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Genetic Testing sites like 23andMe are rapidly emerging as the new Social Networks. Over the last 10 years, millions of people across the world have submitted their DNA for testing and eagerly waited the results, including me back in May 2016. How are genetic testing sites becoming the new Social Networks? People are completing their DNA testing, receiving their results and then opting in to receive contacts from others with a similar genetic profile to them. This process of being contacted by people based on their DNA profile instead of location and shared interests is a fuelling a new wave of social network activity. The big benefit appears to be discovering relatives or distant family members based on a highly relevant profile and scientific match. This new activity could unlock a new use case for Facebook, particularly for older users in the 65+ bracket, not only could people keep in touch with their children and grandchildren by using the world's largest social network, they could also "search" for older or newly discovered family members of the same age. Instagram and WhatsApp are highly appealing to younger users and real assets for Facebook, could 23andMe be the jewel in the Facebook crown for the older user base? Why now, what is so unique and interesting about genetic testing? Genetic testing appears to have hit an inflection point, growth in the last 2 years has increased 300% from around 4M to 12M. In addition to the growth in this core service, a number of peripheral companies and consumer services have emerged, particularly focused on the data produced and analysis to create personalised insights. "Genealogy services use DNA to tell people what continents their ancestors are from and to locate family members, including distant cousins.The type of readout used, called a genotype, consists of around a million measurements of a person’s genome, performed using an inexpensive DNA chip." "Both Ancestry.com and 23andMe allow customers to download the data files.The sheer number of people who have the data could spur growth in websites that offer to reanalyze it. Companies including Habit and Promethease take the files and provide a breakdown of people’s diet or health risks, frequently with little oversight from regulators." "Consumer gene-testing companies have struggled for years to convince buyers that DNA tests have much value. Genealogy testing is, so far, the one killer app that has emerged to capture wide interest." Size of the global direct-to-consumer (DTC) genetic testing market from 2014 to 2022 If Facebook did acquire 23andMe, what would be the benefits of the deal beyond the data? DNA based Advertising – imagine targeting people based not only on their likes, interests, age, location etc.. but also their genetic profile? Their DNA, pre-determined and pre programmed would unlock a new advertising format. Very appealing to advertisers looking to go beyond hyper-local, hyper-targeted, programmatic and retargeted solutions. Advantage over Google – with a new layer of targeting by genetic profile, Facebook’s advertising platform would gain a competitive advantage over Google. Instead of trying to compete on reach, scale and quantity, Facebook could compete with a first mover advantage combined with technology, design and mobile products. Silicon Valley Talent – the 23andMe workforce of about 450 employees is roughly a 50/50 split between men and women and over 50% of its leadership roles (heads of research, regulatory, privacy, comms, ops, and more) are filled by women. This is rare in many companies, but even more so in its home base of Silicon Valley. Sales and Distribution – 23andMe kits are already available to order on Amazon, one of the world’s largest sales and distribution channels, now imagine them also being available to order on Facebook? How quickly could the order numbers scale from 10 million to 20 to 50 million? Following Spotify and MusicalDNA – Facebook would be following in the slipstream created by Spotify a few months ago, “Ancestry.com and Spotify have joined forces in a campaign that marries science, technology and creativity to deliver personalized experiences and new findings for consumers. Specifically, people can now create personalized playlists based on their DNA." Sources : https://www.nytimes.com/2018/06/16/style/23-and-me-ancestry-dna.html https://thestack.com/security/2015/09/16/ancestry-com-dna-advertising/ https://www.technologyreview.com/s/610233/2017-was-the-year-consumer-dna-testing-blew-up/ https://www.thedrum.com/news/2018/09/21/spotify-and-ancestry-invite-people-create-custom-playlists-based-their-dna https://www.statista.com/statistics/792022/global-direct-to-consumer-genetic-testing-market-size/

Introduction to Rwanda Rwanda has made remarkable socioeconomic progress in the past decade with real GDP growth averaging 8.2% annually. This has translated into improvements in the health situation. Major health reforms took place, including the health insurance improvement, which aims to guarantee access for all to health care; and experience from Rwanda has shown that it is possible to achieve universal health coverage in a country with 90% of its population in the informal sector. Life expectancy has doubled during the 20 years following the devastating 1994 genocide against the Tutsi, as a result of increase in the number of health facilities, improvement in immunization coverage, good access to safe drinking water, and improved housing. All targets related to the three health-MDGs were met, with a notable success in reduction of child mortality and considerable improvements in maternal health. "Rwanda’s eHealth Strategic Plan for 2016–2020 is the key driver to economic growth and to improving the lives of people. Digital health improves service delivery and clinical outcomes, and we know that cannot happen if we don’t look at the data." Dr. Patrick Ndimubanzi, Honorable Minister of State, Public Health and Primary Health Care, Rwanda Digital Health Innovation in Rwanda Let's explore 5 examples of Digital Health innovation in Rwanda ranging from artificial intelligence and machine learning to blood delivery by drones and telemedicine. 1) Jembi - Rwanda Health Information Exchange (RHIE) The RHIE project comprises of an international project team and is funded by the IDRC, Rockefeller Foundation, PEPFAR and the HIPPP initiative. The international project team has designed an enterprise architecture based solution at country level, and seeks to further strengthen eHealth and health information systems within Rwanda. The first phase is focused on the maternal healthcare domain, and the main objectives are to: Complete an Implementation Science/Research Project to present the impact of a Health Information Exchange (HIE) on the maternal healthcare delivery system in Rwanda. Develop a pilot implementation of the Health Information Exchange (HIE) in Rwanda that is focused on the maternal health care system in Rwanda. Expand the understanding of HIE in Rwanda within the health delivery system and the technical community. The project includes identifying and defining high level architecture for the health domain in Rwanda, identification of appropriate standards, functional requirements and interoperability profiles across multiple business, and foundational domains. https://www.jembi.org/project/rwanda-health-enterprise-architecture-rhea/ 2) ZipLine - Blood Delivery by Drones More than two billion people lack adequate access to essential medical products, such as blood and vaccines, due to challenging terrain and gaps in infrastructure. Zipline improves access to these supplies by flying over impassable mountains and washed-out roads, delivering directly to remote clinics. We centralize supply and provide on-demand deliveries, completely reducing waste and stock-outs. Zipline provides a seamless delivery system at an affordable price, obsessing over every detail, so you can focus on patient health. 2.9 million children under age five die every year. And up to 150,000 pregnancy-related deaths could be avoided each year if mothers had reliable access to safe blood. Through a partnership with the Government of Rwanda, Zipline will deliver all blood products for twenty hospitals and health centers starting this summer, improving access to healthcare for millions of Rwandans. Learn more at flyzipline.com Follow us on Twitter @zipline 3) Babyl Rwanda - Artificial Intelligence and Machine Learning Babyl Rwanda is a digital healthcare provider, registered in Rwanda but with its headquarters in London. Its objective is to put an accessible and affordable health service into the hands of everyone on earth by combining the ever growing computing power of machines with the best medical expertise of humans to create a comprehensive, immediate and personalized health service and make it universally available. Babyl uses a combination of artificial intelligence and machine learning with live doctors and nurses to provide medical consultations to anyone with a mobile device. In the developed world where the penetration of smart phones is much higher, this is done through an app. A patient will download the app and privately go through a triage, or seek medical advise on the app and get a diagnosis. They can then go to a pharmacy or lab for more tests or request to speak to a doctor. In Rwanda where the mobile telephone penetration is over 75%, with the majority of the population using feature phones, we have developed a USSD version. Anyone may dial *811#, and register for the platform using their National ID - which is attached to their sim card. Your ID is verified with NIDA in a second and feedback provided. This is an important step because patient information is very sensitive, so we need to be sure we are treating the right person. The patient may then book an appointment, after which they will receive an SMS confirmation of the appointment and get a call from the consulting doctor at the time of the appointment. The doctor will either diagnose the patient and send them a prescription or if further tests need to be done, send them to one of our partner labs for lab work and ultimately give a patient a diagnosis. 