There was a lot of provider news in 2015, with hospitals across the country deploying digital health tools not only in pilots but sometimes in full-scale deployments. The list of notable example below, while long, is by no means comprehensive.
Trend: New joint ventures
Some hospital systems launched new business ventures focused specifically on digital health. In February, telecom giant Cox Communications announced that it was teaming up with the Cleveland Clinic to form a “strategic alliance”, called Vivre Health, that would develop digital home health services. The joint venture will be based in Atlanta and will help Cox move its healthcare business beyond providing broadband services to hospitals, according to Reuters. As part of the announcement Cox disclosed that it had also made an investment in health kiosk company HealthSpot, but the amount remains undisclosed.
In March, GE Ventures and Stanford Health Care teamed up to create Evidation Health, a company focused on evaluating the efficacy of digital health technologies. Soon after Evidation was formed it merged with wellness engagement platform company The Activity Exchange. In addition to Stanford, Evidation announced in November that it would also be working with Ochsner Health System.
And in May, Meridian Health subsidiary iMPak Health teamed up with biomedical and healthcare technology group NetScientific to create a new digital health sales and marketing company called Triventis Health. Triventis will market combined offerings from iMPak and Wanda Health, a subsidiary of NetScientific, relying on Wanda Health’s offerings for data analytics and IMPak’s easy-to-use devices for remote monitoring. The product offerings will be rolled out first at Meridian Health hospitals, and then marketed to different hospitals around the country.
Finally, Brigham and Women’s Hospital partnered with seed fund Rock Health to test and possibly integrate technologies from companies in Rock Health’s portfolio. The two organizations launched the partnership this summer and it is expected to last three years.
Trend: Video visits and the return of the house call
Probably the biggest digital health trend in 2015 has been remote visits. Big companies like Teladoc, American Well, and Doctor on Demand grew immensely this year, signing on big payer and provider companies alike. The growth was not without some infighting — American Well and Teladoc are embroiled in a patent fight, and the companies also scuffled in October over a Highmark contract Teladoc lost to its competitors in October. The incident highlighted some tensions over what the business model for telemedicine will be going forward.
Over the course of the year, several hospital systems this have invested in one way or another in this area of telemedicine. Minneapolis, Minnesota-based health system Fairview Health made a “significant” strategic investment in January in telemedicine company Zipnosis, which it has been working with the past several years. The amount of the investment was not disclosed. And later in the month Philadelphia’s Thomas Jefferson University Hospital, a 1,000 bed facility with $2.1 billion in operating revenue, invested $20 million to build two new urgent care centers and to create a video visits program that would enable the hospital to help patients while keeping them out of their physical facility.
California health system Sutter Health launched a new iOS app in February that includes remote visits via MDLive, a company Sutter invested in early last year. MultiCare Health System announced in April that it would offer video visits to Washington-based patients via Doctor On Demand.
In June, the Cleveland Clinic released a new video visits app for Ohio residents, called MyCare Online, that offers patients 24-hour access to a medical professional for urgent care needs. The service is powered by American Well.
In the fourth quarter, American Well scored two other big provider wins: Intermountain Healthcare and Community Health Systems. Intermountain Connect Care will be launched in 2016 and Community Health Systems will start rolling out American Well's VirtualHealthNow platform to local networks in Oklahoma and Washington and continue into Arizona and Pennsylvania in the coming months.
As new opportunities in telemedicine emerge, the old ones die out. This year also saw German company Bosch officially closing its US subsidiary Robert Bosch Healthcare, reducing the scope its healthcare operations to a 50-person team based in Germany. Bosch began offering the Health Buddy chronic disease management system after acquiring it about eight years ago.
And this year saw the launch of a couple of apps that could be the next generation of video visits: a return to the house call, now aided by digital tools. Various services that launched in that wheelhouse this year include Heal, Pager, FirstLine Medical, MedZed, Dispatch Health, FRND, PediaQ, and Circle Medical. Dispatch Health notably partnered with a health system, Centura in Colorado, to make its offering available to its patients.
