Optum’s Utopia of proactive patient care–without telehealth

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/10/question_mark.jpg” thumb_width=”150″ /]And we wonder why telehealth patient monitoring is floundering and telemedicine is only starting to take off? In this Editor’s reading today, up came this rather glossy, beautifully designed advertorial web page in The Atlantic sponsored by healthcare services provider/holding company Optum. It describes a proactive, highly supportive care process that starts with the diagnosis of a chronic condition (in this case developing CHF) through a ‘health scare’ handled at an urgent care versus a hospital ED, then to care at home (from a highly engaged nurse-practitioner no less) and a patient who, suitably engaged, is “responsibly managing her condition through a wellness approach” and has an improved lifestyle.

Other than an EMR (integrated between provider and urgent care–but EHR is the more current term), no other technology other than telephonic is mentioned in this rosy picture. Where’s the telehealth app that touches our patient, letting her chart her weight, breathing and general wellness, sending it to her EHR and alerting that nurse so she can truly be proactive in seeing changes in her patient’s health? Where’s the telemedicine virtual visit capability, especially if our patient’s out of breath outside of normal office hours, or there’s a blizzard and that nurse can’t visit? Here’s all the infrastructure built up for integrated care, but where’s the technology assistance and savings on home health visits and transportation for the patient?

It can’t be that Optum doesn’t know about what telehealth/telemedicine can do and the role it already plays in care? It can’t be that it doesn’t fit in the integrated care infrastructure? Or does it have to do with reimbursement? (Optum is the parent of giant insurer United HealthcareReaders’ thoughts?

NYeC Digital Health Conference (NYC)–next week

NYeC Digital Health Conference, 6-7 December 2016 | New World Stages, New York, NY
The New York eHealth Collaborative’s Digital Health Conference brings together 500 senior-level healthcare industry leaders to learn about new innovations and to foster dynamic conversation addressing how healthcare is being redefined through technology. It is well on track to fill completely, so if you’ve been delaying your booking, now is the time. And our readers enjoy a 10 percent discount.

Updated and expanded agenda here.

Keynote speakers:
• Robert Wachter, MD, Professor and Interim Chairman of the Department of Medicine, University of California, San Francisco, author of “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age” [TTA 16 Apr 15]. (To this Editor, this is a must-see keynote!)
• Steven Johnson, PBS Host and Bestselling Author, “How We Got To Now” and “Where Good Ideas Come From”

Some other speakers: Carol Raphael, the former CEO of Visiting Nurse Service of NY; Kristopher Smith of Northwell Health; James Mault of Qualcomm Life and Aron Gupta of Quartet Health. This year a who’s who of New York’s healthcare and health tech community will gather for two days of networking, lively intellectual exchange, and exploration to see what’s new, what’s cutting edge and what will shape the future of healthcare.

It’s worth taking the trip to NYC for this right before the holidays! For more information, click here for the website.

Telehealth & Telecare Aware Readers receive a 10% registration discount. Click on this link or the sidebar advert. Important–use code TTA when registering. For updates, @NYeHealth. TTA is a conference partner/media partner of the NYeC DHC.

‘Chief Health Officer’ moms want 24/7 connected health for the family: survey (US)

A just-released survey by Blue Cross Blue Shield of Georgia and telemedicine provider LiveHealth Online indicates a near-total desire for–and ability to access–on-demand, 24/7 healthcare and virtual visits. The key motivations are economic, convenience and educational: 71 percent cited the loss of at least two hours of time at work and school due to taking their child to the doctor’s office.

Given their age (starting at 18 and up to 59), the 500+ moms surveyed not surprisingly felt confident using health technology, with 82 percent believing themselves to be the most ‘health-tech savvy’ in the family.

  • 64 percent stated that having access to healthcare on-demand was more important than having streaming video or food delivery
  • 64 percent (64%) of women surveyed said they found it challenging to take their kids to the doctor during office hours during the school year
  • 79 percent said they would be interested in trying or learning more about telemedicine to help themselves and/or their family when faced with a non-emergency medical issue

Over half–54 percent–believed that online video doctor visits would improve their confidence in attending to family health, “like having a health security blanket”.

