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Rock Health: Q1 2018 Digital Health Funding Hits Record $1.62B

April 3, 2018
by Heather Landi
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Following the biggest year for digital health funding, the digital health space is starting off 2018 with a bang, reports San Francisco-based Rock Health in its Q1 2018 analysis. In the first quarter of 2018, $1.62 billion was invested across 77 digital health deals, with three $100-million-deals.

The funding level in the first quarter of 2018 supplants Q1 2016 venture funding, which saw $1.41 million invested, as the largest first quarter yet. According to Rock Health's report, 2017 was the biggest year for digital health funding, and funding continues to climb.

Compared to last year, the commotion from policy debates has largely settled and a path to regulatory clarity has emerged, the report notes.

“As the digital health sector matures, investors have become more confident investing in large, late-stage rounds,” Rock Health states in its analysis. Last year saw a record eight mega-deals ($100M+) completed, followed by three mega-deals already in 2018: HeartFlow, which creates 3D models of coronary arteries to help providers non-invasively detect coronary artery disease, raised a $240M Series E round; Helix, a consumer genetics marketplace spun out from Illumina, raised $200M; and Rock Health portfolio company Collective Health closed $110M to accelerate development of their health benefits solution for employers, Rock Health reports.

The top 10 deals of Q1 2018 represent over 55 percent of total funding—but only 13 percent of deals—in the quarter. The average annual deal size has ticked up over the years, and this quarter was no exception: the average deal size is up to $21 million relative to $16.4 million last year, according to the report.

For the first time, (digital) Diagnosis of Disease was the most-funded value proposition among digital health companies, with five deals totaling $279 million. Monitoring of Disease, the second most-funded value proposition, also had the most deals, 13, with a total of $270 million in funding. Consumer Health Information—technology used to help patients navigate the healthcare system and their own health—continues to be a top-funded value proposition as well, with Helix leading the way. In that segment, there were 10 deals totaling $267 million in funding.

The Research and Development Catalyst proposition has seen 12 deals so far in 2018, with $216 million in funding. On-Demand Healthcare Services had 11 deals in the first quarter of 2018 with $169 million in funding. And, Health Benefits Administration had $166 million in funding with six deals.

“We are in the early days of 2018 and a few large deals could dramatically swing these categories one way or another. Even so, we continue to see digital health startups both tackling the clinical aspects of care (Diagnosis of Disease, Monitoring of Disease) and reducing friction between patients and the healthcare system (Health Benefits Administration, On-Demand Healthcare Services),” the Rock Health report states.

The report notes that Helix’s $200M mega-deal, along with 23andMe’s $250M round in Q3 2017, demonstrates a growing interest in the genomics space. In fact, digital health companies leveraging genomics and sequencing raised 17 percent of the total funding from this quarter, the report notes. Last year, genomics companies accounted for 11 percent of total digital health funding. “With new CMS reimbursement coverage, consumer testing amassing large volumes of data, and better technical infrastructure for precision medicine initiatives (from Oracle and Google), we seem to be hitting an inflection point for genomics,” the report states.

Compared to last year’s volatile policy debates, investors and entrepreneurs are likely heartened by the progress made this year on the regulatory front, the report notes. As part of the $400M FDA budget boost, Commissioner Scott Gottlieb has laid out plans for a new Center of Excellence on Digital Health—aiming to establish a new regulatory paradigm which expands its current pre-certification pilot into a program that streamlines review of digital health technologies for companies that earn a pre-certification based on their demonstrated ability to manage the quality and reliability of their software.

To this point, Rock Health notes there has been an uptick in activity among the nine companies participating in the pre-cert program. For instance, Pear Therapeutics recently partnered with Novartis to develop and pursue FDA approval for digital prescription therapeutics for schizophrenia and multiple sclerosis. “Additionally, Fitbit is planning to seek FDA clearance for its sleep apnea and atrial fibrillation detection tools—a sign of the company venturing more seriously into chronic disease use cases. Apple Health Records launched out of beta allowing patients using certain providers, like Johns Hopkins and Cedars-Sinai, to store and share their medical records on the iPhone. And Samsung’s new smartphones will have a built-in optical sensor to measure blood pressure and stress levels as part of a health study with UCSF,” the report states.

With regard to mergers and acquisitions, Q1 of 2018 was a roller coaster for digital health M&A, the report notes, with 37 digital health companies acquired this quarter. That puts the sector on-track to beat last year’s 119 acquisitions and 2016’s 146 acquisitions.

Big acquisition deals so far in 2018 include Allscripts’ $100 million acquisition of Practice Fusion and Roche’s purchase of Flatiron Health for $1.9 billion. Additionally, Ability Network, a SaaS-based company simplifying administrative tasks in healthcare, was acquired by healthcare data analytics company Inovalon for $1.2 billion.

