Health funding cuts in Australia

Health and science funding in Australia are facing huge cutbacks under the new Government click to enlargeof Prime Minister Tony Abbott leading to expectations that the existing telehealth programmes will be reduced or abandoned as a direct result. A raft of cuts include closure of health and science agencies, funding cuts to major research institutes and the introduction of co-payment for each GP visit.

The Guardian reported that a cut of $1.8 billion of planned health payments to the States will take place over the next four years and The Lancet reports that the government’s share of the health service funding will be cut by $15 billion per year by 2024. The treasurer for New South Wales has stated that NSW itself would need to find an extra $1.2 bn over the next four years. ABC reported yesterday that the South Australian Government is planning to shut hundreds of hospital beds in next month’s budget in what will be the largest cut in its history.

Where will this leave the Australian telehealth and telecare services which have been showing rapid take-up in the recent past, helped along by several far-sighted Government initiatives such as Medicare Locals and telehealth pilots? And what impact will there be on the recent One in Four Lives industry initiative?

 

Another Khosla pronunciamento: self-promoting but myopically correct?

click to enlarge The Gimlet Eye returns and delivers some hefty weekend reading…. Like General Douglas MacArthur, The Eye had to return from my Remote Pacific Island sometime. What better reason than to deliver to our readers Mr Vinod Khosla’s, tech investor and now Health Futurist, latest pronunciamento via VentureBeat.

It is, as they said in 1950, a beaut. It’s apparent Mr Khosla need not even speak at conferences anymore, because he can publish on his investment company’s website a ‘Draft’ entitled ’20 percent doctor included: Speculations and musings of a technology optimist’. It is being treated in certain quarters like Moses toting The Big Tablets down Mount Sinai; at the bottom the DH3 (Digital Health Hypester Horde) swoon in the usual places.

Mr Khosla reiterates some of his bomb-thrower memes from a couple of years ago: 80 percent of doctors could be replaced by machines, doctors were clinging to ‘voodoo-like practices’ and eventually we will not need doctors because we’ll be weller through technology and Big Data anyway. But the Eye’s Review of the ‘Draft’–which Eye was prepared to give the Gimlety Treatment–is that his prior attention-getting statements are not only more qualified (or stated more gently), but also backed up with real data, examples and mostly memorably, legitimately forward thinking whch largely avoids blaming doctors and shifts it onto the laggard Medical Establishment. “In fifteen years, data will transform diagnostics, to the point where automated systems may displace up to 80-percent of physicians’ standard work. Technological developments will AMPLIFY physicians’ abilities (more…)

More on DARPA’s ‘brain chips’ for PTSD, TBI

DARPA’s continued research on deep brain stimulation (DBS) implants to treat PTSD and TBI, as well as other neuropsychological conditions, is given the once-over in this Defense One article. New information from the time this Editor last wrote about it in December is that the SUBNETS program (Systems-Based Neurotechnology for Emerging Therapies), funded with $12 to 26 million, will work with the University of California at San Francisco, Lawrence Livermore National Lab and Medtronic to create an implant with electrodes reaching into the brain and which does not require staying still under a machine in a lab. The prototype development is expected to take five years. The article also points out the US Air Force initiative studying the effects of low amounts of electricity on the brain to boost alertness delivered by an external cap.

Samsung’s ‘shot over bow’ in health

Watched closely as part of Samsung’s various moves in health (here in the US heavily promoting the S5’s heart monitoring capabilities) is their unveiling of a reference hardware called the Simband, a wristband designed for interchangeable body sensor modules yet in fact to be developed. Its platform is dubbed Samsung Architecture for Multimodal Interactions (SAMI) and is part of an open ecosystem which invites developers “to design and integrate their own sensor technology and, through the SAMI platform, develop applications and algorithms for wearables.” The design was in partnership with the biosensing institution Imec and will be available before end of 2014.(Gizmag) Coming before Apple’s Worldwide Developers Conference (WWDC) and the rumored announcement of the Healthbook iOS app [TTA 22 Mar]…the Samsung-Apple wars continue, and not in court. Also Gizmodo

