Restoring the ‘human connection’ in patient engagement. Pre/post-procedure education and monitoring service VOX Telehealth [TTA 23 May] is partnering with spiritual care counsel provider HealthCare Chaplaincy Network [TTA 2 Apr] and clinical teams from Northwestern University (Illinois) and the Princeton (New Jersey) Medical Center to develop the PalliativeCare Program. The VOX program is designed to blend health education and coordination support not only around a care plan for a specific disease but also for decision making, caregiver coordination, and necessary spiritual support and social services. It’s an interesting approach that combines online/mobile communications, telehealth and social services/ministry. HCCN’s inclusion in the program is not surprising as they have been transforming from a chaplain training resource for those ministering to patients and families in hospitals to providing spiritual care and resources directly online (via ChaplainsOnHand) for the seriously/chronically ill and their families. VOX release [Disclosure: Editor Donna is a volunteer on the HCCN’s marketing advisory council.]
Tunstall launches Advisory Service for ‘telehealthcare’
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Tunstall-Bsp63SfCYAETk3Q.jpg” thumb_width=”170″ /]Tunstall Healthcare UK last week announced the addition of an advisory service to help commissioners (CCGs, borough councils) and providers better understand, design, deliver and deploy what they’ve coined ‘telehealthcare’, which is plain ol’ telehealth to The Rest of Us. The Advisory Service will be managed by a team of specialists with clinical, technology, training, implementation and business intelligence expertise. The illustration to the left indicates their ‘swirl of disciplines.’ An interesting quote from the release: “According to NHS England, nearly a third of patients aged 75 or over have two or more long-term conditions; the overall cost of care for a person with multiple conditions is £2,500 per year.” (In US terms, that seems vanishingly small, except when you start multiplying…Ed.D.) In the UK system, commissioners are supposed to stay vendor-neutral so to this Editor there is a question on the objectivity of the advice given. On the clinical side, how many doctors and nurses will be engaged by the Advisory Service? The release also implies that the service will be available internationally, but materials are UK only. Website, release, brochure.
Another indication that Tunstall is trying to broaden itself beyond frameworks, fees and NHS funding is their organization of a European Symposium in Barcelona a few weeks ago. Hot topics were integrating services, enabling self-care and self-management for people with long-term health and care needs, increasing awareness of these service among carers, and of course cost management. Tunstall blog.
According to this GP article, GPs are not impressed by telehealth. They “have expressed doubts over the potential of telehealth to improve patient care, and studies have questioned whether the health-tracking technologies are value for money for the NHS.” Thus the Department of Health will encourage commissioners to use telehealth by surveying telehealth and telecare users, as well as developing a set of metrics for commissioners which will demonstrate their impact on health outcomes. The Telehealth Service Association (TSA) estimates are that 1.37m people in 2011 used telehealth, telecare and telecoaching services in England. Certainly Tunstall’s move in this area is designed to take advantage of Government action in this area and commissioners’ increased accountability.
Medvivo: correction
On 13th July this editor wrote a piece entitled “Wearables & mHealth: a few observations “ which included a paragraph on staff reductions at Medvivo which we suggested might be a part of an overall reduction in Medvivo’s engagement with telehealth. We had tried to contact the company beforehand, without success, however following publication of the story, this editor was then contacted by Andrew Cowie, Chief Executive of Medvivo. He kindly pointed that with the acquisition of Magna Careline, Medvivo’s headcount has actually increased by some 50, significantly more than the number who are en route to leaving the company. The other observation mentioned in the paragraph as supporting our concerns was, apparently, entirely coincidental (and transitory), and the following paragraph, which actually related to the BBC, was so worded that Medvivo (incorrectly) took it to refer to them. We therefore unreservedly apologise, and invite readers to check out the revised article.
