Just the Fax. Or Matt Hancock versus the Fax Machines (UK) (Updated)

December 12, 2018 | by

Updated. Add fax machines to the Endangered Device list. The news that Health Secretary Matt Hancock has banned the NHS from purchasing new fax machines starting in January 2019, with a full phaseout of use by 31 March 2020, was this past weekend’s Big News in the UK health sector. This is to help force adoption of paperless methods such as apps and email, which is a noble intention indeed.

The remaining prevalence of fax machines in the NHS became a cause célèbre after the Royal College of Surgeons in July estimated that over 8,000 fax machines were still in use. The RCS takes credit for nudging trusts to ‘Ax The Fax’. Guardian

This Editor presumes that Secretary Hancock does not possess a printer, or find the need to print his records even for convenience–or posterity. (One wonders what he’s carrying in that folder or brief…) I also presume that he has never heard of electrical outages, data breaches, malware or ransomware which may make print records suddenly quite needed.

The Road to Perdition is Paved With Good Intentions. A wonderfully tart take on Mr. Hancock’s Fax Obsession is contained in Monday’s NHSManagers.net newsletter from Roy Lilley. He looks at why NHS offices and practices have stayed with fax machines–and the absurdity of such a ban when trusts and practices are attempting to squeeze every penny in a cash-strapped, failing environment:

  • It’s point to point and legally binding not only in medicine, but in law and finance–even in the US
  • They are on the desk, easy to use–requiring only plug in to power and a phone line, fax toner, and paper
  • They don’t need IT support
  • Compared to computers, printers, and internet service, they are wonderfully cheap

And paper-free isn’t a reality even in the US with EHR, tablets and smartphones widely used. Even HHS and CMS in the US require some paper records. Confidentiality and hacking–especially when tied to computer networks–are problems with fax, but the same can be said for computer networks. Oh, and if your systems are attacked by ransomware, it’s awfully handy to refer back to printed records and to be able to communicate outside of computer networks.

Mr. Lilley also points out that ‘No 18’, as he dubs the Secretary of State for Health, actually has no power to enforce his edict with trusts or GPs.

This Editor predicts a thriving market in used and bootleg fax machines–“check it out”, as the street hustlers say!

Other articles on this: Fortune, Forbes

News roundup: NeuroPace’s brain study, Welbeing’s Liverpool win, VA’s Apple talks, Medtronic’s diabetes move

December 6, 2018 | by

imageNeuroPace, which developed an implanted brain-responsive neuromodulation system for patients with refractory and drug-resistant epilepsy, announced the result of their nine-year long-term treatment study.

  • Approximately 3 out of 4 patients responded to therapy, achieving at least 50% seizure reduction
  • 1 in 3 patients achieved at least 90% seizure reduction
  • 28% of patients experienced seizure-free periods of six months or longer; 18% experienced seizure-free periods of one year or longer
  • Median seizure reduction across all patients was 75% at 9 years
  • Quality of life improvements (including cognition) were sustained through 9 years, with no chronic stimulation-related side effects.

The study included 256 patients across 33 epilepsy centers with nearly 1,900 patient implant years of follow-up on the RNS System. Release.

Liverpool Mutual Homes (LMH) sheltered housing awarded its emergency alarm contract to Welbeing, a Doro Group company. Welbeing has added 1,200 LMH residents to their alarm services. Release (PDF).  Hat tip to Welbeing’s Charlene Saunders.

It appears that the VA is talking with Apple about a mobile EHR. VA patients would be able to transfer their records to their iPhone — likely through Apple’s Health Records app. No time frame is mentioned and it’s hard to expect a quick turnaround given the VA’s stringent IT and security requirements. Another factor is that VA is making the long transition from VistA to Cerner’s MHS Genesis, bumpily. Mobihealthnews picking up a paywalled Wall Street Journal article.

Medtronic, otherwise known as the 9,000 lb Elephant that Sits Where It Wants, will acquire long-time diabetes partner Nutrino, an AI powered personalized nutrition platform. In June, Medtronic integrated Nutrino’s FoodPrint Report technology that connects meal and glucose variability into Medtronic’s iPro2 myLog app. Terms and timing were not disclosed. It fits in Medtronic’s recent strategy of smaller acquisitions and beefing up its diabetes business. Mobihealthnews.