‘Fashionable safety’ alert device for women

click to enlargeOut of Singapore is a pretty silver necklace or bracelet that does more than adorn: with the press of its small silver button, it can help the wearer get away from an uncomfortable or harassing situation in a public setting (like the workplace, a bar or party) by sending that ‘nick of time’ fake call to your iPhone by Bluetooth LE. Or if held down for over 3 seconds in an emergency, it sends an SOS text, coordinates and a Google Map link via the phone to designated recipients (not law enforcement.) The Guardian Angel pendant was developed by ad agency JWT Singapore to support AWARE (Association of Women for Action and Research) in Singapore through a 10 percent per unit donation, and is available at local retailer My Room Retail or internationally via their website for US$120 (UK£71) plus shipping, handling and optional bracelets. What isn’t clear is if a smartphone is needed–the website indicates that an app must be downloaded from the Apple AppStore but the Daily Mail article says it works with any phone. Also PSFK review, ABC (US) News. What’s a little disappointing is that the first function (‘get me away from this creep’ self-call) is being more widely touted than the second (‘the creep is coming after me with handcuffs, and he’s not a cop’ SOS). This Editor also wonders how reachable the necklace in particular would be in a truly dangerous situation. But it is certainly better than the alternative. Hat tip to Editor Toni Bunting.

click to enlargeIn TTA 6 March we covered another ‘fashionable safety’ item, the First Sign hair clip, which is more violent crime deterrence and recording-oriented. It senses impact and sends audio/video/GPS location to monitors plus designated recipients along with a pre-recorded announcement that it is gathering evidence. It succeeded in its Indiegogo financing round and is available for pre-order here for estimated November delivery at $50-75 plus monitoring. But so far, fashion hasn’t made its way into the maddeningly institutional PERS design (though Chubb has given it a whirl with its Glasgow competition recently.)

Addiction: Improving Outcomes using Computer-based Therapy

Computer-Based-Behavioral-Therapy-Shows-Promise-For-Addiction-Treatment

A recent randomised control trial gives support to the use of computer-based therapy for treatment of addictions. The results were reported this week at the annual convention of the Association for Psychological Science in San Francisco, following publication in the American Journal of Psychiatry. Although the trial focused specifically on cocaine-dependent individuals, it replicates findings of a RCT carried out in 2008, in which participants had a wider range of substance addictions.

Results of this latest study show that those who received computer-assisted therapy were significantly more likely to attain three or more consecutive weeks of abstinence from cocaine as compared to those not receiving any form of Cognitive Behavioural Therapy (CBT) – 36% compared with 17%. And the effects appear to last; the control group also had better outcomes six months after treatment had ended.

Individuals who receive CBT learn to identify and correct problematic behaviours by applying a range of techniques.  Central elements of the therapy include anticipating likely problems, correcting harmful thought patterns, and developing effective coping strategies. The techniques enable people to counteract addiction’s powerful effects on the brain, so they can regain control of their behaviour and lives. (more…)

A random walk through ATA 2014

click to enlarge Editor Donna attended ATA 2014 on Monday only. This article is a set of impressions (mainly) of the exhibit floor and visits to a number of select booths.

Donna, it’s Baltimore. You’re not in NYC or Las Vegas.

Arriving after a long trip to a city you used to visit regularly, but haven’t been to in over 30 years, is disorienting, especially when you are heading on a fair spring day to a section that didn’t exist then. The Inner Harbor and Camden Yards resemble Atlanta, not necessarily a bad thing since the parts of ‘Charm City’ they replaced were largely past ‘gentrification’. The Baltimore Convention Center was unexpectedly huge, the distance to registration made longer by a taxi driver who dropped me off at another entrance two blocks away. Any resolve I had to drop in on the many educational sessions was dissuaded by the sheer length of the halls. The thick Exhibit Guide confirmed that the show floor filled two city blocks–a challenge to cover and spend time with my appointments before the close of the day.

Was it a hardware show, a software show or somewhere in between?

You could make a case for both views. One observer I walked with at the start compared it to a radiology trade show–all hardware. Yet a closer look indicated that the hardware–the PCs, tablets and smartphones–was there to show software that integrated: systems to track patients, distribute information, workflows, store and forward images and reports. It was about enabling secure consults, platforms, interoperability, two-way data flows, mitigating readmissions and putting telehealth, telemedicine and education into provider and patient hands. It was also about making the business case. It was most definitely NOT about gadgets and single purpose peripherals, though the latter were still quite visible. The old picture of telehealth closed systems, of proprietary monitoring devices feeding data onto a proprietary PC platform where it’s seen by a care manager, is so 2011.