4) IntraHealth International - Integrated Health Service Delivery For over 20 years, we’ve collaborated with the government of Rwanda and local partners to meet the country’s need for high-quality health care services by training health workers and strengthening the systems that support them. We’ve helped the country establish decentralized health services that involve communities in defining and ensuring quality, bringing high-quality services closer to communities who need them, including services for family planning, HIV/AIDS, pediatric care, nutrition education, gender-based violence, and more. We’ve also helped Rwanda centralize data on its health workforce so it can analyze health worker information alongside service delivery and medical record data to improve services and referrals for clients. IntraHealth provided technical assistance for significant scale-up of family planning services, training hundreds of health workers and bringing long- acting reversible contraception to the health center level. We served as one of USAID’s key HIV prevention, care, and treatment clinical partners from 2005-2012, creating an innovative strategy to invite male partners of women in antenatal care to be tested for HIV, achieving high rates of participation (>90%). IntraHealth is supporting Rwanda’s efforts to centralize health workforce data so it can analyze health worker information alongside service delivery and medical record data to improve services and referrals for clients. https://www.intrahealth.org/sites/ihweb/files/attachment-files/countrybriefrwandaapr2017.pdf 5) TeleMedicine - Rwanda Military Hospital In an enclosed room at Rwanda Military Hospital in Kanombe, students listen attentively to instructions from a video interaction. This is part of their medical training, a session that allows them to interface with senior health professionals from top countries around the world. However, this practice is not entirely limited to teaching future doctors. On the opposite side of this hospital building, medics gather in a conference room to discuss sophisticated cases with other doctors from different hospitals who have more knowledge on the issues. This is telemedicine; a trend of offering medical services that started as early as 2011 at Rwanda Military Hospital. The aim of this new approach was to improve student training and consequently medical service delivery through regular consultation of experts on advanced medical cases. "Everyone is involved nowadays; it is part of the medical practice. Medical students follow the training in real time but the technology applies even in medical procedures. You could be having a patient here in Rwanda but get guidance from other countries," says Dr Pacifique Mugenzi, the head of research and education at Rwanda Military Hospital. Dr Mugenzi, who is also a trained oncologist, adds that at least once a week, doctors at the hospital meet to discuss complicated cases with other doctors, eventually deriving useful solutions. "We have discussed surgical cases, gynaecological cases and I recall a liver case where we deliberated about its management. Many issues are involved in these discussions but most of them revolve around surgery," adds Dr Mugenzi. Telemedicine provides a base to collaborate with hospitals all over the world and Rwanda Military Hospital has been working with institutions such as the Mercy Hospital in Oklahoma, USA. The recently signed memorandum of understanding between Rwanda and South Korea will improve the quality of telemedicine offered at Rwanda Military Hospital and other referral hospitals within the country. Also, this arrangement is expected to improve hospital information system (HIS) and provision of ICT-based medical services. "Much as the pact is still in early stages, Korea is far more advanced in the field of telemedicine. For example, they may have health centres without all the facilities but use the technology to treat people from another centre with the necessary facilities. During the visit of their delegation, they made assessments on the infrastructure at the hospital. We performed exchanges using telemedicine between RMH and Bushenge to exhibit whether the systems would support the project," Dr Mugenzi explains. The Future - What's Next? Rwanda is poised to play a central role in the African Alliance of Digital Health Networks ahead of its formal 2018 launch. In order to achieve strong and sustainable digital health systems, the African Alliance advocates for in-country leadership, technical capacity and digital innovation to be fostered across the continent. By investing in the development of human resources, the African Alliance will help governments develop the cadres of technology experts and tech-savvy leaders needed to support digital health policies. The African Alliance will also seek to develop a health workforce that is able to use digital health systems effectively in day to day practice, as well as for training, mentoring and performance management. Conclusion Digital innovations have already transformed the way humans interact and communicate. In Africa, the use of digital technology continues to grow rapidly, with roughly 170 million internet users and more and more people joining the internet via computers and mobile devices. Digital health encompasses technologies that enable better collection and sharing of information, improved quality and reach of health service delivery, and better decision-making by governments, health workers, and individuals. It has a critical role to play in achieving Universal Health Coverage and the health-related Sustainable Development Goals. African government leaders play a vital role in developing national digital health systems. Strong governance and leadership is foundational to developing, costing, and implementing a national digital health strategy. Government leadership is also indispensable in responding to the ongoing challenges of fragmentation in digital health investments, limited data exchange capacity within and between countries, and the absence of legislation and policies that promote digital health systems. Lets continue the discussion, tweet @lloygdprice :)

Messaging apps are the future of digital health technology in the UK. Looking forward 2 years, 5 years, 10 years, secure communication between doctors, patients, clinicians and nurses is going to be an essential utility and productivity tool, potentially unrivalled by any other technology in terms of impact and widespread adoption. Today though, demand is outstripping supply and healthcare staff are turning to WhatsApp to fulfil their requirements. It is widely acknowledged that WhatsApp is being used across the majority of NHS hospitals. A recent British Medical Journal study of 2,107 doctors across 5 hospital sites revealed 98.9% of doctors and nurses own a smartphone, and critically around 35% of them use web-based messaging apps to discuss patient care and send clinical information on a regular basis. The BMJ study concluded "we have demonstrated much higher smartphone ownership among doctors and nurses, who perceive these devices to be useful when performing their clinical duties. Large numbers of staff are sending patient related clinical information using smartphone messaging modalities. Care must be taken by doctors and nurses to ensure that no identifiable patient data is transmitted in this way, and healthcare organisations must develop strategies and policies to support the safe and secure use of these technologies by front-line staff." "The findings from this study demonstrate that smartphones have become increasingly popular among healthcare professionals who perceive them to be an excellent tool in supporting healthcare delivery. The results provide strong evidence that healthcare organisations need to develop policies to support the safe and secure use of digital technologies in the workplace and that strategies are needed to secure further innovations in digital health." Healthcare messaging apps in the UK today So if this is such a large market opportunity and everyone is using WhatsApp, what could fill the demand in the UK? There are lots of messaging products available in the UK for healthcare professionals to use, all with varying amounts of traction and use, however one clear market leader is yet to emerge leaving potential for more entrants into the market from within healthcare and also from other industries. Let's look at the 6 main products available in the UK today - 1) Cupris - http://www.cupris.com Cupris was founded by Jules Hamann, a Consultant ENT Surgeon, and Paul Thomas, an award-winning designer and entrepreneur, to develop medical devices that exploit smartphone technology to improve healthcare communication. Jules felt that a significant proportion of the patients he saw in clinic could be cared for without coming to see him in person. We believe that smartphone technology can enable examinations to take place closer to the patient's home and away from over-crowded hospitals. Jules, Paul and Mike believe that providing equal access to healthcare for everyone is an essential step in the future of healthcare and want to enable patients to be treated wherever they are, no matter how remote. 2) MedicBleep - https://www.medicbleep.com Medic Bleep has been developed as a simple and secure solution to the communication challenges that healthcare professionals and wider team in the NHS face while going about their everyday work. This means that if you work in the NHS, Medic Bleep can make your life easier by cutting down on wasted communication time. We’ve made Medic Bleep super easy to use and available on 3 key platforms – web, iOS, and Android – so you can choose what works for you. If you spend the majority of your time at a desk, we suggest you go for our web version (which works in any browser). If you’re on your feet all day or constantly moving between locations then our iOS (iPhone) or Android mobile/tablet apps give you the flexibility to read and respond to messages on the move. 3) MedCrowd - https://www.medcrowd.com medDigital was selected to join the first cohort of the DigitalHealth.London Accelerator - a world-class programme that supports SMEs to develop digital health innovations for the NHS. Through this program, medDigital developed medCrowd, a compliant messenger for health and care teams to work together more effectively and give the best care. Health and care teams are using non-compliant messaging technologies, such as WhatsApp and Facebook Groups, to share confidential health and care information on a daily basis, despite clear guidance from NHS Digital and other professional bodies that only compliant technologies must be used. Therefore, we developed medCrowd to protect confidential health and care information to the right standards. Health and care teams can now join medCrowd and work together compliantly across different organisations all over the world. 