Fortnightly Healthtech Update #25

Docs fleeing Medicare into direct primary care provides many opportunities for technology to take up the slack and help to grow productivity in healthcare. Better patient access to their records would be one, telehealth and remote monitoring of chronic conditions would be others. For that to happen, the emergency order to reimburse virtual visits the same as to face-to-face – or something like it – would need to be permanent. So interesting insights on the future of value-based care from Dr. Alexander Vaccaro at  Rothman Orthopaedics. I’m inclined to agree, if we want the telehealth boom to continue post-pandemic, push population health and then the providers have a bigger reason to drive out cost.

The pandemic isn’t helping either, as primary care docs see their visits dry up. As the article notes, one option is to be swallowed by a larger health system. We are all wise with hindsight. But direct primary care practices – subscription based, rather than fee for service – have a more stable revenue stream. Direct primary care may potentially get a legal boost, with the IRS proposing that direct primary care be treated as a qualifying expense for some type of flexible spending account. In the meantime though, some PCP’s are lobbying congress for direct financial support.

Open source comes to wearables, with the Open Wearables Initiative releasing a step count algorithm, and sets its eyes on gait.

I almost feel like I should put a disclaimer on this one: Israeli missile maker claims AI tech can predict virus patients’ deterioration. Fair enough, but I wonder how many physicians would agree with the quote “In data science, it doesn’t really matter whether its data from a satellite or blood measurements of a patient. You put data in and you get predictions out.”

Evidence – if it were needed – that providing patients with frequent, actionable health data can lead to better outcomes: FreeStyle Libre Glucose Monitor Reduces Hospitalizations in Diabetes. I’ve personally found this device very helpful. Although not diabetic, I have a sweet tooth and my blood glucose tends to run higher than ideal. With continuous glucose monitoring (CGM), I had real-time feedback on how specific foods affected my body. In the US, this device only available on prescription. Elsewhere, it’s over the counter. Not sure why…Wouldn’t it be better to help people avoid becoming diabetic than merely helping them to manage the condition further down the road? But which is more lucrative I wonder…?

Medicare ACO’s appear to be driving productivity growth, with the percentage of non-physician practitioners growing significantly. Which is good to see, the kind of changes that we should see. 

Binah.ai, the Israeli video-based monitoring group, raises a $13.5m B round. Are comparisons to the Star Trek legendary tricorder helpful? Probably not.

Sensors in clothing might be bubbling, with MIT pursuing a research project. Also from MIT, an update on something we’ve seen before, using wireless signals to monitor vital signs. I do have a bit of an issue with the statement “While healthcare facilities obviously employ a number of different measures to monitor resident and patient vital signs over time…” Theoretically true perhaps, but if it were consistently done well in practice, organizations like the Patient Safety Movement wouldn’t exist.

Video games as therapy: Akili Interactive gets FDA clearance to treat ADHD.

Highly valued startup, Proteus Digital Health, files for bankruptcy protection. There seems to be a lot of surprise about this, I’m not sure why. The majority of VC funded companies never make it at the best of times. Plus, digital health has been a bubble for a couple of years now. Ultimately though, however strong the company may be, healthcare is a supremely tough market to find product/market fit. Because “market” is a complex mash of clinician, patient, health system, and payer. If they don’t all align, it’s a problem. Focused on using sensors to track medication adherence, the first product was a smart version of Abilify. Granted, physicians would love to know that their patients suffering from mental illness are taking their meds. But asking those patients to effectively spy on themselves may have been a tough ask. The added challenge in healthcare is to try and find alignment of financial incentives in a crazy broken reimbursement system. Which begs the question, who on the provider side makes money if patients are more compliant with their meds…? There’s no obvious answer to that for me. So that’s always going to be an uphill battle. Because even if physicians love your product, there still needs to be a way for providers to make money from it in the US. And payers willing to support that, which takes time. In other countries, where delivering care cost-effectively matters, the path may be easier.

On the topic of patient compliance, I’m curious how well the Neopenda neoGuard is tolerated by patients. I’ve worn a few hideously uncomfortable prototype medical watches before, but newborns are at least limited in their ability to complain.

A longer read: It’s time for a new kind of Electronic Health Record, one that is more forward looking.

