Kaiser Permanente’s Dr. Yan Chow: Workflow is the barrier for telehealth

By: Neil Versel | Apr 22, 2013        

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Kaiser Permanente Yan ChowUnderserved communities in the U.S. stand to benefit greatly from telehealth and mobile health technologies, but only if clinicians adjust their workflows to include remote care, payers start offering the right financial incentives for providers to do so and the technology infrastructure is in place to support digital outreach, attendees at a conference heard last week.

“It all boils down to workflow,” Jeff Russell, director of vertical market sales for online videoconferencing technology company Vidyo, said at the Health Technology Forum Innovation Conference Friday in San Francisco.

“It’s never the technology that’s the barrier. It’s the workflow,” agreed Dr. Yan Chow, director of Kaiser Permanente’s Innovation and Advanced Technology Group.

One reason why workflows do not support telehealth is because payers traditionally do not reimburse for such services, Chow noted. “For many specialties, they’re still thinking traditional care. That’s how they’re paid,” he said.

That is changing, however. Tapan Mehta, global healthcare lead for Cisco Systems, reported seeing a “significant picking up” in telehealth usage in the last 12-18 months, in no small part because of the wider availability of reimbursements.

The new Medicare policy of not reimbursing hospitals for preventable hospital readmissions within 30 days of discharge of patients with heart attacks, congestive heart failure and pneumonia, as part of the gradual shift in general toward bundled payments, also has prompted some providers to invest in telehealth services, panelists noted.

The growing national primary care physician shortage is another concern, one that likely will worsen in the near term as millions of currently uninsured Americans gain coverage under the Patient Protection and Affordable Care Act starting next year. Telehealth and mobile health certainly can help, but providers and vendors alike still are looking for the most appropriate use cases and grappling with reimbursement issues as they innovate.

“Teledermatology is a winner. Telemental health is a winner. Telestroke is a winner because of the urgency in caring for stroke patients as quickly as possible,” Chow said. Telehealth also is helpful for monitoring patients with congestive heart failure at home, according to Chow, but beyond these areas, the benefits remain unclear.

One problem: Home and even in-hospital monitoring devices turn out a lot of data, and IT systems and clinician habits usually are not set up to process the additional information. “Physicians already have too much data,” Chow said. Keep reading>>

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MC10 nabs $8M more for flexible health sensors

By: Jonah Comstock | Apr 22, 2013        

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MC10 stretchable sensorCambridge, MA-based health sensor developers MC10 announced an additional $8 million in its third-round funding, led by two new undisclosed strategic investors. The new investment brings the round total to $18 million and the company’s total funding to $40.7 million, including investors like Aberdare Ventures, North Bridge Venture Partners, and Windham Venture Partners.

When the company raised the first $10 million of this round, it announced that Medtronic was a strategic investor, but kept a second such investor secret, describing it as a “consumer health company” that is a “clear leader” in its field.

“With the close of this financing, MC10 is fortunate to have strategic investors behind each of our three main business thrusts: consumer, digital health, and medical devices,” said David Icke, CEO of MC10, in a statement this week. “Moreover, we’ve added partners who will help us scale globally.”

Assuming Medtronic is the medical device company Icke is referring to, the consumer health company is most likely Reebok — although we’re only speculating — which has already partnered with MC10 to develop the CheckLight, a sensor-laden mesh skull cap for athletes. The identity of MC10’s digital health partner is less clear, but the company says it will disclose the other partners as it announces product and business collaborations.

MC10 emerged as a sports sensor company, with the CheckLight mesh cap designed to provide realtime feedback about athlete head injuries. Lately, though, the company has branched out to develop a number of different wearable sensors, all predicated on the idea of “stretchable” or flexible electronics. The company’s website lists a band-aid like patch that measures hydration in near realtime, a wristband that tracks heart rate and activity, and a skin patch that alerts the wearer’s smartphone when it’s time to reapply sunscreen.

On the medical side, the company is developing a skin patch thermometer for remotely monitoring a baby’s temperature as well as stretchable sensors for internal use in catheters and surgical implantation for post-surgical monitoring. Finally, the company has teamed up with the US Army to develop flexible solar panels.