4) Hospify - https://www.hospify.com Founded by two surgeons and a technology journalist, Hospify's mission is to give healthcare workers and patients throughout the UK and Europe a very low cost, reliable, industry-wide, legislatively compliant and data secure text and picture messaging app that they can use as an alternative to the frustrating plethora of partial, local channels that they currently have to rely on. 5) Forward - http://forwardapp.co.uk Forward seeks to make bleeps, switchboards and paper handover lists a thing of the past, freeing up doctors to do the things that really matter. Forward is as secure as your NHS email account and is designed to protect both your patients and you. Forward uses end-to-end encryption and stores all data off device in a secure UK hosted cloud in line with NHS Information Governance. Forward users must have access to an approved NHS domain email address. On registering with Forward, a secure activation link will be sent to that address. This unique activation link will expire after 48 hours. 6) CareFlow Connect - www.careflowconnect.com Founded by two surgeons in 2007, Careflow Connect Ltd was acquired last year by System C Healthcare Ltd, one of the UK’s largest suppliers of health and social care software. Originally based on the principle that secure, mobile, social-media-like technology could improve team working and patient care, Careflow™ is now used by doctors, nurses and other healthcare professionals across NHS Acute, Community and Primary Care and is currently contracted across 18 NHS Trusts and counting. Available via web, native iOS and Android, it provides secure messaging, patient identified care-coordination, alerting & escalations, smart patient lists, ward-round management, handover, task management and patient referrals. Healthcare messaging apps in the US Technology innovation tends to start in the US, so what's going on stateside? Is everyone using WhatsApp? No is the short answer, more than 70+ secure text messaging products exist in the market today as a result of the american healthcare ecosystem fully embracing the need to improve communication between patients, doctors, clinicians, surgeons, nurses and staff. In the last 3 to 5 years, the development of secure messaging technology has rapidly expanded from a simple real-time communication tool designed to simply secure PHI, to a platform facilitating advanced clinical communication processes and improved patient outcomes. This rapid expansion has negated the need for WhatsApp, however it is safe to say WhatsApp is being used by healthcare professionals in the US, just on a smaller scale. A direct result of 70+ secure text messaging solutions being available is competition, innovation and the need to diversify. More and more companies are now focusing their attention to large scale enterprise platforms and building combination mobile/desktop solutions that underpin the entire communications structure for healthcare systems and hospitals. Let's look at a few of the market leading products - PingMD - a secure messaging app for doctors allowing medical health experts to connect with other professionals as well as their patients. Patients usually download the application only when their doctors are using it or recommend it to them. PingMD is HIPAA compliant and allows you to connect with your physicians the same way you might communicate with a friend or colleague via text messaging, image sharing and so forth. TigerText - provides secure, real-time mobile messaging for the enterprise, empowering organizations to work more securely. TigerText's encrypted messaging platform keeps communications safe, improves workflows, and complies with industry regulations. TigerText´s secure healthcare text messaging apps have been implemented in more than 5,000 medical facilities and we currently process more than 150 million secure text messages every day. The implementation of TigerText´s secure app for texting in healthcare at the Houston Fertility Institute resulted in the organization create a reliable system for securely recording patients´ notes. Scheduling accuracy improved by 20% and an 80% reduction in phone tag was recorded. QliqSOFT - provides a real-time, HIPAA and HITECH compliant, secure text messaging for healthcare organizations that connects doctors, nurses, and other members of the healthcare team to facilitate patient care. What about closer to home, are the Dutch one step ahead of the UK? Dr Michiel van de Sande, oncological orthopaedic surgeon at Leiden University Medical Center (LUMC) in the Netherlands believes Holland are ahead of the UK when it comes to messaging apps in healthcare and points to the fact that over 30% of Dutch doctors have collectively embraced one solution, Siilo https://www.siilo.com which has catapulted them ahead of the competition as the market leading product. Joost Bruggeman, MD PhD, Co-founder Siilo believes ""Healthcare is in transition. Care is increasingly delivered closer to the home of patients, specialists super-specialize, and locum positions are on the rise. This makes healthcare professionals increasingly mobile and puts pressure on our interrelationships. Siilo helps medical teams to connect and work together." Ok so why did Siilo become the market leader? Why again like the US are doctors not using WhatsApp on such a large scale? No-one really knows for sure, Bruggeman has a theory it is because Siilo understood medicine is mobile, always has been and always will be. From pagers to palm pilots, text messages to mobile apps, healthcare professionals have always frequently communicated to each other in order to share knowledge, ask opinions and access information. He believes "Knowledge is the result of hard work: it involves cognitive and analytic processes after appropriately weighing and collecting information, and in medicine, it is also heavily mixed with professional experience. So first, we were blessed with instantly accessing information. But now, instant messaging has given us the possibility to instantly access knowledge. Thus, your instant messenger has become a new kind of Personal Digital Assistant." What about further afield, what has been the experience in Australia? Australia were in a similar position to the UK a few years ago, due to demand from doctors, nurses and healthcare staff, combined with the use of WhatsApp, a number of secure messaging solutions evolved and were released onto the market. However this evolution of new messaging solutions has not had the same effect as in the US, in fact a lot of healthcare professionals believe the current situation they find themselves in is not a particularly positive one. Jeremy Knibbs for example commented recently in his article Digital Upheaval Asks Demanding Questions Of Austalia’s Health Sector that .. "Digital transformation has been slow to arrive to the healthcare sector because the sector is inordinately complex, fraught with risk and regulation and the economics of supply and demand, especially around the services of doctors, has retarded the normal rapid equalisation of informational power that digital brings to the consumer, in this case, the patient. It is true that the various software and secure messaging vendors, along with the major healthcare data players, like the large pathology providers, have failed largely in Australia to organise well enough to make communication of vital healthcare data efficient and secure. Much of the problem has been a lack of co-operation between competing parties." Conclusion The real benefits of secure messaging go way beyond communication, they are about connecting teams and reducing hierarchies to create efficient working environments. Based on the huge potential of secure messaging, I believe what is needed in the UK is one solution endorsed by government healthcare organisations which has learnt from both the US and Europe in terms of product features, security, UX. UI, auditing, encryption etc... and then applied to meet the needs of local markets in England, Northern Ireland, Scotland and Wales. This could be part of the national IT infrastructure, for example NHS Digital in England could release their own product or co-develop one in partnership with an existing digital healthcare company. Alternatively, the Welsh NHS Board for example could hold a Hackathon or open innovation day and ask four or five digital health companies to present their ideas on the best messaging product for the Welsh market and then commission the development of one solution. Without this approach, more and more solutions will come onto the market, potentially confusing users with different login/registration/authentication/identification processes and ultimately make interoperability and the sharing of data harder and harder as solutions effectively compete for the end user and have little motivation to work together. Messaging could be a repeat of primary care practice management software ... Let's continue the debate, tweet @lloydgprice to start a conversation.

Health tracking equipment is advancing at a significant rate with many items available that are designed to easily and efficiently fit into our busy lifestyles. Bellabeat have now introduced the ‘LEAF’ taking health-tracking design to a whole new level. This health tracker is specifically designed for women and helps to monitor activity, sleep, stress levels and even the menstrual cycle. The latest in health app technology, the LEAF has a beautiful and sleek jewellery-like design making it stand out from other health trackers of it’s kind, such as the Fitbit. It is designed to be worn on a shirt collar or hem and, with accessories, can also be worn on the wrist or neck. Its stainless steel leaf design gives the impression of an elegant brooch when worn on the collar/hem and its wooden back houses the activity tracker and battery neatly. The LEAF has various functions to monitor your health. As it does not have an in-built display, it relies on the LEAF app on your smartphone to help you set goals in various areas such as fitness and stress levels. The LEAF tracks your movements and uses a unique vibrate alarm to let you know when you should increase activity or slow down. It monitors your sleep patterns to help you make necessary changes ensuring you get the best amount and quality of sleep that you can. One unique feature focuses on breathing and encourages users to spend up to 15 minutes a day on specific breathing exercises to help alleviate stress. Another exclusive feature that makes the LEAF specific to women is it’s ability to help women understand their monthly cycles. Users can view their ovulation and period days easily whilst being able to see how other areas of their health affects this. All of the LEAF’s applications are designed to come together and help to create a well-balanced lifestyle in mind and body. These advances in health tracking are helping us to manage our health more efficiently. By keeping such a close eye on our health we are better in tune and informed about our health, which in turn can help our healthcare practitioners – making it a lot easier to inform our GPs when it is needed. Before embarking on any new healthcare regime it is best to get a check up with a GP.

