Washington hospital system launches remote video visits for locals

By: Jonah Comstock | Sep 16, 2013        

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FranciscanTacoma, Washington-based Franciscan Hospital Systems, is partnering with Seattle telemedicine company Carena to offer virtual urgent care visits to all prospective patients in the hospital system’s coverage area. Franciscan has seven hospitals and 100 clinics, covering most of the Puget Sound area of Washington state.

“The value proposition from the system is if we can take care of people virtually, that offloads our already strained physicians’ capacity,” Cliff Robertson, Franciscan’s chief operating officer, told MobiHealthNews. “Folks show up in the emergency room who don’t really need an emergency room, but that’s the only point of access they have at 10 o’ clock on a Friday night. If we’re able to deliver appropriate care outside of a brick and mortar facility, that frees us up to treat patients that really do need our care.”

Patients will be able to use the system any time, day or night over Skype or the telephone. First, users will do an automated intake either via a web form or an 800 number. They will then be transferred to a patient services representative, and finally a physician. The visits will mostly not be covered by insurance, but they will cost patients only $35.

Up until now, Carena has been providing virtual visits to employees of self-insured companies, including Franciscan. This is the first time the company has worked with a health system to offer virtual consultations to the general public.

“We launched our first virtual services back in 2010,” Ralph Derrickson, Carena’s president and CEO, told MobiHealthNews. “We’ve been providing house call services for a long time, and we’ve been able to build an extensive understanding of when people call, time and day, so we can staff our teams to be ready when we get the volume.”

Carena’s staff includes board-certified physicians that can listen to complaints, make diagnoses and even prescribe medication over the phone or Skype. Derrickson said Carena staff are equipped to deal with minor urgent care ailments like upper respiratory infections or urinary tract infections. Physicians only need to prescribe medication about 40 percent of the time, he said. In addition, information from the visit will be sent to the patient’s electronic health record in the Franciscan system, and labs and follow-ups can be arranged directly with Franciscan.

Although web and phone are the only options currently, the system indirectly supports mobile because the website is designed to be mobile-friendly, Derrickson said. He said mobility is less of a priority, since patients will generally want to do their virtual visit in private, rather than out and about.

Franciscan has been rolling out the virtual visits gradually, originally offering them to their 15,000 covered employees and family members, and then quietly turning its phones over to Carena at night six months prior to the official launch. Robertson said Franciscan estimates the employee program allowed them to avoid 300 unnecessary visits since 2010.

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How highly sensitive, wearable thermometers could change digital health

By: Jonah Comstock | Sep 15, 2013        

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temperature sensorFlexible electronic sensors, worn like temporary tattoos on the skin, could be used to detect everything from blood flow to cognitive function, according to a new study published in Nature Materials, led by John Rogers, who is also the cofounder of wearable sensor company MC10.

Rogers, a University of Illinois at Urbana-Champaign professor who has been working on flexible electronic sensors for several years, said he was initially approached by NIH temperature researchers after the publication of his original electronic sensor article in Science in 2011.

“When we were first approached by the NIH guys, temperature to me didn’t seem to be a very compelling or interesting parameter. It turns out that it is, if you can measure it with extreme precision,” he told MobiHealthNews. “If you can determine it to the third decimal place and accurately track the change at that level, it provides a lot of deep insight into physiological health.”

The wearable sensors in the study were accurate to the same degree as the “gold standard” technology, a $250,000 infrared camera. But unlike the camera, the patch can do continuous monitoring without the need to maintain a line of sight.

Using just the temperature sensors, Rogers and his team were able to see when a subject was working out math problems in his or her head, based on minute changes in metabolism. He said this functionality could potentially be used for lie detectors. They were also able to track small physiological changes — a patch on a subject’s left hand could detect the subject rubbing his or her thumb and forefinger together on the right hand.

The electronics in the sensors could also convert them into actuators, generating one to two degrees of heat. Using a combination of actuators and temperature sensors, researchers could assess blood flow and skin conductivity, and extrapolate things like hydration.

Although this study was not officially affiliated with Cambridge, Massachusetts-based MC10, the company’s BioStamp flexible sensors do build on Roger’s work. He told MobiHealthNews that temperature sensors could be built into wearable devices along with other sensors.

“Imagine adding precision temperature to a suite of sensors,” he said. “Use this along with accelerometry, blood oxygen, ECG. I think it adds into a pool of measurement modalities that could be really valuable.”

Currently, the sensors are being used in a six-person pilot study at a Chicago hospital affiliated with Northwestern University. The hospital is using the sensors to monitor wound healing in post surgical patients. Although the sensors are currently being applied periodically, they are compatible with MC10 electronics which could allow them to monitor continuously and provide early warnings of infection, Rogers said.

Bundled payments, gainsharing to make digital health viable

By: Neil Versel | Sep 13, 2013        

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Neil_Versel_LargeRecent MobiHealthNews interview subject Proteus Duxbury, director of technology strategy for virtual health services at Englewood, Colo.-based Catholic Health Initiatives, told me that lack of insurance reimbursement is holding back wider adoption of digital technologies. “A lot of [provider] organizations are going to start pulling the plug on some digital health initiatives for that reason,” Duxbury said.

Perhaps, as MobiHealthNews’ Jonah Comstock suggested a few weeks ago, they are looking in the wrong places. “I never foresee a day where there’s [Medicare] ‘Part M’ and we just reimburse for mobile health,” Welldoc Chief Commercial and Strategy Officer Chris Bergstrom told Comstock.

Nope, there won’t be. But there will be – and already are in some cases – bundled payments and shared savings based on efficiency and improved patient outcomes.

According to the American Telemedicine Association, 19 states currently have telemedicine parity laws, which require health insurers to cover remote consultations just as they would for in-person care. Another 10 states plus the District of Columbia have legislation pending.

