TTA’s Summer’s Here: Done prosecuted on Schedule II teleprescribing, VA extends Oracle Cerner 1 year, Synnovis breach was Qilin ransomware, robot Pepper returns, Change starts notifications, 3 fundings, more!

June 21, 2024 | by

 

 

Lead news this week was the first Federal prosecution on telemedicine prescribing against the leaders of Done. VA extended Oracle Cerner’s EHR implementation for another year. The UK Synnovis hack was ransomware, still affecting London hospitals. Still around Verily gets in on the GLP-1 craze. Pepper the Robot resurfaces in San Diego for mental health. And closing the week, Change/UHG finally getting required data breach notifications out, along with three fundings.

Week-end short takes: Change Healthcare/UHG breach notification starting; fundings for Pomelo Care, Marigold Health, Humata Health (Green funding shoots?)
A lighter update: Pepper the Robot’s comeback at San Diego State University–now AI-equipped for mental health
News roundup: VA extends Oracle Cerner for 11 months; Amwell founders swap jobs; Alphabet’s Verily pivots to Lightpath with GLP-1, retiring Onduo; UnitedHealth hasn’t notified on Change breach
Done CEO, president arrested, charged with $100M fraud on Adderall distribution in first Federal case on telemedicine prescribing (updated) (First of many?)
UK pathology services Synnovis hacked by Qilin ransomwareistes, demand $50M, justify attack due to UK involvement in “wars” (One system, lots of vulnerability)

A week of ‘further developments’. Teladoc replaces its CEO in two months–record time. Waystar finally IPOs after two years. Steward Health gets the DIP bucks at the last minute to continue until it’s sold off. Devices and app systems like Dexcom and Aktiia make significant improvements that improve their marketability. Category consolidations in telemental health and behavioral health risk analytics. And are these the last appeals for Theranos’ Holmes and Balwani?

Short takes: Dexcom G7 now directly connects to Apple Watch, Brightside Health acquires Lionrock, Aktiia CALFREE gains CE Mark for optical BP monitoring not requiring calibration (Further telemental consolidation and digital health device upgrades)
Oracle’s Q4/FY 23 earnings push Cerner to background, stock price soars on AI deals; 81% of VA clinicals really can’t stand Cerner (Can this EHR be saved?)
News roundup: Teladoc’s new CEO from major payer, Steward Health lives with $250M injection, Waystar’s IPO raises $968M, NeuroFlow acquires Owl (A record time for CEO replacement)
Theranos’ Holmes and Balwani appeal fraud convictions, $450M investor restitution (One last try on appeal?)

NHS England made a lot of not-good news this week, with ‘serious harm’ linked to their multiple EPRs and by midweek, a third-party vendor ransomware attack crashing pathology systems in London hospital trusts. Theranos’ Elizabeth Holmes’ defense in court next week for appeal. Steward Health running out of operating money while being sold off in Federal Bankruptcy Court. Ascension breach scares health execs, but 1/3 don’t have contingency plans especially for vendor hacks. On the sunny side–some strong fundings for Eko, Sword, and Plenful.

Short takes: Holmes legal team appealing Tuesday 11 June; Steward Health asset sale OK’d, needs funding; fundings for Sword Health, Eko Health (Them’s that got, has $)
Breaking: multiple London hospitals, borough GPs declare ‘critical incident’ from ransomware attack via third party pathology vendor (Who’s responsible?)
News roundup: Change responsible for data breach notices; 37% of healthcare orgs have no cybersec contingency plan; health execs scared by Ascension breach; CVS continues betting on health services; Plenful’s $17M Series A
NHS electronic patient records linked to 100 ‘serious harm’ issues, with ~50% of NHS England trusts reporting patient issues: BBC News (Many fixes needed here before AI arrives)

This was a big post-holiday week, with Veradigm’s surprising bid for a buyer or ‘strategic alternatives’, a $1B Waystar IPO at last, a $34 million digital therapeutics merger, and an over-the-top Oracle response to last week’s Business Insider article. Clover markets Counterpart Assistant SaaS to other payers, CVS looks for an Oak Street investor, 23andMe looks to go private. Fundings for Wanda Health (UK) and Australia’s Updoc. And Done Health guests on Perspectives.