Unaliwear’s model/muse, Joan Hall, passes at 85

December 6, 2018 | by

imageJoan Hall, the mother who inspired the creation of the stylish wearable PERS, Unaliwear’s Kanega watch, has died aged 85. Jean Anne Booth, Unaliwear’s CEO, founder, and Mrs. Hall’s daughter, wrote her memorable bio on the company’s website. 

Your Editor met Jean Anne in 2014 or 2015 at the mHealth Summit and in showing me the design, she explained that she wanted a wrist-worn emergency alert device/fall detection/assistant device that was stylishly designed to her mother’s exacting standards–and that didn’t require tethering to a smartphone. Mrs. Hall was also her chief style guide and model.

Joan Frances Goss Hall was an Auburn University graduate, professional model, and Army wife and mother who called Fort Sam Houston home. She opened and managed the gift shop at Fort Sam Houston, the well-regarded Army Medical Museum (AMEDD), created a memorial there, and consulted on clothing and props for the Vietnam War TV series, China Beach. For her extensive work, Lt. Gen. James Peake awarded Joan the Army’s highest civilian award, the Outstanding Civilian Service Medal, in 2000.

It strikes this Editor that through Mrs. Hall, we are reminded that this is not wholly a chilly business of seeking funding, avoiding data breaches, AI, sensors, and chips. There’s a human factor here that we are designing technology to help people.

There is much more, which you should read here. 

Our TTA team’s sympathy to Jean Anne and her family.

Will there ever be a medical ‘tricorder’?

December 5, 2018 | by | 1 Comment

ZDNet teases us that ‘the race is on’, but is it? It’s a great clickbait headline, but the substance of the article illustrates the distance between today’s tech reality versus the picture of Star Trek’s Bones pointing a Tricorder at a patient and immediately pronouncing that your malady was Sakuro’s Disease or some strange Vulcan malady.

Was it that long ago that the Scanadu Scout was the odds-on bet to be the Tricorder? The hype began in 2012 [TTA 23 May 2013] with Indiegogo funding, competing for the XPRIZE, and breathless pronouncements at nearly every healthcare conference. By 2016, it missed the Qualcomm Tricorder XPRIZE finals (with Northern Ireland’s Intelesens), bricked all sold units to date to comply with FDA regulations on investigational devices, and with Chinese money in hand, moved into other testing devices. Those looking for Scanadu today will be disappointed as their website is unreachable. The DeBrowers and medical director Alan Greene, all of whom were fêted on the healthcare scene, are engaged over at Doc.ai with a new mission of decentralizing precision medicine onto the blockchain using AI, using your medical data gathered on an app (of course).

Google X was up next as Scanadu was fading. There were various devices they were hyping and testing as Google’s life sciences skunk works morphed into Verily, but to date they have all petered out, with some questions raised about people and project churn at the Alphabet unit [TTA 6 April 2016] .

Basil Leaf Technologies (as Final Frontier Medical Devices) wound up winning last year’s final Qualcomm XPRIZE with DxtER, which could diagnose and interpret a defined set of 13 health conditions to various degrees, while continuously monitoring five vital health metrics, using a mix of sensors and an AI-powered diagnostic engine. What they are planning to market first is not DxtER, but a single-disease device to monitor congestive cardiac failure (CCF) since FDA approval for DxtER “would take aeons to be approved.”

Urine tests are also a ‘wet’ way into a tricorder state, with both Basil Leaf and the University of Glasgow working on devices which could quickly scan for metabolites in urine that indicate particular diseases.

QuantuMDx’s Q-POC, from Newcastle UK, is expected to launch in 2019 with handheld diagnostics for bacterial and viral infections. In addition to quick diagnostics for outbreaks in less developed countries, they are also developing diagnostics to prescribe the right antibiotic the first time. This is critical in treatment superbugs such as MRSA and MSSA, as well as more garden variety infections which can go wrong quickly. TTA profiled their crowdfunding launch in 2014.

The ZDNet article wraps up with a bit of romance about how a tricorder is needed for Mars, but down here on Earth, the reality is that a tricorder will likely be a combination of devices and analytics, stitched together by machine learning and AI.

