En Vogue: smart clothing and wearables to track COVID spread and progression

July 29, 2020 | by

Wearables and smart clothing are having a ‘moment’ in the tracking of COVID symptoms and spread. After TTA noted Nanowear’s clinical trial with two major New York metro health systems last week, both POLITICO and Mobihealthnews catalogued additional trials and uses of innovative clothing and devices for detection: 

  • Apple watches and Fitbits
  • Oura rings (!) by the NBA to detect temperature and heart rate–at about $300 and up
  • Northwestern University and Shirley Ryan AbilityLab have developed a sensor that adheres in the visible dip at the base of the throat to monitor respiratory symptoms
  • Tufts University’s sweat sensor embedded in clothing, to analyze elements in perspiration such as electrolytes (sodium and ammonium ions), metabolites (lactate) and acidity (pH). NPJ Flexible Electronics
  • Paris-based Chronolife, which debuted the Nexkin smart T-shirt in December. It monitors heart rate, abdominal and thoracic breathing, body temperature, physical activity, and pulmonary impedance.

Part of the problem of wearable adoption is that without a specific ‘reason why’, wearables haven’t been all that compelling for the mainstream market beyond the trendy and pricey Apple Watch. Wearables have tried corporate wellness programs that almost give away the devices with the promise of lowering health costs long term. Venture funding (see the POLITICO chart) has been flowing into these companies for a decade. But in the eyes of many, wearables are a solution without a clear and compelling problem. COVID may resolve that.

Withings closes $60 million Series B round to fund expansion, B2B development

July 29, 2020 | by

Withings, a digital health developer with devices ranging from smart scales to analog-style smartwatches , this week closed on a substantial Series B funding of $60 million. Led by Gilde Healthcare, the round also had participation from long-term Withings partners and investors, Idinvest Partners and Bpifrance through their Large Venture funds, as well as BNP Paribas Development, Oddo BHF Private Equity, and Adelie Capital. Their total funding is now estimated at $93.8 million. According to their release, Withings will be using the funds to globally scale its dedicated business-to-business division MED PRO and further develop consumer health devices. With this, they will also add about 100 positions in the US and France, including expansion of sales, marketing and R&D.

Founded in 2008 in France, TTA has tracked Withings since 2009 with a scale that Tweets your weight (at a hefty $159). In April 2016, the company was sold to Nokia for a hefty €170 million and became Nokia Digital Health. Nokia’s hope was to use Withings and its pricey (at least in the US market) but stylish and innovative IoT devices to spur its own development of consumer digital health. Two years later, Nokia sold back Withings to co-founder and former chairman Éric Carreel, having not experienced much success in the consumer sector. Shortly thereafter, they premiered a revived Go (with an e-ink face) and the Steel HR Sport smartwatch, then progressed into heart and sleep monitoring.

MED PRO is a relatively new division that concentrates on professional uses of their devices and data analytics within health systems, health plans, disease management programs, and academic and pharma research. Withings also appointed a new global Medical Advisory Board which includes Dr. John Halamka, President of the Mayo Clinic Platform, Dr. Stéphane Laurent, former Head of Clinical Pharmacology in Hôpital Européen Georges Pompidou in Paris, and Craig Lipset, former Head of Clinical Innovation at Pfizer.  Mobihealthnews, Crunchbase

UK news roundup: Health Innovation Manchester winners, donate Phones for Patients in isolation, British Patient Capital funds SV Health with $65m, Memory Lane on the Isle of Man, SEHTA and Innovate UK briefings

July 28, 2020 | by

A potpourri of health tech and funding news from the UK

Health Innovation Manchester announced the four winners of its 2020 Momentum Call. While the competition was initially scheduled to close in February (see Manchester home page), it was apparently delayed to address priority areas for the COVID-19 response. The winners are Cambio CDS T-MACS (risk evaluation for cardiac), Doc Abode (workforce deployment), Gendius diabetes AI-Intellin app, and Howz for Health (predictive ADLs). Two additional in-progress projects were halted due to the virus.  Each winner was awarded £50,000. Release on BuildingBetterHealthcare.com.

The Phones for Patients initiative helps isolated patients–for instance, those hospitalized with COVID or other infectious diseases–connect with family and loved ones by phone. This is made possible by temporary phones, older models donated by individuals and companies, which are wiped of all data and distributed to patients in NHS hospitals and care homes. This includes cables and chargers.

As a nonprofit initiative, Phones for Patients is organized by Bridgeway Security Solutions. Bridgeway secures, manages, and deploys communication and other apps to these devices for the NHS. Imprivata, a digital identity company that develops access management solutions for healthcare, is working with Bridgeway to secure mobile licenses and the software for the phones. 

According to Bridgeway’s managing director Jason Holloway,  “Bridgeway is providing this service free of charge, as our contribution to the effort to defeat COVID-19. We are delighted that Imprivata has been supportive and keen to be involved from the start. Using the Imprivata Mobile software has enabled us to process devices much more quickly, and therefore get them to the people that need them. We have had many heart-warming messages of gratitude and thanks from people working in care homes and in some cases, even from patients themselves saying how much they valued the service.” 

