Hackermania runs wild…all the way to the bank! Ransomware strikes Crozer-Keystone, UCSF med school, others

July 1, 2020 | by

News to make you livid. After surviving (to date) the COVID pandemic, health systems and medical schools are being attacked by ransomware criminals. Both the small Crozer-Keystone Health System and the globally known University of California San Francisco School of Medicine have been attacked by the ever-so cutely named Netwalker (a/k/a MailTo). Yes, this criminal hacker gang isn’t outside banging pots for first responders or donating money, or even sticking to a brief truce (Emsisoft), but figuring ways to spread malware into healthcare organizations for fun and profit. 

And profitable it’s been. UCSF paid Netwalker the princely sum of $1.14 million (£910,000) in 116.4 bitcoins after an attack starting 1 June that was also (to add insult to injury) published on Netwalker’s public blog. In the timeline presented by BBC News, it was negotiated down (professionally) from $3 million; BBC also obtained some key parts of the negotiation via an anonymous tipoff, and it’s fascinating reading. Netwalker leads the victim to a dark web ‘customer service’ site where there’s a countdown to double payment or deletion of your now-encrypted data. They are also able to live chat with the victim.

UCSF was able to limit the malware encryption damage to servers within the School of Medicine (according to the BBC, literally unplugging computers; according to UCSF, isolating servers) but decided to pay the ransom to unlock the encrypted data and return data they obtained, stating in its public release “The data that was encrypted is important to some of the academic work we pursue as a university serving the public good”. They will work with the FBI on the incident and have brought on board outside expert help.

According to FierceHealthcare, Netwalker was also behind the attack on the Champaign-Urbana Public Health District (Illinois) website in March and Michigan State University’s network in May.

Paying ransom is contrary to the advice of the major world security services such as the FBI, Europol, and the UK’s National Cyber Security Centre, on the simple basis that it encourages them. It’s a true damned-if-you-do, damned-if-you-don’t situation, as Brett Callow, a threat analyst at cyber-security company Emsisoft, said to the BBC: “But why would a ruthless criminal enterprise delete data that it may be able to further monetise at a later date?” 

Crozer-Keystone to date has refused to pay ransom. On 19 June, bitcoin publication Cointelegraph published a screenshot of Netwalker’s dark web auction page of the data. Apparently it is all financial and not medical records or PHI. Crozer also isolated the intrusion and took systems offline. Crozer is a small system of four hospitals in suburban Philadelphia (Delaware County) and serves parts of the state of Delaware and western New Jersey.

Neither Crozer nor UCSF have gone public with the source of the breach, but it is known that the main lure during the pandemic has been phishing emails with COVID-19 results or news, loaded with malware downloads.

As this Editor wrote back in May 2018 on the anniversary of WannaCry, it’s not a matter of if, but when, at highly vulnerable organizations like healthcare and academia with high-value information records. Right now, the Hakbit spear-phishing ransomware connected to an Excel spreadsheet macro is targeting mid-level individuals at pharma, healthcare, and other sectors in Austria, Germany, and Switzerland, according to tech research firm Proofpoint. TechGenix

More: Becker’s 22 June on Crozer-Keystone, 29 June on UCSF, 12 largest healthcare breaches to date, 10 healthcare system incidents for June, Kroger hacking incident exposing 11,000 health records. DataBreaches.net news page.

COVID effect on US practices: in-person visits down 37%, telehealth peaks at 14%; ATA asks Congress to make expansion permanent

June 30, 2020 | by

A Commonwealth Fund/Harvard University/Phreesia tracking study of outpatient visits in 50,000 US healthcare practices, specialty as well as primary care, has tracked the effect of the COVID pandemic on practice visits during the period 8 March through 20 June. Using as their baseline the week of 1-7 March, which was the last ‘normal’ week in line with February, the results are not unexpected:

  • From 15 March to 20 June (three months), practice visits, including telehealth, plummeted 37 percent
  • Disproportionately affected were pediatricians, pulmonologists, and surgical specialties such as orthopedics
  • Against the baseline, week of 14 June visits are still down 11 percent
  • The nadir was 29 March, off 59 percent
  • The rebound tracks the same by US region, with the least dip in South Central and Mountain regions. (The most affected, of course, are New England-Mid-Atlantic and Pacific, with the highest COVID rates and the least rebound.)
  • Looking at the ‘rebound week’ of 14 June, the effects linger on in pediatrics, pulmonology, and (interestingly) behavioral health. (Anecdotally, behavioral health patients are continuing with telehealth for convenience versus the physical visit.)
  • Telehealth visits took off starting 8 March and at their peak were 13.9 percent of visits (19 April)
  • Since 26 April, telehealth visits have declined as in-person visits resume, and are at 7.4 percent as of 14 June (46.7 percent less). However, compared to the baseline of nearly zero (0.1 percent), it’s nearly a 140 percent increase.