CVS-Aetna merger closes, but hardly ‘rubber stamped’ in Federal court

December 5, 2018 | by

The deal is done, but expect unhappy holidays. As expected, the $69 million CVS-Aetna merger closed the week after Thanksgiving, on Wednesday 26 November, and are proceeding with their integration. Later that week, a Federal judge in the Washington, DC District Court complained at a hearing that both companies had treated him as a “rubber stamp” for the agreement. He was “less convinced” than the Department of Justice that the merger was legal under US anti-trust law. Yesterday (Tuesday 3 Dec), Judge Richard Leon ordered both companies and the DOJ to file briefs by 14 December “to show why their integration should not be halted while he considers whether or not to approve the consent decree reached in October,” according to Reuters.

This is despite various pounds of flesh:

  • The Department of Justice imposing the condition that Aetna sell its Medicare Part D drug plan business to far smaller WellCare Health Plans
  • New York State’s Department of Financial Services extracting concessions around their concerns: acquisition costs will not be passed onto consumers through increased premium rates or to affiliated insurers; maintaining current products for three years; privacy controls; cybersecurity compliance. Oh yes, a small $40 million commitment to support health insurance education and enrollment. (Healthcare Finance 26 Nov)
  •  But New York is a piker in its demands compared to California. The Department of Managed Health Care Director approved the merger based upon:
    • Minimal increases in premiums–and no increase due to acquisition costs
    • Investing $240 million in the state healthcare delivery system, including $166 million for state healthcare infrastructure and employment; $22.8 million to increase the number of healthcare providers in underrepresented areas like Fresno and Walnut Creek by funding scholarships and loan repayment programs; and $22.5 million to support joint ventures and accountable care organizations (ACOs) in value-based care (Healthcare Finance 15 Nov)

A CVS spokesman said in an email after the hearing: “CVS Health and Aetna are one company, and our focus is on transforming the consumer health experience.” (CNBC)  That transformation according to CVS president Larry Merlo involves expanding healthcare services beyond their present clinics to managing high-risk, chronic conditions, and transitions in care. Aetna’s expertise will be invaluable here as well as in an rumored expansion to urgent care (Seeking Alpha). All to out-maneuver Amazon, of course, which is promoting (on TV) PillPack and has applied for additional pharmacy licenses to ship drugs to customers in Washington, New Mexico and Indiana from their Phoenix facility (Healthcare Finance).

It appears that Judge Leon has his own serious reading of the 1974 Tunney Act, which requires a Federal court to ensure the agreement is in the public interest, despite the states and the DOJ.

UK’s DeepMind loses Streams, health projects to Google Health

November 15, 2018 | by

DeepMind loses its Health to Google. DeepMind, the London-based AI developer acquired by Alphabet (Google) in 2014, no longer has a Health division. This group will be absorbed by Google Health, now headed by ex-Geisinger CEO David Feinberg. The former DeepMind health team will continue to be headed by former NHS surgeon Dr Dominic King, who will remain in London along with about 100 reported staffers, at least for now.

DeepMind’s major health initiative is Streams, an AI-powered mobile app that analyzes potential deterioration in patients and alerts nurses and doctors, saving time. It also monitors vital signs and integrates different types of data and test results from existing hospital IT systems. Streams is currently deployed at Royal Free NHS Foundation Trust Hospital in north London for acute kidney injury. The rollout is expected to be made at Imperial College Healthcare NHS Trust, Taunton and Somerset NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust. It is expected that test partners will be found outside of the UK.

DeepMind’s other health initatives and research include fast eye disease detection, planning cancer radiotherapy treatment in seconds rather than hours; and detecting patient deterioration from electronic records.

Google Health is now expanding into products and research into digital technologies which was to be expected with Dr Feinberg on board. Currently, its revenue stream consists of advertising and search.

The remainder of DeepMind not engaged with health will remain independent. CNBC, DeepMind blog

The wind may finally be at the back of telehealth distribution and payment (US)

November 15, 2018 | by

Medicare Advantage may lead, but Medicaid and regular Medicare are not far behind. The Centers for Medicare & Medicaid Services (CMS) has announced in two proposed rules changes expansion of telehealth access for both privately issued Medicare Advantage (MA) plans (26 Oct) and state-run Medicaid and CHIP (Children’s Health Insurance Plan) (14 Nov) plan members. This may mean greater acceptance by providers because they will be paid for these services.

