The King’s Fund has helpfully published a report on the (duelling?) presentations at last week’s NHS Health and Care Innovation Expo by Robert Wachter, MD, the ‘digital doctor’ (our review of excerpts from his 2015 book here), and Secretary of State Jeremy Hunt on the feasibility of paperless health records. There is plenty of funding (£4.2 billion) for NHS.UK announced earlier this year, but plans are still sketchy. The adoption of the GOV.UK Verify service used in other parts of the UK government is intended to “standardise the process to activate patient accounts without the need for them to visit a GP surgery in person”. NHS is having another crack at an app library, and there was a bit of surprise, according to the writer, that Secretary Hunt said that fitness data will be integrated into NHS patient records. But Dr Wachter cautions that he’s walking back the 2020 date he advocated for full paperless records to 2023. He recognized that implementation in all but the most advanced hospitals (a handful) isn’t feasible. There are too many competing priorities and too little funding (and, this Editor would add, too many HIT threats like hacking and ransomware). Only the most “digitally-sophisticated hospitals” would be invited to be ‘global exemplars’ in exchange for matched funding, in his view. The King’s Fund will be publishing more about this later in September, presumably as a prelude to their upcoming Designing digital services around users’ needs on 6 Oct. Wachter watch Hat tip to Reader Suzanne Woodman
Patient engagement: a digital divide in health technology accessibility
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/09/earthquake.jpg” thumb_width=”150″ /]Guest editor Sarianne Gruber (@subtleimpact) scopes the ‘digital divide’ separating those who need health services the most from the patient engagement and other tools they need in this article. The studies are US, but the lessons apply anywhere in the world. This Editor notes that many patient engagement tools are over-designed and over-complicated for users, even if they are fairly competent and frequently use online and mobile. (I entered a ‘pilot’ of a stress reduction program which proved to be anything but–and quitting because it is invasive and the reporting is ludicrously burdensome.)
To developers: Imagine your patient engagement platform being used by a person on the less sophisticated, less educated and disconnected end of the spectrum–or by someone less able due to physical (vision, touch) or cognitive impairment. Put on bad glasses and gloves–and start. Better yet, find a few people and put it in front of them. If we can make the mental shift in developing mobile apps for Africa or India, certainly we can do so for Americans, Britons and Europeans.
What the Studies are Showing
Hallmarked as a solution to improve healthcare quality, cost and safety, studies are showing health technology is up against a “digital divide” when it comes to patient engagement. At the Internet Governance Forum, Pew Research Center’s Lee Rainie, Director of Internet, Science and Technology Research presented the Fact Tank Report discussing the “digital divide” that exists in 2016. The report documents that lower income, less educated, non-white, seniors and rural communities are the least likely to have home internet, home broadband, mobile connectors and smartphones. This summer’s medical publications, the Journal of the American Medical Association and the Journal of the American Board of Family Medicine, released studies where demographic and socioeconomic data marked the root causes to limited or no access to digital technology, thus hindering the benefits and improved outcomes it can bring to the neediest and most costly populations. Here are the highlights from each study.
Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014, a research letter submitted from Harvard Medical School’s Brigham and Women’s Hospital, appeared in the August 2, 2016, JAMA. Authors, David M. Levine, MD, MA, Stuart Lipsitz, ScD, and Jeffrey A. Linder, MD, MPH,FACP made mention that this study, based on the National Health and Aging Trends survey (NHATS), was exempted from the Partners HealthCare Human Research/IRB Committee. The research team included participates to the longitudinal NHATS survey in 2011. The participants were re-surveyed annually on everyday (nonhealth) and digital health use until 2014. The research team acknowledged that this may be the first nationally representative study to examine trends in the adoption of digital health technology by seniors age 65 years and older who are community-dwelling Medicare beneficiaries.
Here are some the reported statistics from the study: (more…)
Scotland recognized by EC on innovative tech, practices for healthy aging
Scotland recognized as ‘reference site’ for innovation in healthy aging. The European Innovation Partnership Commission on Active and Healthy Ageing (EIP on AHA), an initiative of the European Commission, since 2012 has awarded select regional and local areas ‘reference site’ status. To quote from their site, “Reference Sites are highly inspirational ecosystems, delivering creative and workable solutions that improve the lives and health of older people. These solutions can be scaled-up and replicated across the EU.”