The survey apparently did not test for price sensitivity; for instance, per visit fees and amount subsidized by the payer.

It was conducted earlier this year by EmpowHER, an online health community for women. BCBSGa’s interest is that it offers coverage for online visits to many of its health plan members via LiveHealth Online, which uses the American Well network but is a separate company. BCBSGa release, EmpowHER/LiveHealth infographic, Internet Health Management

An interesting adjunct to this survey would have been to ask about ideal healthcare tools used in conjunction with that online doctor visit. This is anticipated to be a major market for advanced ‘all-in-one’ telehealth diagnostic units such as those developed by Tyto Care, Scanadu Scout or MedWand [TTA 2 Nov]. These are not only capable of taking standard vital signs, but also clinical quality digital pictures of those sore throats and inflamed ear canals.

Who’s raising what! Babies to pets!

Our takeoff on ace direct response guru Denny Hatch’s ‘Who’s Mailing What!’ has been slightly modified from ‘getting’ to ‘raising’–we do want to be proper ;-)

  • The first big raise happens to be an Editor favorite due to its high Cute Factor–the Owlet smart sock for monitoring your baby’s oxygen level and heart rate. This latest round is $15 million, bringing their funding to $25 million. Investors included Eclipse Ventures and Eniac Ventures, plus new investors Trilogy Equity Partners, the Amazon Alexa Fund, RTP-HC, Capital Integral and Broadway Angels. Owlet is now the commercialization partner on a $1.5 million grant from the NIH to further infant health research, in addition to an earlier equal grant. Plans include a connected care feature giving users access to their data and the ability to share that data with pediatricians, scheduled for a 2017 release; retail and international distribution; two new product lines and a large infant health study. Finsmes
  • Cohero Health closed a $9 million Series A financing for its BreatheSmart lung function platform, which actively engages respiratory patients by tracking medication adherence and measuring lung function. Funding was led by Three Leaf Ventures, an affiliate of the Broe Group, with participation from Zaffre Investments, the investment arm of Blue Cross Blue Shield of Massachusetts, BioAdvance, and new investors GIS Strategic Ventures, Heitkamp & Thumann Group, and P5 Health Ventures. A StartUp Health company, they develop care connected devices and mobile applications that measure lung function and tracking adherence through the BreatheSmart toolkit. Finsmes, Mobihealthnews
  • PlushCare, a California-based telemedicine (virtual visit) company, had an $8 million Series A raise funded through GGV Capital with participation from Lightspeed Venture Partners and Exponent. Finsmes
  • And even pet health is getting funded. PetCoach, a Pennsylvania-based digital pet healthcare platform, secured $2m in seed funding from Comcast Ventures, in addition to earlier funding from DreamItVentures and Maveron. PetCoach provides an online pet care service combining personal advice and 24/7 access to certified pet professionals. Users can leverage the PetCoach website and the app in order to interact with certified veterinarians. Finsmes

Avizia over-subscribes its Series A by $6 million

Telemedicine startup Avizia announced an unusual bonus on what was thought to be a closed Series A with a $6 million additional investment. There was also an unusual investor–the New York-Presbyterian health system. The add-on was led by HealthQuest Capital. Also reported was an extension of Silicon Valley Bank’s agreement for $3 million in debt financing and a $1.5 million line of credit. In July, the first part of the Series A had $11 million from Blue Heron Capital, HealthQuest Capital and five other investors. Total investment is over $22.7 million. From a start in telemedicine carts using Cisco Telepresence, Avizia developed software and apps for mobile devices, including secure messaging for doctors within hospitals. The new funds will be used to upgrade its engineering capabilities to build new capabilities into its telehealth platform, integration with electronic health records and the ability to monitor the battery life of remote diagnostic devices. Also unusual is that they market in the US, UK and Australia covering 400 health systems, including 1,000 hospitals. MedCityNews, Crunchbase

Using telehealth to improve night-time ICU care

Intensive Care Units treat the most sick people in a hospital and requires round-the-clock staffing by doctors and nurses. 24-hour staffing, however, means shift working and an inevitable night shift. To make it fair on all staff the shifts are usually rotated so any doctor or nurse would do a period on one shift and then move to the next shift.

