Contact tracing app ready for Isle of Wight trial this week: Hancock. But is it ready for rollout? (updated)

May 5, 2020 | by

Announced today was what in normal times we’d call a beta test of the contact tracing app [TTA 25 April] developed by NHSX on the Isle of Wight. Transport Secretary Grant Shapps announced it Sunday to Sky News. BBC News detailed today that council and healthcare workers will be first to try the contact-tracing app starting Tuesday at 4pm, with the rest of the island able to download it starting Thursday. Gov.UK  The Isle of Wight has approximately 80,000 households.

Update: How the Isle of Wight residents reacted to the app. BBC News

How the app works: if someone reports COVID-19 symptoms through the app, that information goes to the NHS server and the server downloads that tracking information. The app then notifies the other app users that the person has been in contact with over the past few days, contact being defined as within 6 feet for 15 minutes. This can include someone a person has sat next to on public transport. The tracking in the app is via Bluetooth LE to other mobile phones. The app then alerts contacts with the app and gives advice, including how to get a test to confirm whether or not they do have COVID-19. Users will be able order tests through the app shortly.

Use of the app is voluntary and personal data is limited to postal code and what the user opts in to. So the intent of the app is to warn and test to reduce future outbreaks, as full lockdown is not and cannot be a permanent state. Mr. Shapps stated to Sky that the goal is 50 to 60 percent of the country using the app.

Unfortunately, many of the most vulnerable–older, sicker, and poorer adults–won’t have the smartphone, much less the app, and even with the smartphone, won’t be able to download the app or use it. It’s dependent on self-reporting, which may or may not be reliable. Phones can turn off Bluetooth LE. Another consideration, and one this Editor hopes has been tested, are extremes: extreme density in population and contact areas, and extreme distance, as in rural areas. Additional from BBC News, including a short Matt Hancock clip from the Monday briefing with an almost-touch of his nose or mouth right at the start (!)

The Guardian brings up privacy concerns as well as a Health Service Journal (HSJ) report that the app was ‘wobbly’ and had cybersecurity concerns which would exclude it from the NHS’ own app store. The HSJ story quoted their source stating that the government is “going about it in a kind of a hamfisted way. They haven’t got clear versions, so it’s been impossible to get fixed code base from them for NHS Digital to test. They keep changing it all over the place”.  The reporting data also will reside on NHS servers, not individual phones, but pushes out the alert from the server.

Worldometer gives the current UK statistic as total of 190,584 with 28,734 deaths. While case diagnosis continues to increase, fatalities have been steeply declining. There is concern that COVID is yet to spike in rural areas, as cases have concentrated in Greater London, the Midlands, and the North West. New York and New Jersey alone in the US have over 456,000 cases with just under 32,900 fatalities attributed to COVID-19, 3/4 of which have been in NY–almost as much as the entire UK. (However, the fatality statistic is widely questioned as not screened for contributing causes, since there are certain incentives for attribution.)

In other NHS news, NHS Digital, the information and tech side of NHS (not the innovation unit) has named a new deputy chief executive. Pete Rose will also take on the role of chief information security officer for the Health and Care System, including live services, cybersecurity, solutions assurance, infrastructure, and sustainability.

10 years in 2 months: prognosticating the longer-term effect of COVID-19 on telehealth, practices, and hospitals

May 2, 2020 | by

crystal-ballThis Editor recounted last night in the article below on The TeleDentists’ fresh agreements with Cigna and Anthem the observation of a former associate who has been in the thick of the remote patient monitoring wars for some years that telehealth/telemedicine has progressed 10 years in 2 months. Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), stated to the Wall Street Journal (paywalled),  “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.” Even in a short period of time, CMS-reported telehealth visits as of 28 March trebled from 100,000 to 300,000. When the April numbers are in, it would not be surprising to see it grow well into seven figures.

