The second quarter of 2017 was full of news from hospitals and other providers. Read on for our roundup of partnerships, deployments, research projects and more.
Hospital news
Despite ongoing controversy about data management, DeepMind, the AI-focused, UK-based Google subsidiary, announced this quarter that it would roll out its Streams app in a second hospital. The deployment of the app at Musgrove Park Hospital marks the start of a planned five-year rollout with the Taunton and Somerset NHS Foundation Trust. Streams has been developed in collaboration with kidney experts at the Royal Free Hospital London. The app is designed to help doctors get information about their acute kidney failure patients, including blood tests, faster, which will enable faster diagnostics in situations where time is of the essence. The app uses 'breaking news' alerts to make sure doctors' attention is directed to the patients who need it the most in the moment.
It was a busy quarter for the Mayo Clinic. Epic announced that it will embed authoritative health information from Mayo Clinic in its MyChart and MyChart Bedside portals, aiming to give patients the opportunity to put their healthcare into context. Epic hopes that offering patients at its ambulatory and inpatient clients access to this expertise – more than 18,000 pages of it, covering some 4,000 healthcare topics – will help them learn more about symptoms, conditions, healthy living information and more.
Virtual medical assistant company Sensely also began a collaboration with the Mayo Clinic to ascertain how to leverage patient engagement and chronic disease monitoring technology. The partnership will blend the Mayo Clinic’s triage algorithms and clinical expertise with Sensely’s patient engagement platform in hopes of assessing and predicting which resources can be best used at the right time to help patients without requiring them to leave their homes.
Finally, the Mayo Clinic and 2bPrecise, the cloud-based precision medicine platform, also inked a technology licensing agreement and also announced a research collaboration to develop genomics-based care protocols. Using the 2bPrecise platform and the Mayo Clinic’s electronic phenotyping algorithms and clinical expertise, the two hope to apply those protocols to research in patients with cardiovascular genetic disease.
Another hospital that made a lot of news this quarter was Boston Children's Hospital. Children's is the latest to tackle the problem of continuity of care between a patient's doctor and any emergency room or urgent care center they might find themselves in, testing the technology, from startup Position Health, on some of their smallest and most high risk patients. With Position Health's offering, parents of these high-risk infants will download an app on their phone that will run constantly in the background. Using geolocation, the app detects when the patient enters a hospital emergency department and pings them to ask if they're there to receive care for their child. If they are, their doctor is notified automatically and can reach out to the facility to tell them anything they need to know.
Boston Children's Hospital also rolled into phase two of its deployment of GetWellNetwork’s patient engagement and education platform, which is rooted in putting patients at the center of care by equipping them with digital tools and information to be an active participant in their treatment and condition management. By providing tools for both patients and staff, the GetWellNetwork platform is designed to help hospitals guide patients and their families through self-management of their conditions (pre- and post-admission care) and overall health education while also improving hospitals’ outcome goals. Phase two will expand the deployment from 250 beds to 386, add a new tool for patient-physician communication called the Interactive Patient Whiteboard, and integrate with Boston Children's patient portal.
Additionally, Boston Children’s Hospital and Duke Health System came together this quarter to develop an Apple CareKit-based iOS app called Caremap, designed to help families securely track their children’s health and share that data with members of their ongoing care team. The app can also serve as a detailed repository of critical information such as allergies, devices in use or emergency action plans.
Boston-based Partners HealthCare announced plans to integrate deep learning technology from GE Healthcare across its network. The 10-year collaboration will involve Massachusetts General Hospital and Brigham and Women's Hospital Center for Clinical Data Science.The initiative will feature co-located, multidisciplinary teams with broad access to data, computational infrastructure and clinical expertise. The initial focus will be on the development of applications aimed at improving clinician productivity and patient outcomes in diagnostic imaging.
Partners also entered into a four-year partnership deal with Persistent Systems to build clinical decision support systems for various departments throughout the hospital. The two groups will work together to develop an open sourced platform based on SMART and FHIR.
Cedars-Sinai Hospital in Los Angeles partnered with Noteworth, a startup from the second cohort of its accelerator, to give physicians in several hospital departments new tools to monitor the health of their patients at home. The deal is a three-year engagement. Noteworth is being deployed at the hospital’s heart institute, where it will be used with hypertension and congestive heart failure patients; the diabetes treatment and education center, where it will be offered to patients with diabetes and with thyroid disorders; and the obstetrics and gynecology department, where the focus will be on women with high-risk pregnancies.
