Cigna taps MDLive for remote patient consults

By: Brian Dolan | Apr 23, 2013        

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MDLive CignaCigna announced a deal with telehealth provider MDLive to offer some of its health plan members access to online video, telephone or email consultations with physicians. The plan members would have access to the 2,200 internal medicine, family practice and pediatric physicians that MDLive has on-call in states around the country.

MDLive CEO Randy Parker told MobiHealthNews that the focus of the deal with Cigna is on the health insurance company’s self-insured employers customer group. Cigna members’ whose employer opts to offer MDLive’s services to their employees will have access to the services beginning in 2014. Cigna plans to begin marketing the offering to that group this June.

The eligible Cigna health plan members can use MDLive either by scheduling an appointment or requesting a consultation right away. MDLive says the average wait time is about 11 minutes and the user is notified that the doctor is ready to connect by both text message and email notifications.

Of course, these remote consultations are only for non-emergency medical issues, including colds, the flu, rashes, sinus issues or headaches for children and adults. The video demo of the Cigna-MDLive service also showed an option for scheduling an appointment with a “Therapist”, so mental health services may be included or just around the corner.

While the consultations can be simple phone conversations or email exchanges, Parker said that the video consultations through MDLive work on computers as well as through iPhones, iPads, and Android devices — all via a secure, HIPAA-compliant connection. Parker said his company has noticed a recent uptick in usage among both MDLive physicians and patients using iPads to conduct remote consultations.

Parker also stressed that while MDLive is an alternative for late night emergency room visits when the issue is not an emergency, MDLive aims to make the consultation that takes place between its physicians and patients easily transferrable to that patient’s primary care provider to ensure continuity of care. Parker said that continuity of care is often not maintained when patients go to the ER.

“Whatever takes place during an MDLive visit is captured and transferred securely to the patient’s primary care provider,” Parker said. “It’s all worth noting that we are the 411 not the 911 and MDLive does not replace the need to go the doctor, but we find that more than 70 percent of the patients who go to the ER could have avoided that visit or at least resolved their problems through a solution and a platform like MDLive.”


Google’s ex-Chief Health Strategist launches startup, Smart Patients

By: Brian Dolan | Apr 23, 2013        

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Google’s former Chief Health Strategist Roni Zeiger MD and Gilles Frydman, founder of the Association of Cancer Online Resources (ACOR), announced the launch of Smart Patients, a new online community for cancer patients and caregivers, at the TEDMED event in Washington DC last week.

“What we are primarily trying to do is help cancer patients and caregivers learn more effectively from each other,” Zeiger told MobiHealthNews in an interview before his talk at TEDMED. “It turns out when people get sick or their loved ones do, within a couple of months they become quite expert in their illness and they are really motivated to help each other. That is a part of healthcare that we haven’t really tapped into. We want that to happen more and we want the rest of the healthcare system to learn more from patients so that they can do a better job — whether that’s healthcare providers or pharma companies. There is an opportunity for us to learn more from and with patients.”

Smart Patients

Screenshot of Smart Patients' "Conversation Feed"

Smart Patients has been operating in closed beta for a few months with a group of invitation-only members. As of last week it is now open to all cancer patients and caregivers who can join the free site to search for clinical trials, discuss clinical trials, and start and follow conversations related to their disease. The site has re-architected the database to make it easier to search for and find relevant trials for cancer patients.

“We use everyday and appreciate it, but it is not very good.” Zeiger said. “This is not something we planned to do initially but… we ended up building a next generation search engine for clinical trials with intuitive design and organized with filter option — just like the kind of search you find at or Yelp.”

As part of Zeiger’s job at Google he, of course, spent a lot of time considering how Google might improve search results for health-related queries.

“When I was focusing on search at Google it became clear that for the more severe and rare side of medicine, which most cancers fall into, the static web pages that you can find through search often aren’t enough,” Zeiger said. “They are good for the initial one or two pager but when you need more information, specifically how this applies to my particular context, that’s when learning from others who have particular expertise becomes really important.”

Apart from finding clinical trials, Smart Patients community members can start conversations on any topic of interest and tag those threads with keywords that others can then follow. Since patients will be able to follow both specific conversations they find interesting and keyword tags, which could be commonly used by people with different types of cancer, Zeiger believes one benefit of the platform will be knowledge sharing and community building between patients who have different types of cancer. One feature that early users have requested but is not yet implemented is the ability to follow other people on Smart Patients.

Zeiger said the business model of Smart Patients is to work with partners, including pharma companies, and share with them anonymous insights and data from the communities. It has no plans to add advertising or marketing.

