Autonomous Monitoring of Healthcare Facilities Using AI and Advanced Sensors: Interview with Chakri Toleti, Founder and CEO of care.ai

Autonomous Monitoring of Healthcare Facilities Using AI and Advanced Sensors: Interview with Chakri Toleti, Founder and CEO of care.ai

care.ai,
an artificial intelligence company based in Florida, has partnered with Googlevto create an autonomous patient monitoring system. By combining multiple sensors in a patient’s room and neural network data analysis, the system can identify and predict accidents and clinical events, in some cases warning healthcare staff before an incident happens.

Preventable accidents and medical issues in healthcare facilities result in thousands of patient deaths and significant patient suffering every year. These include falls, infections, and pressure ulcers. While such issues are theoretically avoidable, in many cases it is difficult or impossible for healthcare staff to identify and anticipate every such instance, and in many cases, they can only hope to react to such circumstances once they arise.

To address this, the patient monitoring system developed by care.ai allows patient rooms to be “self aware,” whereby patients are automatically monitored 24 hours a day through advanced sensors, and AI identifies and anticipates mishaps and issues, providing healthcare staff with advanced warning.

The company claims that the system allows healthcare staff to have more time to focus on their patients’ specific needs, rather than constantly keeping an eye on them or reacting to unforeseen events. Moreover, it should also allow healthcare staff to be much more proactive, and lead to lower overall levels of avoidable mishaps in healthcare facilities.

Medgadget had the opportunity to talk to Chakri Toleti, Founder and CEO of care.ai, about the company’s technology.

Conn Hastings, Medgadget: What inspired you to develop a patient monitoring system?

Chakri Toleti, care.ai: In early 2018, I received
a call that my mother in India had fallen and remained on the bathroom floor
for half an hour before her caregiver found her. Even the best medical
professionals simply can’t be everywhere at once, so they are often delayed in
responding to patient issues. This was the catalyst for care.ai, fueled by the
idea that patients should be able to maintain independence and privacy while
still being kept safe.

Other industries, like transportation and aviation,
have really transformed because of AI. Healthcare, however, has been slower to
adopt it. I considered the autonomous
driving – how self-driving technology constantly scans and monitors its
environments, responding to pedestrians, roadblocks, debris, etc. I thought,
“what if we could bring the autonomous monitoring of a self-driving car to a hospital?”
I created care.ai to turn every room into a Self Aware RoomTM.

Medgadget: Please give us some background on the types of incident the system is designed to anticipate.

Chakri Toleti: These
are the few use cases that we have deployed: staff efficacy, fall prevention, pressure
ulcer prevention, and hand sanitization monitoring.

In phase 2 we will be
deploying other use cases such as patient elopement prevention (wandering
patients), security violations and visitor management.

Medgadget: What type of sensors are included?

Chakri Toleti: care.ai’s sensors use the
most advanced technology of any solution in a healthcare setting. We use a wide
range of propriety sensors within our patented hardware and software framework.
We are leveraging NVIDIA’s Jetson platform as a core compute engine and further
accelerating the inferencing of the sensor data using Coral’s Edge TPU.

Medgadget: Please give us a basic overview of how the AI system learns to anticipate incidents in a patient’s room.

Chakri Toleti: care.ai’s purposefully architected deep neural networks are trained on our propriety library of behavioral data – in fact, it’s the world’s largest library of human behavior data in a healthcare setting. Using edge-computing framework, care.ai’s deep neural networks deliver predictive results within nanoseconds. Using this proprietary library, the sensors identify recognized behaviors and immediately send relevant alerts to the appropriate care team members. The alerts are sent through a mobile app, SMS, desktop app, or integrated into existing HIS solutions using our SDK/APIs.

Medgadget: How has the collaboration with Google helped the system?

Chakri Toleti: We chose to work with Google because their software and hardware frameworks for AI – and now their capability to bring it to the edge – meet care.ai’s needs for the scale, accuracy and performance necessary to build an enterprise-class platform. Coral’s edge TPU has been instrumental for us to scale, allowing us to preserve patients’ privacy while still conducting constant monitoring and processing.

Medgadget: Is the system in use at present? How do you deal with patient confidentiality and data security?

Chakri Toleti: Consulate Health Care, a leading provider of long-term healthcare services, is currently piloting care.ai. care.ai’s platform is the most scalable and secure AI solution in Healthcare, we process all of our data on the edge on a highly secure and custom-built operating system and publish the deidentified inferenced data in a secure and HIPAA complaint framework back to the server.