Noteworthy: the growth in specialized services like telepsychiatry, teleneurology, teleradiology and teledermatology. Contrast: despite VGo‘s ubiquitous telepresence robots accosting you on the floor, a tablet-faced robot following a nurse down the hospital hall and ‘consulting’ with patients will likely still be a rarity.

Patient engagement on top

Traditional telehealth device makers are connecting their devices and opening up their reporting platforms to be accessible to patients. But there are bumps along the way in this transition. A&D Medical has gone ‘Wellness Connected’ with a mobile app (more…)

Tunstall’s unhappy lenders and the consequences of debt service

A ‘slipped under the radar’ story (in this Editor’s judgement, based on the lack of news references) is Bloomberg News’ exclusive on last week’s (12 May) meetings between Tunstall Group Ltd and its creditors over the company’s recent performance. According to Bloomberg’s sources, the meeting was called “after income plunged and management changed following a refinancing in September.” In a statement from Charterhouse that cleverly tap-danced past the reason for the meeting, “Tunstall continues to be a successful, profitable, cash-generating business and comparable to many other organizations, experiences short-term fluctuations in performance.” and “The group has been impacted by a number of factors including specific market factors and the continued strength of sterling against the major-trading currencies.” The business has also been hurt by delays in awarding major contracts, according to the statement.

From the Bloomberg article:

As Tunstall’s profits have declined, its ratio of debt to earnings before interest, taxes, depreciation and amortization increased to 5.6 times as of March, from 4.7 times in September, the people said. The loan terms in the March test dictated that the leverage ratio shouldn’t exceed 6.3 times, they said.

Lenders are expecting the company to give a new profit forecast today for the 12 months to September 2014, according to the people. The company didn’t comment on earnings targets or leverage in its statement.

AND: Its 350 million pounds ($590 million) of loans dropped to as little as 77 pence on the pound, according to broker quotes, from 99 pence in September. (Ed. note: these loans are publicly traded and a lowered value is highly significant as to the debt quality.)

The outcome of the meeting is not yet known.

As our readers know, private equity firm Charterhouse Capital Partners LLP acquired Tunstall Group in 2008 from Bridgepoint Capital  for £514 million (US$ 1 billion), funded in part with over £242 million in debt and with Bridgepoint and management retaining small shares (FT.com). The September 2013 refinancing was for £350 million ($590 million). This paints a picture of a highly leveraged company beholden to many beyond its owners and its contractors in local authorities and housing associations. Tunstall and Charterhouse also received negative publicity when the Guardian did an exposé on their use of the (wholly legal) ‘Quoted Eurobond Exemption’, where they pay loan interest at high rates to their parent companies through a mechanism via the Channel Islands Stock Exchange.

Management changes over the past six months have also rocked the top layers of the company. (more…)

More telehealth for the bassinet set

click to enlargeclick to enlargeclick to enlargeclick to enlargeIndustry talk is that wearables are no longer the hottest things on the hype curve because of smartwatches and smartphones getting even smarter, but one area is the exception: baby wearables. MedCityNews has an overview of four, three of which we’ve noted since late 2012: Sproutling, Owlet, Rest Devices’ Mimo Turtle (which fastens into Kimono, a/k/a the ‘onesie’) and (new to us) Sensible Baby SmartOne. All have some combination of heart rate, skin temperature, movement/sleep position monitoring from sensors into a smartphone app. Form factors: Sproutling and Owlet are anklets, Mimo Turtle’s monitor fits into a designated secure pocket in the lower (baby’s) left of the onesie, Sensible Baby goes into a pocket or attaches to clothing so it’s likely more suitable up to toddler age. Last December’s FastCompanyDesign article on Sproutling targeted its debut for this summer [TTA 10 Dec 13], but there’s no trace of a website so it’s still in development. Owlet’s been in market since fall 2013 [TTA 27 Aug 13] as has Mimo Turtle which is now sold through major retailer Babies ‘R’ Us.  Sensible Baby is still inviting beta testers and pre-orders at $99, projecting $149 when on sale later this year. There’s also no reassurance on the site that the SmartOne can be safely chewed — and of greater concern, its size appears to be small enough to swallow. With pricing between $150 and $300, they are at the Velocity of Cute as ‘ooh-ahh’ gifts for those baby showers which are coming up on many calendars and for your favorite Quantified Self Moms. (Just hold the obsessive smartphone checking.)

