A ‘next generation’ house call from the patient’s perspective

July 10, 2016 | by

Guest editor Sarianne Gruber (@subtleimpact) attended May’s d.health Summit on Aging in NYC. She reflects on moderator Christina Farr’s (immediately prior) direct experience with a virtual visit (convenience, proactive care–and utter frustration with her payer) and what the telemedicine ‘next gen’ provider panelists see as their advantages in fixing a fractured healthcare system.

Christina Farr had a “Next Generation” house call for the first time. The on-demand doctor’s visit provided her care and resolved the possibility of a trip to the emergency room, and best of all she felt great. Ms. Farr, an award-winning health and technology journalist, happen to have had her encounter just days prior to the d.Health Summit. Coincidentally, she was to be the moderator for a panel of prominent telehealth business leaders on this very topic. Curious after having had this experience, she wanted to know whether most cases were like hers wondering if they should go to ER, or were the visits more for routine things like coughs and colds, or did people just want a prescription. The d.Health panelists included Damian Gilbert, Founder & CEO of TouchCare (@touchcarehealth), Oscar Salazar, Chief Product Officer and Co- Founder of Pager (@getpager), Dr. Ian Tong, Chief Medical Officer of Doctor on Demand (@drondemand), and Dr. Roy Schoenberg, Co-Founder, and CEO of American Well (@americanwell).  (more…)

Theranos denouement: CMS closes lab, fine, 2-year ban on Holmes (breaking)

July 8, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/04/Yak_52__G-CBSS_FLAT_SPIN.jpg” thumb_width=”150″ /]Breaking News. Theranos has been slapped very soundly by the Centers for Medicare & Medicaid Services (CMS) for violations arising from operations at their Newark, California laboratory. The fine is not disclosed. CMS has revoked the lab’s certificate and also prohibits the owners and operators of the lab from operating a lab for at least two years. That means that Elizabeth Holmes, the CEO, her management and anyone immediately involved with the Newark lab is effectively out of a job.

As the Theranos press release was issued well after hours Thursday night US Eastern Time, there’s no mention of the board actually removing her, but that is another shoe that this Editor expects to drop sooner, not later. COO Sunny Balwani was removed in May [TTA 19 May] Who is not tainted who can actually run the company? Is there a capable person in the industry who wants to touch it? As has been revealed, Ms Holmes still controls the company [TTA 27 Apr].

The revocation will be in effect in 60 days, according to the Wall Street Journal*, but the Newark lab has been closed. There is no mention of the Palo Alto lab which was also under scrutiny [TTA 20 Apr].

The details appear to be lifted or nearly lifted from the CMS order, and are quoted directly from the Theranos release: (more…)

AHRQ ‘evidence map’ pinpoints chronic condition telehealth, telemental health (US)

July 6, 2016 | by

The US Government’s Agency for Healthcare Research and Quality (AHRQ) released a final and fairly positive report analyzing telehealth effectiveness. It was a meta-review of 58 systematic research reviews on telehealth. Criteria were that the studies could examine real time or asynchronous telehealth, onsite or at distance, and that the patient interacted with healthcare providers for the purposes of treatment, management, or prevention of disease.

The abstract’s conclusions are positive for remote patient monitoring (RPM) for chronic conditions and for telemental health:

  • Positive outcomes came from the use of telehealth for several chronic conditions and for psychotherapy as part of behavioral health
  • The most consistent benefits were when telehealth was used for communication and counseling, plus remote monitoring in chronic conditions such as cardiovascular and respiratory disease
  • The improvements were in outcomes such as mortality, quality of life and reductions in hospital admissions

POLITICO’s Morning eHealth has additional and most interesting background. The AHRQ was tasked by two Senators, John Thune (R-SD) and Bill Nelson (D-FL) to analyze telehealth for effectiveness through a literature review and “to give a government’s view – not an industry-funded study or a poorly-conducted academic study – on what the technology could do if, for instance, Medicare paid for more of it.” The December draft seemed to be ambiguous on telehealth studies to date, citing uneven quality and the poor definition of telehealth. (more…)

Detecting a serious car crash, summoning help via smartphone (SA)

July 6, 2016 | by

An intriguing application of accelerometry was featured by BBC News this week. South Africa’s CrashDetech claims to be the first in detecting a serious car crash by using the accelerometer sensors in your phone that measure the g-force of an impact. The app automatically then locates the driver and dispatches the nearest ambulance with paramedics who already know the user’s medical history. Of course CrashDetech needs to access your records, but you are one of those with a PHR, right? It’s being deployed first in South Africa, which according to their website is one of the most dangerous countries in which to drive. Even worse than the NY metro area? Which sets our mind once again on wondering whatever happened to smartphone fall detection… Hat tip again to Mike Clark via Twitter.

