Weekend Big Read: will telemedicine do to retail healthcare what Amazon did to retail?

August 12, 2017 | by

Updated. Our past contributor and TelehealthWorks’ Bruce Judson (ATA 2017 coverage) has penned this weekend’s Big Read in the HuffPost. His hypothesis is that telemedicine specifically will disrupt location-based care, followed by other digitally based care–and that executives at health systems and payers are in denial. More and more states are recognizing both parity of treatment and (usually) payment. Telemedicine also appeals to three major needs: care at home or on the go, with a minimal wait; maldistribution of care, especially specialized care; and follow-up/post-acute care. His main points in the article:

  • Healthcare executives are being taken by surprise because present digital capabilities will not be future capabilities, and the shift to virtual will be a gradual process
  • Telemedicine will address doctor shortages and grow into coordinated care platforms embedding expertise (via connected diagnostics, analytics, machine learning, AI) and care teams
  • Telemedicine will eventually go up-market and directly compete with large providers in urban areas, displacing a significant amount of in-person care with virtual care
  • Telemedicine will start to incorporate continuous feedback loops to further optimize their services and move into virtual health coaching and chronic care management
  • Telemedicine platforms are also sub-specializing into stroke response, pediatrics, and neurology
  • Centers of expertise and expert platforms will become larger and fewer–centralizing into repositories of ‘the best’
  • Platforms will be successful if they are trusted through positive patient experiences. This is a consumer satisfaction model.

Mr. Judson draws an analogy of healthcare with internet services, an area where he has decades of expertise: “A general phenomenon associated with Internet services is that they break activities into their component parts, and then reconnect them in a digital chain.” Healthcare will undergo a similar deconstruction and reconstruction with a “new set of competitive dynamics.”

It’s certainly a provocative POV that at least gives a rationale for the sheer messiness and stop-n-start that this Editor has observed in Big Health since the early 2000s. A caution: the internet, communications, and retail do not endure the sheer volume of regulatory force imposed on healthcare, which tends to make the retail analogy inexact. Governments monitor and regulate health outcomes, not search results or video downloads (except when it comes to net neutrality). It’s hard to find an industry so regulated other than financial/banking and utilities. FierceHealthcare also found the premise intriguing, noting the VA’s ‘Anywhere’ programs [TTA 9 Aug] and citing two studies indicating 96 percent of large employers plan to make telemedicine, also with behavioral health services, available, and that 20 percent of employers are seeing over 8 percent employee utilization. (Under 10 percent utilization gave RAND the vapors earlier this year with both this Editor and Mr. Judson stinging RAND’s findings with separate analyses.)

Tender Alerts: NHS Wales, Southend-on-Sea

August 12, 2017 | by

Susanne Woodman, our Eye on Tenders, brings to our attention two upcoming opportunities:

  • NHS Wales Informatics Service (NWIS) is developing a “cutting edge procurement project to establish a Dynamic Purchasing System (DPS) for Digital Patient Services Partners”, the first ever for health in the UK. It cautions, “DPS are a relatively new and untested procurement process that is believed will have significant benefit not only for the NHS but also as a catalyst to create innovative and agile markets.” Deadline for submission is 29 August. Details at Sell2Wales.
  • Southend-on-Sea Borough Council in partnership with South Essex Homes and the Southend CCG is in the early stages of evaluating technology enabled care (TEC). They are seeking to pilot assistive technology enabled care in a 96 independent living residential block ‘Living Laboratory’. No deadline listed. Details at Gov.UK.

Analyses of New Jersey’s new telemedicine regulations

August 11, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/08/New-Jersey-welcome.jpg” thumb_width=”150″ /]With New Jersey’s telemedicine regulations now signed into law by Governor Christie to be effective 21 July, both providers and payers are adjusting to what the expansion means for those covered by Medicaid, Medicaid managed care, commercial health plans, and NJ state-funded health insurance. Our 27 June article reviews key points, and they are largely positive for expanding telemedicine in the (now official) Garden State. However, the payment parity part was diluted in the final version, with the in-person reimbursement rate set as the maximum ceiling for telemedicine and telehealth reimbursement rates.

