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The NHS’s biggest hospital trust has signalled its intention to spend up to £400m on an electronic patient record system, in one of the biggest tenders of its kind. The tender, issued by Manchester University NHS Foundation Trust (MFT), vows to create a “best in class” data management solution that will deliver “measurable clinical benefits” and an “extremely impressive return on investment”. It forms part of a nationwide drive by NHS Digital to make the health service paperless by 2020. The unit is determined to rid hospitals of their dependence on outdated tech, promising that better use of data will grant patients greater control over their health, empower their carers, reduce the burden on medics and give rise to new treatments. But it has a long way to go. Last year, researchers found that the health service was the world’s biggest buyer of fax machines and owned 10 per cent of its pagers. “[The electronic patient record solution] will bring a number of benefits, including improving the patient experience, for example by reducing the need for patients to give the same information to different members of staff and reducing delays in accessing paper medical records,” a spokesperson for MFT told NS Tech. The trust also hopes that the technology will improve patient safety by identifying medication errors and infection risks, and the quality of care by reducing unwarranted variation in treatments. The price of implementing electronic patient record systems varies wildly between trusts, and is dependent on their size and the complexity of the individual organisation. In March, for example, Leeds and York NHS trust committed to paying Careworks just £2.5m to delivering such a system. Commenting on the level of funding allocated to the patient system, a spokesperson for MFT said it was now the largest trust in the UK. “It is responsible for running a family of nine hospitals across six separate sites, providing a wide range of services from comprehensive local general hospital care through to highly specialised regional and national services. A future EPR solution needs to meet the whole of the Trust’s specialist and complex needs.” The contract lasts a decade, but the tender notice specifies that the trust is looking for the partnership to last for “the next 15 years or more”. Businesses have until 6 September to apply. Source : https://tech.newstatesman.com/public-sector/electronic-patient-record-system-manchester-university-nhs

Introduction to Nomadeec Nomadeec is the most intuitive and secured mobile telemedicine platform for Emergency professionals. Compact, light and extremly intuitive, it allows to set up a complete digital assessment of the out-patient, featuring photos, videos, Scores, 12/18L ECG. Nomadeec accelerates medical decision-making to maximize the patient's chances of winning. The solution features an innovative mobile application on 4G tablet with a set of Bluetooth connected medical devices and a fully secured webApp for real-time patient review by EMS or Expert physicians. Nomadeec and HoloForge Partnership Designed through a partnership between medical software company Exelus and HoloLens developer HoloForge, Nomadeec leverages the gesture-based commands of the HoloLens to give practitioners access to customizable modules for patient assessments, clinical exams, and patient profiles. With Nomadeec, HoloLens can also act as a heads-up display for monitoring a patient's vital signs, as the platform can connect to numerous types of medical devices, such as ECGs, thermometers, stethoscopes, and ultrasound devices, via Bluetooth. And when practitioners need a second opinion from a medical professional, the Nomadeec system can connect them to those medical experts via video conference. While Exelus and HoloForge emphasize Nomadeec's HoloLens capabilities, the platform is also compatible with smartphones, tablets, and smartglasses running on iOS, Android, or Windows. Nomadeec, leader for Emergency telemedicine The Nomadeec platform allows the EMS to consult the assessments of all the primary care effectors, and establish, if necessary, a videoconference. These prehospital patient reports, enriched by vital parameters, ECGs, photos and/or videos, are then shared with the recipient service and integrated directly into the patient file of the hospital. Sources : https://hololens.reality.news/news/hololens-app-hopes-offer-paramedics-augmented-reality-assist-during-emergencies-0181981/ http://nomadeec.com/en/

New agreement enables analysis of anonymised patient data using clinical artificial intelligence technology to accelerate medical research, help find new treatments and improve patient care. Sensyne Health Limited (the "Company"), formerly Drayson Health, a British clinical AI technology company, announces today that it has signed a Strategic Research Agreement (SRA) with Chelsea and Westminster Hospital NHS Foundation Trust. The agreement will allow Sensyne Health to analyse anonymised patient data using clinical artificial intelligence (Clinical AI) technology*. The agreement also includes a new research collaboration between the parties in digital health and biomedical research. The purpose of the research is to derive new insights that will improve the care of the Trust's patients and help to find new treatments. Chelsea and Westminster Hospital NHS Foundation Trust will receive a £5 million equity stake in Sensyne Health and will also benefit from royalties that arise from any discoveries. The royalties the Trust receives will be reinvested back into the NHS which can fund further research and help deliver higher quality patient care at lower cost. Research will be undertaken to the highest standards of information governance and data security in accordance with the Caldicott Principles and data protection legislation. Lesley Watts, CEO, Chelsea and Westminster Hospital NHS Foundation Trust, said: "We are always seeking ways to improve the care we deliver to our patients, whilst ensuring patient information is safe and secure. This exciting and innovative partnership offers the potential to unlock new digital health treatments, allowing us to continue to deliver the very highest quality of care to our patients now and in the future." Lord (Paul) Drayson, CEO of Sensyne Health, commented: "We are delighted that the Chelsea and Westminster NHS Foundation Trust, a leading acute Trust in the heart of London, has joined our research partnership in clinical AI alongside South Warwickshire and Oxford University Hospitals NHS Foundation Trusts. Together, we aim to make new discoveries that will improve care for patients, accelerate medical research and provide a return back into the NHS." The new agreement builds on an existing relationship with Chelsea and Westminster Hospital NHS Foundation Trust, formed in September 2017, when the parties announced a global first, piloting Sensyne Health's wireless environmental sensors in intensive care units at Chelsea and Westminster Hospital. About Sensyne Health Sensyne Health is a healthcare technology company that creates value from accelerating the discovery and development of new medicines and improving patient care through the analysis of real-world evidence from large databases of anonymised patient data in collaboration