The Theranos Story, ch. 20: How Arizonans fell hard and let Theranos change health policy

September 15, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/upside-down-duck.jpg” thumb_width=”150″ /]The face is in the lake, and the yellow duck is upside down–augering in! A flatly-spinning Yak-52 no longer describes the glide path of Theranos, now at value 0. So as the dust settles, the Tales of When The Circus Came to Town are dusted off and published. Here Tim Steller, a writer and columnist with the Arizona Daily Star, reminisces on those dazzling Arizona days back in March 2015–18 short months ago–when Elizabeth Holmes swept into Phoenix in her bodyguarded SUV, trailing lobbyists and dropping names. The state legislature and Governor Doug Ducey, by this telling, were mere putty in her hands, star-struck into approving a bill permitting direct consumer ordering of lab tests, over the objections of the Arizona Medical Association and the questioning of the two doctors in the legislature. The Big Question–“does your blood-testing technology work?”–never was asked, and only two voted against the bill. At least Theranos only sought deregulation to facilitate its placement in Walgreens; Zenefits, another one-time Unicorn, gained employment incentives for its online HR-benefits brokerage, which were voided with recent layoffs. Tucson.com  See here for the 19 previous TTA chapters.

Diabetes management: the Next Big Health Tech Thing?

September 14, 2016 | by

Big Data? Passé. Health IT security and hacking? At a peak. So what’s the Next Big Thing? If you’re tracking where the money’s going, it’s diabetes management. This week saw the joint venture Onduo formed by the controversial [TTA 6 Apr] life sciences-focused Verily (Google Alphabet) and Big Pharma Sanofi with a nest egg of $500 million. Onduo will be combining devices with services to help Type II diabetics. Based upon CEO Joshua Riff’s statements to MedCityNews, their platforms are yet to be developed, but “will be a digital platform that will involve software, hardware, and very importantly service” to change patient behaviors. Partnerships with Sutter Health in Northern California and Allegheny Health Network of western Pennsylvania will test their approaches in a clinical setting. Xconomy, Reuters

Verily’s other diabetes project include the £540 million bioelectronics partnership announced in August with UK-based GSK in Galvani Electronics [TTA 3 Aug] with a focus on inflammatory, metabolic and endocrine disorders, including Type II diabetes. With Dexcom, Verily is also building an inexpensive, smaller next-gen continuous glucose monitoring sensor; Mr Riff was coy about whether this sensor would be used but allowed that sensors might be used in Onduo’s approaches. Verily is also developing the well-known glucose-reading contact lens with Novartis [TTA 1 Sep 15].

Also this week, Glooko and Sweden’s Diasend announced their merger (more…)

Put them on the calendar: autumn/winter UK health tech events

September 14, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/09/calendar.png” thumb_width=”150″ /]September means that we come back from our holidays. Those smartphone calendars come out and the gaps are filled for the last part of the year into 2017 (gasp!) Here’s our (now separate) starter list for UK.

The RSM’s Telemedicine and e-Health Section (which is chaired by our own Contributing Editor Charles Lowe, who will be updating them as usual)…Event listings here and surely more to come (All at the RSM)

Point of care testing: disruptive innovation – is the NHS ready for it yet?   22 November

Recent developments in digital health   28 Feb 2017

The King’s Fund’s upcoming meetings involving healthcare technology (All at The King’s Fund)

Designing digital services around users’ needs   6 Oct 2016
Learning from clinician and patient-centred service design

Integrated Care Summit 2016   11 Oct 2016
Improving local population health and delivering accountable care (more…)

Put them on the calendar: upcoming US IoT, connected health events (updated)

September 13, 2016 | by

September means that we come back from vacations and holidays. The calendars come out and we start to fill in the gaps for the next few months into (gasp!) 2017. Here’s a forward look through to next August for US healthcare and IoT  conferences, including International CES.

If you’re in Dallas this coming Thursday, the Health Wildcatters accelerator is premiering their new office at Pacific Place with a bash starting at 5:30pm. Reserve tickets quickly and find out more #HWGrandOpening Hat tip to Hubert Zajicek

Since TTA’s been a media supporter of Parks Associates’ Connected Health Summit for the past two years, here’s a sample of their other IoT and connected home events.

