Cambridge Wireless Healthcare Special Interest Group

Queens College, Fitzpatrick Hall, Silver Street, Cambridge.  Thursday 26th September 2013

The Cambridge Wireless Healthcare Special Interest Group (SIG) in association with IET, Cambridge Biomedical Campus and EAHSN present  ‘Management of long term, chronic conditions – Technology innovation in patient pathways’.

This half-day topical event will highlight the challenges and opportunities technological innovations present to the health service now and in the future. It will follow the patient pathway; from initial contact with an NHS member of staff (such as their GP), through to referral, primary treatment and support from social care services. Speakers will address the issues surrounding the remote monitoring of carers and how that maps onto the technical world with a focus on clinical improvement and patient support, safety and confidentiality.Confirmed speakers: Keith Swinburne of Papworth Hospital, Dr Afzal Chaudhry of CUH, Dr Andrew Grace of University of Cambridge, Dr Rachel Morris of University of Cambridge School of Clinical Medicine and Charles Lowe of The Royal Society of Medicine.

To find out more information and register, please visit their website. Agenda. Registration.

Editor’s note: our Contributing Editor Charles Lowe will be the kickoff speaker.

O2 to stop selling telecare & telehealth in the UK

To quote from the O2 website: “We would like to let you know that O2 Health has taken the difficult decision to stop selling our telecare (Help at Hand) and telehealth (Health at Home) in the UK. We will cease providing the Help at Hand and Health at Home services to existing customers.”

There are more details on the website – the reason given for the decision is that the uptake of mobile telecare and telehealth in the UK marketplace has been slower than anticipated.

As someone who attended the launch of Help at Hand in March, and who has been really excited about O2’s decision to move into the end-consumer market as the harbinger of the development of a consumer telemonitoring service market, this has left me in a state of shock.

There are of course now apps that can make a standard smartphone or tablet behave in a similar manner to the dedicated kit that O2 has provided.  However the principal challenge with retail sales of telecare and telehealth has always been the monitoring/response end, which O2 will now presumably be withdrawing.

A sad day!

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/07/o2-on-sale-after-withdrawl-26jul13.jpg” thumb_width=”200″ /]Update 26 July: A reader has sent us a snap of the O2 display taken today at their local (Hertfordshire) Tesco pharmacy counter. That person spoke with the pharmacist who said they hadn’t been told it had been withdrawn! This Editor (Donna) notes that the display is jammed in adjacent to the £5 Cholesterol Check and flyers for ‘Are You At Risk For Diabetes?’ Aside from its unattractiveness and medicalization, whatever happened to what presumably was the marketing takeaway message–freedom to live life out of the home in safety for the first time, delivered simply? Looks like the POS (point of sale) missed that all-important mark.

Stats on medical apps on Apple & Android

iMedicalApps reports on the latest stats on medical apps on Apple & Android.  Overall figures show Apple with more than twice as many as Android.  It would be interesting to know how that split would be for apps aimed at patients – notwithstanding the previous post, I get the impression that the balance between the two is evening up.

There is a stark contrast between these numbers (over 19,000 for Apple, just over 8,000 on Google Play) and the small number of medical apps approved by the FDA (just over 100 according to a comment on the report) and on the NHS Choices health apps library.  Even making a very generous allowance for clinician-focused apps, this still emphasises the importance of the work underway just now on ordering the market to give users greater confidence in the safety and efficacy of what they download.

Clever use of augmented reality in patient education medical app (iOS)

iMedicalApps reports the first example it has seen of the use of augmented reality in an app aimed at educating customers – in this case about eye problems.  The iTunes link for EyeDecide is here.  The app is produced by Orca MD.

Looks an impressive app.  The example shown is of the effect of age-related macular degeneration: anything that can encourage people to have their eyes regularly checked by showing them what happens if they don’t has to be good.

Health tech funding reshapes, diversifies

In thinking how funding for health tech startups has changed since this Editor’s early days (2006) when VCs had a lock on the Letter Series (A, B, C) and your real goal was to ‘please, Lord, won’t you find me a strategic investor?’ (are there any of those left?), some more pointers to the future, both in EU and US:

Withings, known for its pioneering Bluetooth scale circa 2009, and more recently other Bluetooth monitors, nimbly moves to wearables with a fitness tracker about the size of a USB drive and priced at an affordable $99. It also has raised $30 million led by Bpifrance with $15 million, with participation from Idinvest Partners, 360 Capital Partners, and Ventech. (Most of us have forgotten that Withings is a French company.) A French challenge to Fitbit, Nike, Jawbone and a whole raft of smartwatches coming 2013-2014 including Sony, Pebble and Apple? VentureBeat