with NHS Trusts. Any analysis of anonymised patient data (and hence the Company's access to it) must be pre-approved for each programme on a case-by-case basis by the relevant NHS Trusts. This is to ensure that the purpose of the anonymisation and the proposed analysis are subject to appropriate ethical oversight and information governance, including conformance with the Caldicott Principles, UK data protection law and applicable regulatory guidance. Sensyne Health, which recently changed its name from Drayson Health, is based in the Big Data Institute at the University of Oxford's Old Road Campus. For more information, please visit: www.Sensynehealth.com About Chelsea and Westminster Hospital NHS Foundation Trust It is one of the best performing Trusts in the country. It employees around 6,000 staff and has recently been rated as 'Good' by the Care Quality Commission (CQC), and Outstanding for use of resources by NHS Improvement. The Trust operates two hospitals, one in central London, the Chelsea and Westminster hospital, and one in Isleworth West London, the West Middlesex University Hospital. *What is 'clinical AI'? Clinical AI is a highly specialised field of AI which uses machine learning algorithms, including deep learning in tandem with human clinical expertise and big datasets with which to train the algorithms. Clinical AI is particularly concerned with the analysis of data acquired during routine clinical care of patients, in order to derive clinically-useful results such as to improve patient outcomes and to discover new insights about the use of pharmaceutical compounds to treat patients. Source : https://www.londonstockexchange.com/exchange/news/market-news/market-news-detail/other/13738790.html

Sponsored by IBM Security and conducted by Ponemon Institute, the 2018 Cost of a Data Breach Study found that the average cost of a data breach globally is $3.86 million, a 6.4 percent increase from the 2017 report. Based on in-depth interviews with nearly 500 companies that experienced a data breach, the study analyzes hundreds of cost factors surrounding a breach, from technical investigations and recovery, to notifications, legal and regulatory activities, and cost of lost business and reputation. ​IBM-Security-Data-Breach-Calculator-2018 This year for the first time, the study also calculated the costs associated with "mega breaches" ranging from 1 million to 50 million records lost, projecting that these breaches cost companies between $40 million and $350 million respectively. "While highly publicized data breaches often report losses in the millions, these numbers are highly variable and often focused on a few specific costs which are easily quantified," said Wendi Whitmore, Global Lead for IBM X-Force Incident Response and Intelligence Services (IRIS). "The truth is there are many hidden expenses which must be taken into account, such as reputational damage, customer turnover, and operational costs. Knowing where the costs lie, and how to reduce them, can help companies invest their resources more strategically and lower the huge financial risks at stake." Hidden Figures – Calculating the Cost of a Mega Breach In the past five years, the amount of mega breaches (breaches of more than 1 million records) has nearly doubled - from just nine mega breaches in 2013, to 16 mega breaches in 2017. Due to the small amount of mega breaches in the past, the Cost of a Data Breach study historically analyzed data breaches of around 2,500 to 100,000 lost records. Based on analysis of 11 companies experiencing a mega breach over the past two years, this year's report uses statistical modelling to project the cost of breaches ranging from 1 million to 50 million compromised records. Key findings include: Average cost of a data breach of 1 million compromised records is nearly $40 million dollars At 50 million records, estimated total cost of a breach is $350 million dollars The vast majority of these breaches (10 out of 11) stemmed from malicious and criminal attacks (as opposed to system glitches or human error) The average time to detect and contain a mega breach was 365 days – almost 100 days longer than a smaller scale breach (266 days) For mega breaches, the biggest expense category was costs associated with lost business, which was estimated at nearly $118 million for breaches of 50 million records – almost a third of the total cost of a breach this size. IBM analyzed the publicly reported costs of several high profile mega breaches, and found the reported numbers are often less than the average cost found in the study. This is likely due to publicly reported cost often being limited to direct costs, such as technology and services to recover from the breach, legal and regulatory fees, and reparations to customers. What Impacts the Average Cost of a Data Breach? For the past 13 years, the Ponemon Institute has examined the cost associated with data breaches of less than 100,000 records, finding that the costs have steadily risen over the course of the study. The average cost of a data breach was $3.86 million in the 2018 study, compared to $3.50 million in 2014 – representing nearly 10 percent net increase over the past 5 years of the study. The study also examines factors which increase or decrease the cost of the breach, finding that costs are heavily impacted by the amount of time spent containing a data breach, as well as investments in technologies that speed response time. The average time to identify a data breach in the study was 197 days, and the average time to contain a data breach once identified was 69 days. Companies who contained a breach in less than 30 days saved over $1 million compared to those that took more than 30 days ($3.09 million vs. $4.25 million average total) The amount of lost or stolen records also impacts the cost of a breach, costing $148 per lost or stolen record on average. The study examined several factors which increase or decrease this cost: Having an incident response team was the top cost saving factor, reducing the cost by $14 per compromised record The use of an AI platform for cybersecurity reduced the cost by $8 per lost or stolen record Companies that indicated a "rush to notify" had a higher cost by $5 per lost or stolen record This year for the first time, the report examined the effect of security automation tools which use artificial intelligence, machine learning, analytics and orchestration to augment or replace human intervention in the identification and containment of a breach. The analysis found that organizations that had extensively deployed automated security technologies saved over $1.5 million on the total cost of a breach ($2.88 million, compared to $4.43 million for those who had not deployed security automation.) Regional and Industry Differences The study also compared the cost of data breaches in different industries and regions, finding that data breaches are the costliest in the U.S. and the Middle East, and least costly in Brazil and India. U.S. companies experienced the highest average cost of a breach at $7.91 million, followed by the Middle East at $5.31 million. Lowest total cost of a breach was $1.24 million in Brazil, followed by $1.77 million in India. One major factor impacting the cost of a data breach in the U.S. was the reported cost of lost business, which