Utah Senate removes telehealth bill abortion restrictions

The controversial topic of abortion has been the centre of discussion of a new telehealth bill in Utah. The bill, HB 154, introduced by Republican Rep Ken Ivory, primarily addresses the issue of insurance coverage for telehealth in Utah and proposes to amend two previous acts and the Utah Insurance Code to achieve this. However, the bill also contained a controversial final clause which stated “A practitioner treating a patient through telehealth services, as described in Title 26, Chapter 59, Telehealth Act, may not issue a prescription through electronic prescribing for a drug or treatment to cause an abortion, except in cases of rape, incest, or if the life of the mother would be endangered without an abortion”

Last week it was reported (in Healthcare IT News) that the bill was discussed in the Public Utilities, Energy and Technology Standing Committee. Similar restrictions on prescribing abortion medication following telemedicine consultations were legally challenged in Idaho by Planned Parenthood resulting in the ban being lifted at the end of January (mobilehealthnews, mhealthintelligence). Earlier, in June 2015, another legal challenge, this time in Iowa, went all the way to the Supreme Court which rejected a state requirement for doctors to see abortion patients in person and ruled that the regional Planned Parenthood unit  could continue to provide abortion inducing medication using remote video consultations.

According to data published by the Guttmacher Institute, as of February 1, 2017, there are 19 states which require a physician to be physically present when abortion inducing medication is prescribed (see Medication Abortion).

This week, when the Utah bill was discussed in the Senate Health and Human Services Committee an amendment proposed by Republican Senator Brian Shiozawa removing the above abortion clause was accepted. Shiozawa expressed fears that a constitutional challenge could give negative publicity to  telehealth as a whole. The bill now moves to the Senate for consideration.

Telestroke continues to expand (US)

Telestroke has expanded over the years and one of the most recent click to enlargeimplementations is in New York at a group of hospitals in Hudson Valley. Health Alliance of Hudson Valley announced last week that its Kingston Hospital is now operating a telestroke service provided by Neurocall that uses a team of 40 “tele-neurologists” based in New York, Texas and Florida.

Stroke is one of those medical emergencies where the speed of diagnosis – usually within minutes of symptoms appearing – can have life-long impact on the patient’s ability to return to an independent life. What is particularly complicated in a stroke is that it can be caused by a blood clot or a burst blood vessel and the treatment for the two types are very different. When a specialist who is able to identify the type of stroke quickly is not available at the hospital, as is commonly the case, the ability to use telemedicine has proved to be a great boon.

A survey in 2012 identified 56 telestroke programs across the US and no doubt this has grown over the years with many well known health service providers such as the Mayo Clinic, Massachusetts General and Cleveland Clinic operating a telestroke service as well as acting as a hub to regional and rural hospitals.

Stroke is the fourth leading cause of mortality in the USA and the leading cause of serious long term disability according to the American Heart Association. With only 1100 stroke specialists in the US, half of US hospitals do not have a stroke specialist on the staff and nearly half the US population live more than 60 miles from a stroke centre according to “Telestroke—the promise and the challenge“, a paper published last year in the British Medical Journal. These factors have led to telemedicine being firmly established as an important part of acute stroke treatment.

CES 2017

The Consumer Electronics Show is half a century old this year and it click to enlargeis promising to be the biggest show yet. Here are some items that may be of interest to TTA readers.

The conference programme includes a Digital Health Summit and a Wearable Tech Summit (the organisers obviously haven’t been reading the TTA view on wearables so recently produced by Editor Donna). In the Digital Health Summit the top topics are going to be advances in genomics and precision medicine (not sure why this is digital health), Digital medicine and current trends such as “tele-everything”, wearables, aging, digital therapies (what’s that?) and VR. The wearable Summit top topics are the science of wearables, hottest wearable tech thus far and interactive jewelry.

There is a new “Sleep Tech Marketplace” presented by the National Sleep Foundation (no, really, I am not making this up) with 10 companies exhibiting everything from sleep tracking devices (Beddit), a system to mask noise during sleep (Cambridge Sound Systems), ultra thin earphones to wear in bed (Dubs Labs), a water mattress-topper to keep you cool while you sleep, an app to record your dream talking and snoring (Snail App) and a stress reducer.

If you are not attending between tomorrow and the 8th, then you could do worse than follow it on the official CES website or on engadget

21st Century Cures and Telehealth (US)

Just before the signing ceremony of the 21st Century Cures Act in click to enlargethe South Court Auditorium of the Eisenhower Executive Office Building President Obama made special mention of his Vice President Joe Biden and his wife Jill who had spoken of the death of their son due to cancer. Obama also mentioned his own mother who had also died of cancer when she was two and a half years younger than he was himself now. The Act provides $1.8 billion for cancer research according to the Washington Post although the allocation is for biomedical research and is not specifically for cancer research.

