#MedMo17: the conference, winning startups, Bayer, blockchain, and more

December 6, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/MedMo-header-crop.png” thumb_width=”150″ /]MedStartr Momentum‘s conference last week was extremely well attended, with 260 registrations over the two days at PricewaterhouseCooper’s NYC HQ. It jumped! (Disclaimers: your Editor is one of the hosts and co-organizers; TTA is a media partner) #MedMo17 had about 50-60 total speakers, presenters, and panelists in fast-moving sessions, most 10-15 minutes, with panels clocking under one hour.

What’s always unusual about MedStartr conferences is the mix of topics and people, and not just from NY. There were startups just getting going, successful startups sharing their stories, patient advocates, providers, and investors sharing what they want to see (and not see) before they fund. There was Deborah Estrin from Cornell Tech describing how they nurture graduate student tech entrepreneurs and Maria Gotsch from the Partnership Fund for NYC discussing how they accelerate, partner, pilot, and fund companies coming to market. One sponsor was nearby Newark NJIT’s NJ Innovation Institute–and one of the presenting companies was Uniphy Health (formerly PracticeUnite) that they’ve worked with and helped make successful over five years. Who would have expected a wild discussion about blockchain? Well, here, hosted by media personality/entrepreneur Ben Chodor (HealthTechTalk Live) with panelists ranging from a digital asset hedge fund founder to a patient advocate. For two panels, questions came from ‘the field’ via a Reddit ‘Ask Me Anything’.

Notably, Bayer G4A Generator, coordinated in the US by Aline Noizet, came on board as a sponsor. They came to the right place as they are seeking early-stage companies for Bayer Grants4Apps. In the US, they are seeking new companies developing self-care products: nutritionals/wellness, therapeutics (pain management, seasonal health), personal care (skin, sun, footcare), and self-care in general. Bayer also runs similar programs in Berlin (Accelerator and Dealmaker), Barcelona, Tokyo, Moscow, Singapore, Shanghai, and Italy.

Of the 18 Grand Challenge finalists competing for financing and guidance, the winners were: Population Health–Valisure (online pharmacy pre-screening meds); Wearables/Medical Devices–Alertgy (non-intrusive continuous blood glucose monitoring); Clinical Innovations–eCaring (at-home senior care monitoring), and in Killer Apps, a product that actually kills bad bacteria on the skin–Xycrobe (good recombinant bacteria for dermatological use). Special awards were given to Check with Ellie (breastfeeding questions answered, Momentum Award for growth) and MedAux (patient ed and HIPAA compliant messaging–Crowd Choice Award).

The full conference (Thursday and Friday) is up on video at Medstartr.tv. And in 2018, it will be 29-30 November, so put it in your calendar. Kudos to the MedStartr team, especially Alex Fair. Hat tip also to the NOLA (New Orleans) Health Innovation Challenge 

Health Care Homes – treating chronic diseases in Australia

December 2, 2017 | by

The second tranche of the so called “Health Care Homes” (HCHs) trial started enrolling and providing services [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Health-Care-Homes.png” thumb_width=”150″ /]yesterday (1st December 2017) in Australia according to Australia’s Department of Health.

HCHs are existing General Practices (GPs) or Aboriginal Community Controlled Health Services providing a more systematic, coordinated care for people with chronic conditions such as diabetes, heart disease and respiratory problems. Patients who have been assessed as eligible can choose to enrol on the programme at a HCH and a care plan is then developed covering care to be received from their GP/ Aboriginal health worker and nurses at the GP practice as well as specialists and allied health workers.

Australia has seen a rise in chronic diseases with 50% of the population now having at least one chronic illness and 25% having at least two. The Australian Government believes that the GP led Primary Care system does not deal well with chronic diseases where patients often need services from multiple professionals working in different parts of the healthcare system. The HCH model is expected to reduce the confusion, delays and costs by using a team based coordinated delivery of care.

A key element of the HCH model is that the patient and all members of the care team (within the HCH and outside) have access to the care plan. A minimum requirement for software tools for creating and sharing the care plan have been defined and several companies have already produced software for this purpose. There has been some criticism of the way the software tools market has developed and the lack of independent guidance on choosing such software.