While many of these offerings have applied the appellation “Uber for Health” to themselves, Uber itself showed it might not be willing to give up on that title, partnering with Boston Children’s Hospital, Voalte, and Practo this year, as well as announcing senior care partnerships at the White House Summit on Aging. Meanwhile Sherpaa CEO Jay Parkinson made the case, based on his own experience, that digitally-enabled house calls are not sustainable or scalable.
Sherpaa provides an additional telemedicine modality, one based mostly on asynchronous messaging. Another company with that business model, Talkspace, announced research partnerships with Duke University and Columbia University in the mental health space.
Telemedicine’s growing pains included plenty of legal and legislative activity. For one thing, Teladoc's antitrust lawsuit against the Texas Medical Board continued, costing Teladoc upwards of $7 million in legal fees according to the company's first earnings call. The Attorney General of Texas weighed in on that case on the medical board's behalf, arguing that there is, in fact, state supervision of the medical board which would make it a state agency under law and therefore immune to suit, but a judge shot down that argument this month. The TMB is now appealing that ruling.
Texas wasn't the only state dealing with telemedicine laws. Over 200 bills related to telemedicine were floated in state legislatures in 2015. The Federation of State Medical Board’s proposed interstate licensing compact accounted for some of the bills passed this year. Eleven states (Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia and Wyoming) passed the medical licensure compact language in 2015, all by large margins. Only seven states needed to pass the compact to put it into effect.
In October, the American Medical Association began the process of creating a host of new CPT codes to support the reimbursement of telemedicine. The codes are especially important for Medicare, which has strict guidelines on what it will and won't reimburse. At present there are various CPT codes originally intended for face-to-face encounters that can also be used for different telemedicine services, but a set of standardized, explicit codes would go a long way toward making providers feel comfortable seeking reimbursement for virtual encounters, and some of them may even pay not just for the service, but the technology itself.
Also during the year, the American Medical Association had a chance to weigh in on the ongoing regulatory conflicts around telemedicine, but ultimately didn't lay down any guidelines. The AMA’s ethics council attempted to come to an agreement over a set of guidelines focused on ethical considerations related to the use of online or mobile visits between patients and physicians, but a physician from Texas helped convince the committee to rethink its plans. The guidelines were tabled and sent back to committee for further review.
In 2015, the federal government introduced two bills that could supersede local laws for VA and Medicare patient populations. The TELEmedicine for MEDicare Act of 2015 (TELEMED Act) and the Veterans E-Health and Telemedicine Support Act of 2015 would create an interstate license, similar to a driver’s license, for practicing medicine on VA and Medicare populations. Also on the federal level, the ONC proposed some best practices for consumer telehealth, although we pointed out at the time that the exclusion of consumer telehealth companies from that meeting was problematic. Telemedicine even cropped up on Hillary Clinton's campaign trail, with the former Secretary of State declaring her intentions to "streamline licensing and explore how to make that reimbursable under Medicare" at a campaign stop in Iowa.
Trend: Patient-facing tools
A number of hospitals, particularly children's hospitals have been releasing patient-facing mobile offerings this year to increase engagement.
Miami Children’s Hospital has been developing mobile tools for patients for several years, but in a January interview CIO Edward Martinez said the most recent feature that they plan to release is a virtual discharge option so that the hospital can record a video of the discharge process. Another app Miami Children’s has created is a care coordination app for its clinicians, which allows providers who are finished with their shift to enter information about a patient’s condition quickly on a mobile device and pass it to the next clinician. Parents can also keep tabs on those transitions via an app called Care Notes and, as a result, stay up to date on their child’s condition.
In March, Reiter, Hill, Johnson & Nevin (RHJN), an OBGYN private practice in Washington, DC, inked a deal with Washington DC-based Babyscripts, which offers a “Mommy Kit” that includes its pregnancy app and partner connected health devices. The provider will equip its patients with a kit, called Mommy Kit, that includes a smartphone-connected weight scale and connected blood pressure monitor. The devices are either from Withings or iHealth depending on which the customer prefers.
