Digital health news update: The NHS' softly, softly stance on telemedicine, and Apple eats the EMR

February 26, 2018 Matthew Arnold

  • The NHS is signaling caution on a key telemedicine effort – a service called GP at Hand, which offers online consults with GPs and lets subscribers text with nurses. The service, from a company called Babylon Health, has garnered high satisfaction scores from patients, but the NHS’ quality control arm found that it was falling short on prescribing decisions, sharing information with physicians and monitoring patients, and many GPs fear that the app will effectively privatize care for the worried well while saddling the system with the chronically sick. One thing the service does not lack, as The Economist tartly points out, is demand – by February, the app had signed up nearly 20,000 Londoners.
  • They're not total Luddites, though. An NHS effort to use sensor tech to flag atrial fibrillation in at-risk patients could save the UK £81 million a year, the agency has projected – and the NHS is distributing 6,000 devices, including the Kardia Mobile and the Watch BP, to do so through GP practices, pharmacies and NHS community clinics as part of a pilot effort.
  • Meanwhile, across the pond, the FDA granted approval to a watch that monitors epileptics for signs of oncoming grand mal seizures and sends an alert to summon help.
  • Perils of tracking device data: a newspaper report found that data from a fitness tracker, Strava, revealed the locations of secret US military bases in Afghanistan and elsewhere, prompting a scramble at the Pentagon
  • Roche is buying Flatiron Health, the Alphabet-backed startup that offers an oncology EMR – thereby gaining a treasure trove of oncologic real world evidence and potentially accelerating its clinical trials. A Roche release on the $1.9b deal said Flatiron Health would remain autonomous, but that “the companies will leverage their combined expertise to advance the use of real world evidence to set new industry standards for oncology research and development.”
  • Apple is angling for ownership of the Personal Health Record, having upgraded the Health app with a feature that allows customers to view medical records on their iPhones. “The updated Health Records section…brings together hospitals, clinics and the existing Health app to make it easy for consumers to see their available medical data from multiple providers whenever they choose,” says the release. Apple’s move into PHRs (and therefore EHRs) could just fix the interoperability problem that’s vexed health IT advocates, by pouring data from disparate systems into a common platform. It might also open the door for pharmas to provide patient resources and financial assistance directly to patients and providers.
  • Apple’s also experimenting with provision of healthcare through a network of primary care clinics for employees. They’re starting small, with two AC Wellness clinics in their home base of Santa Clara County, California, and are, in true Apple fashion, hiring not just medical professionals but “designers” who will put together behavior change programs aimed at nudging patients toward wellness and preventing disease.
  • And Alphabet’s Verily is looking into the business of population health, leveraging its data management expertise to boost adherence and lower readmission rates. “Taking on risk is increasingly appealing to tech companies because it involves aggregating and analyzing a mass of health information but doesn’t necessarily require buying or building a health insurance company,” writes CNBC’s indefatigable Christina Farr (who you should be following!).  
    WEGO Health says Facebook’s news algorithm is great news for patient influencers, who have seen a huge boost in engagement on their posts since the shift. The upshot for healthcare brands? “A strategy change will be needed for brands that have historically seen a positive ROI from organic content to consumers,” says WEGO’s Jack Barrette. “Philosophically, there will be more of a focus on influencers and advertising from brands.”
  • Amazon, like Apple, plans to tinker with the healthcare system using its own employees – and those of JP Morgan Chase and Berkshire Hathaway. The trio are partnering on an as-yet ill-defined venture aimed at better providing healthcare to their combined 1.1 million employees – in part through technological innovation. The goal, per the Oracle of Omaha, is to get around the “hungry tapeworm” of “ballooning costs” afflicting the U.S. healthcare system.
  • Amazon is also piloting an unmanned convenience store in which you pay automatically, via app.
  • And in disappointing study results news, there was a lot of hope for employee wellness programs a few years back, but a series of large-scale studies has failed to show that they do anything to improve health outcomes or costs. Another technologically-enhanced healthcare hope was the use of rideshare services to ferry patients to medical appointments as a means of boosting engagement and adherence/compliance. A substantial study using Lyft rides to ferry Medicaid patients to clinics showed little improvement in appointments missed.
  • It’s becoming clear that part of the motivation for Facebook’s algorithm change was internal freakout over declining engagement. This could have many causes, from “fake news” fears to politics fatigue to the rise of other platforms (like Facebook’s Instagram), but it’s a trend to watch. Meanwhile, in China, WeChat has morphed into a kind of totalitarian killer-app-to-rule-them-all, and is being incorporated into a national ID and biometric snooping system. Zuck can only look on in envy and/or shudder at what might have been in a parallel dimension.
  • Unencumbered by HIPAA and facing crushing patient burdens, China's medical system is also way ahead of its Western counterparts when it comes to implementing healthcare applications of A.I., particularly around imaging.
  • Count on a boom in augmented reality apps, with a fresh crop of smart glasses arriving, five years after Google Glass crashed out of the consumer marketplace.
  • The trend of “vertical integration” mergers in among U.S. healthcare giants is creating some interesting chimeras – along with some “Godzilla vs. Mothra”-class regional rivalries. Here’s a look at two very different models – one with a legacy in health insurance, the other a digitally-innovative hospital system –squaring off in Western Pennsylvania.
  • Pharma discounting of drugs in the U.S. now averages more than 40% off of list price – a huge jump from 28% in 2012 – according to a Wells Fargo analyst. Among specialty pharmas, the average discount is even higher, averaging a whopping 47% in 2016.  
  • A quasi-government body wants to scrap an important carrot meant to spur the shift to value-based care in the U.S., and physician lobbies are fighting to save it, even though they hate it. At issue is the Merit-based Incentive Payment System, or MIPS, envisioned under MACRA (which replaced the HITECH Act).  Meanwhile, the bipartisan budget deal announced earlier this month killed off the ACA’s Independent Payments Advisory Board, which was meant to lower costs to the Medicare program but quickly became a political football and the subject of intense lobbying, and never really got off the ground as a result. These are incremental swipes at the legislative framework meant to support the shift to value, but they could all add up over the course of a presidential administration.
  • Electroceuticals alert: Boston Scientific has won FDA approval for a device that uses electrical impulses to treat pain. Meanwhile, a tiny trial using electrical implants to treat Alzheimer’s patients is showing promise. And somewhat relatedly, a team at MIT has created a hair-thin implant that can drip drugs by remote control deep into the brain, targeting specific regions with pinpoint accuracy.
  • The Onion, of course, had the best scoop on the Bezos/Dimon/Buffett healthcare supergroup.
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