Since Facebook’s acquisition of Oculus VR in March, many of us have been wondering what the future holds for the world of virtual reality. Will the technology be quietly relegated to the realm of gamers, software developers and tech enthusiasts or could Oculus Rift and its competitors soon begin to penetrate our everyday lives? The applications for the sci-fi-esque device are perhaps broader than what television portrayals of virtual reality have led us to believe. For example, Oculus Rift could have huge implications in the field of healthcare. In a post on Facebook, Mark Zuckerberg explained his vision for Oculus Rift goes beyond fun and games; “But this is just the start. After games, we’re going to make Oculus a platform for many other experiences. Imagine enjoying a courtside seat at a game, studying in a classroom of students and teachers all over the world or consulting with a doctor face-to-face — just by putting on goggles in your home.” Since the transition from desktop computers to mobile devices, Zuckerberg sees virtual reality as the next phase. While some may be concerned about the negative impact of Oculus Rift on our health, proponents of the device claim the uptake of virtual reality could offer significant benefits to our wellbeing, improve access to healthcare and even raise standards of care. 1. Mental Health The immersive element of Oculus Rift makes it a perfect tool to alter perceptions in the long term. Virtual Reality is already in use by the US military as a way to treat Post Traumatic Stress Disorder. Researcher Albert Rizzo of the University of California’s Institute for Creative Technologies developed ‘Virtual Iraq’ in 2005 to help soldiers recover from their ordeals, with promising results. Since then, virtual reality technology has progressed rapidly and has also become much more affordable. In an interview with online tech magazine, The Verge, Rizzo has said that virtual reality therapy or VRT through Oculus Rift could revolutionise the way we approach mental health problems. “This has the capacity to turn virtual reality [therapy] into a mass market treatment…I’m sure anyone doing this kind of clinical work will agree with me.” In addition to PTSD, VRT could find its way into treatment plans for autism, addiction, depression, anxiety disorders, eating disorders, phobias and personality disorders. Virtual Reality will allow patients to immerse themselves in a variety of situations in order to overcome their problems in a controlled environment, which they can reflect on afterwards with a mental health professional. Founder of PsyTech LLC, Farnando Tarnogol has been working on the Anxiety Management Virtual Reality Platform. Tarnogol has said “Anxiety disorders and phobias are a real problem that affects one in 60 people in the US. Studies have proved that virtual reality therapy can be as effective as in-vivo exposure – being exposed to real heights, for instance – or imaginary exposure.” Oculus Rift could help people overcome a fear of heights, allowing acrophobics to remove themselves immediately from the situation if they feel too uncomfortable. While virtual reality has been shown to help treat mental health issues, the device could just as easily create them. Video games have long been blamed for increasingly violent behaviour in schools, for example. Overly graphic games could even be traumatic themselves, in which case, will the prescribed cure be more virtual reality? Then again, the aim of some VT software may be to make people feel somewhat traumatised, for example when raising awareness of human rights issues or imploring criminals to understand the psychological impact of their actions. The potential uses for VRT could become very disturbing indeed, perhaps reminiscent of the ‘Ludovico technique’ in the film A Clockwork Orange. 2. Communication and Education Currently, the closest most of us have come to face-to-face communication in the virtual world is via video calling services such as Skype. Oculus Rift, however, promises to make interacting with our peers feel as realistic as if we were there in the flesh. One of the examples Mark Zuckerberg used to show the diverse applications of Oculus Rift was sitting in the doctor’s chair, having a conversation. Virtual reality headsets could become the ultimate Telehealth device by providing patients the same level of support as attending a doctor’s appointment in person and therefore easing the burden on heath services. Similarly, Oculus Rift could make for easier communication between medical professionals and allow students to virtually attend lectures and seminars, ask questions and feel completely immersed without any distractions. A medical student will be able to see an operation performed and experience first hand the high-pressure environment of an operating theatre. Virtual Reality headsets could also transform the lives of the elderly, people with limited mobility and those who are unable to experience the world in the way they would like. For example, someone usually confined to their home would be able to virtually visit friends around the world, forgetting for a moment they are still sat in their own living room. 3. Physical Health There are numerous physical health concerns surrounding virtual reality, many of them dependent on how advanced the technology is, what the virtual reality scenario is and acclimatisation to the device. For example, a fast paced shooting game that is poorly configured and played for five hours straight by a virtual reality virgin is likely to make the player feel more than a little queasy. One thing is for certain, if virtual reality is to make a successful transition to the mass market, it probably shouldn’t be seen as a sure-fire way to induce vomiting. Oculus Rift still has some way to go in this respect. So far, many pioneers of Oculus Rift have reported headaches and nausea after using the device. Quick, spinning movements and head jerks seem to have a particularly adverse affect on the user. Feelings of disorientation could last for hours or even days after a gaming session and pose a significant risk to everyday activities such as driving. While wearing Oculus Rift, the visual signals received are often at odds with other signals. For example, the user may see and hear they are accelerating or turning, but not actually feel it. The body eventually adjusts to this so when driving in reality the movements seem very exaggerated. Eventually, users may be able to flip easily between reality and virtual reality but it is easy to see how unpleasant side effects of excessive use could result in a serious accident. Another key concern involves Oculus Rift’s affect on our eyesight. The evidence suggests, however, that looking through the device is actually better for us than looking at a screen on a computer or mobile device. Our eyes have evolved to look off to the horizon, so activities that involve staring at something as close proximity may result in eyestrain. With Oculus Rift, the eyes are not converging at all and the user sees things at a distance, in a more natural way. The Occulus VR Knowledge Base states “The Oculus Rift causes very little eye strain, particularly compared to other standard displays or headmounts. Normally, when you take a break from using a monitor or TV, the idea is to give your eyes a chance to focus and converge on a distant plane. This is a natural position of rest for your eyes. With the Oculus Rift, your eyes are actually focused and converged in the distance at all times. It’s a pretty neat optical feature.”