For MA, the proposal would, starting in 2020 as part of government funded basic benefits, eliminate geographic restrictions (rural telehealth) and allow members in urban areas to access telehealth services. It would also broaden present location restrictions, allowing MA members to receive telehealth from home versus traveling to a health care facility. The most intriguing wording is here: “Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries.” which very well could mean remote patient monitoring in conjunction with visits. MA plans have always had more latitude to offer telehealth benefits to members, which are about 1/3 of Medicare-eligibles (over 65). Over 11 percent growth is forecast and it is highly competitive though dominated by United Healthcare and Aetna–over 600 new plans are entering the market next year. Enrollments close on 7 Dec for 2019. CMS.gov release, mHealth Intelligence, Healthcare Finance News.

For Medicaid and CHIP, which states use to extend insurance to low-income individuals and families via private plans, states would be able to, under an approved rule, to more flexibly determine what criteria determine telehealth access. Currently, states use proximity factors–distance from provider and time. The proposed criteria under 10. Network Adequacy (pages 15-16) recommends that time and distance be deleted and instead “adding a more flexible requirement that states set a quantitative minimum access standard (later listed) for specified health care providers and LTSS (long term services and supports) providers”. The reasons why are the limited supply of providers and the functional limitations of the LTSS population. Also notable was language in section 8 discussing access to provider directories via smartphone, as 64 percent of the population with incomes less than $30,000 own a smartphone and use it to access health information.  CMS proposed rule, POLITICO Morning eHealth

This adds to the momentum of the Medicare Physician Fee Schedule published on 1 Nov that added even more:

  • Virtual brief patient checkins and evaluation of patient-recorded photos and video to payments
  • CMS is also finalizing separate payments for three new codes covering chronic care remote physiologic monitoring that unbundle 99091 (CPT codes 99453, 99454, and 99457) and interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448, and 99449).
  • Two new codes covering telehealth for prolonged preventive services
  • Finalizing the addition of renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis as originating sites
  • After 1 July, the home will be permitted as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder. CMS.gov fact sheet 

The importance of this is that more digital health covered by Medicare and government payments in public/private programs such as Medicaid and MA lead private insurers to pay doctors for these services, who will then be willing to pay vendors for providing them. For the telehealth and telemedicine companies that have weathered the storms and lean times of the past decade, there may be light at the end of the tunnel that is not an oncoming train.

Is Babylon Health’s AI on par with a human diagnostician? Claim questioned in ‘The Lancet’.

November 8, 2018 | by

In July, Babylon Health released the results of their testing against the MRCGP (Member of the Royal College of General Practitioners) exam based on publicly available questions. As we reported at the time, its AI system passed the exam with a score of 81 percent. A separate test where Babylon worked with the Royal College of Physicians, Stanford University and Yale New Haven Health subjected Babylon and seven primary care physicians to 100 independently-devised symptom sets. Babylon passed with an 80 score.

Now these results are being questioned in a letter to The Lancet. The authors–a medical doctor and two medical informatics academics–argue that the methodology used was questionable. ‘Safety of patient-facing digital symptom checkers’  shows there ‘is a possibility that it [Babylon’s service] might perform significantly worse’. The symptom checking methodology was questioned for not being real world–that the data in the latter test was entered by doctors only, not by patients or other clinicians. While the authors commended Babylon for being open about their research, they felt there was an “urgent need” for improvements in evaluation methods. “Such guidelines should form the basis of a regulatory framework, as there is currently minimal regulatory oversight of these technologies.” Babylon promises a response and additional improvements, presumably from its $100 million investment in AI announced in September. DigitalHealth (UK), Mobihealthnews

Comings and goings: CVS-Aetna finalizing, Anthem sued over merger, top changes at IBM Watson Health

November 8, 2018 | by

imageWhat better way to introduce this new feature than with a picture of a Raymond Loewy-designed 1947 Studebaker Starlight Coupe, where wags of the time joked that you couldn’t tell whether it was coming or going?

Is it the turkey or the stuffing? In any case, it will be the place you’ll be going for the Pepto. The CVS-Aetna merger, CVS says, will close by Thanksgiving. This is despite various objections floated by California’s insurance commissioner, New York’s financial services superintendent, and the advocacy group Consumers Union. CEO Larry Merlo is confident that all three can be dealt with rapidly, with thumbs up from 23 of the 28 states needed and is close to getting the remaining five including resolving California and NY. The Q3 earnings call was buoyant, with CVS exceeding their projected overall revenue with $47.3 billion. up 2.4% or $1.1 billion from the same quarter in 2017. The divestiture of Aetna’s Medicare Part D prescription drug plans to WellCare, helpful in speeding the approvals, will not take effect until 2020. Healthcare Dive speculates, as we did, that a merged CVS-Aetna will be expanding MinuteClinics to create urgent care facilities where it makes sense–it is not a big lift. And they will get into this far sooner than Amazon. which will split its ‘second headquarters’ among the warehouses and apartment buildings of Long Island City and the office towers of Crystal City VA.