What was unsaid at the ceremony was that the Act also has a section on telehealth. The telehealth section of the act requires the Centers for Medicare and Medicaid Services (CMS) to report within one year to Congress on populations of Medicare beneficiaries whose care may be improved by expansion of telehealth services. CMS is also asked to report on the telehealth related work already funded by CMS Innovation, make suggestions on the type of services which might be suitable for telehealth and indicate barriers to expansion. The Medicare Payment Advisory Commission (MedPAC) is asked to identify, by March next year, services for which payment is available through private health insurance plans but not under Medicare. MedPAC is then asked to recommend how to incorporate these into Medicare.

These measures look to expanding the role of and accessibility to telehealth for Medicare beneficiaries. Further, a note entitled “Sense of Congress” states that “It is the sense of Congress that eligible originating sites should be expanded …”. However, unlike the key elements of the 21st Century Cures Act, such as biomedical research, no specific funding has been allocated for the implementation of any telehealth related recommendations. Although some optimism has been expressed about the expansion of telehealth as a result of this Act (see, for example, comments from URAC in HIT Consultant and Healthcare IT News.), with the lower priority on health that is possible from the incoming Trump administration, only time will tell if such optimism is justified.

Europe: how to keep elderly in their own homes longer

A new project to produce smart technical solutions to increase possibilities for the elderly to live at home click to enlargewithout being dependent on children or in-home care has been launched in Europe. The collaborative project named FRONT-VL is led by the Swedish mobile phone operator TeliaSonera and has 21 contributing organisations working within the industry-driven European research initiative “Celtic Plus”.

The project is based on the premise that by enabling elderly people to live at home for as long as possible a good quality of life can be maintained while at the same time reducing care costs. The project proposes to develop predictive health related end-user services in fall prevention, mental health, rehabilitation and palliative care using machine learning and “big data” analysis together with IoT based data acquisition.

FRONT-VL has a budget of 7.2 million Euros and is due to run for 3 years beginning next month. The funding caters for just over 55 person-years of effort over the three year period.

The key innovations of the project will be in two areas. First will be to create a common service delivery framework able to provide Information Computing and Telecommunications based home care and health services to end-users and care professionals. Second is automated data collection to enable peer-to-peer learning and knowledge transfer.

The Celtic Plus initiative defines, performs and finances research projects in telecommunications, new media, future internet and applications and services. It is part of the wider Eureka Network that facilitates R&D projects across Europe.

NZ’s public health advice line continues to grow

New Zealand’s public health advice line is handling more inquiries than ever, with a 16% increase in the twelve months to September 2016. In a press release following the recent visit by the Health Minister Jonathan Coleman to one of the four call centres the Government said that more services will be added to the advice line in the coming months.

Seven advice lines, operated by multiple providers, were brought together a year ago and the 24/7 advice service now operates out of four call centres and employs 250 people, according to Dr Coleman. Known as the National telehealth service (bit of a misnomer), it is operated by Homecare Medical owned by ProCare and Pegasus Health, two of New Zealand’s largest health organisations. It brings together advisory services for queries relating to general health, alcohol and drugs, depression, gambling, immunisation, poisoning  and  quitting smoking. The advice can be obtained through phone, text and online programmes and some are delivered though partner organisations such as the National Poisons Centre.

This is similar to the UK’s non-emergency NHS 111 service that provides a 24/7 free advice line giving access to trained advisors supported by healthcare professionals, except that the UK service is probably more integrated.

Should Australia review restrictions on use of telemedicine?

Research carried out in Australia shows that a hospital with telemedicine facilities for outpatient consultations was using those facilities for only one in seven potential appointments. The retrospective study of outpatient appointments at Princess Alexandra Hospital in Brisbane showed that in a 12-month period 2.5% of outpatient consultations were carried out by telemedicine. Although 17.5% of the appointments were potentially viable via telemedicine, a policy of permitting telemedicine only for rural residents meant that, as the majority of the viable telemedicine consultations were with metropolitan residents they were carried out as hospital visits.

This raises the question whether expansion of the use of telemedicine for hospital consultations in Australia should now be reviewed. Currently there is a geographic requirement that the patient’s location must be outside of an Australian Standard Geographic Classification Remoteness Area 1 (a city) for a telemedicine consultation  to be eligible for Medicare Benefits.

The research has been published in the Royal Society of Medicine publication Journal of Telemedicine and Telecare. The author, Monica Taylor, also presented the findings at Successes and Failures in Telemedicine 2016 in New Zealand where she was awarded the best paper award.

Using telehealth to improve night-time ICU care

Intensive Care Units treat the most sick people in a hospital and requires round-the-clock staffing by doctors and nurses. 24-hour staffing, however, means shift working and an inevitable night shift. To make it fair on all staff the shifts are usually rotated so any doctor or nurse would do a period on one shift and then move to the next shift.

