So, to that word. London Telecare has just announced it is planning to change it’s name to UK Telehealthcare and go nationwide. No ®, no ™: true independence. This follows on from the recent emergence of (more…)
In spite of gamification being at the peak of inflated expectations in the 2013 Gartner Hype Cycle, here’s a great example from the US journal Pediatrics of its use to encourage young people with cancer to improve their medication adherence. The subject was also covered in the BBC’s Click (starts 13.55 into the programme), and the Hope Labs website is here…
…which prompts the question as to where the best examples of gamification use to improve health & wellbeing are on this side of the Atlantic. (more…)
Richard Vize has written a highly-recommended article in the Guardian today entitled “GPs continue to do battle with government over telehealth”. This gives some valuable context to why publications such as Pulse continue to dredge up the historic Whole System Demonstrator (WSD) cost/QALY statistics as it did on Wednesday and Thursday last week.
TTA readers will of course be aware of the reasons why those figures are so unrepresentative of the technology from our recent post on why it’s time to bid farewell to the WSD.
Particularly pleasing is to see recognition of the role of telehealth as a means of promoting wider improvement in the way care is delivered:
“Eventually, other costs will start to fall as telehealth becomes a catalyst for wider system change. At present it is a bolt-on to a care system poorly integrated and not adapted for telehealth. It will require clinicians to work together in new ways, particularly in more effective joint working between community and hospital staff.”
The ‘reasons why’ we (and others like David Shaywitz in Forbes) proposed back on 12 August for Medtronic’s purchase of Cardiocom were fully confirmed by their CEO Omar Ishrak in Bloomberg (21 August) and an analysis in Forbes (24 August). However, the Forbes article continues on to dump a bucket of cold water on Mr. Ishrak’s ‘solutions provider’ strategem (so reminiscent of 2008-9 with different companies), positing that telehealth belongs with wireless/mobile companies (Qualcomm), companies further downstream (Allscripts, a major US pharmacy benefits manager) or other technology/monitoring companies. Mr. Market held the roses though (Deutsche Bank’s reiterated hold rating in Benzinga reflecting the consensus in Yahoo Finance).
What is interesting are their advances in brain stimulation to relieve pain in two areas. (more…)
That’s because some promoters of home monitoring technology believe doctors will carefully scrutinize each EKG or blood sugar reading and use the information to tailor perfect regimens for their patients. This is not how medicine works.
Looking at thousands of EKG tracings won’t add much value either. In fact, putting all that information into an electronic medical record (EMR) only makes it more difficult for doctors to identify other, more vital pieces of information. Instead, doctors need to understand which of a few possible patterns are happening to determine the appropriate course of action.
Dr. Pearl’s prescription is for smartphones to embed telehealth monitoring capabilities at a price point slightly above the current cost, but less expensive than stand-alone devices (more…)
A cardiothoracic surgeon at the University of California, San Francisco recently performed surgery wearing Google’s wearable computer, Google Glass.
Dr. Pierre Theodore described his experience at the recent Rock Health Innovation Summit. During the surgery he used the glasses to compare the patient’s CAT scan images with what was in front of him. “There was a cognitive integration between what I saw in front of me and the radiographs. It was extraordinarily helpful,” he explained, likening it to driving a car and glancing in the rear-view mirror (as opposed to having to turn around to see what’s behind).
Also speaking at the event was Ian Shakil, Co-founder and CEO of Augmedix, a start-up company which is building applications for healthcare on Google Glass. According to Mr Shakil, one aim of the technology is to re-humanize healthcare so that physicians can focus on the doctor-patient encounter and cut down on the non-patient facing tasks, like taking notes and looking up medical records.
While it’s arguable whether or not companies such as Augmedix will succeed in further humanising healthcare (picture your doctor, one eye staring at you as you explain your latest woe, the other twitching around, viewing who knows what in a Google Glass eye-piece), various applications for Google Glass do seem to have real potential for being of benefit in certain healthcare settings.
Indeed, for better or worse, there’s little doubt that Google Glass (or a similar device) will be used in many professions in the not too distant future. And according to research carried out by Augmedix, most of us are fine with that. The company asked 200 patients before a visit if they minded seeing a doctor wearing Google’s head-worn gadget, and only 3 demurred!
However, as highlighted previously by the discerning gaze of TTA’s Gimlet Eye, we might be best served not to disregard the potential for misuse and abuse with wearable ‘cybernetic headbands’ such as Google Glass, not least in a clinical setting!