Fortnightly Healthtech Update #24

New to me Siren raises a $12m C round for it’s sensors-embedded-in-fabric monitoring technology. Ultimately, I think approaches like this have huge potential for monitoring chronic conditions in the elderly. Monitoring that is completely unobtrusive, and requires (almost) zero changes in behaviour. Such as sensors in clothing, or radar based vital sign monitoring.

Gotta love low-cost healthcare innovation: Higi raises series B funding of $30m to further it’s kiosk-based preventative care model. Aimed squarely at organizations taking risk for a population (eg. ACOs), the kiosks are free to use. If things look amiss, they can connect the consumer to a clinician. So far, Higi has been used by 62m people. Lowering the cost of preventative care to zero is good for consumers, and good for the provider taking financial risk for a population too. Looks like it’s working for Higi too….

More on accountable care, with COVID-19 set to disrupt the modest progress that has been made with Medicare ACO’s so far. ACOs are, not unreasonably, concerned about the financial impact of the pandemic.

Philips brings a new wearable biosensor to market, with some nimble footwork to address the COVID-19 monitoring opportunity. Compare and contrast with the earlier wearable biosensor here.

A rising tide lifts all boats, so predictably AI in healthcare gets a boost from the pandemic too.

Very early days, but Surrey University in the UK has an implantable sensor that is powered by the body’s movement.

A new clinical study finds that EarlySense is capable of detecting acute pulmonary embolism

New to me Vtuls offers 3 months free service to UK care homes, a hotbed for COVID-19 infections for many reasons. Hopefully that offer is as genuine as it sounds and comes with no strings attached – like a 3 years paid subscription tacked onto the free.

Evidence that the direct primary care (DPC) model can drive diabetes care costs lower with good preventative medicine. I think direct primary care will evolve to be a major component of employer-provider healthcare. DPC puts the primary care focus on what primary care should be. Preventative medicine and the management of chronic conditions. And there’s no reason why any of that should go through health insurance. Routine servicing on my car doesn’t go through my insurance. Routine servicing on my body shouldn’t either. For that, the insurer is just adding a layer of admin and taking a margin that consumers really don’t need to give up. So I can see more employers carving out primary care (“direct to employer care”) to work with practices like Iora Health. Some states, such as North Carolina, are clearing the legal path for that.

Will the cost savings be passed onto consumers, or will CVS pocket them: CVS to deliver prescriptions with autonomous vehicles.

A length academic-ish article on why innovation isn’t reducing healthcare costs. The conclusion is we need to innovate for cost-reduction, not innovate for novelty. True, but it’s more than that. Before we get to that step, we need to incentivize cost-reduction.

McKinsey is speculating – and I choose that word carefully – that the telehealth market could grow to $250bn a year, post pandemic. Wisely, McKinsey places a question mark at the end of the article’s title. For good reason in my view. The article has lots of good strategic advice on how practitioners can plan for a telehealth world. And it does also touch on the elephant in the room. Reimbursement. There may be many good clinical reasons for telehealth to grow. Telehealth may be embraced enthusiastically by clinicians. But, if the healthcare industry can bill $1,000 an hour for in-person visits, but can only bill $800 an hour for telehealth, change is going to be very slow in coming. (All numbers made up just to illustrate). Unless telehealth segments and increasingly becomes a direct-to-consumer play, like this example. And if I could do eggs over easy like that I’d be a proud man….

Fortnightly Healthtech Update #23

It’ll be interesting to see Startup Health’s next analysis of where the VC money went in Q2. My guess would be telehealth: Carbon Health lands $23m for a partly virtual offering.

As if enough opioids weren’t prescribed already, Practice Fusion got busted for taking payments from a pharmaceutical company to build a pain alert tool to encourage physicians to provide more. 

Atul Gawande is no longer CEO of Amazon-JP Morgan-Berkshire Hathaway health startup Haven. If any kind of sea change happens in the US healthcare industry – and we need it to – it’s going to come from outsiders. But I’m not discouraged by this change. Is being CEO of this venture the best contribution Atual Gawande can make to changing healthcare? Probably not, because being CEO is about far more than having a vision and a medical background. 