Phreesia is a scheduling and patient check-in platform. The practices surveyed are Phreesia clients, covering 1,600 provider organizations, with 50,000 providers in 50 states.

Physicians were also interviewed as part of the study. The office operation has had to change, and the patient experience in returning to practices is very different. Making up deferred care is complicated, and precautions to mitigate risk of viral transmission inevitably slow care down. 

Much of the press around this study is that telehealth is receding quickly. As a trend in an extraordinary time when there was no alternative, as practices reopen a shift back to the office is to be expected, and often there is no substitute for in-person exams and procedures. Still, there are elements of long-term uncertainty on the future of practice telehealth. Both CMS and payers announced that payments for telehealth (audio/visual and telephone only) would remain in place only for the duration of the pandemic. What are their long term plans? Providers are having difficulty getting paid or paid enough even in parity states. State Medicaid presents even more of an unwanted ‘discount’.  Telehealth also demands a commitment to (ultimately) a HIPAA-compliant platform, workflow/staff support, and input in the practice’s EMR/population health platform. STAT, HealthcareITNews

The American Telehealth Association (ATA), coming off their virtual annual meeting last week, sent a letter to Congress with 340 signatories supporting a permanent expansion of telehealth after the public health emergency (PHE) ends in four priority areas:

  • Remove location restrictions 
  • Maintain HHS authority to determine eligible practitioners who may furnish clinically appropriate telehealth services
  • Authorize Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) to furnish telehealth services 
  • Make permanent the HHS Temporary Waiver Authority to respond to emergencies

Release and letter

The TeleDentists now in 14 states with Anthem

June 30, 2020 | by

Updating our May article about The TeleDentists expanding their coverage via Anthem Blue Cross and Blue Shield (BCBS), our initial information was that Anthem was offering teledentistry in only nine states. The current total since May is actually 14 states and covers by state and plan:

  • CA – Anthem Blue Cross
  • CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI – Anthem Blue Cross and Blue Shield
  • NY – Empire BlueCross BlueShield

Part of this Editor’s puzzlement is that each health plan issues releases for its plan by state, and when our original article was written, only nine states had issued releases. This is in addition to their agreement with Cigna in employer-sponsored plans announced in April [TTA 15 April]. Hat tip to FischTank PR’s Kate Caruso-Sharpe for the update on behalf of Anthem.

Breaking: NHSX COVID contact tracing app exits stage left. Enter the Apple and Google dance team.

June 18, 2020 | by | 1 Comment

Breaking News: The NHS finally abandoned the NHSX-designed COVID contact tracing app in favor of the app based on the Apple and Google API.

The NHSX version had issues, seemingly intractable, on the BTE features on distancing and contact duration between devices, as well as the app being inaccurate on the iPhone.

The “Gapple” app is already in use in Italy, Switzerland, Denmark, Latvia, and Poland. As this Editor noted on Tuesday, Austria is in test, Germany just launched their ‘Corona Warning App’ and reported 6.5 million downloads in the first 24 hours. 

The BBC reported that the lead on the NHSX app, Matthew Gould and Geraint Lewis, are “stepping back” and former Apple executive Simon Thompson is joining NHSX to manage it

Depending on reports, the NHS either rejected the Gapple app in April or were working on it in tandem from May. More likely, they revived the latter with the NHSX problems. The Gapple version is decentralized in storing information about user contacts on individual phone handsets because of issues over user privacy, versus the NHSX centralized app.

According to the FT and TechCrunch, the government is de-emphasizing the utility of the app, and relying on its small army of contact tracers. 

But what about all those folks on the Isle of Wight?

More on this: Digitalhealth.net, TechCrunch, Financial Times     Hat tip to Steve Hards for alerting this Editor at the end of a busy day!

