Fortnightly Healthtech Update #29

I came across Tytocare a few years ago and lost track of it. Now, University of Miami hospital is using it for remote monitoring of discharged patients. It’s quite an elegant, yet simple, telehealth solution, enabling loved ones to help in collecting diagnostic information at home. See it in action here. My only observation is Tytocare should sharpen it’s demo script. Not only does mom avoid a late night ER visit, but she most likely avoids a large bill too.

Gabbi, healthcare advice for women, by women.

Docs say “Reimbursement is the key” to growing remote patient monitoring. Which is stating the obvious really, because nobody is going to keep working at something they don’t get paid for. (Side note, it troubles me to keep seeing articles that say the pandemic is the catalyst for the telehealth revolution. Wrong. The pandemic AND providers getting paid for using telehealth is the catalyst). Anyway, back to the article…What is a tad discouraging is that the word “reimbursement” appears in the article four times. The word “value” – as in value-based care – zero times. So, the thinking is still very much focused on getting paid for doing stuff, not for delivering better outcomes at lower cost. We’re not going to get the best from telehealth if we see it as just another way to deliver healthcare as usual. It needs to be more than that. It needs to be a way to deliver better outcomes at lower cost.

Related to that, a UnitedHealth study found that primary care docs paid by capitation outperformed docs paid using traditional fee-for-service on quality metrics. Capitation with quality metrics is pretty much value-based care by another name. So value-based care can get us where we need to go, we just need to get out of first gear already.

And related to that….With a focus on value-based primary care for Medicare patients, Oak Street health IPO’s for $328m. Notably, the article illustrates the advantage of the value-based care model for both providers and patients. For Oak Street, it’s revenue held steady during the pandemic because it’s not dependent on appointments to bring in the cash. Unlike traditional fee for service, it’s subscription healthcare. So, as appointments dropped, Oak Street was able to use vans that were normally used for patient transport for food deliveries to its population instead. Which is exactly what it’s population needed to stay healthy at that time. It’s an all too rare example of aligned incentives in healthcare. Another, more expansive article here. It’s what value-based primary care looks like in my perfect world. 

As opposed to….docs are partly dependent on patients to buy their own devices for remote patient monitoring. In a world where providers are at financial risk for the health of their population – such as an ACO – this wouldn’t happen. In that world, providers would invest in the devices directly  for its patients to avoid acute care costs further down the road. In the fee for services world, that’s less likely to happen because there is no financial incentive to do so.

PhysIQ is on a bit of a tear right now. In May, we saw a contract with the DoD, now it’s part of a plan to monitor discharged patients by NorthShore University HealthSystem.

Digital health continues to grow into mental health as well as physical: Quartet Health is working with SilverCloud Health to use it’s digital cognitive behavioral therapy tools. Also noteworthy, Ginger just added a series D funding round for $50m.

And a sign that telehealth is moving beyond the early adopter phase, Teledoc acquires Livongo. Interesting to wonder if this would have happened without the kick to telehealth from COVID. But investors were less than thrilled, in the short-term at least.

One Medical, a direct primary care startup, beats estimates, and will also offer telehealth only to enter new markets. More on the business model here.

There are a few companies out there developing radar-based vital sign monitoring. Circadia HealthNeteera, and MIT’s Emerald device to name a few. But apparently Google has papers lodged at the European patent office for something similar specifically for babies

Where Apple goes, Samsung often tends to follow: Samsung gets FDA clearance for EKG tracking on its watch.

New to me, smart apparel company Formsense looks for COVID-19 applications.

Lessons learned from a 15 year old ACO type model in Germany. One quote which you think would apply well to the US: “The message of taking responsibility for their own health resonates with communities that value self-reliance.”

More telehealth goodness: AHA study shows that telehealth home monitoring for infants that required cardiac surgery reduced mortality by 40%.

Fortnightly Healthtech Update #28

How telehealth fits into value-based care – especially when your community is a 75 mile boat trip from the mainland.

Somatix scores a win in senior living, monitoring residents at the Garden Spot retirement community in Pennsylvania.

