ATA 2014: TTA is now a media sponsor

click to enlargeThis publication is rarely a media sponsor of conferences, by choice. When we are, it’s because the conference and the organization is significant to the progress of healthcare technology in remote monitoring and related areas. The American Telemedicine Association (ATA) is one of those special organizations in their long-standing advocacy of global telemedicine and telehealth. We are pleased to announce we are joining their distinguished roster of 2014 media partners.

The 2014 conference is being held in Baltimore, just north of Washington DC, from Saturday 17 May (pm) through Tuesday 20 May. There is a very full schedule of pre-meetings, local chapter/co-located meetings, multiple education tracks,and several keynote speakers. Highlights:

  • Industry executive sessions with major companies in telemedicine on Monday and Tuesday
  • Sunday, the ATA Telemedicine Venture Summit with law firm Jones Day has leading industry stakeholders and policy makers speaking, in addition to structured networking and matchmaking opportunities (more details, release)
  • The new Innovation Spotlight: Monday highlights interviews with telemedicine startups (release); Tuesday, ATA’s partnership with the XPrize Foundation (release).
  • For those who cannot attend onsite, there are virtual assets including ePosters and ATA TV.

More information and registration here. Twitter: @ ATA2014. ATA 2014 on Facebook here.

Editor’s Note: This Editor hopes to be able to attend the Monday sessions. Prior commitments prevent her from attending the other days. If you are interested in contributing coverage from one item to a day, please contact Editor Donna about arrangements. Our gentle requirements are that you send a timely report (within 72 hours) from this event. Our standard is that you can be selective and interesting rather than comprehensive. Of course you will receive writing credit, but other expenses will not be covered.  

Disruptive innovation in healthcare hasn’t begun yet: Christensen

Clayton Christensen, as many of our readers know, pioneered a theory of disruption in business models and a three-step cycle of innovation (empowering, sustaining and efficiency, now quite broken indeed). With two other writers, he applied these theories to healthcare in the 2009 book ‘The Innovator’s Prescription’ which this Editor heard co-author Jason Hwang, MD present in 2009 at the Connected Health Symposium and at a private meeting in 2011. One would think that we’d be well into disruption, which is part of the empowering innovation cycle and which the authors championed in the book as underway.

The surprise at the end of this Mobihealthnews article on his recent presentation at “Better Health” in Boston, a McKesson-sponsored meeting series, was not what constitutes disruption, but that it has not really started yet, four years later. This will be much to the surprise of many successful and unsuccessful companies (Misfit ShineZocDoc, Zeo, 23andMe) and health plans which have stoutly touted their products and services as The True Disruptors. Sorry, you may be only a part of the Big Shift: decentralization. Decentralization will push out parts of healthcare off the hospital (more…)

European Knowledge Tree Technology Group Conference summary (UK)

This conference was held in a very salubrious conference facility at the LSE on March 24th & 25th. The organiser – Maggie Ellis – delivered her customary eclectic selection of contributors: there was a very broad range, from telecare and telehealth stalwarts through to insurers specialising in the financial issues of older people, management gurus and broadcasters advising on how best to get a story on radio or TV. In short it is like no other, and so has a faithful following among a certain group of assistive technology professionals, many of whom travel from continental Europe and beyond to be there.

Almost no-one talked about proving benefits of assistive technology; the focus was on how best to deliver those benefits that no one doubted were achievable. The highlight for me was (more…)

Redesigning PERS artistically in Glasgow

Students at the Glasgow (Scotland) School of Arts are participating in a redesign of the traditional medical alarm (PERS)–the ubiquitous (among the old-old) neck or wrist-worn pendant. Sponsored by Chubb Community Care (part of Chubb Fire & Security in the UK, not the insurance company), the challenge is to design a pendant/watch from the user/carer/professional point of view on design and functionality. There are currently five groups competing for a £250 first prize plus second and third prizes. We understand from Chubb that the prizes will be awarded shortly and this Editor will bring you the results. How far afield will the teams will go? We hope as far as they can!  Chubb release

