Monthly Archives: May 2020

Digital Health, Healthcare, Healthcare Reform

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.

Digital Health, Healthcare, Value Based Care

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.

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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.

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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. 

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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.