Vital sign monitoring wearable company Current Health adds continuous glucose monitoring into the mix by partnering with Dexcom. With diabetes on the rise, and COVID-19 being more perilous for those with comorbidities, this looks like a smart play. The more relevant data you can bring into a single view for overworked nurses, the better.

Wildly controversial I’m sure: Uber offers to help out with contract tracing. So many perspectives….Many American’s would see this as an invasion of privacy no doubt. Although no doubt this data sharing is covered by the broad data sharing agreement that people just blindly swiped through when they signed up. In practice, this will cover a tiny fraction of the population – especially as Uber’s business is down by 80%. But also arguably, the sort of contact tracing action that will be necessary on a massive scale to beat the virus. Individual privacy versus public good, discuss. Personally, having lived in both Europe and the US, I can see the US struggling with the virus for longer than many European countries. The balance between individualism and the public good tilts toward public good in Western Europe.

In update #22, I noted that LifeSignals had gained the CE mark for its vital sign monitoring patch. Now, it has FDA clearance too.

New to me, Transformative gets a seed round for machine learning to predict cardiac arrest form existing monitoring technology.

Pandemic or not, digital health funding is still on a tear, with H1 funding being a record breaker. Two noteworthy trends for me. First, on-demand healthcare services are the most heavily funded. In case you needed to know why, InfiniteMD has a 200% growth in virtual consults. Disease monitoring – which would include remote patient monitoring – has the second highest funding. The fitness and wellness segment drops to fourth, having been one of the most funded segments for five years. I think that’s a fair reflection of how priorities have shifted over the last few months. Second, the emergence of healthcare systems as a source of funding is becoming stronger. Is that a good thing or a bad thing? Too early to tell I think. My concern is healthcare systems might be aiming to monopolize emerging technologies for their own profits, and that might ultimately slow broader adoption of new solutions. In other words, health systems could become even more vertically integrated than they already are.

CB Insights has a chunky report on digital health funding too. Taking more of a global perspective, this report highlights explosive growth in Asia. And, there are 46 healthcare unicorns, and only about half of them in the US – which is maybe not what we would assume.

Expected from Google perhaps, but not a company that’s been around for almost 200 years, Wolters Kluwer uses clinicians searches and other social media data to predict coronavirus hot spots.

Cutely named Sema4 raises $121m to push genomics and clinical data into practice – in areas such as precision oncology.

How long can this go on…? Employers aren’t happy with payers lack of transparency and foot-dragging on value-based care. The short answer is, as long as there are no viable alternatives. Direct primary care (DPC) is in its infancy, covering about 0.1% of the US population. Growing DPC is going to be really slow, as it’s very dependent on doctors making the change. And when docs do switch, they support far few patients by definition. Then there are startups like Oscar and Clover, that promise a different, more personal, but tech enabled experience. And opposing all that innovation, there’s lobbying by BCBS to maintain business as usual.

A proposal for really cheap biosensors from the University of Missouri: Pencil–paper on-skin electronics.

Solutions to the ills of healthcare don’t have to be complicated or expensive: Virtua Health cuts no-shows for oncology by 75% and improves inpatient bed availability by improving ED throughput.

Squarely focused on value-based care, Nutrimedy is kicking off a clinical trial to help people get in shape prior to total knee or hip replacement (TKA/THA). This would be attractive to providers taking financial risk, either as an Accountable Care Organization, or through a bundled payment for an episode of care. Medicare’s latest bundled payment experiment runs through 2023. I don’t have the numbers handy, but in Medicare’s prior bundled payment program hip and knee replacements were by far the most popular bundled taken on by providers. That’s because it was a relatively low risk way to dip a toe in the water of bundled payments. So, long story short: If Nutrimedy can cut the cost of rehab and complications by getting people in shape before surgery (pre-hab) that’s a cost saving for those taking financial risk. So, the provider will keep more money in its pocket.

A longer read: How to fine tune Medicare’s alternative payment model (eg. ACO’s and bundled payments) to grow participation.

