TTA’s summer #6: telehealth wars turn, mental health apps get $$, NHS England’s Sir Simon interviewed, Alcuris’ cyber-OK, Cerner promises to right the VA ship

 

 

Weekly Update

The Telehealth Wars teeter-totter with now Amwell and national expansion on the upside. NHS England’s changing of the guard–Roy Lilley’s insightful interview with Sir Simon. Telemental health prospers. Alcuris gets the cyber-OK from Scotland. And Cerner needs to get it right with the VA, right quick.

The Roy Lilley-Sir Simon Stevens ‘Health Chat’ interview (As the order changes at NHS England)
News and deal roundup: another big mental health app funding, Happify Health’s prescription therapy app debuts, Alcuris approved by Scottish Digital Telecare for cybersecurity (Mental health continues to be the It of Digital Health)
Telehealth Wars: Amwell’s raises game with buys of SilverCloud and Conversa Health; Teladoc’s slow member, hospital growth lead to $133M Q2 loss (The seesaw goes up for one, down for the other)
Cerner execs to VA Congressional committee: “We are committed to getting this right” (After $16 billion, One. Would. Hope. So.)
Over 400 telehealth groups urge Congress to retain CARES Acts gains on remote care (Obsolete law change long overdue)

The big news for UK GPs this week was that the GPDPR’s extraction scheduled for 1 Sept is stopped for a Big Rework. Big Blue’s Watson Health dying in pieces, reportedly up for sale. But SPACs and investments have slowed only a bit for the summer with Owlet’s $1bn SPAC and digital health’s torrid $15bn first half. In-person meetings are starting to come back as well (apparently HIMSS21 is still on too).

Softly, softly: GPDPR comes to screeching halt, indefinitely, to be reworked (Don’t hold yer breath!)
News and deals roundup: Owlet’s $1B SPAC, Carbon Health’s $350M Series D, Series Bs by Woebot Health and b.Well, digital health rakes in $15bn (Owlet ‘socks it’ to the market, behavioral health and digital health match the hot weather)
Oh, MAMA! The Medical Alert Monitoring Association meeting, 28-29 September, Chicago (They’ll need the alerts in Chi-Town)
Three healthcare startup events: MedStartr NYC Thursday 21 July, Dallas Startup Week starts 1 August–and apply now for UCSF Health Awards (Look to Texas and California)
IBM Watson Health’s stumble and possible fall (The World Was Not Theirs, leading to Death By A Million Cuts)

Teladoc’s new alliance with Microsoft Teams stakes out real estate with health systems–and more. There’s life in VistA yet as VA throws hands up, puts Cerner EHR on hold. UnitedHealthcare beefs up predictive analytics for SDOH as the Feds make moves, while the parent looks to transform. The King’s Fund’s annual conference is back in November. And just for fun–get your Dead Startup Toys!

Saturday summer morning fun: treat yourself (or your boss) to a Dead Startup Toy (Playtime! If not now, when?)
Volte-face: VA now puts their Cerner EHR implementation on hold (Is this a job for Samson or Superman?)
The King’s Fund annual conference returns in November, virtually (Given all, a good call)
The implications of Teladoc’s integration into Microsoft Teams (Now we know why InTouch Health in health systems was worth the mega-money)
UnitedHealthcare pilots predictive analytics model for SDOH, sets out plan to transform into ‘high-performing health plan’ (Plenty of room for tech in this vision)

PERS makes news with an insider view of what happened at Philips Lifeline as Connect America finalizes its buy, and VRI’s up for a new owner. AliveCor continues to play David to Apple’s Goliath, hospital-at-home gets a $250M boost, UK’s Physitrack IPO raises $20M. 

News roundup: AliveCor’s latest FDA clearance plus antitrust vs. Apple, VRI on the market, Walgreens’ ‘tech-enabled future’ indefinite plus VillageMD status, monthly telehealth usage drops 12.5%
An ‘insider’ point of view on the Connect America acquisition of Philips Lifeline (Good background from industry sources)
News/deals roundup: Connect America finalizes Philips aging/caregiving buy; Amedisys-Contessa $250M hospital-at-home; UK’s Physitrack $20M IPO, Dutch motion tracker Xsens

Summer is speeding up before our eyes as we in the US celebrate our Independence Day (sorry, George III!). Tunstall appeals Swedish procurement exclusion. Bright Health and Olive both had beaucoup funding. StartUp Health spotlights brain health. Cerner and VA, imperfect together. Telehealth usage settling down. And, in product tie-ins–buy a Black+Decker PERS, get a power drill?

Lightning news roundup: AI for health systems Olive scores $400M, VA’s sticking with Cerner EHR, Black+Decker gets into the PERS game (An unseen connection between power drills and PERS units?)
Tunstall under fire in Swedish court on appeal of Adda procurement exclusion (Their Nordic troubles continue)
Four ‘moonshot’ health tech startups aiding cognition and brain health (podcast) (A worthwhile half-hour)
‘Insurtech’ Bright Health’s IPO second largest to date, but falls slightly short of estimates (updated) (Bad market day for an interesting model)
Telehealth usage going flat, off by 1/3 and declining: Trilliant Health study (Not taking over the world)

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

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Cerner execs to VA Congressional committee: “We are committed to getting this right”

Two Cerner executives had their say in testimony to the Senate Veterans Affairs Committee last week, and they hung on by, presumably, their fingernails in their commitment to having working tests and a workable rollout of the Cerner Millenium system. This will replace the warhorse VistA system in use for decades in the VA, but incompatible with the Department of Defense’s Cerner MHS Genesis and earlier EHRs in use in military care facilities.

