TTA’s Last Swing of Summer: CVS wins $8B Signify auction, Amazon-One Medical gets FTC look-see, UHG/Change decision now Oct, Holmes files motions before sentencing, keeping digital treatment tools safe by design, more!

 

Weekly Update

Back from Two Weeks in Another Town (except for a few extra days), the August-September ‘quiet time’ certainly was not. CVS’ big win in Signify’s auction was on Labor Day. Change may or may not be joining UHG/Optum after October. FTC doesn’t much like Amazon’s acquisitions, including One Medical. And Elizabeth Holmes’ legal team was busily filing–and delaying the (maybe) inevitable, including a declaration straight out of Perry Mason.

The passing of a Queen and crowning of a King.

Elizabeth Holmes’ three swings and a miss in overturning her trial verdict reveal a crafty strategy (She’ll be in court long after Sunny Balwani toddles off to prison)
News briefs, catchup edition: UnitedHealth/Change decision October?, CVS wins $8B Signify Health auction, Walgreens majority buy of CareCentrix, FTC requests more info on Amazon-One Medical (Home care wars and a long-awaited decision)
Perspectives: Creating consistent standards isn’t a once and done job (the safety of digital treatment tools)
On the passing of HM Queen Elizabeth II

$130M to Alma’s mental health platform, Cadence Care RPM with ScionHealth, NIH funding telehealth in cancer care, and more.

News roundup: RPM at 79 ScionHealth hospitals, 74% of employers like virtual care despite concerns, Alma Health garners $130M, NIH’s $25M for cancer care telehealth research, Parks’ virtual Connected Health Summit 30-31 Aug

Amazon threw in its beach towel on Care, put its bets on One (Medical), and paddle up in Signify’s auction closing after Labor Day. Babylon Health is eliminating distractions with the NHS to concentrate on the US. Oracle’s hit with charges of massive privacy violations, on top of massive Cerner VA dysfunctionality. But back to the future–Fitbit’s reviving with three new fitness watches.

Oracle in Federal court class-action lawsuit on global privacy violations; Cerner VA EHR had 498 major outage incidents, 7% of time since rollout (Misery upon misery)
Week-end news roundup: Fitbit revives with 3 new watches, Sena Health hospital-at-home, SteadyMD surveys telehealth clinicians, 9.4% fewer adult dental visits in England, save the date for ATA 2023
Perspectives: why digital apps need an in-house clinical safety lead (A Perspective from Wysa, more to come in September)
Breaking: Amazon Care shutting down after three years–what’s next? (updated) (Care an expensive course at the University of Healthcare Delivery)
Babylon Health exits last NHS hospital contract as a ‘distraction’, looks to US market for growth (Tighten your seatbelts)
Signify Health bidding war ensues, waged by Amazon, UnitedHealth Group, CVS, Option Care Health (A scrum with unknown outcome)

An action-packed mid-August. No one seems to be sitting on the beach unless you’ve been laid off. Meanwhile, companies are scrambling. No, Babylon Health is not being bought. But elsewhere, there is some good news around acquisitions and funding. 

Rounding up the week with good news: AliveCor’s Series F round, Scotland’s Smplicare gains £750K for fall research (A needed and refreshing drink!)
Friday short takes: was there a bidding war for One Medical? A concussion risk wearable tested. Get Well’s monkeypox digital care plan (One Medical’s gamble and a return to one of our old follow topics)
Week-end news roundup: +Oscar data tech platform pauses, BD buys MedKeeper pharmatech for $93M, Novant’s Meta misconfiguration reveals PHI, Mt Sinai’s Sema4 genomics spinoff releases 250 + founder (Reality bites in a lot of different areas)
Babylon Health: fending off bubbly rumors of acquisition this week (No, they’re not. Being. Bought.)

Big companies eager to snap up companies to fill out portfolios. Small (and not so small) companies drastically cutting staff and spending, looking for the Magic Survival Formula. Amwell finally closing a Big Deal with CVS Health. Babylon Health’s mixed picture as they grow. Cerner and VA’s miseries continue, but data and IoMT breaches thrive. And ISfTeH not only returns to live conferences, but also comes to the US.

Weekend short takes: May telehealth claims up to 5.4%; three health plan breaches, one at its law firm–affecting over 400,000 patients; layoffs hit Calm, Truepill (updated)
ISfTeH Global Connections for Sustainable Telehealth: 6-7 November, San Jose (International telehealth finally reaches the US)
Week-end news roundup: Allscripts on the acquisition hunt, Amwell’s CVS telehealth deal, Cerner’s $1.8M racial discrimination settlement, predicting Parkinson’s progression via smartwatch data
Mid-week news roundup: CVS eyeing Signify Health for in-home/VBC (updated); Babylon Health mixed pic of revenue and losses up; Geisinger doubles telemed specialties; connected IoT devices expand cyber-insecurity footprint; Owlet layoffs
More Oracle-Cerner VA/DOD EHR misery with 4 hour+ outage; 51% of VA iPads unused for video appointments (Not only VA’s
EHR, but also inventory management gone sideways)

This week’s big news centered on Oracle’s layoffs at Cerner–and Oracle–DOJ versus UnitedHealth Group, and telehealth nearing needed legislative change in the US. In UK news, NHS Digital trials wireless to compensate for looming staff shortages–and Cera raises £264 million. Advances in dementia diagnosis and therapy plus news from all over: multiple raises, VA, Cionic, Withings, Orion Health, Coviu, and more!