Also: Investor/engineering lab Lemnos Labs’ blog posting on Sproutling’s development from application/prototype to a scalable production model will be interesting especially if you are being challenged in the hardware development process.

Previously in TTA: Wearables on the hype cycle: a ‘Fitbit for babies’Owlet baby monitor sock exceeds funding goal (But Huggies Tweet Pee seems to have stayed in Brasil…), Owlet baby monitor sock moving to marketCute sensor fashions now for baby

Sleep monitor for telecare in epilepsy, abnormal night activity

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A truly underserved area is monitoring children who have epileptic seizures or other conditions at night. There’s danger to the child and loss of sleep or inability to detect by the parent or guardian. Sleep/activity monitors, baby monitors and movement sensors haven’t been adequate nor accurate. The Epilepsy Foundation (EF) in the US has developed SAMi, a monitoring system consisting of an camera (left) with built-in infra-red LED illumination connecting to an iPhone, iPad or iPod app. At night or designated sleep times, it alerts only for prolonged movement typical of a seizure or other suspect night activity, activating the phone with both audio and video. The movements are also recorded and logged for date/time/duration. It is not inexpensive: the SAMi camera alone is $399 and $949 for the fully configured kit with a iPod plus Wi-Fi router. The new Indiegogo campaign is to raise $90,000 for the next gen camera and to purchase units for charitable distribution to families. Also Medgadget. (A search here on ‘epilepsy’ will confirm the lack of attention to–and the need for–epilepsy monitoring)

UK Telehealthcare MarketPlace 2014 (UK)

UK Telehealthcare is again having a free-to-attend London Market Place in Kensington Town click to enlargeHall, on 2nd June 2014. In case you are wondering, UK Telehealthcare is the re-branded London Telecare. The change which took place in September last year is taking the London Telecare model nationwide.

These Market Place events provide the supplier members of UK Telehealthcare the opportunity to show their telehealth and telecare products and for visitors to try them out and discuss their requirements. The Market Place is open for five hours and there is a programme of talks running in parallel. See the flyer (pdf) for other details. As the flyer says, there is no need to book but please let Doug Miles know id you are planning to attend.

Of tricorders and lemmings

Telehealth & Telecare Aware is privileged to break the news of the new Tricorder-like device developed by iMonsys called EIMO, a compliment we take to heart. Watch the demo video:
 

 
It seems perhaps a trifle churlish therefore to point out that there is similar functionality in other products under development, such as Wello, which looks like it is going to become available about the same time, too. However the Wello slips over your phone so is much less intrusive and, some would say, has more cool. There are of course a bunch of competitors for the Tricorder X prize too, perhaps most famously the Scanadu Scout.

To explain where the lemmings come in, this reviewer went to a Wayra event recently (at which there were some brilliant pitches, especially from Cookiesmart (telepathology), Handle My Health, My Clinical Outcomes, Virtually Free and BreakBad, that we hope to cover in a future blog).

On arrival, the warm-up had already started, given by a financier who asked if anyone remembered Star Trek. He went on to say (more…)

‘Brain Games’ on preventing, diagnosing sub-concussive brain trauma

Tuesday 13 May, presented at NYC MedTech-the NYC Medical Technology Forum, at Troutman Sanders LLP, Chrysler Building, New York City

In a packed (agenda and attendees) two hour evening meeting, three presenters detailed the latest research on the clinical signs of chronic traumatic encephalopathy (CTE), along with new technologies for detecting it as it happens and diagnosing it plus monitoring recovery: Robert Stern, PhD, professor of neurology and neurosurgery at the Boston University School of Medicine and a leading clinical researcher on CTE (as our long-time readers know) ; Isaiah Kacyvenski, head of the sports segment of electronics designer MC10 which developed the Checklight head impact indicator for Reebok; and Uzma Samadani, MD, PhD, co-founder of Oculogica which presented at ELabNYC a few weeks ago.

Dr. Stern’s presentation reviewed his clinical work with primarily NFL players in how CTE manifests in both behavior patterns and the brain. His focus remains on sub-concussive trauma, the ‘bottom of the iceberg’ in his analogy, and its cumulative, long-term effects.  Repetitive brain trauma–neuronal shearing which is produced by linear, lateral and rotational forces to the head–produce a cascade of brain changes leading to destruction of brain tissues that show as dark patches on post-mortem samples and scans. These differ from Alzheimer’s disease in the abundance of tau protein distributed fairly early in life around the brain’s blood vessels and in the depths of the cortical sulci, where Alzheimer’s signature beta amyloid does not locate. Dr. Stern’s research also incorporates the behavioral changes that precede diagnosis: the emotional ‘short fuse’, the difficulty in memory, accidents, suicide, drastic changes in behavior and impulse control. There are many examples of degeneration and early death among players [TTA 6 Dec 12 which also refers to Dr. Stern’s research published in Brain; also see TTA 5 June 2013 on his German Center presentation which has additional background on his and his team’s research.]