was $4.2 million – more than the total average cost of a breach globally, and more than double the amount of "lost business costs" compared to any other region surveyed. One major factor impacting lost business costs is customer turnover in the aftermath of a breach; in fact a recent IBM / Harris poll report found that 75 percent of consumers in the U.S. say that they will not do business with companies that they do not trust to protect their data. For the 8th year in a row, Healthcare organizations had the highest costs associated with data breaches – costing them $408 per lost or stolen record – nearly three times higher than the cross-industry average ($148). "The goal of our research is to demonstrate the value of good data protection practices, and the factors that make a tangible difference in what a company pays to resolve a data breach," said Dr. Larry Ponemon, chairman and founder of Ponemon Institute. "While data breach costs have been rising steadily over the history of the study, we see positive signs of cost savings through the use of newer technologies as well as proper planning for incident response, which can significantly reduce these costs." About IBM Security IBM Security offers one of the most advanced and integrated portfolios of enterprise security products and services. The portfolio, supported by world-renowned IBM X-Force® research, enables organizations to effectively manage risk and defend against emerging threats. IBM operates one of the world's broadest security research, development and delivery organizations, monitors 35 billion security events per day in more than 130 countries, and has been granted more than 8,000 security patents worldwide. For more information, please check www.ibm.com/security, follow IBMSecurity on Twitter or visit the IBM Security Intelligence blog. Source : http://newsroom.ibm.com/2018-07-11-IBM-Study-Hidden-Costs-of-Data-Breaches-Increase-Expenses-for-Businesses

The Mayo Clinic recently announced it is entering into a transatlantic partnership with the University of Oxford and Oxford University Hospitals NHS Foundation Trust to collaborate on improving healthcare and making scientific discoveries. As part of the new agreement, Mayo and Oxford will share a physical location in London expected to open in early 2019 as an independent business subsidiary. “This transatlantic partnership will bring together leading researchers and clinicians from around the world,” Oxford University CEO Bruno Holthof, MD, said in a statement. “Together we will be able to attract more talent and funding in order to create better health outcomes for our patients.” Mayo Clinic Vice President Gianrico Farrugia, MD, sees the culturally aligned organizations – Oxford University, Oxford University Hospitals and Mayo Clinic – "collaborating to drive better results for patients in all areas of medicine.” “Mayo Clinic and Oxford University medicine are truly global brands in health care,” says Sir John Bell, GBE, Regius Professor of Medicine, University of Oxford. “This unique collaboration will allow these world-class institutions to work together in research, teaching and clinical care to make advances in medicine. It will also reinforce the role of the UK as a major health care centre. I very much look forward to working with our distinguished colleagues from the Mayo Clinic to deliver innovation to patients.” Overview of the partnership The 5 potential areas for collaboration are - 1) Research projects 2) Educational interactions and endeavours 3) Practice pilots to focus on leading improvements in quality 4) Integration and outcomes delivered 5) The exchange of resources to support research, practice and educational activities So are we seeing the beginning of a new partnership strategy emerging in healthcare? Yes, I believe we are witnessing the start of a new phase of strategic partnerships in healthcare which will potentially deliver the "triple aim" and for the first time create IP which can be used to start a new cycle of innovation. I will explain why .. A) "Each organization brings a depth of expertise and achievement" - classic partner model of building on each others strengths, together we are stronger strategy Oxford and the Mayo Clinic are two highly respected and well known brands on either sides of the Atlantic in healthcare. This is like Apple partnering with Nike, two brands trusted by millions joining forces. Trust is an important factor in healthcare and when you add two brands together, you inevitably create a multiplier effect. B) "Financial surpluses generated from these activities will be used to help advance clinical education and patient care, and to fund vital medical research" - sharing success unlocks funds for new research and so the cycle begins Advancing clinical education and funding vital medical research is the first step in delivering better patient care and more positive outcomes. Breakthroughs in technology, new clinical pathways, pre operative assessments, recovery times, theatre and surgical advancements creates IP. Intellectual property which can be shared within the ecosystem for the benefit of all. IP can also be monetised in the form of patents, contracts with other healthcare organisations and providers. C) "Oxford University’s Medical Sciences Division comprises 5,500 academics, researchers, NHS physicians and administrative staff along with over 3,000 graduate and undergraduate students, who sustain an extensive and exemplary portfolio of research, teaching and clinical care" - sharing knowledge at scale and comparing outcomes in two different healthcare systems will only increase the quality of research and care 5,500 academics, researchers, NHS physicians and administrative staff 3,000+ graduate and undergraduate students Plus the Mayo Clinics' infrastructure of staff and students is a lot of people, 14,000 maybe? Sharing knowledge between two highly regarded providers of care and academic institutions will inevitably create competition and transparency in a positive way. Peer reviews, group discussions, pilots, A/B tests, multivariate tests will no doubt raise the bar even higher and produce breakthroughs at the speed and scale not seen before. Conclusion This new model of strategic partnership combining depth of expertise and achievement, advancing clinical education and patient care, funding vital medical research, sustaining exemplary portfolios of research, teaching and clinical care effectively delivers the "triple aim" of healthcare and for the first time creates assets in the form of intellectual property. These assets can then be used again to fund new projects and research, potentially unlocking a positive cycle of innovation ..... self funding and self sustaining innovation. Improve the patient experience - most likely to come from pilots testing hardware or medical devices, lower waiting times due to better capacity management Achieve better health through improved outcomes - most likely to come from of new clinical pathways, pre operative assessments, recovery times, theatre and surgical advancements Manage or reduce costs - most likely in the form of less staff needed per task or procedure, new and cheaper drugs, medical devices or equipment Create intellectual property - most likely in the form of software, hardware or medical devices.