Week-end wrapup: CVS plans to expand primary care, home health; Cera Care raises £264M; Linus Health’s AI enabled dementia screener, Cognito’s cognitive therapy slows brain atrophy
Short takes for Thursday: Diagnostic Robotics $45M raise; Sage’s $9M seed; VA names EHR ‘functional champion’; Aussie telehealth startup Coviu arrives in US
NHS Digital trialling Wireless Center of Excellence–in face of ‘crisis’ level staffing shortages (Can one compensate for the other?)
Mid-week roundup: UnitedHealth-Change trial kicks off; Amazon’s One Medical buy questioned; Cionic’s neural sleeve designed by Yves Behar; Medable-Withings partner; Orion Health’s new CEO; IBM Watson Health’s Simon Hawken passes (Line up your bets on DOJ vs UHG)
Telehealth waivers take critical step in extending to 2024 in House bill now passed (About time, Congress)
Oracle’s Big Vision will be missing a lot of people; layoffs hit Cerner, customer experience, marketing staff (Didn’t take long for the guillotine to fall)

The news for this week is a mix of some good and some not-so. Oracle’s new sheriff moves to fix Cerner’s VA EHR problems, quickly. Investment is reviving, led by Amazon’s buying One Medical, Cleerly, and 3M’s 2023 healthcare spinoff. But Teladoc continues its losing streak. Health plans are shedding real estate and holdings. Also shedding are unicorns–Babylon Health, Included Health, and Noom.

Week-end roundup of not-good news: Teladoc’s Q2 $3B net loss, shares down 24%; Humana, Centene, Molina reorg and downscale; layoffs at Included Health, Capsule, Noom, Kry/Livi, Babylon Health, more (Hit by both telehealth and tech downturns)
Weekend investment/divestment roundup: 3M to spin off Health Care, Cleerly’s $223M Heartbeat, Elation’s $50M Series D, Health Note’s $17M Series A, Galen bought by RLDatix (A revival?)
Oracle’s ‘new sheriff’ moving to fix Cerner EHR implementation in the VA: the Senate hearing (High Noon at VA?)
Amazon moves to acquire One Medical provider network for $3.9B (revised) (Another worry for providers)

Having survived heat waves on both sides of the pond, the news is emerging from its lull. The most significant is around Oracle Health sunsetting the Cerner brand, which frankly has become a bit tarnished. Some of it is about staff cuts and hack attacks piling up, for different reasons in the US and UK. Other news is encouraging in that investment and business are moving forward, despite the parlous state of the markets.

Special congratulations to Herts Careline on its 40th birthday! 

Week-end news roundup: Fold Health launches OS ‘stack’; admin task automator Olive cuts 450 workers; 38% of UK data breaches from cyber, internal attacks; hacking 80% of US healthcare breaches; does AI threaten cybersecurity?
VA’s final, troubling OIG ‘unknown queue’ report on Cerner Millenium rollout; Oracle’s Sicilia to testify before Senate today (Oracle’s inherited mess)
Herts Careline marks 40th Anniversary (Congratulations!)
Midweek heat wave roundup: GE Healthcare’s new name, hospital-to-home health trending big, over 2 million patient records hacked (Hint: GEHC doesn’t have to change the brochures right away)
Cerner’s business now consolidated under Oracle Health (Excuse Cerner as it disappears–but save the swag for eBay!)

 


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine, and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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Perspectives: Creating consistent standards isn’t a once and done job

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s contribution is from Rhod Joyce, Deputy Director of Innovation Development at NHS Transformation Directorate and previously Head of Partnerships for NHSX. As Deputy Director of Innovation Development within the NHS Transformation Directorate, Rhod works to support the ecosystem in the development, assurance, and deployment of digital tools and services at scale. Key programs include the Digital Health Partnership Award and the Digital Health Technology Assessment Criteria. He drives support for patients to access digital health apps to support the management of long-term conditions and leads the Transformation Directorate’s Partnerships team.

This is the second Perspectives contributed by Wysa, an AI-enabled therapy coach for mental and emotional wellness. It recently was granted an FDA Breakthrough Device Designation prior to premarket review. 

