Tag Archives: digitalhealth

Fortnightly Healthtech Update #7

Current Health (formerly Snap40) partners to add axillary temp and spirometry to the parameters it measures.

Detecting antibiotic levels in real-time.

Bioformis ups its game with FDA clearance for BioVitals to help manage chronic conditions.

MC10 partners with University of Rochester to collect real-world evidence for how people live with Parkinson’s. Reminds me a bit of this collaboration between IBM and Pfizer.

Interesting perspective that I hadn’t considered before: Dated US regulatory policies are endangering the US lead in healthcare technology.

Direct primary care (DPC) might help achieve half of the quadruple aim, clinician satisfaction and patient satisfaction. But lower healthcare costs overall, and higher quality overall, I’m not so sure. It’s also typically positioned as an up-sell to people who already have health insurance. But just thinking out loud, maybe there’s another angle. If you can’t afford a traditional insurance plan, would a low cost primary-care-only option with a strong focus on preventative care be better than nothing…?

Sounds like a lawsuit waiting to happen, Rensselaer County launches online emergency room for Medicaid patients. I’m sure the intent is good, to prevent unnecessary ER visits. But, pitching an app called “ER Anywhere” to a patient population might just be asking for trouble.

I expect to see more of this from large employers tired of rising healthcare premiums: Walmart to use Embold Health’s analytics to herd it’s employees to high quality providers.

Can a simplified cardiac risk score also predict strokes?

In case anyone was still in doubt, new research published in JAMA suggests 25% of al, healthcare spending could be waste (free registration required). And that doesn’t include administration. Candidly, a primary care doc once told me the rule of thumb in primary care is 3 admins for every medical practitioner. Their practice at the time had a 5 to 1 ratio! I’m inclined to think that admin overhead is a direct result of the complexity of the payer/reimbursement model. And they say that government managed healthcare would be inefficient…

Best practice for in-hospital rapid response teams (RRT) include having a dedicated RRT, and the ability for anyone to trigger the RRT without fear of reprisal.

The only thing that surprises me about this is that patients still have to pay some of the cost: Devoted health to use Apple Watch with Medicare Advantage patients. I would be shocked if most payers/providers aren’t paying for wearables like this in a few years – and financially encouraging patients to use them. If they’re not, it probably means the push for value-based care has failed.

The ECRI Institute releases its top 10 technology hazards for 2020. Not for the first time, the problem of over-alarming makes the list.

In Pennsylvania a patient tragically expired in the ER after being left unattended. A potential market opportunity for wearables perhaps. But unfortunately, hard to make a business case for it that is going to make a hospital CFO jump for joy.

Funding for digital health startups has cooled a tad, but still an estimated $1.3bn in Q3 according to Rock Health.

Fortnightly Healthtech Update #5

How to make use of pulse-transit-time in wearables.

Researchers at Stanford have developed a bodyNET sensor that could potentially measure vitals. More details here, subscription required. Or, if that’s not your thing, how about bio-compatible magnetic skin.

A study in China looks at the use of photoplethysmography technology to reliably detect atrial fibrillation.

We are less than one month away from a major change in how Medicare reimburses skilled nursing facilities. The aim is to get patients the care they need while removing the incentive to provide excessive amounts of therapy. But as Avalere’s Fred Bentley explains, it’s not really value-based care, because volume will still be a big driver of SNF profitability. MedPAC insists value-based care is coming to post-acute though.

Increased signs of action to tackle social determinants of health.

Honestly not sure what to make of this partnership between Verily (Alphabet, née Google) and iRhythm to develop solutions for atrial fibrillation. iRhythm already has afib detection, that’s what it does. So, maybe this is about reaching a bigger market and going direct to consumer at some point? Because right now, iRhythm needs a doctors order…and the Apple Watch does not, neither does AliveCor. So that would be a bit of a strategic shift. Or is the clue in the word “solutions”…? More to come.

In iRhythm-related news, BardyDX extends it’s own ambulatory cardiac monitor to 14 days. This potentially offers better diagnostic yield, since longer monitoring improves the odds of detecting infrequent cardiac events. It does not, iirc, open it up to an additional set of CPT codes (aka an adjacent market segment).

Vim gets some big name financial backers to provide better integration between payers and providers for value-based care.

Another Israeli project, including Ichilov Hospital, AnyVision, and BioBeat aims to improve monitoring of patients on the general floor.

New to me Health Recovery Solutions jumps into the remote patient monitoring fray.

I wrote about Deepmind’s work on renal failure detection recently, but Intermountain is using SymphonyRM to develop personalized treatment plans for kidney failure

Modern Healthcare’s list of 25 innovators in healthcare. Innovations include avoiding unnecessary ED visits, personalized medicine, price transparency, addressing the social determinants of health, and much more…

Judge blocks former CVS exec from joining Amazon’s PillPack. Admittedly, this is about enforcing a non-compete agreement. But, I can’t help feeling that if one of your top competitive strategies is wielding lawsuits, that’s never a good look. If you were innovating fast enough, whatever your former employee might have in their head would become irrelevant pretty darn quick.

