When this editor was running a telecare & telehealth programme in Surrey, there was always the dread when meeting professionals that one of the daily internet newssheets would publicise another paper about the Whole System Demonstrator (WSD) that ‘proved’ that one or other form of remote patient monitoring (RPM) cost more per QALY than a voyage on Virgin Galactic. The day was then spent unconstructively, making some or all of the points encapsulated in my original post on 22 July last year entitled “Time to bid farewell to the WSD”.
Thankfully the flow of WSD papers has since dwindled. Doubtless many hoped they had stopped for good, in view of their total irrelevance to the real world in 2014. However, on the offchance that some poor reader has found themselves being challenged about the abstract of a recent paper picked up by Pulse, on the high cost per QALY of telecare by one of the few professionals who still do not accept the value of appropriated technology, here is what you might tell them (more…)
The point may be debatable, but that doesn’t prevent Robin Raskin, founder of SilversSummit and Living in Digital Times, from making it. Keying off the summer edition of the Digital Health Summit, the CEOs of three well-known implosions–Zeo (the first big quantified self fail in sleep tracking, TTA 13 Mar 13), HealthRally(social networking/crowdfunding) and Healthrageous (personal health management, sold after it never fulfilled its promise to Humana, TTA 16 Oct 13) discussed their mistakes. Ten points plus each on video.Learning From Failure in the Digital Health Business (HuffPo)
The New York Digital Health Accelerator named its second class of eight companies last week. Each, sponsored by the Partnership Fund for New York City and the New York eHealth Collaborative (NYeC), receive approximately $100,000 in funding through a syndicate of investors in exchange for 1-2 percent in equity and access to SHIN-NY’s (Statewide Health Information Network of New York, colloquially called ‘shiny’) healthcare data. The winning companies are AllazoHealth, Clinigence, Covertix, iQuartic, Noom, Quality Review and Sense Health.In the four month program, the companies are provided with mentoring and networking opportunities with insurance companies, medical centers and hospital groups. However, a number of these companies are past the pure startup stage with real clients and business. Modern Healthcare, iHealthBeat
You have just entered The App Twilight Zone…. Our readers know that concussion and diagnosis have been a focus of this Editor’s, and validating apps a focus of Editor Charles’, who brought this to my attention. The app’s name: The Sport Concussion Assessment Tool 2 (SCAT2). The news report states: “It contains all the essentials you would want in a concussion app: a graded symptoms checklist, cognitive testing, balance testing, Glasgow coma scale, Maddocks score, baseline score ability, serial evaluation, and password protected information-sharing via email.” The plot: it was deactivated without warning or notice by the developer, Inovapp(link to sketchy CrunchBase profile) yet still listed on the iTunes store.
What happened? There was a modified standard (SCAT3) developed in 2012, which updated SCAT2 with non-critical additions: indications for emergency management, a slightly more extensive background section, a neck exam and more detailed return-to-play instructions. SCAT3 is only available on (inconvenient) paper. No word from Inovapp on why it discontinued the app nor any plans for updating.
The SCAT2 had gained, in a short time, a following among coaches and sports medical professionals because it was the first app based upon the international standard (Zurich, 2008, 3rd International Conference on Concussion in Sport) transferring a paper assessment tool to an easy to use app. In fact, the NHL (National Hockey League) has its own version. The revised 2012 standards Users have a right to be upset, but moreover, this points to a glaring shortcoming of medical apps–their developers vanishing into the night without a by-your-leave. And read the comments by (mainly) doctors on securing patient information after the app is used (HIPAA standards) and one physician’s criticism of apps such as this as a ‘crutch’. A Pointer to the Future we don’t want to see. The authors Irfan Husain and Iltifat Husain, MD are to be congratulated. Popular app being used to manage concussions fails, failing patients (iMedicalApps)
click to enlargeclick to enlargePerhaps we should be adding to our sidebar lexicon ‘conformal electronics’. Boston-based wearable health technology developer MC10is partnering with Brussels-based biopharmaceutical company UCB S.A. to develop MC10’s Biostamp platform for treating those with severe neurological disorders. MC10 developed a seamless, disposable sensing sticker with thin film batteries (right above) which is currently in use in the Reebok Checklight to determine sports-related concussion risk [TTA 16 May, “Brain Games”] and in beta for infant temperature sensing (left above). It seems clear from the announcement today and further remarks (see below) that the objective is not drug delivery, but for patient monitoring and disease management. MC10 commercializes John Rogers’ work in stretchable sensor patches and batteries [TTA 10 April]. The Biostamp does not have FDA approval but the partnership may be a way to fast-track CE approval. MC10 release,Fast Company (also reviews Proteus, Corventis, Given Imaging), Mobihealthnews with comments from Ben Schlatka, MC10 cofounder.
