10th Anniversary Article 1: The Next Ten Years of Telecare

This year, on the 10th Anniversary of Telehealth and Telecare Aware, we have invited industry leaders nominated by our readers to reflect on the past ten years and, if they wish, to speculate about the next ten. Here is the first article, with a UK focus, by Dr Kevin Doughty.

Many of us are frustrated at how little progress there has been in the deployment and acceptability of telecare during the past decade. Yet, despite warnings that an ageing population was about to bankrupt the NHS (and health insurance schemes elsewhere in the world), and that access to social care for older people was being withdrawn at such a rate that it could only be afforded by the wealthiest in society, our health and social care systems have just about survived.

But this can’t go on, and in England over the past 12 months: (more…)

Should patients manage their own care records? RSM 4th June

Like the banking industry 10-15 years ago, Healthcare providers are coming to realise that if they start to provide intuitive software that can be used on consumer devices, then people (patients) will start to do more of the work (for free) that the Healthcare Industry currently has to pay for. These unpaid workers will be motivated by a desire for greater transparency of their own health and care information, and the ability to manage that information in the most efficient and effective ways possible; with the ultimate aim of improving their care quality and overall wellness.

This means that they will need something other than an EHR to do this, something that is constructed with the service user in mind, not the clinician. Something that makes it easy for them to see the interactions that they have had, the resultant actions, and the future planned interactions that are to come. Something that when they enter the highly fragmented world of UK care provision, allows them to have immediate access to the core elements of information that any other care provider would need. (more…)

Important: DHACA’s response to the RCP advice on medical apps

The Royal College of Physicians has just published app guidance that, according to EHI “doctors should only use medical apps with an official CE mark”. EHI goes on to clarify that the guidance “applies to medical apps that can be classed as medical devices, which are bound by EU law to carry the mark.”

The Digital Health & Care Alliance (DHACA), of which this reviewer is Managing Director, is extremely concerned that this advice may seriously impact on the beneficial use of medical apps in the UK as it places the onus of deciding whether an app is a medical device on individual clinicians, a decision that at times even experienced MHRA personnel can equivocate on.

As the original research done by this editor on the topic of medical app take-up demonstrated, clinicians (more…)

Cumbria Technology Enabled Care Event Thursday 18 June

This event will showcase the latest developments in technology enabled health & social care products & services. There will be discussions about how professionals can use technology in the redesign of Health and Social Care in Cumbria. This will build on the telecare work already undertaken by Cumbria County Council as well as the telehealth pilots that have taken place around the county and further afield.

It will be held at the Rheged Centre Redhills, Penrith, Cumbria, CA11 0DQ, between 13:30 – 16:00 on Thursday 18th June.

Topics to be discussed include:

  • New tools available from the NHS Commissioning Assembly – the Technology Enabled Care Services Resource;
  • How to use technology to enhance health and social care priorities such as prevention and well-being, remote consultations, managing long term conditions, independent living at home, winter pressures, mental health and dementia care.

(more…)

Nursing homes vs. hospitals for primary senior care

Another way to reduce unnecessary hospitalizations? A recent New York Times article has kicked off a debate on whether many procedures for older adults can be better delivered in a nursing home or skilled nursing facility (SNF) setting rather than in-patient hospitals. Already serving many seniors for rehabilitation and residential care for multiple chronic conditions and old age-related debilities, the dreaded transfer to hospital may be lessened by a combination of outpatient procedure and installation of 24-hour nursing at these homes. Unbelievably (to this Editor) many of the 16,000 nursing homes in the country do not have round-the-clock nursing staff; only five states require 24/7 registered nurse coverage on site and there is no Federal requirement. An advantage is that minimizing hospital stay also minimizes hospital-acquired infections, patient distress (more…)

Care Innovations, UMMC Telehealth Center to expand care outside the home

Intel-GE Care Innovations, which markets both telehealth and telecare (QuietCare, one of the pioneers in behavioral telemonitoring) products, announced today a broadened relationship with the University of Mississippi Medical Center’s Center for Telehealth. CI will help them to establish the Innovation Living Lab which will create and evaluate new models of care via remote technology and techniques for behavioral change. The Lab will open at UMiss’ Venyu Technology Center sometime in 2016. UMMC and CI’s goal is to extend care models so that the home is a key location for care delivery. In the past year, both had partnered on the Diabetes Telehealth Network. CI since their change of management has made several interesting moves in the past year, including grouping telehealth systems under Health Harmony and creating a Validation Institute. Business Wire.