Short takes: Virtual Therapeutics, Akili in $34M merger; why health clinics are struggling; Dollar General, DocGo call it quits; Clover Assistant AI debuts; fundings for Wanda Health (UK), Updoc (AU); Telstra buys out Fred IT (AU)
Oracle’s Glueck kicks back hard at Business Insider’s ‘deadly gamble’ article, Epic’s Faulkner (A response written at maximum seethe)
Perspectives: How Collaborative Care Combats Physician Burnout (From Done Telehealth)
News roundup: Waystar $1B IPO is on (updated); CVS looking for Oak Street PE partner; 23andMe net loss doubles to $667M, may go private; Otsuka dives into digital therapeutics; HoneyNaps’ $12M no snooze (A big IPO after a year)
Breaking news: Veradigm may sell, merge, or seek ‘strategic alternatives’; appoints new interim CEO effective June (updated) (Parts worth more than whole?)

A light news week before the US Memorial Day remembrance and the UK Bank Holiday, the unofficial kickoffs to summer. What’s hot: Larry Ellison’s gamble on Cerner–are he and Oracle losing big after three years at the gaming table? Walgreens cashes in its Cencora chips, Walmart Health workers’ chips are cashed out, Change looks for chips that aren’t hacked, while Cue Health finally runs out of them. But in the chips: Expressable, Centivo, Transcarent. 

Short takes: Cue Health shuts, Walmart Health lays off, Walgreens sells $400M share in Cencora, $26M Series B for Expressable
News roundup: 100+ medical orgs pile on Change/UHG; Teladoc hit with second class-action suit; Congress demands Oracle EHR improvement–or else; Transcarent intros WayFinding; Centivo buys Eden Health 
Must read: Oracle’s ‘deadly gamble’ on Cerner (new with audio file!) (Can Ellison win at  healthcare’s poker table? And listen to this Editor’s first reading, with a few audio-only extras.)

A TON of news this week breaking before the US Memorial Day and UK’s bank holiday. Boots up for sale breaking up Alliance. Oracle Health will be struggling for the next two years. Cue Health sinking. Legrand is acquiring Enovation, Samsung Sonio ultrasound, and LG jumps into home health. And big VC Venrock issues its predictions for the health tech year.

Short takes 2: Humana’s CEO changeover; Owlet Dream Sock CE Mark, UK approval; TytoCare goes to school; LG enters home health with Primefocus; Samsung $92M buys Sonio (FR); raises by Blackwell in health cybersec, Watershed Health
News roundup: GE Healthcare warns on ultrasound vulnerabilities, Geisinger leverages Best Buy/Geek Squad for RPM, telehealth aids NYC shelter homeless, Fay raises $25M, ClearDATA’s AWS distinction, Validic’s MedTech award
A ‘healthcare prognosis’–from an investor POV (Venrock and ‘smart friends’)
Short takes: Legrand acquires Enovation, FDA nixes Cue Health’s Covid tests, Ascension confirms ransomware attack–who did it? (updated), beware of ‘vishing’ courtesy of ChatGPT
Is Oracle Health’s Big Vision smacking into the wall of Healthcare Reality? Their business says so. (Always be wary of Transformation Promises)
Separation or sale? WBA putting Boots out for bids; Walgreens pharmacists end month-long HQ protest. (End of Pessina’s Big Vision?)

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UK pathology services Synnovis hacked by Qilin ransomwareistes, demand $50M, justify attack due to UK involvement in “wars”

June 19, 2024 | by

Pathology services provider Synnovis ransomwared, services continue to be disrupted. The Bloomberg report states that the Russia-based ransomware group Qilin is demanding a $50 million payment, in exchange for a code to unlock affected computers and software, which is the usual M.O. The ‘or else’ is that the hackers will post online the patient data stolen in the attack, according to a ‘spokesman’ quoted by Bloomberg, using a messaging account associated with the Qilin gang. FTA:

  • “A representative for the hackers said that they were very sorry for the people who suffered, but refused to accept responsibility for the human cost.”
  • Qilin is no longer in contact with Synnovis since the ransom wasn’t paid within their 120-hour deadline
  • The vulnerability to gain access to the Synnovis computers/software was not disclosed, but is known as a “zero day”. This could not be independently verified by Bloomberg.

Synnovis partners in pathology services with two London-based hospital trusts, King’s College Hospital, Guy’s and St Thomas’, including the Royal Brompton and the Evelina London Children’s Hospital. GP services affected are in the boroughs of Bexley, Greenwich, Lewisham, Bromley, Southwark and Lambeth. The incident started on 3 June and was announced 4 June. This affected patient tests such as blood, bowel and various swabs that are routine and needed in EDs and surgeries, causing mass reschedulings and diversion of services. TTA 5 June

Procedures continue to be disrupted according to Synnovis’ own Monday update.“We have delivered temporary workarounds including the redirection of non-urgent blood tests and result processing to other pathology labs to allow us to focus on urgent samples received from GPs, to ensure there is sufficient capacity for urgent testing and to respond to the highest priority cases at St Thomas’ Hospital and King’s College Hospital. Changes to processing of testing and results are being communicated directly to GPs and other service users to ensure a smooth transition.” Their analyzers are back online. There is no timetable for full restoration of services.