“For example, we might share a report about what issue lung cancer patients are most interested in over the last quarter,” Zeiger said. “We also do voluntary surveys. One example is to give feedback about a draft design of a clinical trial that might be presented to patients as a summary of the trial or maybe share specific aspects of a trial that a client might want feedback on.”

At launch, Smart Patients announced partnerships with The Bonnie J. Addario Lung Cancer Foundation, Cancer Commons, and WorldOne Interactive (which owns physician social network Sermo now). The company also announced that it is working with Oncosec Medical, which will look to include patient feedback from the Smart Patients community on the design of upcoming clinical trials for its skin cancer treatments.

“One of the lessons that personal health records [taught us] is that the question should not be ‘What should a PHR look like?'” Zeiger said. “The question should be what do real patients actually need?  I’m not sure what the PHR term means, I think it means different things to different people. One thing I think we need to do as an industry is get better at healthcare products. We need to get better at user-centered design and begin with users’ needs and build from there and not necessarily build what the industry thinks patients need.”

Startup Nurep provides iPad-based medical device support

By: Neil Versel | Apr 23, 2013        

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Nurep medical device iPad supportA newly launched company is trying to streamline support for medical devices, make surgical scheduling more convenient and lower the overall cost of pricey equipment by facilitating secure video consultations on the iPad.

San Francisco-based startup Nurep, part of digital health accelerator Blueprint Health’s winter 2013 class, debuted its mobile physician support platform at the annual Demo Mobile conference last week. Nurep was among 29 companies – four of them healthcare-related – to demonstrate products at the event, and was part of the opening session specific to mobile health.

The idea behind the product is that medical devices frequently need support from sales and technical representatives during surgical procedures, according to Nurep co-founder Paul Schultz. Reps’ territories are getting larger and larger as many device companies look to reduce expenses in the face of falling reimbursements for surgical procedures, the new 2.3 percent tax on medical devices as a result of the Patient Protection and Affordable Care Act, as well as other cost pressures.

Customer service and support representatives often are present in the operating room to answer questions on the spot, with the exception of some centers of excellence where the surgical teams are highly trained on specialized equipment, according to Schultz. “This is the dirty little secret of surgery, medical device reps being there,” he tells MobiHealthNews. Surgical consent forms often contain fine print allowing reps to be on hand.

“Physicians are really frustrated because they are relying on the reps’ schedules” to set surgery times, says Schultz.

Another little-known reality, according to Schultz, is that 60 percent of the price of the typical medical device covers selling, general and administrative expenses, commonly known as SG&A, and hospitals are looking to cut their costs. However, the target market is the medical device industry. Keep reading>>

Did Fitbit copy Fitbug? Lawsuit claims it did

By: Brian Dolan | Apr 22, 2013        

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Fitbit Fitbug PackagesAt the end of March, London-based Fitbug filed a lawsuit against San Francisco-based Fitbit that alleges trademark infringement and unfair business practices, which Fitbug claims has caused it irreparable harm and damage. While the company has stated that it sent Fitbit a cease-and-desist letter last year, the official lawsuit was filed on March 29, 2013 — just a few weeks after reports surfaced that Fitbit had raised $30 million at a supposed $300 million valuation.

The companies have a somewhat similar product portfolio. Fitbug offers a Bluetooth-enabled activity tracker called Fitbug Air, a Bluetooth Smart-enabled disc-shaped activity tracker called Fitbug Orb, a Bluetooth-enabled blood pressure cuff called Fitbug Luv, and a Bluetooth-enabled weight scale called Fitbug Wow. On its website Fitbug sometimes refers to its devices, especially its activity trackers, as “Bugs”.

Fitbit offers its own set of activity trackers, including clip-ons Fitbit One and Fitbit Zip as well as its newest device: the wristworn Fitbit Flex. It also launched a WiFi-enabled weight scale called the Fitbit Aria in early 2012. While many of its competitors offer smartphone-enabled blood pressure monitors, Fitbit has yet to add one to its lineup.

While Fitbit is certainly the better known and better funded of the two companies, Fitbug, which got its start in 2004, has been in the market longer. Fitbit was founded in 2007. Fitbug also positions itself as much more of a B2B company than Fitbit does, even though both sell their wares direct-to-consumer and through B2B channels.