Following on from yesterday’s post entitled “Don’t be put off by the title, or the conclusion, of this review of reviews“, Mike Clark has kindly pointed me towards another recent review of telehealth reviews entitled “Telehealth – the effects on clinical outcomes, cost effectiveness and the patient experience: a systematic overview of the literature”, this time from Salford University, authored by Dr Alison Brettle, Tamara Brown, Professor Nicolas Hardiker, Jon Radcliffe and Christine Smith.
This paper provides an intriguing contrast to the paper reviewed yesterday in a couple of, doubtless unrelated, ways. Firstly, whilst the word that was the subject of yesterday’s post does not appear in the title (it does appear in the text), the paper was funded by an educational grant from the organisation most often associated with that word. Secondly, the review is noticeably more positive, for example:
“There is more evidence for some conditions than others, but on the whole the trends are largely positive suggesting that telehealth is effective in:
- Reducing patient mortality and hospital admissions for chronic heart failure
- Reducing hospital admissions for COPD
- Reducing blood pressure in hypertension, improving glycaemic control in diabetes and reducing symptoms in asthma”
As with our two recent posts on Birmingham OwnHealth, it looks like it’s take your pick time again.
It is perhaps just worth adding that there are also significant similarities between some of the observations made in both papers, most notably about the small size of many trials, inconsistent collection of outcome measures and the weaknesses of the methodologies currently used for assessing the effectiveness of trials of medical devices.
Whenever I see the word “telehealthcare” I feel there should be an ® or perhaps a ™ after it as it so often appears in connection with a particular organisation. However no such connection is evident is this paper entitled “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview” (published on the PLOS ONE site), especially as the overall conclusion is far from that often found in articles toting that word:
“Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.”
If you stop there though, you miss some very important points (more…)
16-19 November, Gaylord Palms Resort & Convention Center, Orlando Florida
One of the few design-only oriented conference for healthcare facilities. “With roughly 4000 participants at the 2012 Healthcare Design Conference, this is the industry’s best-attended conference where attendees can earn up to 24 continuing education credits, network with peers, and influence the direction of the industry as it advances into the future.” (And the Gaylord Palms is one of the best venues around for conferences–and afterwards. You will not feel like you are in Orlando nor have any stray desires to go to Disney World.–Ed. Donna) Information and registration
Medivizor, which was one of the better discoveries of our CE Week (NYC) coverage and the H20NYC/Healthcare Pioneers evening back in July [TTA 3 July], has moved out of what was a largely private beta to what they interestingly term a ‘public beta’. The site provides individualized content, understandable by the layman, for subscribers on a larger group of diseases which were on track for this fall: lung, colorectal, breast, and prostate cancer, as well as melanoma, diabetes, coronary artery disease, hypertension and stroke. The goal is to improve doctor-patient communications by better patient education. Another important feature is a “personalized system for matching individuals with specific clinical trials available worldwide.” Company release, Xconomy article.
A related New York Times article is an appreciation of how physicians are overwhelmed by information and that “doctors also need a skilled docent to help walk them through all that curated data.” Healing the Overwhelmed Physician
A heads-up to our readers: a new peer reviewed journal out of South Africa’s University of KwaZulu-Natal’s Department of TeleHealth is the Journal of the International Society for Telemedicine and eHealth. On its second edition, their content (in PDF or HTML formats) seems to be of general interest:
- Editorial: Would a Rose By Any Other Name – Cause Such Confusion? (defining eHealth)
- Original Research:
- TalkMeHome: an in situ evaluation of a service to guide a lost person with dementia home safely
- Assessing the development process of the eHealth strategy for South Africa against the recommendations of the WHO/ITU National eHealth Strategy Toolkit.
- Invited Commentary: Telerehabilitation: Current Challenges to Deployment in the United States
The Editors are certainly an international mix: Prof. Maurice Mars, University of KwaZulu-Natal, South Africa; Prof Richard E Scott, University of of KwaZulu-Natal Director, NT Consulting, Canada; Dr Malina Jordanova, Bulgarian Academy of Sciences, Institute for Space and Solar-Terrestrial Research, Bulgaria.