More consumer tech pressed into COVID-19 monitoring: Mount Sinai deploys Google Nest cameras for remote monitoring. The bad boys of big tech are helping in other ways too, with Amazon involved in multiple COVID-19 related projects.

While the cost of care keeps going up, the lack of competition means hospitals can keep passing on the cost of their inefficiency: 88% of the days first surgery is delayed. I’m guessing if most of the first surgeries are delayed, so are all the others that day. Because if OR’s aren’t running at a high utilization, then we have another problem all together.

I mentioned Tissue Analytics a couple of issues ago. It just got swallowed by a specialist EHR vendor Net Health. That’s OK, but Net Health is owned by private equity groups. I’m not thrilled about private equity getting involved in healthcare. Lack of transparency is a big problem driving healthcare costs higher. Private equity just adds another layer of obscurity since their financials aren’t public at all. Bloomberg has a nice piece that digs deeper into some of the consequences of PE’s move into the healthcare industry. Where there’s a fat margin to be found, private equity goes. If anything, private equities’ growing presence in the healthcare industry is a sure sign that the healthcare industry is more divorced than ever from the practice of medicine.

In a COVID-19 related development, Banner Health introduces virtual waiting rooms and chatbots to its appointment check-in process. Which is great, but I have to wonder: If the healthcare industry was as competitive as it could be, innovations like this might have happened long ago, purely as a way to gain a competitive business advantage.

As the pandemic makes temperature monitoring desirable, so vital sign monitoring companies are looking to fill that hole in their solutions where necessary: Current Health partners with VivaLNK to do just that.

BreatheVision is about to start a trial of its respiration rate monitoring device at the Sourasky Medical Center’s Ichilov Hospital.

Pakistan brings female doctors who are out of the workforce back into action for remote monitoring.

A possible biosensor from A&M University to help gout sufferers.

VitalConnect gets to work with BARDA (the Biomedical Advanced Research and Development Authority) on a COVID-19 monitoring solution.

As the pandemic forces changes to healthcare access, so the spotlight has returned once again to the lack of interoperability restricting access to patient data. It’s been a basic competitive strategy of the software industry forever. If you’re already the dominant player, the best way to retain and grow your customer base is to make it hard for customers to migrate to a competitor’s system. That includes locking up the data. That works until somebody else big has a more open approach and can change that. Like Apple. Because Apple’s growth path is to expand the number of consumers using its devices. The growth path for EHR vendors is to expand the number of hospital systems usings their software. Patients aren’t even in the equation. For Apple, letting customers carry their medical records around on their phone grows customer loyalty. For dominant EHR vendors, open access to data is not in their best interests…

Fortnightly Healthtech Update #22

Really not sure how I feel about this, Primary care needs a new operating system. Especially when the article is written by a venture capitalist…? OK, I do know how I feel about it. It’s not the number of billing codes that’s the problem. Maybe the fact that there are billing codes at all for primary care is the problem. Just focus on delivering preventative care at a fixed rate, problem solved. Whether it’s direct primary care, some form of capitation etc. is less important. A bit like the model proposed by the Pacific Business Group on Health.

After years of desperately slow adoption of telehealth, now the barriers are really dropping. To move things along, CMS agreed early in the pandemic to expand reimburse for virtual visits. Now, some providers are pushing for audio-only visits to be added into the mix. I think we used to call those telephone calls.

New to me, Stasis is providing COVID-19 remote monitoring in India.

Pivots everywhere you look, Chicago’s Neopenda is trying crowdsourcing to help pivot to the US market from the initial target of Africa.

Also new, a collaboration in Belgium makes a play for COVID-19 remote monitoring. In my experience, 6-sided collaborations rarely end well. Just too many cooks. I hope to be proved wrong in this case…

Not much of a looker perhaps, but LifeSignals receives the CE mark for its wireless vital signs monitoring wearable.

Tech experts: Widespread adoption of telemedicine, remote monitoring ‘here to stay’. No not really, not in the US at least. In Western Europe and other places where the aim is decent healthcare at the lowest possible cost, sure. In the US, technology adoption in medicine is decided mostly by lobbyists, lawyers, and accountants haggling over reimbursement policies. People who practice medicine are a poor second sadly. So unless the COVID-19 related temporary telehealth reimbursement policies (see above) are made permanent, telehealth will fade again just as quickly as it blossomed. Despite strong use cases like this, checking in with seniors at home.