News Roundup (updated): Proteus files Ch. 11, VA’s EHR tests now fall–maybe, making US telehealth expansion permanent, Rennova’s rural telehealth bet, Oysta’s Lite, Fitbit’s Ready to Work jumps on the screening bandwagon

June 17, 2020 | by

Proteus Health, the company which pioneered what was initially derided as a ‘tattletale pill’, filed Chapter 11 bankruptcy today (16 June). As early as December, their layoffs of nearly 300 and closure of several sites was a strong clue that, as we put it, Proteus would be no-teous without a big win. Exactly the opposite happened with the unexpected early end of their Otsuka partnership with Abilify [TTA 17 Jan]. Proteus had raised about $500 million in venture capital from Novartis plus technology investors and family offices. Their combination of a pill with an ingestible sensor, a patch that detects ingestion and that sends information to a smartphone app was ingenious, but in a business model was meant for high-cost medications. Proteus’ current partnerships include TennCare (TN Medicaid), plus Xealth and Froedtert to integrate medication information into electronic health records. At one point, Proteus was valued at $1.5 bn by Forbes, making it one of the early healthcare unicorns.  CNBC, FierceHealthcare

VA further delayed in implementing Cerner-Leidos EHR. POLITICO’s Morning eHealth earlier this month reported from congressional sources that further testing would be delayed to the fall at the earliest and possibly 2021. The project to replace VistA stands at $16 bn. Contributing to delay was an April COVID outbreak in Spokane at a veterans’ home, which pushed patients into the VA medical center. 

In further DC news, several senators are advocating that the relaxing of restrictions on telehealth during COVID should largely be made permanent. According to the lead senator, Brian Schatz (D-HI), Medicare beneficiaries using telehealth services increased 11,718% in 45 days. Many telehealth requirements were waived, including geographic, coding of audio-video and telephonic telehealth billing, and HIPAA platform requirements. Other senators are introducing bills to support remote patient monitoring programs in community health centers’ rural health clinics. FierceHealthcare

The climate for telehealth has improved to the point where smaller players with side bets are now betting with bigger chips. Rennova Health, a mid-South healthcare provider with a side in software, is merging its software and genetic testing interpretation divisions, Health Technology Solutions, Inc. (HTS) and Advanced Molecular Services Group, Inc., (AMSG) with TPT Global Tech. The combined company will be called InnovaQor after an existing subsidiary of TPT and plans to create a next-generation telehealth platform targeted to rural health systems. Release, Becker’s Hospital Review

Oysta Technology has launched the Oysta Lite with an SOS button, GPS, safety zone mapping for travel, and two-way voice. The SOS connects to their IntelliCare platform which provides status monitoring, reporting, and device management plus connecting to the telecare service provider. They are specifically targeting post-lockdown monitoring of frail elderly.  Press flyer/release.

Fitbit jumps on the crowded COVID workplace screening bandwagon with Ready to Work, a employer-sponsored program that uses individual data collected via the Fitbit device such as resting heart rate, heart rate variability and breathing rate. Combined with self-reported symptoms, temperature, and potential exposure, the Daily Check-In app then provides guidance on whether the employee should go to work or remain at home. According to the Fitbit release, a higher heart rate–as little as two beats a minute–can be indicative of an immune system response before the onset of symptoms. TTA has earlier reported [19 May] on other COVID workplace screeners such as UHC/Microsoft’s ProtectWell app, Appian, and (in-house) PWC. FierceHealthcare also lists several others on the cart: Castlight Health, Collective Health, Carbon Health, VitalTech, and Zebra Technologies. However, at this stage, few employees are leaving remote work for in office, and fewer still may even return to the office.

Where in the world is the NHS COVID contact tracing app? Apps rolling out globally, but will they roll out before it’s treatable ?

June 17, 2020 | by

It does seem that the NHS contact tracing app, debuted after various tests on 5 May in the Isle of Wight, has vanished from the radar screen. A scan of recent news indicates that the app is further delayed in favor of a manual track and trace system with 25,000 contact tracers, starting 28-29 May A Telegraph article indicates that the app had the Bluetooth blues, with further detail from Wired UK around emerging worries within NHSX about BTE’s ability to accurately calculate the distance between two users.

Folks in the Isle of Wight, who enthusiastically adopted the app (Week 1’s 52,000 downloads), would like to know how they’re doin’, in the immortal words of a real NYC Mayor, Edward Koch. That data about contacts and alarms seems to not be forthcoming from the NHS–as well as an updated app with more questions about symptoms and test requests and results integrated into the process, according to BBC News today 16 June. Yes, it was an odd choice, but often beta tests take place in relatively small and isolated places, not big cities where factors can’t be controlled. But the app appears not to be moving forward in favor of the manual system. Nevertheless, the sound of crickets is deafening.

Some articles like Wired’s blame the NHS’ centralized approach, where a report of COVID goes straight to the NHS server, with outbound messages going to those with whom the person was in contact, defined by BTE tracing within 6 feet for 15 minutes +. Observers like our own Editor Emeritus Steve Hards noted in comments on the 29 May article that “It will only take a few well-publicised malware or phishing incidents to make the job of the genuine trackers unworkable and for any trust in the app to evaporate.”