None of these devices is available for purchase yet, although the CheckLight is slated for a June 2013 release. Last December, Icke told the Wall Street Journal the company’s various skin sensors were 12 to 18 months away from market.

HHS workgroup could shape mHealth regulation

By: Jonah Comstock | Apr 19, 2013        

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hhs logoThe Department of Health and Human Services has formed a new workgroup, charged with “identifying key considerations to improve patient safety and promote innovation in health information technology (Health IT), including mobile medical applications.” The group has been selected by HHS and the FCC and will report to the Health IT Policy Committee which advises the ONC.

This is the same workgroup we reported about last June, when the FDA Safety and Innovation Act was passed with an amendment stipulating the workgroup’s formation. At the time, MobiHealthNews spoke with Joel White, executive director of the HealthIT Now Coalition.

“I think a critical aspect of this is that we have the externals have input into this process,” White said last summer. “From our coalition’s perspective that is absolutely key. The FDA may have one set of experiences and some expertise in this. The FCC brings another and ONC brings another. There are payors, employers, manufacturers, venture capitalists, patients, and providers who bring a completely different perspective. At the end of the day if you go out and get a good recommendation to Congress on what the regulatory framework should be — [one] that promotes innovation and protects patients’ safety — you better solicit input from all those points of view. From our perspective as an organization we believe that external input is critical.”

The workgroup’s efforts will likely end up affecting the regulation of mobile health and health IT. According to HHS, FDASIA requires Sibelius, with the ONC and the FCC, to “develop a report that contains a proposed strategy and recommendations on an appropriate, risk-based regulatory framework for health IT, including medical mobile applications, that promotes innovation, protects patient safety, and avoids regulatory duplication.”  The new workgroup’s input will feed into that report.

FDASIA requires HHS to publish the report by January 2014. The workgroup’s first meeting will be April 29th. According to the workgroup’s website, the group will seek insight on “types of risk that may be posed by health IT that impact patient safety, the likelihood that these risks will be realized, and the impact of these considerations on a risk-based approach,” as well as “factors or approaches that could be included in a risk-based regulatory approach for health IT to promote innovation and protect patient safety” and “approaches to avoid duplicative or overlapping regulatory requirements.”

Advised by the FDA’s Bakul Patel, the ONC’s Jody Daniel, and the FCC’s brand new healthcare initiatives director Matthew Quinn, the workgroup is a veritable who’s who of major mobile health players. Prominent health investor Esther Dyson is one of the biggest names on the list. Several of the witnesses from the recent congressional hearings on mobile health regulation will also sit on the group: Qualcomm’s Robert Jarrin, West Health’s Joseph Smith, and lawyer Bradley Thompson, of Epstein Becker Green P.C. and regular MobiHealthNews contributor.

Providers from hospitals like Massachusetts General and Brigham and Women’s and representatives from big companies like Philips, Aetna, and IBM are also in the workgroup. Finally, representatives from startups round out the group: Geoff Clapp of Better, Lauren Fifield of Practice Fusion, Michael Sweirnik of MobileHealthRx, Inc., and, notably, T. Drew Hickerson from Happtique. Happtique’s Ben Chodor was also a witness at the congressional hearings: asked whether Happtique’s app ceritification process could replace federal regulation, Chodor gave an unqualified “No.”

Brian Dolan has described the push and pull in DC over mobile health regulation as a “painfully slow chess game.” This workgroup is the latest move, but with such a great diversity of voices involved, it’s hard to say what the final effect will be on mobile health regulation and the role of the FDA.

Patients, scientists learn from microbiome data

By: Aditi Pai | Apr 19, 2013        

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Larry_SmarrWhen Larry Smarr started exploring the biochemistry of his body, he turned to his microbiome to find answers. At TEDMED 2013, Smarr talked about the steps he took in the months before he discovered he had Crohn’s disease.

At first, Smarr used apps like Zeo and Fitbit to monitor his sleeping and exercise respectively. Eventually, Smarr delved deeper, turning his attention to blood work and stool analysis. Studying his stool provided Smarr with rich data about his microbiome, the ecosystem inside the human body made up of different organisms such as bacteria.