A British start-up developing virtual reality and artificial intelligence technology for doctors has been snapped up by a US medical devices giant. Digital Surgery, which was known for its surgical training apps and kitting out doctors with VR headsets, has been acquired by New York-listed Medtronic in a deal that represents a substantial exit for Britain's burgeoning medical technology start-up scene. Medtronic and Digital Surgery declined to comment on the value of the deal, but sources said it was in excess of $300m (£229m). Founded in 2013 by former surgeons Dr Jean Nehme and Dr Andre Chow, Digital Surgery first made waves developing an app for helping train surgeons with a database of common procedures. It has also developed virtual reality software to train doctors as well as artificial intelligence tools for surgeons in the operating theatre. As well as attracting interest from the US medical giant, The Telegraph understands that SoftBank, the Japanese investing giant that has backed dozens of tech start-ups through its Vision Fund, came close to an investment in Digital Surgery. No deal was agreed. SoftBank, which has become notorious for its quick-fire investing in start-ups across the world, has recently pulled back from several deals after submitting term sheets. It came close to investing $150m in US healthcare start-up Honor, and also pulled out of a deal with software company Seismic. SoftBank has reined in its investing style after several big bets from its first Vision Fund, including WeWork, turned sour. Medtronic, a US-listed medical technology giant that employs over 86,000 people, is set to fold Digital Surgery into its existing portfolio of robotic surgery technologies. Dr Nehme said: “We have always believed in computational power and data as two central drivers of consistency and quality in surgery. Computational power has impacted our lives in so many ways, and within surgery it is almost absent. By joining forces with Medtronic, we will finally apply computing and AI to surgery on a meaningful scale with a goal of helping more patients in more places benefit from consistently high-quality surgical care.” In 2017, The Telegraph revealed it had secured £15m from 8VC, a West Coast fund whose partners had previously been an early backer of Oculus Rift. Other investors included London's Balderton Capital. The start-up was previously recognised in the Telegraph's Tech4Good awards. According to the start-up's last Companies House statement, between them Dr Nehme and Dr Chow owned around 20pc of shares in Digital Surgery, with those shares now worth millions of pounds. SoftBank declined to comment. Source : https://www.telegraph.co.uk/technology/2020/02/13/virtual-reality-surgery-start-up-digital-surgery-snapped-us/

What is Synchronous Telemedicine? The Office of the National Coordinator for Health Information Technology (ONC) defines synchronous telemedicine as "live video-conferencing," which is a "two-way audiovisual link between a patient and a care provider." The U.S. Department of Veterans Affairs (VA) states, "Synchronous telemedicine requires the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place." The American Telemedicine Association (ATA) defines synchronous telemedicine as follows: "Interactive video connections that transmit information in both directions during the same time period." The University of Miami (UM) Miller School of Medicine states, "Real-time telehealth sessions are live and interactive, and frequently use video-conferencing technologies. Often, special telehealth-enabled instruments, such as a video otoscope or an electronic stethoscope, are operated by a nurse or technician at the consulting provider's direction to remotely perform a physical examination." What is Asynchronous Telemedicine? ONC defines asynchronous telemedicine as "store-and-forward video-conferencing," which is the "transmission of a recorded health history to a health practitioner, usually a specialist." VA states, "Asynchronous telemedicine involves acquiring medical data, then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline." ATA defines asynchronous telemedicine as follows: "Term describing store-and-forward transmission of medical images and/or data because the data transfer takes place over a period of time, and typically in separate time frames. The transmission typically does not take place simultaneously." UM states, "In store-and-forward telehealth, data are captured locally, then temporarily stored for transfer at a later time, either via a secure web server, encrypted e-mail, specially-designed store-and-forward software, or electronic health record. The consulting provider then reviews the stored data and makes diagnosis, treatment, and planning recommendations that are electronically transferred or faxed back to the referring provider." Benefits of Synchronous Telemedicine An article in Healthcare Informatics Research (HIR) states, "The major advantage of a synchronous approach is the efficiencies gained by having the opportunity to refine details pertinent to the care episode during the session, by seeking additional information or data, and in many cases providing a clinical decision or advice within the session." An mHealth Intelligence article notes, "Real-time telehealth provides timely care, especially in emergencies or urgent situations, and maintains the concept of the doctor-patient relationship by enabling a face-to-face analysis and treatment. The doctor is able to see the patient, conduct, and examination and engage in conversation, much as he or she would in an office visit." A study published in the American Journal of Emergency Medicine concludes, "Synchronous audio-video telemedicine consults resulted in short-term cost savings by diverting patients from more expensive care settings." An American Psychiatric Association report on synchronous video-conferencing in psychiatry found that, based on a review of more than 30 adequately powered randomized controlled trials, "… treatment intervention outcomes using synchronous video-conferencing was comparable to in-person care outcomes. With the exception of one study, the review found no statistical difference in clinical outcomes for pharmacotherapy or psychotherapy delivered by synchronous video-conferencing treatment and in-person treatment." Finally, an article in The Online Journal of Issues in Nursing includes the following sentiments: "Synchronous visits enable assessment, diagnosis, and treatment in hospital or clinic settings, and facilitate nurse-to patient-education." "Critical access hospitals with limited resources can benefit from prompt, synchronous consultation by a neurologist, in the event a stroke is clinically suspected, and timely treatment with thrombolysis is critical." "Synchronous telehealth models improve convenience, access, and efficiency of care by offering walk-in telehealth services." Benefits of Asynchronous Telemedicine The HIR article previously referenced states that asynchronous systems "… decouple the components of the interaction so that they can occur at different times at the convenience of the participating parties. This model still allows for multiple component interactions to occur, but the effect of the time separation may add overhead of required refreshing of the episode context during this process. An efficiency gain may nevertheless be obtained in asynchronous services when the telemedicine task does not require to-and-from interactions, and especially when it does not rely on direct interaction with the patient throughout." The Center for Connected Health Policy (CCHP) shares several asynchronous telemedicine benefits, including the following: "Patients can get timely specialty care without needing to travel beyond the location of their primary care providers." "Wait times for specialty care are lessened, especially in areas with shortages of medical specialists." "The store-and-forward process can overcome language and cultural barriers." A study published in the Journal of General Internal Medicine that compared blood pressure control and healthcare use between patients who received "virtual visits" structured as asynchronous online interactions and typical hypertension care concludes, "Among patients with reasonably well-controlled hypertension, virtual visit participation was associated with equivalent blood pressure control and reduced in-office primary care utilization." Finally, the previously cited mHealth Intelligence article notes, "… proponents of store-and-forward technology say the platform is ideal for evidence-based care in which providers are able to gather all the information on a patient, analyze that data, match it to evidence-based care and make a diagnosis. While perhaps not suitable for emergency care, it gives providers the leeway to add clinical decision support to the process and eliminates the sometimes-inconvenient requirement of having both patient and doctor available at the same time." Synchronous Telemedicine Applications While our discussion up to this point has touched on various synchronous telemedicine applications, CCHP provides several examples of other ways organizations can leverage synchronous telemedicine, including the following: "Video conferencing connects emergency providers with medical specialists who otherwise would not be available for consults." "Primary care providers can consult with medical specialists who are not available locally." "Medical specialists can examine patients in remote locations when distance is a barrier, as is the case when patients live in rural and underserved urban areas. This includes situations where the physician needs to directly observe the patient." "Language translators can provide video interpretation services to multiple locations, a cost-effective expansion of these programs." A study published in the Journal of Medical Internet Research on synchronous telehealth services for patients with cardiovascular diseases notes that such services include "… instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis; mutual telephone communication and health promotion; and continuous analytical and decision-making support." A recent FierceHealthcare article notes that real-time video conferencing is leading to a resurgence of "house calls," albeit virtual ones. As a final application example, synchronous telemedicine is helping improve medication management. As a U.S. Pharmacist article states, "Essentially, telepharmacy leverages technology to allow one pharmacist to provide supervision and review prescriptions at multiple locations. Patients pick up medications from a nearby licensed location staffed by pharmacy technicians and have access to the same counseling with a pharmacist at the remote location as they would at the home pharmacy, only it is done via a screen rather than in person." Asynchronous Telemedicine Applications CCHP also provides the following examples of how organizations can use asynchronous telemedicine: "In radiology, physicians at small rural hospitals can forward X-rays or MRIs to specialists at major medical centers for review." "In dermatology, primary care providers can take digital photos of their patients' skin conditions and forward the images to dermatologists for review and determination of treatment if needed." "In ophthalmology, eye screenings for diabetic retinopathy, a disease that is a major cause of blindness among individuals with diabetes, can be captured digitally by retinal cameras and transmitted to a specialist for review." A Urology Times article notes, "In our specialty, a relevant example might involve receiving a computed tomography image or a photo of a genital lesion for expert opinion. Obtaining CME hours via a downloadable course is another example of asynchronous telehealth services." Finally, an article in The Lancet Oncology states, "Store-and-forward communication is practical in fields that require imaging. As an example, the nonprofit organization ORBIS links clinicians in developing countries with mentors in developed countries to improve the diagnosis and management of ocular diseases, including cancer." Source : https://blog.cureatr.com/two-forms-telemedicine-synchronous-vs-asynchronous