More nimbleness from the federal government, flexing Medicare reimbursement rules as hospitals reconfigure to provide more capacity to counter the pandemic. Perhaps more renowned for rapidly adapting to a crisis, the US air force is adapting a monitoring solution used in the field for COVID-19. While on that thread, the DoD is working with PhysIQ for similar reasons.

Hackathon at Cornell gives birth to a smart facemask that also monitors vitals.

A bit of a change in direction/maturing of strategy for AliveCor. Originally marketed as a direct-to-consumer ECG device, the company has also gained traction with healthcare professionals. Notably in the UK, where lifetime cost of care from cradle to grave is a driver. Now, AliveCor partners with Medable for home use with clinical trials.

Also on heart health, I remember seeing this as a research project a couple of years ago, nice to see it getting funded. Bemis Manufacturing leads investment round in NY startup’s in-home cardiac testing device. The beauty of this is the monitoring is unobtrusive – and pretty much unavoidable, so helping with patient compliance. With sensors built into the toilet seat, you’re pretty much guaranteed to get a measurement once a day.

For a longer read, the redoubtable McKinsey maps out the journey for healthcare providers through COVID-19 and beyond.

Fortnightly Healthtech Update #21

The state of Illinois partners with OSF and Southern Illinois School of Medicine team up to monitor some COVID-19 patients at home. But before you get too excited, it’s pretty low tech.

While COVID-19 obviously makes some healthcare providers overburdened, some might struggle to survive: Almost half of primary care practices may have to close in a month due to lack of patients/revenue. Which could allow cash buyers to pick up the assets at fire sale prices, and that often drives up costs for consumers. On the other hand, here’s a viewpoint that it might ultimately send primary care docs down the direct primary care/concierge medicine path instead. For more on that, keep scrolling…

Good to see the federal government can still move apace when it feels the need: The FCC funds 6 hospital telehealth programs within days of application

Is consumer health tech more trouble than it’s worth? A high false alarm rate and lack of robust connectivity is a problem for Owlet. Being open that your device is not a medical device doesn’t matter. It might get you off the hook legally, but new parents who can splash $300 for a monitoring device are going to have high expectations. Being accurate/connected *only* most of  the time isn’t going to cut it.

Binah.ai’s solution for measuring vital signs automatically via camera is being trialed in Montreal.

Necessity is the mother of invention: Mount Sinai in New York adapts an existing stroke solution for remote monitoring of COVID-19 patients. Also adapting existing solutions to the pandemic, the eCart algorithm for early detection of patient deterioration is being fine-tuned.

Sensium gets a COVID-19 bump monitoring quarantined travellers arriving through Heathrow airport.

Could coronavirus derail the decades-long shift to value-based care? Could it derail it…? No “could” about it, it’s nailed on that it will. Coronavirus has already derailed absolutely everything else about “normal” that I can think of, so it’s pretty much guaranteed. Exhibit A: CMS is delaying the new payment model for ET3. There’s no doubt in my mind that we’re entering a new era for US healthcare. We’re a nation where so much of healthcare spend is via employer-subsidized insurance. And suddenly so many people have lost that benefit – and their income – however much we might whine about the cost of healthcare ordinarily. And everyone downstream of that cozy employer-employee relationship is going to lose healthcare revenue too – insurers, big pharma, PBMs, providers – everyone. Something is going to change. It’s a period of destruction, but will it be creative destruction? Maybe this will be a pivotal moment for direct primary care.  Similar thoughts here.

A sharp idea straight out of the University of Washington, using machine learning to distinguish a genuine cough from noise.

Digital health funding broke all records in Q1, according to Rock Health. It’s going to be really interesting to see how much the pandemic affects the rest of the year. I expect funding will drop overall, but anything that supports healthcare-remote-anything might find itself caught up in a funding boom.

Researchers in The Netherlands determine that AliveCor may be just as effective for managing blood pressure remotely as in-the-flesh visits to a clinic. Which leads us neatly into….

A couple of developments coming out of MIT. I think this is a development of a project I first saw maybe three years ago, using wireless signals to measure vital signs for COVID-19 patients at home. And further out still, embedding sensors into clothing to measure vitals continuously.