James Cook University Hospital in Middlesbrough, United Kingdom tapped the services of UK-based digital health company Inhealthcare, which offers a remote monitoring platform used by many National Health Services agencies. It’s part of the hospital’s North England Regional Back Pain Programme – an initiative funded by healthcare charity Health Foundation that is investing over $4.5 million in innovative healthcare projects that can be delivered at scale. Inhealthcare is providing the tools to monitor 3,600 patients who are being treated for back pain in the North East region by sending clinical questionnaires via the web to the patients after they have been referred for treatment by their doctors. All patients voluntarily signed up to receive the questions periodically, and their answers are integrated into existing NHS clinical systems such as SystemOne and EMIS Web.
The Montreal Heart Institute (MHI), Canada’s largest cardiac center, became the latest hospital to use SeamlessMD’s mobile patient engagement and care management system. Notably it’s the first cardiac center in North America to use the technology. Toronto-based SeamlessMD makes a suite of mobile products aimed at patients recovering from surgery. The platform helps patients and providers track a patient's progress, starting from before their operation and going through their recovery.
Nnearly 70 percent of American adults who have a behavioral health condition also have a medical co-morbidity, which led the Bronx, New York-based Montefiore Health System to begin integrating mental health treatment with primary care. It’s a model that has been embraced under mental health parity laws, but typically requires having co-located mental health services at the clinics. So Montefiore is working around the specialist shortages by implementing digital tools, funded by a grant from the Center for Medicare and Medicaid Innovation (CMMI). The most recent example is their 238 patient pilot with Valera Health, makers of a smartphone app and platform to improve treatment of anxiety and depression.
Hospital wayfinding app company Connexient deployed its app at The Jewish Hospital in Cincinnati, Ohio. The hospital is part of Mercy Health, a health system with 180 locations across Ohio and Kentucky. The app, which runs on Connexient's MediNav platform, is called "Right this Way". It offers detailed indoor maps to help patients navigate the hospital which can pinpoint the user's location within a few meters and give step-by-step directions to different areas. The app also allows patients or visitors to save the location of their car in the parking garage and be guided back to it. This is achieved by installing Bluetooth beacons around the hospital.
Seattle Children’s Hospital tapped First Databank, provider of a vast database on drugs and medical device information, to deploy its medication adherence and education tool called Meducation. The tool, which is a cloud-based solution that integrates with many different information systems, is aimed at pediatric patients and their family caregivers who are considered high risk for a few reasons, including language barriers, vision impairments or low health literacy.
Virtual urgent care platform provider Carena announced a partnership with Aegis Health Group, which uses data analytics to help hospitals grow their patient and client basis. Through the collaboration, Carena’s hospital partners can connect with Aegis to guide them on best practices to grow, and Aegis will have the ability to educate employers about virtual care.
Johns Hopkins Medicine tapped Grand Rounds – a digital health company that performs a number of medical matchmaking services like connecting consumers and employers to match patients with specialist doctors, or facilitating meetings for second opinions – to extend the reach of their remote consultations and access to in-person visits. According to a survey by Grand Rounds, 28 percent of people struggle to find a qualified specialist. With the collaboration with Johns Hopkins, Grand Rounds will use its proprietary data and machine-learning toolset to connect patients all over the United States with top neurosurgeons and orthopedic surgeons, which are among the most commonly-sought after specialties from Grand Rounds patients.
Telemedicine news
A lot of the quarter's provider news revolved around telemedicine. The biggest news was probably the passing of legislation in Texas that made put an end to longterm drama around direct to consumer doctor visits in the state. You can dig in on that decision and its impacts here.
The American Telemedicine Association is recruiting now for a two-year task force on climate change with four stated goals. First, the group will devise green outcomes that can be measured as part of how members routinely measure the outcome of their systems. Second, they will focus on making the ATA itself more environmentally conscious by reducing travel. The other two goals are about demonstrating the potential positive effects of telemedicine on the environment. The task force will look to show how telemedicine can create more sustainable healthcare practices and how telemedicine can aid in responding to health emergencies caused by climate change — such as warming, disasters and the spread of infectious diseases.