IoT and the inevitable, looming Big Data Breach

July 6, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye returns to once again cast a baleful gaze on All Those Connected Things, or the Plastic Fantastic Inevitable. Those 6.4 million Wi-Fi-connected tea kettles, smart fridge, remotely adjusted pacemakers (and other medical devices) plus home security two way video systems that accost the dodgy door ringer sound just peachy–but how good is their security? Not very, according to the experts quoted in this ZDNet article. It’s those nasty security flaws in IoT which were patched out 10 years ago on PCs that make them incredibly risky to have, as they can vector all sorts of Bad Things into both personal and enterprise networks. Their prediction is that a Connected Device with a big flaw will become molto popular and provide a Target a Hacker Can’t Refuse within two years. Or that some really clever hacker will write ransomware that will shut down millions of Connected Cars’ CPUs or disable the steering and brakes if 40 bitcoins aren’t placed in a brown paper bag and left on the third stool of the pizzeria at 83rd and Third.

Not much has changed since Eye wrote about those darn Internet Thingys last year [TTA 22 Sept 15]. The mystery is of course why these antique flaws are even part of the design. Designers being cheapskates? No consideration of security? (more…)

A weekend potpourri of health tech news: mergers, cyber-ransom, Obama as VC?

July 1, 2016 | by

As we approach what we in these less-than-United States think of as the quarter-mile of the summer (our Independence Day holiday), and while vacations and picnics are top of mind, there’s a lot of news from all over which this Editor will touch on, gently (well, maybe not so gently). Grab that hot dog and soda, and read on….

Split decision probable for US insurer mergers. The Aetna-Humana and Anthem-Cigna mergers will reduce the Big 5 to the Big 3, leading to much controversy on both the Federal and state levels. While state department of insurance opposition cannot scupper the deals, smaller states such as Missouri and the recent split decision from California on Aetna-Humana (the insurance commissioner said no, the managed care department said OK) plus the no on the smaller Anthem-Cigna merger are influential. There’s an already reluctant Department of Justice anti-trust division and a US Senate antitrust subcommittee heavily influenced by a liberal think tank’s (Center for American Progress) report back in March. Divestment may not solve all their problems. Doctors don’t like it. Anthem-Cigna have also had public disagreements concerning their merged future management and governance, but the betting line indicates they will be the sacrificial lamb anyway. Healthcare Dive today,  Healthcare Dive, CT Mirror, WSJ (may be paywalled) Editor’s prediction: an even tougher reimbursement road for most of RPM and other health tech as four companies will be in Musical Chairs-ville for years.

‘thedarkoverlord’ allegedly holding 9.3 million insurance records for cyber-ransom. 750 bitcoins, or about $485,000 is the reputed price in the DeepDotWeb report. Allegedly the names, DOBs and SSNs were lifted from a major insurance company in plain text. This appears to be in addition to 655,000 patient records from healthcare organizations in Georgia and the Midwest for sale for 151 – 607 bitcoins or $100,000 – $395,000. The hacker promises ‘we’re just getting started’ and recommends that these organizations ‘take the offer’. Leave the gun, take the cannoli.  HealthcareITNews  It makes the 4,300 record breach at Massachusetts General via the typical unauthorized access at a third party, once something noteworthy, look like small potatoes in comparison. HealthcareITNews  Further reading on hardening systems by focusing on removing admin rights, whitelisting and endpoint security. HealthcareDataManagement

Should VistA stay or go? It looks like this granddaddy of all EHRs used by the US Veterans Health Administration will be sunsetted around 2018, but even their undersecretary for health and their CIO seem to be ambivalent in last week’s Congressional hearings. According to POLITICO’s Morning eHealth newsletter, “The agency will be sticking with its homegrown software through 2018, at which point the VA will start creating a cloud-based platform that may include VistA elements at its core, an agency spokesman explained.” Supposedly even VA insiders are puzzled as to what that means, and some key Senators are losing patience. VistA covers 365 data centers, 130 separate VistA systems, and 834 custom installations, and is also the core of many foreign government systems and the private Medsphere OpenVista. 6/23 and 6/24

