MediBioSense partners with MRIGlobal for Department of Defense health monitoring system

March 10, 2018 | by

Doncaster, UK-based MediBioSense Ltd. [TTA 23 Jan, 17 Feb] is partnering with Kansas City’s MRIGlobal to develop a wireless health monitoring system for the US Department of Defense Combating Terrorism Technical Support Office (CTTSO). The limited information in the release indicates that the joint project will provide technology integration and development services for CTTSO. The system “will provide medical grade health monitoring data and allow for real-time decisions to protect health.”

MediBioSense is the developer of the monitoring platform for and global distributor of the VitalPatch, originally developed by VitalConnect. MRIGlobal is a contract research organization for government, academia, and industry that works in the areas of national security, defense, health, and energy. In health, they develop solutions in in vitro diagnostics, infectious diseases, and ‘global biological engagement.’

CTTSO’s website description: “Identify and develop capabilities to combat terrorism and irregular adversaries and to deliver these capabilities to DoD components and interagency partners through rapid research and development, advanced studies and technical innovation, and provision of support to U.S. military operations.”

Which makes this new development quite interesting in what the VitalPatch may be detecting–and possibly a little hush-hush!

A tipping point in consumer acceptance of health apps, AI, and virtual care? Accenture thinks so.

March 10, 2018 | by

Accenture’s 2018 Consumer Survey on Digital Health indicates that the tipping point may be here, sort of. Some key findings:

  • Consumers had high rates of favorable acceptance and likeliness to use AI-enabled clinical services: home-based diagnostics (66 percent of respondents), virtual health assistants (61 percent), and virtual nurses to monitor health conditions, medications and vital signs at home (55 percent), which may be good news for the future of telehealth services.
  • The 2,301 respondents already are using mobile and tablet health apps (48 percent). 44 percent are using patient portals for to fetch their health records, primarily to get information on lab and blood-test results (67 percent), to view physician notes regarding medical visits (55 percent), and their prescription history (41 percent).
  • Wearables are being used by 33 percent and favorably viewed by over 70 percent as beneficial in understanding their health condition (75 percent), engaging with their health (73 percent), and monitoring the health of a loved one (73 percent). 

Virtual care seems to be leading the way over wearables and remote patient monitoring–and after-hours care, patient follow-up, and patient education are leading virtual care.

  • 25 percent had received virtual care services in the previous year, up from 21 percent in last year’s survey. 16 percent are taking part in remote health consultations, compared with 12 percent in 2016. 14 percent are participating in remote monitoring, up from 9 percent in 2016.
  • 47 percent state that given a choice, they would prefer a more immediate virtual medical appointment over a delayed in-person appointment.
  • For after-hours care, 73 percent said they would use virtual care for after-hours (nights and weekend) appointments.
  • 71 percent said they would use virtual care for taking a class on a specific medical condition. 65 percent would use virtual care for a follow-up appointment after an in-person visit.
  • Most respondents said they would also use virtual care for a range of additional services, including discussing specific health concerns with medical professionals (73 percent), in-home follow-up after a hospital stay (62 percent), participating in a family member’s medical appointment (59 percent), and being examined for a non-emergency condition (57 percent).

Accenture release and report.

Is Uber fit to deliver healthcare transport? Healthcare organizations may want to check.

March 10, 2018 | by

Healthcare-related organizations have codes of conduct pertaining to suppliers. Does Uber meet compliance standards? As we reported a few days ago in our article on the burgeoning area of non-emergency medical transport (NEMT) [TTA 9 Mar], Uber Health’s debut with a reputed 100 healthcare organizations has led this Editor to a further examination of Uber, the organization. Uber has had a hard time staying out of the headlines–and the courts–in the past two years, in matters which might give healthcare partners pause.