Angel funding diversifies geographically. No longer do the coasts have a lock on the action. Silicon Valley has had some problems [TTA 18 July], Silicon Alley (NY) is still finding its way and Boston/Cambridge is, well, Boston/Cambridge. We recently covered angel groups in Ohio (LaunchHouse), Texas (Wildcatters) and Arizona (SeedSpot). Now Delaware joins the list with FP Angels. And where are most of the companies? According to the Halo Report, in the US Southwest. Angel investing groups show love for the Southwest and healthcare in Q1 (MedCityNews)

And the rise of crowdfunding. As mentioned previously, angels and ‘FFF’ funding has been supplemented and market tested by crowdfunders such as Kickstarter, IndieGogo, MedStartr and Health Tech Hatch. Two kitchen-table entrepreneurs can market test their idea almost immediately. The problem is failure to deliver on time, on budget and as promised, as witnessed by the overwhelmingly successful Misfit Shine. The math of Hardware+Crowdfunding=Success has more than a few caveats in the formula. The hardware revolution will be crowdfunded (VentureBeat)

And a little-noticed change in Securities & Exchange Commission (SEC) regulations lifted the ban on ‘General Solicitation’ which according to this Forbes article will allow entrepreneurs seeking funding to cast a net beyond their network of ‘pre-existing relationships’–but they have to be accredited investors. It makes the reach to non-accredited investor interest just a little bit closer–for good or ill. The SEC’s Removal of General Solicitation Changes Everything

For our readers, health tech appears ‘siloed’ by region and country. What does it take to move beyond borders?:

  • If your startup is based in the UK or EU, have you thought about reaching out to US funding through a US base?
  • If you’ve considered and rejected it, why? (Health tech
  • Why are we not seeing more activity by UK/EU companies in the US (or Americas) markets?
  • What do you perceive as the differences between developing health tech ex US–and translating it to the US market?
  • Has anyone had experience extending in non-US/UK/EU markets?

News ‘shorts’ for shorts weather

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/07/00114031.gif” thumb_width=”150″ /]It’s summer on both sides of the Atlantic–and shorts were spotted at the British Open! Thus a ‘short’ roundup of three items of interest–but this is after you read Charles Lowe’s superb Soapbox on bidding the WSD farewell, and TANN England’s Chrys Meewella’s latest on rural telemedicine.

An update on the US Department of Defense’s and Veterans Affairs’ efforts to combat PTSD. “Every VA facility is now required to provide evidence-based treatments for PTSD, including prolonged exposure” (PE). PE asks the patient in session to revisit, in their minds, the traumatic event. A study published in JAMA Psychiatry in July examined treatment by relatively novice therapists using PE with over 1,900 patients for PTSD and depression, and found that PE was effective in reducing both comparable to previous trials, plus “The proportion of patients screening positive for PTSD on the PTSD Checklist decreased from 87.6% to 46.2%.” The Reuters Health article reprinted in MedCityNews is an overview; link to JAMA abstract is here (subscription or library access required for full content.) TTA related: PE smartphone app coach 6 Aug 12.

Adding teddy bears to wearables, from Croatia…IDerma has developed Teddy the Guardian, a stuffed bear that according to a PSFK report records a child’s heart rate, body temperature, blood pressure and oxygen saturation, then sends the data to the parent’s smartphone. All the child does is to put their finger on Teddy’s paw or the paw on their forehead. According to the article, the sensors are CE/FDA approved, but reading this over, the system is not FDA approved nor is it in production. Note the IDerma engagement with Croatia’s bid for entry in the EU and the young entrepreneurs behind it. Hat tip to Toni Bunting, our new Contributing Editor and TANN Ireland editor.

Pointer to the future. Webnapperon form factors PCs into everyday objects. This Belgian based company reimagines a simplified PC as everyday, familiar objects on a side table–a picture frame is the screen, a doily interacts with the computer and through its RFID reader, reads a tagged item from family and friends that looks conventional, but has an RFID chip that delivers additional content  Apparently very little capability beyond this from the article but but perhaps serviceable for the oldest–and a pointer to the future in accessorizing objects with RFID chips. Springwise.com, and another hat tip to Toni Bunting. Website (in French)

Establishing high-level evidence for the safety and efficacy of medical devices and systems

I have recently been made aware of an excellent publication jointly by the Royal Academy of Engineering and the Academy of Medical Sciences entitled Establishing high-level evidence for the safety and efficacy of medical devices and systems, so this post is to reach out to those like me who were previously unaware.

It is a major step forward in applying engineering methodology to evaluating the effectiveness of medical devices & systems and, even more important, ensuring their ongoing safety.  Those of us who have participated in a substantial randomised control trial such as the Whole System Demonstrator (see earlier post today) will take great interest at what follows the quote: “For pharmaceutical innovation, the randomised controlled trial is the acknowledged gold standard for creating a body of high-quality evidence. But designing clinical trials to establish the evidence for medical devices has proven more problematic.”

