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

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’. 

The King’s Fund 2017 Digital Health Congress: videos, presentations now posted

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/Digital-Health-email-banner.png” thumb_width=”175″ /]The King’s Fund’s annual two-day Digital Health and Care Congress now has videos and presentation decks posted on the event page.  If you missed it, or want to see the sessions you could not attend, here’s your opportunity to review and share with staff. All the plenaries and keynotes have both video and presentations. Selected workshops/breakouts have video along with PowerPoints on nearly all, including posters. Attendance this year was between 400 and 500. On Twitter: #kfdigital17, @TheKingsFund TTA was pleased to be a marketing supporter of the 2017 conference as we have for several years. Many thanks to events coordinator Claire Taylor.

For planning ahead, The King’s Fund Annual Conference will be two days this year, 29-30 November. Early bird registration is available until 1 September and sponsorships/exhibit opportunities are open.

Fitbit’s smartwatch on track; Intel exits the game

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/Fitbit-smartwatch.jpg” thumb_width=”200″ /]Fitbit’s ‘Project Higgs’ in-house designed smartwatch is, by all reports, on schedule to hit the market later this year in time for the holidays, at least in Wall Street’s expectations. To the FT (may be paywalled) CEO James Park reassured, “The product is on track to meet our expectations and the expectations that we’ve set for investors. It’s going to be, in my opinion, our best product yet.” It will be waterproof, a battery that lasts several days, have mobile payment capability (from the Coin acquisition), simple health tracking,  heart rate monitor, sleep tracking, stream music (Spotify and Pandora are rumored), and its own app store. It will be either Wi-Fi or smartphone connected. TechRadar’s agglomeration of rumors include pricing ($199 to $299 –about £231), swappable bands, a full-color screen with 1,000 nits of brightness, an aluminum body and built-in GPS. The most interesting part is the proprietary operating system which uses Javascript. Also Pocket-Lint articles 18 July and 19 July

Intel, however, is giving up the smartwatch and fitness tracking chase. In 2014 they acquired Basis in a well-publicized move and enlisted hip celebrities like 50 Cent to endorse their products versus the likes of Apple and Fitbit. In November about 80 percent of the group was let go, according to CNBC, and entirely eliminated this month. The New Technologies Group is now focusing on augmented reality. CNBC

Can Google Glass’ enterprise iteration solve the patient documentation crisis?

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/Glass-EE.jpg” thumb_width=”200″ /]”Glass is a hands-free device, for hands-on workers.” What a marketing position! Google Glass finally arrives at where it should have started–not a techie toy or a social snooper banned from bars, but a tool for specific work needs that solve specific but important problems. This is not only ‘on trend’, but also the ‘professional case’ is steak on the grill as a powerful way to lend legitimacy to a new product (the classic is Tang ‘orange drink’ going into space in the early ’60s). The recent announcement of Glass Enterprise Edition (EE) marking its emergence from stealth mode was a refreshingly low-key (for Google and parent Alphabet) surprise. Even the revamped look is sturdy and utilitarian in full glass mode (left) or in clip-on (and also serves as eye protection). 

Their on-trend position for healthcare is to reduce the amount of time that doctors spend charting and documenting patients. Augmedix, a Glass partner, built the documentation automation platform for Sutter Health and for Dignity Health that captures the information from the interaction between patient and doctor via a ‘remote scribe’. Jay Kothari, the Glass project lead, quotes data from Dignity that it reduces clinician daily documentation time from 33 percent to less than 10 percent,  The Sutter Health estimate is two hours per day. Out of the gate this is extremely valuable because it improves the clinician-patient face-to-face (and presumably virtual) visit in eye contact, reduces the break in taking notes, and reduces time pressure generated by post-visit review. Netherlands-based swyMed concentrates on facilitating virtual visits, and is testing a home visit pilot with Loyola University Health System practitioners in Maywood, Illinois. Others, like John Nosta, have been continuing to use Glass in business. Our Readers may want to check out these partners as that is how Google is making the Glass available, not directly. SF/Boston-based partner Brain Power wasn’t mentioned in Mr. Kothari’s blog, but their AI/VR applications for brain conditions such as autism and TBI, as well as other uses such as clinical trials and care for older adults. mHealthIntelligence interviewed Augmedix’s CEO Ian Shakil, who notes that Glass still needs improvements in battery life for the hard work of documenting patient visits.