Synnovis states that they are continuing to work with law enforcement and the UK Information Commissioner, as well as the National Cyber Security Centre (NCSC) and NHS England’s (NHSE) Cyber Operations Team. This story will be updated with further developments.

NHS electronic patient records linked to 100 ‘serious harm’ issues, with ~50% of NHS England trusts reporting patient issues: BBC News

June 4, 2024 | by

EHR harm is not exclusive to the VA, or the US. An investigation published last week by BBC News uncovered problems with IT systems used by NHS England regional trusts to manage patient records. Through a Freedom of Information (FOI) request, it uncovered multiple problems with Electronic Patient Record (EPR) systems that could affect patient care or lead to potential harm. Their investigation found that “IT system failures have been linked to the deaths of three patients and more than 100 instances of serious harm at NHS hospital trusts in England.”

The NHS has spent £900 million over the past two years in pushing trusts to procure EPR systems and to go entirely paperless. The original deadline of end of 2024 has long since been modified to 2026.

Currently, each trust manages its own IT adoption. Teaching hospitals are at the top with the best IT, whether EPRs or operational and clinical systems. Acute care hospitals come next with current systems and infrastructure. The trusts also commission and pay for community and mental health organizations plus general practitioners. They tend to be at the end of the technology chain, without data centers but maybe a computer room. There are lots of variations between trusts, plenty of custom systems, and paper. And as in the US, systems were not necessarily interoperable. (Background courtesy of Rackspace)

The NHS published last November that 90%, or 189, trusts had contracted for and adopted EPRs. EPRs adopted by the trusts include Oracle Cerner, Epic, Meditech, and Dedalus Orbis (replacing the ancient Lorenzo).

What the BBC found through the FOI:

  • 89 trusts confirmed they monitored and logged instances when patients could be harmed as a result of problems with their Electronic Patient Record (EPR) systems. Almost half recorded instances of potential patient harm linked to their systems.
  • Nearly 60 trusts reported IT problems that could affect patient care.
  • There were 126 instances of serious harm linked to IT issues across 31 trusts
  • There were three deaths across two trusts related to EPR problems
  • At the County Durham and Darlington NHS Foundation Trust, more than 2,000 incidents of potential patient harm and three other serious incidents were connected to their new Cerner EPR

Additionally, hundreds of thousands of medical letters went unsent to patients. From the FOI, 200,000 letters were not sent across 21 trusts. Last September, a separate BBC investigation found that 24,000 letters from Newcastle hospitals had not been sent from their EPR system, with more than 400,000 letters lost in computer systems at hospitals in Nottingham.

Separate from the FOI, the BBC report goes into two of the deaths relating to EPR lost information.

  • At Sheffield Teaching Hospitals Trust, a sickle cell anemia and cerebral palsy patient, Darnell Smith, aged 22, was admitted to the Royal Hallamshire Hospital with cold like symptoms in November 2022. His personal care plan was not easily visible in the hospital’s computerized records. He didn’t get the hourly checks he needed for heart rate, blood pressure and temperature. After the records were found, Mr. Smith was then moved to critical care, put on a ventilator the next morning, and died from pneumonia two weeks later. The coroner in this case warned of a “real risk of further deaths” if care teams couldn’t access needed medical information.
  • At University Hospital of North Durham, Emily Harkleroad collapsed and was taken to A&E, where a pulmonary embolism was diagnosed. However, due to errors in the newly installed Cerner EPR, she didn’t receive the blood thinners she needed and died the morning after admission. The coroner found that the EPR did not clearly identify which patients were the most critically ill and needed to be prioritized, a complaint that clinicians at the hospital had previously expressed.  

Clinicians who came forward to the BBC pointed to EPRs making critical information difficult or impossible to find–it could be “buried anywhere”, creating medication errors, and “incorrect patient details on theatre (sic) lists, incorrect operations listed, incorrect allergy status”. 

Professor Joe McDonald, a former NHS clinical leader, dubbed the current rollout of EPRs across trusts “a broken jigsaw” because very few are interoperable. His conclusion: “There is undoubtedly a culture of cover-up in the NHS and nowhere is that stronger than in the health IT sector. It’s not safe. It’s really not safe.”