Interested contributors should contact Editor Donna. (Pictures and graphs are welcome)

Technology is evolving and becoming more and more commonplace in healthcare. As a result of the pandemic, more people are open to the idea of digital treatment tools, and the NHS has pledged to provide ways to ensure that digital inclusion is accelerated. On-demand healthcare, virtual reality, online treatment sessions, big data, and predictive healthcare are all improving access and outcomes. Online and digital health resources can help with prevention, self-care, shared care and shared decision-making, long-term condition management, and appropriate use of urgent and emergency care.

The challenge for commissioners comes when trying to select which tool is best. There are over 350,000 digital health apps in the market, with an average of 250 new health apps being released every day. The question then becomes, how can commissioners and clinical leads uphold safety standards, whilst putting the best tools in the hands of clinicians and patients?

Historically the NHS has worked to a number of different standards, with various contributions to the Apps Library and a digital assessment questionnaire that had evolved. From a patient-facing perspective that was very complex, but it also raised issues for commissioners who had no common standard to work towards.

In most industries such as banking or travel, there is a baseline standard that everyone adheres to and knows is a minimum – an ISO or equivalent. But healthcare has been lacking. That is why we brought together all the standards so that digital health technologies that are being considered by NHS or social care organizations should be assessed against the Digital Technology Assessment Criteria (DTAC), regardless of procurement route, by the NHS or social care organization that is buying the product.

It defines standards for clinical safety, data protection, cybersecurity, and technical assurance and interrupts and also with a view of accessibility and usability and they are set out now as the absolute baseline that digital health technologies need to meet to operate safely within health and social care. While DTAC is intended to be a ‘one size fits all’ baseline criteria in terms of safety and security, it is intended to be part of procurement, it is not intended to be the complete question set for procurements and should be supplemented with additional specifications including any policy and regulatory requirements.

Because clinical safety isn’t a once and done thing. Having a set of standards does not mean that once that box is ticked an application is fine and available to use for everyone. It’s necessary to continuously uphold clinical standards and safety logs that prove efficacy and excellence. Every interaction, assessment, and engagement will result in new information that needs to be tested against the appropriate criteria. A clinical safety risk profile is dependent on a daily update.

When we look at developing standards we need to look at a systems focus, national programs, and patient-facing criteria. These areas are three very different things but in the past have been looked at together, which has muddied the waters. DTAC applies to all types of digital health technologies, from electronic patient records to public-facing health apps.

By ensuring that the patient needs and healthcare system requirements are front and center of every development, every innovation, every interaction, we can be sure that we are delivering the right tools for truly personalized care. That commitment can’t be a one off. If we’re going to do the right thing, let’s do it repeatedly. Only with a common set of standards that are continually being addressed and revisited, can we safely operate and allow for the innovation and progression that the NHS needs to meet an increasingly complex and varied range of needs in a modern healthcare setting.

Wednesday roundup: athenahealth acquisition closes, Tyto Care receives lung sound CE Mark, NHS’ elective care recovery plan for 6 million, NSW health secretary to Telstra Health

Bain Capital and Hellman & Friedman completed their $17 billion acquisition of athenahealth on Tuesday. The purchase was from Veritas Capital and Evergreen Coast Capital, which remain minority shareholders along with an affiliate of GIC and a wholly-owned subsidiary of the Abu Dhabi Investment Authority. athenahealth claims over 140,000 ambulatory care providers in the US, which is not much growth considering they had 88,000 in 2017 and reportedly grew to 160,000. Release 

Telehealth diagnostic monitor Tyto Care received CE Mark approval for the Tyto Lung Sounds Analyzer. It is a standalone Software as a Medical Device (SaMD) that alerts to the potential presence of an abnormal breath sound in respiratory recordings that may be wheezing in adults and children. The analysis is based on their database of clinical exam recordings. Release

Whither the 6 million waiting? The NHS intends to reduce the backlog of elective care caused by the pandemic through the Delivery plan for tackling the COVID-19 backlog of elective care. Highlights are the rollout of a new online platform called My Planned Care, as well as plans for 100 community diagnostic centres, new surgical hubs, and increased capacity to offer tests, checks, and treatments–over three years. Healthcare IT News

And in Australia, the revolving door spins. Elizabeth Koff, secretary of NSW Health, will be moving to Telstra Health as managing director effective 1 July. She succeeds Mary Foley, who will continue to be a special adviser and a non-executive director of the board. Ms. Koff has spent three decades in the state health department which manages 228 hospitals and around 127,000 staff. New South Wales was subject to severe lockdowns in 2020 and 2021, which continue to a lesser degree.  Healthcare IT News ANZ

Wednesday roundup: Amazon Care now (actually) nationwide, Australia’s Eucalyptus telehealth’s A$60M, Withings 2 buys, Glooko buys xbird, HoloLens for nurse-GP comms in Cumbria

Amazon Care, which has compiled a history of playing their news quite close to the vest, coyly dropped another hankie on their website today with a blog post that confirmed that their virtual care platform is now available nationwide. In 2022 they will be adding in-person services to 20 more cities, including San Francisco, Miami, Chicago, and New York City. Companies offering Amazon Care as an employee benefit include Silicon Labs, TrueBlue, and Whole Foods Market (an Amazon company). Back in October, TTA outlined our thoughts on Amazon Care’s structure, offerings, cheap pricing, and our opinion that Amazon’s real aim is to accumulate and own national healthcare data on the service’s users. Then they will monetize it by selling it to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Patients may want to think twice.