A snapshot of telehealth and telemedicine in rural America

Telehealth and telemedicine (virtual consults) are moving forward in large and largely rural Nebraska and neighboring Iowa. The Nebraska Medical Center not only has an executive director for telehealth (not buried in an HIT department) but also no less than 13 initiatives in process from stroke to cancer care. Video networks connect rural hospitals with medical centers. The VA’s leadership in this geographic area has been crucial, with over 550 patients in home telehealth in Nebraska – Western Iowa and additional telemedicine programs for psychiatry, wound care, nutritional counseling and infectious diseases. Videoconferencing equipment in hospitals and public health centers, installed in a mid-2000s program, is being repurposed for video consults. Interestingly, its use in this region is not new. For 10 years, a University of Nebraska Medical Center (UNMC) psychiatry associate professor has been having routine video psychiatric consults with elderly nursing home patients. Telemedicine’s first use in Nebraska was also psychiatric–55 years ago–by a University of Nebraska Medical Center dean using undoubtedly black-and-white two-way video. Doctor’s home visit is back — kind of — as telehealth flourishes nationwide (?–Ed.), Omaha World-Herald

A new analysis of telehealth implementation in the UK

A new report analysing the telehealth development in the UK and proposing improvements has been click to enlargeproduced by Inside Commissioning. The report  Tackling Telehealth – how CCGs can commission successful telehealth services is written by a panel of authors led by Dr Ruth Chambers who co-chairs NHS England’s Task and Finish group for commissioning skills and capability for the delivery of Technology Enabled Care Services (TECS).

The UK has been experimenting with telehealth as much as any country in the world and has notably carried out the largest clinical trial of telehealth anywhere, the Whole System Demonstrator (WSD). WSD produced some valuable results with regard to telehealth benefits, including reduced mortality, and was instrumental in the launching of the key government telehealth programme, 3 Million Lives (3ML) in 2011.

Last year the GP magazine had carried out a major survey of telehealth implementation in the UK by making information requests from all 176 Clinical Commissioning Groups (or CCGs, a new administrative unit introduced by the current government) under the Freedom of Information Act (a common technique to gather official data).  A comprehensive analysis of the returned data (108 out of the 176 had responded) forms a major part of the Tackling Telehealth report.

The research results reported are mixed. Some of the results make painful reading. The 3ML target of 100,000 telehealth users in seven pioneering “pathfinder” areas by end of last year was dismally missed with the actual figure being below 3,000. In one pioneer area the local council had withdrawn a telehealth tender due to lack of a supplier able to meet the requirements. Another 3ML pioneer area had decided to decommission its telehealth services. Meanwhile other CCG areas have reported more than 1,000 telehealth users each and one had budgeted £1M for services this financial year.

The report looks at what needs to change for telehealth to be successful and follows this up with a case study.

This is a very well written and professionally presented report. I do have one reservation though. The case study deals with the selection of a supplier for telehealth products in Nottinghamshire and quite blatantly that selected supplier is noted as a co-producer of the report. I think this does bring the independence of the report into question and somewhat spoils the authority which it may otherwise have had.

The report is free to download so long as you register on the Inside Commissioning website here.

Excellent new report on using digital tech in health

An excellent new report is out now on the use of digital technologies in health systems covering all the click to enlargekey areas of application. A digitally-enabled health system studies the Australian health system and how it is to be improved by the use of various digital technologies.

Published by the Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia’s national science agency, this is a well researched and written report with the underlying analysis applicable to most countries, not just Australia. With contributions from eight experts, and presented in clear language, this is well worth a read. A free download of the report and links to infographics are available on the CSIRO report page.

Australia, in common with many other countries, faces pressures on its health system: “Treasury estimates suggest that at current rates of growth, and without significant change, health expenditure will exceed the entire state and local government tax base by 2043, and require almost half of all government taxation revenue” says Sarah Dods in the introduction to the report. CSIRO suggests several developments to meet this challenge – no surprises here, but nevertheless useful to remind ourselves of these: reduce reliance on hospitals, better manage hospital resources, make in-home patient monitoring (telehealth) the norm and introduce rigorous data security and privacy.

On hospital admissions there is a discussion on managing CSIRO logoEmergency Departments and re-routing ambulances to hospitals with shorter queues, a practice that is already taking place in some parts of the country. There is a section on the use of RFID tags to manage both equipment and continuity of care in hospitals. Another section looks at telehealth and self-monitoring. Other sections look at video conferencing (“tele-presence”) and remote diagnosis.