Dr. Joseph Kvedar of Boston’s Center for Connected Health counted himself in this Editor’s camp as annoyed by the mHealth hype (inflicted by those we’ve dubbed the D3H—Digital Health Hypester Horde), and far more of a believer in SMS for health programs. His blog post is a ‘kind of edge’ towards thinking that mHealth can be habit-forming. In the CCH’s own clinical trials, more participants have smartphones (tracking the general population’s adoption) even with the lag among those with chronic disease (maybe a question of affordability?) and want apps. And then he sees the pattern of people checking their smartphone obsessively, like budgies with bells and mirrors….along with a study that indicates that patients with a passive sensor to upload blood glucose measurement, rather than pushing a button, were “significantly more adherent to their plan and had better health outcomes.” Not having to do something in the Diabetic’s Perpetual Battle of Stalingrad is addictive? Well, this is edging towards a nomination for ‘What in the Blue Blazes?” Could mobile health become addictive? (CHealth Blog) Hat tip to reader Bob Pyke via Twitter
Well, we can send Dr. K to a connected psychiatrist for a session of e-therapy. (more…)
Contributing Editor Charles adds: there’s also an impressive mHealth app just announced in the UK that was developed by doctors in London and Glasgow to help diagnose serious eye conditions in the developing world called the Portable Eye Examination Kit (PEEK). Around 39 million people around the globe are blind, 90% of them in low income countries; 80% of cases could apparently be avoided if health workers could reach them with affordable equipment. PEEK is set to replace standard ophthalmology kit costing more than £100,000 with a £300 smartphone producing equally good results.
Trained health workers first assess a patient’s vision by flashing progressively smaller letters onto the screen. Then they use the camera to check the lens of the eye for cloudy cataracts. Finally, by attaching a special clip to the camera and switching on the flash, they are able to check the retina at the back of the eye for diseases such as diabetic retinopathy. The images can be sent back to a hospital for assessment, along with the precise GPS coordinates of the patient’s location so they can be found later and treated.
A long (and in need of editing), anodyne article on the European tech website Cordis updating the status of the EU/UK robotics project known as MOBISERV and the Kompaï companion robot, has generated a bit of controversy in the mHealth LinkedIn group (membership required). Group manager David Doherty, better known for his mHealthInsight (3GDoctor) website, objects to the design, the time and funds spent on it, and more. To summarize his points:
- It’s a waste of money on a device and R&D which could have been used on more targeted solutions to real problems
- A ‘touch screen robo-vehicle’ may not be usable by an older person who has trouble with smartphones or tablets for cognitive or mobility reasons
- Mobile and other companies are already surpassing the EU project in both innovation and R&D in the job to be done; example Samsung’s gesture control and the LiquidWeb Brain Control brain interface from Italy. (And the ever-popular speech recognition in the here-and-now)
- It’s a closed system versus open innovation, where other developers especially those on Kickstarter build in access (SDK–software development kits). Example is Romo, the small wheeled desk robot for the iPhone. (However, Editor Steve in his coverage of Kompaï in early days reported that its SDK is open source TTA 4 May 10)
We will leave side-taking to our readers, but David’s points are strongly worth considering, as this project has taken at least four years and perhaps more, and funding–who knows? (Editor Donna notes that Editor Steve followed Kompaï since 2010 in articles such as Kompaï by Kompaï, the Dutch TV video, and experiments in gesture-based control for those with strokes and similar impairments.)
Intermountain Healthcare has been well-known for its proactive approach to healthcare models–it moved early to a fixed-fee integrated delivery system (IDS), helped to pioneer the evidence-based healthcare approach and was an early adopter of EMRs. It was one of the main providers cited in the influential The Innovator’s Prescription written by Clayton Christensen, the late Jerome Grossman, MD and Jason Hwang, MD. It’s now further backing technology development and integration through its new Healthcare Transformation Lab. Founding members Xi3 and Intel, and ‘collaborators’ Dell, CenturyLink, NetApp, and Sotera Wireless are participants in the new 20,000 square foot facility at Intermountain’s lead hospital in Murray, Utah. Some of the prototypes already being readied are the ‘patient room of the future’, 3D printing of medical devices for testing purposes, a watch-form handwashing sensor, a ‘life detector’ for patient vital signs (an outgrowth of ViSi Mobile TTA 23 Aug 12?), a mobile vital signs monitor/data collector for use by helicopter rescue teams, an alert system for at-risk for suicide patients based on increased heart rate, and more. What seems to be missing are innovations related to the specific needs of older, frailer patients. Release. The extensive coverage is indicative of Intermountain’s influence in healthcare far beyond Utah: Healthcare IT News, FierceHealthIT, iHealthBeat, Salt Lake City Tribune. Will other health systems follow in influencing and funding health tech?