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/01/Overrun-by-Robots1-183×108.jpg” thumb_width=”150″ /]Dr Eric Topol grooves on ‘The Fourth Industrial Revolution’ of robotics and AI. (more…)

Sonde Health using voice as a biomarker for diagnosis

June 30, 2016 | by

Back in 2013, we profiled Max Little of the UK-based Parkinson’s Voice Initiative, who was in the fairly early stages of voice testing and analysis to aid early diagnosis of this disease. By 2015, he had over 17,000 voice samples, was partnering with the Michael J Fox Foundation, and was seeking to develop a non-invasive, quick, accurate test based on acoustic markers. Dr Little is an Oxford University PhD, currently a Wellcome Trust/MIT fellow at the MIT Media Lab. The Voice Initiative has additional support from PatientsLikeMe, Twilio and Aculabcloud.  But also developed at MIT, by Thomas Quatieri’s team at MIT’s Lincoln Laboratory, is a broader platform for voice diagnosis. This has been applied to mental health conditions such as depression, respiratory and cardiovascular conditions, and in pilots for TBI, cognitive impairment and…Parkinson’s. This has been licensed to Sonde Health, which hasn’t much on their website but is out of the Boston-based PureTech R&D/venture firm. The acoustic markers they cite are ‘dynamic changes in pitch and harmonics, articulation timing and hoarseness or breathiness that indicate and requires no analysis of words’. MedCityNews, MedTechBoston

Medtronic’s moves in post-acute cardiac care management, monitoring

June 30, 2016 | by

Medical device giant (and inverted to Dublin) Medtronic announced today the launch of their Beacon Heart Failure Management Service in the US. It combines their implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) devices with post-acute patient monitoring from Medtronic Care Management Services (MCMS). The patients are checked both through their recorded cardiac device diagnostics and what they called ‘branching logic’ questions which collect daily qualitative, biometric and symptom information, plus provide patient education. Care managers then review the data along what they term ‘established clinical pathways’ check for growing risk factors and alert providers if needed.

What is interesting is that the in-home delivery and collection platform or hub is not specified. Medtronic happens to own one of the telehealth pioneers, a company which used to be called Cardiocom–which is now part of Medtronic Care Management Services in their Cardiac and Vascular Group (CVG).

No launch clients/partners are mentioned, save a quote from a cardiologist at The Stern Cardiovascular Foundation in the Memphis TN area. Release, FierceMedicalDevices

In other Medtronic news, earlier this week they announced the acquisition of cardiac device company HeartWare for $1.1 billion. HeartWare has developed small implantable (more…)

Tracking ER ‘frequent flyers’ community-wide to coordinate care, reduce readmissions

June 29, 2016 | by

“There are folks who have a life of going from emergency department to emergency department, and that’s how their day is spent,” said Sorrell, an emergency physician and administrator at Sutter Health. “It’s sad and tragic, but that’s what happens.”

Alameda County,  just south of San Francisco, spans both wealth (Berkeley)- and poverty-stricken (Oakland) – parts of California. What it has a lot of as well are ER (ED) ‘frequent flyers’ a/k/a ‘super-users’. Some can’t manage their chronic conditions, while others are looking for a meal, a warm bed, safety or human contact. What is also true is that 1) this is an expensive and largely unnecessary form of medicine and social care, 2) there’s a lot of duplicated resources being utilized which are needed elsewhere and 3) the patients aren’t receiving the right sort of care for a better quality of life.

Since a data sharing program, PreManageED, was implemented on 31 March in four Sutter Health hospitals and two Alameda Health System hospitals, two hospitals found that they shared more than 2,000 patients, with over one-third having 6+ visits to the ER in the past year. But this is more than duplicate procedures, multiple EMS calls and badly coordinated care resulting in Medicare or Medicaid penalties. The Alameda hospitals are also integrating local community clinics and social services organizations into PreManageED so they receive alerts from the hospitals when their patients/clients arrive in the ER. It turns out that many patients are receiving social services from multiple agencies–also duplicated and uncoordinated. There is an example here of a mentally ill patient who visited ERs over 900 times in three years. Over 24 separate people had provided her with medical, emergency and social services–and none of them knew what the other was doing. The Alameda County program is a step to bring these ‘frequent flyers’ down to earth and improve their outcomes. Kaiser Health News

A busy Nokia, Withings to partner with HUS/Helsinki University neurology center (FI)