  • On 21 Nov, Uber reported that the personal data of 57 million users, including 600,000 US drivers, were breached and stolen in October 2016–a full year prior. Not only was the breach announcement delayed by over a year, but also in that year it was made to go away by Uber’s paying off the hacker. Reuters on 6 December: “A 20-year-old Florida man was responsible for the large data breach at Uber Technologies Inc [UBER.UL] last year and was paid by Uber to destroy the data through a so-called “bug bounty” program normally used to identify small code vulnerabilities, three people familiar with the events have told Reuters.” The payment was an extraordinary $100,000. “The sources said then-CEO Travis Kalanick was aware of the breach and bug bounty payment in November of last year.” The Reuters article goes further into the mechanism of the hack. It eventually led to the resignation of their chief security officer, former Facebook/eBay/PayPal security head Joe Sullivan, who ‘investigated’ it using encrypted, disappearing messaging apps. Atlantic.
  • CEO and co-founder Travis Kalanick was forced to resign last June after losing the confidence of the company’s investors, in contrails of financial mismanagement, sexual harassment, driver harassment, and ‘bro culture’. This included legal action over Uber’s 2016 acquisition of self-driving truck startup Otto, started by former Googlers who may or may not have lifted proprietary tech from Google before ankling. These are lavishly outlined in Bloomberg and in an over-the-top article in Engadget (with the usual slams at libertarianism). Mr. Kalanick remains on the board and is now a private investor.
  • The plain fact is that Uber is still burning through funds (2017: $1bn) after raising $21.1bn and its valuation has suffered. The new CEO Dara Khosrowshahi, who earlier righted travel site Expedia, has a tough pull with investors such as SoftBank and Saudi Arabia’s Public Investment Fund. Also Mashable.

Healthcare and NEMT, as noted in our earlier article, are a strong source of potential steady revenue through reimbursement in Medicare Advantage and state Medicaid programs, which is why both Uber and Lyft are targeting it. The benefits for all sides–patients, practices, these companies, sub-contractors, and drivers–can be substantial and positive in this social determinant of health (SDOH).  

Healthcare organizations, especially payers, have strict codes of compliance not only for employees and business practices but also for their suppliers’ practices. Payers in Medicare Advantage and Medicaid are Federal and state contractors. While Uber under its new CEO has shown contriteness in acknowledging an organization in need of righting its moral compass (CNBC), there remains the track record and the aftermath. Both deserve a closer look and review.

Lyft and Uber’s big tech twists on a Social Determinant of Health–medical-related transportation

March 9, 2018 | by

Social determinants of health (SDOH), that widely-discussed concept often dismissed as the turf of social workers and small do-good companies such as Healthify, are receiving a substantial boost from two profit-oriented, on-demand transportation companies: Uber and Lyft. Several years ago, smaller companies such as Circulation and Veyo [TTA 21 Feb, 26 Apr 17] entered the non-emergency medical transportation (NEMT) field with their on-demand services. These proved to be valuable links in the continuum of care–valuable in helping patients make their appointments, at generally a lower cost than Access-a-Ride or taxis, while collecting a wealth of data on usage.

Uber and Lyft’s recent announcements take the NEMT concept further with integration into discharge planning, chronic care management in practices, and EHRs while keeping it simple for patients and caregivers.

  • The launch of Uber Health, targeted to healthcare organizations (and just in time for HIMSS). The ride booking for both patients and caregivers uses a HIPAA-compliant dashboard for the health manager to book the ride, and text messaging to the patient for confirmations and pickup. Over 100 healthcare organizations are piloting the service. MedCityNews
  • Lyft Business inked a deal with Allscripts to integrate booking transportation into appointment setting. The Allscripts EHR is in 45,000 physician practices and 2,500 hospitals (which doesn’t include newly-acquired Practice Fusion’s 30,000 small ambulatory sites). Besides its own driver base, Lyft also has used its Concierge API to facilitate partnerships with NEMT brokers working with providers such as Circulation, National MedTrans (the NEMT provider for Anthem’s CareMore Health Plan HMO), and American Medical Response for drivers and more specialized vehicles. Hitch Health works with Lyft and independently integrates into Epic and Athenahealth. MedCityNews, POLITICO Morning eHealth (scroll down).

But does providing transport for appointments save money? The logic behind it is that missed appointments can exacerbate existing conditions; a direct example is dialysis, where missing an appointment could result in a hospital admission. Another area is patient avoidance of making appointments. The CareMore Health Plan study reduced waiting times and ride cost, increasing patient satisfaction–great for HEDIS and ACO quality scores, but the longer-term cost saving is still to be determined.