CONNECTIONS™ Europe  (Smart home, IoT and the connected consumer)
November 2-3, 2016, Amsterdam     www.connectionseurope.com

CONNECTIONS™ Summit at CES
January 5, 2017, CES, Las Vegas    www.connectionssummit.com

CONNECTIONS™: The Premier Connected Home Conference
May 23-25, 2017, San Francisco   http://www.connectionsus.com

Connected Health Summit: Engaging Consumers
August 29-31, 2017, San Diego  www.connectedhealthsummit.com

December is a big month for US conferences; three of note (and likely partners again) are:

MedStartr Momentum (MedMo16) (more…)

The Theranos Story, ch. 19: the dramatic denouement, including human tragedy

September 9, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/04/Yak_52__G-CBSS_FLAT_SPIN.jpg” thumb_width=”150″ /]The deconstruction of Theranos continues, con il dramma, rounding back to those who touted it. There isn’t all that much new in Nick Bilton’s Vanity Fair article, but it adds context and color to this (literally) Bloody House of Smoke and Mirrors. (Ah, where’s Christopher Lee when you need him?–Ed.) There’s the usual Inside Baseball of closed-door meetings in ‘war rooms’, G150 jetting to awards, bodyguards, threatening lawyers, crisis managers, COO ‘enforcers’ (Sunny Balwani) and playing the Silicon Valley investor game (with Google Ventures taking a very smart pass). Where this gets unusual is the portrait of Elizabeth Holmes as an obsessive, secretive, blondined Steve Jobs knockoff from the age of 19, with a hot idea that never matched scientific reality from the start, but with a great line of ‘making the world a better place’ magnified by Silicon Valley’s incessant, We’re The Top And You’re Not narcissism.

Even Narcissus ultimately saw a fool in that pool. Played and tarred to a greater or lesser degree were: the only major SV VC lured in, Draper Fisher Jurvetson, and off-SV investors like mutual funds and private equity have lost it all; Fortune, Forbes, CNN plus much of the tech and financial press; and respected people lured to the board like Marine Gen. James Mattis, who had initiated the pilot program in DOD, Henry Kissinger and former Senator Bill Frist MD. Then the alphabet agencies marched in after the author: FDA, CMS, SEC and DOJ.

Oh yes, that Zika test announced in early August? Withdrawn at end of August. Ms Holmes is appealing her two year lab ban. But she still has absolute control of what’s left of the business. Business Insider

Finally, the lede in many articles is the suicide of British chief scientist Ian Gibbons and Ms Holmes reaction. Already ill with cancer, (more…)

A hybrid telehealth/telemedicine model for health systems

September 9, 2016 | by

Your Editors have been projecting that the Big Future of telecare-telehealth-telemedicine lies in integrating services, not the Big Data backend (though there’s a Big Role there). These three have to be more tightly aligned with health systems, whether ACOs/IDNs (US) or the NHS. Most of our consideration has been where they go at the end of acute care–transitional care (post-discharge/post-acute–those bed-blockers)–but here’s a different approach that puts them at the start of the care continuum. Minneapolis-based Zipnosis [TTA 13 May] has an asynchronous platform that is ‘white labeled’ for a health system and carries their branding. Their model uses pre-screening/assessment first–an ‘adaptive questionnaire’ taken online or on mobile, compiles the information, then depending on the result, returns to the patient to schedule a virtual (video/audio) consult, lab visit or referral to a physician. The smart parts are that this is completely within the the health system and integrates with their EHR, making it reimbursable. It also can be used to expand the patient base even if the care is short term or episodic.

Zipnosis currently has 17 health system clients. The latest is Fairview Health Services in Minneapolis where the system test is first with their 22,000-plus employee workforce. The focus is on early detection of diabetes and heart disease. Also recently announced were two Nebraska health systems, Bryan Health and Memorial Health Care. Somebody likes the model as their Series A back in January was $17 million led by Safeguard Scientifics with participation from Ascension Ventures, the investment arm of Ascension, a large Catholic health system. mHealth Intelligence, Becker’s Health IT, HealthcareITNews,

A review of digital health patent slugfests and Unintended Consequences

September 7, 2016 | by

Mobihealthnews provides a recap of the past four years of patent actions pitting company against company in the hushed but deadly rings of the US Patent and Trademark Office (USPTO) and the US International Trade Commission. On the fight card: the never-ending American Well-Teladoc bout (Teladoc winning every decision so far by a knockout [TTA 18 June]–a second American Well patent being invalidated on 25 August); CardioNet vs MedTel, which the former won but has had to chase the latter out of the arena and down the street to collect; Fitbit-Jawbone which has gone both ways [TTA 27 July]; and the long trail of blood, sweat and Unintended Consequences around Bosch Healthcare’s heavyweight IP pursuit against mainly flyweight early-stage companies (not noting, as we did, their apparent ‘draws’ vs Philips and Viterion, then owned by Bayer).