It is not surprising that the more senior staff manage to have less night work than newer, less experienced ones. On the other hand night shifts may have attractions such as extra pay and this may be more important to the lower paid less experienced staff than to the higher paid senior ones. Also, the cost of staffing nights with less experienced staff may prove cheaper for the hospital. Nevertheless, the patients’ needs are no less important at night than during the day. Another aspect of night-time care is the possibility that a doctor or nurse may not be as alert at night as they would be in the day-time.

Looking at these downsides of night-time ICU care staffing, an hospital in the US has come up with a novel idea – move the doctors and nurses to a zone where it is day-time when it is night-time at the hospital and use telehealth to connect them. This is counter intuitive and has its own drawbacks.

Georgia’s largest healthcare provider Emory Healthcare is sending some ICU doctors and nurses to Sydney, Australia, for tours of six to nine weeks at a time, in a trial to staff ICU at night with health staff in a daylight zone using telehealth. The six month trial in collaboration with Philips and Australia’s Maquarie Health has been underway for 3 months.

The reason this is counter-intuitive is that telehealth was invented to overcome the problems associated with healthcare professionals and patients not being at the same location and here the two are being artificially removed to two ends of the world. While telehealth is a good solution to the diagnosis and treatment from afar, most professionals are likey to agree that it is inferior to being face to face with the patient. So it will be good to see the conclusions reached by this trial on how any drawbacks of distance balances out with having more alert doctors and nurses.

See also mHealth Intelligence article here.

eTELEMED/MATH 2017: call for contributions deadline extended

19-23 March 2017,  Nice, France

eTELEMED, the Ninth International Conference on eHealth, Telemedicine, and Social Medicine, and the co-located MATH (Mobile and Assistive Technology for Healthcare), are both calling for submissions of original scientific results. These contributions and presentations can take any one of these forms:

Contributions:
– regular papers [in the proceedings, digital library] – short papers (work in progress) [in the proceedings, digital library] – ideas: two pages [in the proceedings, digital library] – extended abstracts: two pages [in the proceedings, digital library] – posters: two pages [in the proceedings, digital library] – posters: slide only [slide-deck posted at www.iaria.org] – presentations: slide only [slide-deck posted at www.iaria.org] – demos: two pages [posted at www.iaria.org] – doctoral forum submissions: [in the proceedings, digital library]

Proposals for:
– mini symposia: see http://www.iaria.org/symposium.html
– workshops: see http://www.iaria.org/workshop.html
– tutorials: [slide-deck posed on www.iaria.org] – panels: [slide-deck posed on www.iaria.org]

Submission deadline is 19 November. The general information pages have more information on the conference tracks and topics. Links:  eTELEMED: General information, submission page; MATH: General information, submission page

The cybersecurity black hole–and bad flashback–that is the Internet of Things

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/10/blackhole_596.jpg” thumb_width=”150″ /]One week after the Dyn DDoS attack, the post-mortems get more alarming. Our Readers knew they were coming in 2014-2015 (our ‘Is IoT really necessary–and dangerous?)

IoT devices, and a lot of older networked medical devices, have been proven to be easy to hack, as even this non-ITer, non-codegeek realized then. But those in tech have been to this movie before–with Bluetooth circa 2002! Now shouldn’t designers have learned? From ZDNet:

“It’s almost like we’ve learned nothing from Bluetooth” says Justin Dolly, CISO at cybersecurity firm Malwarebytes.

“Seeing what these IoT vendors are doing, it just blows me away because they haven’t learned from history,” says Steve Manzuik, director of security research at Duo Security’s Duo Labs. “They’ve completely ignored everything that’s ever had bad vulnerabilities”.

Many of these devices, according to these experts, have default log in credentials, if they have them at all. IoT devices are also allegedly findable on a snoop site called Shodan. Reason why: the financial and market need to get products out fast and cheaply.

Over at data security company Varonis’ blog, with the great title in part, “Revenge of the Internet of Things”, another succinct and telling quote:

Once upon a time in early 2016, we were talking with pen tester Ken Munro about the security of IoT gadgetry — everything from wireless doorbells to coffee makers and other household appliances. I remember his answer when I asked about basic security in these devices. His reply: “You’re making a big step there, which is assuming that the manufacturer gave any thought to an attack from a hacker at all.”