Another attraction for Lyft and Uber: steady revenue. In Medicare Advantage, 70 percent of members are covered and all state Medicaid programs reimburse their members for qualifying transportation.

What if you crossed Alexa with a robotic healthcare manager?

March 7, 2018 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/03/pillo_01-625×350.jpg” thumb_width=”150″ /]You might have a tabletop ‘companion robot’ that’s called, interestingly, Pillo. It doesn’t look like something on a bed, nor does it ambulate, but more like a souped-up pastel colored Alexa with Eyes. Debuting at HIMSS 2018 this week, what is non-Alexa-like about it is that is a voice-responsive Wi-Fi/Bluetooth-connected healthcare manager, interacting with the user on Alexa-type requests but in the main managing (nudging?) their care plan, reminding them of medical appointments, delivering patient education, and dispensing their pre-loaded medications in a cup . Pillo claims to use AI algorithms to manage care, proactively engage with patients, and recognize users via voice and facial recognition. Orbita is supplying the platform for the voice assistant technology.

Pillo appears to be targeted to users with chronic conditions who need assistance in care management and with a connecting mobile app to family caregivers and clinicians. There’s no mention of a tracking platform nor connectivity with medical devices such as glucose meters or blood pressure cuffs. According to Forbes, it will ship in 4th Quarter, no pricing mentioned. Pillo raised $1.5 million in a venture round last August from BioAdvance (Crunchbase) with additional funding from Stanley Ventures, Hikma Ventures (the venture arm of Hikma Pharmaceuticals) and Thompson Family Foundation for a total of $4m (Forbes). It’s hard to tell if this will appeal to or be subsidized by pharma, payers, or Medicare primary care providers such as ACOs because the release is rather opaque on specifics.

CVS sets it up for Aetna with $40 billion in the third-largest bond sale ever

March 7, 2018 | by

Obviously, CVS is confident of an approved merger and that it will work. CVS issued $40bn of investment-grade debt today (6 March) to finance the purchase of Aetna, according to sources talking to Bloomberg. The attraction was premium interest and other incentives, up to 1.95 percentage points above Treasuries in the 30-year portion of the nine-part offering. This serves to refinance a bridge loan of $49bn from 20 investors that was taken in December to initially finance the $67.5 bn acquisition. 

By Bloomberg’s calculation, the bond sale ranked only behind $40bn +blockbusters from Verizon (2013) and AB InBev (2016). Analysts and portfolio managers cheered at the terms. It’s expected to close by second half 2018. No word yet from DOJ, however, which asked for additional information on 1 Feb which further extends their waiting period. Mutual shareholder meetings are still scheduled for 20 March [TTA 2 Feb].

Another positive investor take is over at Seeking Alpha, citing excellent fundamentals, a diverse revenue stream, and innovation in “management’s commitment to evolve the company for the future” as well as “trying to revolutionize the doctor-patient-pharmacy relationship, and using its convenience store appeal to support it.” But we knew that already! The article goes on to extrapolate on the Amazon Effect and where CVS, with a bit of tweaking (healthier food choices with pre-made options in stores, much as many Duane Reade/Walgreens have in NYC), could steal a march. (Our prior coverage and mentions are here.)

E-skin? Bionic skin? No matter the name, the ‘ultimate wearable’ for monitoring is advancing.

February 23, 2018 | by

‘Bionic skin’ as the ultimate wearable has been taking several dimensions. TTA Editors have previously reported on tattoo-like stretchy sensors applied to the skin for monitoring vital signs from a variety of academic and commercial developers. Here are two new advances of interest for those who follow the progress of wearables:

  • [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/02/TFT-sensor-Tokyo-U.jpg” thumb_width=”100″ /]From University of Tokyo’s Graduate School of Engineering, a team led by Professor Takao Someya has developed an e-skin (left) that can measure vital signs and basic images, send them to clinicians, and–in what may be a first–display them on the surface in real time. This feature is useful for anyone, but especially for those who have difficulty communicating information due to speech or cognitive impairments. According to EurekaAlert, it combines a flexible, deformable display with a lightweight sensor composed of a breathable nanomesh electrode and wireless communication module. Developed in conjunction with Dai Nippon Printing (DNP), it is a 16 x 24 array of micro LEDs and stretchable wiring mounted on a rubber sheet. In its test form, it communicated temperature, pressure, myoelectricity (the electrical properties of muscle), and recorded an ECG. DNP expects to commercialize it in three years and improving its coverage for larger surfaces. It lasts about one week without creating irritation, another major factor in skin sensors. Video on EurekaAlert. Also Engadget. A paper on this research was delivered at AAAS last week. 
  • More information on Prof. Someya’s research is available in this IEEE Spectrum article, largely about the challenges of e-skin flexibility for use in patches and in prosthetics. Their research is utilizing TFTs (thin film transistors) and plastic skin one-tenth the thickness of common plastic wrap as the most sensitive and adaptable technologies.
  • University of Colorado Boulder has developed a monitoring e-skin that self-heals if damaged, which may extend e-skin life and usability. It uses a polymer (polyimine) laced with silver nanoparticles which can be repaired by easily available ethanol compounds and is fully recyclable with another solution that separates out the silver. The test patch conducts temperature and pressure. This looks thicker than plastic wrap, however. Engadget

Health tech for stroke prevention and rehab from Kardia Mobile, Watch BP, Northwestern U (UK/US)

February 23, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/02/Northwestern-stroke-patch.jpg” thumb_width=”150″ /]Is stroke avoidable? We know it is an expensive medical event at $20-23,000 for hospitalization alone (NIH), which does not count rehabilitation or the devastation to individuals and their families, including loss of ability and work. NHS England is testing two devices, the Kardia Mobile and Watch BP, with an eye to preventing stroke in those vulnerable to it. 6,000 devices are being distributed to GP practices in England in a program through 15 NHS and care innovation bodies known as Academic Health Science Networks (AHSNs). The Alivecor‘s Kardia Mobile is a smartphone add-on clip that captures a medical-grade ECG in 30 seconds, stores, and sends readings to physicians. The application to stroke is primarily in atrial fibrillation (AF) and irregular heart rhythms, which according to statistics, more than 420,000 people across England have. Watch BP is a blood pressure cuff device which is also equipped with an AF detection system. The goal of the project is to identify 130,000 new cases of AF over two years, to prevent at least 3,650 strokes and potentially save 900 lives. Savings to NHS are being estimated at £81 million annually. Digital Health News

Post-stroke rehabilitation treatment is also being boosted by a new device developed at Northwestern University and being tested at the Shirley Ryan AbilityLab, a Chicago research hospital. It is a Band-Aid® like device which can be applied to key areas such as the throat (left above, credit AbilityLab), chest, or limbs to send back information to doctors on how a patient in treatment post-discharge, especially at home, progresses. The sensors and platform measure heart activity, muscle movement, sleep quality, swallowing ability, and patterns of speech. Especially revolutionary is the monitoring of speech communication and swallowing, which are often impaired in stroke patients but hard to track once the patient is out of a facility. The team’s research was presented last week at the American Association for the Advancement of Science (AAAS) annual meeting. New Atlas. Hat tip to Toni Bunting.

UK roundup: CCIO Simon Eccles warns against ‘shiny objects’, NHS Liverpool CCG award to Docobo, 87% concerned with NHS info security

February 23, 2018 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]NHS Digital CCIO doesn’t like ‘shiny objects’. Dr. Simon Eccles used his first NHS Digital board meeting as national CCIO to encourage delivering the current agenda first and not getting distracted by the ‘shiny objects’ of new innovations which also divert funding. “It is our collective challenge to make sure that doesn’t happen to things that are valued by the NHS – to do what we said we’d do and not be too distracted by new and shiny things.” This seems to be at odds with non-executive director Daniel Benton, who “suggested that NHS Digital needed to become more flexible as an organisation so that it was in a better position to roll with the punches in future.” Digital Health News

