NHS Choices Apps Library

If you Google ‘NHS Apps Library’ the early results that come back after those to the library itself are predominantly from US publications. Perhaps we in the UK under-appreciate the potential benefits. The reason I mention this is that while TTA has given the Apps Library a couple of passing mentions during the past month or two, we have not – as one sharp eyed reader pointed out – given it the attention it deserves. So, by way of amends, here are some relevant links:

Mysteriously, the 12 apps recommended in the following enthusiastic US article: UK NHS launches 12 patient decision support apps do not seem to be listed in the library. Perhaps the author mistakes the BMJ for the NHS, or perhaps they are published or endorsed by a different part of the NHS…

I’ll be happy to take recommendations for links to good articles on the Library. Ed. Steve.

Who’s exhibiting at ATA?

More from the American Telemedicine Association conference, by James Barlow.

A tour of the cavernous exhibition hall at the Austin Convention Center and a rigorous back of envelope analysis of the catalogue reveals where the corporate action is: of the 229 or so exhibitors, the runaway top health condition targeted by companies is (surprisingly?) mental health, with 34 exhibitors. Cardiology, diabetes and the other conditions forming the basis of remote care trials around the world all make an appearance, along with other familiar tele-applications.

The 2013 Exhibitors League Table:
Mental health and telepsychiatry (34 exhibitors)
Telecardiology (16)
Telestroke (16)
Paediatric telehealth (16)
Diabetes management (15)
Teleneurology (14)
Teledermatology (10)
Telerehabilitation (6)
Telehospice / palliative care (4)
Oncology (3)
Teledentistry (3)
‘Infectious disease management’ (2)

And by application? Home healthcare (63 exhibitors) beats mHealth (49) – well served with its own conference circuit – with ‘remote monitoring'(48) and ‘videoconferencing’ (36) hot on their heels.

Other reports by James Barlow.

Telemedicine advances in Latin America

Some welcome news out of the ATA 2013 meeting are the advances that telemedicine is making in Latin America and the Caribbean. Honored at ATA’s Sunday session were Jennifer Lopez and her eponymous family foundation for funding telemedicine outreach in Puerto Rico and Panama via the Children’s Hospital of Los Angeles (CHLA). In Puerto Rico, the work is concentrating on pediatrics genetics, and a monthly clinic that counsels four families per session. In Panama, the emphasis is on extending pediatric care beyond Panama City to the low-serve country areas through Panama City’s three major hospitals. The point is that the Lopez Family Foundation is only the start in the region, and that other healthcare providers and funding entities should be joining in kicking off development (Telefónica should be noting) HealthcareITNews

HealthSpot, Netsmart ally for telemedicine kiosks

HealthSpot, which debuted its staffed telemedicine/telehealth Stations at CES 2013 (and this Editor previewed at CES New York in November), is partnering with behavioral health EHR/practice/clinical case management software provider Netsmart to add that capability to its kiosk consults. Announced at ATA yesterday, the MedCityNews article is sketchy on exactly how this will be integrated–will it be an option or will select kiosks be dedicated to behavioral health only–but this is likely a first for telementalhealth (another term in our lexicon!) Kiosk placements can be especially useful in rural areas which have a paucity of mental health/psychiatric providers (see TTA on Forefront TeleCare’s ATA announcement). It also follows this year’s ATA theme of telemedicine to more effectively serve rural US areas. HealthSpot also announced a pilot with Nationwide Children’s Hospital in its hometown of Columbus, Ohio; their CEO claims it has orders for 150 units in hand for its now three health system partners. Surprisingly, as of April they are already at Series C funding with a $10.4 million financing (of a $20 million offering) from giant Cardinal Health and other private investors.

The etiquette guide to Google Glass

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]Lo and behold, we are already anticipating the effects that Google Glass will have on our everyday social interactions! And the view is a bit jaundiced. The Wall Street Journal this weekend catalogued in a most amusing article all the ways wearers could offend, accompanied by 1890s-vintage illustrations (modified) of said gaffes, and what courtesies wearers should exercise whilst wearing in public:


  • Always remember: You have a camera on your head (so easy to forget)
  • Use voice commands only when you need to
  • Don’t use Google Glass to make phone calls in public (what then, pray tell, is the point?)
  • Give it a rest sometimes
  • Don’t be creepy (a tall order)
  • Let people try it on

Unfortunately, the writer reminded the Eye of the unfortunate time around 2004-6 when Bluetooth earleechespieces became the rage among Masters of the Universe and office tech nerds–the item you most wanted to rip off said ears and stomp sans merci into the ground, which fortunately dimmed its popularity. Of course, the article includes a Gallery of Previous Offenders just to show we naysayers how wrong we will be, how benign this all is….