Introduction to Project Nightingale Project Nightingale is a data sharing project financed by Google and Ascension, a Catholic health care system comprising a chain of 2,600 hospitals, doctors’ offices and other related facilities, in 21 states, with tens of millions of patient records available for processing health care data. Ascension is one of the largest health-care systems in the United States with comprehensive and specific health care information of millions who are part of its system. Google is involved with Ascension to process this data, which began in secret sometime in 2018, without knowledge and consent of patients and doctors. Whistleblower A whistleblower who works in Project Nightingale, the secret transfer of the personal medical data of up to 50 million Americans from one of the largest healthcare providers in the US to Google, has expressed anger that patients are being kept in the dark about the massive deal. The anonymous whistleblower has posted a video on the social media platform Daily Motion that contains a document dump of hundreds of images of confidential files relating to Project Nightingale. The secret scheme, first reported by the Wall Street Journal, involves the transfer to Google of healthcare data held by Ascension, the second largest healthcare provider in the US. The data is being transferred with full personal details including name and medical history and can be accessed by Google staff. Unlike other similar efforts it has not been made anonymous though a process of removing personal information known as de-identification. The whistleblower introduces the video with the words: “I must speak out about the things that are going on behind the scenes.” Watch Video - https://www.dailymotion.com/video/x7nvz43 The Four Pillars Stage 1 - Infrastructure and Data Layer transformation Stage 2 - Collaboration and Productivity, G Suite Deployment Stage 3 - Healthcare information layer, EHR Search Stage 4 - Healthcare experience layer, Use cases Stage v Pillars Stage 1 and 2 - moving patient data not de-identified to the Google Cloud Stage 3 - Google using Ascension data to build its own framework in the cloud Stage 4 - Google uses Ascension data to mine patient info, run analytics, run AI algorithms, sell or share data with 3rd parties, create profiles of patients that they can later advertise to online with healthcare ads targeted to their specific healthcare issues Is Google allowed to access patient data? In a word, yes. Company insiders claim that Ascension patients are unaware that their medical data is being shared. While this may raise concerns among privacy advocates, Forbes states that privacy laws 'generally allow the sharing of patient data with third parties without notification if it is for purposes that “help it carry out its health care activities and functions.’” Google has also stressed that its agreement with Ascension means that it can only use patient data for its medical-related algorithms. “To be clear: under this arrangement, Ascension’s data cannot be used for any other purpose than for providing these services we’re offering under the agreement, and patient data cannot and will not be combined with any Google consumer data”, Google Cloud chief Tariq Shaukat wrote in a blogpost. Google Q&A - Was your work with Ascension a secret? "Our work with Ascension was not a secret. In fact, we first announced our partnership with Ascension in July, on our Q2 earnings call. And, as Ascension has stated, they informed acute care administrative and clinical leaders across their organization on the work, held enterprise-wide webinars, and briefed clinical leaders of their employed physician group in detail. In addition, Ascension directly engaged many front-line nurses and clinicians on the project." Google Q&A - Does Google combine patient data across customers? "No. We are building tools that a single customer (e.g., a hospital or primary care group) can use with their own patients’ data. The data is siloed, access controlled, and auditable. We do not combine data across partners, and we would not be allowed to under our agreements or the law." Google Q&A - What does the name “Nightingale” come from? "It’s actually the code name that both parties are using for this project, nothing more. We use code names for many different things--customers, products, etc." Sources : https://en.wikipedia.org/wiki/Project_Nightingale Sources : https://www.dailymotion.com/video/x7nvz43 Sources : https://www.irishtimes.com/business/technology/project-nightingale-google-s-secret-project-gathers-health-data-of-millions-1.4081492 Sources : https://www.theweek.co.uk/privacy/104293/google-project-nightingale-tens-of-millions-of-health-records-gathered-without Sources : https://cloud.google.com/blog/topics/inside-google-cloud/our-partnership-with-ascension

Proteus Digital Health’s CEO once confidently proclaimed that in a couple of decades, “every medicine will have a chip in it.” At a time when many companies are trying to break into the airy realm of digital health, and getting funded, Proteus seemed to not only be making headway toward its CEO’s ambitious vision, but to have the bona fides to back it up. Yet this week, as a CNBC report described it, Proteus is suddenly “desperate for cash.” Given that the company was considered one of the few validations of that chip-in-a-pill strategy, the news — combined with Sanofi CEO Paul Hudson’s just-announced plan to walk back Onduo, the firm’s diabetes management joint venture with Verily, and Sandoz’s October decision to relinquish commercial rights for prescription digital therapeutics to Pear Therapeutics — may have left some feeling unsure what this means for the future of so-called digital medicine. How did Proteus go from a $1.5 billion valuation to having trouble just keeping the lights on? “It’s all about evidence,” explained Everett Crosland, an expert in market access within the digital health field, when asked about the possible missteps that led to Proteus’ funding woes. That is, evidence development and commercialization based off of that evidence. Crosland — formerly VP of market access, reimbursement and governmental affairs for Pear — has become well familiar with that requirement. “There’s a learning curve occurring where multiple [digital therapy] companies raised money and told a story that, ‘Because we’re a new modality, we’re somehow excepted from the laws of healthcare physics.’ [But] we’re not. We have to meet thresholds and oftentimes exceed them because we are digital.” In the case of Proteus, the company said that its body of clinical evidence has shown improvements in cost effectiveness and quality of care. Nevertheless, according to the CNBC report, it’s undergoing a restructuring after failing to close a $100 million funding round that had forced it to furlough the majority of employees last month. The issue involved a lack of traction among patients, sources said, which made Otsuka hesitant to commit further investment from its pledged $88 million, five-year partnership, and other potential investors leery of doing so as well without further data from the partnership. The Redwood City, Calif., start-up, founded in 2001, had spent the ensuing decades developing a smart pill, a device designed to tell a smartphone app whether a patient has ingested a medicine. The firm applied for and secured FDA approval back in 2017 for Abilify MyCite, a product jointly developed with Otsuka that focused on the schizophrenia population. Late last year, Otsuka committed to help Proteus expand its menu of digital medicines to other areas of mental health. As of January, Proteus had begun pushing into oncology, too, and had raised a total of $487 million in funding over 11 rounds from backers including Novartis Venture Fund and Kaiser Permanente Ventures. That promising start made this week’s news all the more surprising. Which is why I asked Crosland for his take. He’s now SVP of commercial for AppliedVR, which markets virtual reality technology to hospitals for use in helping patients cope with pain and anxiety. He spoke with MM&M about what he sees as the reasons behind Proteus’ stumble, as well as the overall state of reimbursement in, and payers’ evolving attitudes toward, digital health. The following interview has been edited and condensed. Talking about Proteus, they’ve had quite a turnabout for a company that seemed to be doing things the right way. Why do you think they’re in this situation now? As a good steward in healthcare, if you’re selling and commercializing anything, you need to show it works and the only way to do that is through prospective studies. That comes in the form of randomized controlled clinical trials, health economics and outcomes research (HEOR) and value-based studies so that you know it works from a clinical perspective and a value perspective, that you’re creating value for health systems, payers and patients. Those are just table stakes. The Proteus news just reconfirms that. In the earlier days at Proteus — I’ve heard them speak on this — is that you have to ensure in your partnerships that you’re driving toward the same goal…which inevitably should be evidence development and commercialization