Docobo announced their win of the NHS Liverpool Clinical Commissioning Group‘s scale up of telehealth as part of the Healthy Liverpool program. The three to five-year contract has a maximum value of £11.5 million. The current Mi Programme (More Independent) partly funded by the Innovate UK dallas initiative and using Philips equipment is at 900 patients with 5,300 total patients since 2013. The plan is to scale up the program to 4-5,000 patients a year and support new clinical pathways and conditions including lung conditions, heart failure, and diabetes. Docobo’s platform is Doc@Home which uses patient information from the CarePortal device or their own digital devices. Docobo release. NHS Innovation Accelerator, Digital Health News

A survey of 500 British adults conducted by UK IT VAR Proband found that perceptions of public sector information security are poor. 87 percent were concerned about the security of their information with the NHS. Of that 87 percent, 34 percent were ‘very concerned’ about their cybersecurity. Taking this with a grain of salt, 80 percent distrusted security at the Driver and Vehicle Licensing Agency (DVLA) and 78 percent on data held by the police. The General Data Protection Regulation (GDPR) can’t come too soon [TTA 17 Feb] — but are you ready? More in Proband’s Online Security Audit (PDF).

Telehealth policy and reimbursement changes summarized by Center for Connected Health Policy (US)

February 23, 2018 | by

A significant barrier to the adoption of telehealth (defined here as video consults, store and forward imaging, and remote patient monitoring) is the issue of reimbursement gaps. Basic Medicare (the Federal program for those over 65) pays for video and store and forward only under certain conditions (primarily under rural telehealth programs) but does pay for RPM as part of chronic care management (albeit under a maze of codes and procedures). Medicaid (the state low-income insurance program) is far more lenient, and private pay in states varies widely, with 36 states having some form of parity payment legislation. However, Medicare is planning expansion beyond what is covered in private plans (Medicare Advantage) by 2020. Some Federal programs such as the advanced Next Generation ACO program and the bundled payment Comprehensive Care for Joint Replacement model have telehealth waivers.

The always-helpful Center for Connected Health Policy (CCHP) has published a five-page guide to where these programs stand. Becker’s Hospital Review. CCHP PDF.  

VA moves closer to doing Cerner EHR deal, real Choice for veterans (updated)

February 23, 2018 | by

The Cerner EHR deal with the VA edges closer to closing. Another VA contractor, MITRE, reviewed the agreement and recommended 50 changes that, according to POLITICO Morning eHealth’s source, address many of the interoperability-related usability features “that irritate EHR users” such as reconciling data coming from outside sources (Home Telehealth, perhaps?–Ed.). VA officially updated the status with Congressional Veterans Affairs staff on Tuesday. The deal could be inked as early as next week, but never bet on this when the Secretary seems doubtful of the agreement date. In any case, it will be a decade before VA is fully transitioned from VistA. Speaking of the Secretary, Dr. Shulkin’s crisis of last week seems to have passed with a White House vote of confidence. He can ‘cashier’ his critics and according to him, everyone’s on board with a clear direction. We’ll see. 

Updated. Well, it’s 2 March and still no word on closing the Cerner contract. Meanwhile, the VA ‘revolt’ continues, with either true or false reports of demands for Dr. Shulkin’s resignation. It’s exhausting, and meanwhile who pays? Staff and veterans. See POLITICO from 1 March here.

Modern Healthcare reported that important reforms in the VA Choice legislation are closer to reality with the Senate Veterans Affairs committee. They are proposing changes, supported by the White House, that would open up VA Choice eligibility to nearly all veterans by “making VA facilities responsible for meeting access standards set by the VA secretary. If a facility can’t, the patient can seek out a community provider if both patient and a VA provider or an authorized provider in the community working closely with VA deem that a better option than a VA facility.” This is a step beyond the earlier proposed access standards which would have given the VA Secretary discretion to relax restrictions to community care provision. Currently the VA Choice program is used by only 1 million veterans who have to prove that they are facing wait times of 30 days or more, or 40-mile travel time to a VA clinic. While the tone in the article is slightly disparaging, firm standards and opening the VA to limited market pressures to this Editor is a good thing–and getting effective care faster to veterans, many of whom live in exurban or rural areas, is beyond all considerations, absolutely necessary. How this affects veterans monitored by telehealth programs–and interoperability of their records–are open questions.

Digital health is not here. Or it is. Or it’s still “the future” and we’re waiting for the ship to come in.