Telemedicine giant Teladoc acquired Best Doctors, a virtual medical consultation company, to enable a connected care platform focused on improving outcomes for some of the most complex medical conditions. Under the terms of the deal, which is expected to close next month, Teladoc will pay $375 million cash and $65 million of Teladoc common stock. The company reports it has secured $360 in financing from Jeffries Finance LLC and Jeffries Group LLC.
Telehealth provider American Well announced two developments the company has taken to expand their footprint, both in regards to consumer accessibility as well as ease of use for providers and health systems using the platform. In a move to nudge telemedicine more firmly into traditional healthcare, American Well unveiled a new enterprise service called AW10, which contains over 100 new features specific to providers to make their experience with American Well’s platform simpler and more comprehensive. The software streamlines the enrollment and verification process for new doctors, so they can start delivering live visits within minutes.
Salt-Lake City-based Intermountain Healthcare joined American Well’s online care marketplace, best known as the Exchange. Through the Exchange, Intermountain will make its nurse practitioners and physician assistants available for patient telehealth visits on Amwell.
NewYork-Presbyterian revealed a pair of new telemedicine options for psychiatric and express care services that build out its existing NYP OnDemand telehealth suite. NYP went live with Express Care at its Columbia University Medical Center, which replaces in-person encounters with a video visit to slash admission-to-discharge times from an average 2.5 hours to 31 minutes, according to NYP chief innovation officer Dr. Peter Fleischut. The appointments take place on-site and enable patients to see specialists from 10 NYP hospitals. NYP also launched a telepsychiatry service so emergency department patients don’t have to come back in for a follow-up visit; this option reduced wait times from 24 hours down to under 60 minutes.
Royal Philips debuted its enterprise-level telemedicine software designed for use in intensive care units at the American Telemedicine Conference in Orlando. Philips’ eCareManager, the company’s new FDA-cleared teleICU software, works to alleviate critical care team shortages by offering a platform connecting regular hospital staff with intensivists – physicians trained specifically for work in the ICU – and offering actionable insights to improve outcomes for patients with the most complex cases.
An Illinois-based law firm filed a class action lawsuit against telemedicine company MDLive, alleging that the company takes screenshots of sensitive patient health information and sends them to TestFairy, an Israeli company that does quality control on apps, and that this is a violation of patient privacy. MDLive, for its part, denies that there's anything improper about its procedures. But, almost before it began, the lawsuit was quickly over.
San Francisco-based telemedicine provider Doctor on Demand added another layer to its virtual visits with the integration of laboratory services with Quest Diagnostics and LabCorp, which will be available in the coming months. Rather than interrupt their service and create additional paperwork or communication chains, clinicians practicing with Doctor on Demand can continue playing the primary role on through to the lab test-ordering and result-reading. And, as opposed to the norm of being at the mercy of their provider or institution to order and direct when, where, and how they get lab tests done, patients using Doctor on Demand will be given the option to directly choose which lab works best for them depending on price, location and insurance.
Westborough, Massachusetts-based EMR provider eClinicalWorks added telehealth capabilities to its mobile app. The company’s device-agnostic platform also provides tools for practice management and patient engagement, and the addition of the TeleVisits feature aims to nudge eClinicalWorks into that one-stop-shop territory.
Telemedicine platform providers – featuring integration with electronic health records, provider networks and various other data streams – are certainly not in short supply. But some healthcare professionals have been eschewing the all-inclusive approach and using the foundational technology of Zoom, the Silicon Valley-based maker of enterprise video conferencing platforms. Zoom took note of those customers, and is now offering a cloud-based video telehealth service called Zoom for Telehealth.
Research news
Much of the news we reported on this quarter took the form of published research, both establishing efficacy for particular digital health interventions and more general observations about the space. Additionally some major research efforts, like the NIH's All of Us intitiative, are studying health more broadly but using digital health tools to do so.
At the HIMSS Precision Medicine Summit in Boston this quarter, All of Us Director Eric Dishman talked a little bit about the role of wearables in the program. Apps and wearables aren’t rolled out in the pilot group but will be added before too long, he said.