On a lighter note, Australia’s Eucalyptus telehealth scored a tidy Series C of A$60 million ($42 million), led by Airbnb and Canva’s early investor, BOND, plus previous investors. Eucalyptus’ telehealth platform markets five services: men’s health-focused Pilot, women’s fertility brand Kin, skincare site Software, sexual health business Normal, and menopause service Juniper. The fresh funds will go towards software development and expanding into the UK. Mobihealthnews

Withings is also on a bit of an acquisition tear, buying Berlin-based nutrition app 8fit on top of last month’s Impeto Medical, which developed a tool for monitoring peripheral neuropathies. 8fit offers efficient workouts, customized meal plans, and self-care
guidance in six languages. While the acquisition cost was not disclosed in the release, Withings plans to invest $30 million to integrate 8fit features into their products. Impeto, a R&D company, developed an FDA cleared technology that measures the ability of sweat glands to release chloride ions in response to electrical stimulus. For those with neuropathy, that sweat gland innervation is reduced and sudomotor function is impaired. Impeto’s tool has already been integrated into Withings’ smart scale, the Body Scan, to be released in the second half of 2022 after FDA clearance. Release, Mobihealthnews

Another Berlin-based company in AI that’s been acquired is xbird. The buyer is Glooko, a diabetes and chronic condition monitoring platform. xbird captures data generated by devices and processes it through algorithms and machine learning models, and will expand expands Glooko’s advanced analytics capabilities and tools. The management and staff will join Glooko GmbH. Glooko release

Closing our update is a Cumbria catchup. Nurses at Kendal Care Home are wearing Microsoft’s mixed-reality HoloLens 2 headset to call GPs through Microsoft Teams. Using the HoloLens, doctors can talk to both the nurses and patients. Kendal Care Home has been working with local GPs, Kendal Integrated Care Community, and University Hospitals of Morecambe Bay NHS Foundation Trust to train staff in the use of the headset, which started use at Kendal in October 2020 and has largely replaced their tablets and smartphones for telehealth consults. In addition to Kendal, the Heart Centre at Alder Hey and Imperial College Healthcare NHS Trust used HoloLens 2 during the pandemic. DigitalHealth.net

News roundup: GE Healthcare spins off, Mercy Health accused of telehealth tech theft, NHS’ proposed $8.1bn bump for backlogs–with a 83 y/o in a 7am queue

Breaking up GE is so very hard to do–or is it? The long-rumored spinoff of GE Healthcare will be happening by early 2023. Leadership will also be changing, with Integra LifeSciences CEO Peter Arduini becoming president and CEO on 1 January, replacing Kieran Murphy who came from the Life Sciences business and the UK. A GE connection will remain since GE chairman and CEO Lawrence Culp will serve as non-executive chairman of GE Healthcare after spinoff. Also spinning off by 2024 will be the power and energy business. What remains of General Electric will be the commercial aviation and defense aviation business. 

A spinoff of GEHC was in the works in 2018, but faltered when the then-CEO left. It currently is a $17 billion business which, like its competitors Siemens Healthineers, Philips, Fujifilm, Toshiba, and Hitachi, has been affected by supply chain disruption. In third quarter, there was a 6% decline in revenue to $4.3 billion in the period compared to a year ago. Barron’s estimates that the valuation of GEHC would be about $54 billion after spinoff, even with debt and related costs.

For GEHC and its people, at least one decision about the future is resolved. And one could hope that GEHC could finally free itself of the Welch (and later) ‘take it or leave it’ legacy that never seemed to fit healthcare, the brutal GE internal culture, and chart its own course of innovation and improved customer service.  CNBC, Healthcare Dive

Mercy Health, a health system headquartered in St. Louis, is being sued by former telehealth provider LifeScience Technologies LLC (LST) for misappropriation of trade secrets, breach of contract, civil conspiracy, and more . LifeScience’s m.Care was being used by Mercy from 2015. In the lawsuit filed by LifeScience, Mercy is being accused of giving Myia Health’s software development team improper access to LST’s virtual health software using @Mercy.net credentials. Mercy then invested $5 million in Myia Health and replaced m.Care with Myia’s ‘derivative’ software. The lawsuit was filed in the United States District Court for the Eastern District of Missouri, Eastern Division on 25 October. Springfield News-Leader, LST release

Last month’s proposed NHS budget from the Finance Ministry included a $8.1 million boost to help resolve patient waiting lists and modernize technology. The ‘boomerang’ of cases from the pandemic lingers on. The increase represents $3.2 billion for testing services, $2.9 billion to improve technology, and $2 billion to increase bed capacity. VOA. Perhaps the increase will help a gentleman like Keith Pratt, aged 83, who faced at London Road Community Hospital first a lost blood test that was part of his diabetes checkup, and then, because he had no computer nor access to log in for a new appointment, was forced to queue at 7am at the walk-in clinic. Derbyshire Live reported that “Keith feels that people without internet access are being overlooked when it comes to accessing NHS services in Derbyshire. He said: “I’ve not got a computer and I am like thousands of other people who haven’t got a computer, not just older people like myself.” Will the technology improvements include not losing tests, and phone backup for appointments? Wouldn’t that be nice?