BBC News also included a response from Professor Erika Denton, national medical director for transformation at NHS England. She stated that EPRs represent an improvement over paper and patchwork systems and have been shown to improve safety and care for patients. “However, like any system, it’s essential that they are introduced and operated to high standards, and NHS England is working closely with trusts to review any concerns raised and provide additional support and guidance on the safe use of their systems where required.”  Also Daily Mail and Yahoo News Canada (reprint of the BBC News article if blocked).

Published: NHS guidance on integrating TEC providers into urgent community response (UCR) (UK)

January 23, 2024 | by

Filling a ‘donut hole’ gap between technology-enabled care (TEC) and emergency response by using urgent community response (UCR) organizations. A just-published NHS guidance document developed in partnership with the TSA (Technology Services Association) is designed to provide guidelines for how TEC providers can utilize local UCR organizations in situations that typically now are answered by emergency ambulance services. According to the report, ambulance services receive around 2,600 daily calls from over 200 TEC providers, approximately 3% of all calls. What if UCRs can effectively supplement this, providing timely response to these call, treating people safely at home, and reducing demand on emergency ambulance services?

The guidance provides five “Gold Standard” indicators on whether TEC providers are ready for using UCR as an option versus referring to the local ambulance service, and clear standards for operating the TEC-UCR pathway:

1. There are direct referral routes in place from locally operating [TSA] Quality Standards Framework (QSF*)-certified TEC responder services into the UCR service, which don’t rely on clinician-to-clinician referral. (*TSA’s QSF is a United Kingdom Accreditation Service (UKAS) accredited scheme for TEC providers which aligns with the standards of a regulated service.)

2. Only activity which is inappropriate for UCR response is directed to 999, with responsibility being maintained by the TEC provider until this transfer of care occurs.

3. The UCR service has open lines of communication into its locally operating QSF-certified TEC responder services, which limit the amount of rejected referrals due to capacity limitations.

4. Training on appropriate referral reasons is available to local QSF-certified TEC responder services, with the UCR service having an ‘accept all’ approach to referrals from providers who’ve completed this training.

5. Induction and refresher training for TEC to UCR pathway is co-designed and co-delivered frequently, with at least quarterly plan-do-study-act (PDSA) approaches to understand the reason for and mitigate against future rejected referrals.

For those unfamiliar with the organization of TECs in the UK, TECs can be commissioned by local governmental authorities (e.g. borough or county councils) but some are private. Some TECs are local/regional, while other providers are national.

An idea of how TEC providers can work with both UCRs and ambulance services is in Dudley in the West Midlands near Birmingham. A gauge of the volume of calls to the local ambulance service was in a six-month audit (October 2020 – April 2021) of the North West Ambulance Service. It showed that of the 3,000 calls from telecare services to the service, 32% (959) required conveyance to ED, but 45% (1,347) were seen and treated and 23% (694) ‘hear and treat’ disposition (referred elsewhere), or closed by the emergency operations centre. Once implemented, the collaboration between Dudley Telecare and local UCR teams saw the number of ambulance callouts for injured fallers reduced by 85% within a month, with response within 45 minutes. In Warrington, between Liverpool and Manchester, the 24/7 UCR service reduced pressure on ambulance services while responding in less than 60 minutes. Outcomes are positive with 80% of people remaining at home following a visit.

The guidance includes information on requirements and best practices on how to map the pathway, developing a project team, implementation, measurement, and continual reviews. TSA Voice release; NHS Guidance: web page, PDF.  Hat tip to TSA’s post on LinkedIn

Short takes: Oracle Cerner still has major hurdles, says VA, Congress; One Medical adds Hackensack Meridian to specialist network, HTA to employer benefits; NHS trialing AI tracking of home behavioral patterns for at-risk patients

November 17, 2023 | by

VA’s All Quiet on the EHR Front doesn’t mean nothing is happening. With the House hard at work with a new speaker, negotiating budget extensions, and generally trying to get work done before the Christmas-New Year recess, the work of subcommittees goes on. Rep. Matt Rosendale (R-Montana), chairman of the House Committee on Veterans’ Affairs’ Subcommittee on Technology Modernization, yesterday (15 Nov) in what was titled “Electronic Health Record Modernization Deep Dive: System Uptime” got an update on the status of Oracle Cerner from Kurt DelBene, the VA’s chief information officer. His testimony wasn’t exactly reassuring. “Overall we still think there’s a ways to go. I don’t want to present the system as all set and ready to go.” In a rare show of bipartisanship, ranking member Rep. Sheila Cherfilus-McCormick, D-Florida, said that “[Oracle] training and change management are still woefully inadequate and user satisfaction is still critically low.” And despite being invited by Chairman Rosendale, Oracle’s Mike Sicilia didn’t show up or send regrets, which made Rep. Cherfilus-McCormick a little livid. FedScoop  HISTalk in its recap also pointed out that Rep.Rosendale “cited a report saying that it will take Oracle Health 15 more years to match VistA’s functionality. [VA deputy CIO Laura Prietula] responded that she doesn’t think it will take that long.” Oracle Cerner, in the few VA locations where it is operative, has not had a complete system outage in six months. Hearing and 1 hour 46 min. video (YouTube), hearing documents