Link: care.ai homepage…

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Source: Autonomous Monitoring of Healthcare Facilities Using AI and Advanced Sensors: Interview with Chakri Toleti, Founder and CEO of care.ai

What the Theranos whistleblowers learned about ethics in health startups

What the Theranos whistleblowers learned about ethics in health startups

Photo: Andrew McGee, Manova

Erika Cheung and Tyler Shultz were the whistleblowers who helped to expose corruption at Theranos. They spoke at the Manova Summit in Minneapolis this week.

Theranos whistleblowers Erika Cheung and Tyler Shultz shared some of the lessons they learned from working in a culture of fear and secrecy at the Manova Global Summit on the Future of Health in Minneapolis.

“There were words we couldn’t say at Theranos, like ‘biology,’ ‘pipette,’ ‘research,’” Shultz recalled. “And we weren’t supposed to talk to other people at Theranos about what you were doing.”

Still, the two didn’t have any other career experience, so it took a while for the red flags to add up, Cheung said.

Now, with the former leadership of Theranos waiting for a 2020 trial, Cheung and Shultz have established an organization they call Ethics in Entrepreneurship, hoping to prevent other tech and health startups and employees from going through what they did.

“We’re all here because we want to make an impact and we want to do good and we have good intentions, but making sure you have that strong vision and figuring out how to maintain that” is challenging, Cheung said. “You have to figure out how to stick to those morals and standards and values despite the chaos.”

Though they’re far from having all the answers at this point, they pointed to some basics that can be applied to almost any company:

  • Discretion from investors: “If the average age of the board is 80, maybe insist on a board seat,” Shultz said. “Or insist on younger blood.”

So-called vanity boards are popular in Silicon Valley, Cheung agreed, but especially in a highly regulated space like health care, “you need the right people asking the right questions.”

  • Be proactive: Think about the impacts a startup will have on customers, investors, employees and society. It’s better to think about these ethical issues early on in the process, Cheung said, rather than reactively.
  • Consider realigning incentives: Shultz and Cheung agree that there should be a way within the investment landscape to prevent an unethical situation from going too far. For example, if someone was personally profiteering or committing egregious actions, there could be a system in place for investors to pull back money. “There need to be ways to keep people accountable, to nudge them to good behavior,” Cheung said.
  • Think before investing: When people were investing in Theranos, Cheung pointed out, it was during a time when investors were scared of losing the next opportunity to buy into an Amazon. “There was not a lot of deep thinking about how to invest in tech companies,” she said. Theranos should serve as a warning to potential investors that they need to ask the questions before signing the check.
  • Create a culture of healthy disagreement: Shultz has started a new company, and while it only has three employees so far, one of his primary missions is to establish a culture in which people are allowed to disagree — even with the boss. “My lab bench scientist and I get into some arguments that are pretty intense, but I tell him it’s really healthy — and we can move on,” he says. How do you scale that for a bigger company? “That’s the hard question,” Cheung said. “But the biggest one is, do you have a way for employees to report problems? Are the right mechanisms in place to compile evidence, and is there investigation and followup?” An ethics hotline, she said, is one way to do that.

Despite spending most of his 20s wrapped up in the Theranos scandal, Shultz maintains a sense of optimism.

“So many things had to go wrong [in the Theranos case] that I think it’s unlikely something like this would happen again,” he said. “Though maybe I’m naive.”

Moderator Rebecca Jarvis of ABC asked the pair whether they thought former Theranos CEO Elizabeth Holmes should go to jail.

“There has to be some justice,” Cheung said, to great applause from the audience. “There has to.”

Source: What the Theranos whistleblowers learned about ethics in health startups

Whistleblower alleges Medicare fraud at iconic Seattle-based health plan

Whistleblower alleges Medicare fraud at iconic Seattle-based health plan

Photo: Feodora Chiosea, Getty Images

Group Health Cooperative in Seattle, one of the nation’s oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.

Teresa Ross, a former medical billing manager at the insurer, alleges that it sought to reverse financial losses in 2010 by claiming some patients were sicker than they were, or by billing for medical conditions that patients didn’t actually have. As a result, the insurer retroactively collected an estimated $8 million from Medicare for 2010 services, according to the suit.

Ross filed suit in federal court in Buffalo, N.Y., in 2012, but it remained under a court seal until July and is in the initial stages. The suit also names as defendants two medical coding consultants, consulting firm DxID of East Rochester, N.Y., and Independent Health Association, an affiliated health plan in Buffalo, N.Y. All denied wrongdoing in separate court motions filed late Wednesday to dismiss the suit.