This year, the 74 sites include Scotland. Previously, Scotland had been a three-star evaluation site twice for the national telecare programme and the joint improvement team’s work on anticipatory care planning. The reference site solutions include digital solutions via NHS 24 and the Health and Social Care Alliance in Scotland. The Reference Sites Award Ceremony is will take place in Brussels at the next European Summit on Innovation for Health and Active Ageing, 6-8 December 2016. Holyrood, Alliance Scotland release Hat tip to Mike Clark via Twitter
The difficulty in differentiating telemedicine and telehealth
Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.
Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence
Funding opportunity for digital health projects in the UK outside London
| Funding opportunity for digital health projects Interactive Healthcare Fund is for businesses (SMEs) who wish to bring innovative digital health and wellbeing products and services to market in the NHS and wider health and social care marketplace |
Funded by Creative England’s Regional Growth Fund and managed by Creative England in partnership with the Yorkshire & Humber Academic Health Science Network (Yorkshire & Humber AHSN), this Interactive Healthcare Fund is for businesses (SMEs) who wish to bring innovative digital health and wellbeing products and services to market in the NHS and wider health and social care marketplace.
Key Information
- £250,000 will be available via investments of up to £50,000 per application
- Companies must be based in England, outside Greater London
- The fund opened on Monday 4th April 2016 and close on Friday 17th June 2016
Funding will support the development of innovative concepts using digital technology to improve patient care and health services, in response to the following priority areas:
- Citizen empowerment and maintaining independence for people living with Long Term Conditions (LTCs);
- Medicines adherence and optimisation;
- Public health and wellbeing priorities (e.g. obesity, alcohol and smoking cessation) and reducing inequalities in health;
- Patient safety and falls prevention;
- Improving mental health and wellbeing (including young people’s mental health).
We will be looking for projects which can demonstrate knowledge of health and social care challenges developed through working with clinical or expert patient groups or both, and the technology skills and the ambition to respond to an identified health and/or social care need.
Here are the FAQs and Application Guidelines, and for applications go here – for further information please contact tim.evans@creativeengland.co.uk (eligibility and technical queries) or p.hedley-takhar@yhahsn.com (healthcare priority areas).
Legrand adds Jontek to assisted living and healthcare businesses (UK)
Jontek Ltd, a Stockport-based developer and provider of monitoring software and response centers for telecare, telehealth, lone worker and mCare, is being acquired by Legrand, a specialist in digital building and electrical infrastructure. Jontek will be joining Tynetec in Legrand Electric Ltd’s Assisted Living & Healthcare Business unit. Like Tynetec, Jontek is one of our Grizzled Pioneers of telecare, having started their business over 20 years ago. Currently they provide services to over 60 organizations in the UK and are a Government Procurement Supplier.
Looking at the release, Legrand sees an opportunity to complement Tynetec’s current lines in at-home alarms and assisted living call systems with Jontek’s Answer-link monitoring software, which is a system integrating database queries/reporting, document management, emailing and incident logging. (This Editor also sees potential for these systems to enhance Tynetec’s telehealth RPM systems and Intelligent Care.) Managing Director Chris Dodd: “Historically, both Jontek and Tynetec have been committed advocates of an open protocol philosophy. This will continue to remain one of our primary considerations when developing integrated digital solutions and innovative IP care platforms of the future.” Legrand release.
Two important takeaways: We continue to see consolidation of health tech businesses with an eye to enhancing and widening capabilities. Companies with established businesses are moving to make their products more accessible and user-friendly with mobility and enhanced response–BYOD and call centers. In design, they are incorporating secure data integration and reporting capabilities to make the data useful to clinicians and to prove worth, reducing the number of time-consuming steps to obtain data–or fall inevitably behind other digital health competitors. The other is ‘open protocol’ which this Editor interprets in this context as the ability to integrate sensors, peripherals, software and other kit which are not proprietary–in other words, to play nicely in the sandbox. Another indicator that the ‘walled garden’ is coming to an end. Not that it is going to be easy for those firms which have invested in a certain way of doing business–a challenge that many heretofore successful companies are facing. Ed. disclosure: Tynetec is and has been a long time supporter of TTA.
Applications invited for the DigitalHealth.London accelerator by 25th April
The DigitalHealth.London Accelerator, is part of DigitalHealth.London. It will work with 30 small digital health businesses each year over an initial three-year period. It will provide help with engagement with clinicians and healthcare experts, so companies can refine their products. It will provide advice on topics such as such as navigating the intricacies of the NHS, understanding how to work with sensitive data, and opportunities to showcase new technologies in hospitals.