Softly, softly: GPDPR comes to screeching halt, indefinitely, to be reworked

UK GPs and offices can now take an August holiday. The entire process of GPs extracting their data for the NHS GP Data for Planning and Research (GPDPR) database and patients opting out has been halted–or “deferred” per the letter from Parliamentary Under Secretary of State Jo Churchill. Formally, the Data Provision Notice was withdrawn on 19 June–and quietly. That means no more deadline of 1 September–or, in fact, any deadline, right now. 

According to the letter to GPs:

Instead, we commit to start uploading data only when we have the following in place:

  • the ability to delete data if patients choose to opt-out of sharing their GP data with NHS Digital, even if this is after their data has been uploaded [This is a significant feature that is expanded on later in the letter–Ed.]
  • the backlog of opt-outs has been fully cleared
  • a Trusted Research Environment has been developed and implemented in NHS Digital [Security based on OpenSAFELY and the Office for National Statistics’ Secure Research Service best practices–Ed.]
  • patients have been made more aware of the scheme through a campaign of engagement and communication

The revised scheme will be created in collaboration with the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA). One wonders why these logical steps weren’t taken before deadlines were set, moved, and about five medical associations plus at least one MP excoriated the NHS publicly. Undoubtedly more tap dancing to come. Our most recent and previous coverage here. Also Pulse and HealthcareITNews EMEA.

NHS Digital GPDPR medical database data extraction start postponed from 1 July to 1 September

Facing a GP revolt and legal action, NHS Digital has postponed the extraction of patient data records from surgeries until 1 September for the General Practice Data for Planning and Research (GPDPR). Before the House of Commons on 8 June, health minister Jo Churchill announced the extension. “We will use this time to talk to patients, doctors, health charities and others to strengthen the plan, build a trusted research environment and ensure data is accessed securely.” Health secretary Matt Hancock also announced that the patient opt-out deadline, originally 23 June, will be extended (date TBD). Pulse (may require registration), NHS revised release

On 4 June, before the extension announcement, the Doctors Association UK (DAUK), the Citizens, openDemocracy, the National Pensioners Convention, and Conservative MP David Davis were among the signatories to a legal letter sent to the Department of Health and Social Care (DHSC) threatening action to halt the data collection from GPs. Pulse (may require registration)   

While Ms. Churchill, Mr. Hancock, and Simon Bolton collectively insist that the additional time will be used for consultations with patients, doctors, health charities, and others, the proof will be in both the data collection and how informed patients will be of their options. Both the opt-out date and September, given the summer holidays, aren’t much time. In this Editor’s estimation, for a major effort, the end of this year would be far better. Perhaps we should send them this poster? Additional TTA coverage 2 June.

News and deal roundup: OneMedical’s $2.1 bn for Iora, CareDx buys Transplant Hero, Mount Sinai’s Elementa Labs; UK news–NHSX/Babylon, Doro-Everon, Tunstall

West Coast-based concierge medical provider One Medical goes ‘mass’ with Iora. One Medical, best known for serving the affluent well through a membership fee, direct pay, commercial insurance, and sponsored contracts with large employers like Google for primary care, announced plans to acquire Boston-based Iora Health. Iora’s primary care providers serve a different market, with primarily Medicare patients moved into full-risk value-based models such as Medicare Advantage plans and practices in shared savings arrangements such as Direct Contracting. The investor presentation here discloses the all-stock purchase with 26 percent of ownership going to current Iora shareholders. Iora for now will be run separately, which makes sense given the disparity in patient base. The major element in common? Primary care practices and ‘white-glove’ services. Healthcare Dive, FierceHealthcare

Consolidation in digital transplant care assistance. CareDx, which provides a wide variety of management services for organ transplant providers and recipients, is acquiring New York-based Transplant Hero. Transplant Hero is an app that reminds recipients to take their vital medications, and was founded by a transplant physician. Financial terms and integration going forward were not disclosed. Release, Mobihealthnews.

Mount Sinai Innovation Partners (MSIP) creates a new health tech incubator. Elementa Labs launched this week, specifically seeking pre-seed or seed-stage healthcare and biotech startups. Companies must also have a clear objective for working with Mount Sinai to develop a comprehensive development plan.The first startup on board is avoMD, a mobile-friendly point of care clinical decision support platform. Applications for the 12-week program close 30 September. FierceHealthcare

UK activity heats up with the late spring…

NHSX and NHS England are assessing Babylon Health’s triage app. According to an exclusive in Pulse (may require registration), a senior delegation from both visited University Hospitals Birmingham NHS Foundation Trust (UHB) last month to look at its use of the Babylon technology. However, NHSX has disclaimed any work towards a national program with Babylon as practices reopen throughout the UK.