That same month an article in the Wall Street Journal highlighted three different hospitals using tablets in their ICUs: Project Emerge, at Johns Hopkins University, the Patient-Centered ToolKit at Brigham and Women’s Hospital, and MyICU, a project under development at Beth Israel Deaconess. In developing these projects, each hospital found that patients often feel like they’re treated with a lack of respect and dignity in the ICU. Mobile software that allows patients and families a direct line to their care team — that doesn’t involve physically tracking down a busy ICU doctor or nurse — lets families air those concerns and allows hospitals to become progressively better at ameliorating them.
Also in March, Phoenix Children’s Hospital announced that it will install 200 tablets in patient rooms to provide patients and their families with customized, interactive information about their treatment plan. Phoenix Children’s Hospital will digitize its “Journey Boards”, which are tools that help a child’s family understand discharge instructions before they take their child home from the hospital. Currently, the instructions are printed out and distributed to patients and their families.
The year also saw Scripps Health finally launch an app for patients. Given Scripps Health’s early involvement in digital health, it was almost surprising that the provider waited this long to launch an informational app for patients. The health system's eponymous app, available for iOS and Android devices, allows patients and visitors to find information about Scripps physicians, hospitals, and clinics.
The fourth quarter saw news of more patient-facing apps. Researchers from Johns Hopkins Department of Neurology and Cincinnati Children’s Hospital Medical Center Department of Neurosurgery developed an app for the Hydrocephalus Association, called HydroAssist. It allows users to manually enter their treatments, organize multiple treatments, and view a history of treatments that is sorted by procedure date. HydroAssist can share this data with other doctors in the case that the patient needs to be treated at a new facility.
In November, Boston Children's Hospital released data from a discharge app pilot they launched last year. The app, called DisCo, was developed in-house, and the data showed that 74 percent and 90 percent of the two study groups respectively had no problems using the app.
UCLA discussed a number of patient-facing app pilots at HIMSS Connected Health conference in November, including a general tablet for patient entertainment and education, an app for patients in the hospital for prostate screenings, and a remote patient monitoring app for post-surgical wound care.
Finally, over the course of the year, hospitals continued to experiment with the boundaries of how much access a patient should have to his or her own data. In January, Boston’s Beth Israel Deaconess Medical Center received a $450,000 grant from The Commonwealth Fund to develop a program called OurNotes that allows patients to contribute to their medical records. The program is an extension of the well-known OpenNotes initiative and will include collaboration with a handful of other providers across the country. And in May, Children’s Hospital Los Angeles (CHLA) announced that they would offer an imaging app, called ImageInbox, to their patients. The app will help patients access digital versions of their imaging records, including MR, CT, ultrasound, and x-ray files.
OpenNotes also received $10 million in new funding at the end of the year to expand its movement to 50 million patients over the next three years. The funding comes from the Cambia Health Foundation, the Gordon and Bettye Moore Foundation, the Peterson Center on Healthcare, and the Robert Wood Johnson Foundation, which originally funded the initiative five years ago.
Trend: Chronic Condition Management
This year number of health systems adopted connected devices aimed at helping users manage a particular chronic condition.
Partners HealthCare announced in April that it would partner with Samsung to create chronic condition management software. Partners plans to launch a clinical trial of the new software in June. Another partnership, with PatientsLikeMe, announced in May, will provide patients with access to PatientsLikeMe via the healthcare provider’s patient portal. As part of the deal, Partners’ Patient Gateway will connect patients into PatientsLikeMe’s system.
Other announcements centered on particular conditions. We’ve listed some of the most interesting ones below.
The year was a big one for asthma and COPD digital health offerings, but the year actually started with one such company shutting down its spinoff due to lack of interest. Michigan’s integrated health system Spectrum Health announced at the end of the year that it would shut down Ideomed, a mobile health app developer that spun out of the provider in 2010.
According to a report in local business journal MiBiz, Spectrum pulled the plug after “tepid sales” and a lack of interest from outside investors. Ideomed had built an app called Abriiz aimed at asthma and COPD patients.