So far, over 8,300 devices have been donated. Both companies and individuals are invited to be part of this ongoing effort. Imprivata representative Melloney Jewell has advised that individuals can donate old phones, cables, and chargers through their JustGiving page.  Companies should go to the Phones for Patients website, review the requirements, fill out the form on the donation page or email donate@phonesforpatients.uk

In funding news, British Patient Capital committed $65 million to SV Health Investors’ latest fund, SV7 Impact Medicine Fund (IMF). SV7 is targeted to fund biotech companies producing high impact precision medicine drugs for poorly treated diseases. According to the release, the commitment increases British Patient Capital’s exposure to life sciences and health technology, building on a commitment to the Dementia Discovery Fund in 2018.

The Isle of Man’s Memory Lane Games, a charity and research partner with Hospice Isle of Man, launched their free app for iOS and Android on 14 July. The app features local nostalgia and familiar places, including visual images from Manx artists and photographers. There are also games based on popular themes like music, TV, animals, history, and sports which will be added to weekly. Hospice Isle of Man will also run proof-of-concept studies on the Memory Lane Games apps later this year to determine outcomes for improvements to the lives of dementia patients and carers. Release on News-Medical.net. Memory Lane Games is also an entrant in Zurich International Insurance’s Innovation Championships. Facebook. 

SEHTA is running free briefing webinars this week for the Innovate UK Biomedical Catalyst Competition. £30 million grant funding is available to UK health & life science SMEs. This is for early and late-stage projects with length from 12-36 months and total project costs between £250,000 and £4 million. Innovate UK can provide 70% of total project costs for SMEs. Previous webinars have been recorded. More information here Information from Innovate UK on how to apply for funding here on Gov.UK, though from 2018.

Weekend ‘Must Read’: Are Big Tech/Big Pharma’s health tech promises nothing but a dangerous fraud?

July 24, 2020 | by

If it sounds too good to be true, it isn’t. And watch your wallet. In 14 words, this summarizes Leeza Osipenko’s theme for this article. It may seem to our Readers that Editor Donna is out there for clicks in the headline, but not really. Dr. Osipenko’s term is ‘snake oil’. It’s a quaint, vintage term for deceptive marketing of completely ineffective remedies, redolent of 19th Century hucksters and ‘The Music Man’. Its real meaning is fraud.

The promise is that Big Data, using Big Analytics, Big Machine Learning, and Big AI, will be a panacea for All That Ails Healthcare. It will save the entire system and the patient money, revolutionize medical decision making, save doctors time, increase accuracy, and in general save us from ourselves. Oh yes, and we do need saving, because our Big Tech and Big Health betters tell us so!

Major points in Dr. Osipenko’s Project Syndicate article, which is not long but provocative. Bonus content is available with a link to a London School of Economics panel discussion podcast (39 min.):

  • Source data is flawed. It’s subject to error, subjective clinical decision-making, lack of structure, standardization, and general GIGO.
  • However, Big Data is sold to health care systems and the general public like none of these potentially dangerous limitations even exist
  • Where are the long-range studies which can objectively compare and test the quality and outcomes of using this data? Nowhere to be found yet. It’s like we are in 1900 with no Pure Food Act, no FDA, or FTC to oversee.
  • It is sold into health systems as beneficial and completely harmless. Have we already forgotten the scandal of Ascension Health, the largest non-profit health system in the US, and Google Health simply proceeding off their BAA as if they had consent to identified data from practices and patients, and HIPAA didn’t exist? 10 million healthcare records were breached and HHS brought it to a screeching halt.
    • Our TTA article of 14 Nov 19 goes into why Google was so overeager to move this project forward, fast, and break a few things like rules.
  • We as individuals have no transparency into these systems. We don’t know what they know about us, or if it is correct. And if it isn’t, how can we correct it?
  • “Algorithmic diagnostic and decision models sometimes return results that doctors themselves do not understand”–great if you are being diagnosed.
  • Big Data demands a high level of math literacy.  Most decision makers are not data geeks. And those of us who work with numbers are often baffled by results and later find the calcs are el wrongo–this Editor speaks from personal experience on simple CMS data sets.
  • In order to be valuable, AI and machine learning demand access to potentially sensitive data. What’s the tradeoff? Where’s the consent?

Implicit in the article is cui bono?

  • Google and its social media rivals want data on us to monetize–in other words, sell stuff to us. Better health and outcomes are just a nice side benefit for them.
  • China. Our Readers may also recall from our April 2019 article that China is building the world’s largest medical database, free of those pesky Western democracy privacy restrictions, and using AI/machine learning to create a massive set of diagnostic tools. They aren’t going to stop at China, and in recent developments around intellectual property theft and programming back doors, will go to great lengths to secure Western data. Tencent and Fosun are playing by Chinese rules.

In conclusion:

At the end of the day, improving health care through big data and AI will likely take much more trial and error than techno-optimists realize. If conducted transparently and publicly, big-data projects can teach us how to create high-quality data sets prospectively, thereby increasing algorithmic solutions’ chances of success. By the same token, the algorithms themselves should be made available at least to regulators and the organizations subscribing to the service, if not to the public.

and

Having been massively overhyped, big-data health-care solutions are being rushed to market in without meaningful regulation, transparency, standardization, accountability, or robust validation practices. Patients deserve health systems and providers that will protect them, rather than using them as mere sources of data for profit-driven experiments.