A great deal of fuss has been made of other countries adopting contact tracing apps that actually work. Most of these are built on a platform developed by Apple and Google. These have been used in Italy, Switzerland, Latvia, and Poland. Austria is in test, Germany just launched. Japan’s is on a Microsoft platform. Countries that launched earlier have had their wrinkles. Italy is feuding over issues of data privacy. Norway’s Smittestopp app, which used both GPS and BTE to advise those contacted to self-isolate, was stopped by the Norwegian Data Protection Authority on disproportionate intrusion into users’ privacy. A bug in the programming affects Australia’s CovidSafe iPhone users in logging matches when the other iPhone is locked. Singapore, after seeing only one-quarter of the population adopting the app,  is going the wearable dongle route that you hand over if you test positive. BBC News

By the time the apps are developed, debugged, and rolled out, the lockdowns will have ended, and the virus will have abated or mutated for next season. Meanwhile, progress has been made on treatment protocols. HCQ, zinc, azithromycin, vitamins C and A in early-stage treatment are already well known, like Tamiflu for the first few days of the flu. In later treatment, nasal oxygen (not ventilators), high dose vitamin C, heparin (a common blood thinner to prevent lung clotting), methylprednisolone (a steroid) and also HCQ were published by the Front Line COVID-19 Critical Care Consortium as early as 6 April. Now another BBC News report reveals that the University of Oxford’s RECOVERY Trial is mass-testing several approaches, including an inexpensive steroid, dexamethasone ($1 a dose). Sadly, they estimate that 5,000 lives in the UK could have been saved. Between cheap and common HCQ, heparin, steroids like dexamethasone and methylprednisolone, and high dose vitamins like A, C, and zinc, let’s hope that the spread in Africa and Latin America, especially Brazil, can be quelled.

Another COVID casualty: a final decision on the Cigna-Anthem damages settlement

June 12, 2020 | by

Remember Cigna and Anthem, a Merger Made In Hell? This Editor loves to follow up a good public slugfest which has been going on in Delaware Chancery Court since May of 2017. As our Readers may recall, the Doomed To Fail merger, finally pounded into the ground by the Federal courts, soon degenerated into what a former VP of your Editor’s would call a ‘Who Shot John’ scenario. Anthem would not pay Cigna the breakup fee of $1.85 bn. Cigna then demanded an additional $13 bn in a ‘Funny Valentine’ of damages, accusing Anthem of harming Cigna’s business. Anthem then in turn claimed $20 bn in damages. Three years later, other than a blip of news in March 2019, the imminent decision was to be at the end of February or even March this year (Axios, Reuters). We all know what happened in March–a pandemic that shut the courts. The timing could not be worse, as COVID has bitten hard into payer profits, and a settlement could bite even harder, putting either company into the red–going back years.

Whatever company wins may, after legal fees, may have enough money to buy one of these–before the concours restoration.

 

ATA’s annual conference now 22-26 June–and fully virtual; announces three awards and Fellows

June 12, 2020 | by

The American Telemedicine Association has reimagined their annual conference and gone fully virtual–including an exhibit hall and poster displays. This year’s theme is “Moving at the Speed of Innovation…. Accelerating Telehealth Adoption”–if it hasn’t accelerated enough during the COVID pandemic, there’s always consolidating the gains.

Perhaps due to the complete cancellation of HIMSS and the addition of Joe Kvedar, MD, incoming ATA President, this year’s ATA has a five-day menu of healthcare leaders and over 300 speakers in 100+ sessions. Here’s a sample from the keynotes:

  • Ken Abrams, MD, Chief Medical Officer, Deloitte Consulting
  • Rachel Dunscombe, CEO, NHS Digital Academy; Tektology
  • Jesse Ehrenfeld, MD, Chair, AMA Board of Trustees
  • Thomas Goetz, Chief of Research, GoodRx
  • Jennifer Goldsack, Executive Director, Digital Medicine Society
  • Victoria Guyatt, Head of Ethnography, IPSOS
  • Joe Kvedar, MD, Professor, Harvard Medical School; Senior Advisor, Mass General Brigham (Partners HealthCare); Incoming President, the ATA
  • Ali Parsa, Founder and CEO, Babylon Health
  • Suchi Saria, Assoc. Professor, Machine Learning & Data Intensive Computing Group, Johns Hopkins University and Bayesian Health
  • Jennifer Schneider, MD, President, Livongo
  • Michelle Segar, Director, Univ. of Michigan Sport, Health and Activity Research & Policy Center
  • Jeroen Tas, Chief Innovation & Strategy Officer, Philips Healthcare

Registration is priced gently at $450. Full information, schedule, and registration here.