Unique parts of the NJ bill require:

  • Telemedicine or telehealth organizations operating in NJ to annually register with the Department of Health
  • Submit annual reports on activity and encounter data, which will include patient race and ethnicity, diagnostic and evaluation management codes, and the source of payment for the consult (final details determined by succeeding legislation)
  • A seven-member New Jersey Telemedicine and Telehealth Review Commission
  • Mental health screeners, screening services, and screening psychiatrists are not required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes

Full reviews of the legislation are available from law firms Foley & Lardner and in the National Law Review by an attorney from NJ firm Giordano, Halleran & Ciesla.

Some reflections on ATA and a future CEO–your ‘nominations’ wanted!

August 9, 2017 | by

This Editor and publication have had relationships at different levels with the American Telemedicine Association (ATA) since at least 2006. Our Readers know of TTA’s long-standing support of ATA’s annual meeting as a media partner. As a marketer, I’ve negotiated booths, sponsorships, and sent staff (including myself) to meetings, which makes this experience like many of our Readers.

It is worth reflecting that in 1993, when Jon Linkous took the ATA helm, few of us other than academics had email or used the Internet except in limited ways like IBMMail or Minitel. Once telemedicine, video consults, and vital signs data capture were the future and mostly theory. We went through the whiz-bang gadget phase, where every new one was going to change healthcare as we know it. Now we are past the buzzy cocktail party hangover into trying to make it work. We are in 2.0 and 3.0 where it’s all about integration of telemedicine and telehealth into patient engagement, behavior change, data analytics, predictive care, genomics, improving life for the aging and chronically ill population, managing the tsunami of patient data for better outcomes, smart pills, hacking and data security, EHRs, ACOs, meeting standards such as MACRA…and heavy engagement with national (Federal) and local entities. And always–getting paid enough to stay afloat!

As an organization, ATA faces an ever-expanding HIMSS, which has expanded far beyond its health information/IT/data analytics raison d’être to media properties, multiple health tech conferences, and now presence with early-stage companies through acquiring Health 2.0.

Dizzying changes, and more to come.

Who do you want to see at the helm of ATA? What will be the new CEO’s problems to solve? List your choices and thoughts in Comments below! (If you wish to be anonymous, email Editor Donna in confidence.)

VA unveils several ‘anywhere’ new telehealth services for veterans

August 9, 2017 | by | 3 Comments

The new Veterans Affairs Secretary, David Shulkin, has wasted no time since his appointment in introducing several technology and mobile-based services at the VA, all of which are long overdue in this Editor’s estimation:

  • Anywhere to Anywhere VA Health Care will authorize telehealth consults and cross-state care for veterans no matter their location and regardless of local telehealth restrictions. VA is already the largest provider of telemedicine services (called VA Telehealth) in 50 specialties to 700,000 veterans annually. This new regulation will enable VA to hire primary care and specialist doctors in metro areas to cover veterans in rural or underserved areas. 
  • Rolling out nationally over the next year is the VA Video Connect app where veterans can use their smartphones or home computers with video connections to consult with VA providers. At present 300 VA providers at 67 hospitals are using it.
  • The Veteran Appointment Request (VAR) app will also roll out from its test. It will enable veterans to use their smartphone, tablet or computer to schedule or modify appointments at VA facilities nationwide.

Dr. Shulkin advocated these programs while undersecretary, especially ‘Anywhere to Anywhere’, which required advice from the Justice Department. VA’s technology is also being supported by the American Office of Innovation to improve care transitions between the Defense Department and VA. 

President Trump participated in the announcement with Dr. Shulkin and sat in on between Albert Amescua, a 26-year Coast Guard veteran at a VA clinic in Grants Pass, Ore., and Brook Woods, a VA internist in Cleveland. VA announcement with videos, POLITICO Morning eHealth, HealthcareITNews

First aging services tech investment fund debuts in Israel

August 9, 2017 | by

Mediterranean Towers Ventures of Ganei Tikva, east of Tel Aviv, has launched an investment fund dedicated to supporting technologies that support quality of life–health, culture, and leisure–for older adults.  Co-CEO Dov Sugarman, via email to this Editor, confirmed that the venture fund is limiting itself for the time being to Israel-based companies in pre-seed and seed stages, although some later stage investments may be considered. They are “open to all opportunities in the aging tech space”. Interested companies should review their website and apply for funding here.