Update: An interesting comment on this via Twitter. The paper is from 2015 but the regulatory and privacy questions around recording patients and information remain. Augmedix does state on its website that it is HIPAA compliant.

 
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Toyota’s $14 million bet on Intuition Robotics’ social companion robot (JP/IL/US)

Social companion robots for older adults and the disabled are hot again. Tel Aviv and now San Francisco-based Intuition Robotics is enjoying a $14 million second Series A investment from Toyota Research Institute (TRI) for the ElliQ ‘active aging companion’. The ElliQ desktop robot is tethered to a proprietary tablet to connect an older adult with the outside world via video chat, using machine learning about the person to recommend activities, and assist with appointments, medication reminders, music, wellness, and environmental monitoring. ElliQ is still in pre-release. The $14 million is being put to immediate use in initial testing with users in the Bay Area, and Intuition is ramping up with a team there. 

TRI is based in Los Altos CA and is wholly owned by Toyota North America. Earlier seed and Series A investments totaling $8 million were made by iRobot, Terra Venture Partners, Bloomberg Beta and ManivMobility. This is the second older adult-targeted robotics news in as many weeks, with the more fully-featured and ‘humanoid’ KOMPAÏ in France going the crowdfunding route (as Intuition did early on) for €250,000 to fund the next generation [TTA 5 July]. After viewing the video below, it seems to this Editor that a lot of the interactive voice command technology has been overtaken by assistants already in market like Siri, Amazon Alexa, and Google Home. TechCrunch, Home Health Care News

 

Tender Alerts: Warwickshire, Thurrock, and Hertfordshire

Susanne Woodman of BRE, our Eye on Tenders, alerts our Readers to two open and one probable new tenders:

  • Nuneaton and Bedworth Borough Council (NBBC) in Warwickshire is seeking a 24/7 ‘reactive repair service’ for Tunstall telecare equipment presently in 35 independent living accommodations. The contract is for an initial period of two years, with two optional one-year extensions. Closing is 4 August. Details here.
  • Thurrock Council in Essex is seeking “to appoint a Consultant who will work as Project Manager with Adult Social Care and Health staff to develop an Assistive Technology Strategy and support implementation of the strategy.” The contract is valued at £25-50,000. Interest must be registered by 28 July at the Council’s Delta eSourcing page. On the Council page there is additional information in a summary of the Council’s of the Careline service and a resolution to expand/upgrade assistive technology for local users. 

Not registered as a tender yet is a plan by Hertfordshire County Council to bring wearables such as activity trackers and software-enabled clothing into the homes of at-risk local adults, plus online systems for video-link calls, scheduling messages and reminders for people to take their medication and connect with families. This article in the Watford Observer tells some of the story but the page on the Hertfordshire blog is oddly missing–however, captured by the sharp-eyed Ms. Woodman here. They advise monitoring the Herts County Council on social media–right now they are burning up Twitter @hertscc on the alphabet countdown to potholes and fire safety tips from Reqs the Fire Dog!

Creepy data mining on medical conditions runs wild: where’s the privacy?