The King’s Fund: International Digital Health and Care Congress
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Q75-digital-health-dot-mailer-banner-e1405212554733.jpg” thumb_width=”450″ /]
10–12 September 2014 at The King’s Fund, London W1G 0AN
This three-day event at The King’s Fund, now in its fourth year, is a truly international Congress in attendance and speakers. It will showcase new ideas, new research and new innovations in digital health, mobile health, telehealth and telecare around these five topics.
- Sustaining independence as people age
- Preventing and managing chronic illness effectively
- Supporting people with mental health issues
- Digitally enabling service transformation
- Innovations in technology
Wednesday’s pre-Congress session begins with lunch, a full day on Thursday concluding with an (optional) dinner and a full Friday. Our own Editor Charles Lowe will be presenting on medical apps during the 11:30 breakout session (the T2F section) at 11:30am Thursday. See here for detailed information on the Congress sessions. PDF summary including keynote speakers.
As TTA is a media sponsor of the Congress, we are pleased to offer our readers a 10 percent discount off pricing for all their registration types, including the Thursday dinner. Click here to automatically obtain the discount.
Tunstall’s 2013 fiscal report: debt service makes short term gloomier
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Updated…Released on this ‘getaway day’ (in the US), and surprisingly only covered by the local Yorkshire Post, is the report of Tunstall Healthcare Group’s year-end closing (30 Sept 2013) results. The short term news is positive: 21 percent revenue growth to £221 million in its 2013 statutory accounts. However, this adds in the acquisition of Spanish monitoring provider Televida for £27.4m in January 2013 and the 2012 purchases of AMAC in the US and STT Condigi in Sweden. The official posture of the company, expressed by CEO Paul Stobart, is that “with continuing Government austerity measures and a fragile global economy, the business does face challenges in the short term.” And one of those challenges making for a gloomy picture is debt service. We’ll let the YP speak: “The group, which is owned by private equity house Charterhouse Capital Partners (CCP) paid £13.7m of interest in cash on its senior and mezzanine debt of £265m, as well as a total of £114.4m non-cash interest on long-dated shareholder loan notes and other loans. This results in a statutory reported loss for the group of £127.8m.” That change of nearly £350 million, which includes operating costs and other expenses, illustrates the critical consequences of debt service on the bottom line, indeed [TTA 22 May]. Many thanks to one of our reliable sources for picking up this report.
New: Founder Steve reminds us of his related (and oh, so prescient) analysis from 2010 about Tunstall’s earnings versus debt service balancing act in Telecare Soapbox: Equity capital. A cautionary tale. (Thank you Steve for adding)
It is worth a detailed read because the 2009 numbers were also ‘challenging’. Steve dug through 2009 publicly filed (in UK) numbers to reach his conclusions. In sum, “The important question is whether their underlying position is sound and reliable, or whether they are shaky. They also tell me that the robustness of a company’s cashflow is the most important survival factor.” If I am reading the report on CompanyCheck correctly, the eye-watering negative net worth of the Group and the low cash positions of both the Group and UK are oddly reminiscent of airline financial statements when this Editor was still in that business. Do remember the object examples of Texas Air Corporation (once the world’s largest airline holding company), Pan Am and TWA! You also have to have some sympathy for the management which was not part of getting into this ‘pickle’ now tasked with getting the company out of the barrel.
Medicare dis-incentivizes home health care in ACA’s name (US)
When it comes to home health care, the C in CMS (Centers for Medicare and Medicaid Services) should perhaps stand for ‘contradiction’. According to recent reports appearing in the pre-holiday ‘dead zone’ of late last week, CMS has decreed that it must save, as part of a four-year plan under ACA, $58 million (0.3 percent) in fiscal 2015 (starting 1 Oct) from home health agencies which were formerly touted as a great way to save money. To put this in perspective: in 2013, Medicare paid about 12,000 home health agencies $18 billion to provide services to 3.5 million patients. In the US, Medicare has always had more restrictive rules for home and community-based services (HCBS); state-administered (but Federally subsidized) means-tested Medicaid still pays for the vast majority of long-term care (well over 60 percent, according to another Federal agency, Housing and Urban Development [HUD]), which strikes many observers as one pocket to another. So where are the contradictions?