Amazon continues to build out One Medical to, perhaps, ubiquity. On the East Coast, Amazon’s One Medical adds a major New Jersey health system relationship, Hackensack Meridian Health. Like its newly inked relationship with CommonSpirit Health, it will add integrated specialty providers to One Medical’s primary care focus. Specific locations based on patient needs are not specified yet nor financials. Implementation timing is unusually long–by the end of 2024. On a faster track may be One Medical’s deal with Health Transformation Alliance (HTA), a consortium of large US employers comprising 67 employers including Coca-Cola, Intel, Boeing, and many others totaling nearly 5 million employees. Timing and financials were not disclosed. This adds to One Medical’s current contracts with 8,500 companies that offer its primary care services as an employee health benefit. Becker’s, FierceHealthcare

NHS experiments with predictive health indicators and AI modeling for at-risk patients to prevent unnecessary admissions. Four GP practices in Somerset will be using an AI system that will flag registered patients who have complex health needs first, and are most at risk of hospital admission or who rarely contact their GP. Monitored in Buckinghamshire, the most interesting part of this is that the AI is linked to electronic sensors on kettles and fridges that spot changes in Somerset patients’ eating and drinking habits, obviously as an indicator of changes in health. (Does this remind anyone of 3rings or QuietCare?) Changes are reported to an Onward Care team of health coaches, nurses, and GPs who speak to patients and ask about any health or living issues. They can provide, based on patient input, deliveries of food parcels, arranging for cleaning or shopping services, home alterations to help to avoid falls, or to link them up with local voluntary groups to reconnect them with community resources or simply to help avoid loneliness. Clinical care can also be scheduled including specialist care. The NHS reports that GP practices can use this system to solve 95% of their issues or escalate anything clinical. Why this is important: hard winter and isolation, even with the holidays, loom after an autumn of wild weather and the persistent shortage of hospital beds and GP capacity/timeliness of appointments.  DigitalHealth.net

Weekend reading: new study finds lack of GP and healthcare access driving 55% of UK patients to online/apps, desire for prescribed apps

October 27, 2023 | by | 1 Comment

A new 26-page study from Swiss ‘innovation service provider’ Zühlke found that 55% of UK adults in the past six months have self-diagnosed their health problems online or with an app, versus seeing a medical professional. Driving it is lack of access, reported by 43% of UK adults in Zühlke’s 1,000-person May sample.

App and online use for self-diagnosis peaks among those 30-39 (72% strongly/somewhat agree), with 67% 18-29 and 65% 40-49, dropping off sharply in the two oldest age groups. The fairly consistent positivity of the 30-39 age group versus the 18-29 group is surprising to this Editor.

According to the study, UK adults are also reaching out to the NHS to vet apps in higher numbers. 49% strongly agree/agree, with the remainder rather lukewarm. in four descending neutral to strongly disagree categories. But by age, those who feel comfortable with healthcare providers prescribing apps range from 41% in the 60+ cohort to 58% in the 30-39% group. The increased acceptability apparently has been driven by the Covid-19 experience with remote health.

55% also feel comfortable with a prescribed app to monitor mental health, with the same strength (69%) in the 30-39 group.

The study also covers price tolerances for paid health apps, with 25% in the 30-39 group willing to pay over £20 monthly for an app, and preferred types of conditions to be managed with an app. The NHS is far and away the #1 preferred provider for prescribed health apps. Full study (link to PDF), press release

CMA clears £1.2B EMIS acquisition by UnitedHealth Group’s Optum (UK)

October 2, 2023 | by

It took a year, but it’s approved. The Competition and Markets Authority (CMA), the UK agency tasked with approving acquisitions, approved the acquisition of UK healthcare tech systems developer EMIS by UnitedHealth Group (UHG)’s Optum. The actual acquisition will be made by Bordeaux UK Holdings II, a UK Optum unit. 