The law of unintended consequences: The post-acute care savings reaped by Medicare value-based payment programs might be at the cost of family caregivers. On the other hand, Medicare’s bundled payment programs do not seem to have worsened the outcomes for frail seniors. Is that a win? I guess it depends if you’re a family caregiver…

GE is developing a sensor to analyse sweat.

Where Apple goes, Android is sure to follow – only much later…..a collaborative effort to let Android users access their medical records.

PeraHealth adds more FDA cleared capabilities to it’s patient deterioration solution.

CMS proffers both carrot and stick to convince providers to accept downside risk. Seema Verma says all the right words about price transparency and competition – albeit with the obligatory S-word thrown in. By which I mean socialist, obviously. How did it became socialist to want high quality, affordable healthcare for all citizens of one of the richest countries on earth? If that’s how it is, I think I can live with that. Anyway, actions speak louder than words so I’ll reserve judgement on what Seema Verma delivers. I just hope value-based care isn’t going to go the same way as commercial nuclear fusion – forever right around the corner.

Covenant Health introduces a remote sitter program for monitoring at-risk patients.

Research into another new type of wearable using graphene sensitized with semiconducting quantum dots.

Mercy Virtual invests in Myia to monitor heart failure patients at home.

Wondering where America’s National Institute for Health is putting it’s money on mhealth apps? You can find out right here.

Fortnightly Healthtech Update #4

I love hearing about startups in emerging nations – I think there is so much potential for cross pollination. Here are five from India focused on blood supply, preeclampsia, kidney health, ECG, and chronic disease detection, among other applications.

The NHS in England shows good results with a pilot for the early detection of sepsis, plans a nationwide roll-out.

A fortnight ago I wrote about Deepmind’s progress in detecting kidney failure. Here’s a bit of pushback, citing some challenges for AI in healthcare in general. This phrase jumped out at me: “(clinicians) also rely heavily on human judgment to diagnose…a level of subjectivity that would be nearly impossible to program into every AI algorithm”. It was well argued almost 10 years ago by very respected clinicians that removing some subjectivity and standardizing care processes (free registration required) would help deliver higher quality care at lower cost.  In other industries, we grow productivity by selectively substituting technology for labor. And we do that in healthcare too. In pockets. Just not enough yet to make high quality, lower cost care repeatable at scale. More on that a little further down the page….

Deepmind, on the other hand, is a half a billion dollar deep hole for Alphabet by the way…

Talking of pushback, Visibly has had to pull its mobile app eye test from the market. The American Optometric Association has apparently lobbied hard against Visibly. Taking a big step back, this might be something of a moral dilemma that we need to figure out over the next 10-20 years. The cost of healthcare is still rising. If that continues, an increasing number of people in the US are going to be priced out of conventional healthcare (i.e consulting a doctor, one on one). Telehealth could be an option.  But pushing the argument further, what happens when people can’t afford to see a doctor at all, even virtually. Are we really going to deny them the opportunity to have their health evaluated solely by an algorithm? Even if that offers a less comprehensive examination than a doctor. If the only options you can afford are diagnosis by algorithm, or no diagnosis at all, which would you choose…?

The American Heart Association is launching a pilot with LifePod Solutions to help care for people with chronic cardiac conditions at home. Also in the remote patient monitoring game, Biotricity reports strong quarter to quarter growth.

Rumors abound that all is not happy in the world of Apple health. But, that hasn’t stopped it expanding use of Apple Health Records to embrace Allscripts. And in not unexpected news, AliveCor has dropped its KardiaBand accessory for the Apple Watch. AliveCor has been pushing into more specialized territory with its 6-lead ECG anyway. But does a 6-lead ECG take AliveCor away from the direct-to-consumer (D2C) model…? I think it might. Meanwhile, if you do see anyone with both hands on a device – while simultaneously pressing it to their left knee or ankle –  you’ll know exactly what they’re doing

Things seem to be quite peachy at not for profit hospitals, with Mayo growing profits by almost 300%.

Researchers are working on a biosensor that uses interstitial fluid and might be used in place of blood draws in the future.

Biobeat gets FDA clearance for cuff-less non-invasive blood pressure. This has potential. First of all, cuff-less non-invasive BP should mean it’s more comfortable for the patient. That could be especially great in the home for chronic conditions. Second, in my experience there aren’t many wireless BP devices cleared for use in the hospital. There are two unknowns for me that are crucial to success down the road. First, does it fit easily into the clinicians workflow? If not, that’s going to make adoption in the hospital an uphill battle. And second, do the economics work? If it’s more expensive overall than existing approaches, it’s probably not going to fly, however much more comfortable it may be for patients.

In the land of mobile appointment bookings, doc’s choke on Zocdoc’s new pricing model.