Graphing his results, he saw a large jump in lactofferin, a protein tested to check for Inflammatory Bowel Disease. Smarr never felt sick, especially not sick enough to have a chronic disease, and yet that’s what the data showed.

“[There’s] this fallacy that you can guess what’s going on inside of you instead of measuring it,” Smarr said.

His experience with self-diagnosis left him with some insight into how technology might assist patients in actively seeking solutions to their medical problems.

“What this allows us to do, if we start thinking about this tracking over time, that’s going to be a very different form of medicine than we’re used to,” Smarr said.

Jessica Richman, cofounder of uBiome, has begun heading down that road already. Her crowdfunding campaign to collect citizen-sourced biome data raised over $350,000 from 40 different countries, according to her press release. Participants paid $80 and sent in a stool sample to have their own microbiome data sequenced. Richman, who also spoke at TEDMED, vouched for uBiome’s business model to spur a new form of scientific research — that of the citizen scientist.

Encouraging scientists to “think outside the current system,” Richman expects her project to democratize research, creating an “open system, so anyone can participate.”

Smarr and Richman agree that the biological data gleaned from the microbiome can help with the exploration of a variety of conditions, including Crohn’s, eczema, autism, and anxiety. The more data Richman receives, the better results and information she can provide those that provided data.

“People are desperately sick and have chronic conditions and there’s no money to fund their research,” Richman said. “We’re all dying waiting for studies to be funded.”

It’s yet to be determined whether uBiome will be an example of a new model for crowdsourced research, but both Richman and Smarr see significant potential in shifting the paradigm. Similar to Smarr’s experience with his microbiome, uBiome offers citizens the opportunity to send in samples of their stool for testing. The success of the uBiome project in terms of what citizens can learn is contingent on how many people decide to participate, according to Richman.

Smarr credits self-tracking technologies for his own discoveries about himself, and believes new technologies will only help more.

“Because of the big data and because of the ability to analyze it, we’ve got hope,” he said.

Manhattan: 72 percent of physicians have tablets

By: Jonah Comstock | Apr 18, 2013        

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Female Doctor with TabletManhattan Research shared a few more numbers from its annual “Taking the Pulse” online research survey of 2,950 physicians in a webinar this week. The numbers showed that smartphone, desktop and laptop use has leveled out among physicians while tablet adoption has risen to 72 percent, up from 62 percent last year. The 62 percent number was a surprise for Manhattan last year, more than doubling 2011’s 30 percent metric. The firm also asked doctors how they used each of their different devices.

“The smartphone continues to be a quick hit device, many times per day being accessed, but for, of course, a much shorter burst,” said Manhattan Research President Meredith Ressi. “It’s largely used for looking up information, as opposed to content consumption, checking email, etc., whereas the desktop and laptop continue to be the mainstay, especially for EHR access.”

“The tablet one is a lot more interesting,” she went on. “It really kind of defies classification, so we’re calling it a hybrid device. There’s 72 percent who own one but they’re not all using it the same way. Theres a minority who are very active users treating it as a quasi-mobile device, using it throughout the day for both information look-up and content consumption. And then there’s more of a leanback crew, more of an ‘on the couch’ thing, watching video and reading emails.”

The study also looked at the apps and programs doctors are running on their devices.

“It was the first time we’ve seen online textbooks surpass print textbook in terms of weekly use,” Ressi said. She also said physicians were “quite amenable to prescribing apps to patients.”

“We did a little section asking what kinds of apps they had prescribed,” she said. “So it’s really interesting to see that becoming a reality.”

The study also looked at many different ways doctors communicate with each other and with their patients. She said doctors’ usage of closed online physician-only communities has remained stagnant overall, although particular communities, including Doximity and QuantiaMD, have grown.

Physician communication with patients by video was stagnant after growing a lot from 2009 to 2011, she said. Overall, digital communication between doctors and patients was up.

“Close to half of physicians had done some sort of email or electronic consultation with their patients,” Ressi said. “That could be email, secure message, video, or text message. I will say that what’s driven that metric is patient-facing portals in EHRs and Meaningful Use criteria. One of the best ways to ensure that patients actually engage with a patient portal is to have the physicians send some kind of outbound message.”