The £1.2 billion bid for the private company was made in June 2022. In March 2023, CMA moved its review to an independent group for a Phase 2 review due to EMIS’ engagement with the NHS. The Phase 2 review determined that the acquisition by Optum did not raise competitive concerns. Optum is currently a supplier to NHS and GP practices in pharmacy prescription, advisory services, and data analytics. The acquisition of the EMIS system was found to not effectively restrict other entities’ access to data or population health services, and that any restriction could be regulated by the NHS to prevent its use by Optum as a business strategy. Further discussion is presented in the CMA release.

EMIS is the leading EHR system used by NHS GPs throughout the UK. EMIS also has systems for business intelligence, pharmacy, EDs and urgent care, and to identify patients for clinical trials. 

This final approval indicates that the acquisition will close before the end of this year.  Becker’s Payer, CMA release, Medical Buyer (India), Reuters

Babylon Health UK operations on fire sale–buyers to be announced Friday 25 August (updated)

August 23, 2023 | by

Quickly and softly, softly, Babylon Health’s UK operations are being sold. The sale will include the proprietary tech stack. If you planned to bid, the deadline passed on Monday 21 August. Winning bids will be announced on Friday 25 August at the latest.  Update: As of 29 August, the bidders have not been announced.

The rush is due to the extreme position that Babylon Health’s operations are in. A UK shutdown is likely without a quick sale. Their UK business is with Bupa insurance, a little left with the NHS, some B2B, and GP At Hand/direct to consumer. Business consultancy Alvarez and Marsal are running the sale, presumably as part of the UK receivership.

Bidders, who were invited by letter, may include Bupa, Vitality, tech companies HealthHero and Cera–and even CEO Ali Parsa, which might lead to questions by customers or the court. Kry/Livi stated to press that they were not bidding. Customers Bupa, with a contract to 2025, and the NHS may have a say in the eventual deals.

The proceeds of the sale are projected not to exceed the $300 million debt owed to AlbaCore Capital nor its last $34.5 million tranche. Other debtors and vendors will be left in the proverbial lurch. Sifted.eu, Becker’s

The sale does not include the US operations that are included under the Chapter 7 liquidation which is still in the filing of documents stage. Babylon US, which generated most of Babylon’s revenue, has already shut down. Close to half its business was with Centene entities such as Ambetter and WellCare, which terminated their contracts on 8 August, the day after the collapse of the AlbaCore deal. The only operating part of Babylon is the Meritage Medical Network, a medical practice IPA. Next steps start tomorrow, Thursday 24 August, for documentation of its secured and unsecured debtors and summaries of assets and liabilities. Babylon’s creditors will meet on Tuesday 12 September.

The UK fire sale also does not include Babyl Rwanda, a semi-independent unit that is engaging with the Rwandan government to find a buyer. There is no further information available on other operations in India or other countries. 

Most recent coverage on Babylon in TTA: 23 August, 17 August, 10 August, 8 August

Digital technology falling (even) short(er) in NHS nursing: QNI report (UK)

February 9, 2023 | by | 2 Comments

When health tech ‘magic’–isn’t. Roy Lilley and his several times per week newsletter (NHSManagers.net, subscribe here) are really must reads for our UK readers dealing with the foibles of the NHS and NHS Digital. Billions have been poured into digitization of records and equipping district (community) nurses with laptops and access to apps that connect them to patient information. All of which is apparently, a flop for the money spent. 

The Queen’s Nursing Institute (QNI) has published a study, Nursing in the Digital Age 2023, via its data gathering and analytics area, the International Community Nursing Observatory (ICNO). It obviously should be microscope-read by NHS Digital, but also by US developers (and in other countries) with clinical users. (Oracle Cerner, Epic, and 00’s of EHRs and workflow apps–take notice).

Mr. Lilley outlines the level of failure here–from his article: 

  • 5 yrs ago; 32.7% reported problems with lack of compatibility between different computer systems… in 2022 the figure had risen to 43.1%.
  • 5 yrs ago; around 85% of respondents reported issues with mobile connectivity… in 2022 this figure was around 87%.
  • 5 yrs ago; 29.5% reported problems with device battery life… in 2022 the figure was almost 53%.