Improved cancer treatment, greater chance of pregnancy and faster heart scans are just three benefits brought to healthcare by UK companies attracting investment from Coutts clients. One business we support claims its technology could potentially save the NHS £200 million a year. Our clients have invested in med-tech businesses through the Coutts Investment Club, which introduces financially sophisticated, high net worth clients looking for opportunities to invest in exciting new private companies. To celebrate the 70th anniversary of one of healthcare’s greatest innovations – the National Health Service – here are five companies following in that institution’s footsteps, into which our clients have invested millions since 2015. 1) CREAVO MEDICAL TECHNOLOGIES Creavo has developed a heart scanner that could save the NHS £200 million a year, according to the York Health Economic Consortium. The portable scanner is designed to relieve the pressure on A&E departments by establishing if someone has a serious heart problem soon after admission. It helps doctors rule out a life-threatening condition early – without the need for invasive, time-consuming and costly monitoring. 2) LIGHTPOINT MEDICAL This medical device company has created ground-breaking imaging technology to help cancer surgeons visibly identify and remove all cancerous tissue during an operation, while sparing nearby healthy tissue. This can reduce the need for additional surgery. 3) QUANTUMDX DNA tests in 20 minutes – that’s the benefit this Newcastle-based business brings to healthcare. The company has developed a handheld, low-cost and easy to use device called Q-POC. This powerful tool can be used for diagnosing, managing and monitoring emerging infections and drug resistance. “Such changes can be scary when they concern something as important as our health. But like most innovation, what is new today will almost certainly be commonplace tomorrow.” 4) FERTILITY FOCUS Every year 12 million women start trying to have a baby, according to the CIA World Factbook. Fertility Focus aims to help those still struggling after six months. Their main product is OvuSense, an internal temperature sensor that significantly increases the chance of pregnancy by predicting ovulation 24 hours in advance. 5) SKY MEDICAL TECHNOLOGY This company has developed breakthrough technology to help prevent deep vein thrombosis, help heal wounds and speed up recovery after surgery. It can be particularly useful for elite athletes. The device straps behind the knee, stimulating blood flow throughout the lower part of the body. This aids the recovery of those unable to boost blood circulation by walking. DISRUPTIVE TECHNOLOGY These companies are part of a new age of innovative enterprises using technology to transform how healthcare is delivered. They are a great example of how the UK has become an exciting place for the development of new, innovative technology – not just in healthcare but across a number of sectors. Investment Strategist Lilian Chovin says other areas of disruption within healthcare where we are likely to see growth include robotics and online consultations with doctors, or ‘telehealth’ as it is known. He says, “Robots will improve the speed of procedures, while speaking to a doctor via an app should lead to patients being seen faster and reduced infrastructure costs for the industry – money that can be put to good use elsewhere for patients. “Such changes can be scary when they concern something as important as our health. But like most innovation, what is new today will almost certainly be commonplace tomorrow.” A HEALTHY SECTOR FOR PORTFOLIOS The healthcare sector as a whole remains one of our favourite themes from an investment perspective. Our exposure focuses on medical technology, health insurers and biotechnology, while our more general equity positioning means we have exposure to large pharmaceutical firms and US-listed companies. In addition, we are directly invested in three healthcare firms which sit within our global 30 basket of holdings. Source : https://www.coutts.com/insight-articles/news/2018/uk-med-tech-revolution-as-NHS-turns-70.html

Why is consumer healthcare an attractive market for startups? Market Size: The market for DTC healthcare products is truly massive. It’s hard to pinpoint an exact number, but Euromonitor International sizes consumer healthcare products at ~$700B in global annual sales. Total U.S. healthcare spend is $3.5 trillion annually, and consumers are increasingly bearing a higher percentage of this cost of care, particularly as people shift to high deductible health plans. As people pay more money out of pocket for their healthcare, they begin to expect the quality of experience they find in other great consumer companies. The power dynamic is evolving as people who were previously “patients” are now becoming “consumers.” Companies who treat them as such will be rewarded. Retention: Many healthcare products have a form of built-in retention. If a product is maintaining, improving, or monitoring, your health, you likely will use it frequently and for an extended period of time. Margin / LTV: Consumer healthcare products is one of the highest margin sectors in the global economy. Incumbents such as Pfizer and Johnson & Johnson enjoy EBITDA margins of 35–45%. Retail/OTC drugs gross margins are significantly lower than pharmaceutical manufacturers but are still healthy. Most startups start by working with an industry partner with an existing supply chain, but eventually many of these startups will vertically integrate at scale, which will improve margins. The existing margin profile of many healthcare products allows startups to compete by offering lower prices to consumers, while still maintaining attractive unit economics. The margin profile and subsequent high LTV of this category allow for significant customer service, and customer acquisition spend. Regulation: While regulation is a risk (which I will speak to), it can also serve as a competitive moat. In consumer healthcare, it can take years to properly set up a company, find the right partner, and get various approvals. Broken consumer experience: The current care model of a doctor visit resulting in a written prescription followed by a trip to a brick and mortar retail pharmacy is a one-size-fits-all model that doesn’t do any one thing particularly well. In this market, each of these product areas have different prescription, cost, delivery, adherence, retention models that may necessitate unique product/go-to-market models. New companies can drive down cost, improve customer experience, and even improve outcomes through personalization, improved adherence, and expanded access. What changes are enabling and propelling the shift to DTC in healthcare (aka WHY NOW)? Telemedicine: Telemedicine is a critical enabler of this market because it supports remote evaluation, diagnosis, prescription, and ongoing treatment. When a customer has an existing need, such as for birth control or acne medication, they can order online, and a doctor can evaluate and prescribe their appropriate therapy asynchronously on the backend. This common operating model enables companies to sell direct via online channels and reduces the customer