Hat tip to Steve Hards.

The Year of the Sensor, round 2: COVID contact tracing + sensor wearables in LTC facilities; Ireland’s long and pivoting road to a contact tracing app

July 24, 2020 | by

Wearables + sensors being used in long-term/post-acute care facilities for COVID contact tracing, decontamination. Historically ‘unsexy’ to digital health techies, long-term and post-acute care (LTPAC) came into sharp focus as the epicenter of COVID-19 deaths in the past four months. 45 percent of US COVID-19 deaths (over 54,000) occurred in nursing homes and assisted living residences, with the percentages being far higher in states like New Hampshire and Rhode Island (80%), Massachusetts and Connecticut (63%), Pennsylvania (68%), and New Jersey (48%). Freopp.org has a wealth of state-level information.

This created opportunities for companies that already had relationships with LTPAC to create systems to 1) contact trace individuals and residents, 2) trace locations not only of residents and staff but also contaminated areas, and 3) help focus ongoing decontamination and sanitization efforts. Featured in this surprising TechRepublic article is CarePredict, which back in March started to develop a response to COVID spread including what they dubbed the PinPoint Toolset. CarePredict already had in place a sensor-based system for residents that consolidated sensors into a wrist-worn resident ADL tracker with location and machine learning creating predictive health analytics that appear in a dashboard form. They expanded their analytics to staff and visitor contact plus locating frequently visited area by residents and staff so that decontamination efforts can be focused there. Also featured in the article are VIRI (website) and Quuppa, a real-time locating system (RTLS) repurposed from manufacturing and security. (Disclosure: Editor Donna consulted for CarePredict in 2017-18)

Ireland’s long and winding road to a national contact tracing app is the subject of an article in ZDNet. Waterford-based NearForm was called in by Ireland’s Health Services Executive (HSE) on week 1 of the lockdown and started work immediately. They had a prototype oapp running on a mobile phone by the end of the week, nonfunctioning but giving the HSE a look at the user interface. NearForm worked on a centralized model first, which was basically terminated by Apple’s insistence on blocking BTE, then in April pivoted to the decentralized Apple-Google (Gapple? AppGoo?) Exposure Notification system, once the HSE secured beta access to the new technology. By 7 July, Ireland launched and had over a million downloads in 48 hours. Germany had a similar saga and timing. Both Ireland, Germany, and other countries moved quickly to adopt Apple and Google’s APIs, when Apple blocked their original centralized app methodology. UK and NHSX did not pivot and are In The Lurch with Test and Trace [TTA 18 June, more deconstruction in VentureBeat]. Editor’s Note to Matt: go to your neighbor island, don’t be shy, and make a ‘deal deal’ for the app. Solves that problem. 

Nanowear’s ‘smart clothing’ in NY/NJ hospital trials to monitor patients for early-stage COVID. Is it the Year of the Sensor?

July 24, 2020 | by

Nanowear, a NYC-based developer of cloth-based nanosensors and monitoring systems, has entered a clinical trial collaboration with two major NY/NJ-area hospital systems to test for vital signs which may be predictive of an advancing case of COVID-19. 

The goal of the investigative teams at Hackensack Meridian Health, the largest health system in north and central New Jersey with 17 hospitals plus 500 patient care sites, and Maimonides Medical Center of Brooklyn, affiliated with Northwell Health, is to determine and assess patients for early signs of the ‘cytokine storm’ in the heart and lungs which indicates inflammation within the circulatory system, often leading to severe complications and death in COVID patients. The clinical trial will monitor patients with confirmed or suspected COVID-19. The release is not specific as to whether the garment will be issued to patients monitored solely in the hospital or inclusive of patients still at home.

Nanowear’s SimpleSENSE adjustable undergarment continuously captures key physiological signs related to the onset of COVID–real-time ECG, systolic and diastolic blood pressure, blood flow hemodynamics, respiration, lung volume and fluid, and temperature. The vital signs are then transmitted via a mobile app to a physician portal for monitoring and interpretation.  

The garment test is also significant as it is a contactless monitoring system–highly applicable to contagious diseases.

Last July, SimpleSENSE launched in a heart failure management clinical trial with Penn State Hershey Medical Center in Pennsylvania and Hackensack Meridian. The patented cloth-based nanotechnology sensors can capture up to 120 million data points per patient per day. The HF management trial was designed to validate and provide a pathway to clear its own diagnostic algorithm generated from the garment. The SimpleSENSE device and mobile platform have been submitted to FDA for Class II 510(k) clearance.  Also mHealth Intelligence.

This may be the Year of the Sensor. Human contact is out, remote monitoring is in. Earlier this week, we covered Philips integrating BioIntelliSense‘s BioSticker into its RPM systems. During 2018-2019, we profiled Doncaster UK-based MediBioSense, which uses the VitalPatch from VitalConnect. They recently announced that an enhanced VitalPatch suitable for seven-day use and body temperature sensing received CE Class IIa medical certification as well as FDA clearance. We last covered them when MBS adopted the Blue Cedar app security system in 2018, but based on their website press section, much has happened since in extending their sensor-based technologies. This Editor will try to catch up with Simon Beniston of MBS.