Is AI really better than physicians at diagnosis? I have two thoughts on that. First, AI’s diagnostic skills are still improving at a much faster rate than human docs. Second, AI is – or will be – cheaper. And that, in countries that have a strong focus on total cost of care, is going to be what drives adoption.

The long read: The history of telemedicine, how it came to be, how it promised to break down socio-economic barriers, and how it seems destined to be a tool for the wealthy. Really, it’s a good read, my description doesn’t do it justice. If nothing else, it highlights the tension between those that see the practice of medicine as a public good, and those that see it more as an opportunity for profit.

Fortnightly Healthtech Update #20

I’ve tried to keep Corona-virus free in the last couple of issues. That’s pretty much impossible at this point. However, the good news – if there is any right now – is that some wearables are actually starting to be used to help fight the pandemic. Not just optimistic press releases, but actual usage. So let’s learn about that.

Providence – first in the eye of the storm in Seattle – are using Xealth to help deliver remote patient monitoring

The ever inventive Israeli’s are adapting a couple of monitoring systems I’ve not come across before for remote monitoring. EchoCare Technologies uses radar to detect falls in seniors primarily, but also measures respiration rate. Neteera uses a similar idea, but seems to capture a broader range of vital signs.

Also from Israel, Nuvo Group gets the nod from the FDA for its remote pregnancy monitoring for both baby and mom.

Unlikely saviors for desperate times, Alphabet’s Verily has helped to roll out COVID-19 testing in California.

Meanwhile, the Aussie’s have developed a biosensor for real-time tumor tracking. Details on how it works here.

New to me, Tissue Analytics, uses a phone app and machine learning to provide remote clinicians with highly detailed insights into wounds.

I’m shocked by this survey result: 91% of American’s want healthcare price transparency. Did the other 9% not understand the question? Why would anybody not want to know the price of care before treatment…? The answer, most likely, because they have a healthcare plan that costs them little or nothing beyond their monthly premium..

It’s been widely suggested that treating patients in their home would reduce the cost of care, versus a hospital visit. Intuitive really, but still needs to be proven out. Brigham and Women’s in Boston has done that to some extent. Less than 100 patients total, but demonstrating 38% lower cost per episode of care.

Plenty of discussion about the almost complete inability to do contact tracing in the US for COVID-19. Not helped by the fact that in many ways the US acts like a collection of 50 smaller countries – not unlike the dreaded EU! Not to mention the complete lack of integrated health records. But, there is at least now an outline of a policy to tackle that. Policy papers may be irrelevant at this point though, as Apple and Alphabet have announced that they will work together to enable contact tracing. But still plenty of unanswered questions about that project.

Remote monitoring in more than one sense, Biovotion has a COVID-19 related remote monitoring project in remote Australia, Murrumbidgee Local Health District to be exact. Not to be outdone, Caretaker Medical is also setting up for remote monitoring of vitals with Australia’s first virtual hospital

Masimo SafetyNet has also been extended to remote-monitoring in the home for suspected COVID cases by St Lukes in Pennsylvania.

CMS requires providers to be compliant with a bundled care protocol called SEP-1. However, there now seems to be evidence that not all elements of the bundle are necessary. Dig deeper though, and it seems SEP-1 might not be based on clinical evidence at all.

Possibly the most classless press release of recent days: MindCotine scores US$230,000 just in time to get at-risk smokers to quit before Covid gets them. Maybe the team at MindCotine just needed to invest a little more of that $230,000 in a better translator, hard to say.

Fortnightly Healthtech Update #19

One small step on the road to reasonable med prices, Illinois caps the price of insulin.

There’s a lot of ongoing speculation that the Coronavirus pandemic might finally bring us into the telemedicine era. The FDA has lifted some restrictions on remote monitoring. It’s also temporarily blessed non-HIPAA compliant audio and video. And practicing across state borders. But it’s going to take more than that to make the change stick. It’s going to take alignment of reimbursement rates, as this tweet shows. Certainly as the stock market craters, investors are excited about companies like Teledoc. A bigger opinion piece by Forbes here.

