UPDATE: New Internet Explorer 6 and 7 security weakness found. Forward this to your IT department if you are battling to get them to upgrade. IE zero-day flaw leaks out from zdnet.

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One of the most daunting choices for a physician in private practice has been whether or not to adopt an EMR (electronic medical record) system--aside from the high cost, which one of many to choose?  For the choice part, Montefiore Medical Center in the Bronx, NY, which has had EMRs for 10 years, is holding a series of day-long 'learning labs' with four pre-screened EMR systems, with reps to walk physicians through the software.  For the funding, there are Federal subsidies available starting next year (and not dependent on the 'healthcare reform bill'), but the cost is still considerable. Hopefully other hospitals will follow this lead.  Release (PDF).

Observations of daily living (ODLs), which in a more limited form called ADLs (activities of daily living) moved telecare from the pendant to sensor-based behavioral telemonitoring, may be making a comeback.  The Princeton, NJ based Robert Wood Johnson Foundation is funding five studies that are centered around gathering information – such as diet, exercise, sleep patterns, medication usage and pain – from the flow of people’s lives, with the objective of seeing how this data can be collected, interpreted and used in clinical settings.  The studies will use smartphones and sensors to monitor obesity and depression, Crohn's disease, low birth weight infants, asthma and depression and seniors with arthritis at risk for cognitive decline.  San Francisco Business Times.

As of January 2010, medical, health and fitness applications for the iPhone topped 6000 (1700 of which are medical), and downloaded by over 1 million users.  New apps introduced in December 2009 topped 1000, double or more versus the prior three months.  Leading the field are disease management, medication tracking, drug recalls, health cost and record management.  Pharmaceutical is relatively new, and Android apps have just started to be developed.  Healthcare marketers now have another tool in the box--but they also have to watch an entirely new competitive space.  FierceMobileHealthcare article.  V-Fluence blog. 

Two items from Gizmag, only connected by the fact that they point to interesting future possibilities for telecare and telehealth devices.

Microrings (very high speed wireless transmission over short distances)

Skinput (turns your hand into a touchscreen and your fingers into a keypad)

Hot on the heels of other criticism of the NHS's commissioning competency, is a survey by Healthcare Republic that three-quarters of general practitioners (who responded to their survey) have little confidence in their local primary care trust managers.

Telecare Soapbox: NHS procurement - bad news and good news for suppliers

Chicago, 19 March 2010

• Boomers were born between 1946 and 1964
• 77 million baby boomers represent 28% of the US population and account for 77% of all financial assets
• Every 7 seconds someone is turning 50
• By 2010, 108 million people will be over 45
• Households headed by someone 40 or older hold 91% of America’s net worth
• Boomers constitute 35% to 38% of Internet users
• The caregiving marketplace is $800 billion

Event website.

UPDATE: Donna Cusano will be moderating Ask the Analyst #4 at 8:20am on March 19. Her panel includes Liz Boehm, Principal Analyst of Forrester Research and Greg O'Neill, Director of the National Academy on an Aging Society.

O2 UK has appointed Keith Nurcombe, a former executive at pharmaceutical giant GlaxoSmithKline, to head a new mobile healthcare division. Report in Rethink Wireless.

I don't often make predictions, but I will here. I predict that we shall see Mr Nurcombe popping up at Continua Alliance events and expounding on 'ecosystems' and the wonderful future ahead and, at the same time, he will have one of the most frustrating years of his life. Large network providers suffer the same problems as large 'box shifting' companies in this field. With the pressure to grow their core business, whether it is broadband or kit, they cannot get close enough to nurses and medics to tune in to their real needs, to talk their language and to handhold them down the path of telehealth adoption. Steve

UPDATE: In this context, the following item is worth reading Build it and They Will Telemed? by Vincent Salvo. To give you a flavour: "In the healthcare device and software industry, the mantra: build it and they will come doesn’t work. It hasn’t worked since Noah built an ark or the movie Field of Dreams was made. Ignoring the user experience is what’s wrong with the healthcare experience and begs for innovation."

Essentially the same presentation as his week-earlier keynote at last October's Connected Health Symposium (see this editor's report here), but you can now see this important presentation for yourself:  from ePatient Connections, Jason Hwang, M.D. on disruptive innovations in healthcare decentralizing care, and the historical futility of cramming new technology into old business models.  Dr. Hwang is Executive Director of the Innosight Institute and co-author of The Innovator's Prescription: A Disruptive Solution for Health Care, with Professor Clayton M. Christensen and the late Jerome H. Grossman.  Thanks to Paul Sonnier of CommNexus (San Diego) for bringing this to our attention (and Kru Research for posting on their site).