I think Remedy Partners really needs this merger with Signify Health. Remedy Partners is arguably the most important player in Medicare bundled payment pilots. It “owns” more episodes of care than any other entity, and in some cases took on the financial risk instead of the providers. But, most of the cost variation in each bundle is driven by post-acute care (slide 16 onward). That is, what happens after the patient is discharged from the hospital. Without a good way to monitor patients post-discharge, that creates a huge financial risk for Remedy. This merger with Signify Health can help to fix that. 

Two chairs aims to take the stress out of finding a therapist.

Strong preventative healthcare is woefully lacking in the US. As Amy Brown of SpringBuk says, incentives for preventative care are not aligned. Honestly, I think there are limits to how much analytics can help with that. There are two massively fragmented, multi-trillion dollar industries here (payers and providers are two different industries, they just share a value chain). There’s a bigger piece here about preventative care that needs to come together in my head, I’ll try and get it written in the next week or two.

And last but not least, Isansys pilot shows that heart rate variability could predict 90 day mortality in patients with cirrhosis of the liver.

iRhythm: 12 words that change everything

iRhythm reported its Q2 results just over a week ago. With a 50% year-on-year growth, and a 76% gross margin things are looking really rather peachy. But there is a potential pothole or two in the road ahead. That’s why these 12 words in the press release are more important than the raw numbers:

“…our CPT code change application was accepted by the AMA for review…”

To be more specific, iRhythm is looking to change the CPT code for its devices from a category III code to a category I. Category III codes are used for experimental tests and treatments. As such, they are usually fleeting, temporary, short-lived. And as Kerrisdale Capital noted, that can create a real vulnerability for companies – like iRhythm – that depend on them. Nailing a category I code means you’ve cleared a big, big hurdle. Category I codes are what medical devices want to be when they are all grown up.

So, the AMA’s review is good and necessary for iRhythm. But, it doesn’t mean the company is home and dry yet. Under the current CPT codes (0295T-0298T, if you really must know…) the total Medicare reimbursement for using the Zio XT is about $90 a patient. They key question is this: Will the AMA review keep the reimbursement the same, increase it, or decrease it? Because that’s going to make a big difference to both adoption by cardiologists, and margins for iRhythm. And the answer to that question is, I suspect, down to lobbyists and lawyers as much as anybody else…

A quick disclaimer…Don’t take this as investment advice, because that’s not what it is, that’s not what I do.

Fortnightly Healthtech Update #1

Caretaker Medical is the only (deep breath…) FDA-approved, Bluetooth-enabled, non-invasive blood pressure monitor for hospital use that I’m aware of.  Now adding end-tidal CO2 via a partner, this should help to bring broader appeal.  Note the use of both Wi-Fi and cellular connectivity, which opens up the possibility for monitoring both in the hospital and in the home.  Since Medicare added reimbursement codes for remote monitoring at the start of the year, many more device manufacturers have started to focus on the home.  While accountable care and bundled payments could ultimately drive that change, there’s nothing quite like a good ol’ fashioned reimbursement to get the market moving…

On that note, CMS reports almost 100% growth in the number of physicians taking part in alternate payment models.  And here’s another change driven by the shift to value-based care: Bundled payments often cut costs by discharging patients home rather than to skilled nursing.  That’s perfectly OK – as long as patients are monitored and rehabbed in their homes.

Intermountain Health has been pushing down the value-based care road for some time.  It’s become so adept that it’s spun off Castell as a platform to help other providers down that path.

While financial incentives need to align for change to happen, communications technology also has to be up to snuff for monitoring in the home to become fully widespread.  So, good to see that the UK is pushing ahead with 5G pilots to fully evaluate the potential for rural communities.  Another (vendors) viewpoint on 5G here.

Talking of financial incentives, the FCC is lining up $100m for 3 years of pilots in telehealth and remote patient monitoring.

Also in the UK, using Amazon’s Alexa to dispense medical advice.  The aim is to take the pressure off overworked primary care docs (general practitioners).  Much easier to try that somewhere with a single payer from cradle to grave – the financial incentives simply align.  Much harder in the fragmented world of US healthcare, but I can see accountable care organizations going down this path too.  Every dollar saved is a dollar in the ACO’s pocket….

The FDA gets more interested in monitoring medication adherence.  Measuring adherence is one thing, improving it something else entirely though….

A new study looks at the use of wearables and machine learning for helping people stay on the path to overcome opioid addiction.  Since we know opioid use depresses respiration rate, it might be good to have a sensor to monitor that too. On a similar thread, Jefferson Health is using analytics to spot opportunities to rein in the prescription of opiates, and that’s no bad thing.

Not the first company to try measuring heart rate and respiratory rate using a camera, but Brainworks is new to me.  Philips has been down this path, while Smart Beat has a direct to consumer device for babies.  And you can find an app for heart rate in your phones app store already.  But, in a clinical setting, respiration rate is often a strong early indicator of impending doom.  For me, the biggest potential application for this type of approach is to help keep people with chronic conditions healthy in their homes.