On the whole this trial is of interest not just to Australia but also to all other countries since chronic disease care is a key issue around the world. HCH model is considered consistent with the models used in the UK and New Zealand.

The stage one trial is due to run until November 2019 and has around 200 HCHs, of which the first tranche of 22 started in October 2017.

A brochure on the HCH produced by the Australian Dept of Health is available here.

OnePerspective: VA shows how technology can improve mental health care

December 2, 2017 | by

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/11/Gigi-Sorenson-GlobalMed.jpg” thumb_width=”150″ /]By: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

(more…)

VA’s Secretary Shulkin wants more private care options for veterans as part of reforms

November 27, 2017 | by

Released days before our Thanksgiving turkey (or steak, or lasagne), the Department of Veterans Affairs Secretary David Shulkin, in an interview with The Wall Street Journal (paywalled), stated his aims to increase veteran access to private care without having to rely on the VA to approve or coordinate it. This is in the direction of the recently signed bill with $2.1 bn in funding for the Veterans Choice program that targets veterans living in areas without ready access to VA facilities, or who are told they cannot get an appointment within VA within 30 days.

“The direction I’m taking this is to give veterans more choice in their care and be the decision maker for their care, which I fundamentally believe is a concept that has to be implemented,” Shulkin said. He admitted that opening the VA to private care programs will be gradual. Mentioned in the article were commodity, non-urgent services like podiatry and audiology.

For instance, the Veterans Choice program started in 2014 after wait times exploded in multiple regions, delaying care past 30 days for over half a million veterans for years well into 2015. Veterans died after waiting for care or follow up for months, notably at the Phoenix VA, creating a massive and rightfully political problem. 

Dr. Shulkin’s drive for reform and speed of care is also increasing the pace telehealth expansion with programs such as Anywhere to Anywhere which would allow cross-state consults and care that published their Federal proposed rule last month, and the rollout of VA Video Connect [TTA 9 Aug]. Earlier this year, four companies were awarded a total of over $1 bn to provide Home Telehealth over five years, reviving a fading program and updating it to not only smaller in-home tablets, but also to mobile and laptop devices. As noted in our OnePerspective article on telemental health deployment, the VA has the largest program in the US, dating back to the early 2000s.

While some veterans organizations, such as the Veterans of Foreign Wars, have been critical of moves towards integrating private care, this Editor cannot see where the problem truly is. Healthcare Dive, The Hill 

Mayo Clinic’s Victor Montori MD calls for a ‘patient revolt’ for ‘careful and kind care’

November 27, 2017 | by

Have a listen…This Editor has kept an eye on Dr. Victor Montori’s concept of ‘minimally disruptive medicine’ which seeks to fit the medical treatment to what the patient can handle through shared decision making, reducing the burden on both doctor and patient. He has recently published a book titled ‘Why We Revolt: A patient revolution for careful and kind care’. ‘Careful’ and ‘kind’ don’t immediately come to mind in this force-fed world of HEDIS quality scores, 31 ACO quality measures, HCAHPS hospital surveys, patient compliance, Ezekiel Emanuel, and the drive to measure every pill, footstep, and mouthful you take via your smartwatch or -phone–then ‘big data’ it.

Dr. Montori makes the case for balancing the agendas between doctor and patient, bringing back empathy, kindness, and respect in that relationship, with the goal to ensuring that “care fits into life and does not demand more than is sensible.” This 15-minute interview journeys from the medical privations Dr. Montori witnessed in his native Peru to his current work as an endocrinologist at the Mayo Clinic. You’ll want to buy the book after you listen. (And he should have included doctors in that revolt as well.) Podcast at Health News Review/Health News Watchdog.

Previously in TTA on Dr. Montori’s contrarian views: Patient non-compliance=toxic healthcare system? and Is how we are treating patients for chronic diseases (and pre-diseases) all wrong?

HeyDoctor! Come and get your diagnosis via text here!

November 27, 2017 | by

An app that makes this semi-grizzled pioneer feel…not quite on board the wagon. HeyDoctor is not for horses, but for those who Text to Live. Yes, all you need to do if you feel under the weather is to download the app, text the doc, get your diagnosis, and prescription. Like that. No need to comb your hair and wash your face for that video visit. According to the website, you can get anything from a UTI to acne to erectile dysfunction diagnosed and treated. Out of birth control? Handled. You can get tests ordered up for blood typing, HIV, and metabolic analysis. Not happy with your lash thickness and growth? Here’s the topical med for you! Trying to quit smoking? Done. All you need do is text one of their in-house board-certified physicians and live in one of 19 states where it’s offered.