Whatever happened to the Delaware Chancery Court battle between Anthem and Cigna? Surprisingly, no news from Wilmington, but that didn’t stop Anthem shareholder Henry Bittmann from suing both companies this week in Marion (Indiana) Superior Court. The basis of the suit is Anthem’s willfully going ahead with the attempted merger despite having member plans under the Blue Cross Blue Shield Association meant the merger was doomed to fail, and they intended all along for “Anthem to swallow, and then sideline, Cigna to eliminate a competitor, in violation of the antitrust laws.” On top of this, both companies hated each other. A match made in hell. Cigna has moved on with its money and bought Express Scripts.

IBM Watson Health division head Deborah DiSanzo departs, to no one’s surprise. Healthcare IT News received a confirmation from IBM that Ms. DiSanzo will be joining IBM Cognitive Solutions’ strategy team, though no capacity or title was stated. She was hired from Philips to lead the division through some high profile years, starting her tenure along with the splashy new Cambridge HQ in 2015, but setbacks mounted later as their massive data crunching and compilation was outflanked by machine learning, other AI methodologies, and blockchain. According to an article in STAT+ (subscription needed), they didn’t get the glitches in their patient record language processing software fixed in ‘Project Josephine’, and that was it for her. High profile partner departures in the past year such as MD Anderson Cancer Centers, troubles and lack of growth at acquired companies, topped by the damning IEEE Spectrum and Der Spiegel articles, made it not if, but when. No announcement yet of a successor.

Canary Care re-emerges as Canary Care Global Ltd, confirms continued operations

November 8, 2018 | by

imageCanary Care, which entered administration in late August, has been reorganized and continues as Canary Care Global Ltd, remaining in Abingdon. The purchaser in the pre-packaged sale, as Readers learned here, is Lifecycle Software Ltd. Their marketing office sent a release last week confirming their operations. Stuart Butterfield, who answered our inquiries in September, is now managing and technical director. He is quoted in the release: “This is a really positive development for our company. We will continue to provide the Canary Care product and service that our existing customers know and love. Our new owner provides us with the stability and resources to further enhance the Canary Care offering and we’re very excited and optimistic about the future and the opportunity to bring Canary Care to a wider audience.”

The administrator’s latest filing with Companies House is clearly a wrapup of the sale as the best possible outcome for the company. Shareholders included major investor Mercia Fund Management. A quick read of the administrator’s proposal is an object lesson how quickly an insolvency can happen. In section 2, the company went from seeking fresh funding to expand markets in May, having been turned down by Mercia due to their funding criteria, to having an interested buyer who ultimately was not approved by the shareholders by a hairsbreadth, to insolvency by August.

We do wish Canary Care luck with their new ownership and success in this very difficult time for acceptance of –and payment for–telecare and TECS services. Release (PDF) Hat tip to Nicola Hughes of Lifecycle Software

Upcoming UK telecare and telehealth events; SEHTA calls for Healthcare Business Awards nominees.

November 1, 2018 | by

Winding up the year….

Managing digital change in health and care/The King’s Fund/Thursday 22 November/8.30am-4.30pm/The Met Hotel, King Street, Leeds, LS1 2HQ

This conference aims to support health and social care organisations that are looking to undertake large-scale digital change, no matter what their current level of technological advancement. Understand the factors that contribute to successful change by showcasing the experiences of different case study sites and Global Digital Exemplars that have already made significant progress. More information and registration here. 

UK Telehealthcare has several events coming up all over the country. For more information and registration, click here or the advert in the right sidebar and scroll down to ‘Members Events Coming Up’.

8th November 2018 – Suppliers’ Forum, Hammersmith Town Hall, King St. London W6 9JU
9th November 2018 – Providers’ Forum, Hammersmith Town Hall, King St. London W6 9JU
14th November 2018 – CECOPs Digital Health Masterclass, Carisbrooke Hall, Victory Services Club, 63-79 Seymour Street, London, W2 2HF
5th December 2018 – CECOPs Digital Health Masterclass, 2 Brewery Wharf, Kendell Street, Leeds, LS10 1JR.