Yet several other hospital services embarked on respiratory-related projects during the year. In March, LifeMap Solutions, a San Jose, California-based company, launched a new pilot with Mount Sinai Hospital in New York. LifeMap will team up with Mount Sinai’s Icahn School of Medicine and the National Jewish Health Respiratory Institute (NJHRI) to develop a COPD platform that includes both a mobile app and, down the road, a smart inhaler. Then in December, LifeMap launched its second app, COPD Navigator, for free in the app store. At the same time, it launched a branded, enterprise version of that app, called iBreathe, with chronic care management company SuperCare Health.
In May, Aliso Viego, California-based Sentrian, the remote patient monitoring company formerly known as Jointly Health, announced that it would work with Scripps Translational Science Institute to study its technology on 2,000 patients with COPD. The Sentrian Remote Patient Intelligence platform uses biosensors to monitor patients remotely, but the company uses machine learning to customize the alert parameters for each patient.
In December, the National Institute of Biomedical Imaging and Bioengineering, a division of the National Institutes of Health, awarded a group of researchers from UCLA and USC $6 million to develop technology designed for children that predicts their asthma attacks. Researchers working on this project are a part of NIH's $144 million Pediatric Research Integrating Sensor Monitoring Systems (PRISMS) initiative.
Matters of the heart
Brigham and Women’s Hospital in Boston announced plans to pilot iGetBetter’s apps to reduce hospital readmissions through remote patient monitoring and post-discharge patient engagement. The pilot will target patients that have heart disease, specifically those with hypertrophic cardiomyopathy (HCM).
Partners Healthcare teamed up with Daichii Sankyo to create a mobile app for atrial fibrillation patients taking oral anticoagulants from Daiichi Sankyo. The app will have the goal of improving medication adherence and compliance and improving patient-provider communication and feedback loops.
Later in the year, the Scripps Translational Science Institute announced that it is working with Aetna and Johnson & Johnson to launch a trial that will test iRhythm's Zio Patch and the Amiigo activity tracker as possible new ways to screen at-risk populations for atrial fibrillation.
In January, smartphone ECG company AliveCor announced the publication of a long-awaited independent trial of the technology conducted by the Cleveland Clinic. As was reported at Heart Rhythm Society in May 2014, the trial showed that AliveCor’s heart monitor detected atrial fibrillation that was present 100 percent of the time, and only returned false positives 3 percent of the time.
Additionally, Utah health system Intermountain Healthcare — and other, as yet unknown providers — started investigating AliveCor’s smartphone ECG device in a clinical context, to determine whether the iPhone version of the device is comparable with traditional 12-lead ECGs.
Tactio Health Group, a Montreal-based company that builds smartphone-connected remote patient monitoring devices, announced that it would run a 25-person pilot study with the University of Michigan Health System, studying the effects of pharmacist-led home blood pressure monitoring and medication reminders on people with hypertension.
April was a big month for reducing readmissions for congestive heart failure. New York City-based Health Recovery Solutions announced that its tablet-based program reduced the 30-day readmission rate for 130 congestive heart failure (CHF) patients at Penn Medicine’s Penn Care at Home program by 53 percent. Then, in a pilot that included more than 350 CHF patients, a Philadelphia hospital was able to reduce its 30-day readmissions by 10 percent — a 40 percent improvement over baseline — by using email and text message reminders to get patients into follow-up appointments. Then a retrospective matched-pair cohort study of 348 patients in Partners HealthCare’s Boston-area hospitals showed that remote monitoring in congestive heart failure patients can reduce 120-day hospitalizations and mortality. Interestingly, while the reduction in mortality held beyond the 120 days of the study, the hospitalizations for the monitoring cohort actually went up after the monitoring stopped.
Diabetes and Prediabetes
New York City-based wellness app maker Noom and CityMD, a network of urgent care medical centers in and around New York City, launched a pilot for people who are at risk for Type 2 diabetes using Samsung's S Health app, integrated with Noom's health program. The pilot will include, at most, around 670 New Yorkers who have been diagnosed with prediabetes. Noom aims to use the pilot to create a health program that offers users preventive protocols and disease treatment therapies in near-real time.
ClinicalTrails.gov also shed light on another digital health-focused trial from Noom. According to the posting, wellness app maker Noom will work with both the Icahn School of Medicine at Mount Sinai hospital in New York and Kaiser Permanente on a 12-week, 200-person trial of a new mobile health app for eating disorders called Noom Monitor.
