“A rose by any other name would smell as sweet” (UK telehealth)

60 Second GP today points to an article on what looks to be essentially a Simple Telehealth-type application, in this case a GP-led internet-based programme to encourage weight loss among obese patients in West Oxfordshire.  What makes it newsworthy is that it never mentions telehealth, yet extolls the benefits in a manner that any telehealth project or programme manager, eager for clinical acceptance will instantly recognise, such as:

  • “An internet-based programme can involve GPs in the weight loss of a large number of patients in a cost-effective manner.”
  • “The main benefit of the programme is that it dramatically reduces the cost of face-to-face time with patients, freeing up healthcare professionals for other activities.”

Does this mean that the good GPs of West Oxfordshire have taken onboard a previous Telecareaware post “When mHealth and telehealth become ‘just healthcare’” ?

I somehow doubt it – however the article is nevertheless recommended reading for anyone wanting to sell successfully a telehealth programme to clinicians without ever mentioning the ‘t’ word.

Also worth pointing out is that a feature of the programme was to introduce some gamification – in this case via a league table of weight losers, where anonymised patients reported changes in weight, so other could compare achievements.  Perhaps that’s why the authors, Professor David Brodie, Emma Doyle, Dr Jey Radhakrishnan and Dr David Shaw, report that “One of the most striking outcomes was the high number of men who lost weight (almost 90%), because men are often more reluctant to become involved in weight loss programmes”? (For another great example of gamification applied to weight loss, without the technology, see Fitfans in Hull.)

Sadly there is no information in the article on the size of the programme…and the implication seems to be that having been shown to be successful it was discontinued after 12 months.

Systems sharing data, still behaving badly

A straight-shooting article in Healthcare Technology Online provides a overview of the EHR and Health Information Exchange (HIE) mess in the US. Essentially our major EHR systems (Cerner, McKesson, athenahealth, Greenway, Epic) don’t interchange data well, if at all–and the 600-odd practice EHRs were built on siloed designs, existing software and used proprietary formats, often in a rush to take advantage of Federal subsidy programs in Stage 1 Meaningful Use–as HTO’s EIC Ken Congdon stated, “electronic filing cabinets”–and heavily outsourced. Well, it’s now ‘uh-oh’ time as a key part of Stage 2 MU is interoperability. Basically we now have a set of what this Editor would term ‘paste ons’ and ‘add-ins’ to facilitate data exchange between systems that speak different languages (Editor’s emphasis):

direct protocol (a standards-based method for allowing participants to send authenticated and secure messages via the National Health Information Network), as well as those developed by HL7 (Health Level Seven), a nonprofit global health IT standards organization, provide EHR users with the building blocks for exchanging data. Blue Button, an application developed by the VA that allows patients to download their own health records, is also being adopted and manipulated by EHR vendors and independent developers as a way for providers to exchange data between systems. Moreover, regional and state-run HIEs offer healthcare providers in several parts of the country a network they can join (and technology infrastructure they can leverage) to share health data with other HIE members.

Some systems work well–EHR and pharmacy systems seem to. However, EHR to EHR interfaces are up to the provider and are expensive. Sharing/translation does not mean that all information makes it over without getting ‘bruised’ or having to be reentered manually.  HIEs, acting as a focal point for data exchange, are also generally non-profit; the exchange platforms cost millions to develop and further millions to maintain–and buy-in is low, as the article states. Fixing The EHR Interoperability Mess (free registration may be required)

(Updated 8/7 pm for Editor Donna’s POV) This is what happens when you rush adoption and development processes that should take years in order to gain quick subsidy money, and non-healthcare entities (that is you, the US Government) encouraged this, distorting the process. The private and public waste of scarce healthcare funds is appalling, and the disruption to the healthcare system is unforgivable–especially in practices where doctors and managers in many cases have been sold a bill of goods, and they are revolting by changing EHRs, going back to paper or retiring. And the Government should look to itself first. Look no further than to the multiple failures of two branches of the US government, Veterans Affairs and Department of Defense, which have the responsibility for current and veteran members of our Armed Services. They have failed spectacularly in serving Those Who Have Served not only the integration of their two EHRs but also in updating their basic architecture [TTA 27 July ‘Pondering the Squandering’… and 3 Apr ‘Behind the Magic 8 Ball’ both review the sad details.] The belief that HIEs with limited funding will solve the interoperability problem is Magic Thinking. At least one move in this direction makes sense: the CommonWell Alliance of six EHR heavy hitters to work on ‘data liquidity’ [TTA 5 Mar announced at HIMSS], but this may be another ‘uh-oh’ and face saving.