Some wearables are certainly getting a kick in adoption, with the Oura Ring being used to monitor the health of caregivers in a couple of San Francisco hospitals.As far as I can tell, this is a wellness device, not a medical device (ie. not FDA approved). Which probably explains why it’s on caregivers, not patients. That said, the FDA has also relaxed the regs on ventilators manufacturing. Which is fine. If the only choice you have is a possibly iffy vent, or no vent at all, which would you pick? Expect the FDA to relax plenty more rules over the next 12 months. The more interesting thing is how many those changes will stick when we make it through to the other side.

While many industries are looking for the federal government to bail them out as their revenue plummets, ACO’s are looking for help as their costs threaten to explode. Personally, I’m just as interested in seeing what help there will be for families who face bankruptcy because their healthcare insurance cover is so meager.

In news that is probably not COVID-19 related, patient monitoring company Masimo is set to acquire a ventilator company, TNI Medical. As the press release states there is no material impact for 2020, it looks like a longer term play. Masimo’s core business is measuring and monitoring patient oxygenation. Acquiring a product for ventilation is perhaps a move to close the loop between monitoring and therapeutic delivery and deliver a more complete solution.

On that note, I’ve highlighted a lack of continuous patient monitoring as an issue in Cleveland before. Therefore good to see further studies and adoption of solutions to address this need. First, Masimo reports zero deaths or injuries from opioid induced respiratory depression from a 10 year study. In the much smaller control group, sadly 3 deaths occurred. Second, Children’s Hospital of Georgia signs up for Philips’ IntelliVue Guardian to measure early warning scores more reliably, and so improve intervention when needed.

Alphabet’s DeepMind throws its weight behind COVID-19 protein structure folding. Protein folding using spare cycles from home computers has been a thing for over 10 years. That means you can do your bit to tackle COVID-19 and other diseases, sign up here.

Population health is an under-rated discipline – especially in the US where the payer/provider landscape is so fragmented. That may change with the current pandemic, aided by the increased use of consumer wearables. Researchers at Scripps have kicked off a project to do just that

Fortnightly Healthtech Update #18

This might just be the only COVID-19-free healthcare email you read this week. I wanted to keep it that way, providing a veritable oasis of calm. But that does make it a smidge shorter than usual….Personally, I am very interested to see how this pandemic might change the delivery of medicine. We’re still mostly dependent on in-person visits in the US. But that’s more about how providers get paid than it is about a lack of technology alternatives I suspect.

Phone camera based vital sign measurement from Binah.ai now offered with Burnalong, a fitness app. I’m hoping this isn’t the be all and end all for Binah.ai. Most likely there’s a professional medical application lurking in here too. But working with the consumer market should give the company quick access to lots of data. And that data can be used to refine the underlying AI models to improve accuracy and accelerate product development.

US researchers working on a smart bandage to both monitor the patient and promote healing.

Somatix has an interesting approach to monitoring the elderly as unobtrusively as possible. It uses gestures and hand movements to look for signs of impending trouble. I don’t quite understand why it positions itself as an AI company and not a medtech company, but it does.

I once had a physical therapist friend tell me that women’s pelvic health was a massively under-diagnosed issue. So it’s good to see VaGenie is the winner of Boston Scientific’s Connected Health Challenge.

BioBeat gets CE mark for its wearables that measure blood pressure, cardiac output, stroke volume, oxygenation, and heart rate. This in addition to the FDA clearance granted last year for some parameters. What’s particularly noteworthy is the ability to measure blood pressure off the chest, as well as the wrist.

Lyft simultaneously finds recurring revenue and helps with the social determinants of health. This deal backs onto an existing 3 years deal. It’s great that people are being creative about solving the transportation issue for patients who need it. And presumably, in an accountable care world, providers will actually pay the $20 for the ride if they are going to save thousands in downstream healthcare costs.

A Philips survey reports that 35% of young doctors are overwhelmed by patient data, or aren’t sure how to use analytics. Sounds like we need to re-think physician education.

Researchers find that 3D printing could lead to a better type of silicone wearable.

Some are excited that the federal government has published interoperability rules that *might* allow patients better access to their data. Others are concerned that said rule is a hefty 1,244 pages long.