Also this year, Joslin Diabetes Center started a small trial to pilot test a mobile health app and an online nutrition education platform for people with Type 1 diabetes. The web platform will help educate patients about how to optimize their glucose and analyze their after-meal behavior. The app will facilitate data logging to help patients and caregivers track and explain variability in their glucose readings. The system is called “Sugar Sleuth”.
Another diabetes-related venture, this one from two American and two European companies, will aim to use near-field communication (NFC) technology to create new options for diabetes management. The Mayo Clinic and Washington, DC-based medical technology company Gentag formed the American half of the venture, while Dutch medical technology company NovioSense and German R&D firm Fraunhofer IMS will work on the problem in Europe. Both pairs of companies have collaborated in the past.
Additionally, Livongo Health, the diabetes management startup launched last year by former Allscripts CEO Glen Tullman, announced this year that it would roll out its platform to a large group of New Yorkers via the Mount Sinai health system. The program, which has already been available to Mount Sinai employees, will now be available to patients in the Mount Sinai network.
Finally, the University of Massachusetts Medical School (UMMS) began a pilot of an app, called Sugar, which aims to help people with diabetes manage their weight and blood sugar level as well as assess the status of chronic foot ulcers.
The CS Mott Children’s Hospital at the University of Michigan announced a new telemedicine program to help reduce childhood obesity. The hospital will work with Fruit Street, a recently-formed digital wellness and telemedicine platform, to provide a program for patients that integrates video visits with monitoring via wearable devices.
The National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), which is part of the National Institutes of Health (NIH), awarded Providence's Miriam Hospital and Boston's Beth Israel Deaconess Medical Center a $1.3 million grant so that researchers can conduct a mobile-enabled study to research weight loss after bariatric surgery.
Researchers will use wristworn a health monitoring device, called ActiGraph, and smartphones to track food, physical activity, behavior, mood, hunger, and cravings for around 100 bariatric surgery patients. The researchers will track these patients before surgery and four times over the year after surgery. Other information researchers will collect include environmental factors, like foods available to patients and support from family and friends, to assess which factors predict weight loss.
Trend: App curation and hospital app stores pop up
As more and more mobile health apps have emerged in recent years, a perennial question is who will step up to help consumers figure out which health apps are worthwhile. This year we've started to see a trend of providers stepping into that role.
The first two of these moves actually happened last year: Ochsner Health System in New Orleans made headlines when it launched the O Bar, the first “Genius Bar-type” in-person center for learning about health and wellness apps. By February the hospital had a roster of two to three hundred apps it’s recommending. The apps run the gamut from food and nutrition tracking, to fitness and activity, to apps that help manage chronic conditions like diabetes. Some help users quit smoking while others offer support and education to expectant mothers.
And toward the end of last year, Morristown Medical Center, a part of the Atlantic Health System in New Jersey, opened up HealtheConnect, an on-site, physical store located just off the hospital’s main lobby where patients, family members, and medical professionals can learn about health apps and wearable devices. While the store is currently backed by the hospital's foundation, the longterm plan is to transition it into a business and revenue stream in its own right — in about a year’s time.
In April, the Cleveland Clinic got in on the game when Cleveland Clinic Innovations, a business unit at the Cleveland Clinic, partnered with the Global Healthcare Innovations Alliance to launch a new e-commerce platform called ADEO. Through the website, both caregivers and patients will be able to purchase care tools, including a number of patient-facing mobile apps. The store quietly launched last October and now plays host to 13 products.
Some non-provider organizations that were already offering app prescription platforms also made news during the year.
In January, Palo Alto-based HealthTap released a ranking of health, wellness, and medical apps based on the public endorsements of thousands of doctors who use the HealthTap AppRx platform. Although not every doctor in HealthTap’s network participated and those that did, didn’t see all the apps, the system is designed to give each app equal exposure and to minimize bias on the part of physician reviewers.