While Israel is statistically a young country, with only 11 percent or 900,000 aged 65 and over, this number is expected to increase to 1.3 million by 2025. At present, 25 percent of households have a member over 65, and because of this distribution, there is a substantial support network of supportive and adult housing. The venture fund grew out of Mediterranean Towers’ main business as a leading publicly traded provider of retirement housing. 

The venture capital group is headed by Dr. Yael Benvenisti, who is the chair of the SIG Technologies of Aging Well (Society of Electrical and Electronic Engineers in Israel), a member of the board of the Israel Association of Gerontology and an advisor to government bodies. Mr. Sugarman is the CEO of Aging2.0 Israel and founder of the third-generation technologies sector at JDC-Israel. (‘3rd generation’, ‘3rd tech’, and ‘third age’ are common expressions for aging and related tech in Israel.) Release, The Marker (in Hebrew)

Change at the top at ATA: CEO Jon Linkous departs after 24 years

August 8, 2017 | by

The American Telemedicine Association’s CEO, Jonathan Linkous, has left ATA after 24 years as CEO. An ATA spokesperson cited personal reasons, according to MedCityNews. Sources told POLITICO Morning eHealth that Mr. Linkous “simply told the organization he was leaving the job effective immediately before its board meeting this week.” It was certainly an unusual departure, without the standard transitional period of months or even a year. The ATA release was short and concentrated on the ‘transitional period’.

Acting as interim CEO will be Dr. Sabrina Smith, who joined last January as COO after senior VP/COO-level positions with the Regulatory Affairs Professionals Society (RAPS) and the American Academy of Physician Assistants (AAPA) after 12 years with MedStar Health, the largest health system in the Washington DC metro. MedCityNews quoted ATA board president Peter Yellowlees, MD that the search is expected to take about six months. This will take the search through ATA’s Fall Forum in October and well into the ramp-up for ATA 2018 in April. ATA is seeking “a vision for the future of healthcare” and “extensive knowledge of telemedicine”, so if you have it, step up! 

Jon Linkous, from the formation of ATA to yesterday, gained much recognition for telemedicine and telehealth, to where ATA presently has 10,000 members and 450 health system and industry partners, a leading annual conference, multiple events and educational programs. They have concentrated much (and successful) effort in gaining parity of payment for telemedicine, a state by state battle, though the POLITICO report (using a quote from a former HIMSS executive director now consulting for ATA!) did not think much of ATA’s influence in the Washington DC swamps. Another major change apparent over the past five years: as an association, healthcare technology has developed way outside ‘telemedicine’. Organizations like HIMSS have exploded in size through redrawing their definitional lines plus aggressive acquisitions in media and of competitors such as Health 2.0. The next chapters won’t be simple or easy for the new CEO. Also FierceHealthcare. (Disclosure: TTA has been for many years a media partner of the ATA annual conference.)

Charterhouse lost half its equity in Tunstall debt refinancing–Sunday Times report (updated)

August 7, 2017 | by | 11 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Breaking News, even though it happened in March! See updates below. The Sunday Times (UK–sign up for limited access) broke news over the weekend that Charterhouse Capital Partners, the main investor in Tunstall Healthcare, along with other shareholders, have been forced to relinquish nearly half the equity in the company to senior lenders and management. According to their annual report on page 65, section 31**, this happened on 17 March after the close of the FY, but only now has come to light through the Sunday Times report.

The article is light on details, but our Readers who’ve followed Tunstall’s history since the Charterhouse purchase in 2008 for £530 million will not be surprised, only that this development took so long. The cold facts are that the company has been wrestling with a stunning debt burden that grew from £1.2bn in 2015 [TTA 15 Apr 16] to the Times report of £1.7bn at the end of last September, with £300m owed to lenders and £1.2bn to investors. Debt service drove their financials to a £391m pre-tax loss last year. 