February 23, 2018 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/long-windy-road.jpg” thumb_width=”150″ /]Another bit of convergence this week and last is the appearance of several articles, closely together, about digital health a/k/a health tech or ‘Dr. Robot’. It seems like that for every pundit, writer, and guru who believes “We’ve Arrived”, there’s some discouraging study or contra-news saying “We’re Nowhere Near The New Jerusalem”. This Editor’s been on the train since 2006 (making her a Pioneer but not as Grizzled as some), and wonders if we will ever Get There. 

Nearing Arrival is the POV of Naomi Fried’s article in Mobihealthnews giving her readers the keys to unlock digital health. “Digital health will be the dominant form of non-acute care.” It has value in chopping through the thicket of the low clinical impact technologies that dominate the current scene (Research2Guidance counted only 325,000 health apps and 3.6bn downloads in 2017). Where the value lies:

  1. Diagnosis and evaluation–devices that generate analyzable data
  2. Virtual patient care–telehealth and remote patient monitoring
  3. Digiceuticals–digital therapeutics delivered via apps
  4. Medication compliance–apps, sensors, games, ingestibles (e.g. Proteus) 

At the Arrival Platform and changing the timetable is machine learning. Already algorithms have grown into artificial neural networks that mimic animal learning behavior. Though the descriptions seem like trial and error, they are fast cycling through cheap, fast cloud computing. Machine learning already can accurately diagnose skin cancer, lung cancer, seizure risk, and in-hospital events like mortality [TTA 14 Feb]. It’s being debated on how to regulate them which according to Editor Charles Lowe will be quite difficult [TTA 25 Oct 17]. Returning to machine learning, its effect on diagnosis, prognosis, and prediction may be seismic. Grab a coffee for The Training Of Dr. Robot: Data Wave Hits Medical Care (Kaiser Health News). Hat tip to EIC Emeritus Steve Hards.

The (necessary?) bucket of Cold Water comes from KQED Science which looked at two studies and more, and deduced that the Future Wasn’t Here. Yet.:

  1. NPJ Digital Medicine’s 15 Jan meta-analysis of 16 remote patient monitoring (RPM) studies using biosensors (from an initial scan of 777) and found little evidence that RPM improves outcomes. The researchers found that many patients are not yet interested in or willing to share RPM data with their physicians. The fact that only 16 randomized controlled trials (RCTs) made the cut is indicative of the lack of maturity (or priority on research) for RPM. 
  2. In JMIR 18 Jan, a systematic review of 23 systematic reviews of 371 studies found that efficacy of mobile health interventions was limited, but there was moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. 

Even a cute tabletop socially assistive robot given to COPD patients that increases inhaler medication adherence by 20 points doesn’t seem to cut hospital readmissions. The iRobot Yujin Robot helping patients manage their condition through medication and exercise adherence lets patients admit that they are feeling unwell so that a clinician could check on them either through text or phone and if needed to see their regular doctor. The University of Auckland researchers recommended improvements to the robot, integration to the healthcare system, and comparisons to other remote monitoring technology. JMIR (18 Feb), Mobihealthnews.

As Dr. Robert Wachter of UCSF put it to the KQED reporter, we’re somewhere on the Gartner Hype Cycle past the Peak of Inflated Expectations. But this uneven picture may actually be progress. Perhaps we are moving somewhere between the Slough (ok, Trough) of Disillusionment and the Slope of Enlightment, which is why it’s so confusing?

Retail health convergence and ‘Amazon Effect’ continues with Albertsons’ acquisition of Rite Aid (updated)

February 20, 2018 | by | 1 Comment

The perceived ‘Amazon Effect’ continues. As predicted when the CVS-Aetna merger proposal made its first news last October while the Autumn Leaves were falling (cue the Ferrante and Teicher), other retail shoes would be dropping. Today’s major news is supermarket Albertsons buying most of drug store chain Rite Aid–the 2,600 stores that Walgreens Boots was prohibited from acquiring due to antitrust concerns. (Their eventual deal was for 1,932 stores.)