- Conundrum #1: CMS has emphasized post-discharge, post-acute care as part of reducing acute care costs, exemplified in the penalty for 30-day same-cause readmissions. Nursing home expenditure is at least three times more costly than in-home LTC (a conservative estimate used by HUD).
- But CMS plans to cut Medicare home health funding in total so fewer people may receive it at all or less of it even if needed. What will be their alternative, and the effect on outcomes? (more…)
Pilot Health Tech NYC winners announced (US)
Last Thursday, the 11 winners of the second annual Pilot Health Tech NYC program were announced at Alexandria Center, NYC. A joint initiative of the New York City Economic Development Corporation (NYCEDC) and Health 2.0, it provides early-stage health tech companies based in NYC a ‘test bed’ in partnership with many of the most prestigious metro area healthcare organizations, and another platform to keep health tech growing in the city. Each project represents a distinct need in the spectrum and a common theme is integration of care into workflow. Some needs are obvious: senior care, pediatrics, rehabilitation, cardiac disease and diabetes management. Others are less so: vision, medication adherence, data analytics, blood donation and social support.
The winners are supported by $1 million in funding to operate and report results from the individual pilots which will take place starting in late summer through end of year. An interesting fact from the announcement release is that the Pilot Health Tech inaugural class companies [TTA 1 July 2013] have raised over $150 million in private investment since their win: AdhereTech, eCaring, Rip Road, Vital Care Services, BioDigital, Flatiron Health, Sense Health, Bio-Signal Group, Opticology and StarlingHealth (acquired by Hill-Rom).
The winners (some of which we’ve been following like GeriJoy, NonnaTech and eCaring) and their partners are:
- Smart Vision Labs / SUNY College of Optometry
- GeriJoy / Pace University
- QoL Devices, Inc. / Montefiore Medical Center
- Urgent Software, LLC / Mount Sinai Health System
- Nonnatech / ElderServe
- Fit4D/ HealthFirst
- AllazoHealth / Accountable Care Coalition of Greater New York
- Canopy Apps / Visiting Nurse Service of New York (VNSNY)
- Healthify / VillageCare
- Tactonic Technologies / NYU Langone, Rusk Rehab Center
- Hindsait, Inc. / NY Blood Center
More information in their release. Many thanks to NYCEDC and Eric Vieira of ELabNYC (another NYCEDC initiative) and CUNY.
Related reading: ELabNYC Pitch Day in March
CEWeek NYC (Part 1): health tech moves to the front
CEWeek NYC, Metropolitan Pavilion/Altman Building (@CEWeekNY)
Part 1
The Consumer Electronics Association (CEA) stages events in New York twice yearly–at the start of both summer and winter, the latter as a preview of International CES in January. CEWeek NYC is a bit of an overstatement–it’s Tuesday-Thursday. It was apparent on today’s main day (Wednesday) visit that beyond the lead dogs of ever-larger HDTVs, in-car audio/smartphone integrators and marvelous audio speakers small and large, something else was different. Health tech was right behind them in prominence, including related areas of robotics and 3D printing. (This builds on CEA’s own trumpeting of the 40 percent growth of the ‘digital health footprint’ at this year’s CES. Hat tip to Jane Sarasohn-Kahn.)
Presentations got the Gordon Ramsay treatment and were re-plated as bite-sized sizzling steak tips. Also different was the format. Instead of a long, dozy general press briefing several flights up at the huge top of the Met Pavilion at 9am, then rushing to the show floors before the crush of buyers, the floors opened to press only for a generous two hours. Then fast-moving keynotes and conference presentations of no more than one hour started at 11am in an intimate downstairs room. Alternatively, the centrally located demo stage between the show floors hosted 15 minute presentations. Other than occasionally having to wait in a narrow hall as the downstairs room emptied between presentations, both were wise moves. Very workable and very low on the Tedium Scale. Three of the eight Wednesday presentations were robotics or health tech-related, not including the closing FashionWare wearable tech show. The proportion is the same on Thursday.
