Falling in Torbay – a mine of useful information (UK)

The Kings Fund has just produced a detailed analysis of the total health & social care costs for older people admitted to hospital following a fall in Torbay over a 12 month period.  This should be of serious interest to anyone writing business cases for falls-related technology or generally doing any financial calculations in that area. (Torbay has excellent integration of patient/service user records that enables this analysis to be done with great accuracy).

The headline finding is that the total health and social care costs of dealing with older people who have had a fall that they have had to go to hospital for, in the year after that fall, is almost four times the immediate cost of the unplanned hospitalisation after the fall.  Unsurprisingly, for those who die within a year of the fall, total costs are somewhat higher than for those who survive.  Using the Kings Fund’s figures I calculate that the incremental health & social care cost of a fall is just under £7,000 (which includes both the immediate hospitalisation cost and the following years’ costs, less the previous year’s costs). This of course ignores the costs to the individual, their family and community.

Many readers will by now doubtless be wondering whether the costs of falling were reduced for those fallers who were Torbay Lifeline users as conventional wisdom is that the cost is very dependent on the length of time someone remains on the ground before being rescued.  Sad to report that analysis was not done (see comments on the paper – I have requested it). Nevertheless it is a brilliant resource for anyone looking for cost information on this very important topic.

Ambient Assisted Living Forum 2013

The AAL Forum is billed as an annual platform for the growing “ambient assisted living” – telehealth and telecare – community in Europe to meet and discuss AAL. It is also a showcase event for people involved in the Ambient Assisted Living Joint Programme which is an initiative involving 20 EU and 3 non-EU countries, with public funding from EU and partner states. This year the Forum meets in Norrköping in Sweden from 24th to 26th of September.

The full programme, a link to the online registration web page, information on the associated exhibition and archived information on the past 4 years’ AAL Forums can be accessed from the AAL Forum website.

 

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/EKTG-logo.png” thumb_width=”150″ /]European Knowledge Tree Group Workshop

A side event at this year’s AAL Forum, this workshop will be held on the 24th of September.  The EKTG is  an  ad-hoc group concerned with the real impact of R&D in the area of ageing and “brings together users, technologists, financiers and governments”. The workshop aims to review the technology of Apps from development, opportunities, appropriateness to costs and finance. To register for the EKTG workshop visit the registration page here.

Surrey telehealth – some good news!

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/Surrey-County-council-Logo1.jpg” thumb_width=”150″ /] The announcement by Medvivo and Surrey County Council of telehealth becoming fully embedded across all six CCGs in Surrey is good news for those who believe in the benefits of telehealth.

Pulse was one of the first to carry the news today, though was  unable to resist the temptation to remind readers of the high cost/QALY found by the Whole System Demonstrator (WSD) programme (which was caused, as Telecareaware readers will know from a previous post, by the high cost of running the WSD RCTs and using equipment that is now some six years old).  The more positive EHI post is here.

Over the past year there has been much concern about whether telehealth arrangements established by the previous PCTs might be taken forward by the CCGs; Surrey shows it can be done successfully.

(Disclosure: Charles Lowe established and ran the telehealth programme in Surrey for NHS Surrey and Surrey County Council between 2011 and 2013, including managing the tender process.  He did not however adjudicate the tender – some 40 representatives of organisations in the county participated in the adjudication.)

A ‘mobilized’ artificial pancreas breakthrough?

Neil Versel (again) profiles a mobile platform that may be the start of the end of the Continuing Battle of Stalingrad for type 1 diabetes patients.  The prototype system, Diabetes Assistant (DiAs), is a closed-loop system which combines a modified Android phone with wirelessly connected wearables attached on the skin–Dexcom glucose monitors and Insulet OmniPod insulin pumps- to effectively act as an artificial pancreas. It was developed by University of Virginia’s Center for Diabetes Technology with funding via The Juvenile Diabetes Research Foundation and the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases. Findings of the 20 patients monitored were initially presented at June’s American Diabetes Association’s annual scientific meeting and published in the July edition of the journal Diabetes Care (PDF does not require subscription). The system was designed by an international team:  Sansum Diabetes Research Institute in Santa Barbara, Calif., University of Padova in Italy and the University of Montpellier in France.  Tests continued with summer campers and the integration of Bluetooth LE into the connectivity system.  Mobihealthnews article.