Ever heard of AcurianHealth? If you are in the US, you may get a letter for one of their research studies or drug trials based upon your prescriptions, your shopping habits, or your internet browsing. Where do they get that data? Quite legitimately, based on consent, Walgreens Boots will mail invitations for studies organized by Acurian to their pharmacy customers, where the user identification is withheld from Acurian. The privacy policy by which Walgreens does business with you permits this type of contact with you. These letters direct users to a generic sounding website for the study–and then life gets interesting. A visit to the site, whether from a letter, a search, or an online ad, may capture your information. There’s a bit of code from a company they work with, NaviStone, that captures information from partial or unsent information requests or signups. NaviStone then matches it up with what you think is anonymous behavior with other databases, and voilá, mail is sent to you via their ‘proprietary technology.’ Acurian uses databases from large data broker/aggregators like Epsilon and cranks away. It’s creepy behavior that stretches the definition of privacy and consent. Not reassuring is that Acurian has a database of over 100 million people who are supposedly opt-ins. How a Company You’ve Never Heard of Sends You Letters about Your Medical Condition (Gizmodo) Hat tip to Toni Bunting

UDG Healthcare buys American, adds Vynamic, Cambridge BioMarketing for up to $67 million

Consultancy acquisitions the latest trend–who’s next? Dublin’s UDG Healthcare acquired Philadelphia-based healthcare consultancy Vynamic last week, then topped it on Monday with marketing/communications company Cambridge BioMarketing. Cambridge has an unusual specialty–campaigns for orphan and specialty drugs and treatments with clients from small to large pharma and biotech. Vynamic, an industry management consultancy, provides services from strategic planning to process design and systems implementation.

This follows on the reveal earlier this month in Bloomberg of the potential sale of The Advisory Board’s healthcare practice to UnitedHealthcare. Last week, this Editor mentioned Evolent Health in Rock Health’s record-breaking review of first half 2017 funding. It turns out that publicly traded Evolent is partly owned by The Advisory Board, with a share valued at $170 million, and reportedly had been seeking funding to itself purchase The Advisory Board, now considered unlikely (BizJournals). What will happen to this share isn’t known.

The Vynamic acquisition is structured as an initial purchase price of $22 million with an additional consideration of up to $10 million payable over the next three years, based on the usual achievement of agreed profit targets, for a total of $32 million (€27.8 million). Irish Times Vynamic will join UDG’s Ashfield Division. Release For Cambridge, it’s a similar arrangement of $30 million (€26m) paid up front, with the potential for an additional $5 million (€4.3m) paid over the next 12 months, again dependent on achieving financial targets. RTE.ieRelease

PharmaTech Innovations/Health 2.0 NYC Wed 19 July –speakers confirmed, reserve now!

Wednesday, 19 July, 6-8:30 pm at Cohn Resnick LLP, 1301 6th Avenue, NYC

Health 2.0 NYC‘s July event examines innovation in the pharmaceutical business. It’s changing radically, from companies like PillPack which disrupt traditional pharmacies to apps that monitor clinical trials or prescribed as adjuvant therapies. Presenters on Wednesday night include:

  • Dan Conely – Managing Director, NJ Angels, active investor in drug discovery automation
  • Grace Cordovano, PhD – Enlightening Results – CEO and private cancer patient advocate. She founded Enlightening Results, LLC in 2010 to foster private, personalized patient advocacy services.
  • Jodie Gillon – Achillion Pharmaceuticals, Senior Director, Patient Advocacy and Professional Affairs

Early stage companies presenting: ClearRx. Other speakers/presenters to come. 

For $25, you get engaging speakers, beverages, food, and plenty of networking time amongst the like-minded and leaders in health tech! More information and registration on the Health 2.0 NYC Meetup page. (Disclaimer: Editor Donna is an event host and TTA is a long-time sponsor and supporter of Health 2.0 NYC) 

“Crazy”: StartUp Health’s 2nd Q digital health funding breaks record

As predicted, a torrid start to the year. StartUp Health‘s 2nd quarter and first half funding estimate shattered records–$6.5 billion first half, $3.8 billion 2nd quarter compared to $8 bn and 500+ deals in full year 2016. StartUp Health takes a wider sample than Rock Health, tracking over 300 international company deals, including those below $2 million, in service and biotech/diagnostic companies. A change from last year is that there are more Series A than seed deals, concentrating on workflow, big data/analytics, wellness, medical device, and personalized health-Quantified Self companies. Series B deals are well-populated, but there is still a long bridge to C and above. San Francisco and the Bay Area continue to substantially lead in deals made, with Chicago at 39 percent and New York at 25 percent of deal value. They also trumpet the success of their funding family. Watch the video below or download the free report here.

