason. A medical area that hasn’t been considered previously, but is becoming more important as restrictions continue, is dental treatment. Nearly all dental practices have been shut or open for emergency treatment only since mid-March.
Cigna is possibly the first payer to innovate a Dental Virtual Care program for emergency care using its own dental network and that of The TeleDentists [TTA 19 June 19]–and at no cost through 31 May. (For instance, The TeleDentists’ average consult cost is $69.) Cigna’s 16 million members of their employer-sponsored insurance plans are eligible for the program.
Teledentristry is designed for urgent situations, such as pain, infection, and swelling, and to avoid an initial visit to the ER. The visit is done through a video consult plus chat (TeleDentists uses the VSee platform) to evaluate the plan member, then to guide on next steps. If necessary, the dentist will prescribe medications, such as antibiotics and non-narcotic pain relievers.
The program will continue later than 31 May subject to state regulations and benefit plans as part of Cigna Dental Health Connect. Cigna release. Hat tip to CEO Howard Reis.
In a deluge of press releases to TTA linking every app, service, virtual event, or device to the coronavirus, no matter the stretch, putting this Editor into ocular overload, a message from James McLoughlin at a small company based in Ascot called Thank And Praise Ltd. (TAP) was a refreshing change. TAP’s social Healthcare “Thanking Wall’ lets individuals thank NHS workers–individuals, groups, or in general–for their work. TAP is primarily focused on both healthcare and education in the UK, including Northern Ireland. Their objective is to be ‘the global platform of thanks.’
I’ll let James, who is their commercial director, take it from here.
TAP (Thank And Praise), a unique social thanking platform, was created in January 2019 to enable the general public to show their appreciation for the unsung heroes in healthcare and education. In response to the COVID-19 crisis, TAP launched a free-to-use Digital Thanking Wall to enable members of the public to post messages of thanks to the courageous and selfless people working in healthcare/NHS and education at this time. Our campaign has resulted in 1000s of visitors to our website to read the hundreds of heart-felt messages, mainly for healthcare workers.
Readers, do drop in and leave a message on the Healthcare Thanking Wall and follow their LinkedIn page. At this Easter and Passover time, I cannot think of anything more appropriate. Hat tip to James McLaughlin. And thanks.
A typically cheery view by Eric Topol, MD of what medical practice will look like after COVID is over. With the full court press to go remote in hospitals and practices worldwide, telehealth and telemedicine has gone fast forward in a matter of under two months. But what will it look like after it’s over? Most of what the good doctor is prognosticating will be familiar to our Readers who’ve followed him for years–certainly he was right on mobile health overall and especially AliveCor/Kardia Mobile— but not so on point with mobile body scanners (anyone remember VScan?)
When the high tide recedes, what will the beach look like?
- “Telemedicine will play the role of the first consultation, akin to the house-call of yore.” (Terminology note–interesting that Dr. T still uses ‘telemedicine’ versus ‘telehealth’–Ed.)
- Chatbots will serve as screeners–once they are proven to be effective (a ways to go here, as the Babylon debate rages on)
- Smartphones will be the hub, connecting with all sorts of monitoring devices (the ‘connected health’ Tyto Care and Vivify Health model–which makes the Editor’s former company, the late Viterion Digital Health, even more of a pioneer that died crossing the Donner Pass of 2016)
- Smartwatches are also part of this hub (this Editor remains a skeptic)
- Now is the time to harness technology by both health systems and individual practices, but multiple barriers remain. (This Editor can speak to the difficulties for both primary care and specialty practices in not only practice but also reimbursement–and acceptance by patients.) Device expense is also a problem for the non-affluent.
As to the rest, it is pretty much what we’ve heard from Dr. T before. The Economist
Your Editor will add:
- Easy to use, secure platforms that don’t put users through multiple security steps remain a concern for users. This Editor’s concern is that easy to use = insecure. Skype and Zoom are inherently insecure–Skype’s user unfriendliness and insecurity outside enterprise platforms and Zoom’s major security problems on its platform and user flaws are well-known (ZDNet).
- Reimbursement, again! CMS has done a creditable job in broadening reimbursement for telehealth a/v and telephonic services, but coding remains a nightmare for practices struggling to remain open and with some lights on. After COVID, will CMS and HHS get religion, or put it right back in its rural bottle? Covered in the CARES Act passed at the close of March, $200 million sounds like a lot from the FCC to bankroll telecom equipment for providers, but these funds will go quickly. At least they are not delayed in endless rule making, as the Connected Care Pilot Program has been for two years. Mobihealthnews
The release is unusually terse in that the funding round, while the lead, is only briefly mentioned in the actual release at the beginning and end. What the funding will support is generic, which is not atypical: “a significant commitment from Tunstall’s lenders and will provide the Company with flexibility and improve the overall financial strength of the business” and that the funding will go towards developing new systems.
There is also no pro forma quote from the CEO, Gordon Sutherland, and no mention of Charterhouse Capital Partners LLP. which has controlled Tunstall since Tunstall is still listed on their website as a unexited portfolio company.
Perhaps clues to their future, or past, are here. An anonymous source advised this Editor to take a closer look at a company called TGH Acquisitions Limited. Their report on Companies House indicates that indeed it is a financing arm of Tunstall Healthcare Group with its last report for the year ending 30 Sept 2018–and showing an after-tax profit of over £75 million. Unfortunately, the parent company Tunstall Healthcare Group in the same period showed a consolidated loss of over £284 million. The good news in that red ink is that the loss was reduced by over £100 million. The report to 30 Sept 2019, which should have come out in mid-February, is not on Companies House.
Tunstall Healthcare remains a major global company in the telecare and remote monitoring field, with operations in 17 countries. In January 2019, they sold their US operation to Connect America, exiting the hyper-competitive US market [TTA 29 Jan 19]. Recently, they entered the complex care management (CCM, often called chronic care management) and transitional care management (TCM) fields.
Given the global spotlight on telehealth during the COVID-19 pandemic, the funding may be just in time to ‘catch a wave’, as they say on the Jersey Shore.
Care Innovations, formerly Intel Care Innovations, formerly Intel-GE Care Innovations, was apparently sold at the end of 2019 to giant drug CRO PRA Health Sciences of Raleigh, NC. This is based on an early termination notice published on 17 Dec 2019 of an FTC pre-merger notification . The notice is interesting as Care Innovations is listed as a holding of Hong Kong-based Essence International Financial Holdings Limited, with no mention of Intel.
It also appears from the website and a quick check on LinkedIn that some of the leadership, such as Marcus Grindstaff, the former COO, has been retained by PRA. And yes, they are still marketing QuietCare (developed by Living Independently Group, this Editor’s employer some years ago).
In recent years, CROs have used remote monitoring as part of clinical drug trials, but this may be the first purchase. PRA’s relationship with Care Innovations dates back to 2017 with a strategic partnership for clinical trials.
The latest iteration of Care Innovations’ Health Harmony is as a turnkey remote monitoring system for COVID-19, to be deployed by employers, payers, providers and health systems to track individuals who may be asymptomatic, exposed or diagnosed with coronavirus. It is designed in three stages: education, quarantine, and in-depth monitoring/care coordination with a healthcare professional. Patients report on a tablet or smartphone vitals such as temperature, heart rate, pulse oximetry and COVID-19 symptoms like shortness of breath, fatigue, and changes in coughing. This information uploads to a dashboard monitored by a clinical call center. Release Hat tip to reader Paul Costello