The terms are cash and stock with an estimated value of the combined companies of $24 billion (WSJ). Present Rite Aid shareholders will take 29 percent of the combined companies and present Albertson shareholders over 70 percent. Another benefit for Albertsons–it’s a quick and easy way to go public without an IPO using Rite Aid’s public status to effect a reverse takeover merger. It solves for Rite Aid (and Walgreens) the large problem of the unsold Rite Aid stores. 

Albertsons’ 2,200 supermarkets are in 38 states and the District of Columbia and comprise multiple brands such as Safeway and Acme in addition to Albertsons. Rite Aid stand-alone stores will continue to operate under their brand name as will most in-store pharmacies. The Rite Aid CEO John Standley will become CEO of the combined company with the Albertsons CEO moving up to chairman. CNBC, Seeking Alpha

Updated: For your weekend reading, here’s Jane Sarasohn-Kahn’s measured take on this acquisition in her HealthPopuli.

Who’s next? Place your bets here in Comments!

Telehealth alternatives to in-person consultation found lacking in effectiveness: Alt-Con Study (UK)

February 20, 2018 | by

It needs work and can’t be top down. That’s the conclusion of the Alt-Con Project and its researchers from several UK universities: Warwick, Bristol, Oxford (Nuffield) and Edinburgh. After examining the use of technological alternatives to GP consultations in eight general practices, they found that there were significant barriers to implementation, including insufficient training of non-clinical staff on these approaches’ benefits. The study includes recommendations to guide a more effective implementation.

Practices have been slow to adopt tech alternatives to F2F consults using telephone, email, e-consultation systems, and online video, despite NHS encouragement and programs such as the GP Access Fund. The paradox is that time devoted to non-F2F consults cuts into GPs time seeing live patients in the office.

  • They were adopted without a clear rationale or clearly thinking through cost-benefit for patients and practice staff.
  • Professor Sue Ziebland from Nuffield found that “…practices introduced alternative consultation methods for very different reasons and to solve problems that the practice had identified. These included a failure to be modern, to work more efficiently, to better serve commuters or dispersed populations, and to ensure appointments were available to those who needed them most.”
  • Other reasons: “the acknowledgment that the previous system was broken and unethical in providing a first-come, first-served system that left patients without appointments that they needed, and “the recognition that reception staff and phone lines were overwhelmed.”
  • Noted by other researchers were that ‘one-size-fits-all’, policy and financial incentive driven approaches were “not the best way forward”.

The study looked at GP practices of different sizes (1,938 to 18,353) covering over 85,000 patients, located in different geographic areas of England (6) and Scotland (2) including urban and rural areas, and with a mixture of patients’ socioeconomic status. 45 staff members and 39 patients were interviewed over eight months.

The University of Bristol Centre for Academic Primary Care has published a web page based on the Alt-Con research, offering guidance for GP practices. 

NHS England’s rejoinder: ‘This is a tiny study based on data that is almost two years old. Online consultations offer a convenient alternative to face-to-face appointments and patients are already seeing the benefits.’ Nuffield Department of Primary Care release, British Journal of General Practice, Daily Mail  Hat tip to former TTA Ireland editor Toni Bunting

Australia’s CNBP develops a 3D printed high-res microscope to clip on to your smartphone–and it’s DIY.

February 20, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/02/Microscope-1.jpg” thumb_width=”225″ /]The Australian Research Council Centre of Excellence for Nanoscale BioPhotonics (CNBP) has published a study by its researchers on a 3D printed, fully functional clip-on microscope which can examine specimens as small as 1/200th of a millimeter, including microscopic organisms, animal and plant cells, blood cells, cell nuclei and more. It does not require external light sources or power to function. It was created on a Formlabs Form 1 3D printer using an iPhone camera (number not disclosed) and flash. (CNBP illustration above at left.)

The 3D printing files and notes are publicly available here for anyone to recreate, along with a separate CNBP paper and tools on creating a portable bioanalytic device from a smartphone. 

Previous microscope clip-ons date back to 2010 with the development of the Ozcan microscope and app we covered in March 2012 and January 2013 (!) Current versions divide up into units that resemble bench microscopes or create hologram images, all requiring external light sources. This microscope is capable of, according to the study, “transmission [of] brightfield [flash on] and darkfield [flash off] microscopy on a mobile phone without any externally powered light source or additional illumination optics.” It also eliminates assembly, with the only requirement the fitting of the lens into the 3D printed clip. The camera’s digital zoom and imaging mode of the iPhone affect the apparent pixel size.

