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 COPD, diabetes, 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 here. Citizen 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.