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Who Isn’t Using Patient Portals? New Study Sheds Light on Portal Use

December 12, 2018
by Heather Landi, Associate Editor
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About two-thirds of adult patients did not use an online patient portal in 2017, and research indicates vulnerable and disadvantaged patients are less likely to use these technology tools, according to a study published in the November issue of Health Affairs.

Technologies such as online patient portals, which provide secure internet access to medical records and test results in addition to email communication with providers, can improve health care quality. And, evidence thus far shows that access to online portals increases patients’ engagement and adherence and may reduce unnecessary utilization and spending.

However, while the majority of adults in the United States believe that online access to personal health information is important, disparities in portal access exist.

“Findings from multiple studies that analyzed different population groups, including nationally representative samples, consistently show that members of racial and ethnic minority groups, older patients, and people of lower socioeconomic status are less likely than others to access an online portal,” the study authors wrote. The study was led by Denise Anthony, professor of health management and policy and sociology in the Department of Health Management and Policy, University of Michigan School of Public Health. Anthony and her co-authors also note that “inequities in access to new and beneficial technologies can exacerbate existing disparities in health.”

One national study, a March 2017 by the U.S. Government Accountability Office (GAO), found that only about 15 to 30 percent of patients who were offered access to a portal used it, with lower use among people living in rural and high-poverty areas.

“To identify appropriate levers that can be used to address inequities in online portal access, policy makers and providers must have a clear understanding of who is and is not accessing portals, as well as the reasons for not accessing them,” the study authors said.

For the study, titled “Who Isn’t Using Patient Portals and Why? Evidence and Implications from a National Sample of U.S. Adults,” researchers analyzed information about 2,325 insured respondents to the nationally representative 2017 Health Information National Trends survey to examine characteristics of patients who do not use portals and the reasons why they don’t them. By identifying who is not using portals and why, the researchers sought to uncover barriers and reduce disparities.

The study indicates that about two-thirds (63 percent) of insured adults with a health care visit in the previous 12 months reported not using an online patient portal. The research indicates that nonusers are more likely to be male and age 65 or older, have less than a college degree, not be employed, live in a rural location, be on Medicaid, and not have a regular provider.

These factors, along with race, were also related to whether a patient reported receiving an offer to use a portal.

Relative to females, males had significantly higher odds of not being offered access to and not using a portal, the study indicates. Members of racial minority groups (specifically, non-Hispanic blacks and non-Hispanics of other races—including Asian Americans, Native Americans, Native Hawaiians, and Pacific Islanders) had significantly greater odds of not being offered a portal. Among only those who were offered a portal, these groups reported rates of using a portal comparable to the rate of non-Hispanic whites.

The study also found that people with only a high school diploma or less were significantly less likely than those with college degrees to have been offered access to a portal. Patients with Medicaid insurance were significantly more likely to report not having been offered access to a portal and not using one, compared to people with other insurance.

Patients who lacked a regular provider were significantly more likely to report not having been offered access and not using a portal.

When evaluating reasons why people did not use a portal, the researchers did not find evidence of disparities in technological barriers. The reasons patients gave for not using portals included the desire to speak directly to providers and privacy concerns, both of which require recognition of the important role of provider communication and patient-provider relationships, the study authors note.

The study authors conclude that healthcare providers will need to address patients’ privacy and security concerns to enhance provider-patient communication.

“Reducing disparities in portal use will require that providers, particularly those serving vulnerable populations, communicate with all patients about portal use and have the capacity to discuss these technologies with patients,” the study authors wrote.

“Health care providers and plans can increase patients’ use of portals and narrow disparities in that use through direct communication about the benefits of portals, while also addressing patient-specific needs and concerns. Such interventions will require recognition that providers’ communication with patients takes time—an extremely scarce resource in clinical practice today,” the study authors concluded, while also noting that careful monitoring of who is and who is not using new technologies, and why, and designing technologies to address patients’ needs, will help ensure that such innovations do not exacerbate disparities but rather lead to improvements for all.

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AMIA, AHIMA Call for HIPAA Modernization to Support Patient Access

December 7, 2018
by Heather Landi, Associate Editor
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Modernization of the 22-year-old Health Insurance Portability and Accountability Act (HIPAA) would improve patients’ access to their health information and protect their health data in a burgeoning app ecosystem, according to two leading health IT industry groups.

During a briefing on Capitol Hill Wednesday, leaders with the American Medical Informatics Association (AMIA) and the American Health Information Management Association (AHIMA), health informatics and health information management experts discussing how federal policies are impacting patients’ ability to access and leverage their health data.

While other industries have advanced forward with digital technology and have improved individual’s access to information, and the ability to integrate and use information, such as booking travel and finding information about prices and products, healthcare has lagged. Healthcare has not been able to create a comparable patient-centric system, AMIA and AHIMA leaders attested.