Notable on the show floor:
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/0625141011.jpg” thumb_width=”170″ /]The latest fitness band/watch is not a brick, mercifully. Withings formally debuts tomorrow the Activité watch (left) which looks like a fine Swiss analog chronometer, not a slab on the wrist. It’s a man’s watch size on a woman, a bit slimmer and simpler than a Breitling, and connects to your smartphone using the Withings HealthMate app to track activity, swimming and sleep monitoring. You also get time (analog, yes!) and alarm clock, all powered by a standard watch battery so none of the recharging shuffle. Available in the fall at $390, but if you are a dedicated QS-er with style…. Also VentureBeat. (more…)
CEWeek NYC (Part 2): wearables, robots, telehealth gone to the dogs!
CEWeek NYC, Metropolitan Pavilion/Altman Building (@CEWeekNY)
Part 2
Over in FashionWare-ville….
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/0625141038.jpg” thumb_width=”170″ /]The Healbe GoBe 100% Automatic Body Manager turned out to be a big draw at this pavilion, for reasons that to the casual visitor were not apparent. Its claim: it automatically estimates both calorie intake and calories burned through measurements taken by an impedance sensor to measure tissue resistance, based on blood glucose being converted to liquid in tissues and the amount of liquid released. Having been through the now-vanished-into-thin Airo affair (with its fictional mini-spectrometer for detecting nutritional blood metabolites from food consumption, TTA 23 Nov 13), I was skeptical of Healbe’s claims and told co-founder and managing director George Mikaberydze (left) just that. He patiently explained how it works to me and seemed to be sincerely understanding of my skepticism. He briefly demoed the display on his smartphone, which was hard to track as it indicated negative caloric burn and was partly in Cyrillic, but these numbers were relative to…?
It turned out that I was not the first to question, and he was well prepared.
Healbe turns out to be quite controversial. The company raised over $1 million on Indiegogo this March/April, prominently featured in its well-produced GoBe materials and in its PR communications. It’s promising delivery in September. On researching this, (more…)
TripleTree ‘Viewpoint’ on hospital of the future
Healthcare investment bank and advisor TripleTree has produced a ‘Viewpoint’ report on ‘the hospital of the future’, examining the proposition that the place for delivery of even acute care may not be a hospital at all due to health tech, robotics and architectural innovation (this last hearkening to TTA 22 April). “High-quality healthcare is frequently described as delivering the right care to the right person at the right time in the right place. This report focuses on the right place. It describes the ongoing evolution of healthcare real estate and offers realistic insight to the characteristics of the hospital of the future.” And rather than hospitals becoming more hotel-like, hotels may become post-surgery ‘home health’ centers. Many other intriguing possibilities in this Report (free download).
VA reduced bed days by 59%, hospital admissions by 35% in 2013
Not all is gloom ‘n’ doom at the US Department of Veterans Affairs (VA), rightly excoriated for cooking the books on wait times for admissions, allowing an estimated 40 veterans to die waiting for care at the epicenter of the coverup, a Phoenix VA hospital, its secretary resigning. A consistent bright spot has been its use of telehealth and telemedicine, along with the Department of Defense (DOD), making them the largest US telehealth contractors. Neurosurgeon Adam Darkins, MD, who is their chief consultant for telehealth services, kept a speaking date at Tuesday’s Government Health IT Conference in Washington, DC to present encouraging results.