Privacy by Design is not part of the vocabulary of the makers of these IoT gadgets

Varonis also gives a how-to on changing settings in your router so you don’t become a victim, and how to secure your gadgets.

Bottom line: when Hackermania is Running Wild, do you, or anyone, really need to be an early adopter of an internet- connected coffee maker or fridge? And if you need internet-connected home security, telemedicine virtual consults, telehealth/remote patient monitoring or telecare….best heed Varonis and secure it!

Earlier in TTA: Friday’s cyberattack is a shot-over-bow for healthcare 

Zimmer Biomet acquires telehealth company RespondWell

Orthopedic device maker Zimmer Biomet today (27 Oct) announced the acquisition of St Louis-based telerehabilitation + telehealth company RespondWell. RespondWell provides several facets of post-surgical physical therapy: telerehabilitation with clinically prescribed exercise routines, virtual doctor-patient consults, tablet-based personalized care plan delivery and data collection/RPM, and ‘gamified’ patient engagement tools. Up to the acquisition, according to Xconomy, RespondWell had raised $2 million from investors and had been seeking another raise of $8 million. Zimmer’s purchase price was not disclosed, but the changeover was swift, with the RespondWell website already copyrighted and top-bar tagged with Zimmer’s information.

Based on the release, RespondWell will be integrated into Zimmer Biomet Signature Solutions, using the brands Therapy@Home and presumably their original Fitness@Home. RespondWell’s former CEO Ted Spooner has been named VP of Connected Health at Zimmer Biomet; in his interview with MedCityNews, he was pleased at the exit and the acquisition by a company which wants to scale his solution.

Signature Solutions was formed from related Zimmer programs a few months ago as essentially a specialized value-based care consultancy and service provider. The combination of the two–VBC consultancy integrating with a health tech service provider–appears to be a nascent trend–and perhaps finally a path for telehealth providers. Hat tip to reader David Lee Scher MD via Twitter

Breaking news – an NHS innovation failure

As a sad indication of the NHS’s – and the UK health & care system in general’s – inability to innovate, v-connect, previously known as Red Embedded, has made the following announcement:

“It is with great regret that we are discontinuing the v-connect service as of the 31st October 2016. I am sure that the reasons will be understandable to you but here is a short summary. The video technology has been in development for more than eleven years. The efforts to commercialise the technology, in care, have been in progress for more than seven. In that time we have developed many features that support people to live independently at home supported by a personalised set of connections and facilities matched to their needs. We were guided by the continual calls for integrated care, personalisation and care closer to  home. We have been somewhat successful in obtaining project and grant funding to facilitate this. (more…)

Telehealth in China: the largest market of them all?

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/10/HC_Bulletin_F14_bigdata_china_feature.jpg” thumb_width=”250″ /]Is China ready for telehealth, and the needed investment? It turns out that according to this article, the market does strongly resemble Western, Latin America and APAC countries in its needs and aging, dispersed population. The numbers (left) say yes. The market divides into three for the writer:

  1. A supplement to the public community care system, which has motivated most of the interest the Chinese government has in telehealth to care for millions (defined in the article as patient-doctor video consults, but doesn’t appear to exclude remote patient vital signs monitoring) as well as EHRs, scheduling, online access to diagnostic test results, and e-prescribing.
  2. Rural health care, not as unique as the writer seems to believe. Virtual consults and telehealth are used, and paid for, by CMS in US rural areas and on Native American reservations by the Indian Health Service. We also wrote about it in Brazil [TTA 27 Feb].
  3. Second opinions by Western physicians desired by high net worth individuals and upper middle class families. Again, not that unusual as this resembles the health tourism practiced by the affluent in Latin America and the adoption of video consults. This is denoted as the narrowest and chanciest of the three markets.

Chinese patients in (1) and (2), for the most part, would see any of these as an improvement. Their experience is that they get little time with a physician, don’t have a personal relationship with one or more doctors, and don’t expect much of a personal relationship with their doctor. So telehealth and RPM would be huge upgrades for China.  From Healthintelasia. Illustration from Analysis Group

TSA’s 2016 International Technology Enabled Care Conference (UK)

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/09/TSA-logo-400×400.jpg” thumb_width=”100″ /]18-19 October, the ICC Birmingham

A reminder than in a few short weeks the annual International Technology Enabled Care Conference will take place at the International Convention Centre in Birmingham, hosting UK organizations across health, housing, home care, social care, industry and more.