But parity is not nationwide, and even if it were, the 19 state laws do not apply to a lot of digital health, just to telemedicine where healthcare professionals are present at both the origination and remote point. “Digital health changes the modalities,” Duxbury noted. Monitoring and care take place outside of traditional clinical settings.  Keep reading>>

Jawbone borrows $93M to meet “crazy demand”

By: Jonah Comstock | Sep 12, 2013        

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Jawbone UPJawbone has raised $93 million in debt, with an additional $20 million in equity rumored, according to a report from Fortune. CEO Hossain Rahman told Fortune that the company resorted to a debt raise in light of a much-higher-than-anticipated demand for its products, mentioning the Up activity tracker specifically.

“We’ve been experiencing crazy sell-through demand, particularly since the relaunch of Up,” Rahman told Fortune. “It’s been faster than anything we’d had before, and equity is not the most efficient way to scale all that. If you’re a software company with high demand, you just call Amazon and add more servers to your AWS account. But when you build a physical good, there is a lot more that goes into it – ordering materials, manufacturing, delivery… Debt is the most efficient way to finance that.”

According to Fortune, $43 million is from Silver Lake and Fortress Investment Group and the other $50 million comes from JP Morgan and Wells Fargo. The rumored equity raise is from existing backers Andreessen Horowitz, Kleiner Perkins, Khosla Ventures and Sequoia Capital, who have pledged a pro-rata investment in a future equity raise. Jawbone currently has more than $200 million in equity funding.

While borrowing money to build its product, Jawbone has still managed to find the money to buy several companies over the last few months, including wellness app Massive Health, nutrition app Nutrivise, and competitor Bodymedia.

Analysts have been predicting a boom in the demand for activity trackers like the Jawbone UP, with IMS research predicting that 56 million sports and fitness monitors would ship in 2017, up from 43.8 million this year, and trackers in general seem to have a higher profile than ever before.

Just this summer, Jawbone competitors Withings and Fitbit raised $30 million and $43 million, respectively, to support growing demand. Meanwhile, Nike recently reported that the Nike+ FuelBand app has 18 million users.

A recent report from consumer tracking site FixYa suggested that the Jawbone Up is not universally beloved by purchasers — some have reported similar problems to the ones that caused the voluntary refund of Jawbone’s first device. Judging by this latest news, however, whatever problems the tracker may have don’t seem to be enough to dissuade purchasers from demanding Jawbone devices en masse.

Six health trackers on crowdfunding sites

By: Jonah Comstock | Sep 12, 2013        

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emotivCrowdfunding is alive and well in mobile health. Just a few months after Scanadu’s record-breaking presale, a number of mobile and digital health companies continue to turn to Indiegogo and Kickstarter to fund projects. Over the last few months, MobiHealthNews has written about Emotiv, Beddit, uCheck, and Eclipse.

EEG-tracking headset Emotiv still has three days left in its campaign, but the company has already raised more than 10 times its funding goal and created and met several stretch goals in the form of additional sensors. Bed-based sleep sensor Beddit also surpassed its goal, with $288,000 raised so far of an $80,000 goal — with 20 more days to go.

On the other hand, uChek, the urinalysis app which was hoping to use its crowdfunding campaign as part of a path to FDA clearance, didn’t do nearly so well, falling short of its $42,000 goal with only $15,000 at the campaign’s conclusion. Similarly, Eclipse, the digital breast exam device, has only raised $4,000 of a $650,000 goal, although the project still has 20 days to go.

Here’s six more crowdfunding projects that are still under way.

BreathAcoustics

BreathAcoustic

BreathAcoustics is a new kind of wearable health tracker, a Bluetooth headset that lets a user listen to music and make phone calls, but also tracks health metrics — including using the headset microphone to measure a user’s breath patterns. The headset also contains optical sensors that can return data about heart rate and pulse oximetry. Finally, the headset contains environmental sensors that return data about altitude, location, and barometric pressure, all displayed on the user’s smartphone.

BreathResearch, the company behind the campaign, is partnered with HeartZones USA to create apps for the device for a number of use cases: stress relief, athletic training, weight loss, and sleep. The campaign is part of the company’s entry for the Philips Innovation Fellows competition and the campaign is being co-supported by Health Tech Hatch, a health-specific crowdfunding platform. With 48 days to go in its Indiegogo campaign, BreathAcoustics is $13,000 into a $30,000 goal. Keep reading>>

Virtual visit company Teladoc raises $15M

By: Aditi Pai | Sep 12, 2013        

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teladocacquisitonDallas, Texas-based Teladoc raised $15 million from five undisclosed investors this week, according to an SEC filing. This brings the company’s total public funding to $46.6 million.

Teladoc declined to comment on its plans for the money.

The last public funding raise that Teladoc announced was in 2011. The company raised $18.6 million in a round led by Kleiner Perkins Caufield & Byers (KPCB). Other investors in the funding round at the time include Cardinal Partners, HLM Venture Partners, Trident Capital, and New Capital Partners.

Teladoc offers patients an alternative to a standard doctors visit. When a patient needs a doctor but doesn’t want to make an appointment, he or she can call Teladoc to schedule a virtual visit. The visit includes a one-on-one consultation with a doctor over phone or video. The doctor can access a patient’s HIPAA-compliant EHR and send prescriptions to the patient’s pharmacy of choice.

Earlier this month, Teladoc acquired Consult A Doctor for an undisclosed amount. This acquisition will allow small- and medium-sized companies access to Teladoc’s patient-physician consult services. Teladoc, which launched in 2002, has since built a team of physicians that complete more than 120,000 consults annually and have an average of 15 years experience.