based off of [that] evidence. What kind of evidence? These [digital medicines are approved for] serious conditions that require evidence both from a clinical perspective to get through regulatory hurdles and health economic evidence to ensure that we’re driving value and cost savings. We have to show more than a traditional drug because we have to demonstrate we’re clinically safe and effective and that patients will use our product, which if you’re a drug (for the most part) it’s assumed patients will use it, even though evidence shows poor adherence rates. Still, we have to hit that bar through randomized clinical trials. Do you think they had trouble hitting that bar? I can conjecture that what we’re all experiencing now is that the early pioneers of the industry — and there are a number of them — have signed…large, promise-based, bio-bucks deals that come in at $100 million to $300 million, if the product performs. For the product to perform, you have to invest significant dollars in the evidence development and ultimately in true commercialization and scaling efforts. For the field force, that’s often a rather unique sale. While Proteus has done some very impressive deals, it takes a few years for those deals to come to fruition…and to determine if a product is truly performing. And if you didn’t invest where you needed to invest in the early days, then it’s hard to catch up. That’s what ended up happening. As you look around the industry, what digital health companies are leading the way with outcomes data? A great example is Click Therapeutic’s [prescribable software] product for smoking cessation. They’re covered by 200 mid- and large-sized employers. And the reason they have that coverage is their evidence. Big Health’s Sleepio insomnia app has a mountain of evidence behind it and has coverage across the U.S. Evidence development drives coverage, and it’s a well-worn path. We are new in many ways but again, [there are] laws of healthcare physics that you’re never going to get around, [nor] should we try. We’re not selling bits and bobs; we’re selling healthcare products. If you don’t want to develop evidence, you shouldn’t be in healthcare. Sunday’s news story said pharma lacks a clear roadmap to get these products out to patients. Is there a demand problem? Of course there has to be demand for it, but you have to be out there with the on-ground sales force, and most of that is selling to payers and to physicians and educating the market to ensure that you’re changing the prescribing behavior that needs to be changed. You’re pulling through those prescribers, making it clear that this is a benefit to patients, and [that] we have an amazing opportunity to monitor that data in a quicker turnaround than any other modality. We can see when patients are using it, what’s working and what’s not. But at the same time, the sales force has to be out there educating. These products won’t sell themselves by any means. This is not a traditional pharma sale, but a modality where largely what we’re trying to do is change behavior, and a behavior-change sale is not a pill sale. Pharma and start-up don’t always adhere to the commercial roadmap, as we saw when Pear and Sandoz unraveled part of their co-promote recently. To what extent are these kinds of relationships fraught with friction? I think that we’re getting to a place between digital health and pharma where we’re really understanding how we work well together. I sat on a panel with Proteus and Otsuka a year and a half ago, and they talked about how when they first got together, their relationship…struggled but got to a place where they understood best practices in their alliance. More and more, we’ve got pharma players who have dealt with enough digital-health companies where they now know how best to work with us. At the same time, we as digital therapeutics companies have to ensure that we…are good partners. That requires us to ensure that our product team has dedicated resources and bandwidth in the roadmap so that when these pivotal partnerships come in the door, we have product [teams] tell us what’s possible in the deal-making phase and [inform] every step of the alliance. That’s an alliance digital-therapeutics companies are starting to understand. It’s not something that was clear even two years ago. Interestingly, the Pear-Sandoz breakup announcement was almost immediately followed by Bayer, Novartis and other pharma companies getting [deeper] into the space. There’s no slowing of these partnerships [due to] the precedent of Sandoz and Pear. Are the two ironing out their cultural differences? We both come to the table with distinct cultures and mindset. Pharmas come to the table with often decades…of process. Every decision has an incredible amount of rigor behind it. In our world, the start-up digital therapeutics world, we don’t have that legacy. That can help us move faster, scale faster, help us think more creatively and get into markets that a pharma probably would have overlooked or killed due to process. At the same time, we have to recognize there are limits to that agility and risks. And if we’re talking about a deal worth hundreds of millions of dollars, we need to find a middle ground between cultures. Most importantly, both need to understand it’s not our job to change the mindset of our partner’s organization. It’s not the digital therapy’s job to drive digital transformation at our pharma partner’s organization. It’s our job to execute on the deal in the timeframe we agreed to and make it a success. It’s not the pharma partner’s job to help [the start-up] grow up and be more process-driven. We just have to understand that there are middle grounds to be found, and our success is executing and pulling through on the deal ahead of schedule. That’s success, not driving some sort of ethereal or cultural change at the partner. Sunday’s story also alluded to a lack of clarity around patient monitoring for digital therapies. Do you agree? That’s an accurate general statement, and that would vary by health condition and disease state. Especially with MyCite and schizophrenia…when a schizophrenia patient isn’t following up and is struggling to adhere, I could absolutely see that being challenging. In other disease states, like with [ADHD], if a pediatric patient isn’t adhering you can find a primary care physician and the caregiver — most likely a parent — and follow up with them. Not every disease state is so clear, [certainly] not schizophrenia….We felt that at Pear in the opioid-use disorder area. The patient journey still has a lot of gaps in it. If a digital therapeutic fills those gaps, it can help bring clarity [i.e., data] to that patient journey that you just otherwise don’t have. But at the same time, we won’t be able to solve everything. How have payer views evolved in reimbursing digital-therapy combos? They’ve evolved more rapidly than I thought they would and in a positive direction. They’ve moved beyond “is this competitive with pharma” or “a replacement of pharma” and recognize there’s a role and need for both products, either alongside of, or within, the treatment paradigm. Just like any product for unmet need, it’s not replacing a drug but supplementing or filling in a gap in the current treatment paradigm. More importantly [payers] like Express Scripts, CVS Caremark, Solera with BCBS of California are putting in place the plumbing or infrastructure that facilitates payment and coverage of digital therapeutics. That wasn’t the case two years ago; every payer was different. Now, we’re seeing a move toward uniformity in the evidence payers require for coverage and payment, and mechanisms like billing and coding being put in place. When Express Scripts announced they were putting together a digital health formulary, and CVS Caremark followed suit, that was a watershed moment for the industry. Have regulators been moving rapidly enough in this area? The Food and Drug Administration has been very helpful and forward-thinking. They recognize the potential of these products to help patients. They also see the need for evidentiary rigor to be applied to these products because they’re going to be used, one way or the other, and need to be held to the gold standard. I haven’t seen anything to suggest they’re slowing down. The Centers for Medicare and Medicaid Services is behind the FDA in that regard. They have not put in the amount of thinking, have not engaged stakeholders in that way. They are lagging behind, and that will become an increasingly stark lag as CVS Caremark, Express Scripts and other payers start to facilitate coverage and payment for the commercial, Medicare Advantage and Medicaid managed care populations. When those populations start to be able to access these innovative solutions at scale and start to improve outcomes, and if those on traditional Medicare are unable to access these products, that will be a problem. Source : https://www.mmm-online.com/home/channel/whats-behind-smart-pill-maker-proteus-funding-woes-lack-of-evidence-to-convince-payers-of-value-says-one-expert/

Facebook's WhatsApp has been growing in user numbers to become one of the globally dominant and most widely used messaging apps. And as such, it was only a matter of time before it found its way expanding from the casual, private userbase to professionals, even in fields such as healthcare – that must surely rank as some of the most sensitive. The website providing a guide to the US Health Insurance Portability and Accountability Act of 1996 (HIPAA) asks the pertinent question: is using WhatsApp in a professional setting by healthcare workers compliant with the law? Specifically – if doctors and nurses choose to exchange information about their patients' health via WhatsApp – can patients count on this private data to remain safe – according to the standard set by the protected health information (PHI)? PHI regulates anything from information about a person's health status to their healthcare payments – in other words, it's a collection of extremely comprehensive and sensitive personal information. But could all that be getting out in the wild if professionals exchanged it via WhatsApp? The HIPAA guidance website analyses the circumstances both from the point of view of the legislation and the way WhatsApp is deployed to conclude a resounding – just don't do it. Despite WhatsApp deploying end-to-end encryption – and more on that later – the conclusion here is that the app, though it can still be used by healthcare professionals “for general communication” – is not up to par as a trusted app to transmit and exchange patients' electronic protected health information (ePHI) – though “de-identified PHI” can still be