“Congress has long prioritized patients’ right to access their data as a key lever to improve care, enable research, and empower patients to live healthy lifestyles,” AMIA president and CEO Douglas B. Fridsma, M.D., Ph.D., said in a statement. “But enacting these policies into regulations and translating these regulations to practice has proven more difficult than Congress imagined.”

“AHIMA’s members are most aware of patient challenges in accessing their data as they operationalize the process for access across the healthcare landscape,” AHIMA CEO Wylecia Wiggs Harris, Ph.D. said. “The language in HIPAA complicates these efforts in an electronic world.”

AMIA and AHIMA recommend that policymakers modernize HIPAA by either establishing a new term, “Health Data Set,” which includes all clinical, biomedical, and claims data maintained by a Covered Entity or Business Associate, or by revising the existing HIPAA “Designated Record Set” definition and require Certified Health IT to provide the amended DRS to patients electronically in a way that enables them to use and reuse their data.

According to AMIA and AHIMA, a new definition for “Health Data Set” would support individual HIPAA right of access and guide the future development of ONC’s Certification Program so individuals could view, download, or transmit to a third party this information electronically and access this information via application programming interface. Alternatively, a revision of the current DRS definition would provide greater clarity and predictability for providers and patients.

The groups also noted that a growing number of mHealth and health social media applications that generate, store, and use health data require attention as part of a broader conversation regarding consumer data privacy.

Congress should “extend the HIPAA individual right of access and amendment to non-HIPAA Covered Entities that manage individual health data, such as mHealth and health social media applications, the two groups said. The goal is uniformity of data access policy, regardless of covered entity, business associate, or other commercial status, the group leaders said.

Beyond HIPAA, during the briefing Wednesday, panelists discussed the success of efforts to share clinical notes with patients during visits, including the successful OpenNotes initiative, and recommended that federal officials look for ways to encourage more providers to share notes with patients through federal policies, such as Medicare and Medicaid payment programs.

“More than two decades after Congress declared access a right guaranteed by law, patients continue to face barriers,” Thomas Payne, M.D., Medical Director, IT Services, UW Medicine, said in a statement. “We need a focused look at both the technical as well as social barriers.”

What’s more, AMIA and AHIMA recommended federal regulators clarify existing regulatory guidance related to third-party legal requests, such as those by attorneys that seek information without appropriate patient-direction.

“HIM professionals continue to struggle with the existing Office for Civil Rights guidance that enables third-party attorneys to request a patient’s PHI,” Harris stated. “We recognize there are necessary circumstances in which a patient has the right and need to direct their health information to an attorney. However, AHIMA members increasingly face instances in which an attorney forwards a request for PHI on behalf of the patient but lacks the information required to validate the identity of the patient. As a result, the HIM professional is challenged as to whether to treat it as an authorization or patient access request, which has HIPAA enforcement implications

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Health Systems Work with Epic on Electronic Patient-Reported Outcomes for Oncology

November 18, 2018
by David Raths, Contributing Editor
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With eSyM app, patients will provide feedback to their cancer care team via the EHR

Six U.S. healthcare systems are sharing a $9 million grant to research introducing electronic patient-reported outcomes (ePROs) into the routine practice of oncology providers to improve symptom management and to decrease hospitalizations.

The National Cancer Institute, in association with the Beau Biden Cancer Moonshot Initiative, recently announced the funding of the collaboration, the SIMPRO (Symptom Management IMplementation of Patient Reported Outcomes in Oncology) Research Center. The SIMPRO team will work with Epic, the EHR system used by all six participating institutions, which are New Hampshire-based Dartmouth-Hitchcock, Dana-Farber/Brigham and Women’s Cancer Center in Boston, Baptist Memorial Medical Center in Memphis, Lifespan Cancer Institute in Rhode Island, West Virginia University Cancer Institute, and Maine Medical Center in Portland.

SIMPRO will develop, implement, and evaluate an ePRO reporting and management system through an app called eSyM. Patients’ smart devices will enable a secure connection to their cancer care team via the EHR, and facilitate symptom tracking following cancer surgery or chemotherapy. The study will test whether monitoring the symptoms patients experience and providing coaching on how to manage them can decrease the need for hospitalizations and emergency room visits.

“The opportunity to partner directly with Epic and their resources, to build these tools into our electronic health record, means in the short-term the research is more likely to bear fruit “and in the long-term that successful strategies can be disseminated around the country.” said Dartmouth-Hitchcock Chief Health Information Officer Peter Solberg, M.D., in a prepared statement,

After development and pilot testing, eSyM will be fully integrated into the EHR at each participating center, allowing for direct communication and real-time updates for clinicians who will have access to a dashboard of patients’ symptoms to prioritize outreach efforts and coaching.

The SIMPRO investigators will conduct a randomized trial to evaluate implementation of eSyM from a patient, clinician and health system perspective. Across all study phases, the implementation, adoption, acceptance, and adaptation of the ePRO system will be critically evaluated to promote better delivery of cancer care.

 

 

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