For our UK Readers, this is a service with similarities to Babylon Health‘s chatbot service but without the decision support ladder–it goes straight to the doctor.

They claim on the website that most visits are five minutes and under $20 in cost, plus affiliations with leading medical centers like UCSF and Georgetown, although this Editor doubts that Amazon Web Services (AWS) is a ‘healthcare organization’ in the same category.

MedCityNews confirms their playbook, for now, is B2C, but the San Francisco-based founders are considering partnering with health systems. According to Crunchbase, funding so far is seed from the two founders, Brendan Levy, MD, a SF-based family medicine practitioner, and Rohit Malhotra, an attorney. LinkedIn counts three employees.

So why not on board the Conestoga? While the convenience is very attractive, there’s also the opportunity for misdiagnosis–the kind of thing we used to worry about with telemedicine. Does the app secure the texts for privacy? Many of these conditions aren’t hangnails–HIV and UTIs come to mind. Oddly, photo upload isn’t mentioned–important with acne. Testimonials point to convenient prescription renewals, but that information can be falsified–easy to do with text. Identity too with smartphones can be faked. A video consult also permits the doctor to see the patient and pick up at least some physical signs of illness. Also not inspiring confidence: a website that crashed when I looked for FAQs and had a chatbot named Brendan (same face as Dr. Levy’s) constantly popping up after X’ing him out. To this Editor, it feels like some verification and diagnostic layers are…missing.

NHS, Public Health England testing multiple digital health devices for obesity, diabetes

November 22, 2017 | by

NHS England, Public Health England, and Diabetes UK launched a pilot, announced on World Diabetes Day on 14 November, to test various digital health approaches to controlling obesity and Type 2 diabetes. Approximately 5,000 patients will be recruited for a test period of up to one year. Multiple apps, gadgets, wristbands, and other digital devices to measure their results against goals will be tested,  combined with health coaching and online support groups. NHS is also offering to some wearable devices which record activity levels and receive motivational messages and prompts. 

The test will use products and services from five companies and the patients will be recruited from eight areas of the country. The companies, programs, and tools are:

  • Hitachi – Smart Digital Diabetes Prevention program combines an online portal + coaching
  • Buddi Nujjer – a wristband which monitors the user’s activity, sleep patterns and eating frequency, paired with a smartphone application
  • Liva Healthcare – 12 months of a dedicated coach starting with a personal face-to-face meeting. The Liva platform and patient app supports the patient with smart goal setting and plans, lifestyle tracking, video communication, and online peer to peer support.
  • Oviva – An eight-week intensive lifestyle intervention with an experienced dietitian providing personalized advice and support.
  • OurPath – A six-week mobile and desktop digital program with structured education on healthy eating, sleep, exercise and stress management.

The pilot builds on Healthier You: The NHS Diabetes Prevention Programme, launched last year to support people who are at high risk of developing Type 2 diabetes. This adds digital tools to a coaching-intensive, educational, and activity-oriented program. Public Health England also has the Active 10 app, which encourages at least 10 minutes of daily brisk walking. NHS press release, Digital Health

MedStartr Momentum ’17 this Thursday–50+ speakers, 20 pitches, $2M in prizes! (NYC)

November 21, 2017 | by

MedStartr Momentum (#MedMo17), 30 Nov-1 Dec, PwC HQ, 300 Madison Avenue (@42nd) NYC

Now that you’ve finished off the last of the Thanksgiving leftovers, leave some room for this year’s MedMo17. You’ll feast on over 50 speakers and panelists in two full days of talks, networking, and real discussion on how to improve healthcare. There will be plenty of ideas served piping hot on innovation, adoption, and investment in the future of healthcare. Highlights:

  • Nine Momentum Talks on Healthcare innovation from inspirational leaders like Deborah Estrin of Cornell Tech,  Maria Gotsch of the Partnership Fund for NYC, Jack Barrette of WEGO Health, Jay Helmer of Livongo, Stuart Hochron MD of Uniphy Health, Jim Lebret MD of NYU,  and George Mathew, MD of DXC Technologies and CarePredict.
  • Four panels with thought leaders and CEOs on healthcare innovation and investing, reviewing the hottest topics for 2018, such as blockchain, smart cities, empowered patients and digital health for the rest of us.
  • Four Grand Challenge pitch contests covering wearables/ IoT, hospital solutions, clinical innovations, pharmatech, patient connectivity, AI, precision medicine, and more. (Rumor has it that this Editor will be on one judging panel!)