ATA 2020 Awards

The ATA Champion award this year is to the Veterans Health Administration, US Department of Veterans Affairs. The VA has been a leader in telehealth and store-forward technologies since, well, 2002 or so. VA Video Connect last year had 1.3 million appointments. (Sadly, your Editor’s former company, Viterion, which pioneered with VA in a RPM platform, is not currently a telehealth/RPM vendor–VA’s sole vendor is Medtronic.)

The President’s Award for the Transformation of Healthcare Delivery went to The Children’s Health Virtual Care Program at Children’s Health in Dallas. They have pioneered telemedicine programs for children.

The ATA’s Woman of the Year is  Tania S. Malik, J.D., an entrepreneur and a lawyer focused on healthcare, and specifically, telehealth solutions that facilitate online patient-provider interactions for primary care, mental health treatment, and naturopathic and integrated medicine.

Six Fellows were also named to ATA’s College of Fellows. Release.

 

‘Thank and Praise’ to healthcare workers continues (UK)

June 12, 2020 | by

One of the few bright spots in the low spot of early April was learning of Thank and Praise [TTA 10 Apr]. James McLoughlin of the organization reached this Editor with an update on their social thanking of the ‘unsung heroes’ in healthcare in the continuance of the COVID-19 pandemic. They have a new television commercial out (viewable on YouTube) that highlights the ability of anyone to use their platform to thank a healthcare worker. According to Mr. McLoughlin, “So far we have received 1,000 inspiring messages of thanks which have been viewed over 500,000 on our website and social media channels.” Another feature is that those who leave messages on the Thanking Wall for healthcare workers are also invited to donate to NHS Charities Together. TAP is now also inviting companies to adopt their platform or to participate as sponsors. Find out more here. Also catch them on Facebook, Instagram, and LinkedIn. 

Telehealth and the response to COVID-19 in Australia, UK, and US: the paper

June 12, 2020 | by | 1 Comment

Published last week in the Journal of Internet Research (JMIR) is the study by Malcolm Fisk, PhD which TTA previewed last month on telehealth’s part in the two-week response, starting 12 March, in response to COVID-19 in Australia, UK, and the US. Malcolm Fisk, PhD, who our readers know as Senior Researcher at the De Montfort University in Leicester, led a group from Australia in comparing these three countries in including telehealth in their responses to the pandemic. It looks at how telehealth models were used, awareness of the role of telehealth in response, and how restrictions previously in place were dealt with. 

The study’s conclusions, briefly summarized:

  • Australia: immediately funded on 11 March with AUS $100 million (US $68 million) a “new Medicare service,” at no cost for patients, for telehealth consultations. Telehealth in Australia is well developed, particularly in rural areas, for health and social care needs. The added funding will aid in the rollout.
  • UK: at the same time, the UK was in a ‘containment’ phase with the PM’s admission that “many more families will lose loved ones before their time”. At that point, telehealth was not in the plans, but the Imperial College projections and recommendations on home quarantining and ‘social distancing’ severely affected the most vulnerable, older people. COVID wound up being quite a jolt to the NHS since telehealth is underdeveloped in most of the UK with the exception being Scotland. Clinicians to this point did not see a need, and many older people do not have access to smartphones, tablets, or the internet. Intents are good–NHSX and the Topol Report setting a framework for telehealth–but to this point telehealth rollout is limited.
  • US: 17 March could be called ‘Telehealth on Steroids’ Day, as CMS announced the ‘dramatic’ expansion of telehealth services via non HIPAA compliant platforms such as Skype and Facetime for Medicare, retroactive to 6 March. Telehealth mushroomed starting 11 March in hospitals first, reporting 15 and 20-fold increases in telehealth consults. Then CDC and the AARP got on board. The US has an uneven system, between differences in state parity reimbursement, Medicare concentrating on rural health, state Medicaid, private pay, and integrated hospital systems’ approaches. What holds telehealth back are providers and areas in the US that simply do not have the internet connectivity that telehealth consults demand.

Good reading. Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States Hat tip to Dr. Fisk for sending it our way!

Babylon Health leads a $30 million Series B for Higi health kiosks, continuing US push

May 30, 2020 | by

Here’s an interesting investment by Babylon Health. Earlier this week, diagnostic/symptom checking app Babylon Health was reported to lead a $30 million Series B investment in Higi. Higi has about 10,000 health monitoring kiosks (Smart Health Stations) placed in various US retail locations like supermarkets (Stop & Shop, Shop Rite), pharmacies (Walgreens), workplace and community locations. A user can check their blood pressure, pulse, weight, and BMI for free, along with uploading data from one of 80 connected devices and apps. What then happens is that Higi stores that data on their platform for the user, who can log in and access it from the Higi app on their computer or smartphone.