But can this small miracle of a system be hacked–and can providers be held accountable? This scary thought of ‘harm or death by hacking’, with the example given of an insulin pump gone awry–was tagged at the 2011 Hacker’s Ball, a/k/a Black Hat USA by Jerome Radcliffe [yes, in TTA back in August 2011]. The late Barnaby Jack was also on the medical device hack track. The danger is only now entering the consciousness of medical administrators and the industry press in mainstream venues such as Information WeekAre Providers Liable If Hacked Medical Device Harms A Patient? (Healthcare Technology Online). Also Kevin Coleman in Information Week tells more about the liability providers may find themselves in if they don’t update their systems.

Both the diabetes closed-loop systems under development (Diabetes Assistant is one of three) and the hacking threat were addressed by Contributing Editor Charles earlier this month [TTA 5 August] in his examination of how systems should move from decision support to decision taking in order to truly reduce patient or caregiver burden.

Health tech scenes we DON’T want to see

The real reasons for wellness monitoring in the corporate world, as seen through the eyes of the Dilbert comic strip. Could this be CVS Caremark or the average employer in five years or less? [TTA 12 AprilHat tip to Neil Versel in his Meaningful HIT News; note comment from our own Contributing Editor from Australia, George Margelis, on algorithms missing the healthcare point.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/192722.strip-Dilbert.gif” thumb_width=”650″ /]

Future GP consultation – boring but very important (England)

NHS England has just launched a consultation on the future of GP practices, with a slide set of the case for change and the NHS’s underlying objectives for general practice together with an evidence pack which provides some information about current general practice and health needs.

This is important to everyone who senses that modern technology can help make a real difference to the way care is delivered because there is a serious lack of ambition (more…)

How best to help older people to understand the benefit of technology? (UK)

Last week we reported on the survey commissioned by the National Telehealth Forum that found that 9 out of 10 people didn’t know what the word ‘telehealth’ meant, a proportion that was worse for those who were more likely to need it. We suggested that asking a different question about whether they knew that technology could enable them to remain in their own home might give a more positive response.

Well no sooner said than (sort of) done – Invicta Telecare reported a similar-sized poll that, among many, included the finding that “more than three out of five over-65s (65%)…admit they hadn’t seriously thought about the type of care and support they would prefer as they get older during the last five years”. Other responses in the interesting survey seem to confirm that a significant number of older people are in denial of the implications of their age so are inadequately prepared to remain independent.

This clearly strengthens the conclusion from our earlier piece, and from our retrospective on why O2 pulled out of this field of the increasingly pressing need to make people aware of how technology can support independent living. Is 3millionlives the way forward?

This is obviously a topic of great interest that will undoubtedly be debated this autumn particularly at the two conferences specifically aimed at how technology can supporting people to age well, run by the Kings Fund on 22nd October and the Royal Society of Medicine on 25 and 26th November. (Disclosure: Charles Lowe is one of the organisers of the latter).

Birmingham OwnHealth Take II – take your pick

You wait for a cohort study to come along for ages, then suddenly two come along within a week of each other…of the same intervention, although with apparently different conclusions. The second paper, entitled “Analysis of the Impact of the Birmingham OwnHealth Program on Secondary Care Utilization and Cost: A Retrospective Cohort Study”, is published online in the Journal of Telemedicine and e-Health, ahead of print, with lead author Liv Solvår Nymark.  (Our post on the previously-reviewed paper, whose lead author was Adam Steventon is here).

The Steventon paper found that the OwnHealth intervention “did not lead to the expected reductions in hospital admissions or secondary care costs over 12 months, and could have led to increases” whereas the Nymark paper “found difference in costs constituted (more…)

Fast funding and sale roundup for Thursday/Friday

A quick summary of news on both recent funding, another recently released funding analysis to add to the pile and sales–one completed, one potential:

  • The StartUp Health accelerator is now producing its independent analysis of health tech funding deals, presumably to catch the fire of RockHealth’s recognized quarterly report [TTA 9 July]. The July 2013 Digital Health Insights Funding Report is available in Slideshare format on their website with the most reported news being the 47 percent year-over-year growth to date, contrasting to RockHealth’s 12 percent, though the difference in all three may be the sampling. Practice management, big data and body computing/sensors lead the trends, according to their summary.
  • What is intriguing in the July deals is the whopping $40 million Series A funding of Oscar, which will integrate telemedicine (presumably consults) and free generic medications to its members in New York State, where they’ve stated they will be integrated into the Health Exchange in NY State. One wonders how they plan to do so on insurance exchanges which haven’t even started yet and which will be having their own challenges being a retail platform for health plans. Not unexpectedly you’ll find Khosla Ventures and Thrive Capital on the roster. MedSynergies led with a $65 million Series A for their software which will facilitate hospital networks performance monitoring of practices and provider referrals/scheduling. Internationally, Withings raised a $30 million Series A in July. MedCityNews also delves deeper into what they see as trends.
  • Fitbit just raised an additional $43 million to add to their previous $23 million. While they are still lagging fitness monitoring rival Jawbone UP by $84 million, rumors abound on what Fitbit plans to do with it: a more fully featured smartwatch? Additional apps to keep their user base engaged?–at the risk of overcomplication?   Fortune, TechCrunch
  • Toronto-based Diversinet closed their sale to New Jersey-based IMS Health for what seems like a small amount: (US)$3.5 million. Its MobiSecure technology provides government-security level mobile app security to customers such as AirStrip and the US Army. However, they were embroiled in early days in a breakup with a mobile provider, AllOne Health, and despite all their high-level tech clearances, the income realized, according to Mobihealthnews, was only in the $1 million range per year and declining and losses increasing. IMS Health is best known for its healthcare informatics, but has been involved with Ford’s in-car SYNC in development of the Allergy Alert app [TTA 7 Aug 12].
  • The ‘For Sale’ sign is also up at BlackBerry, with a corporate committee now officially exploring alliances and a sale, in the usual depressing drill. In a company once ubiquitous enough for smartphone usage to be dubbed ‘Crackberry’, and which still enjoys major worldwide market share and enterprise favor, they cannot get traction with new models. This Editor never used or liked BB, but it’s still kind of sad. ZDNet.

For NY health techies–here’s an accelerator roundup

A sure sign that Silicon Alley in NYC is actually moving beyond the focus on shopping/retail and gaming to support early-stage companies in health tech is in this AlleyWatch guide to 14 accelerators, some of which are exclusively focused on health tech companies but others which may accept the right idea. It should be noted that both Blueprint Health and StartUp Health (with GE Ventures) have moved beyond the angel-funded to more ‘mature’ companies [TTA 15 July]. NY Digital Health Accelerator is a joint initiative of New York eHealth Collaborative and Partnership Fund for New York City [TTA 23 May]. But those without an exclusive focus on financial services or education (for instance), such as NYC SeedStart, Women Innovate Mobile and Founder Institute, may be viable alternatives to the Blueprint-StartUp-NYDHA nexus. It also balances out the fact that NYC is an expensive place to be a startup–only a little less so than SF. Hint, hint UK, European, Israeli and Latin American entrepreneurs–set up shop in NY, and the Coke and a slice (pizza, that is) is on Editor Donna! 14 New York-Based Accelerators to Help You Launch Your Company

Health tech growing in Brazil

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/Saude.jpg” thumb_width=”150″ /]We hear relatively little about health tech developments in Latin America–and in a region with huge healthcare needs and population at all income levels, it has great potential. EmpreenderSaúde (roughly ‘to undertake health’) is looking to change that with events (including Meetups, Twitter @EmpreenderSaude and a Facebook page) that present local healthcare entrepreneurs and help to educate them on both business and healthcare. This report on their 6 August meeting features diagnostic medicine company Grupo Fleury and Projeto Dom, an initiative supporting not-for profit healthcare organizations; Saútil, a online information site providing information on Brazil’s public healthcare system; healthy food company Natue; and Medicinia which is a secure website for physicians to follow-up with their patients. The face of the rising stars on the EmpreenderSaúde website

So 9 out of 10 people haven’t heard of ‘telehealth’…and your point is?

Apparently echoing the comments about health technology awareness made in our post last week about O2 (who are, by the way, to be congratulated for their parent company’s announcement today that they are preferred bidders for two of the three smart meter regions), the HSJ has reported the results of a YouGov poll that nine out of ten adults in the UK have never heard of telehealth.  Of those over 55, the age above which use of telehealth is more likely, 92% hadn’t heard of it. (Note that the HSJ article is behind a paywall, however via a Google search on “National Telehealth Forum”, the commissioner of the survey, you can currently go past it). The National Telehealth Forum press release is here.  EHI also covers the story, here.

So is this a matter of serious concern?  (more…)

The pill spot – Proteus’s first trial and FDA approval for the next generation PillCam (US)

One of the greatest misconceptions I had when I first got involved in telecare was that the main reason that people don’t adhere to their medication regime is that they forget to take their medicine – therefore all they need is an automated pill dispenser or perhaps even an alerting system and all will be well.  If only it was so simple!

In reality there are all sorts of reasons, such as (more…)

Well someone thinks telehealth is good news!

Medtronic has just announced a $200m takeover of Cardiocom, the telehealth device maker.  If you can get through the paywall, the WSJ article is here (updated link not paywalled–Ed. Donna)FierceMedical quotes Medtronic as saying that “At-home monitoring is a proven method of reducing the rates of hospital readmission…and that translates to savings for payers, providers and governments.” First area of joint working is expected to be heart failure. Recent US regulations on Medicare, and increasingly insurance payers, penalize hospitals for 30-day same-cause repeat admissions. Medtronic press release.