Life Sciences Minister George Freeman launched DigitalHealth.London at City Hall in February with the aim of speeding up the use of new digital health technologies by bringing together clinicians, healthcare providers, research institutes, entrepreneurs and industry to give companies a clearer route to market based on the needs of patients, the NHS and wider health sector.
Speaking at an Accelerator information day held recently, Dr Tony Newman-Sanders, Consultant Radiologist and Chief Clinical Information Officer, Croydon Health Services NHS Trust, said (more…)
The mixed picture of health tech investment: a potpourri
One picture is generally positive–plenty of opportunity in the aging and ill population, particularly in data integration from various sources, and value-based care. Everyone loves the excitement that a startup with a novel technology or way it can make knowledge more useful brings to the field. Another picture is one of pitfalls aplenty, from overhyping technology (poster child, Theranos) to overestimating growth, overspending and especially picking the wrong (nervous, impatient) investors at the wrong time, which have left a general patina of mistrust around digital health. There’s also the fact that healthcare is a highly, confusingly regulated, long-cycle business that’s challenged money-wise, whether in the US, UK, Europe or Asia. Some advice to startups contained in these two articles, including from the principals of StartUp Health accelerator (who’ve seen it all), has to do with building trust, finding the right investors, the right advice/advisors, collaboration (though that is difficult with IP), finding proven (affordable) management and a sustainable (and resilient) culture. Underpromise, overdeliver. TechCrunch, Healthcare Dive
No wonder that investment was flat in 2015, and that much of the news is around acquisitions that rearrange companies and/or offerings. The latest today is Allscripts‘ and GI Partners’ acquisition of behavioral EHR/care coordination company Netsmart for $950 million; Allscripts is moving its homecare business into Netsmart’s CareFabric suite. Kansas City Business Journal, Healthcare Dive In addition we’ll cite our earlier Mo’ Money article on the $600 million in various digital health investments. UPMC, which had invested in Vivify Health’s telehealth/RPM platform, is spreading $3 million around partly in-house to six health tech projects developed under the Pittsburgh Health Data Alliance. And in an example of Wearables Confusion, investors put $16 million into LifeBeam to develop another DTC ‘holistic’ health wearable (LifeBeam’s origins are sensors for aerospace and defense) while early wrist fitness entrant Pebble has laid off 40 staff in an attempt to refocus on…fitness.
Early-stage companies are also alliancing and merging. Fresh out of Newark and the New Jersey Institute of Technology’s NJ Innovation Institute, the merger of Practice Unite (which knits together secure mobile clinician/patient communications into a customized platform) and Uniphy Health (physician engagement), is an example of complimentary enlargement. This expands care collaboration offerings and shades over into patient engagement if you look at the PHM quadrant here. According to Director/Chief Medical Officer Stuart Hochron, MD (who was a Practice Unite founder), “We’re really pleased with the outcome of this merger. It’s given us the capital and resources that we need to scale.” It’s also good to see that both the founders and the CTO are moving into the new Uniphy Health–and staying in Newark. Release
Mo’ money! Over $600 million in funding washes into digital health
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/Looney-Tunes-Were-in-the-Money.jpg” thumb_width=”150″ /]The unicorns may be getting gored, the bloom off the rose in health tech funding, and it’s a ‘hangover’ from 2015, but both January and February wound up being strong months for digital health funding, with over $600 million to companies in various stages. Mobihealthnews racks up the wins, leading with MindMaze (recovery for stroke patients) $100 million in February, Pear Therapeutics (digital tools + pharmaceuticals) with $20 million and Cala Health (hand/wrist tremor treatment) with $18 million. In remote patient monitoring, Vivify Health raised $17 million completing a 2014 round for $23 million and interestingly will use some of this funding to develop an IVR (interactive voice response) solution (Mobihealthnews 25 Feb). They don’t total in insurer Oscar which had a massive raise of $400 million bringing their funding over $765 million, not that far from Unicorn Territory–probably a good idea as they have some dizzying goals like 1 million members in five years from its current 145,000 members in New York and New Jersey, adding Texas and California. The caution on Oscar is that they are heavily dependent on narrow networks and exchange business that may be unsustainable. But if you sign up, you get a Misfit Flash tracker and access to their mobile app! Digital health funding in February reached $197 million (Mobihealthnews)
Technology for Aging in Place 2016
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/elderly-smartphone.jpg” thumb_width=”150″ /]Laurie Orlov’s updated view of technologies that assist home caregiving/living, and her observations on trends for both boomers and those well over 65, is hot off the (virtual) presses and available here on her website. It is US-market oriented, but the trends explored here will be of interest internationally. The focus in this study is home-based systems for safety, alerts, activity/location tracking (telecare), home care/caregiving tools and what this Editor would call ‘health monitoring light’–med minders and logging apps versus medically-oriented telehealth (vital signs, save for AliveCor) and telemedicine (virtual visits/consults).