Oh, but not so fast! Jason Perlow in ZDNet’s TechBroiler considers Glass as Cybernetic Headband, or Cyband, that in current design it is flawed in being too much in one device–and a massive security risk. Not much of a leap, because the ‘Explorer’ version has already been jailbroken, opening all sorts of nasty possibilities for stealthy surveillance by sociopaths. It’s Alice through the ‘Evil Glass’. Mr. Perlow also has a torturous view of the future, when we are Beyond Google Glass: 2034 into full-blown Augmented Reality implants. A dystopia that makes one scream. The Eye is now checking residency requirements and travel itineraries (boat and seaplane only) to the remotest parts of New Zealand or Tulabonga… [Editor Donna: We ask our readers to help keep The Gimlet Eye in civilization. Please help the Eye see that GG is not all bad! Your comments please!]

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/05/surveillance-ban.jpg” thumb_width=”150″ /]Update: And the revolt continues with locations from Vegas casinos to Seattle dive bars telling GG that they are No Wearing Zones–but the NY Times article spends 20 percent of its space on a long-dead Twitter/photo controversy. More to dine on about the jailbreak plus, courtesy of the worthy anti-GG blog Stop The Cyborgs and Jay Freeman’s blog Saurik. (Photo courtesy of Stop the Cyborgs)

Previously in TTA: The Gimlet Eye weighs The amazing lightness of Google’s Being There vs The Private Eye, and storms the barricades with The revolt against Google Glass

Qualcomm Life ‘circles’ to care coordination

Qualcomm Life, which to date has been more involved in device connectivity, interoperability and data management through its 2net Platform, has acquired care coordination platform HealthyCircles. Announced at ATA2013, the HealthyCircles service-as-a-software adds a front end to 2net’s biometric data that will aid in post-discharge and chronic care management from the hospital to home care providers to family caregivers. Qualcomm is clearly going after  the hospital ACO (accountable care organization) market in areas such as reductions in 30-day same cause readmissions; the fit with WebMD in integrating 2net biometric data with the former’s reference information, as announced at mHIMSS, is a little less apparent [TTA 5 March]. MedCityNews, HealthcareITNews, Qualcomm’s (jargon-laden, nearly unreadable) release.

Reducing dementia patient anti-psychotic drug usage via telemedicine

A largely hidden problem in US skilled nursing facilities (SNFs) has been the inappropriate and over-use of multiple psychotropic drugs in dementia patients. A two-year old telemedicine (telepsychiatry) company, Forefront TeleCare, is targeting SNFs and clinics in rural counties across 18 states. Rural areas have sparse behavioral health coverage; medications to mitigate the effects of dementia and other mental illnesses are often prescribed by non-psychiatrists who have a limited knowledge of their effects over time, particularly in older adults. Forefront’s virtual consults weekly can keep track of these patients and reduce, adjust or update their medications. Video (from ATA). MedCityNews.

Microgripping and touching robots

Need that tissue sample, doctor? You may be laying aside your scalpel and forceps for a swarm of microgripping robots that you place and retrieve.  David H. Gracias, PhD. and his Johns Hopkins team has developed star-shaped nickel metal discs of only 300 micrometers in size which snip bits of tissue. Using a magnetic catheter, the microgrippers are then gathered and removed–hopefully. Gizmag; study in Gastroenterology.

Last week, the TakkTile, this week, piezotronic transistors. Thousands of them arrayed, and designed to give robots–and touchscreens–that extra and almost human edge in touch sensitivity. The transistors in thin, flat material can sense changes in their own polarity when pressure is applied due to their zinc oxide composition. Initial use will probably be in touchscreens, but the Georgia Tech project’s supporters–the Defense Advanced Research Projects Agency (DARPA), the National Science Foundation (NSF), the US Air Force (USAF), the Department of Energy (DOE), and the Knowledge Innovation Program of the Chinese Academy of Sciences–are also considering its use in prosthetic skin or limbs. Gizmag.

Where the real remote care innovations are

Another report by James Barlow from the ATA Conference.

More evidence that the really innovative thinking in the remote care world is coming from lower income countries. Dr Sikder Zakir from the Telemedicine Reference Centre (TRC – www.trclcare.com) in Bangladesh reported on the use of mHealth to improve access to underserved populations. Usually this would involve telemedicine – in its m- or non-mHealth guises – bringing healthcare to remotely located rural populations. Bangladesh is no exception, with 40,000 doctors and 25,000 nurses for 160 million people. But as is only too obvious to anyone who has been to countries in the Gulf there is a huge population of migrant workers living there. The 5 million expats from Bangladesh have 20 million dependents back home dependent on remittances, but neither side is well served for healthcare. The TRC is using mHealth to provide expats with access to doctors in Bangladesh via SMS messaging and voice calls, and extends the service – free – to up to five of their family members. Funding is via a $3 a month subscription paid via the migrant worker’s mobile phone network. The scheme is being tried out with 80,000 migrant workers in Singapore, before moving to Saudi Arabia and the UAE.

We also heard from Dr Zakir about AMCARE (www.amcare24.com), an example of mHealth being used to extend diabetes care from hospitals to villages. This uses microinsurance payments (50 US cents / month) to cover the costs, a business model that is now gathering momentum in developing countries’ health systems.

Other reports by James Barlow.

Avatars to help close the doctor-patient communication gap?