Fitbug has inked deals with other digital health companies to provide hardware that can help their users track activities. Fitbug’s B2B customers include, among others: Healthrageous, The Vitality Group, and MeYou Health. As MobiHealthNews has reported in the past, The Vitality Group’s US division is a joint venture with Humana. In 2011 Fitbug announced that its offerings would be offered to 16,000 employees through The Vitality Group — one of the employers is a pharmaceutical company headquartered in the US and the other is a “leading supplier of services to healthcare providers” in the US.

Since Fitbug is listed on the London’s Stock Exchange, AIM, it has to be a bit more transparent about its financial situation than privately-held Fitbit. According to the latest financial report from Fitbug from September 2012, it posted a loss of about $988,000 (649,000 GBP) on revenues of about $1.02 million (674,000 GBP) for the first six months of last year. The company posted a loss of about $1.2 million for the calendar year of 2011 on revenues of just under $2 million.

In response to the allegations, Fitbit CEO James Park sent MobiHealthNews a written statement: “Fitbit is very proud of our fantastic products and reputation, which we have earned solely through the tremendous efforts of the Fitbit team. We are surprised by the allegations contained in Fitbug’s complaint. We are confident of our legal position in the case and look forward to addressing the allegations in court.”

Of course, Fitbug’s lawsuit is not the first time a digital fitness company has filed a suit against a newer startup. Last May BodyMedia filed a patent infringement lawsuit against Basis Science.

For more on Fitbug’s allegations that Fitbit is infringing on its trademark, check out the visual evidence that Fitbug is submitting to the court in the slide show below: Keep reading>>

Interview: FCC’s new health director Matt Quinn

By: Jonah Comstock | Apr 22, 2013        

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Matthew QuinnSome time last month, the Federal Communications Commission (FCC) quietly filled its long-vacant Director of Healthcare Initiatives position, responding to a call made last September by its mHealth task force. The FCC’s appointee, Matthew Quinn, is no stranger to healthcare innovation. With a background in two previous government agencies and a number of large and small healthcare companies, Quinn brings a range of experience to the role. It’s recently been announced that one of his first duties will be to advise an HHS workgroup on mobile health regulation. MobiHealthNews caught up with Quinn last week on Day 6 of his new job.

We were under the impression you had worked with Matthew Holt at Health 2.0, but it predated that?

In 1999 or 2000 we started a personal health record company called i-Beacon. It lasted for about nine months and the economy started falling apart, but it was a great opportunity to meet Matthew, and he’s a guy who just has unbelievable perspective on healthcare. I learned a ton from him.

Could you start off by giving us an overview of how you got to where you are, what your background in healthcare is, and how those experiences are going to be helpful to you in your new job?

I probably have taken the road less travelled to get here, but I think it’s a good thing. I came to government in 2007. I started in the Agency for Healthcare Research Quality (AHRQ). It’s part of HHS and it’s focused on health services research. I joined the health IT team there as a special expert and my role really was to promote research projects that were relevant to industry and also to policy makers and academia, really to bridge the gaps. One of my key areas of focus was on aligning the goals of health reform with the use of health IT, so [determining] what information models and standards and workflow changes were needed to support patient-centered medical homes and other models of care envisioned in the Affordable Care Act.

One of my projects there was a report on certified EHR vendor practices and promises with regard to usability or lack thereof and this really led me to go to NIST [the National Institute of Standards and Technology] for the last few years to focus on this specific issue. We held a few workshops in coordination with FDA and ONC and other folks really to provide technical guidance and to hear best practices from elsewhere on how to improve the usability of not just EHR but health IT apps in general. And some of this technical guidance was included in the Meaningful Use Stage 2 certification requirements. NIST is not a regulatory organization, but I really like the model NIST uses as a convener, bringing people together to help solve problems. I think it’s a good model that allows industry to make some progress before regulatory groups like the FDA or whoever just make the rules.

I realized really bad things can happen when entrepreneurs and policy makers aren’t speaking the same language, when they don’t have a Rosetta Stone. So one of the things I did at AHRQ was I attended the Health 2.0 accelerator meetings. I remember a webinar I did for them: AHRQ had done a meta-review of research on consumer health IT tools and it was to see whether there was evidence that use of these tools could impact quality, safety, efficiency, effectiveness of healthcare. And research was very positive about these tools. I think there were 55 or 56 people on the call. I asked how many folks had heard of these studies, and only a few folks had. These were all people who were trying to communicate the value of consumer health IT tools, so this would be great in helping them sell these to some insurer or venture person, but they hadn’t heard about this research. So making those connections is something I really enjoy that makes you want to be a public servant and get up in the morning and do that. I’m trying to take the experiences I’ve had in the private sector and the public sector and make those connections.

Keep reading>>

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>>