GeriTech’s Take on AARP’s 3rd Health Innovation@50+ LivePitch Finalists

GeriTech’s quick take on the AARP LivePitch finalists

Here are the AARP descriptions of the companies/products presented at the LivePitch event, along with my initial reactions. I took a quick look at everyone’s websites, but have not tried any of these products.

• Yet another company promising easy point-of-care diagnosis, and marketing to both consumers and clinicians.
• The only test specifically named is BNP, and the consumer part of the site pitches better congestive heart failure (CHF) management. Presumably the company will be working on additional tests.
• CHF is certainly an important problem among older adults, however as doctors we usually would be interested in following weight gain and symptoms as well. I’m also not sure how often one wants to order a BNP alone; people with CHF are usually on diuretics, so it’s important to check kidney function and electrolytes. 
• Last but not least, for insurers to pay for this, I assume one would have to prove that tracking BNP at point-of-care outperforms tracking weight gain, vitals, and symptoms…or at least offers a marginal benefit that justifies the additional cost.
• I do think we all will eventually benefit from easy point-of-care diagnostic testing, but am not sure pitching a heart failure blood test to consumers is the way to go. 
• BNP is especially useful to distinguishing between breathlessness due to heart failure exacerbation versus another cause. Will be interesting to see if the company pursues consumers with multi-morbidity.

CareTicker: “Careticker is the world’s first web/mobile platform that helps unpaid, family caregivers track and earn incentives for the care provided to their loved ones.”

• Crikey, measurement and incentives are coming to family caregivers!
• Smartphone app allows users to log common caregiving activities, including medication, bathing, wound care, transportation, finances, grooming, shopping, etc.
• Could help a family figure out just how much hands-on help an older person is requiring. Could come in handy for families in which some caregivers feel their work isn’t entirely recognized or appreciated by others. Might help a care circle divide the labor more reasonably.
• Unclear just what the incentives are; they have a dollar sign on the website. Who provides the dollars? And what are the implications of linking incentives to work that people have historically done for the sake of relationships and duty?
• A “For Healthplans” section states: “A supported and engaged caregiver equals better

outcomes for your high risk populations.” Also says “Careticker connects care managers directly with the family caregiver. We track the care provided between your interactions with the patient.” Well, the plot is definitely thickening…

Healthspek: “Healthspek manages all personal and family health information in one secure place from multiple devices. The unique myDashboard helps you track medications, vitals and access care. The myInbox receives your medical records; in addition you control who accesses your records with chartnow.com.”

• This looks like a personal health record (PHR) service. Older adults and families certainly need a service like this, although it’s important that the design be easy to use even if one has a lot of medications and chronic conditions. (Here’s my post on searching for a good PHR for aging adults.)
• Includes a “request your records from your doctor” feature. This is important, would be interesting to know how well it works in practice. Healthspek’s website says this feature requests a Continuity of Care Record; if this routinely includes progress notes and lab results, could be very useful. 
• Includes “ChartNow”, a feature that allows users to share complete record with the doctor. This is a feature that is great in principle, but in practice I bet few doctors will use it unless the provided information is very easy to access and review (a tall order!) 
• Overall this seems promising; certainly a huge need for this, but whether the execution allows it to be usable by patients, families, and doctors…that is the big question.
• In the short-term: only available for iOS and no web browser version. That last one is an absolute deal-breaker for me. Mobile access is important but should not be the only way to access a complex data set. (And believe me, the people who need this kind of service have complex health information.)

Just: “Our mobile app helps you to upload your medical bills and related documents like the medical records, insurance etc. The documents are redacted to protect privacy. We use machine learning algorithms and community of expert billing advocates to analyze bills for errors. The advocates negotiate with providers / insurance companies to resolve errors and help save you money.”

• It’s never been clear to me how many Medicare patients spend time worrying about errors in their medical bills. I assume this will initially be used more by people who don’t have Medicare.
• The service also promises to provide access to pricing database, that can help others shop for healthcare.
• If it works well, could provide a valuable service to users. 
• A business with access to a pile of medical billing data will presumably be able to leverage it somehow, hopefully in a way that also benefits patients and society.

• This makes me think of my grandfather, who had a pronounced essential tremor. He managed to not spill his food (to the amazement of my brother and I) but I’m sure food spilling is a serious problem for some people.
• I like the simplicity of this, in that it’s quite clear who this is for — people with tremor such that they are spilling their food — and how it’s supposed to help. 
• It should also be straightforward for the older user to determine whether there’s a benefit or not, which is nice.

Pixie Scientific: “Technology embedded in consumer products that unobtrusively monitor nutrition and onset of chronic conditions in children and seniors before symptoms occur.”

• I heard about this company at Aging 2.0. They started off with a sensor-enhanced pediatric diaper that reportedly could detect signs of UTI, dehydration, and kidney failure. They are now offering a “Smart Brief”  to detect similar problems in older adults.
• The brief detects leukocytes, nitrites, pH, and electrolyte concentrations. Sounds similar to a urine dipstick, but would obviate the need to have an older adult pee in a cup…so certainly easier in many ways than a dipstick. 
• Then again, we currently only dipstick urine when we have clinical concerns. No one knows what would happen if you were to dipstick a frail elder’s urine every day…could one end up with much ado about not-so-much?
• This does not, sadly, track episodes of urinary incontinence, as far as I can tell.
• Given how often clinicians and caregivers are concerned about UTIs in frail older adults, it might be helpful. Would also be interesting to see if one could get useful data by tracking changes over time in an individual person’s urine composition.
• Many many older adults with incontinence issues have asymptomatic bacturiuria, so false positives might be an issue. Could frequent tracking with a smart brief help us detect a clinically significant UTI in someone with a colonized bladder? This is a clinical problem that we often struggle with.