friction of an in-person visit. Data: Today, healthcare DTC companies, can create brands that directly engage with the end consumer. These new companies, armed with first- party data, can internalize product pain points and quickly adapt to their customer’s needs. Targeting specific types of people is now possible with social media marketing. Many of these products only serve a certain type of consumer who may be reachable at scale through digital marketing channels. With these inputs, companies can now efficiently target specific age ranges, genders, locations, incomes, and psychographic profiles. Cutting out the middlemen: DTC flips the value chain of healthcare products on its head. Selling products directly allows startups to pass savings on to the end consumer, rather than giving margin to third parties such as distributors, doctors, and retailers. Also, the increase in high deductible plans makes consumers more price sensitive in categories where they might not have been previously. Incumbents see DTC potential: Manufacturers and distributors who are tied to legacy distribution channels and sell commoditized products feel the pressure to innovate and are now open to partnering with new DTC brands that can target and engage the end consumer more effectively. Increased transparency: Social media, online reviews, and increased access to information have contributed to greater transparency and awareness in the healthcare industry. Brand authenticity matters more as the decision-making and purchasing power shifts from industry practitioners to consumers faced with choice. A survey run by Fortune/GHG found that a minority of millennials view doctors as the single best source of healthcare information (41%, vs. 68% of non-millennials). Consumer consciousness: People care more about what is going into their bodies than they have before and are spending more on elective healthcare products. An example of this is the skincare market, which has been growing at a 10% CAGR for the past five years. What are the major risks in the category? Regulation and operational excellence: Operating in a highly regulated environment is fraught with obstacles, and regulatory compliance is imperative. Many of these products require FDA approval and clinical oversight. The bar on quality is significantly higher when people’s health is at stake, as it should be. Companies that bend the rules will quickly find themselves out of business, which is not the case in all other VC-backed industries. One way companies can reduce the burden of navigating the regulatory environment is by creating a new brand around an existing FDA-approved product. Competition: Competition is omnipresent, both from new startups and industry incumbents with large balance sheets. There are few network effects in this area, which could make it hard for startups to survive if incumbents invest meaningful capital behind building DTC operations. Startups need to find creative ways to scale efficiently and should be prepared to navigate competition, regulation, and even litigation. In certain categories, the barriers to entry can be low, which is why you see five or more companies spring up in a short timeframe chasing the same market. This can manifest in increased acquisition costs, churn, and decreased capital efficiency. If you can’t already tell, I am super excited about this space! If you are building a Healthcare Consumer Products company at any stage, I would love to chat. If I am clearly missing a company, please email me and I will add it. You can find me at teddy@greycroft.com Source : https://www.linkedin.com/pulse/direct-to-consumer-healthcare-teddy-citrin/

Some of the US' leading health systems, including Cleveland Clinic and Oakland, California based Kaiser Permanente, are highlighting group medical appointments as a way to give patients expanded healthcare access and help providers see more patients, reports the Washington Post. Seven report insights: 1. Cleveland Clinic offers over 200 types of shared appointments, such as groups for diabetes or heart disease, male and female wellness, osteoporosis, prenatal and postpartum issues, chronic pain and cancer survivorship. 2. Rather than rushing through a one-on-one appointment, patients can meet with eight to 10 peers and a physician to discuss health challenges, nutrition and exercise for an hour or more each month. "When we think of advances in healthcare, they're always technology or medication or vaccines, and it's really time to look at the healthcare model," said Marianne Sumego, MD, internist, pediatrician and director of Cleveland Clinic's shared medical appointments. 3. Group appointments let providers see more patients than their usual schedules allow, which could prove particularly beneficial when considering the looming physician shortage. 4. Ten percent of family physicians offered group appointments in 2015, up from 5.7 percent in 2005, according to data from the American Academy of Family Physicians cited by The Post. During his time as a psychologist at Kaiser, Ed Noffsinger, PhD, pioneered group medical appointments. Dr. Sumego, who was one of the original providers, brought them to Cleveland Clinic in 1999. Shared appointments are now considered an important, standardized part of care options Cleveland Clinic offers. 5. Each year, more Cleveland Clinic patients participate in shared appointments. The health system's internal surveys suggest a high level of patient satisfaction, especially when taking access to care into account. Additionally, the health system addresses privacy concerns by requiring patients to sign confidentiality paperwork and by having its staff remind patients "how we really want to respect [all participants] and keep the information within the room," Dr. Sumego noted. Dr. Sumego fields a number of calls every week about shared appointments. "I think it's gaining traction," she said. "Our success indicates that it's very sustainable, viable, and that it's well received." 6. Several years ago, Joanna Stark, MD, an obstetrician with Kaiser Permanente Santa Clara Medical Center in California, saw two women in back-to-back appointments who were both 28 weeks pregnant and asked similar questions. Noting this, Dr. Stark searched for a way to bring these patients together. "I'd have more time to answer their questions, and they'd also maybe make a friend," she explained. 7. While researching shared medical appointments, which Kaiser now offers at facilities nationwide, Dr. Stark found Centering, a licensed group-appointment model developed for prenatal care in the 1990s. These sessions have consistent start and end times, one-on-one time with providers as well as group time. Dr. Stark highlighted the comfortable, less formal environment of these sessions. "Patients call us by our first names,” Dr. Stark said. “We don't wear our white lab coats. We dress more casually. We're all at the same level," she said. "There will be somebody who says, 'What do I do about my hemorrhoids?' and you feel like, 'Oh, I'm not alone, I'm not the only one.' And it just normalizes it. And that is just such a reassuring thing for people." Source : https://www.beckershospitalreview.com/quality/why-cleveland-clinic-kaiser-are-touting-group-appointments-for-patients.html