exchanged on the platform, the HIPAA website said. Then, there's UK's national healthcare service, the NHS, where nurses using the app to communicate about patients has raised privacy concerns. “We use WhatsApp for everything, reminding other nurses about problems with patients, which patients to be careful with or which patients have problem relatives who they need to look out for. Having a group chat for a ward can be quite useful to keep everyone up to date on what’s been going on,” one NHS nurse said to Reclaim The Net. Another shed some light on the treatment of patients' medical data: “It’s not so much the nurses that are sharing patient stuff, it’s usually the doctors that use it to share more personal stuff. Lots of doctors take photos of patients’ wounds and x-rays and share them with other doctors on WhatsApp. It's kind of worrying when you think that Facebook owns WhatsApp, and we all know what they're like with privacy.” However, the NHS has recently suffered other technological setbacks like the organization's slow and reluctant upgrading from some pretty abysmal existing technologies, like Microsoft's Windows XP. That, in the end, cost the NHS a lot of money and good faith in the 2017 WannaCry ransomware disaster. You might think – that was then. But even now, as MobiHealthNews reports that a St. George's University Hospital NHS Foundation Trust study has found that the NHS is “a privacy and clinical safety time-bomb.” The study is based on “77 staff members in the trauma and orthopedics department revealing that 87 percent of staff used smartphone apps to discuss patient cases at work, despite 56 percent not being sure whether the information was secure.” EU’s General Data Protection Regulation (GDPR) plays into the way the UK deals with this type of data and privacy issues. When and if the UK leaves the EU, the GDPR will continue to be enshrined in the national law – so it's particularly disconcerting that a recent Freedom of Information Act (FOI) request has found as many as 58 percent of 136 NHS trusts lacking any policy in place whatsoever when it comes to protecting patients' personal medical data from messaging apps. The study, that is yet to be published, is comprehensive – and one of the points it touches upon is Facebook's WhatsApp. Even if WhatsApp's redeeming feature seems to be its end-to-end encryption – there's more to the story than meets the eye. While direct communication may be protected – allowing backups on WhatsApp means that data stored in this way becomes vulnerable to outside snooping. That was revealed in one of the controversies of the day, back in the summer of 2018 – and Buzzfeed expanded on it at the time. On the other hand – it's a no brainer that emergency services, and those they work to assist in a crisis can greatly benefit from a real-time communication tool that will make their work as efficient as possible. But, as Nursing Times observes, – “Instant messaging can have clinical utility – but remember that the law places obligations on clinicians to protect patient confidentiality.” Outside the immediate medical tasks – UK's health service might have mitigated some damage from deploying vast amounts of outdated Windows operating systems that made it a soft target in 2017 for the WannaCry crisis. Digital Health writes that NHS staff using encrypted messaging apps like WhatsApp as an unofficial communication channel back then was not such a bad idea – the website claims that “national bodies and trusts told us it worked well during the incident.” But the NHS in 2018 felt it was the right time to introduce some new rules when it comes to using WhatsApp to exchange sensitive patient data. The guidance is designed to help doctors and nurses use messaging apps “safely to coordinate patients' care during emergencies.” The guidance recommends using messaging apps that “meet the NHS encryption standard”; not allowing other people to use their device and not allowing lock-screen notifications; and keeping “separate clinical records and deleting the original messaging notes once any advice has been transcribed and attributed in the medical record.” Source : https://reclaimthenet.org/hospitals-doctors-nurses-whatsapp-data-privacy/

Yesterday evening the German Parliament / Bundestag decided to pave the way for a broad usage and reimbursement of digital health applications and to improve the digitization of the German healthcare market. Until now, apps or other medical software offerings for patients could only be reimbursed by an insurance company on a case-by-case basis or under special selective agreements. The first-mentioned was a very complex process for the patient and did not open up a sustainable business model for the provider of the app or software. A selective agreement was and is a way of having the product reimbursed by statutory health insurers, but these agreements were limited in time and did not allow for comprehensive market coverage in Germany. Once the contract expired, there was no direct route to transition into the regulated reimbursement by all statutory health insurers in Germany. The new Digital Healthcare Act (DVG) now opens up a structured path to have digital health applications reimbursed by statutory health insurance funds, thus make them accessible to patients on a broad basis. But what does the Digital Healthcare Act actually mean for stakeholders in the healthcare market? What are the key implications for patients and providers? All such health apps, which can help patients to manage a diagnosed medical condition, can from January 2020 onwards be prescribed by their doctors. The costs are borne by the statutory health insurances, hence those insurances 73 million people in Germany are members of. To receive market clearance, apps have to undergo an assessment on data security and functionality by the Federal Institute for Drugs and Medical Devices (BfArM). It is important to know, however, that statutory health insurances will reimburse the costs provisionally for one year only. In order to qualify for cost reimbursement, providers of health apps have to generate proof for positive effects on care for their respective apps within these first twelve months. This process is referred to as the “Fast Track” into standard care in Germany. Such positive effects could be related directly to medical outcomes for patients or to process and structural improvements. Providers of health apps which already generated proof for these positive effects can now apply at the BfArM to become component of German reimbursed standard care directly. What does the act mean for telemedicine and digitization? In 2018 the before then highly restrictive regulation on distant treatments had been opened towards remote/video consultations. Now, doctors are allowed to better inform patients about their video offerings, and video consultations will be reimbursable. In addition, there will be stronger incentives and regulations in place to further improve digitization of traditionally paper-bound documents, e.g. certificates for sick leaves, medical reports, and prescriptions. To allow for a more efficient exchange of data amongst all stakeholders in the healthcare sector, doctors, hospitals, and pharmacies are now obliged to connect to the German telematics infrastructure. Midwives, physiotherapists as well as rehabilitation and nursing facilities can voluntarily join the telematics infrastructure and will be reimbursed for that voluntary connection. As a consequence, the relevant preconditions for an electronic patient file will highly improve as well. Does it have an effect on funding options for start-ups? Yes, it does! Statutory health insurances are now allowed to support start-ups not only know how- and market-related, but also financially – by investing directly into VC funds with focus on digital solutions in the healthcare space. Up to approximately 400 million EUR out of the financial reserves of the German statutory health insurances could be potentially invested. The euphoria and excitement in Berlin’s digital health ecosystem is enormous. And the speed at which the Federal Ministry of Health has designed the new law is worthy of a start-up: in 18 months from the idea to the passing of the law. „As a former co-founder of a digital-health startup, I am relieved and impressed. Relieved, as the #DVG is a key milestone in Germany’s strategy to leapfrog its health system into the 21st century. And impressed, as the very robust but also rigid German system is now taking a pioneering role to open up for digital health innovations.”, says Dr. Henrik Matthies, managing director of Berlin based health innovation hub (health innovation hub) – think tank and digital transformation partner of the German Ministry of Health. Digital health start-ups can now prepare their market entry in a clearly defined regulatory environment. Patients can look forward to easy and fast access to their physician, pharmacy and digital healthcare applications, as well as improved medical care. And we healthcare investors can better assess the opportunities for our portfolio companies to enter the market. Source : https://www.frontiers.health/german-digital-healthcare-act/

Sony has entered the Digital Health market with a remote monitoring wearable device called mSafety. The product is a wristwatch designed to capture and track patient data such as blood pressure, blood sugar and heart rate continuously. mSafety Watch mSafety allows providers of health and safety services to monitor people remotely and keep them safe. Expand and improve your offer with this scalable, secure and energy-efficient platform. Remote monitoring Keeping people safe, without being intrusive. Whether you’re rescuing a kite surfer, monitoring employees in high risk occupations or aiding the elderly, remote monitoring via the mSafety connected wearable device maximises not only safety, but also the users’ sense of personal freedom. How remote IoT monitoring improves patient care As a healthcare provider, how can you continue offering high quality services in the future, without adding costs? Combining a power-efficient wearable with a secure backend solution, the mSafety platform from Sony addresses this question head on – allowing you to monitor patient data such as blood pressure, blood sugar and heart rate continuously from a remote location. With mSafety, you can provide an even better service to users while also reducing your costs. Low complexity wearable Easy to use, read and manage, this straightforward device eliminates many of the difficulties associated with smart phone apps. Thanks to energy-efficient IoT connectivity battery life is 7 days or more. Source : https://iot.sonynetworkcom.com