The highlights of the deal as reported in the Sunday Times:

  • Senior lenders (not disclosed) received 24.9 percent of Tunstall’s shares. Management received 25 percent.
  • Charterhouse with other shareholders now have a razor-thin controlling balance of 50.1 percent. Prior to this, Charterhouse alone had 61 percent of Tunstall’s shares.
  • In return, the lenders agreed to relax covenants on their debt, termed a ‘covenant reset’.
  • Tunstall also spent £18.5m last year on an abortive attempt to sell itself for up to £700m. We noted reports in April 2016 that they rejected a £300 million (US$425 million at the time) buyout offer from private equity investment firm Triton Partners.

**For those who wish to dig deeper, Tunstall’s hard-to-find annual report through last September (but not filed until 29 March 2017)  is available through Companies House. Go to their index here and select the “Group of companies’ accounts made up to 30 September 2016” which currently is the first listing.

This will be updated as other sourced reports come in, if they do–for now, it appears that the Sunday Times has the exclusive ‘dig’. It is unfortunate since Tunstall is responsible for millions of customers and employs thousands worldwide, and has been aggressively investing in the company and technology while having a fair amount of churn in executive and director positions. Regrettably, they never capitalized on a established position in a big market when they bought AMAC in 2011, then estimated as the US’ third largest PERS company. But as this Editor closed her 2016 article, the whole category of healthcare tech, while becoming more accepted and with a few exceptions, regrettably is still mired in ‘too many players, too many segments with too many names, all chasing not enough money whether private or government.’ I will add to that equation ‘too few users’–still true among older adults and the disabled–and ‘technology that moves too fast’ to make it even more confusing and unsettled for potential buyers (obsolescence on steroids!). And ‘gadgets’, to use the Times’ wording, are among the worst culprits and victims of these factors.

Updated: Equity capital. A cautionary tale was Editor Emeritus and Founder Steve Hards’ prescient analysis of the risks that Tunstall and Charterhouse undertook in acquiring so much debt. After you read it, note the year it was published. More recent commentary on Tunstall’s financial deteriorata dating back to 2013 can be found here.

Siemens plans IPO of Healthineers during 2018, possibly in US: reports

August 4, 2017 | by

The long-rumored IPO of Siemens’ healthcare business, dubbed Healthineers, will likely be first half 2018. How CNBC put it was that the IPO would enable “Healthineers to have its own currency for acquisitions and investments as the global healthcare market shifts focus from Siemens’ core business of imaging to molecular diagnosis and patient self-management.” Estimated value is €40 billion (US$47 billion). This separate listing has been delayed, further depressing their share price after a weak quarter. A Siemens board member with responsibility for Healthineers, Michael Sen, said to reporters on the third quarter earnings call that he was positive on the advantages of listing on a US exchange (Reuters).

Healthineers was one of the few bright spots in Siemens’ disappointing quarterly report, with low earnings in their energy related businesses, especially a potential €100 million sales loss resulting from four gas turbines illegally getting up and walking from southern Russia to sanctioned Crimea. We also strongly recommend that Siemens use the time before the IPO to find another name to replace the silly (in English) ‘Healthineers’ (after Three Musketeers? Mountaineers? Out of a Karl May western novel?) Hat tip to Paul Costello.

The Theranos Story, ch. 44: Walgreens settles lawsuit, cash box empties further

August 3, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/11/jacobs-well-texas-woe1.jpg” thumb_width=”150″ /]Walgreens realizes Theranos’ funds are not bottomless. Confirming the June Wall Street Journal report [TTA 26 June] that Theranos had advised its investors of a negotiated settlement with Walgreens Boots Alliance, Tuesday’s announcement offered few specifics. According to the Theranos release, the settlement resolves all claims by Walgreens and dismisses the lawsuit, with no finding or implication of liability. Terms were not formally disclosed, but sources told the WSJ (FoxBusiness) that the settlement was over $25 million. In June, it was estimated to be less than $30 million, so the over/under wasn’t very wide. Payment timing was not disclosed.

As we noted in June, Walgreens had invested an estimated $140 million between direct funding (a $40 million loan convertible into equity), and an “innovation fund’ designed to fund the store location rollout. The lawsuit filed last November was intended to recoup that amount. The thorn that Walgreens and its attorneys grasped was that even with insurance, there was not $140 million left in Theranos and nothing of equivalent non-cash interest. As a public company, certainly the realization that putting $25 million on the books this year was better than nothing. It is also likely that $110+ million has already been written off.