Vote now for finalists in the Aging 2.0 Global Innovation Search (to 31 July)

July 24, 2020 | by

Vote daily online for your favored technologies up to 31 July. Aging 2.o, the international organization that seeks to accelerate innovation around the biggest challenges and opportunities in aging, plus the Louisville Healthcare CEO Council (LHCC), are sponsoring the Global Innovation Search. 

Aging 2.0 chapters selected the companies (left) on the basis that they help keep older adults connected to their communities, families, healthcare providers, and provide vital information. In addition: 

  • The innovation should address social isolation and loneliness in older adults
  • Innovators must have a commercial-ready or commercially available product/service
  • The company’s Founder or C-level executive (or equivalent) must be the person to present if selected to advance to the Virtual Pitch Competition
  • The top ten innovators that are selected to pitch at the Virtual Pitch Competition will be required to present in English
  • The Global Innovation Search is not only open to startups. Established companies and non-profits are welcome to apply if they have recently (within the last 3 years) launched an innovative solution to improve the lives of older adults

Vote on this page. One vote per day up to 31 July is permitted. Based on the vote, the ten finalists will receive sponsorship, mentorship, and the opportunity to virtually pitch at an event in August (date TBD). 

Some familiar US names in this group are a very old friend from this Editor’s QuietCare days, GrandCare, and UnaliWear [TTA features here]. Many are from the US,  but a sample of international semifinalists are:

  • Canada–AltumView, Sirona.tv, Famli.net, Anna, Tamaduni Connect, Tochtech Technologies, Virtual Coffee House 55+
  • Spain–Oroi
  • Sweden–Camanio Care
  • Israel–BaldPhone
  • Brazil–Eu Vô, Cerebrar – Cérebro Ativo
  • UK–Joy, Buddy Hub, eargym Ltd (interesting to this Editor as it addresses age-related hearing loss and cognition through auditory training)
  • Australia–Feros Care

Hat tip to Jean Anne Booth, CEO of UnaliWear, via LinkedIn.

Can technology speed the return to office post-COVID? Is contaminated office air conditioning a COVID culprit?

July 23, 2020 | by

Most offices in the US are still not open or only ‘essential personnel’. As this Editor noted on 19 May, a number of companies, including startups, are focusing on working with employers on return-to-work strategies. There are a raft of approaches including on-site clinics, temperature screening checkpoints, and check-in/reporting apps from Verily (Alphabet) and Fitbit’s Ready to Work. These screeners generally monitor for self-reported symptoms, but some will advise and track you to testing if you demonstrate risk, such as UnitedHealth Group and Microsoft’s ‘ProtectWell’ with a closed loop of testing recommendations that are reported to the employer. Collective Go from Collective Health goes a bit further in emphasizing up-front (molecular [PCR]) testing and continuous employee monitoring into their protocols for, apparently, every worker. OneMedical, which works with 7,000 employers, adds to their on-site management and testing additional contact tracing. FierceHealthcare

Maybe it’s in the air-conditioned air you breathe? Office building air circulation may be a culprit in the spike in Florida, Arizona, and Texas cases. The uptick in cases in Southern states where the contagion rates were initially fairly light may be due to the mostly recirculated air in office air conditioning systems. Most modern buildings don’t have windows which open. Older buildings have their own problems like mold from leaky systems and ‘soot’ (from air pollution and when people used to smoke in offices, remember when?). Newer LEED buildings are so ‘tight’ and energy efficient that air tends to be stagnant. Few buildings have good ratios of air exchange with the outside plus use HEPA filtration throughout the HVAC system. The total picture is that any virus can make its way through offices–six feet of distancing, masks, sanitization, no cafeterias, and acrylic panel separators be d****d.  (Contrast your average office building with modern commercial aircraft where about 50 percent of air is recirculated at any one time, there’s a total change about every three minutes, and HEPA filters are used! AskThePilot, a great site for all things airline)

A return-to-work readiness strategy suggested here by a Harvard Medical epidemiologist whose main area is TB spread are germicidal UV lights high in the room to catch the viruses that go up, then down. UV light for sanitization and disinfection is a technology used for several years to disinfect patient care areas (PurpleSun is one). Far-UVC, versus near-UVC, and potential uses are outlined in this Nature article from February 2018.  Harvard Gazette

While telehealth virtual office visits flatten, overall up 300-fold; FCC finalizes COVID-19 telehealth funding program (US)

July 22, 2020 | by

As expected, the trend of telehealth visits versus in-person is flattening as primary care offices and urgent care clinics reopen. Yet the overall trend is up through May–a dizzying 300-fold, as tracked by the new Epic Health Research Network (EHRN–yes, that Epic). Their analysis compares 15 March-8 May 2020 to the same dates in 2019 using data from 22 health systems in 17 states which cover seven million patients. It also constructs a visit diagnosis profile comparison, which leads with hypertension, hyperlipidemia, pain, and diabetes–with the 2020 addition of — unsurprisingly — anxiety.