Fortnightly Healthtech Update #27

Another shift in the primary care landscape, Walgreen’s aiming to move away from pharmacy to become a “health and wellness destination” by bringing primary care practice into the store. Mostly targeted on underserved populations, so that’s a win-win. I don’t have the data, but I imagine a growing percentage of prescriptions and OTC meds are now fulfilled by mail order or online. In other words, the traditional pharmacy is a dying business. Better then to evolve and wrap a service layer around your product business.

CMS calls for a renewed commitment to value-based care. Contrast with the acknowledgement that the Medicare trust runs out in 2026 from my last update. And why call for it in a press release…? Medicare and Medicaid combined spend is a trillion dollars a year…don’t write a press release, use your muscle to make it happen.

Or, maybe it is…? CMS proposes to make COVID-19 telehealth changes permanent for home health agencies. I hesitate to say it, but this could be the silver lining to the pandemic. First, CMS makes the reimbursement for telehealth and remote monitoring permanent, so providers start using it routinely. That helps manage the pandemic in the short-term. Most likely, in the medium term, this will cost CMS more, because in-person visits will return at some point. When they do, the healthcare business being what it is, many providers will bill for both remote monitoring and in-person visits if they can do so. But then, as full capitation kicks-in (eg. ACOs) and providers are carrying financial risk, they will see remote monitoring and telehealth as a way to cut costs and keep more money in their pockets. So maybe this is the way we get to value-based care that delivers both better outcomes *and* lower costs. 

Philips partners with Biointellisense for in-home vital signs monitoring. I imagine the big attraction for Philips was the 30 day life of the device. Philips’ recently released in-hospital wearable is fully disposable, and good for up to 5 days. In the home, that shorter life is inconvenient for patients, and also more costly, everything else being equal. Surely no coincidence either that providers get paid for a 30 day remote monitoring period under the reimbursement codes introduced 18 months ago. So, Biointellisense is very smart, because it’s just as important for medtech companies to focus on how they will get paid as it is to deliver clinical value. Deliver a 25 day device when providers get reimbursed for 30 days of monitoring and you’ll find yourself with a dud on your hands.

A first for EarlySense I think, providing patient monitoring for a detox center in Texas. Acute care hospitals, skilled nursing, and long term care are where the company has mostly scored in the past as far as I know.

Can surgery analytics be used for operating room performance enhancement? Of course! But you have to be willing to take action on the insights you get from the data. And that’s usually the hard bit.

Not to beat on insurers any further, but….profits surged at UnitedHealth. The culprit apparently is the cancellation of elective surgeries that is pushing many hospitals to the brink. The fact that hospitals are so dependent on elective surgeries for revenue is another story. A functioning healthcare system just shouldn’t be that way.Amazon tries direct primary care clinics for its employees. As the article notes, not the first company to do this by any means. Some tech companies have been doing this for a long time as “a benefit”. A benefit that also minimizes working time lost to doctors visits. But I think this is a growing trend. There’s a growing realization that primary care via health insurance doesn’t work. There’s no reason that preventative care should go through insurance. First, insurance just adds a margin to something that really isn’t an insurance risk, it’s routine maintenance. Second, insurers have no incentive to spend on preventative care, it’s just a cost to them.

Another glimmer of hope for Medicare ACOs, almost 70% are using, or plan to use, home health agencies. Related to that, some concern that value-based care is going to drive smaller home health agencies out of business. That’s because smaller providers don’t have the resources to adjust to new processes and deal with the reporting burden that comes along with it. That’s unfortunate, but probably necessary. Don Berwick argued a decade ago that healthcare needed to move on from being a cottage industry to become more industrialized. That is more repeatable, more scalable, more efficient. That article is 10 years old, and we’re still mostly waiting for that.

But, on the subject of driving care processes through data, differences in care for the over 80’s having a total hip replacement. Not many as it happens, but good that somebody studied it.

Vitls gets FDA clearance for a 6-day wireless wearable with continuous remote monitoring. Looks like the company is seed funded and runs a very small team. So it’ll be interesting to see what the go-to-market model is, because the company doesn’t seem to have the resources to go it alone..

Not too many startups focus on the less wealthy end of the healthcare business, but here’s one: CityBlock Health raises $54m to bring primary care and behavioral health to low-income communities. Especially important, the company includes a focus on the all important social determinants of health. More on the company’s business model here.