The event will focus on TEC with the theme ‘Connected Care, Connected Homes and Connected Communities’, and feature a packed programme with, as they put it, “challenging debates, thought-provoking presentations, interactive workshops and brand new interactive zones to inspire, inform and drive forward sector collaboration.” The draft programme is here. Find out more at the conference’s home page and register at the full website here.  There are also a few exhibition booth stands and sponsorships left, looking at the interactive floor map, so your company may want to check here as well.

If you are a Reader and attending, please feel free to send Editor Donna your thoughts for publication on where the industry is going and what is it doing. (Please indicate if it is for attribution under your name or a nom de plume)

TTA’s Friday roundup of interesting articles, updates and weekend reads

Fitbit may succeed in blocking Jawbone from selling in US? The Jawbone wins [TTA 27 July] in the US International Trade Commission court was apparently reversed due to a judge’s error for two Fitbit patents, and this may open the way for Fitbit to further block Jawbone. An additional California court action on infringement and misappropriation on trade secrets by Jawbone is headed for court in 2017. Mobihealthnews…..Maybe texting is enough? Dr Joseph Kvedar seems to think so for simple medication adherence and reminders, with reasons like the easy scaling of text messaging in EHRs, but prefers installing an app to deliver them due to the downsides of plain text messaging such as HIPAA and security. Thus we return to the logic of the desktop unit days (e.g. Health Buddy, Viterion) but delivered via smartphone. CHealthBlog….550 US primary care docs say no reimbursement, no telehealth (actually telemedicine). Usage in the past year was a scant 15 percent, with higher usage in Federally designated ‘safety net’ clinics (FQHCs) and HMOs versus PCMHs and ACOs where reimbursement by Medicare, Medicaid and private payers is far chancier. The survey was conducted by their association, the American Association of Family Physicians (AAFP). mHealthIntelligence….iHealth Andon Group buys France’s eDevice for $106 million. The aim seems to be integration of eDevice’s backend infrastructure to iHealth’s RPM devices. Mobihealthnews….A analysis of what went wrong at HealthSpot is in the new publication Telehealth & Medicine Today. A summary is that they had a business model that started out on point quite a while ago (2010) but then competitors and fresh technology ate their lunch (Editor’s term). They didn’t pivot to fit, moved too slowly and were overly wedded to their business model. A big problem was scaling costly kiosks and not finding the right places for them. While initially impressive, there was something all too elephantine about HealthSpot from the start. Our Readers interested in a Trip Down Memory Lane may read our collection of articles from 2013 here which pointed out most of the above….In the industry moves department, Peter Radsliff, whom this Editor worked with briefly on AgeTek-The Aging Technology Alliance (apparently defunct), has joined Arrayent, an IoT developer, as VP Marketing. Now that tells us something! Congrats to Peter!

And finally for a good long, but not light, read, this article in The Atlantic will give you a chilling glimpse of front-line medicine attempting to heal the carnage in Syria, using WhatsApp, texts and the simplest forms of telemedicine. A dedicated group of primarily Syrian-American doctors on a WhatsApp volunteer group called Madaya Medical Consultants uses it to perform consults with the minimal medical resources available in Syria. And yes, they know what Aleppo is.

Telehealth the way forward for chronic disease treatment – Australian report

  1. Telehealth has been confirmed as the way forward for sustainably treating the leading chronic diseases in Australia says a report published following a scientific study. The study, which analysed the effects of monitoring a mixed group of patients with chronic conditions using home-based telehealth equipment, concludes that use of home-based telehealth will not only reduce the hospital admissions but will also reduce the length of stay when admitted. The analysis of the data from the trial has shown that for chronically ill patients, an annual expenditure of AU$2,760 could generate a saving of between AU$16,383 and AU$19,263 representing a rate of return on investment of between 4.9 and 6. This is equivalent to a saving of AU$3 billion a year, says the report.