POLITICO Future Pulse analyzed EHRN data into July (which was not located in a cross-check by this Editor) and came up with its usual ‘the cup has a hole in it’ observation: “TELEHEALTH BOOM BUST”. But that is absolutely in line with the Commonwealth Fund/Phreesia/Harvard study which as we noted tailed off as a percentage of total visits by 46 percent [TTA 1 July]. But even POLITICO’s gloomy headline can’t conceal that telehealth in the 37 healthcare systems surveyed was a flatline up to March and leveled off to slightly below the 2 million visit peak around 15 April. 

Where POLITICO’s gloom ‘n’ doom is useful is in the caution of why telehealth has fallen off, other than the obvious of offices reopening. There’s the post-mortem experience of smaller practices which paints an unflattering picture of unreadiness, rocky starts, and unaffordability:

  • Skype and FaceTime are not permanent solutions, as not HIPAA-compliant
  • New telehealth software can cost money. However, this Editor also knows from her business experience that population health software often has a HIPAA-compliant telehealth module which is relatively simple to use and is usually free.
  • It’s the training that costs, more in time than money. If the practice is in a value-based care model, that is done by market staff either from the management services organization (MSO) or the software provider.
  • Reimbursement. Even with CMS loosening requirements and coding, it moved so quickly that providers haven’t been reimbursed properly.
  • Equipment and broadband access. Patients, especially older patients, don’t all have smartphones or tablets. Not everyone has Wi-Fi or enough data–or that patient lives in a 2-bar area. Some practices aren’t on EHRs either.
  • Without RPM, accurate device integration, and an integrated tracking platform, F2F telehealth can only be a virtual visit without monitoring data.

Perhaps not wanting to paint a totally doomy picture (advertising sponsorship, perhaps?), the interview with Ed Lee, the head of Kaiser Permanente’s telehealth program, confirmed that the past few months were extraordinary for them, even with a decent telehealth base. “We were seeing somewhere around 18 percent of telehealth [visits] pre-covid. Around the height of it, we’re seeing 80 percent.” They also have pilots in place to put technology in the homes of those who need it, and realize its limitations.

Speaking of limitations, the Federal Communications Commission (FCC) COVID-19 Telehealth Program, authorized by the CARES Act, is over and out. The final tranche consisted of 25 applications for the remaining $10.73 million, with a final total of 539 funding applications up to the authorized $200 million. Applicants came from 47 states, Washington, DC, and Guam. FCC release. To no one’s surprise, 40 Congresscritters want to extend it as a ‘bold step’ but are first demanding that Chair Ajit Pai do handsprings and provide all sorts of information on the reimbursement program which does not provide upfront money but reimburses eligible expenditures. That will take a few months. You’d think they’d read a few things on the FCC website first. mHealth Intelligence

Telehealth, virtual, and ‘omnichannel’ health winners in CVS’ ‘Path To Better Health’ study

July 17, 2020 | by

CVS Health’s third annual ‘Path to Better Health’ study contains both cheerful (for health tech) and distressing news (for practices). While we do have to consider the source–CVS Health definitely has an entire kennel of dogs in the fractionalization of health delivery race, HealthHUB as only one–the key findings illustrate a greater acceptance of telehealth and remote visits by the surveyed consumers. Providers seem to be shifting in the same direction, albeit not that dramatically.

Percentage results are 2020 versus the (2019 study).

Consumers are much more accepting of virtual communication:

  • Telehealth interest: 32 percent (14 percent)
  • Virtual office visit interest: 29 percent (20 percent)
  • Messaging interest: 48 percent (41 percent)
  • More women (35 percent) than men (27 percent) are interested 
  • 40 percent are interested in virtual behavioral health; 38 percent in virtual advice from a pharmacist

Providers are moving more slowly in connecting virtually with patients, though telehealth had the greatest boost:

  • Telehealth: 40 percent (22 percent)
  • Virtual office visits: 24 percent (23 percent)
  • Digital messaging through email, text and patient portals: 36 percent said they are very valuable for successful interactions with their patients

While the study does not speculate on the lagging acceptance numbers for providers except for telehealth, virtual visits (by telehealth!) and digital messaging add to workload and do not necessarily at this time have clear workflows.

Predictive analytics

  • 39 percent of providers claim that they already have or are likely/somewhat likely to incorporate predictive analytics into their practices within several years
  • 31 percent of providers are somewhat likely to incorporate predictive analytics or artificial intelligence
  • Acceptance is greater among providers with very large (450+ patient) practices (48 percent)
  • Younger providers with under 15 years of experience are also more likely to incorporate predictive analytics in their practices (50 percent), versus those over 15 years of experience (35 percent)

Mental health issues. Perhaps it was the timing of the study (March), but the need for mental health support, evidenced by social connection among those 18 to 34 and 35 to 50, was drastically on the rise–unhappiness among social connections (29-30 percent), no desire to be social (44-45 percent), not knowing where to meet new people (44-51 percent).

There is also a great deal of information on concerns around affordability of medical and drug costs, convenience, the cost of chronic disease management, mental and cognitive health, and community-based resources. In reading through the executive summary, it is easy to see how delivery of care has shifted from the primary care office and hospital to urgent care clinics, but interoperability (information sharing) is a major concern. 75 percent of physicians have a high to moderate concern of a looming physician shortage.