The EHR implementation, which is at last report costing $16 billion, failed miserably at Mann-Grandstaff VA Medical Center in Spokane, Washington in late 2020 into this year. The three-month review of the program “raises more questions than it answers,” said Committee Chair Frank Mrvan, D-Indiana. Other members concurred in being less than impressed by Cerner. Ranking Member Matt Rosendale, R-Montana, wasn’t interested in “shoveling more money into a flawed program just to keep the paychecks flowing.”

However, Brian Sandager, senior vice president and general manager of Cerner government services, pointed out that wait times at Mann-Grandstaff, with nearly 70% of veterans seen within 15 minutes of their scheduled appointment time, with urgent care patients seen within 13 minutes of arrival. Opioid treatments were flagged for alternative treatments. HealthcareITNews   Our earlier coverage here.

Cerner Government Services has a great deal riding on the successful implementation of the VA contract, including their extensive government work with DOD on MHS Genesis and other healthcare organizations within the US Government, including those listed on their website: the US Coast Guard, CDC, HHS, and CMS. 

Volte-face: VA now puts their Cerner EHR implementation on hold

The US Department of Veterans Affairs has pulled a 180° on the Cerner EHR implementation. In a move worthy of the old-time moonshine runners, VA Secretary Denis McDonough went before the Senate Veterans Affairs Committee on Wednesday to announce that the deployment of the Cerner system in the VA is on hold. This is after maintaining two weeks ago [TTA 2 July] that they were sticking with Cerner and the implementation, pending a further review.

In the interim, the VA Office of Inspector General (OIG) issued two reports that criticized the unreliable estimating process for various upgrades to the system, including lack of complete documentation, and the implementation of the Cerner EHR at Mann-Grandstaff VA Medical Center in Spokane, Washington, starting in October 2020. HealthcareITNews

In a classic ‘falling on one’s sword’ in the Wednesday hearing, Secretary McDonough told the committee that the project review found multiple “governance and management challenges” as well as patient safety concerns and system errors. He attributed them to VA and Cerner leadership, or lack thereof. For instance, VA clinicians couldn’t easily find help from Cerner on the initial rollout at Mann-Grandstaff VA Medical Center. The clinician using it called the help desk, reaching a Cerner employee there but a week. The Cerner EHR also generated duplicate prescriptions and confused patients.

The approach to implementing the modernized Cerner EHR approach will be ‘reimagined’ (DC-speak for redoing what should have been done right the first time, which started in 2017). This will start with a new, enterprise-wide governance structure to manage the project and integrate it with other modernizations, according to the Secretary. He admitted that the original plan to roll out the EHR by geographic area was a mistake. It will also not be synchronized with the Department of Defense rollout, which has proceeded without serious hitches. Go-lives will now be based on evidence of readiness, such as training, infrastructure, and management.

The Deputy Secretary has been designated to be directly in charge of the project. Acting undersecretary for health Richard Stone, MD, who had been in charge of the Cerner implementation, resigned in June after not being considered for the deputy secretary post. Secretary McDonough pitched the senators on quickly confirming nominee Donald Remy, with whom he will be speaking on big decisions. (One would hope. Mr. Remy, who was confirmed on 15 July. )

The final straw for the senators was budget. HISTalk summarizes: “The cost of the project, which was originally estimated at $10 billion when Cerner was awarded a no-bid contract in 2017, has risen to over $20 billion. McDonough has ordered a new budget estimate for the entire project, which will include the several billion dollars of infrastructure upgrades that the original estimate missed.”

Looks like the Old Gray Mare of EHRs, VistA, will be lingering for awhile. This Editor lays even money that the senators will be discussing the same issues, such as revenue cycle management, in 2025. Becker’s Hospital Review, Federal News Network

Lightning news roundup: AI for health systems Olive scores $400M, VA’s sticking with Cerner EHR, Black+Decker gets into the PERS game

As here in the US we are winding up for our Independence Day holiday (apologies to King George III)….

Olive, a healthcare automation company for healthcare organizations, scored a venture round of $400 million from Vista Equity Partners. To date, it’s raised $856 million through a Series G plus this round and is now valued at $4 billion according to the company release. Olive’s value proposition is automating via AI routine processes and workflows, such as benefit verification discovery, prior authorizations, and billing/payments for health systems. About 900 US hospitals have adopted Olive’s systems. Mobihealthnews.