Higi claims 62 million people have used a Higi device for a total of 372 million tests. This Editor has seen them in some local stores, usually in a corner, sitting forlornly or with an out-of-service sign. (Sanitization, of course, is a real concern.) 

So what is Babylon’s interest in Higi? The US health data, of course, which Babylon can put into their database and improve their modeling. Babylon also is gaining a foothold in the US with high-profile partners such as Mount Sinai in NYC and with health plans in Missouri, New York, and California. For Higi, the tie with Babylon increases their clinical data information base and adds access to a symptom checking app. 

In the Series B, Babylon Health was joined by Higi’s Series A investors, 7Wire Ventures, Flare Capital Partners, Jumpstart Capital, Rush University System for Health, and William Wrigley Jr. Confusingly, on Crunchbase, these investors are listed as a Series C,  not a Series A. They list a B funding round with lead partner Blue Cross Blue Shield Venture Partners, without a funding amount, with the previous round as venture, so possibly the Series B failed. Higi’s funding to date is over $61 million not including the new round. TechCrunch, Higi blog

News roundup: LabCorp CRO boosts Medable, Propeller Health gains 510(k), EU’s 34 medtech startups, Amazon’s healthcare moves, Google’s Arizona privacy lawsuit

May 29, 2020 | by

It does seem ages since our last one! One major winning category for digital health is clinical trials. LabCorp has one of the largest CROs (contract research organization), Covance. LabCorp has partnered with startup Medable, a Palo Alto-based company that decentralizes the gathering and analysis of clinical trial data from recruited participants through apps and telemedicine. Mobihealthnews  Confirming this trend: earlier this month, Medable cleared a $25 million venture round from GSR Ventures. Crunchbase  This does make rival CRO PRA Health Science’s pickup of Care Innovations from Intel late last year, for an undisclosed amount, look like a prescient (and likely a bargain) purchase.

Propeller Health, which specializes in digital respiratory health with sensors connected to inhalers and apps, gained 510(k) FDA clearance for a sensor/app for use with AstraZeneca’s Symbicort inhaler. This medication is used for asthma and COPD. It does not seem that long ago (2014) that the startup was at trade shows like NYeC and mHealth Summit with an exceedingly modest display of popups and brochures. Their 2019 acquisition by ResMed for the stunningly premium price of $225 million made news in late 2018. Mobihealthnews

In Europe, COVID-19 has boosted at least 34 medtech startups, including 11 in UK alone, followed by Switzerland and Sweden. This is based on a study by Oxford University data visualization spin-out Zegami. One of them happens to be Zegami on a project in using a limited dataset to distinguish between x-rays of COVID-19 infections and infections caused by viral or bacterial pneumonia, as well as images of healthy lungs. On the list are (naturally) Babylon Health and the slightly mysterious Medopad. Sweden’s Kry (LIVI in the UK) is also on the list. Kry/LIVI last made some news when Juliet Bauer of NHS Digital ankled to Kry in early 2019, Med-techInnovationNews, Mobihealthnews

Amazon’s latest stretches into healthcare are noted in a brief Becker’s Health IT article which notes AWS’ deals with Cerner and addition of healthcare-specific features with hospitals using AWS. Mayo Clinic has partnered with Alexa for voice responsive ‘Mayo Answers’. Some Amazon employees now have access to telehealth benefits (this Editor wonders why not all, beyond those Seattle warehouse workers). Industry research company CB Insights is projecting that Amazon’s next move will be a benefits marketplace for employers and payers. Meanwhile, their partnership with JP Morgan Chase and Berkshire Hathaway, Haven, has stumbled with its CEO Atul Gawande, MD, leaving the post to return to practice after less than two years. Executive turnover has been high, and the company has yet to announce a major initiative. FierceHealthcare 

Meanwhile, Arizona’s attorney general has sued Google for violating state privacy laws. Seems like Android users are trackable, even if they turn off location on their phones, through Google apps like Maps and Weather. The lawsuit also charges that Google changed its default tracking settings without informing users, using data for targeted ads. Becker’s Health IT 

NHS’ COVID contact tracing service started today–but where’s the app? Australia? (with comments)

May 29, 2020 | by | 4 Comments

To paraphrase the burger chain Wendy’s long-past spokeswoman, Clara Peller, ‘Where’s The App?’. The NHS debuted a contact tracing scheme for COVID, but it is a manual system dependent upon–people. If you test positive for the virus, you will receive a call from the NHS’ test and trace system. The person will ask for information about your recent contacts with others, and then asked to self-isolate for 14 days. Those names you provide will be contacted as well.

