How technology can help fight elder abuse–ethically

The increasing awareness of abuse of older people by their caregivers, whether at home or in care homes/assisted living/nursing homes, invites discussion of the role that technology can play. This presentation by Malcolm J. Fisk, PhD, co-director of the Age Research Centre of Coventry University, in the BSG Ageing Bites series on YouTube looks at technologies viewed by level of control and intrusiveness:

  • Social alarms, which include pull cords (nurse call) and PERS–what we think of as ‘1st generation’ telecare: high level of control, low intrusiveness–but often useless if not reachable in emergency
  • Activity monitoring, which can be room sensor-based or wearable (the 2nd generation): less control, slightly more intrusive–also dependent on monitoring and subject to false positives/negatives
  • Audio and video monitoring, while achieving greater security, are largely uncontrolled by the older person and highly intrusive to the point of unacceptability. (In fact, some feedback on tablet-based telehealth devices indicates that a built-in camera, even if not activated, can be regarded with suspicion and trigger unwanted reactions.)

The issues of consent, and balancing the value of autonomy and privacy versus factors such as cognitive impairment, personal safety and, this Editor would add, detecting attacks by strangers and not caregivers, are explored here. How do we ethically observe yet respect individual privacy? This leads to a set of seven principles Dr Fisk has published on guiding the use of surveillance technologies within care homes in the latest issue of Emerald|Insight (unfortunately abstract access only) Video 11:03Hat tip to Malcolm Fisk via Twitter.

A Plum European app report

plum logoFor a pleasant change, thanks to Prof Mike Short, we can share an excellent report on the app business in Europe with readers without explaining that to access it costs gadzillions. The Plum App Report gives a very level-headed yet exciting description of how apps are changing Europe and hints at some very exciting potential savings to realise from health apps, and elsewhere.

Accelerated Access Review – my blog

As a member of the Stakeholder Reference Group of the Accelerated Access Review, this editor was recently invited to write a blog to encourage contributions to the review, the purpose of which is to identify actions necessary to accelerate the uptake of innovation into the NHS. It seemed a shame for the blog also not to be shared with TelecareAware readers, so here it is:

The Digital Health & Care Alliance (DHACA), of which I am Managing Director, has a strong interest in the success of the Accelerated Access Review, both because the majority of our 550-odd members work in SMEs whose very existence depends on the responsiveness of the health & care organisations in the UK, and because all of our members have a strong interest in improving patient outcomes & treatment efficiency.

One thing I’m going to be very interested in seeing emerge from the Review is the consensus on how innovators gather and use evidence to develop their product to meet the demands of the NHS and needs of patients. In DHACA we think we have a fairly clear idea about how our members go about this, however we can only claim to represent the digital health stream in the Review, and then only for small organisations. Allied to this is the much tougher question for many, particularly our smaller and more innovative members, of how to sell to the NHS. (more…)

What it takes to make telehealth really work

In line with my fellow editor, forgive this editor engaging in a little nostalgia – going back to 2006, when the Whole System Demonstrator was a still a wonderful idea, before the competing forces of academia and management consultancy put short-term financial gain before long term patient outcome improvement. Those were the days when we genuinely believed that recording vital signs was what it was all about.

Move on nine years and it’s clear from the American Heart Association review referred to in this column recently, and subsequent articles, that one key success factor is drip-fed education. To quote:

“The amount of information that must be conveyed and the support that is necessary to counsel and motivate individuals to engage in behaviors to prevent CVD are far beyond what can be accomplished in the context of face-to-face clinical consultations or through traditional channels such as patient education leaflets,” the researchers say. “Mobile technologies have the potential to overcome these limitations and to transform the delivery of health-related messages and ongoing interventions targeting behavior change.”

This is underlined by a recent study of attempting to control hypertension using just text messaging, which was far from an unqualified success.

Another major driver of course is cost saving, as demonstrated by (more…)

NHS Expo & Testbeds – another view

This year this editor went to NHS Expo in Manchester primarily to advise a US company, Humetrix, over the two day period, so got to see proceedings through a different lens.

Overall the event seemed to be much better attended than last year, in spite of the proximity to the Bank Holiday. Whereas last year the Future Care Zone was virtually deserted by both exhibitors and visitors, this year’s New Care Models Zone was buzzing. The Digital Zone was a particular attraction with some excellent talks, and the opportunity to meet many key people working in this area.

On the stage, the politicians painted their visions and senior health & care directors explained how these were to become a reality. This week’s NHS Networks blog, a perennial favourite of this editor, commenting on comparative performances, described Tim Kelsey as “more digital even than Mr Hunt but less binary”(reminiscent of Iain Banks’ description of lawyer LL Blawke in The Crow Road as “pencil-thin and nearly as leaden”). Of particular concern to this editor’s interests was the response to Jeremy Hunt’s commitment to enabling everyone to be able to access their detailed medical record in 2016, (more…)

Telehealth patient engagement program improves orthopedic outcomes

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/09/orthocare_06.png” thumb_width=”150″ /]VOX Telehealth‘s patient engagement program with Bon Secours St. Mary’s Hospital in Richmond, Virginia, which was announced back in January [TTA 12 Jan], published results for its pilot last month, and they appear to be outstanding. VOX’s model is ‘episode of care’, over a 90-120 day span starting 30 days prior to surgery to 60-90 days post-procedure; the online/tablet platform delivers educational content, reminders and notes on potential symptoms that ties into a customizable by patient alert escalation and notification system. The goal is to reduce post-discharge complications and readmissions, in this case for hip and knee replacement patients, through managing expectations and better preparation by the patient. And the results reported are encouraging:

  • 92 percent of enrolled patients were discharged directly to home–the US average is only 30 percent
  • Length of stay dropped to 1.6 days, nearly 50 percent lower than the US average of 3.7 days. It is lower than Bon Secours’ average of two days.
  • There were 0 readmissions after 30 days, compared to the US average of 6 percent
  • Patient satisfaction was also high: (more…)

‘Frontiers Innovators’ need apply by 11 Sept (UK)

As Editor Charles mentioned last month in his autumn roundup, if you would like to be considered for the Wellcome Trust’s ‘Frontiers Innovators’ program, the deadline to apply is 11 September. Ten spots are open to early-career researchers, entrepreneurs, technology developers, healthcare professionals and representatives from the pharmaceutical and medical technology industry. If selected, you will travel and accommodation to attend the ‘Digital Phenotypes – Health research in the digital age?’ meeting on 5-6 November in London, which will explore the research potential of digital health data captured outside of normal healthcare settings. More information on the meeting is here. For ‘Frontiers Innovators’, to apply, send your CV and a video message to d.phenotypes-innovators@wellcome.ac.uk by 11 September 2015.

Avoiding the FDA health IT-medical device regulatory trap for general IT companies (US)

If you are an IT company in the US or internationally with services which could be useful to healthcare companies or practitioners, it’s easy to be overly specific and stray into FDA-regulated territory. The always-informative Bradley Merrill Thompson of the Epstein Becker Green law firm delineates the fine regulatory line that general purpose IT companies must observe when working with healthcare customers. First there is intended use, based on how the manufacturer intends its customer to use the product; if the customer uses it for the diagnosis or treatment of disease or other conditions, FDA will regulate it as a medical device. This is less clear than it seems, and Mr Thompson explores where a general IT company can, in the old PR adage, ‘say it safely’ and avoid falling into the unwanted medical device trap by avoiding medical feature and advice claims, and keeping the context away from medical use. The Journal of mHealth (August)–online version, optional PDF download. Hat tip to Mr Thompson via the Continua LinkedIn group. Other articles of interest in the JMH are: Scottish company HCi Viocare and its ‘smart insole’ pressure sensors for foot ulcer detection following, Northwestern University’s research around patterns of smartphone usage detecting depression (page 19) and a lengthy article on transforming patient data into actionable insights (page 34).

CVS puts a retail triple spin on telemedicine

A definite boost to telemedicine providers American Well, now-publicly traded Teladoc and Doctor on Demand is retail drugstore CVS Health piloting their services through CVS MinuteClinics, starting in 2016. CVS’ release is disappointingly heavy on company quotations, light on specifics, but what can be determined is that CVS will test various arrangements, including onsite telemedicine in stores, through CVS ‘digital properties’ (presumably online or through apps) and MinuteClinic provider consults with telemedicine provider doctors. It carefully avoids referring to the three companies as ‘partnerships’ though it generically refers to them deep in the release. CVS currently has 1,000 MinuteClinic locations in 32 states and plan to grow by 50 percent by 2017; they have been testing telemedicine in about 50 clinics in Texas and California.

Annoyingly, both CVS and the three companies improperly use ‘telehealth’ in describing their services when correctly they provide only doctor-patient video consults, or telemedicine. The clinic providers (or individuals) may be reporting vital signs data as part of the visit, but tools are not integrated. Equally annoying is CVS, in the release and in conferences, citing a paywalled study (at the not inconsiderable sum of $39.95 / €34.95 / £29.95!) in the Journal of General Internal Medicine (JGIM) of their results. If you are touting that “95 percent of patients were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care.” –well, with results like that, make some arrangements and grant access to the study! CVS release, Medscape, FierceHealthIT

Alphabet action versus diabetes with Life Sciences’ contact lens and Sanofi

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/google-contacts_1401174_616.jpg” thumb_width=”150″ /] Monday’s Big Story. As previously reported [TTA 25 Aug], the new Google holding company Alphabet is bringing the Life Sciences group formerly under Google X into its own company, with a new name TBD. On Monday, Life Sciences and Paris-based pharma Sanofi announced a partnership on projects related to diabetes monitoring and treatment. According to BioSpace, “at least part of the partnership will be focusing on helping Life Sciences create small, Internet-based devices that either automatically adjust insulin levels, or make suggestions based on real-time monitoring. ”

Clearly Life Sciences’ raison d’etre includes a focus on this disease, others that may relate to it, and in developing devices that others may market. Your Editors have been tracking their research for well over a year. A roundup of Life Sciences’ partnerships include more than diabetes:

**Novartis division Alcon for the glucose sensing contact lens [TTA 17 July 14, patent report 27 Mar 15 ]

** DexCom to develop a Band-Aid sized wearable for glucose monitoring, announced 15 August

**A 10 year deal with Abbvie for age-related disease exploration (which relates to the accelerated aging associated with diabetes)

**Biogen for multiple sclerosis (MS) treatments

We continue to have doubts about the practicality of the contact lens and the viability of embedded sensors in lenses, as the eyes are extremely sensitive and especially vulnerable for those with diabetes. But directionally on this disease, which is expanding almost uncontrollably worldwide, the research and devices which Life Sciences can develop for a variety of companies looks promising. Business Insider, Re/Code, Digital Trends