Methodology. The US survey was taken in March. The consumer sample was 1,000 18+. CVS oversampled 12 metropolitan statistical areas (MSAs): Atlanta, Austin, Boston, Cleveland, Dallas, Houston, Los Angeles, New York City, Philadelphia, Providence, Hartford, San Francisco, Tampa plus two ethnic groups: African American and Hispanic. 400 providers were surveyed, primarily primary care physicians and specialists with at least two years’ experience, as well as nurse practitioners, physician assistants, and pharmacists.

Infographic, Executive Summary, press release. Also Fierce Healthcare. (An annoying part of the summaries is that they state changes in percentage points as percentages.)

Philips awarded by VA 10-year, $100 million remote ICU, telehealth contract; partners with BioIntelliSense for RPM

July 17, 2020 | by

The US Department of Veterans Affairs (VA) awarded Philips a ten-year contract to build out their remote intensive care (ICU) service infrastructure to make it accessible to veterans from any location in the US. The VA currently manages 1,800 ICU beds nationwide in its approximately 1,700 sites. Based on the release, the Philips engagement in VA Tele-Critical Care will expand the VA’s current capabilities to encompass telehealth, tele-critical care (eICU), diagnostic imaging, sleep solutions, and patient monitoring. The agreement may total $100 million over the 10-year contract duration.

Philips has about 20 percent of the adult eICU market. They claim that 1 in 8 adult ICU patients are monitored 24/7 by their eICU Program, which combines audio/visual technology, predictive analytics, data visualization, and advanced reporting capabilities. Their proprietary research points to shorter ICU visits by eICU patients plus better outcomes. Healthcare IT News, Philips release (Photo: Philips)

By this Editor’s calculation, VA remains the single largest user of telehealth in the US. In their FY 2019, the first year of the ‘Anywhere to Anywhere’ initiative [TTA 24 May 2018], VA delivered more than 2.6 million telehealth episodes to 900,000 veterans. During the early part of the pandemic, they grew virtual home visits from an average of 10,000 to 120,000 per week. By the end of FY 2020, their goal is to deliver all primary care and mental health provider services, both in-person and via a mobile or web-based device. The VA release from November 2019 does not break out the different types of VA telehealth and usage.

Philips and BioIntelliSense have also inked a partnership deal to integrate BioIntelliSense’s BioSticker sensors into their post-acute remote patient monitoring (RPM) systems. The BioSticker is a wearable FDA-cleared 510(k) Class II sensor that transmits passive monitoring of key vital signs, physiological biometrics, and symptomatic events up to 30 days. The first announced user of the RPM+BioSticker systems will be Healthcare Highways of Frisco, Texas, a provider of health plans, employer self-funded health plans,  pharmacy benefit management, population health management, and benefit plan administration. Healthcare Highways is participating in seven patient monitoring programs to assess patient health status with providers: COVID-19, CHF, hypertension, diabetes, total joint replacement, cancer, and asthma. Release (Photo: Philips)

News Roundup: Doctor on Demand’s $75M Series D, Google’s Fitbit buy scrutinized, $5.4 bn digital health funding breaks record

July 9, 2020 | by

More evidence that telehealth has advanced 10 years in Pandemic Time. Doctor on Demand, estimated to be the #3 telemedicine provider behind Teladoc and Amwell, announced a Series D raise of $75 million, led by VC General Atlantic plus their prior investors. This increases their total funding to $240 million.

Unlike the latter two, DOD actively courts individual users in addition to companies and health plans. In May, they announced that they were the first to be covered under Medicare Part B as part of the CMS expansion of telehealth services in response to the pandemic (and for the duration, which is likely to be extended past July), which would reach 33 million beneficiaries. Other recent partnerships include a pilot with Walmart for Virtual Primary Care in three states (Colorado, Minnesota, Wisconsin) in conjunction with Grand Rounds and HEALTHScope Benefits as well as with Humana for On Hand Virtual Primary Care (regrettably only a video clip on the DOD press site with the noisome Jim Cramer). DOD covers urgent, chronic, preventative care, and behavioral health and claims about 98 million users, doubled the number of covered lives in 1st half 2020, and passed 3 million visits. Crunchbase News,  Mobihealthnews

Google’s Fitbit acquisition scrutinized by EU and Australia regulators, beaten up by consumer groups in US, EU, Canada, Australia, and Brazil. None too happy about this acquisition is a swath of powerful opponents.