The NHSX-developed Bluetooth LE app remains in beta test on the Isle of Wight, which started on 5 May [TTA 5 May]. Reportedly there were 52,000 downloads in week one, which for an island with only 80,000 households is pretty impressive. 

The original rollout date set by Health Secretary Matt Hancock and NHSX chief Matthew Gould to the House of Commons’ science committee was mid-May, which has come and gone. The new date is now sometime in June. However, Baroness Dido Harding, the new director of NHS’s Test and Trace program, would not confirm that date–as we’d say, tap dancing quite hard. Digitalhealth.net, Telegraph

The US has been hiring contact tracers by state from Alaska to New York. A recent study in preprint in MedRxiv (PDF) by Farzid Mostashari of ACO management company Aledade and others found that in order to reduce the transmission rate by 10 percent, a contact tracing team would have to detect at least half of new symptomatic cases, and reach at least half the people with whom they were in close contact. MIT Technology Review 

Apps have been deployed in Australia (COVIDSafe) and Singapore (TraceTogether) and are in development in Switzerland and Germany. Most use BTE, but South Korea, India, Iceland, and some US states including North Dakota and Utah are using GPS phone location. China has been the most ruthless in using GPS data to monitor citizen locations and activity, to restrict their movements. Previously mentioned here [TTA 19 May] are UnitedHealth Group and Microsoft’s ProtectWell, PWC’s homegrown app–and Google and Apple announced in April a BTE app which hasn’t debuted yet. The Verge

Why ‘masking up’ isn’t such a great idea–more than a false sense of security, a possible gateway to harm

May 27, 2020 | by

The signs and reminders to wear a mask outside the home, lest those COVID-19 germs get in (or out), are everywhere. You could be strolling on the beach, with hardly anyone in sight, or in a park with everyone more than 6′ away, and you’re made to feel guilty for wanting to breathe fresh, unimpeded air. This Editor has seen people driving cars solo–with masks on, steaming up their glasses, and restricting their vision (and apparently hearing as one hears mainly one’s breathing) for a dangerous combination in driving safety. And even in a short visit to a supermarket, a fabric mask of the type most common to us civilians can make you feel a little light-headed, as you breathe in less O2 and more of your own CO2, like breathing in and out of a paper bag–as you touch the cheese and the detergent. It all begins to appear a little less than logical, a belief shared with medical professionals with whom I’ve spoken.

Along comes the BMJ to confirm exactly these concerns–and add a few more. A team from University College London and UCL Institute of Epidemiology and Health Care responded to a BMJ editorial that advised that “surgical masks should be worn in public to prevent some transmission of covid-19 [sic], adding that we should sometimes act without definitive evidence, just in case, according to the precautionary principle”. The authors of the ‘Rapid Response’ article note that the ‘precautionary principle’ also should prevent the neglect of potentially harmful side effects of any intervention, including the wearing of masks in public.

The two acknowledged (by most) side effects are: a false sense of security that may lead some to neglect proven infection control measures like hand (and face–Ed.) washing and inappropriate use of a face mask including facial touching and infrequent washing. The writers added five others:

  • Speech is compromised, leading people to come closer simply to hear each other, and increasing contact risk
  • The face mask propels exhaled air into the eyes, leading a person to touch their eyes and possibly contaminate them
  • “Face masks make breathing more difficult. For people with COPD, face masks are in fact intolerable to wear as they worsen their breathlessness.” The rebreathed CO2 also may increase breathing frequency and deepness, thus more contaminated air exhaled in the infected, and conversely increasing their viral load.
  • If face masks are already infected, these points are amplified
  • Reduction in innate immunity that limits the spread of pathogens through the body. “If face masks determine a humid habitat where the SARS-CoV-2 can remain active due to the water vapour continuously provided by breathing and captured by the mask fabric, they determine an increase in viral load and therefore they can cause a defeat of the innate immunity and an increase in infections.”

In short, despite all the ‘stay safe’ and ‘mask up’ admonishments, there are both positive and negative effects of mask-wearing–and risks –and they certainly are not the cure-all for COVID spread. (We will, of course, see if COVID outbreaks in the next few weeks appear in the cities where demonstrations have been rampant and mask-wearing/physical distancing have been noticeably absent.–Ed. Donna)

Reflections of a TechForce19 Participant

May 23, 2020 | by

Ever wonder what it’s like to successfully apply for, and then to deploy your program, as part of a high-stakes challenge? Reader Adrian Scaife, Business Development Manager of Alcuris Ltd., has been on an eight-week merry-go-round on hyperdrive (to mix a few metaphors). We invited him to tell us what it was like after the reports were handed in, and his impressions follow. Thank you, Adrian!

