A ‘before the alarm’ approach to the soundtrack of ICU data

ICUs–and indeed, any acute care setting–have a soundtrack of boops and beeps that accompany regular telemetry of data from multiple devices. Alarms which indicate emergencies shatter the rhythm, eventually inducing ‘alarm fatigue’. What if ICUs could get a step or two ahead and use the torrent of data to predict a downturn in a patient’s condition and warn clinicians before that alarm goes off? That is the idea behind the system being developed at Boston Children’s Hospital with a local data analytics startup, Etiometry.  The latter’s Risk Analytics model is designed to transform data into clinically actionable information and to predict decompensation–a worsening or emergency status for the patient. For the cardiac intensive unit at BCH, the Stability Index pops up on the vital signs screen. “Doctors choose different parameters to measure, then the Etiometry system renders its risk assessment on a simple numerical scale, with 0 being most stable and 4 the least.” Not the first innovation for Boston Children’s either; with another software provider, they developed a single view of vital signs interface dubbed T3.  Boston Globe, FierceMobileHealthcare

Nike FuelBand out of gas

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/FuelBand.jpeg” thumb_width=”175″ /]In what is the first of the major players in fitness bands and wearables exiting the category, CNet reported last Friday that Nike is winding up its hardware business with the layoff last Thursday of nearly 80 percent of its Digital Sport staff. Previously, Nike had canceled a new version of the FuelBand due for release later this year, but they will continue sales and support for the present iteration which only works with Apple. Their focus is now on fitness and athletic software, which can plug into smartphones and other companies’ devices at far less cost and greater profit than the hotly competitive band business. Much of the speculation surrounds their strong Apple connection; Tim Cook, Apple CEO, sits on the Nike board. This maneuver could benefit them both greatly when Apple finally gets into the smartwatch biz. Perhaps two world-class brands could better sort out what to do with the data, which is another sore point according to PC Magazine’s take on it. Further reasonable discussion on this courtesy of Gigaom. Hat tip on the last to David E. Albert, MD via Twitter @DrDave01.  (Nike photo)

Why healthcare doesn’t encrypt: correct, incorrect assumptions

As our readers know, we’ve preached the Gospel of Data Security for quite awhile, to the point where even The Gimlet’s Eyes have crossed. Based on this smart analysis in Healthcare IT News (done by an outsider to healthcare), there are real reasons why HIT leaders are reluctant to implement encryption and security that would be SOP for other types of organizations. Mr. Schuman sorts the ‘drag the feet’ factors:

  1. Outdated but still widely believed: Encryption makes information less accessible across a broad network, increasing retrieve and review time. There is increased, not decreased, pressure to increase access, including by practices and patients, as part of  Meaningful Use (US).
  2. Encryption as a barrier: Providers see encryption as increasing time, decreasing  usability of systems, making workarounds more difficult.
  3. Encryption not permitted: Equipment designed with a specific hardware/software configuration block security add-ins. The logic is that any add-ins, even for security, could and do compromise performance. They thus violate manufacturers’ warranties and leave hospitals/practices open to legal action if equipment does not perform as intended.
  4. It’s complicated and pricey: Encrypting proliferating devices multiplicity of devices and systems takes manpower–it’s not only not there, but also expensive. Good intentions, but little money, is there.

The solution may lie in encrypting data between applications, not in the hardware/software itself. Hat tip to reader ‘Klondike Playboy’ John Boden.

Apple patents built in emergency alert for iPhone

Apple have filed a patent for a “Mobile emergency attack and failsafe detection” which uses the iPhone’s inbuilt sensors to detect a probable emergency situation, such as a physical attack against the user.  When the device is in ‘attack detection mode’, certain events can cause it to request help automatically, by calling a defined emergency contact or the emergency services. The GPS co-ordinates can also be transmitted. Apple Insider

A focus on Parkinson’s with Google Glass

Some pretty exciting work is happening at Newcastle University’s Digital Interaction Group with researchers evaluating the potential of Google Glass to support people with Parkinson’s. Much of the work is relevant to other conditions that affect movement, including Stroke and Multiple Sclerosis.