  • EU regulators have sent 60-page questionnaires to both Google and Fitbit competitors asking re the effect the $2.1 bn acquisition will have on the wearables space, whether it will present disadvantages to competitors in Google’s Play store, and how Google will use the data in their advertising and targeting businesses. While #2 and 3 are no-brainers (of course it will present a competitive disadvantage! of course, they’ll use the data!), it signals further investigation. The next waypost is 20 July where EU regulators will present their decision.
  • The Australian Competition and Consumer Commission (ACCC) announced in mid-June their concerns in a preliminary decision, though they don’t have the jurisdiction to block it. “Buying Fitbit will allow Google to build an even more comprehensive set of user data, further cementing its position and raising barriers to entry to potential rivals,” according to ACCC Chairman Rod Sims. This adds to the controversy Down Under on how Google and other internet companies use personal information. Final statement is 13 August. Reuters
  • The US Department of Justice is also evaluating it, as is the Federal Trade Commission. But an acquisition like this doesn’t easily fall under antitrust regulation as Google and Fitbit aren’t direct competitors. Fitbit has only about 5 percent of the fitness wearable market. However, this plays into another related investigation by DOJ — Google’s abuse of advertising data and its dominance of the market in tech tools such as Google Ad Manager in the US. DOJ asked competitors for information at the end of June. There are separate investigations by state attorneys general and also by Congress of Google and Apple. Reuters. 
  • The consumer group opposition rounds up the usual suspects like Open Markets Institute, Omidyar Network, Center for Digital Democracy, Open Knowledge and Public Citizen in the US, and in the EU Open Society European Policy Institute and Access Now. Their grounds expressed in a letter to regulators in the above countries are the usual dire-sounding collection of “exceptionally valuable health and location datasets, and data collection capabilities.” Sound and fury….

It will keep Google’s attorneys in DC, Brussels, and elsewhere quite busy for a lot longer than perhaps Google anticipated. Meanwhile, Fitbit is in the Twilight Zone. The Verge, Android Authority, FierceHealthcare 

US digital health companies smash funding records in 1st half 2020. Despite–or because of–the pandemic, US digital health investment funding tracked by Rock Health is at a torrid pace of $5.4 bn–$1.2 bn above the record first half posted in 2019.  That is despite a pullback in 1st Q + April.

Investors came roaring back in May and June, spurred by telehealth success and a rallying market, closing 2nd Q with $2.4 bn in investment. That was 33 percent higher than the $1.8 bn quarterly average for the prior three years. And the deals were big: on average $25.1 million, with the big boosts in Series C and bridge financing. M&A is still cloudy, but what isn’t? Notably, Rock Health is not projecting a final year number, a good move after they stubbed their collective toe on last year’s final investment total, down from both forecast and 2018. [TTA 7 Feb]

The big moves of 1st half in real digital health (not fitness) were Teladoc-InTouch Health (just closed at $600 million stock and cash) and Optum-AbleTo (at a staggering $470 million, which has apparently not moved past the ‘advanced talks’ state). Two of last year’s Big IPOs–Phreesia and Livongo— are doing just fine; Health Catalyst not so much. The bubble bath we predicted turned out to be a cleansing one–but there’s six months more to go. Also Mobihealthnews

Kent County Council announces videophones for vulnerable residents in £1.5 million COVID response initiative (UK)

July 9, 2020 | by

Kent County Council has launched an initiative to connect 2,000 of its most vulnerable residents to KCC support staff. Alcove, an assisted care technology provider, and care transformation consultancy Rethink Partners will set up the videophone tablet-type units. The £1.5 million Video Carephone program will support “vulnerable and digitally disadvantaged elderly residents and those with a learning disability (who) will be able to receive virtual video care and health consultations, as well as video contact with friends and family while minimising the infection risk to other residents and care staff.” The unit is delivered to the person’s home, ready to go; presumably there is already in place an internet connection with a router as the KCC website release is not specific on the technical side.

This was rolled out in response to the COVID pandemic, but this program is also aligned with the national digital switchover program starting in 2023. The release also includes a testimonial from Robert Greenfield of Gravesend (above left). Diagnosed with multiple sclerosis 20 years ago, he set it up himself, using it not only to communicate with his home care provider but also friends and family. An interesting sidelight is that Mr. Greenfield edits a magazine (MS) for others with the MS diagnosis and will be writing about it. 

Walgreens Boots goes big with billion-dollar medical office deal with VillageMD

July 9, 2020 | by

Go big or go home. That seems to be Walgreens Boots Alliance’s’ theme in its 8 July announced deal with and investment in primary care provider VillageMD. They will set up 500 to 700 co-located full-service Village Medical offices in more than 30 markets over the next three to five years. The “Village Medical at Walgreens” offices will be staffed by a projected 3,600 primary care providers and fully integrated with Walgreens pharmacists for one-stop shopping. According to the release:

  • Most of the Village Medical medical offices will be approximately 3,330 square feet each, up to 9,000 square feet, and utilize existing store space. “80% will be used by VillageMD to fund the opening of the clinics and build the partnership.”
  • 24/7 care will be available via telehealth and at-home visits
  • Fees will be covered by insurance or for those without, on a sliding scale
  • Over 50 percent will be located in Health Professional Shortage Areas and Medically Underserved Areas/Populations, as designated by HHS. These would reach underserved “older, sicker, and poorer patients” without regular access to care, said VillageMD CEO Tim Barry in an interview with CNBC
  • Capacity would be 100 to 120 patients per day 

This follows on a pilot of five Village Medical clinics at Walgreens locations in Houston, and Village Medical’s eight-state expansion in the Find Care telehealth program announced in April.

Walgreens Boots Alliance will invest $1 billion in equity and convertible debt in VillageMD over the next three years, including a $250 million equity investment to be completed today which will culminate in about 30 percent ownership.