“There’s lots of small-scale studies looking at consumer wearables and finding interesting things, but nothing that’s scaled out enough to be able to say ‘These work great for clinical research, these don’t,” he said. “…We want to and will do mHealth and personal health technologies. We’ll initially start with what people already have, but I think at some point we may have to get the industry to create something for us that would be an All of Us unique device. But I think that’s several years down the road for us.”
A couple of interesting studies during the quarter shed doubt on the effectiveness of mobile health tools: A study of a 450-person cohort at 15 primary care practices across the University of North Carolina Chapel Hill health systemfound that, compared with the traditional method of in-office visits, self-monitoring of blood glucose (SMBG) via digital tools didn't result in better health and wellness for people with non-insulin-treated type 2 diabetes. And the 1,500-patient HeartStrong Study, published in JAMA Internal Medicine casts doubt on the effectiveness of several promising medication adherence technologies and strategies, including connected pill bottles and lottery-based incentives. Ultimately, the study showed no difference in readmissions, mortality, medication adherence, or medical costs between the intervention and control groups.
Results are yet to come, but The Duke Clinical Research Institute, funded by a grant from Novartis, launched a large-scale study this quarter to explore the effectiveness of mobile apps in the treatment of heart failure patients. The study, called Connect HF, is aiming to enroll 8,000 patients across 160 hospitals by the end of fall 2018, with results hoped for by the end of 2020.
Additionally, new research from IBM suggests technology can fill gaps in screening for diabetic retinopathy. Using a mix of deep learning, convolutional neural networks and visual analytics technology based on 35,000 images accessed via EyePACs, the IBM technology learned to identify lesions and other markers of damage to the retina’s blood vessels, collectively assessing the presence and severity of disease. In just 20 seconds, the method was successful in classifying DR severity with 86 percent accuracy, suggesting doctors and clinicians could use the technology to have a better idea of how the disease progresses as well as identify effective treatment methods.
In the form of a wrist-worn band embedded with flexible sensors and microprocessors, researchers at Stanford and the University of California Berkeley are unlocking the molecular insights from sweat that could diagnose cystic fibrosis, diabetes and other diseases. The device, which is described in an article published in the journal Proceedings of the National Academy of Sciences, sticks to the skin and stimulates sweat glands, then electronically transmits the results of which molecules are present for analysis and diagnosis. Since different molecules and ions create different electrical signals, the device can identify the presence or absence of compounds indicative of disease. Researchers ran separate studies to detect different molecules –high chloride levels suggest cystic fibrosis; high glucose can indicate diabetes.
Validating whether connected devices actually can passive track caloric intake has become something of a sticking point in recent years. Researchers at the University of California Davis want to figure out if it's possible, and so they initiated a five-year agreement with Healbe, makers of the GoBe 2 Smart Life Band fitness tracker. The band, which retails at $179, uses the company’s Flow technology, which claims to automatically track a range of metrics including human caloric intake, hydration and emotional state. Dr. Sara Schaefer said she was intrigued by the potential.
Microsoft HealthVault Insights, a research-based project using big data to generate deeper patient health insights to improve care, brought Validic’s data connectivity platform into the mix to better understand the engagement part of the equation. Validic’s platform will serve as a key backend component by enabling Microsoft to connect to some 400 clinical and consumer devices. By creating added visibility and contextualizing health data – including trends and correlations from everyday activities and behaviors – HealthVault Insight’s mission is twofold: improve clinicians’ delivery of care on a continuum and foster a sense of personal responsibility in patients.
A new partnership in the diabetes space could bring the promise of an artificial pancreas closer to reality. Senseonics, a Germantown, Maryland company working on a pill-sized, implantable continuous glucose monitor that can last 90 days without needing replacement, will work with digital, personalized medicine company TypeZero Technologies on a project to integrate readings from Senseonics devices into TypeZero’s inControl software platform, which can either be used for decision support for manual insulin dosing or automatically adjust and regulate insulin delivery via an insulin pump. The two have signed an R&D licensing agreement.
Cardiogram, a startup working on algorithms to make the Apple Watch’s heart rate data clinically actionable, announced some results from its mRhythm Study. The data, presented at the Heart Rhythm Society’s 38th Annual Scientific Sessions, shows that the company’s algorithms can detect atrial fibrillation with 97 percent accuracy.
Finally, Apple added some new features to its ResearchKit app.