Breaking: The US Department of Veterans Affairs will be staying with Cerner Millenium for their EHR modernization from VistA. This follows a 12-week review of the implementation following failures within the $16 billion program itemized by the Government Accountability Office (GAO) in February [TTA 19 Feb]. Secretary Denis McDonough is scheduling two further review weeks to determine additional changes to the program. The intent is to build a cloud-based system fully interoperable with the Department of Defense’s Military Health System (MHS) also built with Cerner. FedScoop, Healthcare IT News

And in the What Are They Drinking in Marketing? I want some of that, stat! department…

Black + Decker is now becoming a PERS provider with the introduction of Black+Decker Health and the goVia line of mobile and home-based PERS with optional fall extension and call center monitoring through Medical Guardian . The devices are a fairly predictable line of cellular-connected (Verizon, AT+T) with a ‘classic’ home landline unit. The units are being sold through Amazon. B+D release

From a marketing perspective, the Black+Decker name, identified for decades with home and power tools, on a PERS line is also a classic–a classic mistaken line extension like Cadbury mashed potatoes or Colgate frozen entrees. Buy a PERS, get a drill? Relevance and fit to a older, female-skewing group?  It surely looks like their parent Stanley, which is a leading company in institutional alarm and location services. offloaded this legacy business to them. (Judging from the website, someone’s in a rush as some pages still have ‘greek’ copy under headings.) Hat tip to a Reader who wishes to remain anonymous.

Deals and news roundup: Ginger’s $100M, myNEXUS to Anthem, Everlywell snaps up PWN, Amwell’s banner year for revenue–and loss, VA reviews Cerner rollout, voice visits for MA, GE’s vScan goes wireless, uBiome founders indicted

Deals–and news–are piling up like Easter eggs before the hunt. Mental health and cognitive digital therapy scored another raise with Ginger‘s $100 million Series E to fund expansion into health plan and government partnerships. Blackstone Growth led the round. Total funding to date is $220 million. It’s entered unicorn status with a valuation just north of $1 bn. Ginger to date has concentrated on corporate mental healthcare. From being an ugly duckling only a few years ago, digital mental therapies are this year’s ‘it’. But competition is fierce: the traditional telehealth companies such as Teladoc, Doctor on Demand, and Amwell are closing in on the early entrants such as AbleTo. Direct-to-consumer models like Talkspace; UK/Ireland’s SilverCloud Health; and Lyra, Spring Health, and Happify, which just closed a $73 million Series D, all step out with slightly different ‘differentiators’ but target the same companies, health plans, and health systems. FierceHealthcare, Ginger release

Home health is also another former ugly duckling transformed into a swan. Anthem is acquiring home health/nursing management company myNEXUS, which manages home-based nursing services for 1.7 million Medicare Advantage members across 20 states. Their digital authorization and visit management couples with a nationwide network of providers and nursing agencies for local care. Exiting myNEXUS are private equity investors led by New York’s WindRose Health Investors, after four rounds and a conservative $31 million in funding (Crunchbase). Neither terms nor management transitions were disclosed. myNEXUS will join Anthem’s Diversified Business Group. FierceHealthcare, release.

Home testing+telehealth company Everlywell (not connected with the Everly Brothers) has a different take on home health. They are now integrating their self-test kits with fully owned lab testing. New acquisitions PWNHealth and its subsidiary Home Access Health Corporation will join Everlywell in Everly Group. PWN was Everlywell’s main telehealth partner and diagnostic testing partner since 2016. It will become Everly Health Solutions with their testing data kept separate from Everlywell’s. Home Access was PWN’s self-collected lab test company. Everly Health now will support more than 20 million people annually in all 50 U.S. states, Canada, and Puerto Rico. Acquisition terms were not disclosed. PWN’s CEO will take a seat on the Everly Group board to assist integration. Valuation is now estimated at $2.9 bn.  Mobihealthnews, Everly release, Bloomberg News

And in other news…

Amwell reported a Very Good Year in their telehealth services, with visits growing to 5.9 million from 2019’s 1.1 million. Total revenue was up over 65 percent to $245.3 million. However, profitability continues to be elusive, with net loss almost equaling revenue. Release

The Department of Veterans Affairs (VA) finally announced a review of the Cerner-Leidos EHR integration. Back in February, VA was hanging tough on the rollout after the GAO report questioning its wisdom and recommending postponement until high severity issues were corrected. Secretary Denis McDonough, new VA head, has directed the undertaking of a 12 week strategic review without pausing the project. Taking bets on that 12 weeks! Healthcare Dive

Payers and their lobbyists are supporting a newly reintroduced House bill that would permit telephonic-only telehealth visits to be reimbursed for their Medicare Advantage plans after HHS closes the pandemic period. There is considerable information that video/audio virtual visits still have limitations with the 65+ group, clustered around high-speed internet or good data connections, smartphones, and computers with cameras, making video visits difficult or impossible. Which begs the question about continuing coverage for those on Original Medicare. Healthcare Dive

Those readers with long memories will recall GE Healthcare’s heralded introduction of the VScan handheld clinical-grade ultrasound device–back in 2010, complete with Eric Topol rave and demo. Not much has been heard from GEHC since till this month, and other competitors, such as the Butterfly IQ from 4Catalyzer, have made handheld ultrasound common and affordable. GEHC announced Vscan Air, a fully wireless version that connects to iOS or Android. It was FDA cleared in November 2020 and will be shipping its dual-headed probe and accessories starting 1 April for a US-listed target price of $4,495. GEHC page (with the cute domain vscan.rocks), Mobihealthnews