You can buy the book (GBP £):

You can buy the book (USD $):

A more-than-likely final wrapup of HIMSS and the week's activity relevant to our area, mainly from Mobihealthnews:

• HIMSS unplugs, embraces mobile:  Sprint CEO Dan Hesse's keynote overview of mobile opportunities, 4G, WiMAX and M2M in the transformative lead (FierceMobileHealthcare), 4G being able to send images at 'Blu-ray quality' and video;  Allscripts considering adding Android to their EHR app already on iPhone and BlackBerry.
• Epocrates' mobile EHR--Brian Dolan interview with Geoff Rutledge, Chief Medical Officer and EVP of Product Development and Bob Quinn, Chief Technical Officer and SVP of Engineering.  Tight integration with their drug reference application, teaming with practice manager partner (to be announced), targeting solo and small group practices (versus competition) with pricing at affordable monthly rates, and  how they negotiated differences in delivery between the desktop and mobile version.
• "Views at variance' between Panasonic and Motion Computing.  Panasonic announced its Toughbook C1 convertible tablet for the healthcare user which can survive a 30" drop--a very cool triple hinged screen, multi-touch screen for stylus and finger pads along with a keyboard;  Motion Computing is sticking to the tablet as a tool format and away from traditional keyboards.  Many comments on the iPad, agreement it's moving 'beyond the keyboard' but currently has substantial shortcomings.
• Nuvon announcing their IDM-MG 1000, a mobile and portable solution to collect and present critical biomedical device data.  Their VEGA platform is designed to capture, display, and transmit real-time data at the point of care. [Nothing to do with the Vega bracelet]
  
• VeriWave targeting the surely beleaguered HIT exec with the Mobile Healthcare Test Suite for testing WiFi in healthcare facilities.
• Aetna finally gets 'On-The-Go' for smartphones and desktops on the road, a full 21 months after its announcement in Mobihealthnews. This will also include an iPhone and BlackBerry app allowing GPS location of plan physicians from the current location with turn-by-turn directions, an electronic ID card (interesting, but most offices copy said card) and more. (Android, where art thou?)  Aetna is piloting an app for their commercial membership:  a text-based alcohol risk assessment to determine a member’s risk for problem drinking tied into the company's EAP (Employee Assistance Plan).  Why any actual problem drinker would want this information anywhere near the hands of the employer is a puzzle, though.

Minus the WSJ snark, MarketWatch reviews various wireless health initiatives and pilots and finds them nearly ready for consumer prime time, with the usual caveats:  the promise of cost savings and hurdles of insurance payment and provider reimbursement stall adoption.  The proof of effectiveness is accumulating, but is wireless health at a tipping point for consumers, insurers and the Feds?  Highlights:

• MedApps/Microsoft/Cleveland Clinic:  this long-term (3 months to over one year) test of over 250 patients, evenly divided between mobile and non-wireless vitals reporting, is finding improvement in control of chronic conditions--diabetics and hypertensives increased the number of days between physician visits by 71% and 26% respectively.  The dramatic study of the hypertensive long-distance truck driver who uses MedApps for monitoring that leads the article is a great example of the portability of M2M systems.
• Another trial of 300 patients by CardioNet of their MCOT (Mobile Cardiac Outpatient Telemetry) that uses small sensors and a transmitter to monitor during everyday living, reported that MCOT is three times more effective than prior technologies in detecting cardiac arrhythmias.  [See Telecare Aware 20 Jan 2009]
• Jitterbug developing simple 'out of the box' applications such as LiveNurse and Samsung/American Heart Association's text message tips.
• Dr. Eric Topol of the West Wireless Health Institute predicting a wristband that will send all your vital signs continuously to your phone (but who will be looking at them?)

The headline may be doomy-gloomy to grab attention, and it does, but perhaps not in the way intended.  An interview with Dr. Mohit Kaushal, director of health care for the FCC’s Broadband Strategy Initiative in the interestingly named GigaOM, jumps off from the Intel/Mayo Clinic/GE study into broadband, telehealth and telemedicine.  While Dr. Kaushal projects a possible $700 billion in savings via 'e-care' over the next 15-20 years, blame is put on the usual culprits:  'failure on the part of doctors to use the technology and on the part of Medicare and other government-sponsored health programs to pay for health outcomes rather than procedures' plus less broadband access in rural areas (which is why you see satellite dishes by most homes).  Yet three paragraphs down now it is made clear that the FCC and FDA will be in the future jointly regulating home health and mobile health devices.  Recommendations, 'setting frameworks, 'taxonomy of terms such as e-health, telemedicine, telehealth and e-care'--just like 'conversation'--it all makes this editor's [Donna] teeth hurt.  Article

Our link here is to the US Department of Veterans Affairs' vendor presolicitation notice for 'Home Telehealth Devices and Services,' for the 38,000 patients enrolled in the Home Telemedicine program, which will grow by an additional 32,000 patients by the year 2011.  Up to six vendors covering eleven listed items including digital image capture, IVR software, messaging and video are requested.