Join 200 attendees who are leading the healthcare innovation drive. There’s a great team that puts this all together, with Alex Fair of MedStartr the real spark plug behind it all. Much credit is due to generous sponsors and supporters like PricewaterhouseCoopers, DataArt, SparkLabs, HealthTechTalk Live, Moses & Singer, CohnResnick, McCarter & English, Epion Health, WEGO Health, Chardan Capital Markets, NJ Innovation Institute/NJIT, and others. 

TTA has been a supporter of MedStartr/Health 2.0 NYC since early days (2010). We’ve been able to obtain this special offer for our Readers–25% off a regular $299 ticket. Use Code TTA25. It’s an unbeatable deal for two full days with lunch and coffee breaks–conferences of this type are usually three to five times more. (And if you fall into certain special categories, like student or a pre-revenue startup founder, it’s even less; though our discount isn’t available on these ‘specials’, you won’t need it.) For our UK and EU Readers, it makes it worthwhile to catch an inexpensive NY flight, attend, and get started on your holiday shopping! See the action on Twitter #MedMo17, updates on @MedStartr.

One free spot at The King’s Fund Leeds conference–info in our next weekly Alerts

November 21, 2017 | by

The King’s Fund has been kind enough to offer to our Readers one complimentary spot to their Wednesday 13 December ‘Sharing health and care records’ conference at the Horizon Leeds. Entry information will be available in our weekly Alerts only on the 22nd and 29th.

If you’re not getting our Alerts, and you’d like to go to the conference, here’s a good reason why to subscribe. But why should you be an Alerts subscriber anyway? Convenience! It’s your personal table of contents to our articles. Each email rounds up two to three weeks of articles with links, plus a few of longer-term interest. It’s easy to click on what piques your interest or a past article you missed. Subscribe today–click here (your name, email, and country are all we need–and no promotional emails or spam, ever!)

NHS ‘GP at hand’ via Babylon Health tests in London–and generates controversy

November 18, 2017 | by | 2 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/11/Babylon-NHS-tube-advert.jpg” thumb_width=”150″ /]The GP at hand (literally) service debuted recently in London. Developed by Babylon Health for the NHS, it is available 24/7, and doctors are available for video consults, most within two hours. It is a free (for now) service to NHS-eligible London residents who live and work in Zones One through Three, but requires that the user switch their practice to one of the five ‘GP at hand’ practices (map). Office visits can be scheduled as well, with prescriptions delivered to the patient’s pharmacy of choice.

Other attractive features of the service are replays of the consult, a free interactive symptom checker, and a health record for your test results, activity levels and health information. 

While the FAQs specify that the “practice boundary” area is south of Talgarth Road and Cromwell Road in Fulham, and north of the River Thames, it is being advertised on London Transport (see advert left and above taken on the Piccadilly Line) and on billboards.

Reviewing the website FAQs, as telemedicine it is positioned to take fairly routine GP cases of healthy people (e.g. colds, flu, rashes) and dispatch them quickly. On the ‘can anyone register’ page, it’s stated that “the service may however be less appropriate for people with the conditions and characteristics listed below”. It then lists ten categories, such as pregnancy, dementia, end of life care, and complex mental health conditions. If anyone is confused about these and other rule-outs, there is a support line. 

Babylon Health is well financed, with a fundraise of £50 million ($60 million of a total $85 million) in April for what we profiled then as an AI-powered chatbot that sorted through symptoms which tested in London earlier this year. This is a full-on telemedicine consult service with other services attached.

Now to the American view of telemedicine, this is all fairly routine, expected, and convenient, except that there’d be a user fee and a possible insurance co-pay, as more states are adopting parity for telemedicine services. We don’t have an expectation that a PCP on a telemedicine consult will take care of any of these issues which Babylon rules out, though telemental health is a burgeoning and specialized area for short and long-term support. But the issues with the NHS and GPs are different.