Scanadu raises $35 million in Series B, develops for China market

click to enlargeEric Topol’s Doctorless Patient takes one step closer to reality. The Scanadu ‘tricorder’ vital signs diagnostic ‘hockey puck’ received a major vote of confidence on Monday where it counts–funding. Their Series B of $35 million came from nine investors, led by Tencent Holdings, Fosun International and including Three Leaf Ventures, AME Cloud Ventures, Redmile Group, Relay Ventures, I Globe Partners, Fenox Venture Capital and CBC Capital. Three Leaf, AME and Relay also invested in their Series A. Tencent, Fosun and CBC are Chinese; I Globe is from Singapore. Why the Asian interest? It turns out that China is extremely interested and forward thinking in mobile healthcare–it has a lot of rural area to cover, all health-underserved, as is the rest of Asia. The introduction of the company was made by Jerry Wang, a Yahoo founder and former CEO.

Scanadu is also nearing market: Fortune reports that a $199 consumer version of the Scanadu Scout will be released in 2016, pending FDA approval, and in development is a urinalysis test, Scanadu Urine, an app that would analyze the color of a testing stick. (more…)

Global HIT, digital health VC funding falls 35% in 1st Q 2015: Mercom Capital

Mercom Capital Group, a research and communications group, tracks global VC funding, mergers and acquisitions in the digital health area and notes a distinct slowing of activity, except for mobile health. They tracked $784 million in 142 deals in Q1 2015 compared to $1.2 billion in 134 deals in Q4 2014. Leading are consumer health companies with $437 million in 98 deals, then healthcare practice-centric companies, with $347 million in 44 deals–both dropping over $200 million each versus the previous quarter. Mobile health companies had $282 million in 56 deals; app companies accounted for $220 million. In transactions, mobile health led with $578 million, with UnderArmour’s acquisitions of MyFitnessPal and Endomondo. Since 2010, digital health companies have raised almost $10 billion. Mercom Capital release (the full study will run about $300-500). mHealthIntelligence notes that M&A activity is steadily rising in the healthcare sector. Also iHealthBeat.

Figure 1: an Instagram for medical professionals

Secure, free medical image sharing, access and collaboration is the idea behind Canadian startup Figure 1. It provides a platform for medical professionals, who are largely ‘verified’ with a blue tick (check)–a process the company is doing across 40 countries–to upload pictures into feeds, make comments and bookmark. While anyone can join, images are also put through a fairly strict vetting and access process to preserve patient privacy. They have to be deidentified, patient consent provided via signature (country-specific consent forms held by the doctor), and edited using their special software so that faces aren’t showing and identifying metadata deleted. Doctors have been using it for virtual consults and for teaching. The idea is not all that new–ClickCare has had a similar service for iPhone/iPad/iPod since 1995, but it is a paid subscription service. Available in the Apple Store and Google Play for North America, Australia, New Zealand, South Africa, and across Europe. What is the economic model, however? Guardian. Hat tip to Guy Dewsbury via Twitter.

When remote monitoring ends, what happens to patient outcomes?

They do not maintain improvement, just as we thought. A just-published study fills a significant gap in telehealth knowledge. The study published in the Journal of Medical Internet Research (JMIR) analyzed the long-running Partners HealthCare-Massachusetts General Hospital Connected Cardiac Care Program (CCCP) for patients with heart failure. They matched 174 patients participating in the 120-day program between January 2008 and August 2012 with an equal number of control patients, all with heart failure, previously hospitalized and receiving care at MGH. The program patients were provided with a ViTelNet monitoring hub plus devices–a digital weight scale, a blood pressure cuff and meter, and a pulse oximeter–as well as receiving patient education plus unscheduled education intervention from nurse care coordinators when results trended out of pre-set ranges.

During the 120 day program, the program patients (predictably) had consistently lower hospitalization rates versus the control group at the 30, 60, 90 and 120 day marks, though the differential narrowed over time. But after program completion, in the study’s follow up eight months after the end of the four-month program (see one year below), the program group’s hospitalization rates increased to exceed the control group’s. Mortality rates remained lower though not statistically significant:

(more…)

Medical apps & medication adherence: two key reports from the UK Academy of Medical Sciences

This editor was involved in the development of two events at the Academy of Medical Sciences that took place at the end of 2014, the reports of which have just been publicised.

The first, on medical apps, brought together a wide range of stakeholders to:

  • Explore the current and proposed regulatory frameworks for health apps;
  • Hear case studies of the development of health apps and of the regulation and oversight of software development in other medical, nuclear and automotive sectors;
  • Discuss the current and future challenges faced in the oversight of health apps and devise solutions to these issues.