Silicon Valley Bank, Zinc.vc and The Up Group recently hosted a breakfast on ‘Female Health Innovation’, often known as FemTech. The event brought together the ecosystem of founders, investors, scaled organisations and advisors and was chaired by Nooman Haque, MD at Silicon Valley Bank. The discussion was diverse, covering the reality of the market segment, the link between physical and mental health, and how B2C models are slowly forcing the big health authorities in the UK and US to change. CVC’s recent acquisition of the women’s health division of the Israeli drug developer Teva for $800m created a company dedicated to contraception, fertility, menopause and osteoporosis. Opening the discussion, it was clear this is an underserved segment. Recent analysis from Frost and Sullivan shows this market to be worth up to $50bn by 2025. This is driven by the fact that 90% of primary healthcare decisions are made by women. Women are also 75% more likely to use digital tools for their healthcare and spend 29% more per capita on healthcare compared to men. Reaction of Health Authorities – There is a perfect storm for FemTech to emerge now. Firstly, national health organisations around the world have less money to spend than ever before. Therefore some of the solutions which involved long term low cost solutions are being looked at closely to reduce these costs which would otherwise be absorbed. Secondly, direct to consumer wellness is forcing health organisations to look at how they respond to and leverage these types of innovation. Finally the combination of female founders, ‘Women making products for Women’ and a period of sustained innovation in connectivity, data and hardware has meant more products coming to market and getting funding to begin their growth journey. The link between physical and mental health – Many of the attendees stressed that when women experience physical health problems, there are almost always mental problems that link to that also. Whether that be loss of confidence, relationship or sexual problems. The long term impact of this can be far greater than the treatment of the physical symptoms. This has also meant the ability to attract talent and resource to this group of companies has been easier given how purpose driven many of these organisations are. Most health businesses are really tech businesses – Many of the founders in the room immediately looked to find a Co-founder who would be the CTO or Head of Product from day one. The challenge in the room is that you have to be really careful on making recommendations about health unless you are very, very, very sure of your data. There is not a clear line between what would be B2C wellness and what would count as a health care product and therefore be subject to approval by the likes of the FCA. Unlike quicker pizza delivery or improved download speeds, getting health data wrong means more than cold pizza and buffering. The group will continue to meet and create the ecosystem in a segment which is attracting more investor attention and can solve problems in an historically underserved market. Source : https://ww2.frost.com/frost-perspectives/femtechtime-digital-revolution-womens-health-market/ Source : http://www.theupgroup.com/2018/06/femtech-the-rise-of-female-health-innovation/

Digital identity system for patients to access their health records The NHS is planning to roll out a digital citizen ID scheme for patients across the UK - with 'video selfies' touted as a potential verification tool. Presenting to technology suppliers at an event hosted by industry trade body TechUK last week, NHS Digital's lead on Citizen ID, Adam Lewis, outlined plans to trial a digital identity system for patients to access their health records as part of a wider rollout of digital services. Lewis said the plans would see patients register through their smartphones by providing their unique NHS number, showing a form of photo ID on camera and recording a short video, according to the Health Service Journal (HSJ), which broke the news, and later confirmed by NHS Digital. He added there would also be physical locations where patients without the means or capability to video themselves could register, as he demonstrated a prototype of the system at the event. NHS Digital will commence testing on private beta within the next few months, with a public beta starting towards the end of the year or early next year. The system itself - which is yet to be built - will cost £85 million through to March 2019, according to papers released to HSJ under the Freedom of Information (FOI) Act. The plan, which is in its very early stages, will not involve capturing or storing biometric data for one-time verification, but may use biometrics, such as fingerprint scanning or facial recognition, as part of multi-factor authentication for users to access an app in future. 25 million people within five years NHS Digital declined to comment directly on the project, although it labelled Citizen ID "a key element to future digital health services" in a tweet sent during the TechUK event. NHS England and the Department of Health both declined to comment, instead referring IT Pro to NHS Digital. Although Lewis, during his presentation, claimed the system will aim to reach 25 million people within five years, NHS Digital played down this figure as speculative. In Whitehall's own Government Transformation Strategy, it sets out a similar goal to get 25 million people using Verify, another form of confirming people's identities online, that is an initiative of the Government Digital Service. The NHS's digital ID plans feed into a wider roadmap to digitise health services across the UK, outlined by NHS England chief digital officer Juliet Bauer in February. "We're engaging developers inside and outside of the health and care system; letting them know that the digital NHS is open for business to encourage innovation that will raise the bar on the standard of digital health and care tools and services for patients," she said at the time. "And we're also working closely with CIOs and CCIOs locally to support them in commissioning, developing and implementing the very best digital services for their unique populations." The health service has already taken steps to realises its ambitions in recent months, for instance, calling in February for developers to submit their digital health applications for inclusion in its Apps Library, which offers a catalogue of verified and trusted tools to help patients manage their healthcare. According to the NHS's roadmap for digital health and care services, Citizen ID will be ready by 2019/20, in conjunction with an app that is set to be released by the end of the year. The NHS is trying to digitise many aspects of how it delivers services, but has experienced problems in doing so. All 200 NHS trusts failed cyber security assessments earlier this year, conducted after last year's WannaCry ransomware attack that forced more than 40 hospitals to postpone operations. Meanwhile, the body has been criticised for data-sharing deals with the Home Office and private companies like DeepMind. Source : https://www-itpro-co-uk.cdn.ampproject.org/c/www.itpro.co.uk/identity-and-access-management-iam/31119/nhs-to-trial-video-selfies-to-verify-patient-identities?amp