DoroCare UK and Everon announced a partnership on products and services for social care, such as Everon’s Lyra, a cloud-based emergency call system, and Doro’s Eliza, a smartcare hub. Release

Tunstall announced the release of the Tunstall Service Platform (TSP) in the UK. It’s described as a connected care software platform supporting the Tunstall Alarm Receiving Centres coordinated by local authorities and social housing providers. It has four unique functions: PNC (call handling), service manager, fieldforce manager, and proactive services. It also will transition these systems from analogue to digital and will be operable in both. Release

NHS touts COVID-19 Test and Trace app; Livi’s MJog notifies users of vaccine jab info

The NHS Test and Trace app, launched in September in England and Wales, released its first report on notifications this week. 1.7 million app users have been advised to isolate due to close contact (not defined) with a person then found to test positive for the virus. The app notifies the user of the positive contact as quickly as 15 minutes after a user inputs a positive test result. Over 3.1 million test results have been entered into the app across England and Wales, of which 825,388 were positive. The testing combines both those booked through the app and manually entered there. 

The NHS’ analysis suggests (their term) that the contact tracing has prevented approximately 600,000 cases. Test and Trace incorporates a symptom checker that has been used over 1.4 million times.

As well as contact tracing and booking a test the app allows users to check their symptoms via the symptom checker. Coronavirus symptoms have been reported into the app over 1.4 million times in England and Wales since 24 September.

For a contact tracer, it’s been extremely successful with a download count of 21.63 million. It’s estimated that 56 percent of the eligible population aged 16+ with a smartphone has downloaded the app. It was 2020’s second most downloaded free iPhone app in the App Store in 2020. Gov.UK Department of Health and Social Care release, Mobihealthnews

Seeking info on your vaccine jab? Livi is supporting the NHS through its MJog app, notifying users of vaccination messages including vaccination eligibility, the latest information about vaccines, and whether or not users can phone their GP. Since the December rollout, 25 million vaccination text messages have been sent to NHS patients. The MJog platform saw a 220 percent increase in messages sent during the same period the prior year. The app in addition sent out five million appointment reminders. Livi acquired patient notification app MJog, a patient messaging service for the NHS during the past 12 years, last October. Mobihealthnews.

NHS digital triaging app eConsult closes £7 million funding round

Closing out last week was eConsult’s announcement of a new £7 million round of financing. The triage app is currently used by about 40 percent of NHS practices–3,200 NHS GP practices across the UK. The funding, on top of a £5 million Series A raise last October (Crunchbase, AngelNews) was via Gresham House Ventures (this raise and the Series A lead) and Calculus Capital, plus existing investors.

The fresh funding will boost eConsult capabilities for primary and secondary care, plus expansion into urgent care with an Urgent and Emergency Care tool, eTriage, and outpatient triage tool, eSpecialist. They are also developing a triaging service for Emergency Departments (EDs). 

eConsult was formed in 2013 by four NHS GPs. It uses a bank of over 10,000 questions from a number of clinical sources to direct patients to the most appropriate care, assign priority, and direct to a GP surgery. Their research indicates that 70 percent of GP enquiries can be closed without a F2F consult. 

Last August, eConsult, Q doctor, and Cognitant Group jointly created a toolbar that combined eConsult with Q doctor’s video consult technology and Cognitant Group’s ‘Healthinote’ verified patient information service. They later added HCI’s medical video library service. In June, eConsult added the Ministry of Defence; 183,500 service members and dependents in 124 international locations are able to access online consultations with Defence Primary Healthcare (release).

eConsult’s service volume exploded during the early pandemic and has held its leading share versus competitive services such as Babylon Health, Push Doctor, Infermedica, and Livi (Kry). Babylon has had its challenges in the UK market but is aggressively moving into enterprise accounts in the US and Canada, quietly raising just before Christmas $100 million (£74.5m) in a convertible loan led by VNV Global. Mobihealthnews. UKTechNews

News roundup: Pfizer’s COVID-19 vaccine on horizon, CVS’ new CEO, Vodafone UK 5G health survey, Centene acquires Apixio AI, Doro’s 24/7 Response

As infection rates continue to rise, Pfizer’s and German partner BioNTech SE’s COVID-19 vaccine was the top of the news this undecided post-US election week. It was found to be “more than 90 percent effective in preventing COVID-19 in participants without evidence of prior SARS-CoV-2 infection in the first interim efficacy analysis” of the Phase 3 clinical study. They exceeded their evaluable case count (total was 94). Protection was achieved 28 days after the initiation of the 2-dose vaccination. Pfizer release. Chain and independent pharmacies have already signed on for distribution at no cost to patients, covering about 60 percent of pharmacies through the US, Puerto Rico, and the USVI. It’s expected that FDA approval will be by end of year with availability early next year. HHS release. Work on 10 other vaccines goes on. The NHS is lining up for distribution with Health Secretary Matt Hancock promising that they’ll be ready from December as coronavirus diagnoses and deaths climb up from summer levels. BBC News