- The VA’s FY2013 telehealth program totaled 608,900 patients and 1.8 million telehealth episodes of care. 45 percent of the patient population live in rural areas, receiving care from 151 VA Medical Centers (VAMC) and over 705 Community Based Outpatient Clinics (CBOCs)
- 2009 to 2012 data show showed a 4 percent cost reduction after a year in a telehealth program, versus a one-year spike of 48 percent in costs for those veterans outside telehealth
- Cost savings are estimated at just under $2,000 per year per patient
- Over 41,000 patients were enabled to live independently in their homes using telehealth
- VA also leads in telemental health, with its National Center providing 2,893 video consults to 1,033 patients at 53 sites in 24 states
- The program is expanding at a rate of 22 percent per year
VA’s telehealth covers six areas: clinical video telehealth, home telehealth, (more…)
“A rose by any other name would smell as sweet” take II (UK)
Names again! E-Health Insider today has published a typo-prone summary of a Technology Strategy Board survey of the public’s understanding of “‘health and safety devices”. Unsurprisingly, just as most people would not know what acetylsalicylic acid is (though would be happy to take it when it was called aspirin), so only 10% knew that “‘health and safety devices” meant telecare and telehealth. Not sure I’d get that one right either.
There is better news though. The article also quotes the survey as finding that “38% of people said they did not understand the benefits for both self-care technologies and for health and care apps for smartphones and tablets” which I reckon is fantastically marvellous because it means that 62% of the population did understand the benefits of these technologies, which is a heck of a lot more than I suspect a random sample of GPs would, and shows we have been successful beyond our wildest dreams, especially if those happen to be concentrated in the oldest 62% of the population.
Sadly not all was quite so good as “…the research found that 43% of people would not consider telehealth because they would prefer to be seen by their clinician face to face.” Just as whenever in conversation someone tells me they wouldn’t share their health data, and I’ve asked whether they’d still feel like that if they were lying dying in the street and could be saved only if a clinician had instant access to that data, so I wonder if the question had been posed, as with our local surgery for non-urgent consultations, “would you prefer to wait 28 calendar days to see your clinician face to face or would you be consider remote consultation within 24 hours”, the answer might be slightly different.
The good side of course is that (more…)
Medtronic, Covidien and what it might mean for digital health
“This acquisition will allow Medtronic to reach more patients, in more ways and in more places,” Medtronic Chairman and CEO Omar Ishrak
Cover the Earth? While the healthy Medtronic offer ($42.9 billion in cash and stock) for Ireland-headquartered Covidien plc is not a ‘digital health deal’, it does point to Medtronic’s strategy which includes digital health. There is of course the obvious: growth by acquisition and integration. Acquisitions require cash, and the highly controversial change of domicile to Ireland via ‘tax inversion’ will fatten the exchequer in two ways. First is through the lower overall Irish corporate tax versus the 35 percent US tax, one of the highest in the world. Second is much more flexibility in repatriating plentiful foreign earnings at lower Irish corporate rates rather than the high US rates which Medtronic has avoided. Third is increasing dividends, which can drive up stock price and investor interest. Of interest to the latter is also that Covidien adds horizontal (and global) competitive strength to Medtronic in the clinical area–surgical, vascular, respiratory and wound care.
More Ways-More Places. Not just staples and sutures, Covidien has developed its own advanced in-hospital mobile patient monitoring in Vital Sync as well as several hospital monitoring devices in their Nellcor line. In addition to technology collaboration, the next point of integration could then be with Medtronic’s post-acute telehealth devices from Cardiocom, purchased less than one year ago. We noted at the time that it gave Medtronic entreé into the “chronic condition management continuum– not only into telehealth via Cardiocom’s devices and hubs, but also their clinical and care management systems.”
Approval will take time. Both the US and UK, through various regulatory agencies, scuppered the Pfizer-AstraZeneca deal on similar tax domiciling and competitive grounds. If it does go through, there will be a lot of reorganization. But while it digests, this Editor will be watching Medtronic for its usual pattern of making smaller ‘more ways/more places’ deals in the interim with an eye to diversifying past US-taxable medical devices. One pointer is their just-announced partnering with Sanofi to develop drug delivery-medical device combinations and care management services for diabetes patients (MedCityNews).