An interesting concept and some interesting stats lurk under the pedestrian title of an article by Willie D Jones in the biomedical section of IEEE Spectrum’s risk analysis blog: Can Avatars Help Close the Doctor-Patient Communication Gap? The idea is that an electronic entity that can be interrogated by a patient and which has access to his or her electronic health record could act as a non-threatening intermediary between doctors and their patients…’someone’ who can be asked those stupid questions one might feel to powerless to ask the doctor in person. Heads-up thanks to Toni Bunting.

Plus ça change – this appears to be a modern take on the centuries-old Chinese practice for women to use small statuettes called ‘doctor’s models‘ to indicate to the doctor what was ailing them when face-to-face contact was embarrassing. (Although experts at Christie’s now believe these figures had a ‘more erotic intention’.)

NHS telemedicine system for strokes hailed a success

A few weeks late in the posting, but relevant to the telemedicine collaboration issues raised by Professor James Barlow’s report from the ATA 2013: Over the last 18 months a telemedicine system set up to help stroke patients by the NHS Cumbria & Lancashire Cardiac and Stroke Network (CSNLC) has provided 24-hour access to thrombolysis treatment from remote specialists. The telestroke network serves eight hospitals that serve a population of 2.2 million. NHS telemedicine system for strokes hailed as a success (ComputerWorld) Heads-up thanks to Alistair Hodgson.

Surgical telemonitoring – the next milestone for telemedicine?

The first in a series of real-time reports from American Telemedicine Association annual conference in Austin, Texas, by James Barlow, Imperial College London.

The ATA conference has just included an interesting session on surgery as the next milestone for telemedicine. While telesurgey has long been an area of interest in remote care, pressures in the health system and developments in technology are combining to create new opportunities for supporting surgeons in their work. But many of the familiar implementation challenges are also looming large. So what were the reflections from the panel and discussion?

The consensus was that we need to shift the state of the art in operating room practices from considering volume and quality to broader notions of ‘value’ embracing cost, quality and access. Hospitals will be increasingly rewarded on outcomes and patient satisfaction, and telesurgery potentially helps improve both.

Two kinds of broad telesurgery model are envisaged – the expert surgeon ‘broadcast’ their operations to a wide audience and a more 1:1 relationship where the expert is remotely located and provides support for a specific operation. The ‘new telesurgery’ will involve three things.

  1. Just phoning another surgeon for advice in the middle of an operation is no longer good enough. There will be much more collaboration between surgeons, using new collaborative tools for bringing people together at a distance. The possibility of virtual environments around the operating room is already here and should be widely embraced.
  2. Large peer-supported integrated surgery networks will emerge with surgeons paid for the time they spend providing advice or moderating discussions. Spending 10% of your time mentoring other surgeons – perhaps around the world – will become part of the norm.
  3. A pool of recognised expert mentors will develop. Mentors can be ‘in the room’ virtually during the procedure. Or they can be invited to participate in situations where there is an ‘index case’ – a rarely encountered procedure – where the pool of knowledge is spread thinly.

All this is going to clash with the inherent conservatism of surgeons and their unwillingness to change tried and trusted approaches and technologies. The big challenges for moving forward in telesurgery are:

  1. ‘Network effects’ need to kick in – there has to be a critical mass of users and installed technology to generate the biggest benefits.
  2. Inevitably there are incompatibilities in technical standards for data transfer.
  3. The focus so far has been on audio and video, but integrating patient data into telesurgery and back into patient record systems is also essential.
  4. Tools for virtual collaboration are rapidly developing, allowing crystal clear video, remote access to laparoscopic images, virtual laser pointers, and doing all this on tablets. These need to be made widely available.
  5. Reimbursement and business models – who pays for what? Can we find ways of reimbursing hospitals / surgeons providing experts? How do we schedule expert mentor time and build this into their contracts?
  6. Medico-legal. There are cross border (or cross state issues here in the US) licensing issues and big problems of responsibilities in the event of problems arising in a telesurgery procedure.

Other reports by James Barlow.

Northamptonshire NHS contracts for video consultation service (UK)

The Saypage Telehealth Platform looks like an interesting addition to the number of companies providing video conferencing services to health services in the UK but the company’s announcement would get a warmer welcome from us if were not for its classic hype-it-up press release. Just because one NHS Trust has contracted for the service does not justify the implied claim that the whole NHS is rolling it out. NHS Launches Online Video Consultations Service Using Saypage Telehealth Platform. The lesson for all suppliers is to keep it real if you do not want to undermine readers’ respect.

Wales: telehealth research participants sought

The Institute of Rural Health and Aberdeen University are to research the effect of technology on patients interactions with their home carers, and are seeking input from patients using telehealth in the Powys and Betsi Cadwaladr health board areas. Recruitment is open until the end of June and seeks patients aged 60-79 years, who are visited by a nurse or other professional carer at least once a week and are using some sort of telehealth technology to help them to manage chronic pain or another medical condition. ‘Technology’ might include the use of internet forums, phone ‘apps’, or Skype links to carers. For further information please contact Sophie Corbett at the IRH on 01686 629480. (Info via Dispensing Doctors’ Association)