The Reader will note our tracking Bosch’s activities go back to 2012 (here, here and here). Moreover, with Mr Tim Rowan of Home Care Technology, we broke the news of Bosch’s demise in June 2015, drawing the conclusion that their offense versus Cardiocom’s patents (now in Medtronic’s cardiac division) directly led to the invalidation of their key patents, IP–and the very basis of the company’s existence. See the 19 June 2015 article and our recap one year later in reviewing AW-Teladoc. (Any similar phrasing or conclusions within the Mobihealthnews article, we will leave to our Readers to decide!)

The ‘right package of care’ sought for ‘bed-blockers’, home care (UK/US)

September 7, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”150″ /]’Bed-blocking’ as a signal failure of transitional care. Here is a term that may be unique to the UK, but not the problem: older people who cannot be discharged after an illness because there is no plan and no suitable place for transitional care and/or a safe return home with care. According to the Guardian, the term originated among UK healthcare managers and economists as early as the late 1950s as a marker of system inefficiency. The writer, Johnny Marshall, director of policy for the NHS Confederation, correctly notes that it should be a marker of “(a) system that has failed to move quickly enough to put together the right package of care to enable the person in the bed to return home” and that unfairly blames the patient. He gives examples of programs across Britain with home assessment and care, particularly for older people post-fall injury, that reduce or eliminate hospital days.

In the US, transitional care is pointing to a blend of home care tech/services. Some of the indicators for LTC support that Laurie Orlov points out in Tech-enabled home care — what is it, what should it be?: 

  • Assisted living growth is flat as this past weekend’s open can of soda–housing is chasing residents (though cost doesn’t seem to be following the usual supply/demand curve), the average resident is 87 years old and staying 22 months, and their net worth can’t afford present AL
  • There’s a huge and growing shortage of home care workers for an ever-increasing number of old and old-old
  • Yet finally big investment is taking place in tech-facilitated home care locating and matching: Honor.com, Care.com and ClearCare–a total of just under $150 million for the three

But can technology–front and back end–make up for the human shortage? And there’s a value in wearing the Quantitative Self hat here. (more…)

Contact lenses as sight-saving drug delivery system

September 7, 2016 | by

A drug-dispensing contact lens has shown success in effectively lowering eye pressure in monkeys with induced glaucoma. In what is termed a ‘pre-clinical model’, the study found that the medication, latanoprost, usually administered by the patient in conventional eye drops, in the contact lens form had equal or better intraocular pressure reduction. To quote the study’s first author, “We found that a lower-dose contact lens delivered the same amount of pressure reduction as the latanoprost drops, and a higher-dose lens, interestingly enough, had better pressure reduction than the drops in our small study,” said Joseph B. Ciolino, M.D., an ophthalmologist at Massachusetts Eye and Ear and an Assistant Professor of Ophthalmology at Harvard Medical School. The design of the lens does double duty: the periphery contains the thin film of drug-encapsulated polymers that slowly releases the drug; the center of the lens is clear and breathable, thus usable for standard vision correction.

Contact lenses for drug delivery have been for decades intriguing to researchers, but the embedded drug delivery has been too rapid to be effective in most cases; thus the polymers and the design are critical in slowing delivery. (more…)

Connected health: what’s different than last year?

August 31, 2016 | by

This Editor was interested in what the organizers of the annual Connected Health Summit, now taking place in San Diego, are seeing as the differences in the digital health and remote monitoring sector over the past year. This year, Parks Associates promoted it as “spotlight(ing) health technologies as part of the Internet of Things (IoT) phenomenon and the transformational impact of these connected solutions on the US healthcare system.” I’ve been reading Parks’ research since 2006, when telecare was riding quite high, but the marketplace between consumer and enterprise-focused tech, monitoring and analytics has exploded. I asked Stuart Sikes, President of Parks Associates, for toplines on the key differences in the market and the conference between last year and this. It’s shifting to implementation, how to streamline processes around data, making data useful….and still finding someone to pay for it.

What is different this year than 2015?
The primary difference this year is that we will be discussing case studies and implementation and engagement issues, shifting the focus from “what elements are needed to encourage engagement” to “how is implementation working.” In addition, the emphasis on the power of data to provide meaningful data that empowers both consumers and care providers will increase, as secure collection and management of data is a central theme to most of the solutions on the agenda.
Regarding the agenda, one difference this year will be presentations by emerging companies to members of the investment community, who will offer some feedback on the company concepts and approach.