CVS’ CEO Larry Merlo announces 1 Feb 2021 retirement, Aetna head Karen Lynch to take the helm. Ms. Lynch will also join the board of directors. Mr. Merlo will depart after the shareholder meeting and serve as a strategic adviser until 31 May, which is typical of CEO phased departures. He leaves CVS in excellent shape having conducted during his 10-year tenure the acquisition of Aetna in 2018 and the growth of CVS to almost 10,000 store locations, initiating 1,500 HealthHUBs, and over $199 bn in earnings through Q3 this year. Ms. Lynch joined Aetna in 2012 from Magellan Health Services, a specialty/behavioral managed health company, and Cigna. She hit a home run with vitalizing Aetna’s Medicare Advantage business to 2.5 million members from under 1 million in 2013 and became Aetna’s president in 2015. Mark Bertolini, Aetna’s CEO during the merger in 2018 (but not Federally approved till September 2019), lost his spot on the board in an apparent spat/downsizing last February.  FierceHealthcare, Healthcare Dive, Fortune

Vodafone UK’s new survey on 5G and Internet of Things (IoT) devices in UK health and social care has been issued. A key finding is the comfort level of some telehealth consults well past 50 percent, and over 60 percent in the 18-34 and 35-54 age groups. There is 60-70+ agreement with Government investment in digital technology to ‘future proof the UK healthcare sector’ and to pay for care homes’ high-quality broadband and mobile. More in Vodafone’s study here.

Healthcare payer Centene Corporation is acquiring healthcare analytics company Apixio. Apixio’s AI platform analyzes large amounts of unstructured patient data in physician notes and medical charts. It then creates algorithms to extract high-quality insights to support payers’ and providers’ administrative activities. Acquisition cost is not disclosed and close is expected by end of year. It will be an ‘operationally independent entity’ in an Enterprise group, but complement other in-house technologies such as Interpreta. A bit of catch up here as larger plans Anthem, UnitedHealth/Optum, and Humana all have either substantial in-house AI analytics or have contracted with outside vendors (e.g. Microsoft) for this capability. Release. (Disclosure: This Editor was formerly with Centene, via their WellCare Health Plans acquisition)

Doro Mobile UK and Ireland is introducing ‘Response by Doro’, a touch button service to summon help if needed. The alert button is on the back of the phone versus on the screen, which differs it from most mobile systems. The standard level connects to family and friends, with the Response Premium level connecting to a 24/7 service. For BT Mobile and EE mobile customers with a Doro mobile phone, their first month’s access to Response Premium is free. Release (PDF)

Is the NHS ready to adopt telemedicine through and through–and is telemedicine ready?

This analysis by Dominic Tyer in Pharmaphorum discusses the rapid adoption of telehealth during the COVID pandemic, both telephonic and online, to keep people in touch with their doctors. Health Secretary Matt Hancock quantified the changes wrought as “I’ve lost count of the number of times someone said to me: ‘what would have taken months took minutes’.” The article goes on to quote him as saying that COVID-19 has “catalysed deep structural shifts in healthcare that were already underway”, citing as examples data-driven decision-making, working as a system, and telemedicine. In fact, to Secretary Hancock, “From now on, all consultations should be teleconsultations unless there’s a clinical reason not to.”

For all the advances, Mr. Tyer points out flaws such as safeguarding sensitive health issues, particularly for young people, use by rare disease patients and those with a genetic condition, and reaching the 10 percent of the population who do not use the internet. All of these are significant. He concludes that “in the UK there’s clearly the political will and healthcare backing for wider use of telemedicine by the NHS, despite some, as-yet not entirely resolved, technological and safety issues.”

Will the UK revert to ‘underuse’, as the US has rolled back as well as practices have reopened? (What is ‘underuse’ defined as anyway?) Will these issues be resolved or ignored in a push forward for telehealth? And teleconsultations as a norm, with in-person an exception, is perhaps at this time, and in improving health outcomes, an overreach? Hat tips to Roy Lilley of the nhsManagers.net newsletter and Steve Hards

Will the rise of technology mean the fall of privacy–and what can be done? UK seeks a new National Data Guardian.

Can we have data sharing and interoperability while retaining control by individuals on what they want shared? This keeps surfacing as a concern in the US, UK, Europe, and Australia, especially with COVID testing.