Highlights:
- In communication, internet non-usage among 75+ has declined to 50 percent over the past 15 years.
- The tablet form factor is losing ground as smartphones get bigger. Older adults and smartphones are beginning to ‘get along’ partly as they grow larger, but also that feature and simple phones are becoming less available.
- Also losing ground is senior housing–residents are delaying entry to assisted living until they are mid 80s and frailer. Savings and debt in the boomer group is low and high, respectively.
- Investors are caring more about home care, with large investments ($80 million) in three regional home care worker startups: Honor (San Francisco), Home Hero (Los Angeles), and Hometeam (New York/New Jersey), caregiving apps and chronic care management (CareSync, with an $18 million raise).
- Dementia care support tools are (finally) developing into its own category.
Surprising conclusions: PERS alerting stays strong, but changes to be mobile-enabled and more cosmetic; a lot of convergence of categories and forms; and the term ‘health tech’ will replace ‘digital health’. Oh my!
IBM automates diagnostic image analysis
“Most smart software in use today specialises on one type of data, be that interpreting text or guessing at the content [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/Avicenna.jpg” thumb_width=”150″ /]of photos. Software in development at IBM has to do all that at once. It’s in training to become a radiologist’s assistant” writes Tom Simonite in MIT Technology Review.
According to Simonite, the IBM software, named Avicenna, analyses diagnostic images like CT scans and the associated data such as a patient’s medical record and suggests possible diagnoses.
An example quoted was the case of a 28-year old with shortness of breath whose pulmonary angiogram images and medical history were analysed by the software. Using a family history which showed a tendency to form blood clots the software diagnosed a pulmonary embolism which was the same diagnosis an independent radiologist reached.
Simonite reports that IBM have thus far used annonymised data and are now working on commercialising the software although an independent researcher is quoted as saying that the accuracy needs to be increased before it would be a useful diagnostic tool.
Read the full article here.
Telegraph takes a quick look at CES 2016 trends, including wearables (updated)
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/CES-GX-p25a2_400x400.jpg” thumb_width=”150″ /]It’s hard to believe that with the end of the year, the Next Big Event for many is the Consumer Technology’s Association‘s CES 2016 in Las Vegas 6-9 January. The Telegraph notes six trends in this breezy overview of what’s going to be The Next Big Things at the show: connected cars (lots of automaker concepts including the hush-hush Faraday electric), cybersecurity (especially irking this year with healthcare taking three of the top seven-Healthcare IT News), drones (buzzing at a location near you, despite the FAA), wearables (most impacting digital health), virtual/augmented reality (with utility in rehabilitation not mentioned here), and the ever-annoying, ever-cloying Internet of Things. On wearables, the show floor has apparently tripled in size since last year, and the article highlights the Mimo baby sleep monitor and the Qardio ECG monitor. (Unfortunately this Editor missed the November New York CES preview as she was attending HIMSS Connected Health, and due to other commitments won’t be going to Vegas, Baby.) Six predictions for CES 2016: drones, cybersecurity, wearables and more (Telegraph)
Update. During CES, Parks Associates will hosting their 7th annual CONNECTIONS Summit on 6-7 January (Wednesday – Thursday). The most health tech related session is ‘Wearables: Healthcare, IoT, and Smart Home Use Cases’ on Wednesday 10:30am-11:45am, with a panel including executives from Honeywell Life Care, Care Innovations, Qualcomm, Independa, IFTTT and Lumo Body Tech, hosted by director Harry Wang of Parks whom this Editor counts as a Grizzled Pioneer, Research Division. Separate registration required. Information and full agenda here.
To our Readers: Are you attending CES? Interested in contributing some insights? Contact Editor Donna.
2015 digital health VC funding flat, consolidations nearly double: Rock Health
Rock Health published yesterday their 2015 annual Digital Health Funding report, and perhaps it is good news that 2015 activity maintained the blazing 2014 total at $4.3 bn. Still, it represents a compound annual growth (CAGR) from 2011-2015 of 30 percent.
Consumer digital health is thriving, with healthcare consumer engagement, personal health tools and tracking accounting for 23 percent of overall funding. Two of the six largest deals were won by consumer-driven genetic companies, 23andMe and Helix.