First, signing up to ‘GP at hand’ requires you to change your GP to one in that program. US systems are supplementary–a telehealth consult changes nothing about your other doctor choices. This is largely structural; the NHS pays GPs on a capitation basis.

mHealth Insight/3G Doctor and David Doherty provide a lengthy (and updated) analysis with a critical view which this Editor will only highlight for your reading. It starts with the Royal College of GPs objections to the existence of the service as ‘cherry-picking’ patients away from GPs and creating a two-track system via technology. According to the article, “NHS GPs are only paying them [Babylon] £50 a year of the £151 per year that the NHS GP Practice will be paid for every new Patient they get to register with them” which, as a financial model, leads to doubts about sustainability. Mr. Doherty advises the RCGPs that they are fighting a losing battle and they need to get with mHealth for their practices, quickly–and that the NHS needs to reform their payment mechanisms (GPs are compensated on capitation rather than quality metrics).

But there are plenty of other questions beyond cherry-picking: the video recordings are owned by Babylon (or any future entity owning Babylon), what happens to the patient’s GP assignment if (when?) the program ends, and patients’ long-term care.

Oh, and that chatbot’s accuracy? Read this tweet from @DrMurphy11 with a purported video of Babylon advising a potential heart attack victim that his radiating shoulder pain needs some ice. Scary. Also Digital Health.

Tunstall partners with voice AI in EU, home health in Canada, update on Ripple alerter in US

November 17, 2017 | by

Tunstall Healthcare seems to be a recent convert to the virtues of partnership and not trying to do it all in-house. Here’s a roundup of their recent activity in three countries with advanced technology developers. 

Perhaps the most advanced is conversational computing, which with Siri and Alexa is the 2017-2018 ‘IT Girl’, albeit prone to a few gaffes.  The European Commission is incentivizing the development of the next generation of interactive conversational artificial intelligence to assist older adults to live independently within their home. The largest award of €4m is going to Intelligent Voice, a speech recognition company based in London. The EMPATHIC project will develop a conversational ‘Personalized Virtual Coach’ with partners including Tunstall and the University of Bilbao, as well as several other companies and academic organizations in seven European nations. Digital Journal

On the other side of the Atlantic, Tunstall is partnering with TELUS Health in Toronto. TELUS will use Tunstall’s ICP Integrated Care Platform with remote patient monitoring and videoconference telehealth capabilities to monitor patients in their network. Apparently, this is the first use of the ICP in the Americas, as previous deployments have been in Europe, Australasia, and China. It is also additive to TELUS’ own capabilities. TELUS itself is a conglomerate of healthcare tech, with EHRs, analytics, consumer health, claims/benefits management, and pharmacy management. TELUS release.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/02/ripplenetwork_5890862790fc7.jpg” thumb_width=”150″ /]This Editor also followed up with the CEO of Ripple, the smart-looking compact alerter targeted to a younger demographic that would dial 911 in emergency situations through a smartphone app or for a subscription fee, connect to Tunstall’s call center network. It was Americas’ CEO Casey Pittock’s last move of note back in February. In June, with his departure, a check of Kickstarter and social media indicated that Ripple also disappeared. Last month, after reaching out to their founder/CEO Tim O’Neil, it was good to hear that this was quite wrong. Ripple was featured on HSN on 23 September (release) and joined that month with Michigan Governor Rick Snyder and first lady Susan Snyder at the End Campus Sexual Assault Summit. On the new website, it’s priced as an affordable safety device: $19 for one unit connecting to an app to push notifications, plus $10 monthly for 24/7 live monitoring through Tunstall. A discreet alert device that has a jewelry-type look, pares safety down to the essentials, and extends safety coverage to the young does have something on the ball.

 

A fistful of topical events

November 16, 2017 | by

The London Health Technology Forum has just announced the details of its Christmas evening meeting on 13th December. Star turn will be the seasonally-appropriate Andrew Nowell, CEO of Pitpatpet who has a brilliant story to tell of how an activity tracker can unlock so many revenue sources. Attendees will also unlock mince pies, courtesy of longstanding host Baker Botts, and a roundup of key digital health changes in 2017 from this editor.