(Included in the paper is the observation  that the ultimate health improvement device when you leave an aeroplane that is in the air – the parachute – has never been proven by an RCT.)

Finally just to return to an earlier comment, the report makes the point that because medical devices can be changed far more often than the composition of a drug, the importance of appropriate safety monitoring is absolutely critical, an issue that is becoming increasingly relevant as penetration of telehealth (in particular) and telecare increases.  Whilst  we might choose to ignore the different nature of medical devices when assessing a trial, we cannot ignore the different nature of medical devices when designing and putting in place appropriate safety systems.

Digital economy twice the size the government thought it was (General interest)

The FT reports that the National Institute of Economic and Social Research conservatively estimates that there are 270,000 digital companies compared to less than half that estimated by the government.

The report, just out, supported by Google, is entitled Measuring the UK’s Digital Economy With Big Data.  As the title suggests, it makes a strong case for the use of extensive data analysis in determining that the digital economy  has spread into every sector of the economy.

Hal Varian, Chief Economist of Google, wrote the foreword which includes the only reference to ‘biotech’ specifically in the report: “The UK is one of the world’s strongest internet economies yet the myth persists that it consists largely of tiny dotcom or biotech startups in a few high technology clusters that quickly bubble up and often go bust.”

Telehealth Soapbox: Time to bid farewell to the WSD?

TTA Contributing Editor Charles Lowe asks whether it is now time to stop looking back to the UK’s pioneering Whole Systems Demonstrator (WSD) programme.

As the person who led the bid for Whole System Demonstrator status for LB Newham back in 2006/7, this is my case that it’s time now to bid farewell to the programme, as soon as is possible.

Why?  This was a great programme that came up with some encouraging results for telehealth, and taught us a huge amount about how best to implement telehealth and telecare.  However the echoes from that long gone time are increasingly providing ammunition for the naysayers, when in reality the world is now a totally different place.  The technology is unrecognisable from that that we considered when bidding for the WSD in 2006; it is far more efficacious and far cheaper; and it can be deployed much faster & for many more conditions, opening up many possibilities not available to us when we won in 2007.  We now know much more about how to implement the technology too: in particular it delivers greatest benefit when a part of an overall programme for improving care and not, as the WSD randomised control trial (RCT) treated it, as a simple intervention, like most drugs.  In retrospect therefore there were significant weaknesses in the way the trial was run.

The continuing drip-feed of WSD results is sadly resulting in (more…)

Telemedicine in rural parts of developing countries

Implementing “telemedicine” in developing countries is one way to spread the availability of healthcare to the poor in remote rural areas, says an article in Unite for Sight.

Without access to advanced laboratories, healthcare workers rely on evaluating symptoms to diagnose illnesses. Even then, the shortage of trained healthcare workers, particularly in rural areas, means alternative approaches are often needed. Telemedicine in this scenario is often limited to telephone consultations with specialist consultants and image and data exchange using the internet.

The unavailability of widespread basic infrastructure is however a limiting factor – creating a new “digital divide”.

Read more about the problems surrounding getting healthcare to the poor in developing countries at Healthcare Technology in Resource-poor settings and the Guardian article Getting medicines to the poor: solving the logistics challenge.

NaviGo Health: matching doctors and patients like a dating site

Here in NYC, the major success envy story for eHealthy entrepreneurs has been doctor appointment-setting website ZocDoc. With multiple rounds of funding from the likes of Goldman Sachs, it’s appeared to have unassailable ‘cred’ and ownership on a national basis. Cleveland Ohio-based NaviGo Health wants to cut a small and specialized slice of this pie through using a ‘dating model’ process. (This Editor wondered “why didn’t I think of that?”) Their platform CompassMD matches newly diagnosed cancer patients with doctors, based on how both parties answer a list of questions based on communication, decision-making, treatment and personality preferences. The founders are working out of co-working space at a Shaker Heights Ohio accelerator, LaunchHouse (built in a 1950s car dealership!), and on ‘FFF’ money attempting to snag a pilot. The website’s a home page, they tweet at @navigohealth. Can a few docs out there lend them a hand on their pilot? Maybe some crowdfunding and Health 2.0 folks to the rescue? Compatability (sic) matters: NaviGo Health puts an online dating-style twist on physician searching (MedCityNews)

VA distributing iPads to Family Caregivers (US)

