Connecting mental health specialists with rural community health providers (US)

A cheering development out of New Mexico is that the GE Foundation is granting $4.6 million to the University of New Mexico Health Sciences Center in Albuquerque to expand its Project ECHO (Extension for Community Healthcare Outcomes) to increase mental health expertise delivered by eight selected community health centers. In this mainly rural state, there is nearly nil access to mental health and addiction services in many areas. This model of telemedicine consults between specialists and primary care providers in these centers started with treatment for hepatitis C. Unfortunately, the telemedicine consults do not extend directly to the patient. Project Expands Reach of Mental Health Providers  Hat tip to reader Ellen Fink-Samnick of Ellen’s Ethical Lens.

Innovation in large healthcare organizations: set up to fail?

Are innovation-oriented internal groups or subsidiaries, designed to reinvent their large healthcare provider parents, doomed to fail? Dave Chase of Avado writing in Forbes seems to think that is the truth more often than not. “The challenge is it’s hard for a big company to take seriously a new market segment when its initial revenue impact is a tiny fraction of their existing business”. The metrics of success may not be recognized or validated, lunch is eaten by stealthy competitors, and new models/behaviors stump managements used to the old ways of what constituted success and profit. His own experience was at Microsoft, where he observed the success of Xbox (fresh blood unshackled from MSLand) contrasting with MSN, the latter processed and staffed largely by Office/Windows veterans.  In this Editor’s experience, the only part that Mr. Chase has missed is the high resistance, often personally driven, of process-oriented, bureaucratic organizations to meet outside or inside change which dooms high-minded efforts at setting up ‘skunk works’. Health orgs dooming their “innovation” to failure (Please note Editor’s comment under article is ‘called-out’)

The ‘Wild West’ of 40,000 mobile apps

Following up on our 11 June article that took a stern, fingerwagging view of these 40,000 unvetted apps out there on the prairie, MedCityNews looks at them and finds good news. Healthy lifestyle helper apps plus a health coach can produce positive results–and we’ve covered those like AliveCor and WellDoc which turn a smartphone into a medical device and are regulated by the FDA. The problem remains that there’s no vetting of apps of either type to confirm for the user that they are effective. Happtique is still cited as a app curator for consumers and doctors, when by all reports they have changed direction [TTA 17 May]. 40,000 health-related apps and no easy way to know which ones work

And while we are on the subject of FDA, now they are dealing with the strong possibility of cyberattacks on the data and systems of the very medical devices they are regulating. In a 13 June communication to manufacturers and providers, “Many medical devices contain configurable embedded computer systems that can be vulnerable to cybersecurity breaches”–the introduction of malware or unauthorized access to configuration settings–made worse by internet, mobile access and the infamous cloud. Government Health IT

Beyond the bracelet; the coming ubiquity of sensor-equipped wearables

Wearables are developing into the next big thing in the health tech/monitoring area, and developing beyond the bracelet form factor represented by Jawbone UP, Fitbit and Nike Fuelband. Misfit Shine of course has been touted as the major future player, but has experienced a few bumps on the road to Damascus, taking a technically-caused delay to their bracelet/pendant sensor debut now mid-July and not being compatible with Android [TTA 30 May]. But they have also entered the clothing fray with a trademark filing, according to Mobihealthnews. This article also spotlights wearables makers Zephyr, OMsignal (compression shirts); Heapsylon Sensoria socks. This Editor will be seeing and reviewing wearables such as Basis at CEWeek’s FashionWare, sponsored by Living in Digital Times, next week. Disclosure: TTA is a media partner of the Digital Health Summit, also produced by Living in Digital Times.

Button TrackR: Object and people finding with an added extra

There are a number of small phone app-based tracking devices in development but stick-on Button TrackR has an extra something. The phones of other people running the app can pick up the signal and flag the location to a server if the object (or person) is out of range of the owner’s device. The developers’ modest crowdfunding target of $15,000 has been wildly exceeded. It’s publicity that money can’t buy. Button TrackR adds crowd sourced tracking to search for lost objects (Gizmag)

Health 2.0 MatchPoint|East

New York City, NY Times Building, Tuesday 25 June

Also for the NY metro area on the day before the main CEWeek activities is Health 2.0’s MatchPoint|East, a half-day conference with speakers and workshops led by health tech innovators. Topics range from funding (angel, accelerator, crowdfunding), building your IP portfolio and partnerships/collaborations. Agenda here and registration here (a very reasonable $49.00 including closing reception.) This Editor will be attending and reporting. Follow Twitter on @health2con.