OK, so I didn’t quite live up to my promise, but it’s a great story that points to the future: Italian hospital 3D prints values it needed for the ICU.

Fortnightly Healthtech Update #17

Lengthy article on the evolution of mobile phones for digital phenotyping (ie. continual data collection of the individual). 

CareSignal (formerly Epharmix) gets funding from customers and others for remote patient monitoring. The beauty is, it’s a relatively low-tech solution that can be used by many diverse patient populations with different conditions. See studies on COPDdiabetes, and mental health. Often, simple really is better.

The direct primary care model continues to evolve with Clove Health claiming to be the first legally incorporated as a public benefit corporation getting to work in Florida. More on that style  of incorporation hereCitizen Health is heading down a similar path.

I touched on the ongoing battle over patient access to their own data. Apparently the federal government has started hitting providers with fines if they make it difficult for patients to get their data.

From Imperial College London, using sound to detect vital signs allows a device to penetrate layers of clothing.

Medicare builds on the mixed success of ACOs to create the Direct Contracting model for the next stage of value based care. There’s also the Primary Care First model, now due sometime next year. Also, a fresh study of Medicare ACOs finds that much of the cost variation comes from the use of out-of-network primary care docs.

More Medicare, the CJR program was controversially introduced as a hip and knee replacement bundle a few years ago. Controversially because it was a mandatory bundle introduced because providers didn’t sign up for the similar voluntary program with sufficient enthusiasm. Now CMS wants to extend it for another 3 years, and add in outpatient settings too. Which makes sense because it will drive the cost down, all other things being equal.

A new design to make better, cheaper biosensors for fluid analysis. Quite honestly, it works in ways I don’t fully comprehend, but hopefully it means something to some of you…

More healthcare reform, CMS picks 205 EMS services for the experimental ET3 model. The intent of ET3 is mostly to help people with chronic conditions get treated in their homes, avoiding the personal discomfort and stress of perpetual trips to the ED. It also should save Medicare money on avoidable ED visits too. To do that, ET3 allows EMS to get reimbursed for other services, not just transport. This potentially opens up another route to market for medtech vendors in applications like remote patient monitoring.

Wearables and machine learning start to show real promise: PhysIQ and VitalConnect study shows promise for predicting hospitalizations for heart failure patients. We’re already seeing machine learning breaking into imaging. I think continuous patient monitoring also has real potential. There’s a big need to determine baseline vital signs for individual patients, rather than just using generic values. I think machine learning might have the potential to usher in more adaptive algorithms that can help to reduce the long-running over alarming problem.

Apple leans hard into atrial fibrillation. A new collaboration with J&J makes the Apple Watch available for $49 to seniors who take part in a study. This could be a win for everybody: Seniors who avoid a potential stroke through the early detection of afib, cardiologists who get more business, and obviously Apple. Presumably J&J has some meds for managing afib in its portfolio too. And Medicare could win, since stroke care is reckoned to cost $40bn a year.

Sepsis has been a silent killer for a long time. A new study finds a stunning growth of 40% among Medicare beneficiaries who were hospitalized. Digging deeper into the economics, the same study finds the total cost of treating sepsis to be much higher than previously thought – over $23bn for inpatient care alone.

At the other end of the age scale, Children’s Hospital of Philadelphia has developed a new algorithm for detecting pediatric sepsis.

A new potential tool in the opioid crisis, a wearable to detect opioid induced respiratory depression (OIRD) in the community. Developed by Altair Medical in Scotland, I’m interested to see how this develops and works in practice. There are definitely challenges in current opioid addiction treatment that this could address. (For podcast fans, Freakonomics has a good two-parter on the crisis and current approaches). Also, equal parts tragic, genius, and sheer practicality, a number of communities are training kids to administer Narcan. Note, OIRD is still a major problem for post-surgical patients too, where hopefully the patients location and time to rescue are more predictable, so potentially more effective overall.

Simple early warning scoring is still an undervalued (and under adopted) practice for catching patient deterioration early. One hospital system in the UK dropped cardiac arrests by 75% by capturing vitals at the bedside with iPads and calculating the early warning score automatically. 

An unfortunate reminder that technology alone can’t change anything: WellSpan Health York Hospital gets cited for failure to respond to a patient in distress. It seems even thought the patients falling heart rate and oxygenation levels were noted for at least 20 minutes, nursing staff failed to intervene.