Editor Donna: The announcement of Medtronic’s (#4 in worldwide revenue) acquisition of Cardiocom (both Minnesota-based companies) created quite a stir in the US as Medtronic is a ‘traditional medical device’ company best known for its implantables: cardiac shunts, stents, heart valves, pacemakers, insulin pumps and interestingly, a wide range of neurostimulators for different conditions. Now with the acquisition of Cardiocom, Medtronic moves into the post-implant/post-discharge/post-diagnosis chronic condition management continuum– not only into telehealth via Cardiocom’s devices and hubs, but also their clinical and care management systems. $200 million in cold cash is a fair bet even though Medtronic’s market cap is north of $55 billion. Medtronic has to see the opportunity to make a bottom line difference to providers and payers. It is also reacting to a narrowing in its profitable core market–medical devices are now taxed, there have been recent product defect-related ‘scandals’ tarring the industry, and there is pressure to reduce pricey device costs to fit a cost-constrained environment, driven by the new healthcare ‘scheme’ (in both the British and American English senses!) Forbes‘ David Shaywitz has a smart take on it today (though he won’t hold his breath for the pharmas to follow), as well as VC TripleTree’s Chris Hoffman ‘connecting the dots’ and coming up with what we’ve been talking about for some time–integration making sense. It is also most definitely a shot over the bow for major competitors such as Alere, Bosch and Philips plus a raft of smaller companies which have been working with a scattering of hospital discharge areas, integrated delivery systems, ACOs and home health agencies, looking nervously over their shoulder–and other leading medical device companies such as Stryker, BD, Baxter and yes….GE. (Bosch also sued Cardiocom on patent infringement this time last year [TTA 7 Aug 2012]; presumably as this suit was not announced as settled or decided, Bosch is now dealing with a company its own size!)

It also should be noted that Medtronic’s CEO, Omar Ishrak, is well acquainted with home health. Mr. Ishrak was formerly the CEO and president of GE Healthcare through mid-2011–and the driver behind making what was an ultimately failed bet in getting GEHC into home health. That was in 2008-9 with a tiny company called Living Independently Group, developer of a telecare system called QuietCare, which ultimately went to the Care Innovations JV with Intel. (Disclosure: I was head of marketing at the time of the acquisition.) Like GEHC, Medtronic is acquiring a closely-held company in a very different line of business with drivers quite unlike its own; they are retaining the former CEO as a general manager of the division but whether other management or the brand name will survive is not disclosed.

Whilst on the subject of telehealth devices, Heartwire reports a meta-analysis of 52 studies that shows that just measuring your blood pressure regularly results in a significant reduction in both systolic and diastolic levels after six months. Sadly the paper itself in the latest issue of the Annals of Internal Medicine is behind a paywall so it’s not possible to try to understand how the final comment in the synopsis of the paper on the Annals website that: “Additional support enhances the BP-lowering effect.” fits with the comment in Heartwire that “Low-strength” evidence from 13 studies comparing self-monitoring plus additional support vs self-monitoring alone “failed to support a difference” between the two strategies.”

Meanwhile back in the UK, Medvivo has become the first company to be accredited to the telehealth elements of the TSA’s Integrated Code of Practice. Sadly the TSA website will only release the Code to members (TTA isn’t one) or those aspiring to achieve accreditation (TTA fails on that one too) so it’s not possible to make meaningful comment. However the prospect of a Battle of the Codes is looking up with word from Malcolm Fisk that the final version of the European Code of Practice for Telehealth Services will be available for all to read and download on the TeleSCoPE website within a month. There has been talk of a third code being developed too…

ITALIA Project Launch Event (UK)

18th September 2013, The Oculus, The Gateway, Gatehouse Road, Aylesbury   10am to 5pm

Unfortunately not a Ferrari in your driveway, the ITALIA (Innovative Telehealth and Assisted Living Ideas and Applications) Project initiated by Buckinghamshire New University’s institute, the Centre of Excellence for Telehealth and Assisted Living (CETAL),  is a public/private year-long initiative to develop the telehealth applications of the future. The kickoff event will bring together companies with products, ideas or technologies, clinicians and commissioners from organizations such as Buckinghamshire Business First (BBF) and Buckinghamshire Healthcare NHS Trust. More information here (PDF download) and Bucks New University News. Admittance is free but registration on Eventbrite is requested. Our Contributing Editor Charles Lowe is scheduled to be a speaker. Hat tip to reader Stephanie Carrington of BBF.