The great thing about Google Glass for people with motor control problems such as tremors, is that it gets around the difficulties in trying to negotiate the touch screen of a phone, or when trying to press a panic button. This is because the technology can be voice-operated and links to the internet. So in an emergency you can just tell it to call someone and it will. (more…)

BlackBerry’s investment: what’s in it for NantHealth

This week’s news of BlackBerry Ltd’s minority investment in the Dr. Patrick Soon-Shiong eight-company combine called NantHealth has generally focused on BlackBerry. Across the board, BlackBerry is depicted as the party badly needing a raison d’être. Down for the count in both retail and enterprise mobile phone markets it dominated for years, BB’s six-months-in-the-saddle CEO is now going back to those same enterprises singing the wonders of their QNX operating system and upcoming BBM Protected communication platform to highly regulated verticals which need max security: healthcare, finance, law enforcement, government. Although FierceCMO inaccurately reported that BlackBerry was acquiring NantHealth (Reuters/WSJ reports to contrary), it’s generated yawns from former tea-leaf readers such as ZDNet as yet another flail of the Berry as it sinks beneath the waves. Add to this the bewilderingly written CNBC ‘Commentary’ under BlackBerry CEO John Chen’s byline–who should fire the ghostwriter for inept generation of blue smoke and mirrors–and you wonder why the very smart Dr. Soon-Shiong even desires the association with a company most consider the equivalent of silent movies. It is certainly not for the investment money, which the doctor has more than most countries–an expenditure carefully considered at BlackBerry, undoubtedly. 

Cui bono? NantHealth first, BlackBerry second is your Editor’s contrarian bet. Consider these three factors:

  1. Way down the column in most coverage is that BlackBerry and NantHealth are developing a healthcare smartphoneIt will be optimized for 3D images and CT scans but fully usable as a normal smartphone. Release date: late 2014-early 2015 (Reuters). (more…)

ELabNYC Pitch Day

10 April, Microsoft HQ, NYC

The Entrepreneurship Lab NYC (ELabNYC) presented its second annual class of companies to nearly 200 life science funders, foundations, pharmaceutical companies, healthcare organizations, universities and the occasional Editor. Of the cohort of 19 companies finishing the three-month program, 56% are now funded and 25% had first customer revenue by the end of the program. Each company pitched for five minutes on its concept, its current state of advancement (including pilots/customers), its team and a funding timeline. This Editor will concentrate on the five companies with a digital health component; she was intrigued by their diversity and focus on difficult problems of compliance and diagnosis, especially dementia and concussion. (more…)

eCaring gains Series A financing (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/eCaring-Screenshot.jpg” thumb_width=”170″ /]Home care management/monitoring system eCaring (New York) this week secured $3.5 million in Series A funding, led by Ascent Biomedical Ventures. Private investor Stephen Jackson will be joining the eCaring board, as well as being on the board of client MJHS. Funding will go to product development, sales and marketing targeted to managed care plans, home health agencies, payers, hospitals and related entities. The CareTracker program is unique in that caregivers/aides with relatively low English language or computer literacy can, through icons, easily input both clinical and behavioral information on a home care patient which summarizes by patient and aggregates at the care manager level. There is also a CarePortrait feature that determines baseline norms for behavior such as activity and sleep. eCaring, with Pace University, was also one of 2013’s PILOT Health Tech NY/NYEDC/Health 2.0 winners for a project with the Henry Street Settlement. A big cheer for CEO/founder Robert Herzog who has been championing this aging services/aging in place technology for several years while QS apps and fitness trackers stole all the buzz at the cocktail parties and accelerators. Release, MedCityNews (photo)

Vision therapy app for amblyopia prescribed, reimbursed (DE)

Amblyopia, also known as ‘lazy eye’, is a treatable vision processing disorder where vision in one eye decreases for no structural reason. It’s often seen in young children and is generally treated with a combination of patches (to block the stronger eye), eye exercises and glasses–on occasion, requiring surgery–in a process that can take up to two years. In a young child, that is a recipe for tedium. Caterna Vision Therapy, a spinoff from Technische Universität Dresden, has advanced the exercise portion to be child engaging and downloadable through the Apple App Store and Google Play to a PC or mobile device. Caterna claims the exercises also shorten length of treatment. The therapy is CE marked for Europe and in Germany is both prescribable and reimbursable through statutory provider Barmer Gek, fortunate as the cost is €980. It may presage more apps receiving similar treatment. Videos are available in English and German on their home page. Caterna hopes to expand their vision therapies into age-related macular degeneration (AMD) and eye-tracking.  eHealth Law and Policy

EU green paper on mHealth – VERY IMPORTANT

This week the European Commission published its green paper on mHealth previously announced in the eHealth Action Plan 2012-2020, kicking off a broad stakeholder consultation on existing barriers and issues related to mHealth deployment and helping to identify the right way forward to unlock mHealth potential. To accompany it, a very short video by Neelie Kroes is available. An accompanying short (10 page) paper by the EC on the current legal position for people using health & wellbeing apps is also well worth a read. Finally, to complete the set, the EC has produced an mHealth infographic as well.