Last week, Manhattan released a press release with one of their most interesting findings: that seven in ten physicians have had a patient share self-tracking data with them.

Mobile health startups talk innovation, acquisition

By: Jonah Comstock | Apr 18, 2013        

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TED talk

Left to right: Michael Weintraub, Giovanni Colello, Josh Stein, Nina Nashif, and Juan Enriquez.

The TEDMED organizers tried something new this year: they dedicated Thursday morning to some unscripted meetings of the minds about innovation in healthcare. The first discussion (which TEDMED maintained was not a panel) centered on the topic “From Start to Scale to Exit, the Trajectory of Innovation.” Juan Enriquez, managing director of Excel Venture Management, moderated a group of entrepreneurs at various stages in the launch process. Nina Nashif, CEO of Healthbox, a startup incubator, and Josh Stein, founder and CEO of AdhereTech, represented early stage companies, while Giovanni Colella, founder of Castlight Health, and Micheal Weintraub, founder and CEO of Humedica, spoke as experienced founders.

The speakers had a lot of opinions on the question of what drives — and what should drive innovation.

“It’s really important for entrepreneurs to understand industry,” said Nashif. “In healthcare, the buyer and the user are not always the same individual, so figuring out who you’re going to approach is actually really hard.”

Several of the speakers stressed the importance of researching the market, identifying the need, and “skating toward the puck” (in Weintraub’s words.) Colella emphasized not research and preparation, however, but passion and risk-taking.

“You need that free spirit, free market mentality, and you need a few people who are unemployable, who just want to do something big,” he said. “The guys I can guarantee you will succeed are the ones who say ‘I don’t know what I want to do, but I want to do something big, I want to change the world.’ Once you have the right social structure and the unemployable entrepreneur who wants to do something big, make sure they marry with the right investor. When those three things come together, innovation will happen.”

Weintraub also said there’s a sweet spot where the best startup ideas fall.

“If there’s too many people doing it, you’re too late,” he said. “And if it seems too simple and no one’s done it for a decade, it’s probably a bad idea.”

Enriquez asked Weintraub, whose company was recently acquired by UnitedHealth Group, and Colella, whose old company Relay Health was acquired by McKesson, about the realities of acquisition.

Weintraub advised founders to never build a company to sell it. He said acquisitions work best when a startup does research well ahead of time on any companies that might make an offer, so founders don’t feel pressured to make a decision quickly. Weintraub also offered advice for companies looking to make acquisitions. He mentioned two extremes companies should avoid.

“On one extreme, I call it the ‘smash and crash,’ which is just smash it all in, merge everything in functionally, and hope — and hope is never a good strategy. It will not work because the DNA, the culture, the ecosystem will evaporate overnight, and that’s not what we’re doing,” he said. “The other extreme is just leave it alone, leave it as a separate business and do nothing, but then why’d you buy it? So how do you thread the needle and truly have a plan that is not casual, about really finding those leverage points and doing them thoughtfully, not too fast, not too slow? There’s an art or a science to that.”

Collela said that it’s a hard choice, whether to try to push through alone or be acquired.

“There’s a point in the life of a company when an entrepreneur has to ask the hard question: can we build a company to last, or are we better off as a feature of a bigger product?” he said. But he warned that being acquired does make a difference. “For a big company, any new dollar is marginal revenue. For you, any new dollar is real revenue. So, your life is going to change.”

Colella also talked about IPOs, a notable topic since Castlight has been floated by many in the space as headed in that direction.

“Just look at it as a financing effort. I mean there’s nothing different — well its different because it’s a public market, but that’s how you should look at it, its just one more tool to grow your company,” he said.

Finally, the speakers were asked about their strategies for risk management. Stein said risk mitigation meant focusing on your minimum viable product. Nashif said it was about starting small and being realistic. Colella said he was a person who took a lot of risks, so risk management for him was “know your limits and pick the right team.”

“I think that managing risk is an oximoron for an entrepreneur. We sort of jump in headfirst and think later,” said Weintraub. “If something doesn’t feel right, move, because big risks start out as small risks.”