UK HealthTech/4 December/Cardiff Park Plaza

At the UKHT conference, over 300 delegates will hear speakers discuss the major strategic issues and policy developments facing the life science and healthcare sectors. Showcases include the latest advances in R&D technologies and up and coming spinout companies. It closes with the 13th annual MediWales Innovation Awards, celebrating the achievements of the NHS, life science and health technology communities in Wales. More information and registration here.

SEHTA is calling for nominees for its 2018 Healthcare Business Awards through Friday 14 December. They are looking for the best achieving companies of 2018 in the following five categories: Export Achievement, Start-up, Innovation, Partnership with the NHS
MedTech, and the new category of Healthcare Investment of the Year (most significant/transformational public and/or private sector funding received in 2018). To download application forms, click here. Completed forms should be returned to Clare Ansett – clare.ansett@sehta.co.uk 

A critical take on Pepper’s Parliament Question Time (UK)

November 1, 2018 | by | 1 Comment

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/10/103886629_mediaitem103886628.jpg” thumb_width=”150″ /]Perhaps this Editor should have been less credulous. Somewhere, this Editor failed to notice a mention in the press she picked up that Pepper’s Question Time before the Commons select committee on education had been fully prearranged and scripted. (Thank you and a Big Tip of The Hat to reader Alistair Appleby for pointing that out.) It made Pepper’s appearance a little less than All That Sensational–more like a pre-recording delivered by an automaton prompted through a Middlesex University student’s smartphone.

Mr. Appleby provided a link to a Wired UK article that bears close reading. It sharply critiques not only the presentation, but also the trivialization of what the select committee was really examining, which was the “Fourth Industrial Revolution” of large-scale automation and its disruptive effects on the work of the all-too-near future.

Wired‘s reporter Gian Volpicelli sat in the front row and acidulously observed that Pepper’s appearance was a PR stunt that detracted from the substantive (I think) conversation that preceded it.

“For one hour before Pepper’s triumphal entrance, three experts from UCL, Nesta and Siemens engaged just in that kind of nuanced, data-based, academic conversation with the Committee’s MPs. They studiously tackled issue after unresolved issue, from AI bias, to education reform, to pure epistemology. “What is knowledge? Why should we believe something?,” asked UCL professor Rose Luckin at one point. “What a wonderful philosophical discourse,” committee member William Wragg MP would remark – under the austere blue gaze of Maggie Thatcher’s portrait. “

It does sound like the usual academic drift-off into La La Land, making it a discussion on Big Issues That Make Your Head Hurt because they have a thousand possible outcomes out of H.G. Wells and Aldous Huxley, but what is remarkable is that neither BBC News nor the Guardian saw fit to mention the experts’ testimony.

Mr. Volpicelli rightly labels Pepper’s appearance a media stunt that gained all the attention versus a real discussion about the societal effect of future robots. Will it be the Pepper-future of cute machines that can perform few tasks and are non-threatening? Will it be the Atlas-future, the one projected by Boston Dynamics’ humanoid athlete-robot that does parkour and skillfully leaps large boxes, funded by DARPA to be a search and rescue robot? Will the future belong to the weirdly humanoid Frubber-skinned Sophia, who fell into the ‘uncanny valley’ at CES last January [TTA 23 Jan] — the same CES where Pepper ‘fainted’ to a non-working slump (schlump?) More than likely, it will be the robotic arm that flips and bags the fast-food burger that is more of the immediate future–and displacing low-wage workers–than any of the above. We need to have a very serious chat about Pepper’s pointless parliamentary pantomime 

Pepper pays a first-ever robot visit to Commons on the future of AI and robotics on education, older adult care (UK)

October 25, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/10/103886629_mediaitem103886628.jpg” thumb_width=”150″ /]Pepper paid a visit to a House of Commons select committee on education and became the very first robot to meet with MPs. Accompanied by students from Middlesex University, where Pepper is part of an initiative on teaching primary school-level children, he made a short presentation about the future of artificial intelligence in education and older adult care.

Certainly his introduction has some historic value. Pepper bowed and then said in his rather high-pitched and somewhat Japanese-inflected voice: “Good morning, chair [Robert Halfon]. Thank you for inviting me to give evidence today. My name is Pepper and I am a resident robot at Middlesex University.”