Responses to the Green Paper are required to the European Commission by 3rd July at the latest.

In view of the potential for mHealth to benefit everyone if correctly regulated and supported, all readers are urged to respond, either individually or collectively via an industry body (eg DHACA – see below), or both.

The document, at only 19 pages long, is hugely impressive, making an excellent case for (more…)

Looking ahead with TeleSCoPE (EU)

Perhaps because we have covered the topic before, a cryptic email arrives from Malcolm Fisk, the driving force behind the development of the European Code for Telehealth Services, suggesting I consult the TeleSCoPE website and his Med-e-Tel presentation last week where “you’ll see a little announcement that indicates that things are moving forward”.

The website now includes a yellow box with the statement:

The framework for telehealth services to be assessed against the requirements of the European Code of Practice for Telehealth Services is being released on May 16th 2014. This follows collaborative work between the Telescope Partnership and DNV Healthcare. A four year cycle has been agreed that includes a Foundation Assessment followed by (mostly off-site) reviews and conformity checks. Accompanying the framework will be the new version of the Code by which the first tranche of services will become accredited.

…and the presentation includes, at the end, (more…)

Two new health applications for Google Glass

Beyond the surgical suite [TTA 24 Sept, 16 Nov], developers keep building platforms that enable telemedicine consults with Google Glass. An exciting one is Beam, developed by Remedy, which allows clinicians to securely share images, text, video and location through Glass. The consult can either be live streamed (synchronous) or store-and-forward (asynchronous) through Beam’s ‘expert interface’. Harvard and The University of Pennsylvania started pilots of Beam in March. The intriguing background is that one of the co-founders, Noor Siddiqui, is but 19–albeit one who has a Thiel Fellowship which gives young entrepreneurs the $100,000 opportunity to skip college and work on their project. Fast Company/Co.Exist, MedCityNews, press release via Telepresence Options. A bit more ‘out there’ is Personal Neuro Devices’ Introspect PND Wearable, a ‘passive brain monitor’ that based on the pictures, is an add-on to Glass that surrounds the head from back to front, with two sensors that extend between the ears and eyes. Ottawa, Canada-based PND claims it reads brain waves and the app then applies the changes to provide feedback, such as special content to modulate moods (their other business.) Release, PND page with video/pictures, ApplySci

US Army mCare app’s most-liked feature: appointment reminders

A two-year study on the mCare mobile messaging app used to support ‘Wounded Warriors’, published in the June issue of Telemedicine and e-Health, found that the most popular use of this US Army-implemented program was the appointment reminders (85 percent). 70 percent continued app usage for six months, with the same percentage using it multiple times per week, making the app very ‘sticky’. Other features were wellness tips, care team reminders, care team messaging and announcements. Average participation was 48 weeks. ‘My Appointments’ was created about halfway through the study (January 2010) and other rolling changes were made. The regional US Army Community-Based Warrior Transition Units (CBWTU), which coordinate care for soldiers who receive outpatient care in civilian facilities due to distance from military facilities (and Guard/Reserve status), enrolled 497 veterans in five states who required at least six months of complex care. Satisfaction was high, with 78 percent of soldiers stating that mCare improved their experience in the transition unit, and half of the 75 care teams reporting that they saw an improvement in appointment attendance among patients using mCare.  The results are strong and mCare continues to be used by the Army. The study was headed by Col. Ronald K. Poropatich, MD, Deputy Director of the Telemedicine & Advanced Technology Research Center (TATRC).