And in our Scandal Sheet section, a Federal grand jury in the Northern District of California has indicted the founders of now-bankrupt uBiome on 40-odd counts encompassing conspiracy to commit securities fraud, conspiracy to commit health care fraud, money laundering, and identity theft. Separately, the Securities and Exchange Commission (SEC) also filed charges. Between 2016 and 2018, uBiome had raised $100 million through a Series C, and was likened to Theranos, after its fall, in the Big Claim (‘inventing the microbiome industry’). Its business was analyzing the DNA of fecal and other biological matter to sequence the bacteria of the body’s microbiome. Starting with low-cost, limited data comparison for at-home tests, the founders progressed to claiming to doctors that their diagnostic tests were clinical-quality and would be reimbursed by payers. Payers did–for awhile–and the investors piled in. By 2019, the wheels fell off their scheme and the FBI came knocking at their Silicon Valley offices after the founders cashed in. Chapter 7 followed in late 2019. The Register reports that the two married founders are on the run, whereabouts unknown. US Attorney’s Office release, SEC filing (PDF)

 

GAO tells VA to postpone Cerner EHR implementation–but VA will be continuing

The US Department of Veterans Affairs (VA) is still in the long rollout of the Cerner/Leidos EHR system to replace their home-grown, once groundbreaking VistA and to be interoperable with the Department of Defense’s Cerner Millenium system. The Government Accountability Office (GAO) issued a report (PDF link) that concludes that “VA should postpone deployment of its new EHR system at planned locations until any resulting critical and high severity test findings are appropriately addressed.” These potential system failure points were brought up by GAO to Congress last October at the time of the first implementation in Spokane, Washington. The sidebar on GAO’s report states that VA agreed with the postponement, but a news report in FedScoop indicates that VA believes, per their comments in the report, that:

  • VA and Cerner have resolved the major issues (down to 55 from close to 400)
  • They will resolve the rest by January 2022
  • They will proceed with the scheduled rollout to the VA’s Puget Sound Health Care System in Q4 2021.

Hat tip to HISTalk, which managed to summarize this in seven short sentences (!).

News roundup: CVS cashing out notes, catching up with ISfTeH, India’s Stasis Labs RPM enters US, Propeller inhaler with Novartis Japan, Cerner gets going with VA

CVS Health is pricing out a tender offer for some notes. If you are holding one of a potpourri of notes with due dates of 2023 and 2025 from CVS, the company is making a cash tender offer, meaning they are cashing these notes out. This is usually done as part of rearranging financing, especially appropriate in the wake of the Aetna acquisition. The details are here in their release of 12 August. The collective value for both note years is approximately $3 bn each. An update is here on Seeking Alpha.

We have been remiss in not maintaining our following the Swiss-based International Society for Telemedicine and eHealth (ISfTeH) so we will direct your attention to their August update which features the effect of COVID on teledermatology, women’s health, teleurology, and news on members and developers. Their Journal, still edited by Professor Maurice Mars of South Africa, has published once this year in January.

India’s Stasis Labs, developer of a remote patient monitoring (RPM) platform utilizing a smartphone, vital signs devices, a bedside monitor connected into a platform, is entering the US market. It monitors six vital signs in a single monitor: heart rate, blood oxygen, electrocardiogram, respiratory rate, blood pressure, and temperature. Awarded a 510(k) clearance in April, Stasis, out of the Cedars-Sinai Accelerator program, has had a limited deployment at Texas-based emergency-care provider Hospitality Health ER and California-based Glendale Surgical Center and Orthopedic Surgery Specialists. It has also deployed to 50 cities in India. Mobihealthnews

Smartphone-connected inhaler sensor company Propeller Health has inked a deal with Novartis in Japan. Patients prescribed Novartis’ drugs for uncontrolled asthma, the Enerzair or Atectura Breezhaler, can now enroll in Propeller’s digital-management program. Data about their inhaler use will be transmitted from the sensor on the inhaler to Propeller’s smartphone app. The app also pings users with reminders and usage data. Propeller was acquired last year for a stunning $225 million by ResMed. Propeller this past May gained 510(k) FDA clearance for a sensor/app for use with AstraZeneca’s Symbicort inhaler.

Cerner’s EHR implementation with the US Department of Veterans Affairs finally took a step forward after many delays with the launch last Friday of a new scheduling system at the VA Central Ohio Healthcare System in Columbus, Ohio. Cerner migrated the information of some 60,000 veterans in preparation. The full EHR at the Mann-Grandstaff VA Medical Center in Spokane, Washington, originally scheduled for March, will go live this fall. Healthcare Dive

Philips awarded by VA 10-year, $100 million remote ICU, telehealth contract; partners with BioIntelliSense for RPM

The US Department of Veterans Affairs (VA) awarded Philips a ten-year contract to build out their remote intensive care (ICU) service infrastructure to make it accessible to veterans from any location in the US. The VA currently manages 1,800 ICU beds nationwide in its approximately 1,700 sites. Based on the release, the Philips engagement in VA Tele-Critical Care will expand the VA’s current capabilities to encompass telehealth, tele-critical care (eICU), diagnostic imaging, sleep solutions, and patient monitoring. The agreement may total $100 million over the 10-year contract duration.