Why is this relevant? According to Dr. Anthony Orth, the lead researcher and CNBP Research Fellow at RMIT University, “Powerful microscopes can be few and far between in some regions. They’re often only found in larger population centres and not in remote or smaller communities. Yet their use in these areas can be essential—for determining water quality for drinking, through to analysing blood samples for parasites, or for disease diagnosis including malaria.” Aside from this use and similar such as healthcare provision in disaster sites or in rural/remote areas to send images for further analysis, when coupled with an app and machine learning, an initial analysis could be performed. Doctor house calls, telemedicine, telehealth vital signs monitoring, and home care monitoring (especially in infection situations) also come to mind.  Nature.com Scientific Reports, CNBP News. Also ZDNet and Gizmodo Australia.

Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?

February 17, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Here’s our roundup for the week of 12 February:

VA wins on the budget, but the Secretary’s in a spot of bother. Updated. Last week started off as a good week for Secretary Shulkin with a White House budget proposal that increased their $83.1 billion budget by 11.7 percent, including $1.2 billion for Year 1 of the Cerner EHR implementation in addition to the agency’s $4.2 billion IT budget which includes $204 million to modernize VistA and other VA legacy IT systems in the interim. While the Cerner contract went on hold in December while record-sharing is clarified, the freeze is expected to be lifted within a month. POLITICO  Where the trouble started for Dr. Shulkin was in the findings of a spending audit by the VA’s Inspector General’s Office of an official European trip to Copenhagen and London which included unreimbursed travel by Mrs. Shulkin and free tickets to Wimbledon, at least partly justified by a doctored email. This has led to the early retirement of the VA Chief of Staff Vivieca Wright Simpson and also an investigation of hacking into Wright Simpson’s email. It also appears that some political appointees in the VA are being investigated for misconduct. CNBC, FierceHealthcare.

Updated: POLITICO doesn’t feel the love for Dr. Shulkin in today’s Morning eHealth, linking to articles about the supposed ‘internal war’ at the VA, with veterans’ groups, with the Trump Administration, and within the VA. It’s the usual governmental infighting which within the 16 Feb article is being whipped by POLITICO and co-author ProPublica to a fevered pitch. Dr. Shulkin comes across as doctor/tech geek who underestimated the politicization of and challenges within an agency with the mission to care for our veterans. It’s also an agency having a hard time facing the current demands of a dispersed, younger and demanding veteran group plus aging, bureaucratic infrastructure. As usual the ‘privatization’ issue is being flogged as an either/or choice whereas a blend may serve veterans so much better.

Digital health entrepreneur named CEO of the American Telemedicine Association. A first for ATA is a chief from the health tech area who is also one of the all-too-rare executive women in the field. Ann Mond Johnson, who will be starting on 5 March, was previously head of Zest Health, board chair and advisor to Chicago start-up ConnectedHealth (now part of Connecture), and had sold her first start-up company Subimo to WebMD in 2006. She began her career in healthcare data and information with The Sachs Group (now part of Truven/IBM Watson). Ms. Johnson replaces founding CEO Jonathan Linkous, who remained for 24 years before resigning last August and is now a consultant. ATA release, mHealth Intelligence. ATA relocated in January from Washington DC to nearby Arlington Virginia. And a reminder that ATA2018 is 29 April – 1 May in Chicago and open for registration.

Allscripts’ ‘Such a Deal’! Following up on Allscripts’ acquisitions of Practice Fusion for $100 million (a loss to investors) and earlier McKesson’s HIT business for $185 million [TTA 9 Jan], it hasn’t quite paid for itself, but came very close with the sale of McKesson’s OneContent, a healthcare document-management system, for a tidy $260 million. Net price: $25 million. Their CEO is some horse trader! Some of the savings will undoubtedly go to remedying the cyberattack in January that affected two data centers in North Carolina, shutting down EHR and billing applications for approximately 1,500 physician practices, which have launched a class action lawsuit. FierceHealthcare 

Flatiron Health acquired by Roche. (more…)