The one new record was that there were 278 deals across 248 companies, with an record-breaking average deal size of $15.6m. What continued is that the vast majority of funding deals (70 percent) were Series B and below, but C and C+ deals increased slightly. It was also a big year for exits. M&A activity nearly doubled in volume with 180 deals and $6B in disclosed activity. Their index comprising shares of publicly traded digital health companies was off over 5 percent with two of this year’s IPOs trading lower than their opening prices.
According to the Rock Health newsletter, early-funded companies had a few zombies among them. Rock Health looked at companies up to five years ago, and found that 11 percent they classified as either dead or “zombies” (which have not raised a round in 3+ years). “Most likely to die? A disproportionate number of these zombie companies are in the care coordination, EHR, or clinical workflow space.”
The web page with a link to the full study is here. Unfortunately, the download is not free, but $99.
Xcertia takes another pass at app certification, but will it fly? (US)
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/alp-mountains-peaks-in-winter.jpg” thumb_width=”150″ /]An app developer and a healthcare/digital health innovation lab get into the certification game. Can they fly over the treacherous peaks this time? Social Wellth made good on their promise (or threat?) to get into the app vetting business this past week through announcing a partnership with Columbia University-based HITLAB at the HITLAB Summit this week to develop a certification organization known as Xcertia. Last year, Social Wellth acquired the remains of Happtique from GNYHA Ventures [TTA 12 Dec 14]. The Xcertia principles center around privacy, security, operability and content–as Happtique’s did. The intent is to not only develop a program to certify apps based on established standards, but also form a Signature Steering Committee to ensure they maintain “their definitive set of criteria for evaluating mobile health apps.” MedCityNews, release
Possible conflict of interest. It all sounds positive, but the head of Xcertia, David Vinson, is also the CEO of Social Wellth, which despite its nonprofit-ish name makes its living by developing consumer apps and “dashboards” for insurance companies, a task grandly called (from their press release) “the curation of digital health experiences by leveraging mobile health technologies that allow for integration and aggregation of all digital assets.” Social Wellth also makes quite a bit of hay on its website about app curation for its clients. (more…)
A diagnosis of why digital health startups die–an old (and new) story
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/upside-down-duck.jpg” thumb_width=”150″ /]For years now, your Editors have championed integration of data and system interoperability–search on these terms and you’ll find a wealth of articles and views. This Editor also included how data is integrated in patient records as the Fifth Big Question (FBQ) in 2012 [TTA 8 Aug 13]. Many digital health companies, not just startups, have failed at the data integration (and security) tasks, whether with EHRs, hubs, billing and practice management systems or with other devices. (Let us not forget that the initial impetus for Continua back in 2007, the US state/regional HIXs and for HL7 now, was to have common data and interchange standards.)
So there’s no real element of surprise here by John Sung Kim’s pleading in TechCrunch re ‘integrating into legacy systems’ and the troubles his own startup DoctorBase encountered in what he tactfully puts ‘political and technical hurdles’ encountered. But then the velvet gloves come off about EHRs and their less-than-scrupulous idea of ‘partnerships’. (more…)
FDA’s ‘ossification tango’ side 2: what’s the social cost?
Catching up in the back file of articles is another in Bradley Merrill Thompson’s (Epstein Becker Green) series in Mobihealthnews on how the FDA is biased, by its very structure, against novel healthcare technology even if low risk. He further reflects on what’s truly novel, and what’s not. ‘Novel’ means Class III clearance and potentially millions of dollars. to gain it. He reckons that 80 percent of new digital health technology doesn’t qualify as ‘new’ in a regulatory sense–it may be ingenious in transferring the color reading of a test strip to, for instance, a smartphone and an analytic back end. All the new technology has to do is to demonstrate equivalence to the clunky traditional test–in other words, incremental improvement. What he’s worried about is the 20 percent that don’t fit any FDA classification, in particular software that automates what professionals do, repurposing non-healthcare technology for healthcare use (e.g. videogames for ADHD) or algorithms that automate what’s been done manually through a different method. The social cost is that the most in need, who would benefit from novel health tech that cuts cost and improves quality for individuals and populations (that old Triple Aim), will forever be blocked from having it by regulation. “We need a new paradigm where new technology is quickly evaluated for potential risk, and placed promptly into an appropriate regulatory category.”
There are certainly regulatory parallels ex-US. Much more here to ponder for your Weekend Reading.
Previously and related by Mr Thompson: Avoiding the FDA health IT-medical device regulatory trap for general IT companies, FDA, new technology approval and the Ossification Tango
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