The Justice Department has thus far declined to take over the case, but said in a June 21 court filing that “an active investigation is ongoing.”

The whistleblower suit is one of at least 18 such cases documented by KHN that accuse Medicare Advantage managed-care plans of ripping off the government by exaggerating how sick its patients were. The whistleblower cases have emerged as a primary tool for clawing back overpayments. While many of the cases are pending in courts, five have recovered a total of nearly $360 million.

“The fraudulent practices described in this complaint are a product of the belief, common among MA organizations, that the law can be violated without meaningful consequence,” Ross alleges.

Medicare Advantage plans are a privately run alternative to traditional Medicare that often offer extra benefits such as dental and vision coverage, but limit choice of medical providers. They have exploded in popularity in recent years, enrolling more than 22 million people, just over 1 in 3 of those eligible for Medicare.

Word of another whistleblower alleging Medicare Advantage billing fraud comes as the White House is pushing to expand enrollment in the plans. On Oct. 3, President Donald Trump issued an executive order that permits the plans to offer a range of new benefits to attract patients. One, for instance, is partly covering the cost of Apple Watches as an inducement.

Group Health opened for business more than seven decades ago and was among the first managed-care plans to contract with Medicare. Formed by a coalition of unions, farmers and local activists, the HMO grew from just a few hundred families to more than 600,000 patients before its members agreed to join California-based Kaiser Permanente. That happened in early 2017, and the plan is now called Kaiser Foundation Health Plan of Washington. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In an emailed statement, a Kaiser Permanente spokesperson said: “We believe that Group Health complied with the law by submitting its data in good faith, relying on the recommendations of the vendor as well as communications with the federal government, which has not intervened in the case at this time.”

Ross nods to the plan’s history, saying it has “traditionally catered to the public interest, often highlighting its efforts to support low-income patients and provide affordable, quality care.”

The insurer’s Medicare Advantage plans “have also traditionally been well regarded, receiving accolades from industry groups and Medicare itself,” according to the suit.

But Ross, who worked at Group Health for more than 14 years in jobs involving billing and coding, said that from 2008 through 2010 GHC “went from an operating income of almost $57 million to an operating loss of $60 million. Ross said the losses were “due largely to poor business decisions by company management.”

The lawsuit alleges that the insurer manipulated a Medicare billing formula known as a risk score. The formula is supposed to pay health plans higher rates for sicker patients, but Medicare estimates that overpayments triggered by inflated risk scores have cost taxpayers $30 billion over the past three years alone.

According to Ross, a GHC executive attended a meeting of the Alliance of Community Health Plans in 2011 where he heard from a colleague at Independent Health about an “exciting opportunity” to increase risk scores and revenue. The colleague said Independent Health “had made a lot of money” using its consulting company, which specializes in combing patient charts to find overlooked diseases that health plans can bill for retroactively.

In November 2011, Group Health hired the East Rochester firm DxID to review medical charts for 2010. The review resulted in $12 million in new claims, according to the suit. Under the deal, DxID took a percentage of the claims revenue it generated, which came to about $1.5 million that year, the suit says.

Ross said she and a doctor who later reviewed the charts found “systematic” problems with the firm’s coding practices. In one case, the plan billed for “major depression” in a patient described by his doctor as having an “amazingly sunny disposition.” Overall, about three-quarters of its claims for higher charges in 2010 were not justified, according to the suit. Ross estimated that the consultants submitted some $35 million in new claims to Medicare on behalf of GHC for 2010 and 2011.

In its motion to dismiss Ross’ case, GHC called the matter a “difference of opinion between her allegedly ‘conservative’ method for evaluating the underlying documentation for certain medical conditions and her perception of an ‘aggressive’ approach taken by Defendants.”

Independent Health and the DxID consultants took a similar position in their court motion, arguing that Ross “seeks to manufacture a fraud case out of an honest disagreement about the meaning and applicability of unclear, complex, and often conflicting industry-wide coding criteria.”

In a statement, Independent Health spokesman Frank Sava added: “We believe the coding policies being challenged here were lawful and proper and all parties were paid appropriately.