The overall take of the QNI study is that nurses are highly digitally literate and embrace technology at scale, but in practice, the apps and the hardware have become impediments as the workload increases. For non-UK readers, district nurses travel a lot, often working from home–akin to home care or rural nurses in the US. Points from their executive summary:

  • Hardware–battery life, weight of laptop, old laptops, ergonomics not only from weight but also when working in cars. Safety and confidentiality issues lead many nurses to take the work home, leading to delays.
  • Software–connectivity, authentication, multiple platforms, little integration, repetition of data entry, and poor connectivity and software design leading to interrupted workflows.
  • Some scheduling tools cause workload issues, such as over-allocation of work, unmanageable workloads and loss of personal autonomy.
  • Systems design–impersonal, designed to act as a barrier to interacting with patients.
  • Duplicative workload–repetition with dual entry on paper and into platforms because of poor connectivity and software design
  • The use of electronic health records (EHR) and similar platforms was mixed in terms of productivity gains and work capture. 

Another issue: “Moving technology-enabled care (remote monitoring) to the community appears to have shifted work from the hospital to the community”, meaning an increased workload on nurses where specialists or non-nursing staff could do this. 

Mr. Lilley summarizes as a service what both the hardware and software should be accomplishing:

Just ten simple things:

  1. Who is the patient,
  2. where have they come from.
  3. See their record, have they been sick before and…
  4. What we did we do?
  5. Anything in their history that’s a red flag?
  6. What do we do to fix them up this time and…
  7. Record how we did it.
  8. Figure out what worked,
  9. What did it cost and…
  10. Do we want to do it again.

Both Mr. Lilley’s newsletter and the study (PDF) are must reads wherever you live. Especially if you are a software designer.

No wonder nurses are single-day rolling striking!

(He also has an interesting take on ChatGPT, AI for copywriting and reporting, which we will take on next week….) Hat tip to Editor Emeritus Steve.

‘KillNet’ Russian hacktivist group targeting US, UK health info in Ukraine revenge: HHS HC3 report

January 18, 2023 | by

Warnings about DDoS (distributed denial of service) ramped up at the end of last year–only three weeks ago. Here’s one reason why. “KillNet” is a pro-Russian hacktivist (hackers who advance a cause) group that recently claimed responsibility for DDoS attacks as payback for US and UK military support of Ukraine. A senior member of KillNet with the nom de guerre Killmilk has threatened the US in general “with the sale of the health and personal data of the American people because of the Ukraine policy of the US Congress”. 

The US Health and Human Services (HHS) Health Sector Cybersecurity Coordination Center (HC3)’s Analyst Note (link to PDF) gave two examples of KillNet claims:

  • A “US-based healthcare organization that supports members of the US military and claimed to possess a large amount of user data from that organization”
  • Hacking threats against the NHS, specifically ventilators in hospitals and the Ministry of Health. This was in reaction to the May 2022 arrest of a 23-year-old alleged KillNet member accused of being connected to attacks on Romanian government websites. KillNet demanded his release in return for not attacking. Daily Mail  

Other institutions are hardly exempt. In the UK, KillNet DDoS attacks in November reportedly affected Bankers Automated Clearing Service (BACS), the London Stock Exchange, and the official website of the Prince of Wales. Computer Weekly

DDoS attacks are their leading weapon. KillNet uses publicly available DDoS scripts and IP stressers for most of its operations although it has its own. Before aligning with Russian state interests, it was a hacking-for-hire operation available for $1,350 per month, including a single botnet with a capacity of 500GB per second and 15 computers. This Editor noted previously that DDoS attacks may be a convenient cover or smokescreen for other cybercrime activity. While IT goes into crisis mode over the DDoS, other attacks and information gathering on systems preparing for future attacks may be taking place. [TTA 22 Dec 22].

This updates an earlier Cybersecurity & Infrastructure Security Agency (CISA) Cybersecurity Advisory (CSA) jointly issued by the US, UK, Australia, and New Zealand (the Five Eyes group), that broadly assessed multiple threats from Russian state organizations such as the Federal Security Service (FSB) and the Foreign Intelligence Service (SVR), as well as cybercrime groups like KillNet which have aligned themselves for the duration with Russia. KillNet has grown over the past year and now has subgroups organized under Cyber Special Forces of the Russian Federation and LEGION 2.0. SOC Radar

The best defense is a good offense. HC3’s advice on preparation to mitigate a DDoS threat includes enabling web application firewalls to mitigate application-level DDoS attacks and implementing a multi-content delivery network (CDN) solution to minimize the threat of DDoS attacks by distributing and balancing web traffic across a network. The HC3 Analyst Note is heavily footnoted with other sources for additional incidents. SC Media, Cybernews

Perspectives: Could the telehealth VIMPRO model save the NHS from drowning in demand?