‘Record-shattering’ Q2 for digital health deals: Rock Health’s volte-face

In a pirouette worthy of Nureyev in his prime, Rock Health’s latest Digital Health Funding review for Q2 and the first half of 2017 bangs the drum loudly. With $3.5 bn invested in 188 digital health companies, it’s a record in their tracking. (∗See below for their parameters, which focus on larger fundings and omit others by type.) Q2 reversed the muddling results of Q1 [TTA 11 April] and then some. If the torrid pace is maintained and the market doesn’t take a pratfall, this year will easily surpass 2016’s full year venture funding at $4.3 bn and 304 investments.

Looking at trends, the average deal size has ballooned to $18.7 million from the 2015-16 range of $14 million. Seven $100 million+ deals led the way: Outcome Health, Peloton, Modernizing Medicine, PatientPoint, Alignment Healthcare, PatientsLikeMe, and ShareCare. Of these, three are consumer health information (Outcome, PatientPoint, ShareCare), with PatientsLikeMe closely related with a patient community focus; as the lead category of investment overall, there’s now gold in consumer health. All seven businesses are located outside of Silicon Valley, a refreshing change. A surprise is Modernizing Medicine in the settled (we thought) EHR-clinical workflow category. There’s also an interesting analysis of the shift in top categories from last year to this, which takes out the $100 million+ deals (click to enlarge): [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/Top-Funded-Categories-Midyear-Funding-Report-2017-1200×744.png” thumb_width=”200″ /]

Other changes from the usual: no IPOs and a slowing pace of M&A: 58 this year versus first half 2016’s 87 and full year 146. Their public company index is brighter, with positive gains in first half led by Teladoc (up 110 percent YTD), Care.com (up 80 percent), and consulting favorite Evolent Health (up 70 percent–with United Healthcare’s acquisition of The Advisory Board’s healthcare practice, can an acquisition be far away?). Remaining in the doldrums are NantHealth, Fitbit, and Castlight Health. Rock Health Digital Funding Review First Half 2017

Soon up will be StartUp Health’s first half analysis, which takes a different cut at the companies and looks at the balance of deals by funding series.

∗ Rock Health tracks deals over $2 million in value from venture capital, excluding government and grant funding. They omit non-US deals, even if heavily US funded; healthcare services companies (Oscar), biotech/diagnostic companies (GRAIL), and software companies not solely focused on healthcare (Zenefits), but include fitness companies like Peloton. 

Jawbone finally T-bones, founder starts Jawbone Health Hub (updated)

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/05/The-End-Pic-typewriter.jpg” thumb_width=”200″ /]Confirming the decline of the fitness tracker/wearables business, Jawbone is finally over and done. Their liquidation this week was initially reported by The Information (subscription only) and that co-founder/CEO Hosain Rahman has started a new company, Jawbone Health Hub. JHH will work on medical software and hardware, as well as eventually servicing the buggy existing Jawbone products† which were sold off to a third party last September. JHH is also reportedly hiring many former Jawbone staff and on job boards such as Glassdoor. 

Jawbone’s demise comes after a troubled 18 months, starting with a $165 million private equity raise in January 2016 led by the Kuwait Investment Authority, rumors of financial problems, repositioning into clinical medical monitoring, and abandoning what was left of consumer market support. There is also the continuing saga of court actions with Fitbit over trade secrets, employee poachings, and IP–all additional reasons for the founder to walk away. The only value left in Jawbone is that IP which includes BodyMedia patents and anything left that wasn’t voided by a court. Fitbit shares are also sinking, currently trading at a near 52-week low of just above $5.