To this Editor, Walgreens is sitting at a giant poker table, stacking the $1,000 chips, and saying to its rivals, ‘see ya and raise ya’. These are full-service offices, not urgent care clinics, and they are investing in their provider. It could be transformative–or flop on executional niceties such as location, medical competition, or even COVID keeping down physical visits. The competition is also daunting on the retail side. Recently Walgreens has pared back hundreds of locations and faces the deep pockets of CVS-Aetna, which plans to open 1,500 HealthHUBs which integrate stores, MinuteClinics with nurse-practitioners, pharmacies, and health data, Amazon with PillPack aimed at its pharmacy business, and Walmart with its toe in the water with clinics. 

Village Medical, formerly Village Family Health, is a multi-state primary care provider which is part of Chicago-based VillageMD. Both include more than 2,800 physicians across nine markets, so the Walgreens deal will more than double their size. Also Forbes (Photo: Walgreens)

News roundup: Teladoc closes InTouch, Samsung bets on tele-genomics, SURE Recovery app, Optimize.health’s seed round, Walgreens’ Microsoft boost

July 3, 2020 | by

Teladoc completed the acquisition of InTouch Health on 1 July. The purchase, announced at the JP Morgan soireé in January (and an eternity ago) took place just before the ’10 years in 2 months’ leap forward in telehealth services. InTouch’s telehealth offerings are primarily for hospitals and health systems, heavily based on multi-feature carts and camera setups. The purchase price of $150 million in cash and 4.6 million shares of Teladoc Health common stock, valued then at $600 million, may be a great bargain for Teladoc considering the rich prices that other telehealth-related companies commanded during the peak of the pandemic, and that Teladoc’s revenue boosted to almost $181 million in revenue in Q1 2020, up 41 percent versus Q1 2019. Release

Samsung makes a telemedicine bet with Genome Medical. Through its Catalyst Fund, Samsung is the lead among 15 investors in a $14 million Series B extension financing that includes LRVHealth, Revelation Partners, and Kaiser Permanente Fund. Genome Medical’s connection to telemedicine is on-demand, standard-of-care genetics and genomics through virtual health services, including counseling, patient drug response, and provider-to-provider consults through its platform. Release. CNet. Crunchbase.

Mindwave Ventures, which this Editor noted last December was opening up an office in the Leeds health tech hub, has continued its development and research with multiple platforms and apps in partnership with NHS and academic/research clients. One that came on our ever-whirling radar screen is the release of the SURE Recovery app, for those in recovery from alcohol and drug problems. It enables users to work with the SURE (Substance Use Recovery Evaluator) and SUSS (Substance Use Sleep Scale) measures, plus a personal diary, to track their recovery over time. Mindwave developed the app in conjunction with The King’s College London and theInstitute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London. The app is now available to download; search ‘SURE Recovery’ on the App Store or Google Play. The page on the Mindwave site is on their Clinical Research page–click the tab for SURE. Hat tip to Ellis Noble of KC Communications.

Connected to telehealth and RPM is provider reimbursement. Optimize.health is an early-stage company which provides a turnkey setup for practices for its remote patient monitoring platform, with the usual features such as patient engagement, integrated devices with the platform, and call center support. The apparent difference is the emphasis on sharing data and simplifying reimbursement, the hard part of any RPM or telehealth platform. Announced this week: a $3.5 million seed round led by Bonfire Ventures. A small boost to this part of the telehealth field which has not had the great success of virtual consults. Release.

Back in January 2019, Walgreens Boots announced a partnership with Microsoft to migrate their IT over to the Azure platform. It took a while for results to manifest to the public. When COVID happened, they rolled out a COVID-19 risk assessment tool on its website and mobile app based on Azure. Their Find Care platform doubled the number of virtual care providers and services available. Walgreens also provided a link to COVID-19 clinical trials through the Find My Clinical Trial program on its mobile app. This article in FierceHealthcare touts how they are maneuvering to stay even with CVS Aetna and Amazon, which is hardly waiting for its partners in the gone-pearshaped Haven.

Hackermania runs wild, Required Reading Department: The Anatomy of a Ransomware Attack

July 2, 2020 | by

Cue the Duke Ellington score and Jimmy Stewart for the defense, we now have a moment-by-moment look at how a ransomware attack on an organization unfolds. The example is from a Ryuk ransomware attack last October on an unnamed organization.

      • The first step was a probe of the network via the Trickbot malware
      • Hackers then explored the network to determine a valuation–to monetize data
      • They then unleashed other tools in the Pivot and Profile phase–PowerTrick and Cobalt Strike–to search for open ports and other devices
      • The hackers, finding what they want, deploy their Anchor backdoor and Ryuk ransomware to secure their hold on the network
      • Total time from initial malware to Ryuk ransomware encryption: about two weeks

Ryuk has been a highly successful ransomware, netting its extortioners $61m in ransom between February 2018 and October 2019 according to the FBI. UK’s National Cyber Security Centre advisory indicates global attacks starting in later 2018.

The value in this study is substantial–the SentinelOne article is chock full of terminology and screenshots a programmer or white hat would love. It also reveals a multi-step process that if stopped at step 1 (the Trickbot malware) means a tougher nut to crack for the hackers, and a nearly two-week window for a response. ZDNet’s article is written for us ‘civilians’. The sidebar has links to several articles, including this horror compendium from UK victims, ‘The most stressful four hours of my career‘.  Earlier: Hackermania runs wild…all the way to the bank!