FDA finally issues proposed rule simplifying medical device classification

The FDA has now published its proposed rule simplifying its medical device classifications as directed by the 2012 FDA Safety and Innovation Act (FDASIA). This permits reclassification by administrative order versus the rulemaking (notice and comment) process. (Presumably this rule, as part of the latter process, sets up the process for the former.)  In the US, the Food, Drug & Cosmetic Act (FDC Act), which FDASIA amends, has three classifications of devices from least restricted (Class I general controls) through premarket approval (Class III).  

As published yesterday in the Federal Register, the class definitions are being amended to balance the assurance of safety and effectiveness with “the level of regulation necessary to provide such assurance should be closely tailored to the risk presented by a type of device.” The long-awaited changes are seen as highly favorable for mobile health devices and apps which for the most part do not fit neatly into the present Class I-III structure.  (more…)

Biocompatible batteries for ‘sensors of the future’

click to enlarge Pointer to the Future. Implantable medical sensors and devices have a main drawback–their power source. Current batteries are bulky and must be manually removed. External power transference means fairly bulky outside and inside devices.

What if the sensor and batteries could simply dissolve harmlessly in the body when no longer needed?

Research from John Rogers at the University of Illinois at Urbana-Champaign and his team first led to biodegradable (in the body) electronics in 2012, and now dissolving batteries (above). (more…)

Pacifying baby, taking temperature

UK developer BlueMaestro has announced a temperature-sensing baby pacifier with the somewhat obvious name Pacifi. According to Mobihealthnews (but frustratingly not on their website), the pacifier sends temperature data via Bluetooth Smart to an iPhone or Android app. Parents can record medication dosing and reminders, track temperature and medication over time, and set up an alarm when baby runs a high predetermined temperature. It’s also dishwasher safe. Pacifi joins Raiing Wireless‘ body thermometer FDA cleared in 2012 (now iThermometer) and Kinsa’s plug-in smart thermometer which took a crowdsourcing approach to local public health. It is not cleared for sale yet in the UK or US, but was shown at last month’s Mobile World Congress Barcelona and the Smart UK Project in London. Unfortunately, it may be a while before Quantified Self Moms can put it on the list for their baby showers, along with the Owlet monitoring sock, Mimo onesie and iTeddy [TTA 10 Sept]. Related: MedCityNews compares Mimo to adult sleep monitor Lark, awarding the matchup to Mimo. The real matchup is Owlet versus Mimo (see this Editor’s comment). (Also see our comments here discussing the safety of RF monitoring around babies.)

NHS futures: Personalised and Preventative Care presentation

Courtesy of Accenture, we now have (perhaps exclusively?) Aimie Chapple’s full presentation delivered at the NHS Futures Summit in November. The link is contained at the end of Editor Charles’ article on ‘NHS futures – more encouraging signs of change‘ which puts it into context and is definitely worth your reading time. Hat tip to Mark Radvanyi of Accenture for providing Personalised and Preventative Care: Technology Trends and Disruptors that will Shape the Healthcare Transformation.

DARPA’s brain injury ‘blast gauge’

This Editor, as our long-term readers know, has been following the issue and the dangers of soldier TBI and PTSD for several years. One of the problems with TBI is measuring the amount of blast a soldier has actually sustained in battle–and thus the medical danger. A cheering development is the further development of the ‘blast gauge’ developed by DARPA and the Rochester Institute of Technology (RIT), the testing of which we noted in mid-2012 [TTA 12 June 12]. It is now smaller than a wristwatch (now thumb-sized) and worn in three positions attached to a soldier’s body armor: chest, shoulder and back of helmet. As in the wristwatch model, there’s a red-yellow-green light for an instant read, in addition to the downloadable data which a medic can interpret on a laptop using a USB cable. It is now being worn by 11,000 US troops and 1000 Australian soldiers in Afghanistan. (more…)

Music, art app for Alzheimer’s patients; diagnosing brain performance

GE Healthcare has developed an iPad app, MIND, for patients with Alzheimer’s and other neurological disorders which presents favorite music, music videos and a virtual art gallery. The aim is to stimulate the brain, evoke emotions and promote social interaction.  This extends the pioneering research from New York City’s Institute for Music and Neurologic Function‘s Music and Memory program, which provides personalized music on iPods for those with both cognitive and physical challenges in long-term care to improve quality of life and reduce anti-psychotic drug use. GE release. Website.