With basic, necessary health and patient information stuck in systems and getting lost in translation, how can anyone rationally expect that personal data from telehealth devices will be integrated anytime soon, in any meaningful way? Does this mean that parallel, separate systems and platforms will continue to develop–and yet another wave of integration?  

Alere Connect gains FDA approval for MobileLink

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/topper-mobilelink1-1140×180.jpg” thumb_width=”175″ /]We had been surprised at how quiet Alere Connect, the former MedApps, has been since its acquisition a year ago. Their latest news is that their newest and quite streamlined gateway hub, Alere MobileLink, has received FDA clearance to add to its recent CE Mark certification, clearing it for introduction in both US and Europe later this year. The US announcement also indicates that it will be packaged with Alere’s INRatio 2 PT/INR Monitor as part of home patient monitoring of anticoagulant medications programs through Alere Home Monitoring. This Editor notes that anticoagulant monitoring is ‘high-value’ and for remote monitoring, fairly different. Like the earlier MedApps HealthPal, it is also ‘vendor neutral’ compatible with multiple telehealth devices for glucose meters, weight scales, blood pressure monitors and pulse oximeters. Much of the emphasis of the new Alere Connect is how it integrates tightly with Alere’s programs and Connected Health informatics, care management and accountable care solutions, which is confirmed by CEO Kent Dicks’ quote included in the release: “The Alere Connected Health platform has the ability to connect flexibly with devices and systems regardless of their manufacturer and origin. The platform captures and analyzes data with robust analytics, and then backs it up with comprehensive health management services.” No information on rollout in UK or Europe. Release.

For long-time followers of MedApps, their HealthPal wireless hub is still being supported by Alere but will not at this point be integrated with INR monitoring. Also pending FDA clearance is a home health information tablet, Alere HomeLink.

Flashback: Integration of devices with service delivery providers was a major point brought up in our discussion of the MedApps acquisition value back in January, What a telehealth device company may be worth.  “What may be a better way is that device developers joint venture themselves from the start with health or service providers. And that those already seeking financing seek provider partners.”–Editor Donna

The exploding black market in healthcare data

When medical records’ black market value is estimated at an average of $50 per record–94 percent of health care organizations have had at least one breach in the past two years–and 2 million Americans were medical identity theft victims in 2011–it’s one unpleasant ‘pointer to the future.’

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/IDExperts_Infographic_v4_72-crop1.png” thumb_width=”150″ /]Data firm ID Experts studied a decade of data breaches and notes that medical data has become very attractive to professional hackers and cyber thieves. ID Experts’ full infographic.

  • First, there is so much of it with the increasing electronification of health data.
  • Second, so much of it resides on insecure or unsecured networks: smartphone, tablet, laptop.
  • Third, organizations and individuals still are only semi-conscious of fraud reality, and are negligent and sloppy when it comes to securing devices and over-reliance on the cloud without tight enterprise security. The new and underfunded health insurance ‘exchanges’ are particularly vulnerable as they, as well as other healthcare organizations, can over-rely on technology to protect data–which clever hackers can work around. Moreover, they can extract and sit on data till the trail goes cold. (Scroll down infographic to find out more). Also Ponemon Institute’s recent report in Healthcare Technology Online.