Fortnightly Healthtech Update #26

A two year research project to develop a wearable specifically for patients in emergency air transportation.

The pandemic is stalling the rollout of Accountable Care Organizations (ACOs) in many places, but accelerating it in others. Visionary hospitals, such as Intermountain and Mayo Clinic are pushing ahead with hospital at home models. There are no payment details in that article, so I’m thinking the only financial incentive for the health systems is cost saving as part of an ACO. Also looking at treating people in their homes, DispatchHealth raises $136m for its model of delivering a medical team promptly to someone’s home. A service that I think would be attractive for ACOs.

By the by, perhaps one of the problems with Medicare ACOs is that participation can be relatively short-lived. It’s a five year minimum for the Medicare Shared Saving Program. Five years is fine for a bit of tinkering around the edges. But, is it really enough to get providers to commit to the deep, radical changes in care delivery that are needed? Like changing clinical practices and investing in telehealth to keep people with chronic conditions at home. Because according to the Medicare Payment Advisory Commission, we’re almost out of time to keep the ship off the rocks. The Medicare Part A trust fund will be empty in 2026. So a more rapid pivot to Accountable Care Organizations is highly recommended.

Circadia Health gets FDA clearance for contactless respiration rate monitoring using low-power radar. Can’t be a better time to release something that monitors a key vital sign while protecting caregivers and limiting opportunities for cross-contamination. The company suggests providers use the new remote monitoring billing codes introduced by CMS at the start of 2019. These codes can work well for reusable devices, but are going to be an economic challenge for disposable devices. In a healthcare facility, single use helps to limit cross-contamination and cut equipment cleaning work. In the home, that doesn’t matter so much, so disposable devices just add cost.

Masimo steps into new territory with Centroid, measuring respiratory rate, orientation and detecting falls. New territory because Masimo is most famous for measuring blood oxygenation and related parameters. On the face of it though, this device doesn’t seem to offer anything different to VitalConnect, the Philips biosensor, or the Biointellisence BioSticker.

A bit of a tangent, vital sign monitoring underwear for race car drivers.

Hospitals lost the latest (but not the last) round of court battles over price transparency. While they ready an appeal, the hospitals’ position is that it would be a bad idea to force them to implement it during a pandemic. Maybe, but they could have complied last year instead of fighting it all the way. I don’t think this will help much in itself, but it’s a start. Transparency for the big expenses isn’t just down to the hospital. For surgery, there’s the surgeon. Easy enough to find out if they are in-network ahead of time. But the other really expensive skill in the room, the anesthesiologist, the patient rarely knows who that is going to be until a couple of hours before surgery. In-network or out, you know nothing about arguably the second most important person in the OR (after you). Oh, and Aetna’s handy advice on avoiding surprise bills includes patients should know the billing codes for everything beforehand. So, really no chance for the average person to get a fair shake at a reasonable healthcare bill then.

Not the most comfortable looking design perhaps, but Kyocera helps develop wearable for remote rehab monitoring.

Apple is set to make arguable its biggest healthcare contribution to date, introducing watch functions that are broadly relevant for senior health. If this can truly be used for remote medical monitoring, the reimbursement codes noted above for Circadia Health are probably the likely path to revenue for providers. But healthcare costs overall are only going to drop if that remote monitoring means in-person visits can be avoided.

A couple of longer reads: First, The promise and the perils of virtual health care. The author asks, “is virtual care a future we want?” If it makes healthcare more affordable, absolutely it is! Second, McKinsey chimes in with the implications of COVID-19 for value-based care. The biggest point is very valid, that value-based care is fine for steady-state healthcare. Not fine for a pandemic – but then neither is the traditional fee-for-service payment model. More tellingly for me is confirmation of the glacial pace of payment reform. A quoted report states that only 6% of payments have downside risk for providers. And that percentage hasn’t changed in 5 years. By my reckoning, that means payment reform has either stalled, or it was just a fiction all along. Fiddling while Rome burns springs to mind.

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., 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.’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.