In addition to the work he has done relating to (American) football (he is on the NFL Players Association brain injury committee and his research was instrumental in the PA’s lawsuit against the NFL), he studies other contact sports such as hockey (brain injury clusters (more…)

Big Data – Royal Society of Medicine 5th June

Finding the needles in an ever bigger health information haystack – that’s what the latest RSM conference on 5th June is all about.

There is now a mass of data in the NHS accumulated over the past 60 years about health, its delivery, and increasingly about the individual characteristics, personal health and genetic data of individual and massed patients. The novelty is that this data can now be linked up with data from ever more disparate sources to give answers to questions that only yesterday we could barely conceive.

We have access to a vast data volume, faster, and in increasingly varied ways. We have more papers about how to manage it and more tools. Where are the experts? We have moved rapidly from bytes to gigabytes, and now Petabytes (and soon evenbiggerbytes) of data held by health systems about people.

But how can we use this data rationally? How can Big Data analytics help? (more…)

Risky hospital business: happy device hacking, insider data breaches

A heap of ‘insanely easy’ hospital hacking–but no harm done: Essentia Health’s head of information security, Scott Erven, set his team to work–with management approval–on hacking practically every internal device and system over two years, and found that most were ‘insanely easy’ to hack. They successfully hacked drug infusion pumps, EHRs, Bluetooth-enabled defibrillators, surgery robots, CT scanners, networked refrigerator temperature settings and X-ray machines with potentially disastrous results. Where the common security holes are in networked equipment: lack of authentication, weak passwords, embedded web services and the list goes on. Mr Erven presented this at an industry meeting in April, without naming brands or devices as he’s still trying to fix them. Essentia Health operates about 100 facilities, including clinics, hospitals and pharmacies, in Minnesota, North Dakota, Wisconsin and Idaho–and should receive much credit for facilitating this study. This is the environment into which we will be plonking tons of patient information in PHRs and telehealth monitoring. Pass the painkillers. Summary in HealthIT Outcomes, much more essential detail in Wired worth the read.

The ‘Maybe No One Will Notice’ Data Breach:  The recent incident at the University of Massachusetts Memorial Medical Center in Worcester illustrates the difficulty that even academic medical centers have with detecting data security breaches, particularly when they are small, sneaky, over time and by an insider. UMass uncovered a series of low-profile breaches by a former employee who helped himself to patient information such as name, address, date of birth and Social Security number–and may have used it to open up credit card and mobile phone accounts. Only four records appear to have been misused in this way, but at least 2,400 records were estimated to be improperly accessed–over 12 years, which made it even more difficult to find. Perhaps the employee was funding retirement? HealthcareInfoSecurity

The ‘Ambulance Chaser’ Data Breach: What better way for lawyers and shady outpatient clinics to get accident patients fresh from the ER (ED), than to have someone on the inside feeding them patient information? (more…)

Smartwatches, fitness trackers: overload in several ways

click to enlargeDedicated Quantified Selfers, who have more than one device strapped to their arm and wrist, know that when like measurements are compared from two different devices (e.g. step counts, weight, activity, blood pressure), like stock or mutual funds, their performance will vary. Sleep trackers are among the worst offenders. But newbies just ‘into’ this may be confused. Not to worry! The prescription from Dr Kvedar is: “Expecting these consumer devices to have scientific accuracy is unrealistic. Expecting them to help you keep your activity level top of mind and measured in context from day to day is realistic and in most cases helpful.” They set a tone and help motivation, with other tools such as social groups and coaching. Reassuring words, especially as Dr Kvedar has launched Wellocracy to help individuals to understand that.

There’s of course pressure from clinicians to upgrade fitness monitor readings to clinical quality so they can use it…but absolutely no clarity on exactly how they would use it, a seemingly contradictory statement which centers on the quality of analysis and what alerts would be pushed to the clinician, who memorably has his or her ‘hair on fire trying to do what they do right now.’   (more…)