I can, and do, write prescriptions for her many medical problems, but I have little to offer for the two conditions that dominate her days: loneliness and disability. She has a well-meaning, troubled daughter in a faraway state, a caregiver who comes twice a week, a friend who checks in on her periodically, and she gets regular calls from volunteers with the Friendship Line.
It’s not enough. Like most older adults, she doesn’t want to be “locked up in one of those homes.” What she needs is someone who is always there, who can help with everyday tasks, who will listen and smile.
What she needs is a robot caregiver.
—Louise Aronson, MD
From a medical practitioner and geriatrician is a view on robots as not dehumanizing, but a source of companionship, comfort and ‘always on’ emergency assistance for older adults and the disabled, particularly those who live alone. Dr Aronson also advocates assistance robots for everyday tasks such as bed transfer, lifting and dressing assistance. Mentioned favorably: PARO the Japanese ‘seal’ robot, MOBISERV Kompaï, Sweden’s GiraffPlus but notable by omission GrandCare Systems, the GeriJoy tablet-as-pet companion and (perhaps too new) the JIBO ‘family robot companion’ [TTA 18 July]. She also makes the apt point that those of us who’ve spent most of our adult lives interacting with machines will be quite comfortable with robotic companions. The Future of Robot Caregivers (New York Times) Also Katy Fike PhD from the Aging 2.0 group takes a look in their blog at Dr Aronson’s insights as well as JIBO.
Restoring the ‘human connection’ in patient engagement. Pre/post-procedure education and monitoring service VOX Telehealth [TTA 23 May] is partnering with spiritual care counsel provider HealthCare Chaplaincy Network [TTA 2 Apr] and clinical teams from Northwestern University (Illinois) and the Princeton (New Jersey) Medical Center to develop the PalliativeCare Program. The VOX program is designed to blend health education and coordination support not only around a care plan for a specific disease but also for decision making, caregiver coordination, and necessary spiritual support and social services. It’s an interesting approach that combines online/mobile communications, telehealth and social services/ministry. HCCN’s inclusion in the program is not surprising as they have been transforming from a chaplain training resource for those ministering to patients and families in hospitals to providing spiritual care and resources directly online (via ChaplainsOnHand) for the seriously/chronically ill and their families. VOX release[Disclosure: Editor Donna is a volunteer on the HCCN’s marketing advisory council.]
click to enlargeFinally something useful in automotive biometrics! Researchers from Spain’s Instituto de Biomecánica de Valencia (IBV) have integrated sensors into a car seat and seat belt to continuously track the driver’s heart beat and respiration, with the aim of warning a drowsy driver. Data is gathered through a signal-processing unit (SPU) in real time, then sent to a computer program which through modeling patterns of fatigue in these two metrics, determines whether the driver is drowsy. It’s in working prototype save the proactive warning part, which does present a design challenge. (An electric shock? A VC10 at takeoff? Jimi Hendrix or Queen at 80 dB?) It’s appropriately dubbed The Harken Project. A potential life-saver far more useful than Ford SYNC/IMS’s Allergy Alert. Press release. MedgadgetHat tip to reader David Albert MD @DrDave01 via Twitter (!)
click to enlargeUpdated 25 July If our exclusive on the ‘tricorder-like’ Eimo device caught your attention [TTA 19 May], you will be interested in the extra information about it given on its Kickstarter page. See the second video down and read some more on its background, history and the philosophy of the developers, iMonSys, located in North Yorkshire. You may even want to pledge some cash to help produce the first 1,000 units! (Unfortunately, funding stands at only £2,000 of a required £145,000 pledge by Wednesday, 13 August.) iMonSys will also be developing two versions: for home use to retail at £300 and the medical version to retail at £600. What is different about this is that based on the demo, anyone can be taught to use Eimo and it produces a reading of core body temperature, full ECG trace, oxygen levels, pulse and blood pressure in well under two minutes as seen in the video. Also it stores data so that the ‘funny turn’ that doesn’t consistently happen can also be captured and stored for later analysis by a doctor. Will it actually be a vital signs monitor ‘which even Granny can use’? Based on the video it certainly seems so.