The top three consumer-facing iOS apps recommended by HealthTap doctors were MyFitnessPal, Weight Watchers, and Lose It! (in that order), while the Android list had Weight Watchers in the number one spot, followed by White Noise Lite and Lose It! once again at number three. White Noise Lite came in 4th on the iOS list, and The American Red Cross First Aid app and RunKeeper rounded out the top six and top five, respectively.
In May, IMS Health, a multinational big data and analytics company, partnered with Quantia, developer of a web and mobile community for physicians. Through this partnership, Quantia provided the 225,000 members on its network with access to IMS’ app curation platform, AppScript. Quantia was later acquired by Physicians Interactive, now called Aptus Health, in July.
And across the pond in England, both the NHS England and the Royal College of Physicians both made moves towards curating approved apps for patients. In March, NHS England launched a library of five approved apps on its NHS Choices website, which gets 40 million visits per month. Then in May the Royal College of Physicians of London, the professional organization that sets the standards of medical training in the UK, published a set of guidelines about how doctors there should use medical apps. The two-page guidance document places a heavy emphasis on the CE Mark, but also places the onus on doctors to use their own judgment in using apps in clinical practice.
Finally, in November, the new Hacking Medicine Institute, a nonprofit that spun out of MIT this past summer, launched an initiative to produce reviews of mobile health apps and digital health tools. The vetting will be done by Harvard-affiliated physicians, and the venture will curate the mobile health app both for consumers and for providers looking to make recommendations about apps to patients. The group argues it will differ from past and current attempts at such an offering because the Hacking Medicine Institute, as an academically-rooted nonprofit, can be unbiased in a way companies like Happtique, IMS, or HealthTap can't be.
Trend: Apple and Google court healthcare more directly
Between an enterprise partnership with IBM, the continued integration of Apple HealthKit into hospitals, the announcement of ResearchKit, and even some early hospital pilots for the Apple Watch, Apple's footprint in healthcare was bigger this year than ever before. Google, meanwhile, continued to play around the edges of healthcare with moonshot projects from Verily (formerly Google X) and Google Glass which, though it may be on life support for consumers, still appears to have legs in healthcare enterprise.
Many of Apple's healthcare launches this quarter build on plans announced last year: Apple's partnership with IBM to develop enterprise apps was announced last year, but only in the first quarter of 2015 did the companies unveil their first batch of healthcare apps. These include Hospital RN, which helps nurses manage patient information; Hospital Lead, an iPad app designed to help charge nurses manage the nursing staff; Hospital Tech, an iPhone app for connecting nurse technicians to the rest of the care team; and Home RN, an iPhone app for nurses working in patients’ homes or otherwise outside the hospital. In May, Apple added an Apple Watch extension to Hospital RN, with plans to do the same for other enterprise apps.
Apple HealthKit, and its associated app Apple Health app, were also announced last year, at Apple's WWDC event. A big part of the initial announcement was integration with Epic which would allow a number of hospitals to make use of the data sharing platform. In February, a Reuters report asserted that at least 14 hospitals were either actively involved in a HealthKit pilot or in talks to roll one out, including Oschner Medical Center in New Orleans, Stanford Children’s Hospital, Penn Medicine, Duke University Hospital, Johns Hopkins, Mt. Sinai Hospital, and the Cleveland Clinic.
Just a few days later Stanford officially launched its patient-facing, HealthKit enabled iOS app. The new iOS 8 app, called MyHealth, allows patients to review test results and medical bills, manage prescriptions, schedule appointments, and conduct video visits with a Stanford physician, the latter via the hospital’s ClickWell Care telemedicine service. The Apple integration allows patients to upload vital signs and have them automatically and securely added to the patient’s chart in Epic.
Later in the year, in April, Cedars-Sinai Medical Center in Los Angeles took a new tack on HealthKit: opening up HealthKit functionality to all of its patients, and letting them tell doctors what data they want to share. Initially, any Cedars-Sinai patient who uses the Epic patient portal will be able to upload data from their devices to the weight, blood pressure, steps, pulse, glucose, and SpO2 fields in HealthKit and have that information sent to the EHR. More than 87,000 Cedars-Sinai patients are active users of the patient portal, and will now be able to integrate their health records with HealthKit.