December 6, 2022 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s Perspectives is from Adam Hunter, CCO at Phlo Connect, an API-driven pharmacy infrastructure platform to deliver enhanced patient and clinician experiences. Phlo Connect integrates with prescribing technologies and digital health platforms used by the NHS and by private healthcare providers, from the initial consult and prescribing, and processes the request through to patient delivery. This article discusses how Vertically Integrated Micro-Providers (VIMPRO) can work in partnership to streamline NHS services using technology and telehealth.

Interested in being a Perspectives contributor? Contact Editor Donna. 

The NHS is in crisis: with staff vacancies currently exceeding 130,000, elective care waiting lists are predicted to exceed 10 million by March 2024, and up to 22,000 appointments are cancelled every single day.

Speaking at a King’s Fund conference in London earlier this month, NHS Chief Executive Amanda Prichard told delegates that demand on national health and care providers is rising so quickly that patients are not always getting the level of care they deserve. Highlighting a projected £7bn NHS budget shortfall, she went on to emphasise that “We’ve got to shift the model of care from one that does late diagnosis and expensive treatment to one that does faster diagnosis, better treatment and better value for the taxpayer in the process.”

Such a model, where all patients can access timely, preventative care without exorbitant cost, is one that every developed national healthcare system aspires to adopt. Navigating the practicalities and finding the capacity for transformation has to date stalled the full realisation of this. However, gathering pace in the past decade has been the VIMPRO model of healthcare delivery, which is increasingly proving to be a successful way of meeting the needs of underserved patient groups and alleviating pressures. At this time of critical need, could this model save struggling public systems from drowning in demand?

The VIMPRO model explained

A Vertically Integrated Micro-Provider (VIMPRO) is a telehealth provider focused on delivering an end-to-end service to a specific patient group. VIMPROs are characterised by excellent user experience and personalised clinician-led care, and are increasingly entering into partnerships with national healthcare providers (including the NHS) to help bridge gaps in service delivery.

One example of a successful existing VIMPRO model operating in partnership with the NHS to meet a previously unmet patient need is Leva Clinic. They are UK leaders in chronic pain management and medical cannabis treatment. The majority of their users pay to use their digital platform, where they access psychology consultations, nurse appointments, physiotherapy advice, prescription and direct-to-door medication delivery.

This is a big step in the right direction towards meeting the needs of the UK’s underserved pain patients, many of whom have spent years with inappropriate support owing to a shortage of pain specialists and lack of personalised treatment options.

Patient and system benefits

From the perspective of NHS leaders, the benefits of the VIMPRO model are multiple. Firstly, they provide an alternative point of access to care for patients who’d otherwise need to be seen by GPs and referred on to NHS consultants. This frees up system capacity and cuts wait times and workloads. Secondly, VIMPROs provide the education and information that their specific patient group needs to manage their condition and improve their outcomes. This reduces the burden of ill health on the NHS further down the line. And thirdly, when VIMPROs are integrated properly with NHS systems, all the information about the patient’s care can be tracked in their electronic record without adding to practitioners’ admin burden. 

The VIMPRO model also offers multiple benefits to patients. Convenience and timeliness of access to healthcare are primary amongst these, as they remove the barriers of geography and waiting lists that obstruct care in the NHS. Patients can be quickly connected to leading specialists and prescribers anywhere in the county, and don’t even have to leave their homes to collect their medication. In addition, accessing remote care through a VIMPRO model means that patients who are reluctant to engage with local services for support – perhaps because of stigma around their condition – are offered an alternative source of care that’s entirely virtual and distinct from other NHS services. Finally, VIMPROs often take on the responsibility of creating education materials and championing the needs of their patient vertical. For example, men’s health VIMPRO Numan hosts a medically-reviewed blog delivering advice on weight management, erectile dysfunction, hair loss, mental health and other under-discussed men’s health issues.

The future of NHS care delivery?

There is no single solution that can fix the problems facing the NHS and other public health systems around the world. Replacing the core of NHS services with a network of VIMPROs is an unrealistic proposition that would be extremely difficult to achieve. However, carefully planned VIMPRO partnerships have already proven to be effective at redirecting patient demand to where it can be successfully dealt with.

If the right streamlined system integration and tailored digital infrastructure is put in place, patients and clinicians can enjoy seamless and convenient experiences. This means no clunky transition between platforms and service providers: from first consultation to the arrival of medication on the doorstep of the patient. 

Global health needs, and our expectations of healthcare, are constantly evolving. Only by constantly evolving the models of care delivery will we be able to keep up, and right now, that means embracing the opportunities of the VIMPRO model and making it work as well as we possibly can.

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

September 9, 2022 | by

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

February 16, 2022 | by

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

February 9, 2022 | by

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

November 12, 2021 | by

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

July 23, 2021 | by

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.