mHealth reality: Complicated (Uganda)

Do we detect a slight air of surprise in the comment of Pia Rafller, one of the authors of a report by Yale University’s department of Political Science that “The findings do show that the reality is more complicated than at times we like to think, that information can have a different impact on different types of people”? The report was on an mHealth project designed by Google and the Grameen Foundation’s AppLab which allowed users in 60 central Ugandan villages to text questions on sexual and reproductive health to a server and receive pre-prepared responses from a database. The expectation was that the information would lead to a reduction of risky behaviour but it had some unintended consequences… Ugandan mHealth initiative increases ‘promiscuity’ IRIN Africa.

Semi-related item: Let’s hope that Orange Botswana takes note of the Ugandan experience: Orange Roll Out Telemedicine

Digital Health Summit @ CEWeek adds speakers

If you are in the New York area or can get there on 26 June, you should be attending the Digital Health Summit at CEWeek. There is a definite ‘made in NY’ focus with local healthcare technology companies increasingly being backed by investors [TTA 14 May MIT Forum conference report]. Topics include ‘five technologies we’re betting your health on’, sports and fitness devices and apps, sensors in a wide variety of clothing and other applications, and pharma in the age of digital. Companies include Aetna/Healthagen, Etymotic (quiet sound amplification), Medivizor (personalized e-patient content), SecuraTrac (mPERS), GreatCall and Qardio (vital signs sensors). This Editor will be attending CEWeek exhibits and events, including the DHS, next week; watch this space for a report. For more information, click the sidebar advert.

Disclosure: TTA is a media partner of the Digital Health Summit.  

Supra goes Wonka – update (UK)

UPDATE 20 June 2013: SupraUK has announced that Surrey Heath Borough Council has found the first of the eight Golden Keys in the 18th Birthday Competition (details below). Now they have to start planning a community project to fund.

ORIGINAL posted 12 June: To celebrate its 18th birthday, UK key safe supplier SupraUK is running a Willy Wonka theme-based competition. Eight of its customers will find a golden key in a delivery. Those eight can propose £18,000 projects to improve their community. Once all eight proposals are in, the public will vote for the project that they think deserves the £18,000. The winner will be the project with the most public votes and will be announced at a Willy Wonka themed birthday celebration in November. Sounds like a ‘win, win, win’ to us! Competition website, main SupraUK site.

Staying up at night with telemedicine (and telehealth)

Our readers have many things which keep them up at night, including that extra taco, but René Quashie of leading healthcare/life sciences law firm Epstein Becker Green adds a few more to the list. While muddling telemedicine (remote consults) with telehealth (vital signs tracking and monitoring), he outlines the legal pitfalls (and consequences) that both are facing: non-compliance with state prescribing and licensure laws (physical examination requirements); lack of highly developed protocols and guidelines (liability exposure); lack of greater coverage and reimbursement by payers (low credibility=low/no pay); HIPAA compliance in privacy and security (lack of protection against unauthorized data access). However, how many of these have already experienced accomodation by state regulators, or have started to modify to follow regulations?  Awake yet? This is only Part 1. Things That Should Keep the Telehealth Community Awake at Night (Part 1) (TechHealth Perspectives/EBG blog) Hat tip to reader Ellen Fink-Samnick of Ellen’s Ethical Lens.

VA networks breached from overseas; 20 million records affected (US)

Department of Veterans Affairs IT systems have been breached since 2010 by eight ‘nation-state-sponsored organizations’, affecting records of 20 million veterans, according to recent testimony in hearings held earlier this month by the House Veterans Affairs Oversight and Investigations Subcommittee. While the normal ‘hack’ is due to theft or an inside job for financial gain, these likely have a far more sinister nature. According to former VA Chief Information Security Officer Jerry Davis (now at NASA), the attacks continue from these countries, and according to Subcommittee Chairman Rep. Coffman, may include China and Russia. Testimony and evidence also revealed that those responsible for informing Secretary Shinseki may have understated the problem. The VA has certainly been taking its lumps with a Magic 8 Ball of late, with a derailed joint EHR project with the Department of Defense and wrangling on who’s leading integration [TTA 3 April; iHealthBeat]. VA Systems Hacked From AbroadWas VA Secretary Misled About Breaches? (HealthcareInfoSecurity)

Patient non-compliance=toxic healthcare system?