ID Experts’ study conclusions are reinforced by the California State Attorney General’s report that 55 percent of breaches “were intentional intrusions by outsiders or by unauthorized insiders” and that healthcare breaches were the third largest in reported incidents. A counter-measure may be the Medical ID Fraud Alliance, a collaboration in progress that is planned to include the Federal Trade Commission, the Secret Service and the Veterans Administration. More in Amednews.com (published by the American Medical Association)

Healthcare breaches due to criminal activity and plain error are becoming more common as well. All one has to do is bop over to Privacy Rights Clearinghouse, click on ‘MED’ for healthcare and 2013 and check the frequency to date (113) of breaches both tiny and huge. (By comparison, full year 2012 totaled 224.) Our TTA ‘Into The Breach’ Awards go to:   (more…)

Introducing the What in the Blue Blazes spot

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/blue-blazes.jpg” thumb_width=”175″ /]

When touting telecare and telehealth, sadly occasionally one encounters negativity, so I try to avoid negative comment myself for fear of adding fuel to the fire.  However, once in a while an item appears that really does pull you up short.  So TTA has decided to introduce a “What in the Blue Blazes” spot, to which reader nominations are also encouraged.

Pride of place as first entry is a new research2guidance report, Mobile Health Trends and Figures 2013-2017, which will lighten your wallet by £812 for individuals, and considerably more for multiple access.  The FierceMobile summary of the report is here.

As a (free) taster, this highlights 10 key trends that it reckons will shape the mHealth market until 2017.  These include:

1.   Smartphone user penetration will be the main driver for the mHealth uptake

2.  mHealth applications will be tailored specifically for smartphones or tablets

6.  Buyers will continue to drive the market

8.  mHealth market will grow mainly in countries with high Smartphone penetration and  health expenditure.

There are six more penetrating insights where these come from.

A  caveat on the survey methodology is that the “324 opinion leaders and mHealth app publishers” surveyed are largely with early-stage companies, with a sprinkling of consultancies and major players thrown in. Could this put a rosier picture on commercialization, market sizing and barriers than is realistically warranted?

It is of course up to our readers to determine the report’s value.  In the past, research2guidance reports have been favorably reviewed in TTA for their data analysis, which is also extensive here, and these can be of value. However for this Editor, it is our first ‘Blue Blazes’ award.

One step further towards smartphone-based health apps becoming autonomous

It’s my contention that telehealth, or whatever it is called then, will only start to have a really significant impact on reducing the burden on caregivers when the technology begins to move from decision support to decision taking; only then will clinicians be able to disengage from needing to be involved in every decision regarding a patient’s treatment and focus on those decisions requiring significant skill and judgement. Sure there are all sorts of genuine hurdles in the way like ensuring that the decision-making process is not compromised by other genuine – or rogue – processes taking place on whatever the smartphones is called in the future that is processing and transmitting information, and there have been several recent warnings on malicious hacking of medical devices, so it won’t be happening any time soon. However, given the way so many medical processes that began with manual involvement have moved steadily towards automation, from ECG to Point-Of-Care-Testing, hopefully one day these problems will be solved.

One pointer, reported in iMedicalApps, is three trials currently underway using smartphones to control artificial pancreases to manage diabetes. The smartphones in this case are completely locked down and are only used for the decision-taking process around closed-loop insulin delivery. Nevertheless it’s a step.

Encouraging adoption of telehealth by clinicians x 3

At the Royal Society of Medicine every year there is a medical students careers fair at which the Telemedicine & eHealth Section runs a stand.  Unlike other sections such as cardiology and general practice, we don’t see telehealth and other related technologies offering a career for many – the stand is purely to raise awareness because, scary as it may sound, many of the students who have visited us in recent years have never been taught about these technologies at medical school.  It is therefore good to see an article by Ben Heubl in Medcrunch, an online magazine aimed at tech-savy young doctors, discussing the reasons for slow adoption of telehealth (and telecare) which in part built on a meetup of the London Health 2.0 chapter last week.

In this context it’s also worth mentioning an article by Atul Gawande in the New Yorker on why some medical innovations spread fast, and other slowly.  He begins by contrasting the rapid adoption of anaesthesia with the slow adoption of antiseptics, both of which were discovered at about the same time.  From this he draws the lesson that where doctors see a clear benefit – in the case of anaesthesia, no longer having a patient struggling and screaming whilst being operated on – the adoption was fast.  Where the immediate benefit is harder to see and in particular it challenges the modus operandi – washing hands, sterilising instruments and replacing frockcoats caked in blood for clean white operating gowns – as with antiseptics, adoption was much slower even though the impact on patient outcomes was dramatic.   This not in any way a complete summary though – I would urge you to read this excellent piece in its entirety as there are many nuances…and important lessons for the future.