Not much left in Theranos’ till, other than some dollar bills and coins. In June, Theranos disclosed that their cash on hand was $54 million with a monthly burn of $10 million, leaving as of today $44 million. Even if the Walgreens settlement is covered 100 percent by insurance, at best Theranos has about four months of life–if nothing extraordinary happens. There are also ongoing SEC and DOJ investigations, plus the Colman/Taubman-Dye suit in California, which may result in more fines and settlements.

While Theranos makes much of its new management structure and commercializing new technologies (of which there is no word), there are no signs that beyond recapitalization earlier this year that there is fresh investment. Reports indicate they are trying, at long last, to exit real estate they no longer need–subleasing their expansive (and expensive) Palo Alto headquarters and relocating to their former lab in an industrial park in less tony Newark, California. As this Editor concluded in June, it is increasingly difficult to see a future for Theranos without Chapters 11 or 7 in it. It is rapidly arriving at a familiar place for startups, but not former Unicorns: Flat Brokedom.

Meanwhile, Walgreens Boots Alliance, barely dented in the exchequer, has closed on a $1.4 bn joint investment with KKR for institutional pharmacy company PharMerica. Drug Store News

It’s all hackable by Black Hats: pacemakers, Amazon Echo, trains, heart monitors, prison cells!

August 2, 2017 | by

It’s the servers, stupid! Unlike the economy, where people comprehended the problem, it seems we are automating more and securing less. The annual Black Hat Conference, where participants see this as a challenge, and the news are serving up some prime examples.

In Las Vegas, Lucas Lundgren, a senior security consultant at IOActive, scanned away–and was able to open prison doors, gain access to alarm systems, an oil pipeline, a German train controller, pacemakers, heart monitors, and insulin pumps. These communicate with servers through an open-source messaging protocol known as MQTT used in home and industrial systems. The problem is that access to the servers is not protected through a user name and password, much less two-factor authentication. “Not only can we read the data — that’s bad enough — but we can also write to the data.” Scary when you contemplate a hospital with insulin pumps, BP monitors, and multiple surgical devices all going haywire.  ZDNet 

Similarly, easy hacking pickings have turned up in IoT cameras–over 175,000 inexpensive cams made by Chinese manufacturer Shenzhen Neo Electronics’ as NeoCoolCam and distributed worldwide, discovered by BitDefender. Older Amazon Echo devices can be physically tampered with and malware uploaded to be turned into listening devices, according to MWR InfoSecurity.

And Anthem gets no respect. After suffering its 2015 data breach of 80 million members–and spending $115 million to settle the lawsuit–there’s a third-party contractor, LaunchPoint Ventures, who decided that no one would notice if 18,500 patient records were sent to a home email a year ago. Actually, it was noticed after the contractor was nabbed for unrelated “identity theft-related activities” this past April. More ‘splainin’ to do to HHS, surely, after filing their July 24 report. At least it’s not an IoT breach! Healthcare Dive

AI good, AI bad (part 2): the Facebook bot dialect scare

August 2, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/08/ghosty.jpg” thumb_width=”175″ /]Eeek! Scary! Bots develop their own argot. Facebook AI Research (FAIR) tested two chatbots programmed to negotiate. In short order, they developed “their own creepy language”, in the words of the Telegraph, to trade their virtual balls, hats, and books. “Creepy” to FAIR was only a repetitive ‘divergence from English’ since the chatbots weren’t limited to standard English. The lack of restriction enabled them to develop their own argot to quickly negotiate those trades. “Agents will drift off understandable language and invent codewords for themselves,” said Dhruv Batra, visiting research scientist from Georgia Tech at Facebook AI Research. “This isn’t so different from the way communities of humans create shorthands.” like soldiers, stock traders, the slanguage of showbiz mag Variety, or teenagers. Because Facebook’s interest is in AI bot-to-human conversation, FAIR put in the requirement that the chatbots use standard English, which as it turns out is a handful for bots.