Do you see progress in adoption by physicians, healthcare organizations, consumers–and who is paying? (more…)

Is ‘ZDoggMD’ restoring humanity to health care? (weekend reading)

August 27, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/08/zdogg.jpg” thumb_width=”175″ /]ZDoggMD–an advocate/video artist, real name Zubin Damania, MD, internist, former hospitalist at Stanford Medical Center and founder of a member-based healthcare service called Turntable Health HQ’d in reviving downtown Las Vegas–has a cause, and that is reforming primary care out of the present failing model, saving patients and healthcare professionals as well. The ZDoggMD videos focus on the breakdown of the system, including that doctors–and nurses–have become the face of a system that is bankrupting both older adults and the chronically ill. This Editor would also add that it’s a system that is burning out and driving out older, more experienced doctors and nurses to retirement and admin-type jobs, and making the entire field unattractive to 20-somethings, as it gets more formulaic, cost savings-driven and care-short. See Dr Damania on ‘stopping playing the game’ in this TEDMED talk on Zombie Doctors.

The Unbreak Healthcare movement has a specific list of grievances, here as listed in investor/consultant Dave Chase’s Rosetium.com article:

  • Doctors: Working as glorified billing clerks to insurance companies and are abused by the system leads to burnout
  • Nurses: Volume-driven disregard for patient safety & understaffing cause major stress (focus on computer data entry instead of bedside care)
  • Middle class: Healthcare’s hyperinflation caused an economic depression & is #1 driver of bankruptcy
  • Millennials: Their health care “bill” makes their college debt look small and will make them indentured servants to healthcare (more…)

Writing an ‘Electrical Prescription’ for biosensing ‘neural dust’

August 27, 2016 | by

How can sensors better communicate with and regulate the central nervous system (CNS)? DARPA (Defense Advanced Research Projects Agency), which is part of the US Department of Defense, is on the case with research on miniaturized electronics suitable for chronic use for biosensing and neuromodulation of peripheral nerves in the Electrical Prescriptions (ElectRx) program.  A DARPA-funded ElectRx research team led by the University of California, Berkeley’s Department of Electrical Engineering and Computer Sciences has developed what they term ‘neural dust’–a millimeter-scale wireless device small enough to be implanted in individual nerves, using ultrasound for power coupling and communication. In vivo test results on rodents have been published in the peer-reviewed neuroscience journal Neuron. A nice return to Armed With Science, which has been bereft of device or robotics news for months.

Startupbootcamp Digital Health Berlin–applications close 31 August (DE)

August 27, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/08/Über_den_Dächern_von_Berlin.jpg” thumb_width=”150″ /]This Berlin digital health accelerator has space for ten early-stage companies in its upcoming ‘bootcamp’ that starts 7 November, but is closing for applications next Wednesday. They boast major support from Philips, arvato CRM Solutions, apoBank, Sanofi and Munich Health to “shape your startup, get on stage on Demo Day (16 Feb 17), pitch and win the hearts (sic) of your investor audience.” There are seven digital health foci listed, six months of co-working space, €15,000 in cash per team, a wide variety of international mentors, etc. Details and application on their website.

We note there is also a digital health program from the same organizers in Miami which is starting 6 September with its Demo Day on 1 December.

Now an app to aid doctors with inflight emergencies

August 26, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/08/Leslie-Nielsen-in-Airplane-movie2.jpg” thumb_width=”200″ /]“Is there a doctor on board?”Having spent the first half of my career in and around the travel industry, including a three-year stint working as an advertising manager for an airline, near the top of The Worry List was the communications fallout of a Bad Outcome in-flight medical incident. When my brother took a flight to somewhere, it was also his concern–while he was familiar with emergency medicine, it was generally of the psychiatric variety. Doctors, at least in the US, are covered by ‘Good Samaritan’ laws that shield them from most liability, but most will be up in the air if an emergency presents itself.

According to the New England Journal of Medicine (NEJM) (YouTube), in-flight medical emergencies occur in about 1 in every 604 flights, which in 2013 equaled annually 44,000 in-flight emergencies with nearly 50 a day in the USA (USA Today). While cabin crews receive training, they usually don’t have specialized medical training unless they moonlight as (or were formerly) EMTs. And an airplane cabin and a flight are deceptively difficult environments–pressurized, dry, confining and with help not exactly nearby.