NICE Health App Briefings: NICE has finally published the end result of its review of three health apps on their Guidance & Advice list. Given that digital health is so much faster moving than pharma, it is disappointing that these apps appear to be being judged to a very high level of evidence requirement.

For example Sleepio, whose evidence for  effectiveness “is based on 5 well-designed and well-reported randomised controlled trials and 1 large prospective unpublished audit” is still judged, in terms of clinical effectiveness, as “has potential to have a positive impact for adults with poor sleep compared with standard care. There is good quality evidence that Sleepio improves sleep but the effect size varies between studies, and none of the studies compared Sleepio with face-to-face cognitive behavioural therapy for insomnia (CBT‑I).”

This editor is unaware of any other app that has five good RCTs under its belt so (more…)

Telemedicine comes to Saint Lucia–and the Caribbean

November 16, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/11/Coat_of_arms_of_Saint_Lucia.jpg” thumb_width=”100″ /]The wide world of telemedicine! It’s hard to get away from the internet (see The Telegraph’s digital detox list of countries and areas with little to none, like North Korea), but your Editors have found that telemedicine is reaching far away places like the small, volcanic Windward Island of Saint Lucia. For those who are considering a winter holiday or are resident in this eastern Caribbean Commonwealth-member island with a dual French and British history, you can take advantage of Bois d’Orange’s Easycare Clinic‘s telemedicine services. These include real-time video consults, answers to healthcare questions, creation and maintenance of PHRs, vital signs tracking, and full access to a health network. Registration is free at www.easycare-stlucia.com along with the app. St. Lucia Times

Elsewhere in the Caribbean, a report from the Bahamas tells us that that the Princess Elizabeth Hospital A&E department is now covering Fresh Creek Community Clinic in Andros and Marsh Harbour in Abaco (the ‘family islands’). According to Edward Stephenson, a healthcare consultant in the Caribbean, telemedicine has been established privately in Turks & Caicos, Haiti, Dominican Republic and St. Vincent. The VA’s Home Telehealth program was established in Puerto Rico and the USVI, although in what present condition after two hurricanes is unknown. The University of the West Indies has had a telehealth program for Trinidad and Tobago since 2004 and works with The Hospital for Sick Children (SickKids) in Toronto in a program that includes that country as well as the Bahamas, Barbados, Jamaica, St. Lucia, St. Vincent and the Grenadines.

ATA has had a long-standing Latin America and Caribbean Chapter (ATALACC) which also is affiliated with the University of Arizona’s well-known Arizona Telemedicine Program–which in turn is affiliated with Panama’s Proyecto Nacional de Telemedicina y Telesalud. Readers’ updates welcome on this subject!

Breaking: FDA approves the first drug with a digital ingestion tracking system

November 14, 2017 | by | 1 Comment

Not many drug approvals warrant an FDA press release, but this one did and deservedly so. The US Food and Drug Administration (FDA) approved a version of the psychiatric drug Abilify (aripiprazole) equipped with the Proteus Digital Health ingestible tracking system. Abilify MyCite has been approved for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder and for use as an add-on treatment for depression in adults. It is the first approved commercial version of a drug equipped with the Proteus Discover system, which tracks the ingestion of the pill from a sensor in the tablet activated by gastric juices to a patch worn by the patient and then to a smartphone app. The patient, caregivers, and physicians can track medication usage (timing and compliance) through the app, adjusting dosage and timing as needed.

The Proteus press release states that the rollout is gradual through select health plans and providers, targeting a limited number of appropriate adults with schizophrenia, bipolar I disorder, or major depressive disorder. It is contra-indicated for pediatric patients and adults with dementia-related psychosis.

Abilify, developed by Japan’s Otsuka and originally marketed in the US with Bristol-Myers Squibb (BMS), has been generic since 2015. This Editor finds it interesting that Proteus would be combined with a now off-patent drug, creating a new one in limited release. Proteus’ original and ongoing tests were centered on combining their system with high-value (=expensive) drugs with high sensitivity as to dosage times and compliance–for instance, cardiovascular and infectious disease (hepatitis C, TB). Here we have a focus on managing serious mental illness and treatment. 