The genie may be out of the bottle, but what will the genie do? Genies are, after all, unpredictable, and fly around.  Out of the smoke, some educated guesses:

  • Insecure, non-HIPAA compliant audio/video platforms will be the first which should be struck from CMS approval. Zoom has become a hackfest, with all sorts of alerts from mobile providers like Verizon on how to secure your phone. (An organization of which this Editor is a member had a panel this week completely disrupted by a hacker in five minutes.) Skype’s problems are well known. The winners here will be telehealth platforms that integrate well with EHRs, population health platforms (or may be part of population health platforms), and have robust security.
  • Primary care practices and specialists, who’ve been surviving on non-F2F visits, will be adjusting their practices to patient demand, and integrating telehealth with physical visits in a way that their patients will prefer. This means a search for integration of EMRs/EHRs with secure platforms and reconfiguring areas such as care coordination. If planned correctly, this could create better management of patients with multiple chronic conditions.
  • Actual physical visits will rebound, creating financial pressure on Medicare, hospitals, and private payers. How many people’s health has declined in two-three months is key. Small practices, who may see this first, will see another level of pressure, because they will be held to their Medicare quality metrics in value-based models even if adjusted. Hospitals will also rebound–if they are able. The dark side: private payers may run the numbers and scale back on benefits for the 2021 year especially if COVID is projected to make a return.
  • Behavioral health may benefit, yet drive individual practices and a wave of retirements, or a consolidation into clinic or group settings. There’s a reason why Optum is buying out AbleTo; we may see a wave of competitor acquisitions in this area with the emphasis will be on cognitive health and short courses. Why retirements? Many psychiatric practices are still independent, concentrated geographically, and the average psychiatrist is over 50. Psychiatric EHRs are both costly and not particularly suited to practices. If faced with technological challenges, a lot of MDs and senior clinical psychologists may very well exit–threatening clinics which need MDs to legally operate.
  • Rural health’s failure accelerated. USA Today’s analysis pinpointed at least 100 rural hospitals to close within the year. They already operated on thin margins, but with COVID expenses for additional equipment, the closing down of more profitable elective procedures and dependence on Medicaid, the over 1,100 unprofitable hospitals, over half of which are the only hospital in their county, have received a body blow. HHS allocated $10 billion to rural hospitals and clinics of the $100 billion aid package, but it may be too little and too late. Becker’s Hospital Review continues to track the bankruptcies and closures. Here there are no easy solutions from the digital health area.
  • A culture of cleanliness should accelerate. If the genie pulls this out of the bottle, one major benefit will be that hospital-acquired infections will decline. Effective sanitization methods that reduce human application and scrubbing will be the ones to look at: disinfecting foggers and UV full room or area systems–or combinations of same. Cleanliness and lack of virii and bacteria may become a new metric. Look and bet on companies that can provide this, from rooms to computers/mobile tablets and phones.

Readers can help with these prognostications and especially how they will play out not only in the US, but also in the UK, Europe, and worldwide.

Anthem Blue Cross Blue Shield adds virtual dental care with The TeleDentists in 9 states

May 2, 2020 | by

Could it be that a certain sage from New Jersey is on the money in predicting to this Editor that telemedicine has advanced about 10 years in the past two months? Anthem Blue Cross and Blue Shield (BCBS) is adding the virtual dental care provided by The TeleDentists to its plans in nine states: Maine, New Hampshire, Connecticut, Ohio, Kentucky, Indiana, Wisconsin, Colorado, and California. Through 30 June, the plans will cover virtual exams at 100 percent with no deductibles, copays, paperwork or claims to file. The virtual visit dentistry service offered by The TeleDentists is designed for urgent situations and to avoid an initial visit to the ER which can be several hundred dollars.

A member will locate a remote dentist through Anthem’s provider finder, then link to The TeleDentists’ site where the member is screened for history. A connection to a dentist then takes place quickly, in as little as 10 minutes, 24/7/365. The format is a video consult plus chat (TeleDentists uses the HIPAA-compliant 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.

In the US, Anthem is #3 after UnitedHealthCare and Kaiser. It is the largest for profit insurer in the Blue Cross Blue Shield Association. In California alone, it has 800,000 members.  This adds to The TeleDentists partnership with Cigna announced earlier this month [TTA 15 April]. Releases (9) on Business Wire. Hat tip to CEO Howard Reis.