Philips has about 20 percent of the adult eICU market. They claim that 1 in 8 adult ICU patients are monitored 24/7 by their eICU Program, which combines audio/visual technology, predictive analytics, data visualization, and advanced reporting capabilities. Their proprietary research points to shorter ICU visits by eICU patients plus better outcomes. Healthcare IT News, Philips release (Photo: Philips)

By this Editor’s calculation, VA remains the single largest user of telehealth in the US. In their FY 2019, the first year of the ‘Anywhere to Anywhere’ initiative [TTA 24 May 2018], VA delivered more than 2.6 million telehealth episodes to 900,000 veterans. During the early part of the pandemic, they grew virtual home visits from an average of 10,000 to 120,000 per week. By the end of FY 2020, their goal is to deliver all primary care and mental health provider services, both in-person and via a mobile or web-based device. The VA release from November 2019 does not break out the different types of VA telehealth and usage.

Philips and BioIntelliSense have also inked a partnership deal to integrate BioIntelliSense’s BioSticker sensors into their post-acute remote patient monitoring (RPM) systems. The BioSticker is a wearable FDA-cleared 510(k) Class II sensor that transmits passive monitoring of key vital signs, physiological biometrics, and symptomatic events up to 30 days. The first announced user of the RPM+BioSticker systems will be Healthcare Highways of Frisco, Texas, a provider of health plans, employer self-funded health plans,  pharmacy benefit management, population health management, and benefit plan administration. Healthcare Highways is participating in seven patient monitoring programs to assess patient health status with providers: COVID-19, CHF, hypertension, diabetes, total joint replacement, cancer, and asthma. Release (Photo: Philips)

News Roundup (updated): Proteus files Ch. 11, VA’s EHR tests now fall–maybe, making US telehealth expansion permanent, Rennova’s rural telehealth bet, Oysta’s Lite, Fitbit’s Ready to Work jumps on the screening bandwagon

Proteus Health, the company which pioneered what was initially derided as a ‘tattletale pill’, filed Chapter 11 bankruptcy today (16 June). As early as December, their layoffs of nearly 300 and closure of several sites was a strong clue that, as we put it, Proteus would be no-teous without a big win. Exactly the opposite happened with the unexpected early end of their Otsuka partnership with Abilify [TTA 17 Jan]. Proteus had raised about $500 million in venture capital from Novartis plus technology investors and family offices. Their combination of a pill with an ingestible sensor, a patch that detects ingestion and that sends information to a smartphone app was ingenious, but in a business model was meant for high-cost medications. Proteus’ current partnerships include TennCare (TN Medicaid), plus Xealth and Froedtert to integrate medication information into electronic health records. At one point, Proteus was valued at $1.5 bn by Forbes, making it one of the early healthcare unicorns.  CNBC, FierceHealthcare

VA further delayed in implementing Cerner-Leidos EHR. POLITICO’s Morning eHealth earlier this month reported from congressional sources that further testing would be delayed to the fall at the earliest and possibly 2021. The project to replace VistA stands at $16 bn. Contributing to delay was an April COVID outbreak in Spokane at a veterans’ home, which pushed patients into the VA medical center. 

In further DC news, several senators are advocating that the relaxing of restrictions on telehealth during COVID should largely be made permanent. According to the lead senator, Brian Schatz (D-HI), Medicare beneficiaries using telehealth services increased 11,718% in 45 days. Many telehealth requirements were waived, including geographic, coding of audio-video and telephonic telehealth billing, and HIPAA platform requirements. Other senators are introducing bills to support remote patient monitoring programs in community health centers’ rural health clinics. FierceHealthcare

The climate for telehealth has improved to the point where smaller players with side bets are now betting with bigger chips. Rennova Health, a mid-South healthcare provider with a side in software, is merging its software and genetic testing interpretation divisions, Health Technology Solutions, Inc. (HTS) and Advanced Molecular Services Group, Inc., (AMSG) with TPT Global Tech. The combined company will be called InnovaQor after an existing subsidiary of TPT and plans to create a next-generation telehealth platform targeted to rural health systems. Release, Becker’s Hospital Review

Oysta Technology has launched the Oysta Lite with an SOS button, GPS, safety zone mapping for travel, and two-way voice. The SOS connects to their IntelliCare platform which provides status monitoring, reporting, and device management plus connecting to the telecare service provider. They are specifically targeting post-lockdown monitoring of frail elderly.  Press flyer/release.

Fitbit jumps on the crowded COVID workplace screening bandwagon with Ready to Work, a employer-sponsored program that uses individual data collected via the Fitbit device such as resting heart rate, heart rate variability and breathing rate. Combined with self-reported symptoms, temperature, and potential exposure, the Daily Check-In app then provides guidance on whether the employee should go to work or remain at home. According to the Fitbit release, a higher heart rate–as little as two beats a minute–can be indicative of an immune system response before the onset of symptoms. TTA has earlier reported [19 May] on other COVID workplace screeners such as UHC/Microsoft’s ProtectWell app, Appian, and (in-house) PWC. FierceHealthcare also lists several others on the cart: Castlight Health, Collective Health, Carbon Health, VitalTech, and Zebra Technologies. However, at this stage, few employees are leaving remote work for in office, and fewer still may even return to the office.