Express Scripts, the major pharmacy benefit manager, is nationally testing the Vitality GlowCaps medication reminder system, with a small test in April and a larger test this summer with patients using cholesterol, diabetes, high blood pressure and heart failure drugs.  Their objective is to see not only if GlowCaps improves compliance, but also learning how and why patients take—or fail to take—medication based on the information that GlowCaps records and also via a telephone reminder and interactive menu that prompts for feedback on side effects and if the patient has run out.  There's a bit of snark in the article (the caps lights and 'arpeggios' are 'insistent' and 'annoying') but a few of the comments on the website are even more so.  (Who knew that these were 'big brother' in pill bottle form?).  'Beep! It's your medicine nagging you'--Wall Street Journal

The (UK) Times Online Health goes a bit over the top with the lead (smartphones are a long way from being a 'doctor in your pocket') and subhead ('Will we all become iPho-chondriacs?'), but otherwise it's a lively, current consumer-oriented overview of how diverse, powerful and versatile applications, programs and online resources have become for mobile health.  Plenty of real world examples from the sublime (Zoll Medical's Pocket CPR, WaveSense's Diabetes Manager, the first aid information online that saved a trapped and injured Haiti quake victim) to the ridiculous (Acneapp, which uses phone light to kill bacteria).  It's also a decent business article highlighting developing technology (Gentag's wearable sensors, Proteus Biomedical's chip pills)--'a market worth billions' to Michael Reilly of Orange, an outcome devoutly to be wished.   Why your phone is now the doctor in your pocket

This is crucial for any suppliers (including consultancies) that wish to be in the UK market and there is an end-of-month deadline. It's also very interesting for the rest of us.

NHS PASA is dead, long live Buying Solutions! Or not, depending on your point of view. What's happening? This new arm of the UK Government is breathing life into the legacy of the NHS PASA National Telecare Framework Agreement (NFA) that came into effect in June 2006. To recap, the intention of the NFA was a) to speed up telecare procurement for NHS organisations and local councils and b) to save money for them by negotiating savings on prices. Again, depending on your experience, it was either...

Download the PDF version of the eNewsletter here. (4.4Mb)

Cisco formally debuted its HealthPresence telemedicine platform at HIMSS on Monday.  It's a combination of video teleconferencing and telehealth devices in an 'remote office' setting that is very high quality and interactive for patient and doctor/clinician.  The system has been in test here in the US and internationally for some time (Molina Healthcare California, Argentina--Telecare Aware 20 Jan) but beginning March 2010 it will be available in the US, Canada and Europe. The release (a very long slog) also included that it is a FDA Class I medical device.

The HIMSS (Healthcare Information and Management Systems Society) meeting this week in Atlanta has plenty of news on mobile health, which Mobihealthnews is covering onsite.  Highlights:

• One-stop RIM BlackBerry solution shopping:  despite the iPhone hype, still the most common smartphone in use for business including healthcare.  New apps announced were from Voalté for Voalté One (text/voice/critical care alarms)--Wallace Wireless and Vocera are also demonstrating their systems in the BlackBerry booth.  Article
• Epocrates will launch its own “mobile and Web-based” EHR (electronic health records) solution this fall (autumn), targeting small and solo practices, which will include its innovative drug and safety content information.  No real announcement on their website, but a 'sign up for info' page. Article
• Google Health partnerships:  Surescripts, an e-prescribing network in the US; Withings for its WiFi Body Scale, which now allows Google Health users to seamlessly update their weight.  Article
• Nuance is demonstrating four voice-enabled mobile solutions for smartphones for dictation and documentation.

It's about time Philips was getting some traction with Motiva, and a study with heart patients undertaken by the Catalonian Health Service may help it along. The preliminary data shows that patients who participated on the study showed an improvement in their perception of their quality of life and hospitalisations were reduced 68% during the one-year period of the study. More information from eHealthNews Europe.

[Another take on this story on Laurie Orlov's blog]

We know what Tunstall was thinking when it started pushing the term 'telehealthcare' - it needed to reposition itself from being the dominant UK telecare alarm system provider to get in on the fledgling telehealth market, and this was a convenient way to form a bridge from one to the other.

But what on earth are councils doing adopting the term? Specifically:

• Moray Council
• North Yorkshire County Council
• Reading Borough Council
• Southampton City Council

• Birmingham PCTs
• Coventry
• Dudley
• Hereford and Worcester
• North Staffordshire
• Sandwell
• Shropshire County
• Solihull
• South Staffordshire
• Stoke-on-Trent
• Telford & Wrekin
• Walsall
• Warwickshire
• Wolverhampton