Apple did launch two new health-related products this year: the Apple Watch and Apple ResearchKit. Apple Watch launched with as many as 264 health and wellness-related apps, but also began to be used here and there in hospital pilots. Two of those focus on cancer: the MedoPad Apple Watch app being used at King's College Hospital in London and Southern New Jersey’s MD Anderson Cancer Center at Cooper, which set up a program for 30 of its breast cancer patients that equips them with Apple Watches to help them self-manage their treatment as well as stay better connected to their care team and each other. The center is working with Wayne, Pennsylvania-based behavioral health technology company Polaris Health Directions on the nine-month feasibility study, which will move into a Phase 2, randomized control trial if it goes well.
And Ochsner Health System in New Orleans, which already has a HealthKit integration and a genius bar-style app and device store for patients, also launched an Apple Watch pilot. The watch will be given to high blood pressure patients, who will use it for medication reminders as well as using the Watch’s built-in fitness software to remind them to get enough exercise each day. Chief Clinical Transformation Officer Richard Milani told Forbes he plans to recruit two dozen patients and use the rest of Ochsner’s existing HealthKit program as a control group to collect data about the effectiveness of the Watch specifically.
In March, Apple announced a new, open source platform for medical research called ResearchKit, which integrates with Apple’s previously launched health data exchange HealthKit. Apple had already begun working with about a half dozen healthcare systems to create specific disease research apps.
The University of Rochester and Sage Bionetworks worked together to create the Parkinson’s research app, mPower, which aims to make it easier for people to sign up for studies and providing consent to do so. Massachusetts General Hospital used ResearchKit to build a diabetes research app called GlucoSuccess. Stanford and the University of Oxford used it to create a heart disease research app called MyHeart Counts. Mount Sinai Hospital and Weill Cornell Medical College teamed up to create an asthma research app called Asthma Health. And Dana Farber Cancer Institute, UCLA School of Public Health, Penn Medicine, and Sage Bionetworks created an app for breast cancer survivors called Share the Journey.
Various voices in the media reacted to the news with a lot of questions and concerns, but ResearchKit has pushed through. The platform became widely available to researchers in April, and toward the end of that month Apple made some new rules to address concerns about vetting of ResearchKit projects. The company added guidelines stipulating that all studies conducted via ResearchKit must obtain prior approval from an independent ethics review board.
Additional ResearchKit studies were announced as the year went on: A longitudinal study of lesbian, gay, bisexual, transgender, queer (LGBTQ) and other sexual and gender minority (SGM) adults to examine how their sexual orientation affects their health, conducted by UCSF called PRIDE; a Yale study for people who have or may develop cardiomyopathy, a disease of the heart muscle, called the Yale Cardiomyopathy Index, will offer participants self-assessments about their quality of life and heart-related symptoms; an autism study developed by Duke University; an epilepsy study from Johns Hopkins that uses the Apple Watch; a mole-tracking study from Oregon Health and Sciences; a second Yale study aimed at decreasing the chance of pregnancy loss resulting from an undersized placenta; a Japanese study called Heart and Brain; and an app called StopCOPD from the COPD Foundation. Even more have come out since then.
At the end of the year, ResearchKit finally came to Android as news broke that the Robert Wood Johnson Foundation would fund ResearchStack, a project developed by Open mHealth and Cornell Tech and led by Deborah Estrin. The RWJF money will fund the group through the development of the overall framework and the release of at least one app, Oregon Health and Sciences University’s Mole Mapper. They're hoping to have that released in beta by January 2016. Other researchers have already begun to contact Open mHealth, and the group may work with some of them as well.
Though not an Apple or Google product, the NIH awarded UCSF $9.75 million to develop a platform similar to ResearchKit that can be used to conduct digital health studies. This platform, called Health ePeople, will provide researchers with access to a large group of volunteers that have agreed to participate in research and the infrastructure to collect participant health data through mobile and wireless technologies.