The danger in AI-to-AI divergence in language is that humans don’t have a translator for it yet, so we’d never quite understand what they are saying. Batra’s unsettling conclusion: “It’s perfectly possible for a special token to mean a very complicated thought. The reason why humans have this idea of decomposition, breaking ideas into simpler concepts, it’s because we have a limit to cognition.” So this shorthand can look like longhand? FastCompany/Co.Design’s Mark Wilson sees the upside–that software talking their own language to each other could eliminate complex APIs–application program interfaces, which enable different types of software to communicate–by letting the software figure it out. But for humans not being able to dig in and understand it readily? Something to think about as we use more and more AI in healthcare and predictive analytics.

AI good, AI bad. Perhaps a little of both?

August 1, 2017 | by

Everyone’s getting hot ‘n’ bothered about AI this summer. There’s a clash of giants–Elon Musk, who makes expensive, Federally subsidized electric cars which don’t sell, and Mark Zuckerberg, a social media mogul who fancies himself as a social policy guru–in a current snipe-fest about AI and the risk it presents. Musk, who is a founder of the big-name Future of Life Institute which ponders on AI safety and ethical alignment for beneficial ends, and Zuckerberg, who pooh-poohs any downside, are making their debate points and a few headlines. However, we like to get down to the concretes and here we will go to an analysis of a report by Forrester Research on AI in the workforce. No, we are not about to lose our jobs, yet, but hold on for the top six in the view of Gil Press in Forbes:

  1. Customer self-service in customer-facing physical solutions such as kiosks, interactive digital signage, and self-checkout.
  2. AI-assisted robotic process automation which automates organizational workflows and processes using software bots.
  3. Industrial robots that execute tasks in verticals with heavy, industrial-scale workloads.
  4. Retail and warehouse robots.
  5. Virtual assistants like Alexa and Siri.
  6. Sensory AI that improves computers’ recognition of human sensory faculties and emotions via image and video analysis, facial recognition, speech analytics, and/or text analytics.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/08/AI.jpg” thumb_width=”200″ /]For our area of healthcare technology, look at #5 and #6 first–virtual assistants leveraging the older adult market like 3rings‘ interface with Amazon Echo [TTA 27 June] and sensory AI for recognition tools with broad applications in everything from telehealth to sleepytime music to video cheer-up calls. Both are on a ‘significant success’ track and in line to hit the growth phase in 1-3 years (illustration at left, click to expand).

Will AI destroy a net 7 percent of US jobs by 2027? Will AI affect only narrow areas or disrupt everything? And will we adapt fast enough? 6 Hot AI Automation Technologies Destroying And Creating Jobs (Forbes)

But we can de-stress ourselves with AI-selected music now to soothe our savage interior beasts. This Editor is testing out Sync Project’s Unwind, which will help me get to sleep (20 min) and take stress breaks (5 min). Clutching my phone (not my pearls) to my chest, the app (available on the unwind.ai website) detects my heart rate (though not giving me a reading) through machine learning and gives me four options to pick on exactly how stressed I am. It then plays music with the right beat pattern to calm me down. Other Sync Project applications with custom music by the Marconi Union and a Spotify interface have worked to alleviate pain, sleep, stress, and Parkinson’s gait issues. Another approach is to apply music to memory issues around episodic memory and memory encoding of new verbal material in adults aging normally. (Zzzzzzzz…..) Apply.sci, Sync Project blog

Tunstall pairing with Inhealthcare digital health for NHS remote monitoring

August 1, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]A digital link of hope for Tunstall’s future? Announced at The King’s Fund Digital Health & Care Conference but oddly not receiving much notice was the UK collaboration of Tunstall Healthcare and Inhealthcare. Inhealthcare builds infrastructure for digital health services, and currently works extensively with multiple NHS regions and programs, such as the North of England Regional Back Pain Programme, NHS England’s Sheffield City Region Test Bed and the Darlington Healthy New Town project. Their services include telehealth monitoring for INR, COPD, medication reminders, a smartphone app platform, chronic pain management, and a surprising one that addresses undernutrition in older adults. The Tunstall-Inhealthcare objective is to integrate health and social care with clinical care systems in six areas: LTC home monitoring, identifying vulnerable patients, involving family members, 24/7 clinical care coordination centers, post-discharge management, and digital health at home innovation. Also noted is that Inhealthcare has programming technology that can reduce the time to build out services and apps.