June 29, 2016 | by

Nokia Technologies, wasting no time with deploying its latest acquisition Withings, announced a new partnership with Finland’s largest neurology and leading stroke center at HUS/Helsinki University Hospital and University of Helsinki. Withings devices will be used to develop home-based remote monitoring platforms for HUS. This marks Nokia/Withings move into clinical-level monitoring from its present base in wellness devices. HUS is a five-hospital system centered on Helsinki University Hospital. Its Department of Neurology treats 14,000 patients each year at the Meilahti Hospital Neurological Outpatient Clinic, and specializes in the diagnosis, treatment and rehabilitation of diseases of the nervous system or the brain, spinal cord, peripheral nervous system and muscles. Nokia release  mHealth Intelligence

Nokia is on a roll, closing on the Withings acquisition 31 May and opening up a headquarters in San Francisco for their Digital Health business unit led by Cédric Hutchings, the former Withings CEO. A week later, they announced the Withings Body Cardio which measures in seconds weight, BMI, body composition (fat, muscle, water and bone mass), standing heart rate and PWV — a measurement that is a key indicator of cardiac health and associated with hypertension and risks of cardiovascular incidents. It will be sold only on Withings.com and Apple Stores worldwide, priced at $179.95. In early June, Nokia announced the 4th annual Open Innovation Challenge focusing on the Internet of Things (IoT) for public safety, connected automotive, industry 4.0, digital health, utilities, security and smart cities. Submissions close 15 August. The Nokia Growth Fund has a $350 million piggybank for IoT investment (and we hope secure IoT).

Nokia is also proceeding with the full acquisition of Alcatel-Lucent, establishing a 5G network  and licensing its brand name to HMD for mobile phones.

Forbes also has a fairly long disquisition on why Nokia is moving into healthcare, citing PWC’s 2014 forecast of a $ 2.8 trillion US “new health economy” in the next ten years. But our Readers saw it here first in October and April!

2016 International Conference on Successes and Failures in Telehealth (NZ)

June 29, 2016 | by

31 Oct-3 Nov 2016, SKYCITY Convention Centre, Auckland New Zealand

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/HiNZ16_SFT16_AUCKLAND_1000_x-1.jpg” thumb_width=”100″ /]Hurry if you want to submit your abstract! The 7th Annual Meeting of the Australasian Telehealth Society (SFT-16) is actually a 4-in-one conference, held concurrently with the Global Telehealth Conference (GT 2016), the Health Informatics New Zealand Conference (HiNZ 2016), and the NZ Nursing Informatics Conference (NZNIC-16). Delegates register for one, and can attend any session in the four conferences. Topics for SFT-16 include telehealth in Australia and New Zealand, the future of clinical telehealth, the telehealth business and the state of evidence. Abstracts in the categories of scientific papers and case studies are still being accepted through Monday 4 July midnight NZ time, and according to HiNZ’s Twitter feed, extensions are available by emailing ceo@hinz.org.nz . It’s also supported by organizations including American Telemedicine Association (ATA, a TTA media partner), the University of Queensland and the International Society for Telemedicine and e-Health (ISfTeH). Registration appears not to be up yet. Website

Telemedicine finally gets some respect: WSJ

June 28, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/long-windy-road.jpg” thumb_width=”250″ /]Telemedicine consults between doctors and with their patients are, at long last, progressing on the Long And Winding Road, according to this sizable recap in the Life and Health section of this weekend’s Wall Street Journal. The focus is on virtual visit growth in the US, but it opens with Doctors Without Borders (MSF) connecting their doctors in Africa with their specialist network worldwide. Mercy Health provides 24/7 ICU/ER support for 38 local hospitals out of a Virtual Care Center outside St. Louis manned by ICU specialists. Their results? A 35 percent decrease in patients’ average length of stay and 30 percent fewer deaths than anticipated. The important statistics here are on acceptance: 72 percent of hospitals and 52 percent of practices are finally integrating some form of telemedicine into care; 74 percent of large employers are covering telemedicine cost–yet awareness is still lagging among prospective patients, with only 39 percent familiar with it according to a recent survey. Challenges remain in reimbursement (more…)

Events last week beyond Brexit: London Technology Week, CE Week NYC

June 28, 2016 | by

The world may have turned upside down (and around) with Brexit, but London Technology Week happened nevertheless. It’s exploded into 400 events and 43,000 attendees, with 300 attending an event at London City Hall on health tech within the NHS. (Attendees invited to contribute in Comments.) Designer Brooke Roberts, an ex-NHS radiographer who advocates the fusion of fashion and tech, debuted her brain scan-inspired knitwear, accomplished by translating scans into digital files capable of programming industrial knitting machines. According to GP Bullhound in their annual European Unicorns report, 18 of Europe’s 47 billion-dollar digital startups are now based in the UK. So who needs the EU?  TechCityNews, CNN, Yahoo Tech