Rounding this post off, Pulse has just introduced a GP Guide to Telehealth (written and funded by MSD) which is short and to the point, balancing the UK experience of the Whole System Demonstrator with the very positive experiences of the Department of Veterans Affairs.  Much to be welcomed and with the added bonus of CPD points too.

Online psychotherapy as good as conventional therapy. Maybe even better!

In a randomised controlled non-inferiority trial, researchers from the University of Zurich have provided evidence of the effectiveness of internet-based psychotherapy, as compared with face-to-face consultations. Based on earlier studies, the Zurich team assumed that the two forms of therapy were on a par. Not only was their theory confirmed in this most recent clinical trial of 62 patients diagnosed with moderate depression, but the results for online therapy actually exceeded expectations. For both patient groups, the degree of satisfaction with the treatment and therapists was more or less equally high. However, in the medium term, online psychotherapy yielded even better results. University of Zurich News Release.

Snowden and digital health – the FT finds a worrying connection

The FT’s excellent journalist Gillian Tett has written a thought-provoking article on how increasing privacy concerns brought about by recent cyber surveillance revelations are threatening the ability to use ‘big data’ to connect specific genomic features with individual health conditions.  This in turn is threatening the ability to find and improve treatments and cures for many ailments.  All is not lost though; she describes a number of possible solutions, most notably a “people’s movement”.

Well worth a read even though it fits more under a wider definition of Digital Health than is conventional on TTA.

Now an accelerator for aging tech

Major Midwest non-profit aging services provider Ecumen and ‘innovation co-operative’ MoJo Minnesota are co-sponsoring The Age Power Tech Search, seeking young companies or subsidiaries of larger companies which have pioneered technology that improves the quality of life of older adults. To quote their announcement email, “AgePower differs from “incubators” or “accelerators” in that its focus is on transforming the future of aging and providing real-life test environments, along with access to business strategy experts in key areas necessary to fueling a successful new venture.” Advisory board includes many well-recognized leaders in aging services, thought and tech, refreshingly outside the usual Digital Health Hypester Horde (D3H). Four finalists gain a real-world test environment in Ecumen communities for six months. Both Ecumen and MoJo will take small equity stakes in the finalists as well.  Applications are due on 31 October; a 90-minute information session will take place on 13 August in Minneapolis (register here). Age Power Tech information and specs here.

Note to developers: This may be Minneapolis, but Ecumen is not only #17 on the 2012 Ziegler/LeadingAge list of US largest non-profit senior living organizations, but also a quick Google or LeadingAge search will uncover their large ‘thought leader’ role in both care and tech implementation. There’s no restriction on origination, but since MoJo’s put is developing business in MN,  if you are outside the state this Editor would expect a major factor would be a commitment to establishing a base there.

Angels to the rescue in health tech

Funding ‘angels’ in the health tech space are increasingly taking on roles that go beyond investing.  Venture-Med Angels has funded 24 companies in seed and Series A rounds, generally at less than $500,000 along with larger syndications, in areas as diverse as Class 1 and 2 medical devices, including diagnostics, as well as mobile health, health IT, telehealth and remote diagnosis. A key problem is in this admission–so many companies have similar products or services. Common to accelerators, the Angels give their help to startups in pitches, achieving milestones and understanding the importance of their intellectual property. From company name to investment, Venture-Med Angels advise startups (Entrepreneurship.com’s eMed/MedCityNews)

Alere under shareholder fire

Medical device and care management company Alere has come under fire from ‘activist investor’ Coppersmith Capital Management, which owns 7 percent of the company’s shares. Most recently in our pages for their acquisition and restaging of MedApps, now Alere Connect [TTA 4 Jan], Alere’s recent acquisition streak has added to revenues in its diagnostic unit and to about 9.1 percent growth in the past quarter, but not to profits. Struggling units such as Diagnostics and Health Information Solutions have helped to spiral debt. Coppersmith wishes to place three directors on the board at the shareholder meeting 7 August to stop the car crash of shareholder value and sell off assets. Management believes that it is carefully investing for the future of the company. Next week will tell. Alere’s losses triple as investor fight awaits (FierceMedicalDevices)