Inhealthcare Ltd is part of Intechnology plc, owned by Peter Wilkinson, who has developed several UK internet and technology companies at scale–Planet Online, Freeserve, and Sports Internet (now Sky Betting and Gaming). Tunstall release

CTE found in 99% of former, deceased NFL players’ brains: JAMA study (updated)

July 26, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/h_research_Figure-4.-Annotated-Normal.-Mild-CTE.-Severe-CTE.jpg” thumb_width=”200″ /]Updated for additional information and analysis at conclusion. In the largest-ever case study published of CTE–chronic traumatic encephalopathy—VA Boston Healthcare System (VABHS) and the Boston University School of Medicine’s CTE Center found mild to severe CTE pathology in nearly all of the brains of former football players studied. Jesse Mez, MD, BU Medical assistant professor of neurology and lead author on the JAMA study, said that “The data suggest that there is very likely a relationship between exposure to football and risk of developing [CTE].” The CTE is marked by defective tau (stained red in the brain sample pictures, click to expand), which is also evident in Parkinson’s and Alzheimer’s Disease.

Of the 202 brains donated to the VA-BU-CLF (Concussion Legacy Foundation) Brain Bank:

  • The most dramatic finding is the detection of CTE in 110 of 111 donated former NFL players’ brains (defined as having played one play in a regular NFL season game).
  • In addition, the brains of other football players were studied. CTE was detected in seven of eight Canadian Football League former players (88 percent), nine of 14 semi-professional players (64 percent), 48 of 53 college players (91 percent), and three of 14 high school players (21 percent).
  • The severity increased with length of play, with the majority of former college, semi-professional and professional players having severe pathology. The deceased high school players diagnosed with CTE had mild pathology findings. Age at death ranged from 23 to 89.
  • Player position mattered. Linemen, running backs, defensive backs, and linebackers, who take most of the punishment in football, were the bulk of the donated brains with CTE.

Separately, and with no knowledge of the pathology, backgrounds on each donor were compiled to gather medical history and symptoms. What was striking were the personality changes evident with even mild CTE. Dr. Mez: “We found cognitive, mood and behavioral symptoms were very common, even among players with mild CTE tau pathology. This suggests that tau pathology is only the tip of the iceberg and that other pathologies, such as neuroinflammation and axonal damage, contribute to the clinical symptoms.” 

Preliminary to the current study was UNITE (more…)

Shouldn’t we be concentrating on digital therapeutics rather than ‘health apps’?

July 26, 2017 | by

Where the money and attention are going. The first generation of Quantified Self apps was all about viewing your data and storing it online in a vault or graphs…somewhere, usually proprietary. Your Pebble, Fitbit, or Jawbone tracked, you crunched the numbers and found the meaning. At the same time, there are wellness companies like Welltok, ShapeUp, Keas, Virgin HealthMiles, and RedBrick Health, usually working with companies or insurers, that use various methods (money, gamification, other rewards) to influence lifestyle and improve a person’s health in a quantified, verifiable, but general way. What’s happened? There are now apps that combine both data and behavior change, focusing on a specific but important (again) condition, coach to change behavior and verify results rigorously through clinical trials. Some, like Omada Health, prove through those clinical trials that their program successfully changes pre-diabetic indicators, such as weight loss, decrease cholesterol and improved glucose control–without medication. This results in big savings for insurance companies, one reason why a $50 million Series C was led by Cigna. Another model is to work with pharmaceutical companies to better guide treatment. Propeller Health with its asthma/COPD inhaler tracker is partnering with pharma GlaxoSmithKline on a digital platform to better manage lung patient usage, and surely this will go through a clinical trial. We will be seeing more of this type of convergence in medical apps. (The rebooted Jawbone Health Hub is moving in this exact direction.) The Forbes article, while short, is written by someone who knows the business of apps– the co-founder of the AppNext distribution/monetization platform. He does achieve his aim in making us think differently about the potential of ‘health apps’.