Related reading: Medtronic hints at more acquisitions following $43 billion Covidien deal (MedCityNews); The Medtronic, Covidien Inversion Deal Is More About Dividends Than Tax (Forbes); Medtronic agrees to buy Covidien for $42.9b in cash, stock (Boston Globe); Medtronic’s $43B Covidien deal—and Irish tax move (CNBC)
Medvivo comes of age (UK)
A year after this editor began his three year stint with Telehealth Solutions, we had a corporate near-death experience, as money got very tight waiting for that first big telehealth order (thankfully it came, courtesy of NHS Norfolk). In those days of reduced salaries, and few employees, we could only dream of becoming a full service remote healthcare monitoring organisation.
This week’s announcement of the acquisition of Magna Careline shows how things have changed in just five years. After being acquired by Moonray Investors, (more…)
More Samsung ‘we try harder’ telehealth moves
Is Samsung playing Avis “We try harder®” to Apple’s Hertz?
Samsung’s other, less noticed end-run in addition to the Simband reference hardware and SAMI ‘open ecosystem’ is an initiative creating a joint research center with the University of California, San Francisco (UCSF) called the Center for Digital Health Innovation (CDHI). It is being headed by Michael Blum, a medical doctor who is the UCSF assistant vice chancellor of informatics. From the statements made to The Atlantic, Dr Blum’s intent is to clinically validate the sensors and algorithms produced within the Samsung ecosystem. Already featured are four initial projects: CareWeb (a collaborative care platform built on Salesforce.com), Tidepool (infrastructure for diabetes apps), Health eHeart (clinical trial app on heart disease) and Trinity (‘precision team care’). On the frontier: ‘novel vital signs’ which he predicts will come out of the analysis of standard vital signs, “…new markers of health and wellness that come out of these large datasets.” Is Samsung, rather than going head-to-head with Apple on Healthbook [TTA 22 Mar] is leapfrogging into something akin to Telehealth 2.0 or 3.0? Yet this Editor notes that we haven’t figured out, for the most part, the FBQs (Five Big Questions)* of 1.0….
* The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.
Grant funds telemedicine for brain aneurysm
A grant of $150,000 has been awarded by a charitable foundation to fund a telemedicine [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/The-Missy-Project-logo.jpg” thumb_width=”150″ /]programme to help patients with brain aneurysms. The grant from The Missy Project, a Texas non-profit founded in 1999 after the sudden death of 12-year old Marisa (Missy) Magel due to a brain aneurysm, is being awarded to the Dartmouth-Hitchcock Hospital Center for Telehealth.
The funding will enable brain aneurysm patients in northern New England to have rapid access to neurovascular specialists, according to Dartmouth-Hitchcock. This will be achieved through telemedicine platforms to access the specialists at Dartmouth-Hitchcock from local facilities and community hospitals in what will be virtual aneurysm clinics. Once a patient has had a CT scan they will be able to proceed to a specialist consultation faster and more conveniently under this programme. In addition to virtual aneurysm clinics, the Dartmouth-Hitchcock project will include a 24/7 emergency department telemedicine acute consult service for pediatric and adult patients with suspected subarachnoid hemorrhage (which accounts for half of all hemorrhagic strokes), and customized educational video content, according to the Dartmouth-Hitchcock.
The number of deaths each year in the United States due to brain aneurysms is estimated to be 32,000, more than either AIDS or prostate cancer, according to The Missy Project and an estimated 1 in 50 people, or 6 million people in the US have an unruptured brain aneurysm according to the Brain Aneurysm Foundation, so this project brings telemedicine to an important area.
Dartmouth-Hitchcock Center for Telehealth was awarded nearly a $1M from the USDA in February this year (see USDA invests $16M in distance learning and telemedicine) to deploy telemedicine equipment and services in New Hampshire and Vermont.
Most Recent Comments