Google's news in the provider world mainly concerned Google Glass. In January, Google made a controversial announcement about Google Glass: that the Explorer program (by which consumers were able to get access to the devices) was shutting down, and Google Glass would move out of Google’s experimental Google X Lab to become their own Google Team, under Nest creator Tony Fadell. Though many in the media were ready to declare Google Glass dead, for the healthcare space (and enterprise in general) reports of Glass's death were greatly exaggerated. Augmedix and Pristine, two companies working on Glass applications in healthcare, said they were bullish about Glass's future.
And just a month later we saw some validation of that optimism. After two and half years of negotiations with Google and with the Illinois Department of Public Health, a Skokie, Illinois ambulance service rolled out a program to give doctors live access to paramedics’ points of view via Google Glass. The Medical Express Ambulance Service, or MedEx for short, uses software developed by Pristine and is working with The Advocate Illinois Masonic Medical Center in Chicago at first, but plans to expand into additional hospitals in the future.
Then in April, a feasibility study published in JAMA dermatology showed that patients are overwhelmingly satisfied with dermatology consults via Google Glass, even preferring them to consultations over the phone. Twenty-nine of the patients 31 patients in the study (93.5 percent) were satisfied overall with the procedure and 30 (96.8 percent) were confident in both the accuracy of the video equipment and the privacy of their information. Twenty-eight people said they would recommend the Google Glass consultation to others.
At the very end of the third quarter, the Google X Life Sciences team, which is the same team behind the Baseline study, announced that it's building a wearable health sensor for cardiac and activity tracking. Google’s device is a clinical-grade sensor designed for investigational use. The wristworn sensor will measure pulse, activity level, and skin temperature continuously. It will also be able to take an ECG and pick up on environmental information like light and noise levels, which might indicate to investigators that a person isn’t wearing the device or isn’t leaving their house much. Google will investigate different research cases for the device, including sending it home with discharged patients at risk for readmission.
Toward the end of the year, Google Life Sciences rebranded as Verily. Verily projects that we know of include a glucose-sensing contact lens in partnership with Novartis subsidiary Alcon, a multiple sclerosis research project with Biogen, a "cancer sensing pill" powered by nanoparticles, and the Baseline Study, a major research project with Duke and Stanford. Lift Labs, the company that is developing smart eating utensils for people with Parkinson’s and essential tremor, has also been operating under the auspices of Verily since it was acquired last September. More recently, the company has announced it was developing a wearable for clinical research and has partnered with both Sanofi and Dexcom on continuous glucose monitoring.
In other Google news, Google Flu Trends, or at least the public-facing website version of the tracking software, shut down. The Google Flu Trends team will continue to track flu patterns based on search history, but it will now provide that data directly to public health researchers at Columbia University’s Mailman School of Public Health, Boston Children’s Hospital, and the Centers for Disease Control and Prevention (CDC) Influenza Division. Google Dengue Trends is also no longer publishing new data.
Vision and Hearing Screening
Call it a mini-trend, but we saw a few developments this year around mobile vision and hearing screening.
In March, Vital Art and Science, developers of myVisionTrack, a vision test service for patients with age-related macular degeneration or diabetic eye disease, announced that it would soon launch a major clinical trial in partnership with the Scripps Translational Science Institute and Roche.
In November, Gobiquity Mobile Health (formerly iCheck Health Connection), officially launched its vision screening smartphone app, called GoCheck Kids. The company began rolling out the product to pediatric practices at the end of last year on handheld devices that were issued to practices, but has since added more functionality and released it on the Apple App Store. Now, physicians have the option to download the app on their own iPhone or use it on a preloaded handheld device.
That same month DigiSight Technologies launched a new version of its smartphone-based eyesight test and a new offering called Scope, a hardware-software combined system that allows a medical professional to use the smartphone camera to photograph the back and front of the patient's eye.
Somerville, Massachusetts-based eye diagnostic tool maker EyeNetra launched a new service called Blink, which brings eye tests to the patient, in New York City. Blink emphasizes that the appointments are only for users who need to be tested for glasses, not eye health.
Finally, Boston Children’s Hospital validated a study of an iPhone-based system for screening for inner ear problems. The system is a low-cost alternative to an expensive screening process. It involves placing the iPhone in a plastic bucket to block out stimuli