With so much hype and expectation placed upon the shoulders of the two letter acronym AI, you may expect the letter ‘A’ to stand for Atlas. After all, it was Greek legend Atlas who carried “the weight of the world” on his shoulders. At this point in human evolution, AI is a ray of hope for our future. Excitement revolves around AI solving global issues too complex for human minds to comprehend, such as: how can we save the sea from plastic pollution? This week our Prime Minister, Teresa May, set a target for a “whole new industry around AI-in-healthcare”. But where did AI come from? The first use of the term AI can be traced back to 1956 in the American State of New Hampshire, when a summer conference was laid on by John McCarthy, an assistant professor of mathematics at Dartmouth College in Hanover. Along with three other researchers, Marvin Minsky of Harvard, Nathan Rochester of IBM and Claude Shannon of Bell Telephone Laboratories, they submitted a funding proposal to the Rockefeller Foundation that stated: “The study is to proceed on the basis of the conjecture that every aspect of learning or any other feature of intelligence can in principle be so precisely described that a machine can be made to simulate it. An attempt will be made to find how to make machines use language, form abstractions and concepts, solve kinds of problems now reserved for humans, and improve themselves.” As a shortened advertising pitch for the conference, the term Artificial Intelligence was coined. McCarthy was an aficionado of symbolic logic, a branch of mathematics that represents concepts as symbols. He wanted to expand the horizon of computers to be more than number crunchers and data processors, and push them into the next frontier of manipulating symbols to reason deductively from hypothesis to conclusion. In a similar way to Aristotle’s logical reasoning example: knowing that all men are mortal (major premise) and that Socrates is a man (minor premise), the valid conclusion is that Socrates is mortal. McCarthy was optimistic that computers could be far more than plain vanilla automation. However, it’s not clear if anything was accomplished during that summer conference, as the promised final report was never delivered. In fact, the same overly optimistic overtures have dogged the AI journey or roller coaster ride ever since. AI has travelled repeatedly from exaggerated optimistic highs, followed by deep dips of disappointment, quickly followed by new discoveries, renewed funding and a recumbent climb. By the mid-60’s AI had a funding stream with deep pockets, the US Department of Defence Millions of dollars were poured into nascent academic AI labs at MIT, Stanford University, and Carnegie Mellon University and some commercial research labs, such as SRI International. The consistent flow of money fostered multiple graduate students, who also went onto collaborate with other global universities. But by 1974, there was mounting criticism from the US Congress about the lack unproductive projects and not getting enough bang for their buck. As a result, the US government cut off exploratory research into AI and the British Government quickly followed suit. The following years were bleak and it became a struggle to obtain funding for AI research in a period that has since become known as the ‘AI winter’. It took until the 1980’s for ‘expert systems’ to be developed that created AI computer programs that deconstructed tasks into symbolic forms for facts, rules and relationships. But AI remained heavily reliant upon human programmers to painstakingly encode. Such symbol systems remained dogged with a common problem and plagued by the vast number of possible sequences. Combinational explosions made it too difficult to examine all the options. Take the everyday example of Lego, a mere six eight-studded bricks of the same colour could be combined together in 915,103,765 ways! By the late 1990s AI advanced further thanks to increasing computational power in accordance in Moore’s Law, so more advanced statistical techniques could be employed. The most famous step change came when Deep Blue, the first chess-playing system, beat the reigning world chess champion, Garry Kasparov on the 11th May 1997. It came as a surprise to the chess world and has been etched into the memory of the Russian grand master, who was forced to eat his words, after he had previously quipped “if any grand master has difficulty playing a computer – I’d happily offer advice.” It was hailed within the AI community as a major confidence boost to the entire sector and put AI firmly back on the global stage. Machine Learning The next breakthrough came with the upgrade to ‘machine learning’. Learning is perhaps key to all human intelligence, and is more than just knowledge, analogous to symbol systems that require code to be written upfront with knowledge captured, stored and used. Learning requires a more dynamic approach to problem solve novel situations, and has the ability to iterate improvements with training and practice. Machine learning has taken inspiration from neuroscientists who have studied neural networks in the brain. In the 2000’s, IBM worked on an AI machine to answer questions, such as those posed in natural language by the TV host in the quiz game Jeopardy! The team developed a machine consuming four terabytes of disk storage, and named it after IBM’s first CEO, Thomas Watson. In 2011 ‘IBM Watson’ went head to head against former Jeopardy winner’s Brad Rutter and Ken Jennings and neither human nor machine participant had access to the Internet. It was a nail biting time for the AI world with a winning first place prize of one million dollars. ‘IBM Watson’ consistently outperformed its human opponents and won. It showed that AI neural networks had been able to mimic the human ability to not only understand the question but to also ‘best guess’ the answer. By 2013 ‘IBM Watson’ software was used for its first commercial application in management decisions for lung cancer treatment at Memorial Sloan Kettering Cancer Centre in New York. March 2016 brought another exciting challenge for AI when it competed in the game Go. Go is far more difficult to play than other games, such as chess, and uses black and white pieces on a nineteen by nineteen board. The game dates back to ancient China and was considered to be an essential art for a cultured Chinese scholar, even getting a mention as a worthy pastime in the Analects of Confucius. Go is a prohibitively difficult game for traditional AI methods such as alpha-beta pruning, tree traversal and heuristic search. The AI machine developed was named AlphaGo and it succeeded in a significant milestone when it won four out of five games in a match against Go champion Lee Sedol. This feat should not be underestimated, as it leveraged two advancements. First, it harnessed more mathematical powerful processing units for matrix and vector calculations by using graphic processing units (GPUs) that came about thanks to the gaming industry. Second, it had the ability to spot patterns after learning and searching through thousands of games. Then it managed to combine these two feats in a famous