Editors (Steve and Donna) first noticed Proteus as far back as September 2009. Looking back at our early articles, Proteus has come a long way from ‘creepy’ and ‘tattletale’. With nearly half a billion dollars invested and a dozen funding rounds since 2001 (Crunchbase), approvals were long in coming–nine years from submission of patch and tablet sensor to the FDA (2008), seven years from the patch approval (2010), five years from the tablet sensor approval (2012), to release of a drug using the Proteus system. The only thing this Editor still wonders about is what happens to the sensors in the digestive tract. They contain copper, magnesium, and silicon–copper especially can be toxic. If the sensors do not dissolve completely, can this be hazardous for those with Crohn’s, colitis, or diverticulitis/diverticulosis?  Hat tip to Bertalan Meskó, MD, PhD, via Rob Dhoble, on LinkedIn.

Also, if you can stand it, a lengthy article from the New York Times with lots of back and forth about the existential threats of monitoring drugs, potential coercion (preferable to injected Abilify), how some with schizophrenia already manage, and Proteus as a ‘biomedical Big Brother’. (Some commenters appear to have the very vapors about any digital trackers, including AiCure and etectRx.)

Telehealth roundups: Cuyahoga County (OH), BMJ systematic review, AAFP Forum

November 14, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/stick_figure_push_up_arrow_400_clr.png” thumb_width=”100″ /]Telehealth/telemedicine case studies are many, but those of us in the field are always on the hunt for fresh results. And the results seem to be fairly successful.

Cuyahoga County in Ohio instituted a telehealth program for its 569-person Educational Service Center this past July. In the first 90 days, 45 telemedicine consultations were completed with an average savings of $342 for each visit. Median wait time to the doctor consult was 2 minutes, 23 seconds. This amounted to a 130 percent return on investment, or $48,000. This is over the summer, when many employees were on leave, and does not calculate productivity gains, e.g. less sick time. The ESC goal is 80 percent utilization. This last would boggle the Big Minds over at the RAND Corporation which criticized the 88 percent rise in utilization when CalPERS members used Teladoc. TTA 8 Mar, 25 Mar  The provider of telehealth services is First Stop Health. Healthcare IT News.

BMJ reviewed 44 studies (of over 2,100 studies surveyed in the last five years) to identify factors around telehealth effectiveness and efficiency. “The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences.” Patient satisfaction was achieved when providers delivered healthcare via videoconference or any other telehealth method. Telehealth and patient satisfaction: a systematic review and narrative analysis (PDF)

The American Academy of Family Physicians (AAFP) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care hosted a Capitol Hill meeting on telehealth in primary care 9 November. The conundrum that PCPs face: telehealth is well-suited to primary care, the CPT codes are there, physician time can be easily recorded, and patients now are comfortable with it–but connectivity, health plans, and expansion of the referral network beyond the local are still not there. Regina Holliday, a well-known patient advocate who will be speaking at MedMo17, spoke about telehealth’s great advantages in mental health, especially to younger patients who want anonymous counseling and those in rural areas where it’s hundreds of miles to a mental health clinic or a psychiatrist. AAFP Forum Report

Tender/Prior Information Alerts: North Yorkshire, North Ayrshire

November 14, 2017 | by

Susanne Woodman, our Eye on Tenders, has located more complete information on a North Yorkshire tender we listed on 7 Nov and a prior information notice by North Ayrshire for a contract to be published next month.

  • North Yorkshire: The North Yorkshire County Council has listed full information on the tender for Assistive Technology services for North Yorkshire. It is for technology, monitoring and support to extend healthier independent living in the home and reduce demand on social care services. It is a three-year contract (extension up to 24 additional months) valued at £4.85 m. Bids close on 17 January 2018. TED–Tenders Electronic Daily 
  • North Ayrshire (Scotland): This Prior Information Request by North Ayrshire Council is for a 24/7/365 call handling system which is fully compatible with alarm equipment and telecare peripherals installed or provided by the Council in the full North Ayrshire Council area which includes the islands of Arran and Cumbrae. There are about 4,200 services users of primarily Tunstall equipment with a volume of 21,000 to 28,500 calls per month. The contract will be from 01 September 2018 to 31 August 2019. The contract will be published on 4 Dec. Public Contracts Scotland and TED