VA running at least one month late on Cerner implementation launch

Only a week after Veterans Affairs secretary Robert Wilkie reassured the press that the rollout of the Cerner EHR to replace VistA was right on time, FCW was advised by a VA spokesperson that the implementation is only 75-80 percent complete, and more time is needed for the system build and staff training. The 28 March rollout at Spokane, Washington’s Mann-Grandstaff VA Medical Center will have a new ‘go-live’ date according to the spokesperson. Another source said to FCW that the interfaces between Cerner, VA IT, and VistA has been a worse ‘slog’ than anyone imagined, so it made little sense to train anyone on a unfinished system. The date is now estimated to be end of April.

Apparently key Congresscritters on the House Veterans Affairs Committee and IT subcommittees were prepared for the delay by Secretary Wilkie–a wise move–and they applauded the recognition that more preparation and training are required.

VA’s fiscal 2021 budget, revealed on 10 Feb, requested $2.6 billion for the Cerner EHR modernization project, up from $1.5 billion in the prior year. There’s $500 million more for infrastructure readiness and $62 million hike in program management support.

Comings and goings, wins and losses: VA’s revolving door spins again, NHS sleep pods for staff, Aetna’s Bertolini booted, Stanford Med takes over Theranos office

VA’s revolving door spins again with #2 person fired, but VistA replacement implementation moves on. James Byrne, deputy secretary, was fired on 3 Feb “due to loss of confidence in Mr. Byrne’s ability to carry out his duties” according to secretary Robert Wilkie. Mr. Byrne, a Naval Academy graduate and former Marine officer, had been VA general counsel, acting deputy secretary starting August 2018, then confirmed five months ago.

Mr. Byrne’s responsibilities included the Cerner implementation replacing VistA and other IT projects (HISTalk), of which Mr. Wilkie stated in a press conference today (5 Feb) “will not impact it at all” (FedScoop). The termination comes in the wake of a House staff member on the House Veterans Affairs committee, herself a Naval Reserve officer, stating that she was sexually assaulted at the VA Medical Center in Washington (NY Times). Axios claims that the White House was disappointed in the way the VA handled the investigation. At today’s presser, Mr. Wilkie denied any connection but attributed the dismissal to ‘not gelling’ with other team members. The launch of Cerner’s EHR is still on track for late March. The turnover at the VA’s top has been stunning: four different secretaries and four more acting secretaries in the last five years. Also CNBC, Military Times.

NHS’ sleep pods for staff to catch a few ZZZZs. A dozen NHS England hospitals are trialing futuristic-looking ‘sleep pods’ for staff to power nap during their long shifts and reduce the possibility of errors and harm by tired clinicians. Most of the locations are in the A&E unit, doctors’ mess, and maternity department. They are available to doctors, nurses, midwives, radiographers, physiotherapists, and medics in training. The pods are made by an American company, MetroNaps, and consist of a bed with a lid which can be lowered along with soothing light and music to aid relaxation. The pods may cost about £5,500 each but are being well-used. Other hospitals are fitting areas out with camp beds and recliner chairs. The sleep breaks take place both during and end of shifts before returning home and average about 17-24 minutes. Everything old is new again, of course–dorm areas were once part of most hospitals some decades back and doctors’ lounges with sofas were popular snooze-gathering areas. Guardian (photo and article)

Mark Bertolini bumped off CVS-Aetna Board of Directors. The former Aetna CEO, who was the engineer of the sale to CVS Health two years ago, isn’t going quietly out the door with his $500 million either. The high-profile long-time healthcare leader told the Wall Street Journal that he was forced off the BOD. He maintains the integration of the Aetna insurance business is incomplete, contradicting CVS’ statement that it’s done. Mr. Bertolini and two other directors are being invited out as CVS-Aetna reduces its board following, it says, best practices in corporate governance. Looking back at our coverage, Mr. Bertolini had hits, bunts (ActiveHealth Management) and quite a few misses (Healthagen, CarePass, iTriage). According to the WSJ, the contentious nature of the statement plus the departure of the company’s president of pharmacy is raising a few eyebrows. And recently, an activist shareholder, Starboard Value LP, has taken a stake in the company. CVS is demonstrating some innovation with rolling out 1,500 HealthHubs in retail locations as MinuteClinics on steroids, so to speak.  Hartford Courant (Aetna’s hometown news outlet) adds a focus on how many jobs will be remaining in the city with a certain skeptical context on CEO Larry Merlo’s promises. 

Stanford taking over Theranos Palo Alto HQ space. HISTalk’s Weekender had this amusing note (scroll down to ‘Watercooler Talk’) that the 116,000-square-foot office building in Stanford Research Park will now house the Stanford medical school. Theranos had been paying over $1 million per month in rent for the facility. The writer dryly notes that Elizabeth Holmes’ bulletproof glass office remains. This Editor humbly suggests the floor-to-ceiling application of industrial-strength bleach wipes and disinfectant, not only in the lab facility but also in that office where her wolf-dog used to mess.