Update: Laurie Orlov picks up iMonSys’ local roots in Staithes in her post on Boomer Health Tech Watchlinking to an article in the Whitby Gazette. Founder and developer Graham Priestley’s original concept resembled the ‘black box’ on an aircraft to monitor a soldier’s vital signs, with the original research under the aegis of the (UK) Ministry of Defence but shelved around 2008. He picked this up two years later with the assistance of the University of Hull, and is currently seeking to
Our readers can help spread the word on this UK product on Kickstarter!
click to enlargeIt’s time to go cold turkey. One of the hallmarks of being active on healthcare tech or digital health scene is Twitter. Even more than LinkedIn groups, websites and blogs, it’s how increasingly we communicate with and acknowledge each other in the field. But it has its shortcomings. It’s become a chore to follow the tweetstream in my (deliberately limited) account, because there’s all that filler. I have to scroll…and scroll…to find the ‘wanna read’ nuggets by those who post ‘the good stuff’ (and you know who you are).
The volume increases dramatically during conferences. There’s good links and photos, but increasingly it’s become a festival of incidental remarks about speakers being on (sans content links), tweets about going here and there, social pictures of lunches and dinners, selfies. Increasingly, no one puts down their phone! At sessions, instead of being riveted (or not) on the speaker, attendees are glued to their phones, furiously keyboarding and tweeting…whatever. It’s insulting to the speaker who’s trying to engage with the audience, for starters. Then there are the meetings with the tweetstream posted to the side of the stage–another distraction. Most of all, by furiously fingering, aren’t you cheating yourself of the conference experience for which you or someone has paid dearly? Isn’t the point of being there human contact and time off the screen?
–that live-tweeting isn’t a problem for me –that I could quit anytime –that the tweets I send to my Twitter followers while listening to a conference speaker onstage are actually interesting, high-quality messages –that it must be okay because everybody else in the audience is doing it, too
But now I know that it’s time to quit cold-turkey.
A bandage-like system that wirelessly transmits data from a patients vital signs is being developed by an interdisciplinary team at the National Taiwan University. The system called Bioscope allows various sensors to be stacked on top of the bandage, depending on which vital signs need to be monitored. Read more: New Scientist
Students from Imperial College of London have come up with a novel way to help athletes and people with disabilities, who might struggle to correctly assess the severity of an injury. Internal injuries often don’t give visible warning signs such as swelling or marks on the skin and if left untreated can be potentially life threatening. But where an impact occurs in the ‘Bruise suit’ a removable pressure reactive film registers it as a magenta stain. The colour changes to reflect the intensity of impact. Although currently a prototype, the team is exploring further applications for the technology and developing a product line. Read more: Wired
Editor’s Note: There doesn’t seem to be any sound on the YouTube video for this at the moment!
click to enlargeTunstall Healthcare UK last week announced the addition of an advisory service to help commissioners (CCGs, borough councils) and providers better understand, design, deliver and deploy what they’ve coined ‘telehealthcare’, which is plain ol’ telehealth to The Rest of Us. The Advisory Service will be managed by a team of specialists with clinical, technology, training, implementation and business intelligence expertise. The illustration to the left indicates their ‘swirl of disciplines.’ An interesting quote from the release: “According to NHS England, nearly a third of patients aged 75 or over have two or more long-term conditions; the overall cost of care for a person with multiple conditions is £2,500 per year.” (In US terms, that seems vanishingly small, except when you start multiplying…Ed.D.) In the UK system, commissioners are supposed to stay vendor-neutral so to this Editor there is a question on the objectivity of the advice given. On the clinical side, how many doctors and nurses will be engaged by the Advisory Service? The release also implies that the service will be available internationally, but materials are UK only. Website, release, brochure.