Pepper used voice, gesture, and his embedded front tablet to explain about the role robots like him will play in education and healthcare. At Middlesex, final year students in robotics, education, psychology, and biomedicine like Joana Miranda, one of his two escorts, work with Pepper on projects such as developing numeracy skills in primary school students. According to BBC News, Tory MP Lucy Allan dryly noted that Pepper was “better than some of the ministers we have had before us”.

In healthcare for older adults, the Pepper robot developed by Softbank is part of a major research project funded by the EU, the Japanese Government and UK’s Horizon 2020. The objective of the three-year CARESSES program is to develop a culturally aware robot to provide care suited to a wide variety of individuals and reduce loneliness. Another desired outcome is to relieve pressure in hospitals and care homes by promoting independent living at home with a care robot.

The education committee is examining the “fourth industrial revolution” which impacts STEM education, school curriculum, and workforce skills (and reskilling). Videos on BBC News and Gevul News (YouTube) A tart take on Pepper versus PM Theresa May from The Guardian. (And no fainting, as Pepper did at CES earlier this year.) Hat tip to The King’s Fund weekly newsletter.

Connected Health Conference highlights (so far): FCC’s $100 million telehealth pilot, NIH’s ‘All of Us’, MIT’s social robots integrating AI

October 19, 2018 | by

Expanding FCC connected health programs. FCC Chairman Ajit Pai in his keynote reinforced the agency’s interest and support of connected health initiatives, from rural to opioids. Most of the programs have a rural focus to bring broadband and telehealth/RPM to the ‘end of the line’ in underserved communities, something close to Mr. Pai’s heart as his parents were both rural physicians in Kansas..

  • This summer, the Connected Care Pilot Program was proposed and approved unanimously in August [TTA 9 Aug]. Funding for this is proposed at $100 million.
  • The spending cap for the rural healthcare program, which has been around since 1997’s dial-up days and now includes telemedicine and remote monitoring, was increased for 2017-2018 from  $400 million to $571 million, a 43 percent increase. The FCC has pledged to fully fund 2018 programs.
  • New initiatives were announced covering new uses for telehealth and remote patient monitoring:
    • Connected care at home via RPM as part of the Connected Care Pilot Program
    • Cancer care in partnership with the National Cancer Institute. The Launch program for rural and underserved communities aims to bring high-quality cancer care to where patients work and live through bringing together government, academia and community health providers.
    • For opioids, there are two programs. One is expanding the mapping broadband health platform to include critical drug use data. This will allow users to rapidly visualize, overlay, and analyze broadband and opioid data together at the national, state, and county level. The second is to launch a chronic pain management and opioid use challenge as part of the pilot program.  Mobihealthnews

A status report on NIH’s All of Us. Back in January as part of setting the stage for 2018, this Editor briefly mentioned the National Institute of Health’s massive All of Us program, part of the Federal Precision Medicine Initiative (PMI). All of Us needs almost all of us–their goal is to collect data on at least one million Americans for a major leap forward on data supporting population health. Dr. Dara Richardson-Heron, All of Us’ chief engagement officer, confirmed that over 100,000 participants have registered since the launch in May, with over 65,000 completing the full protocol. She mentioned that 75 percent of signups are from groups often underrepresented in modern medical research, with 50 percent from racial and ethnic minorities. The Mobihealthnews article ends on a ‘Debbie Downer’ note of doubting whether the program will reach enrollment goals, the cost will be justified, and whether the data will be kept private as promised.

MIT’s social robots may be the future of emotional support for wellbeing. MIT associate professor Cynthia Breazeal heads up the Personal Robots Group and is working on how to integrate AI into emotional robots for pediatric patients at Boston Children’s Hospital. The robots serve as a go-between child life specialists and the patient. The initial results were positive, with higher verbal scores (as a measure of engagement) than with stuffed bears or digital avatars. Professor Breazeal wants to extend the technology to older adults for wellbeing and engagement. Running against the conventional wisdom, their research found that older adults were more open to technology than the children. Following MIT’s work are companies like Hasbro and Embodied. Mobihealthnews.

DNA-based personalized food choices to prevent Type 2 diabetes onset in test with Imperial College, London and Waitrose (UK)

October 18, 2018 | by

Can DNA analysis and an app help prevent Type 2 diabetes onset in the pre-diabetic? The problem of preventing Type 2 diabetes in people determined to be pre-diabetic is multi-factorial, but one approach is diet to control 1) obesity and 2) improve glucose regulation. DnaNudge, which has developed a DNA analysis from a cheek swab, is being used in a clinical trial conducted by Imperial College London’s NIHR (National Institute for Health Research) Imperial Clinical Research Facility to determine whether DnaNudge’s scanner and app, used while shopping at Waitrose & Partners stores, can prevent the development of Type 2 diabetes in prone individuals.