The LA Times reports that Ms. Holmes is also defending herself without counsel in the Phoenix civil class-action lawsuit against Theranos. On 23 January, she dialed in to the court hearing’s audio feed and spoke for herself during that hour. One has to guess that she doesn’t have much to do other than read legal briefs. (Perhaps she sees herself as a cross between Saint Joan and Perry Mason?) Last fall, Ms. Holmes was dropped by Cooley LLP for non-payment of fees [TTA 9 Oct 19]. Williams & Connolly continues to represent her in the criminal DOJ suit, where prison time looms. 

VA’s REACH Vet uses algorithms and AI to predict critical mental health needs–including suicide risk

The Department of Veterans Affairs (VA) has been using artificial intelligence and patient data as part of a suicide prevention program for veterans–a top clinical priority for VA. The REACH Vet program, started in 2017, uses predictive algorithms to identify risk factors for suicide in millions of veteran patient records for medications, treatment, traumatic events, overall health, and other information. It then uses the information to determine the top 0.1 percent of veterans at any facility at the highest risk for suicide in the next year. Clinicians then call these veterans for about an hour’s conversation, offering to help them create a mental health care plan.

In its first year (2007-8), the program reached more than 30,000 veterans and identified about 6,700 active VA users a month. According to the short article on findings published by the Suicide Prevention Resource Center in 2018, “veterans who engaged with REACH Vet were less likely to be admitted to an inpatient mental health unit, and more likely to attend mental health and primary care appointments compared to those not in the program. REACH Vet infrastructure includes a coordinator at every VA facility and a national team of clinicians who provide overall program support.”

There are pros and cons to this proactive approach–the pros being a reduction in veteran suicides and evidence of higher suicide risk in the three-to-six months of starting–and ending–an opioid prescription; and the cons being that some of the algorithms may be inaccurate–a veteran could be inaccurately ‘dinged’ for risk or a traumatic involuntary hospitalization. VA is still refining its algorithms in areas such as changes in medication dosage (including opioids) and clinical notes for mention of negative personal issues. POLITICO Health Care

FCC’s $100M Connected Care Pilot Program for rural areas up for July vote

Finally, a big boost for rural telehealth comes to the ‘yea or nay’ stage. The Federal Communications Commission’s (FCC) Connected Care Pilot Program, which was approved to proceed last August [TTA 9 Aug 18] with comments on the creation of the program, now moves to the next stage with a formal FCC vote on 10 July on the program itself. The FCC vote was announced by FCC Commissioner Brendan Carr, the co-proposer of the program with Mississippi’s Senator Roger Wicker, during a visit on Tuesday to a rural health clinic in Laurel Fork, Virginia.

The three-year program increases support for telehealth efforts aimed at low-income Americans in underserved regions and who are veterans, to increase their access to health technologies. Providers would be assisted in securing both technology and broadband resources needed to launch remote patient monitoring and telehealth programs. 

Commissioner Carr quoted, in his rural health clinic visit, stats from multiple studies including the VA‘s long experience (since the early 2000s) with remote patient monitoring:

  • A study of 20 remote patient monitoring trials found reductions of 20 percent in all-cause mortality and 15 percent in heart failure-related hospitalizations.
  • A remote patient monitoring initiative (not attributed) reduced ER visits by 46 percent, hospital admissions by 53 percent, and in-patient stay length by 25 percent.
  • The Veterans Health Administration’s remote patient monitoring program had reductions of 25 percent in days of inpatient care and a 19 percent in hospital admissions.
  • In savings, a diabetes trial run by the University of Mississippi Medical Center (UMMC) saved nearly $700,000 annually in hospital readmissions. This extrapolated, based on 20 percent of Mississippi’s diabetic population, that Medicaid would save $189 million per year.

HealthLeaders Media also noted that at the July meeting, the FCC will vote on a notice of proposed rulemaking to seek comment on funding to defray the cost of healthcare providers joining the telehealth initiative and innovative pilot programs aimed at responding to critical health crises including diabetes management and opioids. Also mHealth Intelligence

The wind may be even stronger at the back of telehealth this year–but not without a bit of chill

Late last year, this Editor noted that ‘the wind may finally be at the back of telehealth distribution and payment’. The expansion of telehealth access for privately issued Medicare Advantage (MA) plans, state-run Medicaid and CHIP (Children’s Health Insurance Plan) plan members, and this year’s Medicare Physician Fee Schedule, along with a limited expansion of telemedicine in the Value-Based Insurance Design (VBID) model for MA announced earlier this year by CMS, is a leading indicator that government is encouraging private insurers to pay doctors for these services, who in term will pay vendors for providing them.