Updated 20 June

A decidely contrarian view. Medication and treatment non-compliance is listed as one of the top ‘evils’ that patients inflict on the system which negatively affect outcomes and increase health costs. The doctor/hospital/insurance company laments, Why don’t they do what we tell them to do, exactly? Can’t we punish the patient for this?  But what if non-compliance indicates a bigger problem to be solved in the system, comparable to a canary’s silence in the mine when toxic gases are present? Maybe it’s because clinicians don’t take the time to understand the patient’s life and how to fit the treatment. Victor Montori, MD of the Mayo Clinic, at MedCityNews’ ENGAGE conference last week pointed out that patient non-engagement can point to the following:

  • The treatment isn’t right for that patient to begin with, and asking him to do more of it is only going to make matters worse.
  • The medication and patient options aren’t adequately explained prior to the protocol starting or the prescription–after going home and reading the side effects of the drug, or talking to a friend, the patient opts out. Or the patient doesn’t understand or trust the drug, protocol or doctor.
  • The burden of treatment or change is too much (temporarily or permanently) to handle for the sick patient (e.g. additional monitoring, diet)

To Dr. Montori, the best health system is not a ubiquitous, authoritarian one permeating every facet of life, but one that actually shrinks in size, makes it easier for the patient to follow treatment, focuses on treatments that reasonably match a patient’s lifestyle so that the person is ‘able to fully play the role he plays in his life’–in other words, meets the patient ‘job to be done.’ Mayo doc: Stop blaming patients. Healthcare industry’s take on non-compliance is all wrong (MedCityNews) Video excerpt 01:50.

Update 20 June: Full video of Dr. Montori’s talk via YouTube, Patient Centered Care–The Right Thing to Do Right (29:03)

Previously in TTA: Type 1 diabetes self-monitoring as a perpetual Battle of Stalingrad in The diabetic experience: the fly in the Quantified Selfing ointment.

The ultimate in Quantified Selfing?

The Quantified Brain may be the ne plus ultra of QSing. Only a neuroscientist on a Mission from God (and a really good insurance plan) would be getting twice-weekly MRIs and weekly blood tests for hormonal and gene activity levels. Russell Poldrack’s year-long self-study is to correlate his diet and moods, mental state and outdoor time with the scans and blood testing to capture the fluctuations in brain activity and networking–and his physical state. Example: his psoriasis flareups with increases in stress and changes in gene activity. Finally a bit of QSing that doesn’t have a hint of the faddish about it.  The Quantified Brain of a Self-Tracking Neuroscientist (MIT Technology Review)

Health tech used more by urban affluent (US)

A report by the US Commerce Department’s National Telecommunications and Information Administration confirms what most of us already have assumed–that telemedicine and telehealth’s early adopters are both urban (8 percent versus 4 percent rural) and with household income above $100,000 (11 percent versus 4 percent with $25,000 or less income). The usage sampled in the study of 53,000 households in July 2011 looked at the 7 percent who go online (via PC or increasingly smartphone) to access medical records,  engage in video conferencing with a health care provider (telemedicine) or participate in remote procedures, such as heart rate monitoring (telehealth). Ethnic differences are not great but notable:  “Asian-American internet users were significantly more likely to use telemedicine than other ethnics groups, but the differences between whites, blacks and Hispanics is minimal, with white utilization at 7 percent and black and Hispanic participation at 6 percent.” iHealthBeat, Clinical Innovation + Technology overviews; USDOC study (PDF)

CONVERGE: Summit for Healthcare Innovation

Hyatt at the Bellevue, Philadelphia, 9-10 July 2013

MedCityNews has now added a second day to CONVERGE and much new in the way of content from health systems, payers, medical device, pharma, digital health/health IT, entrepreneurs, government leaders and  investors. Speakers include Nicholas LaRusso M.D., Medical Director, Mayo Clinic Center for Connected Care; Wendy Mayer, Vice President, Worldwide Innovation, Pfizer; Bryan Sivak, Chief Technology Officer, US Department of Health and Human Services. Information, schedule and registration.