Now there is an app for that. AirRx was developed by a six-person team (with CSE Software) led by a physician at the University of Illinois College of Medicine at Peoria, Raymond E. Bertino, MD, a clinical professor of radiology and surgery as well as a practicing radiologist. He had the ill luck to find himself in three in-flight situations plus one where he was a patient. The app, which also works in airplane mode and without live internet, guides doctors through 23 common situations, from chest pain and seizures to emergency delivery. It is available in the Apple Store and via Google Play for $4.99, with any proceeds going to the non-profit they organized to maintain the app. According to Dr Bertino, “The only person who doesn’t know what they’re supposed to do is the doc who’s volunteering. Docs aren’t taught about this in medical school and AirRx is meant to fill the gaps.” Mobihealthnews, mHealthIntelligence, Chicago Tribune.

Bucharest–the next hot European digital city? 170 startups say ‘da’. (RU)

August 25, 2016 | by

It certainly came as a surprise that the second fastest growing economy in the EU is–Romania. Identified in your Editor’s mind with the monstrous dictator Nicolae Ceaușescu, grinding poverty and the lost orphans (who are now lost and underground–see this horrific Daily Mail article), it has a burgeoning tech startup scene and a superior digital infrastructure including the fastest internet in Europe, achieved through a combination of post-Ceaușescu entrepreneurship and state avoidance. The Communist emphasis on what we call STEM also has paid off for both young men and especially for women as techies and developers. There are even accelerators: Innovation Labs and MVP Academy. Where Romania lags versus similarly situated Estonia and Bulgaria is native investment–angel investors are almost unknown. Being also an EU member, most of the best are lured away to attractive opportunities in other countries (including the US) at least for some time. But the low cost of development versus other digital cities like London and Berlin, educated workforce and a robust infrastructure are factors favoring Romania. Hat tip to reader Jerry Kolosky. One of the poorest countries in the EU could be its next tech-startup hub (Quartz) and the Digital City Index. (We note the photo at the top of the Quartz article is Google Chicago, not Bucharest)

Patient engagement: a digital divide in health technology accessibility

August 25, 2016 | by | 2 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/09/earthquake.jpg” thumb_width=”150″ /]Guest editor Sarianne Gruber (@subtleimpact) scopes the ‘digital divide’ separating those who need health services the most from the patient engagement and other tools they need in this article. The studies are US, but the lessons apply anywhere in the world. This Editor notes that many patient engagement tools are over-designed and over-complicated for users, even if they are fairly competent and frequently use online and mobile. (I entered a ‘pilot’ of a stress reduction program which proved to be anything but–and quitting because it is invasive and the reporting is ludicrously burdensome.)

To developers: Imagine your patient engagement platform being used by a person on the less sophisticated, less educated and disconnected end of the spectrum–or by someone less able due to physical (vision, touch) or cognitive impairment. Put on bad glasses and gloves–and start. Better yet, find a few people and put it in front of them. If we can make the mental shift in developing mobile apps for Africa or India, certainly we can do so for Americans, Britons and Europeans.

What the Studies are Showing

Hallmarked as a solution to improve healthcare quality, cost and safety, studies are showing health technology is up against a “digital divide” when it comes to patient engagement. At the Internet Governance Forum, Pew Research Center’s Lee Rainie, Director of Internet, Science and Technology Research presented the Fact Tank Report discussing the “digital divide” that exists in 2016. The report documents that lower income, less educated, non-white, seniors and rural communities are the least likely to have home internet, home broadband, mobile connectors and smartphones. This summer’s medical publications, the Journal of the American Medical Association and the Journal of the American Board of Family Medicine, released studies where demographic and socioeconomic data marked the root causes to limited or no access to digital technology, thus hindering the benefits and improved outcomes it can bring to the neediest and most costly populations. Here are the highlights from each study.

Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014, a research letter submitted from Harvard Medical School’s Brigham and Women’s Hospital, appeared in the August 2, 2016, JAMA. Authors, David M. Levine, MD, MA, Stuart Lipsitz, ScD, and Jeffrey A. Linder, MD, MPH,FACP made mention that this study, based on the National Health and Aging Trends survey (NHATS), was exempted from the Partners HealthCare Human Research/IRB Committee. The research team included participates to the longitudinal NHATS survey in 2011. The participants were re-surveyed annually on everyday (nonhealth) and digital health use until 2014. The research team acknowledged that this may be the first nationally representative study to examine trends in the adoption of digital health technology by seniors age 65 years and older who are community-dwelling Medicare beneficiaries.

Here are some the reported statistics from the study: (more…)