The Veterans Health Administration (VA) has historically been the largest user in the US of telehealth services (home telehealth, clinical video telehealth, store-and-forward). They are also a closed and relatively inflexible system (disclosure–this Editor worked for Viterion, a former RPM supplier to the VA). In 2017, under then Secretary David Shulkin (who left under a cloud, and not an IT one), there were hopes raised through the Anywhere to Anywhere VA Health Care Initiative. So the news released at the start of HIMSS’ annual meeting that veterans will be able to access their health data through Apple’s Health Records app on the iPhone, perhaps as early as this summer, was certainly an encouraging development. According to mHealth Intelligence, the key in enabling this integration and with other apps in the future is the Veterans Health Application Programming Interface (API), unveiled last year.

Anywhere to Anywhere is also making headway in veteran telemedicine usage. Of their 2.3 million telehealth episodes in their FY 2018, over 1 million were video telehealth visits with veterans, up 19 percent from 2017. 105,000 of those video visits were through VA Video Connect to veterans’ personal devices. The remainder were real-time interactive video conferences at a VA clinic. The other half were assessment of data between VA facilities or data sent from home (the underused Home Telehealth).  Health Data Management

Virginia also moved to make remote patient monitoring part of covered telehealth services for commercial health plans and the state Medicaid program. The combined bills HB 1970 and SB 1221 will be sent for signature to Governor Ralph Northam, to whom the adjective ‘beleaguered’ certainly applies. National Law Review

But service providers face compliance hurdles when dealing with governmental entities, and they’re complex. There are Federal fraud, waste, and abuse statutes such as on referrals (Anti-Kickback, Stark Law on self-referral), state Corporate Practice of Medicine Doctrine statutes, and medical licensure requirements for telehealth practices. Telehealth: The Beginner’s Guide to Legal Pitfalls is a short essay on what can face a medical practice in telehealth.

VA expands telehealth services again with T-Mobile’s 70,000 lines

The US Department of Veterans Affairs and T-Mobile announced on Monday that T-Mobile would be adding 70,000 lines of wireless service to increase telehealth services in the VA network and expand services to veterans, especially those in rural areas. The expanding network will connect veterans at home and at VA facilities, such as community-based outpatient clinics (CBOCs), with VA clinicians within the VA network.

This adds to VA’s push this year to extend telehealth to distant veterans in rural areas through initiatives such as with T-Mobile and the Spok Health – Standard Communications partnership to expand the Spok Care Connect messaging service to more VA healthcare systems. The VHA (Veterans Health Administration) has long been the largest user of telehealth services in the US. Until recently, their emphasis has been on store-and-forward and clinic-based patient consults, but finally Home Telehealth (HT) is being supported. Reportedly, only 1 percent veterans used Home Telehealth, while 12 percent used other forms of telehealth [TTA 24 May]. Yet the VA was among the earliest users of remote patient monitoring/home telehealth, dating back to 2003 and even earlier, with companies such as Viterion and Cardiocom.

While most of the news about VA has been about their leadership changes and their difficulties around EHRs, their ‘Anywhere to Anywhere’ program was finalized in May. This allows VA practitioners to provide virtual care across state lines to veterans, regardless of local telehealth regulations.

T-Mobile is already the lead wireless provider to the VA. The 70K line addition is part of the carrier’s $993.5 million five year contract with the US Navy.  Business Wire, Mobihealthnews

News roundup: NeuroPace’s brain study, Welbeing’s Liverpool win, VA’s Apple talks, Medtronic’s diabetes move

imageNeuroPace, which developed an implanted brain-responsive neuromodulation system for patients with refractory and drug-resistant epilepsy, announced the result of their nine-year long-term treatment study.

  • Approximately 3 out of 4 patients responded to therapy, achieving at least 50% seizure reduction
  • 1 in 3 patients achieved at least 90% seizure reduction
  • 28% of patients experienced seizure-free periods of six months or longer; 18% experienced seizure-free periods of one year or longer
  • Median seizure reduction across all patients was 75% at 9 years
  • Quality of life improvements (including cognition) were sustained through 9 years, with no chronic stimulation-related side effects.

The study included 256 patients across 33 epilepsy centers with nearly 1,900 patient implant years of follow-up on the RNS System. Release.

Liverpool Mutual Homes (LMH) sheltered housing awarded its emergency alarm contract to Welbeing, a Doro Group company. Welbeing has added 1,200 LMH residents to their alarm services. Release (PDF)Hat tip to Welbeing’s Charlene Saunders.

It appears that the VA is talking with Apple about a mobile EHR. VA patients would be able to transfer their records to their iPhone — likely through Apple’s Health Records app. No time frame is mentioned and it’s hard to expect a quick turnaround given the VA’s stringent IT and security requirements. Another factor is that VA is making the long transition from VistA to Cerner’s MHS Genesis, bumpily. Mobihealthnews picking up a paywalled Wall Street Journal article.

Medtronic, otherwise known as the 9,000 lb Elephant that Sits Where It Wants, will acquire long-time diabetes partner Nutrino, an AI powered personalized nutrition platform. In June, Medtronic integrated Nutrino’s FoodPrint Report technology that connects meal and glucose variability into Medtronic’s iPro2 myLog app. Terms and timing were not disclosed. It fits in Medtronic’s recent strategy of smaller acquisitions and beefing up its diabetes business. Mobihealthnews.