Fortnightly Healthtech Update #16

Walmart moves into radiology, opening a clinic in Calhoun Georgia with x-ray facilities. Which is a nice lead in to will big retail disrupt healthcare more than big tech?

Profusa’s Lumee tiny oxygen sensor gains a CE mark. Intended for conditions such as peripheral artery disease, the device operates for 28 days, clinical study here.

Apple highlights it’s healthcare presence in its earnings release, claiming 100% of F500 companies in the healthcare sector use Apple. Which sounds impressive, but when you think about it, that’s a small number. You might even be able to count those companies on the fingers of one hand. 

Medicare’s bundled payment isn’t perfect, it rewards doctor’s who take lower risk patients. Really would be nice if it worked the other way around perhaps.

The legal fight over price transparency continues. Meaningful transparent hospital pricing would lead to meaningful competition among hospitals. Competition among hospitals would lead to lower prices. Hence, the AHA is obliged to fight it on behalf of its members. But the American Academy of Family Physicians is not.

On the theme of overpaying, Medicare paid $7.8bn for insulin. If it paid the same prices as another federal government department (the VA) it would only have paid $3.4bn. That is just one of many examples of Medicare overpaying because of a lack of political will.

Verily partners up with Santen for vague eye are projects.

Continuous vital sign monitoring in hospitals is becoming a thing at glacial pace. (See Isansys in the last post). This study compares the performance of devices from EarlySenseSensiumVitalConnect, and Masimo. In summary, all are accurate for heart rate, some better than others for respiratory rate.

The lack of continuous monitoring still hits the broader headlines occasionally. In this case,  Cleveland area hospitals are highlighted for their tardy adoption following the tragic loss of a patient in 2016. 

Also continuous monitoring, continuous monitoring of urine for the early detection of kidney problems from Serenno Medical.

Virta Health – treating diabetes the old school way with diet – has been running a pilot with the VA for a year.

Scientists in Korea have developed a biosensor test for the early detection of Alzheimer’s.

An opinion piece from a Professor at Stanford University School of Medicine, outlining how a simple market segmentation would improve healthcare delivery. In practice, I think market forces are already doing this to some extent. The reasonably wealthy/reasonably healthy are starting to adopt concierge medicine, or direct primary care. But, I can’t figure out how direct primary care is going to work for the chronically ill. The direct primary care model often touts unlimited primary care access as a benefit. But, unlimited access to a primary care doc is just like having unlimited paid time off. It only works if you don’t take the “unlimited” literally. And that won’t apply to many chronically ill people with multiple comorbidities of course. And if that mild criticism wasn’t enough for you, Molly Osberg well and truly shreds direct primary care – the comments are definitely worth a read too.

Oh, and Iora Health, one of the pioneers for direct primary care, just closed $126m in funding.

Apple finds itself squaring up to Epic and assorted hospitals in the fight to allow patients to easily access and share their healthcare data. Epic and friends voice concerns about patient privacy. But, dig deeper. Allowing Apple access to health records is a long-term threat to Epic’s dominant position in the EMR business. And, as noted above (on price transparency), hospitals aren’t keen on competition either. Preventing people from easily moving their data from one provider to another is just one more way to lock in a patient’s revenue stream. Which is really unfortunate. Because, if consumers had better access to quality data, better access to pricing, and could easily move their health records from one provider to another, hospitals that delivered greater value to consumers would ultimately thrive. And those that did not would either raise their game or wither and die. Everybody wins – except sucky hospitals.

Also in the EMR connectivity game, Innovaccer raises $70m to create longitudinal patient records to support the transition to value-based care. I imagine it will find “patient privacy concerns” to be a challenge too. 

Caretaker Medical of finger-cuff blood pressure fame, adds ECG via a partnership with VivaLNK. Ditto VitalConnect, partnering with CorVitals to add arrhythmia detection.

Researchers in New South Wales come up with a superior algorithm for early detection of sepsis.

Machine learning is steadily making inroads into the diagnostic space. PhysIQ adds a patent to estimate cardiopulmonary function from wearables.

Challenging assumptions or a little Christmas humor…Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.