Smartwatches as the 2014 tablet, redux

Mobihealthnews does a very good roundup of smartwatchesboth familiar and not in this 10 page report. Most are in kickstarter mode, raising funds and some may never see daylight, but all a Pointer to the Near Future:  Pebble, AGENT, Kreyos Meteor (sounds like a sportscar), Sony Smartwatch, i’m Watch (from Italia), Motorola’s MotoActv, Androidly, Neptune Pine, the unfortunately named GEAK Watch, Toshiba, the Qualcomm Zola and the rumored Apple iWatch and Google Watch. If you want to watch smartwatches more, there is a website called The Smart Watch Review10 smartwatches that may take on fitness trackers

Previously in TTA: Smartwatches as the 2013-2014 tablet…and will they knock out fitness bands? at the end of the ‘Apple-ologist” article. A situation we spotted two weeks ago.

No more lying through your teeth, indeed!

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/tooth-sensor.jpg” thumb_width=”200″ /]By: Toni Bunting

A sensor embedded in your tooth could tell doctors if you have defied medical advice to give up smoking or to eat less!

Built into a tiny circuit board, the sensor includes an accelerometer that transmits data to a smartphone. So from each tell-tale jaw motion pattern, the software can work out how much chewing, teeth grinding, smoking, coughing, talking or (…okay I’ll stop there!) that you are doing.

The device can be fitted into dentures or a dental brace, and the team at the National Taiwan University in Taipei plan to miniaturise it further to fit into a cavity or crown. Results so far look promising, with the system having recognised ‘oral activities’ correctly 94 per cent of the time in tests to date. New Scientist and IEEE Spectrum have both covered the story. Paper: Sensor-Embedded Teeth for Oral Activity Recognition 

It kind of takes ‘wearables’ into a whole new sphere! Don’t you think?

Editor Donna addendum 2 August: We are refreshing Contributing Editor Toni Bunting’s story originally posted 26 July (original story and comments here), and moving it up as current. Once again TTA’s fresh set of Eagle Eyes have broken stories ahead of the competition, now twice in two weeks: first Charles Lowe with the O2 withdrawal (now up to 41 comments!) on 23 July and now this story.* While TTA will never be the spot for breaking news on a regular basis, when we see something, we will say something (to quote the NYPD). Our team of Editors will continue to interpret trends, cast the occasional Gimlet Eye or Blue Blaze in amazement at the direction some item is taking–and letting you know about it.

In Founder Steve’s words:

We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.

* Oh yes. Mobihealthnews just featured this dental sensor in an article dated 30 July (but they beat us to the Quantified Tooth), and got around to O2 on 29 July (see our Australia-based Contributing Editor George Margelis’ comments). We appreciate that UK and international is not their focus, plus we have benefited and cited from their timely coverage more times than I can cite….but a dapper hat tip would have been appreciated!

Telehealth in Thailand from Canadian company

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/08/KNT_ReFleX_Poster_H300.png” thumb_width=”180″ /]Demonstrating that companies can cross borders successfully [TTA 26 July], Vancouver-based ReFleX Wireless is conducting a paid trial of its telehealth system with Kluaynamthai Hospital Group (KNT) in Bangkok starting in October. Their eVitals patient portal/monitoring service will be used with KNT’s remote patients via its Geriatric and Stroke Centres as part of the KNT Virtual Hospital Strategy (see left). It connects with monitors such as the AQWave HeartRhythm mobile application. The lessons here for developers are:

  1. Trade missions can work, and quickly. ReFleX’s initial contact with KNT was through the British Columbia ICT Trade mission in June. Your Editor has not heard of US health tech using this channel–or maybe the barriers are higher.
  2. US and UK products should look to international competitions and markets. ReFleX Wireless originated as Project Z out of University of British Columbia, gained support from the local Wavefront Accelerator and was one of two winners in the 2010-2011 New York City Economic Development Corporation (NYCEDC) Next Idea competition, which invites ex-US applicants to NYC.
  3. Accept that the design will shift. ReFleX started as a multi-patient monitoring system for use in hospital wards. It’s now clearly being used for remote, at-home post-discharge patient monitoring.

ReFleX Wireless press release.