Unlike most other research studies, this one had some unusual hurdles to overcome. There were significant changes in ownership of mCare’s contracting company during the main study period (May 2009-April 2011, with a follow on study completed December 2012). First developed by AllOne Mobile [TTA 20 Nov 2009] with security provided by partly-owned Diversinet, AllOne ‘zeroed out’ of business halfway through the study [TTA 20 April 2010], with Diversinet picking up the program after a legal wrangle. mCare was named one of the US Army’s ‘Greatest Inventions’ in September 2011. Diversinet itself, after a seemingly successful period having its MobiSecure platform adopted by AirStrip [TTA 24 Feb 2012], a five-year, $5 million Canadian distribution deal [TTA 14 Jan 2011] and continuing military contracts, could not pull itself into financial health and was acquired by ‘velocity of big’ IMS Health for a small $3.5 million last AugustAdditional study coverage in Mobihealthnews and iHealthBeat.

If you are having telehealth terminology turmoil

…consider the US Government. A survey of 100 respondents across 26 Federal agencies participating in the Federal Telemedicine (FedTel) Working Group presented multiple definitions of telehealth in use by agencies. Combining iHealthBeat’s summary with some extra commentary in Becker’s:

The Agency for Health Research and Quality defines telehealth based on evolving technology and adopted definitions for telehealth that fit the technology being used;

CMS and the Office of the National Coordinator for Health IT (ONC) both define telehealth as the use of telecommunications and IT to provide access to diagnosis, health assessment, information and patient care;
The Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance” health care and lists some of the specific technology used to transmit data; and
The Indian Health Service uses specific health technologies in its definition, such as videoconferencing and remote patient monitoring. (Becker’s: the “telehealth toolkit encapsulates real-time videoconferencing, store-and-forward consultation, secure messaging, remote patient monitoring and mobile health services.”)

The report found that definitions also varied for health-related agencies outside of HHS. For example:
The National Institute of Standards and Technology (NIST) uses the American Telemedicine Association’s (ATA) definition;
The Department of Agriculture uses definitions of specific technology such as electronic health data and telecommunications; and
The Department of Veterans Affairs (VA) defines telemedicine as something that should be used “with the intent of providing the right care in the right place at the right time.”

One wonders if the FedTel members spend a good deal of governmental time defining their definitions and sorting through the variations. Which is why, for our readers in over 120 countries, your Editors try to stay away from the ‘inventive and idiosyncratic’ and mainly stick with the definitions you see in our right sidebar. Becker’s Hospital CIO. Full study published in Telemedicine and e-Health (May) courtesy of Becker’s.

First kick at World Cup will be by exoskeleton-equipped paraplegic

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Exoskeleton_WEB.jpg” thumb_width=”170″ /]A Duke University team’s robotic exoskeleton will be worn by a Brazilian for the ceremonial first kick at the first World Cup match (Brazil-Croatia) in São Paulo in June. According to Mashable, the development of the lightweight alloy (though not in appearance from the video) body assistive ‘walking suit’ is by a multi-national team headed by Duke professor Miguel Nicolelis. The suit is connected to an electrode cap that uses brain waves to direct physical motion, enabling the wearer to ‘think and move’. Prof. Nicolelis has trained nine Brazilian paraplegics, ages 20-40 with different types of paralysis, to use the suits, and three will participate in the opening ceremonies. Guardian (also illustration) Duke University video (Mashable).

Stick on that comfy sensor patch

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/skinpatch-1-John-Rogers.jpg” thumb_width=”150″ /] From the head researcher (John Rogers at the University of Illinois at Urbana-Champaign) who brought you biodegradable implanted batteries and sensors [TTA 26 March], comes an almost tattoo-like stretchable sensor conforming to the skin which uses off-the-shelf, chip-based electronics for wireless monitoring. It is envisioned for wireless health tracking connecting to smartphones and computers, and for vital monitoring such as ECG and EEG testing, although this Editor would not use the term ‘clinical’ as Gizmodo has done (it is probably at the fairly sound level of an AliveCor.) However the article points out the advantages in long term use–adherence to skin is far more reliable, no dangling pendants or clunky bracelets, and it allows for multiple sensors to be worn comfortably. This type of patch would also be far kinder to the delicate skin of babies and the elderly. For them, it would make consistent long-term telehealth monitoring (e.g. blood pressure, ECG, O2, blood glucose) far easier over time. Perhaps the core of this is the PERS of the future with gait tracking and fall detection. Cost isn’t mentioned, but off the shelf elements undoubtedly are less expensive than custom/bespoke. Published in Science 4 April (abstract and summary; full text requires log in) Also see Editor Charles’ earlier take–maybe Mr. Rogers should speak to him!