Whistleblowers sue on behalf of the federal government and can share in any money recovered. Typically, the cases remain under a court seal for years while the Justice Department investigates.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Source: Whistleblower alleges Medicare fraud at iconic Seattle-based health plan

New $100M fund to invest in pre-revenue medical device and digital health startups

New $100M fund to invest in pre-revenue medical device and digital health startups

Photo: Abscent84, Getty Images

Accelmed, a group of funds that invests in health tech companies, announced Monday that it is launching a new, nearly $100 million fund to invest in early-stage, pre-revenue medical devices and digital health startups in Israel and around the world.

This is the fourth fund launched by Accelmed, which currently manages more than $300 million. The new fund will be led by Dr. Irit Yaniv and Amir Blatt, both partners at Accelmed. Dr. Yaniv said that the fund will help to alleviate the problem that device entrepreneurs face in raising capital for their novel devices, in a news release. Blatt said that the fund will invest in device companies “in advanced clinical trials, nearing FDA approval, and after first-in-human trials” whereas in digital health, the fund will invest in “companies in initial commercialization stages in the US, be it with hospitals or insurers.”

The fund expects to make an average investment of $8 million to $10 million per startup, including follow-on investments.

Accelmed comprises of two entities:

  • Accelmed Partners – a U.S. -based private equity fund focused on health tech that does buyout and growth investments in commercial-stage companies.

  • Accelmed Ventures – an Israel based venture fund that invests in pre-commercialization health tech companies.

Since Aceelmed’s founding in 2009 by Dr. Uri Geiger, founder and managing partner and Mori Arkin, it has funded about 20 healthtech companies, of which several have been acquired.

These include Edge Medical Devices that was sold in 2011 to Claymount, which was then acquired by Varian Medical Systems; NLT Spine was sold to Seaspine Holdings in 2016; and MCS (Medical Compression Systems) was sold to Zimmer Biomet in 2017.

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Source: New $100M fund to invest in pre-revenue medical device and digital health startups

Analysis: Impact of CVS, Walgreens, Walmart Retail Healthcare Expansion Strategies

Analysis: Impact of CVS, Walgreens, Walmart Retail Healthcare Expansion Strategies

– Recently, Walmart, CVS, and Walgreens have all announced their intent to invest in healthcare. Placer.ai, an advanced foot traffic analytics platform, analyzed their data to take the temperature of those efforts.

– Walgreens experiences an even greater reliance on evening hour visits than CVS. Analyzing the period from January 2017 through August 2019, Walgreens saw 27.6% of visits come between the hours of 6 pm to 12 am.

– While these moves may give a tremendous amount of hope to both brands, Walmart, the king of offline retail, is a significant threat looming on the horizon. 

– The move into health services could provide a major boon for CVS, Walgreens, and Walmart, adding new revenue streams and increasing core retail metrics like visit duration and repeat visits.

One of the critical themes that will determine offline retail success in the coming years will be the capacity to maximize physical locations. That will obviously place a huge emphasis on site selections, store formats, localized approaches to store stocking and more. But an important piece of this puzzle will center around the ability to take full advantage of each space with added services. Whether it be classes in a Lululemon or a meal at a Crate & Barrel, the change is coming.

And no sector is experiencing this shift with greater force and focus than Health. In recent months, Walmart, CVS, and Walgreens have all made significant announcements regarding their intention to dive more deeply into Health services.

We dove into the data to analyze the potential impact.

The Opportunity

When CVS announced the expansion of their Health Hubs, the first place to look was the potential value of pilot sites in Texas. Unsurprisingly, the locations showed a unique ability to extend visit durations, and to bring visitors during beneficial off-peak time periods. The result is a unique combination of a new revenue source, an ability to expand classic shopping with added visits, and visits that can be scheduled for off-peak hours to maximize the full day.

So to measure success, the locations would be looking to show ‘greater than average’ visit durations and visits during off-peak hours. And this is just what the CVS pilot showed. Two of the pilot sites have shown average visit durations of 42 (red) and 41 (green) minutes respectively. This is is 22.1% higher than the nationwide average for CVS, for the period since the launch of the pilot in February 2019. Looking at the graph below shows how much more dependant the CVS nationwide average is on shorter visits.

Even more, these visit durations amounted to an increase of 7.7% and 10.8% respectively for those specific locations when comparing the period between January 2017 through January 2019, to the time since the pilot was launched.

Why The Wider Trend?

There is always the concern that this is perhaps a CVS-centric benefit that has a unique capacity to support that chain. But, in this case, it looks like Walgreens may have even more to gain. Walgreens (red) sees an even greater reliance on evening hour visits that CVS (blue). Analyzing the period from January 2017 through August 2019, Walgreens saw 27.6% of visits come between the hours of 6 pm and 12 am. While the absolute number of visits may remain stagnant, the ability to drive more morning visits could help increase earning potential.