‘Death by overfunding’? Updated During its lifetime from wireless audio speaker innovator Aliphcom to wearables leader with the Jawbone UP, Jawbone raised $938 million (Crunchbase), and at one point was valued at $3 billion. An interesting take from a Reuters article was that one consensus among Silicon Valley tech funders was that the company would have been far easier to acquire had it raised less money. Jawbone ranks only behind solar tech Solyndra among largest failures among venture-backed companies. (The difference, of course, was that Jawbone didn’t take $500 million of public stimulus money, as Solyndra did before it failed.)

The words ‘Chapter 7’ have not been included in reports but Sherwood Partners, a busy Mountain View CA financial restructuring company that has wound down plenty of startups through unicorns, was reported to be in charge of the liquidation process plus any remaining legal actions with Fitbit. None of the usual sources have been able to obtain statements from Mr. Rahman and ‘the information’ remains limited. The Verge, TechCrunch, Business Insider 

†Editor Charles’ struggles with seven personal Jawbone UPs were often typical of the user experience.

Conference & Tender Alert: Perth & Kinross TEC event, Flintshire (Wales) tender (UK)

Susanne Woodman of BRE, our Eye on Tenders, alerts our Readers to a Scotland TEC conference and a Wales tender.

The Perth & Kinross Technology-Enabled Care Conference will take place on Tuesday 26 Sept at Perth Concert Hall. It’s expected to have an attendance of about 120 people from across the social and health care area. Sponsorship packages are available to about 20 organizations. See details on Public Contracts Scotland. Email TEC@pkc.gov.uk 

In Wales, the Flintshire County Council is seeking a telecare emergency alarm  system with 24-hour telephone support. Flintshire currently operates 70 sheltered housing developments with 2613 units, currently connected to a call handling system provided by Jontek. Tenders are due 4 August. Information on Sell2Wales. Contact dawn.kent@flintshire.gov.uk 

‘Let me die at home’. The human and financial cost of ending telehealth (Cornwall UK)-update

See below for ITV coverage. Jill Diggett, a resident of Bodmin in Cornwall, is one of undoubtedly many local people losing their telehealth monitoring next week. A business decision was made to abandon telehealth monitoring provided by NHS Kernow, whose statement is extensively cited by this article in Cornwall Live. NHS Kernow, which is £54 million in the red, cites “the service did not have significantly robust clinical evidence for effectiveness and did not demonstrate the desired outcomes that we would expect to see.” The Cornwall Partnership NHS Foundation Trust, which provides the service, will hand it off in advance to the telehealth user’s GP, and will provide community services or getting a helper to manage their condition.  

From this article, Mrs. Diggett is 1) an exception to their findings and 2) the handoff appears to have been dropped. Mrs. Diggett has five serious chronic conditions. She is on oxygen. Last December, she was in hospital for three weeks. Post-discharge, she was given telecare and telehealth monitoring of her vital signs (weight, blood oxygen, blood pressure), performed by her husband and sent to a care coordinator (a ‘medical expert’ in the article). There’s medical intervention if things trend poorly. However, she has stayed out of hospital since and is presented here as medically stable, though not doing handsprings. In the article, Mrs. Diggett expresses despair and real fear that she will be taken from her home and wind up back in hospital where she assumes she will die, an understandably emotional reaction. Worse, her husband gives no indication that his wife’s care has been transitioned. 

Readers of Cornwall Live are also pointed to the closure of a Bodmin treatment centre in March. So the Diggetts will be traveling much farther to receive care if they were using it.