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/MonBaby.jpg” thumb_width=”200″ /]On the other side of the Atlantic, there was a disappointing absence of wearables and health tech at the Consumer Electronics Association’s NYC summer event, CE Week. It’s been a major feature since 2009 at International CES in January; the NYC summer show and the November CES preview had always featured a mostly local exhibitor contingent and conference content. None this year–a representative cited a mystifying ‘change in direction’. There was one lone wearable way back in the exhibit hall–MonBaby, which came in from 16 blocks uptown. The snap-on button monitor works with any garment (unlike the Mimo onesie and the Owlet sock) (more…)

Data breach cost crests $4 million: Ponemon Institute

June 22, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”150″ /]The average fully allocated cost of a data breach, according to the 2016 Ponemon Institute study (sponsored by IBM) is now over $4 million. The average global cost of every lost or stolen record is $158, but for healthcare organizations, that average cost is $355 per record, which reflects the higher street value of healthcare information. Healthcare was the second most ‘churned’ type of organization, surpassed only by financial services. Across the industries surveyed, hacking and ‘inside jobs’ caused the most data breaches overall–48 percent. (Hackermania does really run wild!) Healthcare organizations can mitigate costs by being proactive in detecting breaches early, having a CISO (chief information security officer), instituting employee training and awareness programs, deploying encryption and endpoint security plus a business continuity management plan. Ponemon/IBM website. Healthcare IT News

Threat hunting is also emphasized in a second Ponemon study sponsored by Raytheon, which recommended offensively hunting down threats to data security, and defensively setting up a security barrier to protect patient data and care systems. With nation-state attacks (think China and Russia), ransomware, compromises due to IoT (add outdated software), and physical data theft, the game is now complete control rather than plain ol’ disruption. After the attack, when most healthcare organizations finally get into gear on cyberthreats, is far too late. Ponemon/Raytheon ‘Don’t Wait’. Healthcare IT News

The healthcare future according to Britons before London Technology Week

June 22, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/ltw-2016-logo1.jpg” thumb_width=”150″ /]More robots than people, VR visits to the GP and 3D printed human organs were among the predictions in a survey of over 2,000 British adults. Also in their collective vision in the next 20 years (2036) were communications devices being embedded inside the human body (37 percent), a cloned human born by that year (50 percent), clothing connected to the internet (50 percent) and more driverless cars than conventional models. The study was conducted by SMG Insight and YouGov, commissioned by London & Partners, the Mayor of London’s promotional company, in the runup to London Technology Week through 26 June, highlighting London as a global technology hub. According to their release, an EY report ranked London as second only to Silicon Valley as the most likely place to produce the world’s next tech giant. The event also promotes Imperial College London’s Foresight team and their Tech Foresight 2036 on 24 June.  Also ITPro.

Robot greeter on the job at Ostend, Belgium hospital–and those killer robots

June 21, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/Robot-Belgique-1.png” thumb_width=”250″ /]This humanoid (but not Terminator-like, its developers are careful to say!) robot is currently on the job as a receptionist at Ostend, Belgium hospital AZ Damiaan. Equipped with healthcare-oriented software developed by local company Zora Robotics, the Aldebaran/SoftBank Robotics’ demure Pepper robot stands 1.2 meters (just under 4 feet), speaks 19 languages and works for about 20 hours on a single charge. Pepper communicates via its tablet interface but also is responsive to actions and emotions in what SoftBank calls a natural and intuitive way. The Pepper robot was first deployed in the hospital’s maternity area. The video has an awwwww…. illustration of a newborn grasping Pepper’s fingers. Previously, the toddler sized Nao robot worked with patients at AZ Damiaan for physical therapy. (Nao robots have also been featured in modern dance and as greeters at Japanese hotels and banks.) Reuters (video 1:51)

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/robottoy-1.jpg” thumb_width=”150″ /]This is a far more benign take on robots than the Daily Mail‘s recent screamer that “Killer robots are ‘quickly moving toward reality’ and humanity only has a YEAR to ban them” which conflates drone weaponry (human guided) with ground robots (human guided). As of now, They’re Still Puppets (more…)