The Australian study, carried out by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) is reminiscent of UK’s Whole System Demonstrator (WSD), the world’s largest randomised control trial of telehealth. Although the Australian study is much smaller with a total of 287 participants over 5 sites (covering the 5 States) compared with over 6,000 in the WSD, the principles are similar. Due to the smaller sample sizes and the need to have patients connected to the National Broadband Network (NBN) the selection of patients was not random but other techniques were used to obtain statistically significant results. Patients selected had unplanned acute hospital admissions indicationg one or more of Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Hypertensive Diseases, Congestive Heart Failure, Diabetes and Asthma.

The TeleMedCare Systems Clinical Monitoring Unit (CMU) was used as the home-based unit although not all features offered by the device were utilised in this study. The CMU system deployed in this study was developed in Australia, registered with TGA (Therapeutic Goods Administration) and has been extensively used and tested in previous trials.

Typically patients would have some or all vital signs measurements scheduled at a convenient time, typically in the morning. These measurements were blood pressure, pulse oximetry to measure arterial blood oxygen saturation, ECG (single channel), lung capacity, body temperature, body weight and blood glucose concentration. In addition to scheduled times, patients could take their vital signs at any time. A full suite of clinical questionnaires was also available.

The full report Home Monitoring of Chronic Diseases for Aged Care is available to download here.

The ‘right package of care’ sought for ‘bed-blockers’, home care (UK/US)

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”150″ /]’Bed-blocking’ as a signal failure of transitional care. Here is a term that may be unique to the UK, but not the problem: older people who cannot be discharged after an illness because there is no plan and no suitable place for transitional care and/or a safe return home with care. According to the Guardian, the term originated among UK healthcare managers and economists as early as the late 1950s as a marker of system inefficiency. The writer, Johnny Marshall, director of policy for the NHS Confederation, correctly notes that it should be a marker of “(a) system that has failed to move quickly enough to put together the right package of care to enable the person in the bed to return home” and that unfairly blames the patient. He gives examples of programs across Britain with home assessment and care, particularly for older people post-fall injury, that reduce or eliminate hospital days.

In the US, transitional care is pointing to a blend of home care tech/services. Some of the indicators for LTC support that Laurie Orlov points out in Tech-enabled home care — what is it, what should it be?

  • Assisted living growth is flat as this past weekend’s open can of soda–housing is chasing residents (though cost doesn’t seem to be following the usual supply/demand curve), the average resident is 87 years old and staying 22 months, and their net worth can’t afford present AL
  • There’s a huge and growing shortage of home care workers for an ever-increasing number of old and old-old
  • Yet finally big investment is taking place in tech-facilitated home care locating and matching: Honor.com, Care.com and ClearCare–a total of just under $150 million for the three

But can technology–front and back end–make up for the human shortage? And there’s a value in wearing the Quantitative Self hat here. (more…)

Connected health: what’s different than last year?

This Editor was interested in what the organizers of the annual Connected Health Summit, now taking place in San Diego, are seeing as the differences in the digital health and remote monitoring sector over the past year. This year, Parks Associates promoted it as “spotlight(ing) health technologies as part of the Internet of Things (IoT) phenomenon and the transformational impact of these connected solutions on the US healthcare system.” I’ve been reading Parks’ research since 2006, when telecare was riding quite high, but the marketplace between consumer and enterprise-focused tech, monitoring and analytics has exploded. I asked Stuart Sikes, President of Parks Associates, for toplines on the key differences in the market and the conference between last year and this. It’s shifting to implementation, how to streamline processes around data, making data useful….and still finding someone to pay for it.

What is different this year than 2015?
The primary difference this year is that we will be discussing case studies and implementation and engagement issues, shifting the focus from “what elements are needed to encourage engagement” to “how is implementation working.” In addition, the emphasis on the power of data to provide meaningful data that empowers both consumers and care providers will increase, as secure collection and management of data is a central theme to most of the solutions on the agenda.
Regarding the agenda, one difference this year will be presentations by emerging companies to members of the investment community, who will offer some feedback on the company concepts and approach.

Do you see progress in adoption by physicians, healthcare organizations, consumers–and who is paying? (more…)