Particular issues raised during the day included: (more…)

Politics, clinicians or demand holding back Australian digital health? The debate.

A familiar debate raged at the Connect Expo Future Health Summit in Melbourne this week [TTA 15 Apr]. Is lack of digital health adoption due to lack of political push, as Lyn Davies, managing director at Tunstall Healthcare, maintained? Australia continues to back the Personally Controlled EHR (PCEHR) to the tune of AU$1.1 billion so far, yet it is still not integrated into the healthcare system. Are clinicians allergic to technology qua technology projects, and need to be approached differently to adopt digital health, as Donna Markham, advisor to chief executive affairs at Monash Health, said? Is it people–the patients– not seeing any benefit to things like PCEHR, a lack of demand filtering down to the practice level, per Toby Hall, Group CEO of St Vincent’s Health Australia? There is a certain comfort in the issues not being much different in a smaller, centralized health system (as the US is not–and as we’ve learned from ISfTeH, in Germany telehealth adoption is low). What seems to be missing is a perspective on what individuals are doing with their own health management and tracking outside the system. TechRepublic Hat tip to David Trainor of Belfast’s Sentireal on David Doherty’s mHealth LinkedIn group (signup required).

A very important positive shift in attitude to digital health

Hat tip to Mike Clark for alerting this editor to a particularly important run of recent papers on digital health that suggests that we have at last turned the corner from the seemingly endless enquiries of the “does it work?” type, to asking instead “how can it be made best to work?”.

We’ll start with perhaps one of the most unequivocal papers on the benefits of telehealth this editor can remember – a review by a team from the Mayo Clinic of controlled trials between 1990 and 2014 of digital health for managing cardiovascular disease. It is entitled “Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis”. The results found were that “digital health interventions significantly reduced CVD outcomes”. It makes great reading. Another smaller academic study of an NHS Croydon implementation for both CHF & COPD also showed positive results, and strong patient appeal specifically, too.

Another paper, just published by Stephen Agboola of Partners Healthcare, and colleagues from Boston US, entitled “Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program”,  further supports the benefits of telehealth for managing CHF. However, benefits disappeared after the 120-day telehealth usage ended, as discussed by Jonah Comstock of mobihealthnews – important lessons to be learned there, relating perhaps to what follows in this post.

(Though not an academic study, it’s worth perhaps also recording en passant a Health Recovery Solutions (HRS) claim that they reduced the 30 day readmission rate for 130 congestive heart failure patients by 53%, from 8.0% to 3.8%, over a period from July 2014 to February 2015.)

Moving on then to a paper by Trisha Greenhalgh and colleagues entitled “What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services”. This paper concludes that (more…)

A good week for telehealth in Senate committee hearings (US)

In contrast to last week’s deletion of telemedicine by the House Energy and Commerce committee from  ’21st Century Cures’, this past Tuesday’s Senate Commerce subcommittee on Communications hearing was far more cheering for both telehealth and telemedicine advocates. More than twelve Senators spoke on behalf of telehealth expansion, especially Medicare reimbursement for telehealth in rural areas where there is limited care access. Holding this expansion back, according to iHealthBeat, are four factors: the limited cross-state licensing for physicians; the sluggishness of the Federal Communications Commission–despite initiatives such as Connect2HealthFCC [TTA 6 Mar 14], the FCC has blocked subsidies for nursing home broadband; reimbursement and limited broadband access in the same rural areas (more…)

‘Alarming deterioration in NHS finances’: The King’s Fund April report

The King’s Fund has prepared since 2011 a Quarterly Monitoring Report on the performance of the NHS as seen by its finance directors. It is a ‘regular update on how the NHS is coping as it grapples with the evolving reform agenda and the more significant challenge of making radical improvements in productivity.’ Report #15 does not bring auspicious news as the challenges deepen. 7 of 10 NHS trust directors are concerned about balancing their books next year, and 60 percent have either drawn down reserves or relied on additional financial support. In healthcare delivery performance, over 440,000 patients in this quarter spent more than four hours in A&E (US=ER or ED), the poorest performance since 2003. (more…)

ATA announces award winners, Strategic Summit companies

ATA announced the six winners of their Annual Awards recognizing innovators in telemedicine and telehealth for significant contributions, along with six new members of the ATA College of Fellows. One of the more intriguing winners (Innovation in Remote Care) is the US/UK company Sentrian which has built intelligent predictive data models (‘Remote Patient Intelligence’) that can monitor disease and co-morbidity in thousands of patients with the goal of preventing hospitalization and readmissions. Release. ATA has also selected 30 emerging companies to participate in the Telemedicine Investor and Strategic Summit  (more…)