In recent news, last week’s acquisition of Ancestry by Blackstone [TTA 13 August] raised questions in minds other than this Editor’s of how a business model based on the value of genomic data to others is going to serve two masters–investors and its customers who simply want to know their genetic profile and disease predispositions, and may not be clear about or confused about how to limit where their data is going, however de-identified. The consolidation of digital health companies, practices, and payers–Teladoc and Livongo, CVS Health and Aetna, and even Village MD and Walgreens–are also dependent on data. Terms you hear are ‘tracking the patient journey’, ‘improving population health’, and a Big ’80s term, ‘synergy’. This does not include all the platforms that are solely about the data and making it more available in the healthcare universe.

A recent HIMSS virtual session, reported in Healthcare Finance, addressed the issue in a soft and jargony way which is easy to dismiss. From one of the five panelists:  

Dr. Alex Cahana, chief medical officer at ConsenSys Health.”And so if we are in essence our data, then any third party that takes that data – with a partial or even complete agreement of consent from my end, and uses it, abuses it or loses it – takes actually a piece of me as a human.”

Dignity-Preserving Technology: Addressing Global Health Disparities in Vulnerable Populations

But then when you dig into it and the further comments, it’s absolutely true. Most data sharing, most of the time, is helpful. Not having to keep track of everything on paper, or being able to store your data digitally, or your primary care practice or radiologist having it and interpretation accessible, makes life easier. The average person tends to block the possibility of misuse, except if it turns around and bites us. So what is the solution? Quite a bit of this discussion was about improving “literacy” which is a Catch-22 of vulnerability– ‘lacking skill and ability’ to understand how their data is being used versus ‘the system’ actually creating these vulnerable populations. But when the priority, from the government on to private payers, is ‘value-based care’ and saving money, how does this prevent ‘nefarious use’ of sharing data and identifying de-identified data for which you, the vulnerable, have given consent, to that end? 

It’s exhausting. Why avoid the problem in the first place? Having observed the uses and misuses of genomics data, this Editor will harp on again that we should have a Genomic Data Bill of Rights [TTA 29 Aug 18] for consumers to be fully transparent on where their data is going, how it is being used, and to easily keep their data private without jumping through a ridiculous number of hoops. This could be expandable to all health data. While I’d prefer this to be enforced by private entities, I don’t see it having a chance. In the US, we have HIPAA which is enforced by HHS’ Office of Civil Rights (OCR), which also watchdogs and fines for internal data breaches. Data privacy is also a problem of international scope, what with data hacking coming from state-sponsored entities in China and North Korea, as well as Eastern European pirates.

Thus it is encouraging that the UK’s Department of Health and Social Care is seeking a new national data guardian (NDG) to figure out how to safeguard patient data, based on the December 2018 Act. This replaces Dame Fiona Caldicott who was the first NDG starting in 2014 well before the Act. The specs for the job in Public Appointments are here. You’ll be paid £45,000 per annum, for a 2-3 day per week, primarily working remote with some travel to Leeds and London. (But if you’d like it, apply quickly–it closes 3 Sept!). It’s not full time, which is slightly dismaying given the situation’s growing importance. The HealthcareITNews article has a HIMSS interview video with Dame Fiona discussing the role of trust in this process starting with the clinician, and why the Care.data program was scrapped. Of related interest is Public Health England’s inter-mortem of lessons learned in data management from COVID-19, while reportedly Secretary Matt Hancock is replacing it with a new agency with a sole focus on health protection from pandemics. Hmmmmm…..HealthcareITNews.

Propel@YH digital health accelerator open now for applications to 24 September (UK)

The Yorkshire & Humber AHSN (Academic Health Science Networks) returns for a second year with Propel@YH, their regional digital health accelerator program.

We will cut to the chase and the key dates

Applications Open – Thursday 6th Aug 09:00
Webinar – 2nd September 13:00 GMT
Applications Close – Thursday 24th September 23:59
Assessment Starts – Monday 28th September
Assessment day – Friday 9th October
Cohort Launch – Friday 16th October
Programme commences – Monday 26th October

While Propel is regional, the program’s objective is to attract global applicants who are interested in solutions for the Yorkshire & Humber area. Backing it is the University of Leeds and the Leeds City Council. The accelerator will provide advisory, guidance, and supportive services, enabling digital health solutions to accelerate their growth and market presence in the longer term. An example is masterclasses on how to build clinical safety cases, develop evidence-based proposals, and understanding procurement in the NHS.

What companies accepted for the 2020 cohort will engage with:

  • How the NHS works – an introduction to the health system in England
  • Clinical safety by design – how to design in clinical safety throughout the digital development process
  • Making the grade – how to develop your digital product to meet the requirements of the NHS Digital Tools library
  • Digital by design – how to implement a human-centred design approach to developing digital products and services
  • NASSS Framework assessment clinic
  • Building the evidence base – how to develop a benefits realisation case and generate evidence that really counts
  • Understanding procurement in the NHS – find out from the experts about how procurement works in the NHS
  • Cohort-defined learning clinics

For more information on the program, content providers, partners, and applying–start here. Download application here

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

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!

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