Back in May 2012 we noted a Veterans Affairs (VA) program for 2013 that would distribute 1,000 iPads to primary caregivers of seriously wounded veterans to facilitate care delivery and data transfer. Then called ‘Clinic-In-Hand’, it is now officially debuting as the Family Caregiver Pilot for caregivers of seriously injured post-9/11 veterans already enrolled in VA’s Family Caregiver Program. The intent is now more clearly focused on reducing caregiver stress, via  pre-loaded apps to share health information, coach patients through chronic pain and PTSD and serve up tools such as reminders and a health journal. A second, the Veteran Appointment Request Web App Pilot, facilitates appointment setting via mobile or desktop PCs for a separate test group of 600 veterans and was launched at the Washington, D.C. VA Medical Center and VA Palo Alto (California) Health Care System. According to EHR Intelligence, if successful it will be rolled out to all patients at these two VA centers with a system rollout in the future–complicated by the fact that every VA center has a different scheduling system. Meanwhile, VA’s VistA and the DOD’s AHLTA still don’t talk to each other. VA integrates mHealth into daily care, gives iPads to vets (EHR Intelligence); VA Mobile Health release (for additional details go to the left hand drop-down menu). Hat tip to Contributing Editor Charles Lowe.

Hospitals can benefit from telemonitoring (US)

As someone who has spent a huge amount of time attempting to persuade acute trusts in the UK that telehealth is in their interests (with, I’m glad to say, a modicum of success more recently) it is good to see this paper entitled The Financial Impact of a Pediatric Telemedicine Program: A Children’s Hospital’s Perspective in the July 2013 edition of the Journal of Telemedicine & e-Health (freely accessible).  The key finding is (more…)

Apple-ologists discern ‘new’ interest in health tech and telehealth

With the same obsession that Kremlinologists had during the Cold War, the Apple-ologists at 9to5Mac divine that Apple is now suddenly interested in the sensor-based fitness sector of telehealth. Recent remarks by their CEO have been examined like the mutterings of the Oracles at Delphi. Their SVP of Technologies has been spotted wearing a Nike FuelBand, just like the CEO–and by looking at his picture, he does need it! Apple Marketing folks have been examining wearables like the Jawbone UP! (naturally as competition, duh!) Far more indicative from their sources: An all-star team from semiconductors to batteries to sensors is working in secrecy on the long-awaited iWatch. Talent’s been snatched from telehealth sensor companies AccuVein (vein mapping), the recently defunct C8 MediSensors (blood monitoring), and Senseonics (embedded sensor for blood glucose).  And they are most interested in sleep tracking. iWatch’s novelty emerges as Apple taps sensor and fitness experts

Apple’s been interested all along in healthcare–and others have been interested in Apple

No surprise to TTA readers, as you’ve been tracking Apple’s and competition’s healthcare moves along with us from the start.

  • the iPad in hospitals and their preliminary tests starting in early 2011 when tablets were new and untried [TTA 8 Feb 2011]
  • Editor Steve on the Apple Smart Shoe US Patent application back in January
  • Samsung’s hype on healthcare devices and software on the new Galaxy S4–fitness tracking disruptor?
  • 5.5 million plus of health app downloads (US) from the App Store (May)
  • the development of many devices that are based on the iPhone (Misfit ShineAliveCor‘s ECG, the Ozcan microscope and food testers only a few)
  • …though Microsoft’s Surface for healthcare back in February is likely a dud–MS just wrote off $900 million with the Surface RT, lowered its price (though only a fool with money to burn would buy it) and the Pro continues to struggle (ZDNet)

Smartwatches as the 2013-2014 tablet…and will they knock out fitness bands?

But this press focus on ‘Apple for Health’ does disguise that Apple is behind the curve, not leading it, on the watch form factor. Just like the Soviets, Apple better get a move-on or lose the race that gets serious next year. Smartwatches are fast becoming the new tablet [TTA 2 July]. One rosy industry estimate has 5 million units sold by end of 2014 (Canalys Research in Gigaom). Sony’s been there for awhile. Pebble sold 275,000 pre-orders through Kickstarter, their web store and now retail through Best Buy. This week the rumor broke among the Microsoft-ologists that they are working on an aluminum smartwatch with a 1.5-inch screen and a band out of Star Trek IV. (The comments below the TechCrunch article on the very thought of smartwatches are a good chuckle!) And undoubtedly looking over their shoulder because they’re gaining on you, contrary to Satchel Paige’s advice, are Fitbit, Jawbone and Nike, wondering if they’ll be the next Zeo.

App platforms & mobile devices: what’s hot and what’s not (free report)

Readers might be interested in an excellent free report entitled “Developer Economics 3Q 2013: State of the Developer Nation” produced by VisionMobile.  Based on a survey of 6,000+ respondents from 115 countries it charts the fortunes of the different app platforms, and of the hardware suppliers on which those apps sit.

Just one quote to whet your appetite:”2013 presents an inflexion point in the evolution of app ecosystems.”

Many thanks to Professor Mike Short for the pointer.