To this Editor’s knowledge, this is the first time that personalized DNA testing and an app have been used in conjunction with retail food choices.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/10/MyDNA-Report-Sample.png” thumb_width=”125″ /][grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/10/product-feedback-recommended.png” thumb_width=”150″ /]How it works is that the individual’s DNA is analyzed first and then used to match what food choices are best for that person via a simple thumbs up or down indicator on the app. 

  • Using a sterile cotton swab, users sweep the inside of their cheek to capture a sample of saliva.
  • The swab is inserted in a processing cartridge plugged into the DnaNudgeBox, a small instant DNA analyzer
  • The analysis of specific genetic traits related to nutrition is completed in minutes and uploaded to the DnaNudge app on the smartphone via a wearable ‘capsule’, the DnaBand (left #1)
  • The wearer then can scan individual food items as that person shops, receiving the ‘thumbs up’ for good choices and ‘thumbs down’ for ones not so good, with alternatives suggested for the latter (left #2)

The 12-month clinical trial was launched last week, with Waitrose contacting customers in the North London area with information on how to take part. Professor Nick Oliver from Imperial College London, who is leading the clinical study at the NIHR Imperial Clinical Research Facility, stated in the release: “This key trial with DnaNudge allows us – for the very first time – to study in detail the outcomes of DNA-personalised food choices for pre-diabetic individuals, and to explore whether this type of accessible technology can deliver a proactive and sustainable solution to managing nutrition, and preventing the development of Type 2 diabetes in people at highest risk of this long-term condition.” It is not clear from the release whether there’s further information provided on the food choices or other education.

DnaNudge was co-founded by Regius Professor Professor of Engineering at Imperial College London Chris Toumazou and published geneticist and leukemia researcher Dr. Maria Karvela. Waitrose has staked out a healthy food position with the introduction of 100 Healthy Eating Specialists, shop floor specialists who direct customers who ask towards healthier choices. This tie-in is interesting, and if it works, this Editor can see it in use in a CVS-Aetna test or Walgreens, as both have edged into food retailing in many locations, albeit with not many apparent healthy choices, unless one considers Milky Ways fine food.

Apple Watch, Zimmer Biomet in clinical trial for monitoring hip and knee replacements

October 18, 2018 | by

imageZimmer Biomet, a musculoskeletal medical device company, is partnering with Apple to use the Apple Watch with an iPhone 6s and above in tracking the pre-surgery and post-operative recovery process for patients with hip and knee replacements. Zimmer is using the mymobility app developed with Apple to track patient-reported feedback, provide patient education and guidance, and share continuous health and activity sensor-based data with care teams. The aim is to improve the standard of care and patient outcomes after these surgeries.

The mymobility Clinical Study started on 15 October and may enroll up to 10,000 patients with 16 corresponding healthcare facilities including academic health systems, hospitals, and orthopedic surgery centers/practices. No length or end date for the study has been disclosed. 

A positive outcome leveraging patient engagement and providing continuous detailed clinical tracking data could have major significance. There are over 1 million hip and knee orthopedic replacements in the US annually, which is expected to increase to 3.5 million by 2035. The average cost of a hip or knee replacement is estimated at about $31,000, varying widely by region, based on a 2015 Blue Cross Blue Shield Association study. Post-surgery complications are common enough so that Medicare.gov tracks them through Hospital Compare.

According to Zimmer, “the mymobility app provides instruction and opportunities for enhanced engagement between the patient and healthcare provider. This mobile application is designed to work with the Apple Watch® wearable companion to remind patients to check their smartphone application daily, to read pre-planned and timed educational information, perform tasks, and complete assigned exercises; understanding their condition and care plan gives patients the ability to actively participate in optimizing their surgical outcome.” For the clinician, it is a communication tool between the patient and care team. “Surgeons use a clinician dashboard to monitor the threshold values and actively observe progress throughout each patient’s journey. Through the adoption of multifunctional sensor technology in the form of a wearable companion on the wrist, mymobility provides the potential to identify metrics that may permit further refinement of pre and postsurgical care.”

Healthcare Dive, Zimmer Biomet release, Zimmer mymobility study website