Another indication that Tunstall is trying to broaden itself beyond frameworks, fees and NHS funding is their organization of a European Symposium in Barcelona a few weeks ago. Hot topics were integrating services, enabling self-care and self-management for people with long-term health and care needs, increasing awareness of these service among carers, and of course cost management. Tunstall blog.
According to this GP article, GPs are not impressed by telehealth. They “have expressed doubts over the potential of telehealth to improve patient care, and studies have questioned whether the health-tracking technologies are value for money for the NHS.” Thus the Department of Health will encourage commissioners to use telehealth by surveying telehealth and telecare users, as well as developing a set of metrics for commissioners which will demonstrate their impact on health outcomes. The Telehealth Service Association (TSA) estimates are that 1.37m people in 2011 used telehealth, telecare and telecoaching services in England. Certainly Tunstall’s move in this area is designed to take advantage of Government action in this area and commissioners’ increased accountability.
click to enlargeIt must be summer and The Gimlet Eye is looking for amusement and diversion. In a Real World of shotdown passenger aircraft and Middle East war, even Neil Versel in Meaningful HIT News is opting for the lighter side. He draws our attention to the humor of Steven Colbert on the subject “The Golden Era of Digital Toys”. Instead of actually running a marathon, simulate it with your Fitbit by mounting it to a paint shaker. But beyond these yuks, Mr Colbert aptly points to the vaporous language used by every DH3-er (Digital Health Hypester Horde) to promote their ‘revolutionary’ device.
click to enlargeCase in point: Vessyl, a cup that reads out what you are drinking down to the brand, flavor and calorie count and tosses the information to an app on your smartphone. (Of course, you could read the container, but that would be soooo uncool.) Colbert uses Vessyl to skewer Healthcare Startup Bloviation. There’s the Founder with red oblong glasses on ‘tracking real time hydration’. Then another principal, of whom The Gimlet Eye notes must be so dedicated that has no time to shave, tweeze his eyebrows, comb his hair or put on a clean shirt for the promo video, uttering their mission statement like Moses Bringing Down The Tablets from Sinai: ‘we help people make healthier and more informed decisions in real time.’ The final reductio ad absurdum is the creative director whispering in awe on its seven years of intensive design work. For a drink cup. Retail $200 if it meets its early 2015 ship date. Raising $50,000 via MarkOne’s oh-so-hip ‘n’ cool glossy demo website. With the requisite hipsters (none over 25) livin’ large in San Francisco’s glam settings, of course clutching their Vessyl.
This is what gets funded? As in the proverb, has the mountain labored to bring forth a mouse? Mr Colbert’s device in counterpoint is brilliant. It should be funded shortly. Colbert Video.
Additional breathless D3H coverage: VentureBeat. CNet traces its ties to the Jawbone UP designer. (Editor Donna note: the cup readout on brands and accuracy re sugar and caffeine does sound a bit too good to be true. Let’s see if it’s for real in 2015.)
Last Octoberwe profiled a UK-developed mobile app in beta called KeepUs. We said at the time that it “when installed on an older person’s or a child’s Android smartphone, (it) allows a family member to monitor that person’s both indoor and outdoor activity. Using geolocation, the family member can see that person’s visits (locations can be labeled), level of activity on any given day, alerts (being idle for too long), how much time was spent at each named location over the past two weeks and trends over two months.” For this Editor, it has the potential to supersede PERS of both the traditional and mobile types since it is free/low cost and also fits into an accepted form factor (phone) which increasingly PERS is not. It’s now well out of beta and with some “commercial care institutions” (we are following up). Founder Tom Doris is now inviting 10,000 volunteers to download a free version of the app by going to keepus.com and following the instructions (see at the top ‘go ahead and install the app’ which will take you to Google Play). PDF release.
Update: A follow up with Mr Doris confirms that KeepUs has users in the US, UK, Ireland, India, Turkey, Australia and even Cambodia (!). He explains, “It works the same as you’d expect any normal app and website to work: as long as you have access, KeepUs works fine. It doesn’t need any special hardware, nor does it need any special support from the cellphone network operators.”
Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:
• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.
• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.
Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.