Sway Medical: “Sway is a medical software company building regulated mobile software solutions that utilize the existing sensors in a mobile device for clinical and at-home screening of balance and neurological conditions with nothing more than the mobile device you already own.”

• According to their website, this is “The First FDA-Cleared Mobile Balance Testing System.” Seems to be an app and needs to run w a provider’s mobile device. You have the patient clutch your phone to their chest and it somehow assesses balance.
• The good news is that they published a validation study, in which they compared this device’s balance assessment to the assessment of a “Biodex Balance System SD.” The bad news is that they validated with 30 healthy college students. Who weren’t even drunk, ergo presumably not balance impaired, unlike most of the older adults who we send for assessment.
• Sway’s website proposes their smartphone balance assessment tool as a valuable component of fall management. They say it can be used to identify people at risk, and to track change over time.
• I think there are probably easier ways to identify older adults at risk for falls. This also doesn’t help busy clinicians identify and address the many factors that usually increase fall risk, and that’s probably what we need most of all.
• This could potentially be a useful tool for assessing one aspect of balance, in a reproducible way. It’s not a substitute for watching an older person walk, and for doing a basic neuro exam. But it won’t substitute for a visit to PT for a balance and gait assessment, and that provides lots of other useful information that this device doesn’t.
• I just thought of an additional use case: maybe I could use this app to convince my older patients that their balance really IS worse, when they use Ambien or benzodiazepines? (They are always assuring me that it doesn’t affect their balance at all.)
• Practical problem: website is opaque about the pricing. Unclear how an individual provider (like me) would get this and try it out. This is basically an app; why not let providers have a free 30 day trial?

TalkSession: “TalkSession is a telemedicine platform aimed to increase access to mental healthcare by leveraging last minute cancellations and no-shows. TalkSession’s platform isolates mental healthcare providers’ availabilities and connects patients via secure mobile video on any browser-enabled device.”

GeriTech thinks:

• Website feels different from frame than description above. Description above sounds appealing to administrators and those trying to maximize productivity. Website promises to make it easier to match people to a good therapist, and from the comfort of their home to boot. (This is extremely important by the way.)
• Website is overly designed and lacks useful information. Esp given they pitched at AARP, why is it impossible to tell if any of these therapists have expertise/experience in aging-related issues? 
• Seriously, they have a section for “addiction” and “child & adolescent” but none for “aging”. 
• Can any of these therapists help evaluate memory concerns? 
• Can any of these therapists help aging adults facing serious illness, declines in independence?
• Which of these therapists will provide good therapy to people with cognitive impairment? I am often looking for someone to help a patient with mild dementia; anxiety and depression are common in this population (not to mention in their caregivers).
• Instead of providing a “quote” from each provider, it would be better to explain what kinds of therapy they are experienced in providing.
• Who pays? As a clinician, I would be reluctant to recommend this service since there isn’t enough information about how it works.
• Will these therapists send updates to the primary care doctor, and to other involved clinicians? I’ve often found that therapists are TERRIBLE about sharing their notes and telling anyone else what is going on, which is a pain because our work in primary care is strongly influenced by the patient’s mental state.
• I would like to see services like this take off as it’s often very hard to connect older patients with good therapy. But, they need to be clear about their ability to serve the needs of older adults, and also about their ability to coordinate with a primary care team.

Zansors: Zansors combines science and technology to create tools that help you know yourself. Our sleep sensor makes it easy for you to collect your personal health data, painlessly and comfortably, which can then be used to make personal health decisions with much greater clarity, accuracy and relevancy.

GeriTech thinks:

• Meh. Insomnia is a huge problem that I’d love tech help with (see this post about Zeo). However Zanzors website currently lists “Sleep Related Breathing Disorders” as their main focus. They also have a kids section promising to “empowers parents to catch potentially life-threatening disorders like apnea—gaps in breathing—that routinely go missed at doctor visits.”
• Yet again, I have the feeling that the company never went to regular primary care doctors to ask “what kind of patient sensor data would help you help your patients? What kind of sleep data would help you help your patients?”
• Note that no one knows if healthcare value will improve, if you put sleep apnea sensors in the hands of millions of people before they’ve discussed with their doctors…especially since most people have trouble sticking with CPAP. I am all for empowering patients, esp as they often need to compensate for the healthcare system’s deficiencies. But I won’t be surprised if flooding consumers with sensor technology ends up being less helpful than initially envisioned, esp if the healthcare system isn’t adequately prepared to help people with this data. 
• That said, sleep apnea is a serious problem that is under-diagnosed, and conventional sleep studies are expensive and difficult to arrange for patients. A simpler and cheaper alternative will certainly come in handy in some circumstances.

What I’m most interested in

And which companies won at LivePitch?

(Note: As with prior Health Innovation@50+ events, the judges did not include any practicing physicians, geriatric care managers, or professional experts in helping aging adults with their health.)

The investor judges voted for Lift Labs .

The consumers voted for CareTicker. (Interesting!)

Ok dear readers: what do YOU think of these companies’ offerings? Bonus points if you are on the front-line, which means you are an aging adult, a caregiver to an aging adult, or a healthcare professional who helps older adults and families.