Another approach to brain diagnosis and therapy for Alzheimer’s, stroke and brain hemorrhage may be pioneered by Multineurons. This startup has developed a head-worn sensor device that works with an iPad app, WakeUp, for non-invasive brain diagnosis and therapy. It measures speed (connectivity of neurons), fitness (neuroplasticity) and robustness – at 10 different points in the brain. Testing is planned to start in a Swiss rehabilitation facility this summer. MedCityNews

Augmenting human performance in the USAF

A pointer to the future is how the US Air Force is taking a new look at what we call telehealth and they call Human Performance Monitoring. Current sensors are large and complex in measuring heart rate, blood pressure, blood oxygenation and skin temperature–critical data for pilots and other airmen. For instance, the USAF measures O2 in F-22 pilots to determine effects and compensate to keep both man and machine safe. Not only do they want to make sensors smaller–like skin patches–but also these are key to a new concept in aviation medicine called Human Performance Augmentation, which will measure human health status in real time. And both play into Human Systems Integration, which integrates man and machine. The implications here for civilian use are many: miniaturization of sensors into wearables, real time telehealth and machine assistance for human tasks. Performance-detecting Biosensors (Armed With Science)

CVS Caremark’s employee wellness ‘stick’ revisited–in court (US)

Exactly a year ago, retail drug store/onsite clinic/PBM giant CVS Caremark unveiled its ‘big stick’ approach to employee wellness–if you are in their health plan, you must participate in their ‘voluntary’ health screenings and management program or be charged $50 per month. One employee is now suing about this in Alameda County (Oakland/San Francisco, California area) Court.

According to the Courthouse News Service, the complaint states that “During the ‘Wellness Exam,’ a doctor performs blood work, which, upon information and belief, is utilized by defendants to ‘flag’ employees who are at risk for a variety of medical conditions.” Also from CNS, “In addition to the exam, which Watterson says she had to pay for, CVS made her fill out a survey that asked personal questions such as weight, body fat percentage, whether she drinks or smokes and is sexually active. The survey was “required in lieu of a $600 fine,” according to the lawsuit.” (Editor’s emphasis) If she had the exam in-house–at a CVS MinuteClinic–it also would have cost her $125 out of pocket, so she went to a private physician who charged her the co-pay, $25. She’s seeking compensation for “class certification and damages for failure to pay hourly and overtime wages, failure to indemnify, illegal wage deductions, failure to provide accurate wage statements and unfair competition.” 

All of which was easily predictable that CVS Caremark would be asking these questions, as they are fairly standard in a health workup –but is the ‘cross the line’ part (and what most of the dither may be about) the last item noted?  (more…)

Pilot testing of telehealth service in Philippines

Filipino company Metro Pacific Investments Corporation (MPIC) plans to offer telehealth services in its hospitals allowing Filipinos in remote areas to avail themselves of healthcare services, reports Interaksyon, the online news portal of the Philippines TV network TV5.

In a briefing last week MPIC Hospital Group president Augusto Palisoc has said it is piloting a telehealth service involving two machines located in company-owned Asian Hospital and another in a government hospital in Batangas. This will allow patients in remote areas — with the assistance of a professional with medical training — to seek diagnosis or the advice of doctors in a base hospital, the article says.

Metro Pacific’s planned venture into telehealth is part of its efforts to look at other healthcare delivery processes in addition to its regular hospital investments. MPIC operates the largest private hospital group in the country with approximately 2,150 beds. Its network includes the Makati Medical Center, Cardinal Santos Medical Center, Our Lady of Lourdes Hospital, Asian Hospital & Medical Center, De Los Santos Medical Center, Central Luzon Doctors’ Hospital in Tarlac, Riverside Medical Center in the Visayas and Davao Doctors Hospital in Mindanao.