Mr. Diggett was told that the average cost of a hospital bed is £1,000 a night. For 21 nights, that is £21,000. Let’s assume that the fully allocated cost (devices and monitoring) of the telehealth service is £100/month. That is 210 months–17.5 years–of monitoring for the cost of one hospital stay. If it is £250/month, that is 84 months or 7 years.

What is not cost-calculable but has consequences? Mrs. Diggett’s state of mind and her husband’s quality of life. Her predicament is shared by patients and caregivers who had telehealth or telecare withdrawn after a pilot or the ending of an at-home program. There is a feeling of abandonment, that they don’t have this help or support, no one is listening, the safety net’s been taken away, and they are all alone again. Anyone who has worked for telehealth and telecare companies, such as this Editor, knows this is an unavoidable consequence of service withdrawal unless that person is much better or is transitioned properly, which almost never happens. Readers on both sides of the Atlantic will surely be able to supply their own examples where the books don’t balance. Hat tip to Susanne Woodman, our Eye on Tenders.

Update: ITV last night (11 July) reported on this here, interviewing the Diggetts. Bravo!

Weekend reading: the life and spread of microbes in the average hospital room

We in healthcare and health tech know how deadly nosocomial or hospital-acquired infections are. Current CDC estimates are that in US hospitals, there are 1.7 million infections and 99,000 associated deaths each year (up from a previous estimate of 75,000) PatientCareLink. Most of us know that visiting a patient in a hospital room means also making sure hands are washed, clothes and shoes are clean, and that we bring a container of industrial strength bleach wipes for cleaning surfaces versus flowers.

However, it was news to this Editor that few studies have been done on the actual hospital room environment–the microbiome–and how the microbes in the room interact with the patient and the staff.  Sue Barnes, an RN who spent 30 years as the National Leader for Infection Prevention for Kaiser Permanente, reviews a newly published study in Science Translational Medicine (24 May, abstract available only). The study collected bacterial cultures from the ‘patient zone’ around the bed, every surface in the hospital room, and swabbed the hands and noses of patients and staff, along with the shoes, shirts, and cell phones of staff members. The problem is much more complex than simple cleaning.

  • Patient skin and the microbial makeup of room surfaces became more similar over time. Non-ambulatory patients were less so, as they had less contact with external surfaces.
  • The longer patients were in the room, the more genetic resistance to antibiotics the organisms acquired. This is despite the lack of association with antibiotics save topicals. The author suggests that regular cleaning may be the reason–only the strongest survive.
  • The hospital room is most threating to the most vulnerable, such as babies in a neonatal ICU
  • “In the Lax study, several bacterial samples taken more than 71 days apart were identical,  (more…)

Cerner DoD deployment on time; Coast Guard EHR shopping; Air Force, VA sharing teleICU

The US Department of Defense announced that the deployment of Cerner’s EHR MHS Genesis at the Naval Hospital in Oak Harbor, Washington is on time for later this month. It’s a little unusual that anything this big and in the government is actually on time. It’s also meaningful for VA, as they are adopting MHS Genesis in an equally, if not longer, rollout [TTA 7 June]. Healthcare IT News

Less well known is the Coast Guard‘s dropping its costly six-year deployment of the Epic EHR last year and reverting to paper. They are not in the MHS Genesis rollout because the CG is part of the Department of Homeland Security, despite its service roots and structure similar to the US Navy. This has led to much speculation that their final choice will be DoD’s Cerner platform, although the OpenEMR Consortium has already answered their April RFI.

And even less noticed was the late June announcement that the US Air Force Medical Operations Agency and the VA are implementing a tele-ICU sharing arrangement, giving the USAF access to the VA’s capabilities at five AF locations: Las Vegas; Hampton, Virginia; Biloxi, Mississippi; Dayton, Ohio; and Anchorage, Alaska. The VA central tele-ICU facility is in Minneapolis. Doctors there can remotely consult, prescribe medications, order procedures and make diagnoses through live electronic monitoring. Becker’s Hospital Review, VA press release