Beware The Giant

While these moves may give a tremendous amount of hope to both brands, there is a significant threat looming on the horizon – Walmart. Walmart, the king of offline retail, is obviously involved in the trend as well with a specific focus on leveraging its massive retail footprint to get involved in health services. Analyzing the location of one of their first Walmart Health sites shows a location that is already a strong and consistent performer.

Yet, there are already indications that the plan may indeed be working. Analyzing average daily traffic for September 2018 compared with the first 17 days of September 2019 shows an increase of 7.6%. This is a dramatic difference for a brand that already boasts huge daily visitor numbers. However, all this should be taken with needed caution as Walmart spikes can be related to a variety of factors, and not just the launch of a new service. In fact, even a minimal percentage increase could provide tremendous revenue improvements because of the audience size.

Moving Into Health

The move into health services could provide a major boon for CVS, Walgreens, and Walmart, adding new revenue streams and increasing core retail metrics like visit duration and repeat visits. Yet, the move must be seen within a wider context. Offline retailers have recognized that the full value of their physical footprint is not being met and are increasingly searching for new and innovative ways to fill this gap.

The experiential shopping perspective is spreading and more brands are going to ask how to better utilize the offline investment to maximize value.

The analysis originally appeared at  https://blog.placer.ai/2019/09/26/pushing-into-health/and is re-published with permission from Placer.ai, the world’s most advanced foot traffic analytics platform.

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Source: Analysis: Impact of CVS, Walgreens, Walmart Retail Healthcare Expansion Strategies

Datica Launches New Health Data Integration Platform That Works With Any EHR, Any Data, In Any Format

Datica Launches New Health Data Integration Platform That Works With Any EHR, Any Data, In Any Format

– Datica launches new health data integration platform, Integrate that mitigates the complexity and risk of integrating and using healthcare data in the cloud.

– Integrate, is the first and only any-to-any solution that combines healthcare data integration with compliance, as well as a full set of services to ensure successful integration.

– Its HITRUST CSF Certified integration APIs also work with any EHR, any data, in any format.

Today, Datica, a provider of a complete, cloud-based platform that mitigates the complexity and risk of integrating and using healthcare data in the cloud, has launched a new health data integration platform. The solution, Integrate, is the first and only any-to-any solution that combines healthcare data integration with compliance, as well as a full set of services to ensure successful integration. Its HITRUST CSF Certified integration APIs also work with any EHR, any data, in any format. Integrate results in the most complete and scalable solution for those who collect, store, manage and share protected health information (PHI) in the cloud.

Activate Your Digital Health Product with Health Data In Any Format

Integrate
brings together two industry-leading solutions, Datica’s
Compliant Managed Integration and Emissary, into a single advanced solution as
a result of the recent merger between Datica Health,
Inc. and Sansoro Health, Inc. Datica Integrate is a proven application
programming interface (API) solution that allows health data to be exchanged
across any EHR platform – while ensuring compliance and the utmost security for
PHI. Modern times call for modern measures. Datica Integrate allows you to
focus on your product – not on the integration.

Within
days, you are up and running with comprehensive APIs that work across EHRs. Datica
Integrate is also a fully compliant application package that alleviates the
hardships of working with standards-based interoperability, such as HL7v2 or
FHIR.

The Bigger Picture

Healthcare’s adoption of the cloud is on the rise, which has
resulted in an increased need to use patient data to power the next wave of
innovative healthcare applications. However, the complexity of healthcare data
exchange and compliance has created significant hurdles to bringing advanced
digital health solutions to market. Datica Integrate now offers a complete solution
to solve the complexities of both healthcare data interoperability and
compliance, helping to streamline the development and management of
HIPAA-compliant, cloud-based digital health solutions. As a result, previously
cumbersome development processes become frictionless, resulting in enhanced,
secure solutions at lower cost and with greater speed to market.

“Developing healthcare applications in the cloud means overcoming key obstacles like compliance and integration—a big challenge for innovation teams that often prevents them from creating the breakthrough solutions healthcare needs,” said Dave Levin, MD, Chief Medical Officer at Datica. “Integrate removes the stress, risk and complexity of EHR integrations—without sacrificing PHI security—so our customers can focus on delivering exceptional solutions to today’s healthcare challenges.”

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Source: Datica Launches New Health Data Integration Platform That Works With Any EHR, Any Data, In Any Format