Now the Rapid Feasibility stage has been completed and outcome reports submitted, it’s a good time to sit back and take stock of the last 8 weeks.

It all started in late March when Matt Hancock asked for innovative tech companies to support vulnerable people during the Covid crisis around three themes, Optimising Staffing in Care and Volunteering Sectors, Mental Health and Remote Care. The funding available totalled £500,000 and was planned to be shared across 20 companies.

Even at the start the ambition, the scale and the pace of the initiative were very clear.

Looking back, it is apparent that the initiative has become a brand–TechForce19 – a great name, logo and its own website. The benefit to all is a set of unifying objectives, direction, urgency, and something that people and organisation can come together to support.

The sheer number of organisations involved in the initiative was breath-taking. Funding was from the Department of Health and Social Care along with the Ministry of Housing, Communities and Local Government. It was run by NHSX supported by Public Ltd., the Academic Health Science Networks including the Health Innovation Network in London and other experts from a variety of organisations.

The application process was at speed with a launch date of 24th March and application submission by noon 1st April (and that was the extended deadline!). The application form was thorough in the questions asked particularly around how you would conduct a two-week test to demonstrate that you can solve the challenge(s). We also knew it was going to be scored based on Solution feasibility, Company credibility, Impact, and Digital maturity.

The selection process was equally fast with feedback on the next stage due Friday 4th April. Friday came and went, and we feared the worst. Little did we know at the time that over 1,600 applications had been received. Just before midnight on Saturday an email was received announcing we were through to the interview stage and ours was on Monday. 60 interviews were completed over the next few days.

Just over a week later, confirmation that our proposal had been accepted, one of just 18 participants. Time to deliver on our plan. Just 10 days to plan the project in detail, provide partner training, deliver the hardware, for our partners to collect their referrals and then to deploy the Memo Connected Care Suite. Two weeks of live running. Evaluation and an outcomes report to be submitted by the 18th May.

I must give enormous praise and thanks to our partners for their commitment to deliver when all around them the pressures on their services due to Covid were unbelievable.

So now the Feasibility and Outcomes report has been submitted. We have received some terrific feedback both from families and Social Care staff. Did the project go according to plan? Well not entirely but when do they ever, especially during a national crisis.

One surprise that I shall never forget is Nasdaq, the American stock exchange, wanted to applaud digital innovators globally who were supporting the Covid fight. They promoted the work of TechForce19 on their seven storey Nasdaq Tower in Times Square, New York by highlighting each of the 18 participants.

TechForce19 is an NHSX Covid-19 response initiative, supported by PUBLIC and the AHSN Network. The views expressed in this article are those of the author and not necessarily those of NHSX or its partners.

PUBLIC’s website has profiles on the 17 other TechForce19 participants, including many names familiar to our Readers, such as Just Checking and Buddi. Our earlier article is here.  Hat tip to Reader Alistair Appleby.

 

 

Optum buys naviHealth for reported $1 billion; Amwell raises $194 million in Series C

May 23, 2020 | by

In non-COVID-19 news, Optum has confirmed to industry press that they have acquired post-acute management company naviHealth. Becker’s HealthIT cites sources that the purchase price is in the vicinity of $1 billion. Continuing their PAC-MAN path, this pharmacy benefit, population health, and care services wing of UnitedHealth Group in the past six months finalized the purchase of DaVita Medical Group from renal treatment giant DaVita for over $4.3 bn and is reportedly closing on a full acquisition of virtual behavioral health provider AbleTo [TTA 29 Apr] for a less stunning $470 million.

naviHealth provides post-acute care clinical decision-making tools that manage pre and post-acute care as part of value-based care programs such as the Bundled Payments for Care Improvement (BPCI) program with CMS. Their customer base includes health plans (4.5 million members within Medicare Advantage alone), over 140 hospitals, and post-acute care providers such as nursing homes, LTC facilities, rehabilitation, and home health. The company will retain current management and staff, and operate as a stand-alone company within OptumHealth. It’s a well-paid exit for Cardinal Health and Clayton, Dubilier & Rice. Also MedCityNews

Amwell raises $194 million in a second Series C. The former American Well did not need telehealth to receive a gratifying boost from its investors Allianz X and Takeda Pharmaceuticals. This follows on a February $60 million venture round from Chetrit Ventures (BostInno). Amwell has raised $711 million in nine funding rounds (Crunchbase). Their main business has been with payers, health systems, and employers. In April, they added a branded program, Amwell Private Practice, for practices under 100 providers for these mostly shuttered offices to reach their patients at home and to continue care. Release, Mobihealthnews.