move, so well known in the AI world, that it’s simply termed ‘move 37’ in the second game against Lee Sedol. It was at this moment that AlphaGo turned perceived wisdom about the Go game on its head. AlphaGo played an entirely unexpected yet beautiful move. No human player had ever played that move and legend goes that Lee Sedol had to leave the room momentarily with shock. AlphaGo had recognised patterns and played a novel move in a moment of genius, which not only turned the course of the game but perhaps changed history forever - AI had been creative! So, it’s clear that the optimism about AI has been worth the wait and although Hollywood has a tendency to anthropomorphise AI, from here it should be less about being scared if AI will supplant humans, and more focused on what AI will do for the world. In a similar way to Brunel being able to build a bridge, the most important quandary became how to build a bridge to safely ensure passage from one side to the other. AI is not just intellectually fascinating, it is morally crucial to consider as how it evolves as it will affect the future of life, including healthcare. About the Author Dr Michelle Tempest MA LLM MB BChir (Cantab) ACAT has expertise in medicine, psychiatry, psychotherapy, business, law and politics. She has been a Partner at Candesic since 2013 and has led multiple projects reviewing market opportunities for investors, public and private providers to develop beneficial partnerships. She has delivered projects for NHS Trusts (acute, community and mental health), Private Hospitals, Specialist Hospitals, Private Patient Units (PPUs), Community Providers, Care Home and Care at Home. In 2006 she edited the book 'The Future of the NHS' and more recently has delivered strategy projects for the UK government on ‘new ways of working’. She has an expert interest in medical technology companies, and has worked with several MedTech companies on expansion plans and advised throughout the entire life cycle of deals. Previously Michelle worked as a hospital doctor and liaison psychiatrist for over a decade, and continues to lecture in 'medical ethics and law' at Cambridge University. Twitter @DrMTempest mtempest@candesic.com

What do Canada, Estonia, Israel, New Zealand, South Korea, Uruguay and the United Kingdom have in common? They form a group known as The D7, and argue that they’re the most advanced digital nations in the world. They exclude a few strong contenders like China and Singapore on the basis of also requiring the members to be committed to open systems and democracy. The definition of a digitally advanced nation is that government services are delivered online in all areas from administration and security to education and healthcare. D7 Charter 1. The Treasury Board of Canada Secretariat, the Ministry of Economic Affairs and Communications of the Republic of Estonia, the Prime Minister’s Office of the Government of Israel, the Ministry of the Interior and Safety of the Government of the Republic of Korea, the Department of Internal Affairs of the Government of New Zealand, the Department of Digital, Culture, Media and Sport of the Government of the United Kingdom, and the Office of the President of the Oriental Republic of Uruguay, hereinafter individually referred to as "the Participant" and collectively as "the Participants" have reached the following understanding: 2. The Participants have mutually decided to expand from the D5 to the D7, a group of the most digitally advanced governments in the world. The D7 will provide a focused forum to share best practice, identify how to improve the Participants' digital services, collaborate on common projects and to support and champion our growing digital economies. 3. The Participants have decided to commit to working towards the following principles of digital development, acknowledging that they will not be able to meet all of the criteria on joining: 3.1. User needs - the design of public services that work for the citizen 3.2. Open standards - technology requires interoperability and so a clear commitment to a credible royalty free open standards policy for software is needed 3.3. Open source - where possible all future Government systems, tradecraft, manuals and standards are created as open source and are shareable between participants are 3.4. Open markets - in government procurement create true competition for companies regardless of size. Encourage and support a start-up culture and promote economic growth through open markets 3.5. Open government (transparency) - be a member of the Open Government Partnership and use open licences to produce and consume open data 3.6. Connectivity - enable an online population through comprehensive and high quality digital infrastructure 3.7. Teach children to code - commitment to offer all children the opportunity to learn to code and build the next generation of skills 3.8. Assisted digital - a commitment to support all its citizens to access digital services 3.9. Commitment to share and learn - all participants commit to work together to help solve each other’s issues wherever they can 4. The Participants acknowledge that Digital Government is evolving, and will update these principles as work together refines them, and in the light of new challenges and opportunities. 5. Each Participant will lead by example and contribute to advancing digital government in other D7 countries by sharing best practices and expertise, on a non-binding, voluntary basis. 6. The Participants’ collective goal is to harness the potential global power of digital technology and help each Participant to become an even better digital government faster and more efficiently through sharing and learning from each other. 7. D7 will meet once a year with a rolling host nation who will chair the meeting. All Participants will be invited to each Conference. 8. Following the establishment of the D7 it has been mutually determined that a joint working group will establish: 8.1. future chair / host nations, and themes for future conferences 8.2. principles and arrangements for expanding the circle of countries involved. The group will be open to include upon consensus of all Participants additional countries that meet the principles as stated above 8.3. The principles may iterate and evolve as part of this work 9. The Participants will decide on a case by case basis how any joint initiatives will be funded and resourced. 10. Any differences arising from the interpretation or implementation of this Charter will be settled amicably through consultations and negotiations between the Participants without reference to any third party or international tribunal. 11. Each Participant may, as appropriate, designate another institution(s) or institutions to lead and (or) participate in the initiatives. 12. This Charter is not legally binding. It will come into effect on the date of the signature of all Participants and will continue to have effect for a period of five (5) years unless terminated by a Participant giving three (3) months written notice to current Chair. 13. Signed digitally in Wellington, New Zealand on the 22 February 2018 in English Language. Source : http://www.tomorrowtodayglobal.com/2018/04/21/the-d7-digital-nations-worth-watching/