It is not surprising that the more senior staff manage to have less night work than newer, less experienced ones. On the other hand night shifts may have attractions such as extra pay and this may be more important to the lower paid less experienced staff than to the higher paid senior ones. Also, the cost of staffing nights with less experienced staff may prove cheaper for the hospital. Nevertheless, the patients’ needs are no less important at night than during the day. Another aspect of night-time care is the possibility that a doctor or nurse may not be as alert at night as they would be in the day-time.

Looking at these downsides of night-time ICU care staffing, an hospital in the US has come up with a novel idea – move the doctors and nurses to a zone where it is day-time when it is night-time at the hospital and use telehealth to connect them. This is counter intuitive and has its own drawbacks.

Georgia’s largest healthcare provider Emory Healthcare is sending some ICU doctors and nurses to Sydney, Australia, for tours of six to nine weeks at a time, in a trial to staff ICU at night with health staff in a daylight zone using telehealth. The six month trial in collaboration with Philips and Australia’s Maquarie Health has been underway for 3 months.

The reason this is counter-intuitive is that telehealth was invented to overcome the problems associated with healthcare professionals and patients not being at the same location and here the two are being artificially removed to two ends of the world. While telehealth is a good solution to the diagnosis and treatment from afar, most professionals are likey to agree that it is inferior to being face to face with the patient. So it will be good to see the conclusions reached by this trial on how any drawbacks of distance balances out with having more alert doctors and nurses.

See also mHealth Intelligence article here.

US: Telemedicine to be used during disasters

The American Red Cross has entered into a partnership to pilot the use of telemedicine during periods of disasters in the US. During the pilot a nationwide network of physicians will be available for consultation via video calls.

Through this pilot collaboration, physicians working with Red Cross partner Teladoc will be available to people helped by the Red Cross whose access to health care providers has been limited or is unavailable after large-scale disasters. Teladoc’s virtual physician visit services will be made available via web, Teladoc’s mobile app and phone to address the primary health care needs of individuals affected by disasters.

Teladoc is reported to have donated remote medical care during the recent Hurricane Matthew. This partnership is positioned as an expansion of such disaster relief efforts rather than an expansion of its commercial activities.

Use of telemedicine in disaster relief has been implemented previously in the US by the Department of Veterans Affairs (VA). In 2014 the Office of Emergency Management of the VA awarded a contract to use the JEMS Technology disaster relief telehealth system. Going back much earlier, following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa, a satellite based audio, video and fax link, known as the Telemedicine Spacebridge, between four US and two Armenian and Russian medical centres,  permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems. Last year NATO tested use of telemedicine in disaster situations in a simulated disaster scenario in Ukraine.

Another system, Emergency Telehealth and Navigation, is deployed in Houston for helping with 911 calls. The Houston Fire Department has agreements with doctors so they have access to a doctor at any time to take calls from crew at emergency sites. They find that this avoids having to take some people to hospital when a doctor is able to determine that a condition is non-emergency where a paramedic may well have taken the patient to an Emergency Department.

Telehealth the way forward for chronic disease treatment – Australian report

  1. Telehealth has been confirmed as the way forward for sustainably treating the leading chronic diseases in Australia says a report published following a scientific study. The study, which analysed the effects of monitoring a mixed group of patients with chronic conditions using home-based telehealth equipment, concludes that use of home-based telehealth will not only reduce the hospital admissions but will also reduce the length of stay when admitted. The analysis of the data from the trial has shown that for chronically ill patients, an annual expenditure of AU$2,760 could generate a saving of between AU$16,383 and AU$19,263 representing a rate of return on investment of between 4.9 and 6. This is equivalent to a saving of AU$3 billion a year, says the report.

The Australian study, carried out by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) is reminiscent of UK’s Whole System Demonstrator (WSD), the world’s largest randomised control trial of telehealth. Although the Australian study is much smaller with a total of 287 participants over 5 sites (covering the 5 States) compared with over 6,000 in the WSD, the principles are similar. Due to the smaller sample sizes and the need to have patients connected to the National Broadband Network (NBN) the selection of patients was not random but other techniques were used to obtain statistically significant results. Patients selected had unplanned acute hospital admissions indicationg one or more of Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Hypertensive Diseases, Congestive Heart Failure, Diabetes and Asthma.

The TeleMedCare Systems Clinical Monitoring Unit (CMU) was used as the home-based unit although not all features offered by the device were utilised in this study. The CMU system deployed in this study was developed in Australia, registered with TGA (Therapeutic Goods Administration) and has been extensively used and tested in previous trials.

Typically patients would have some or all vital signs measurements scheduled at a convenient time, typically in the morning. These measurements were blood pressure, pulse oximetry to measure arterial blood oxygen saturation, ECG (single channel), lung capacity, body temperature, body weight and blood glucose concentration. In addition to scheduled times, patients could take their vital signs at any time. A full suite of clinical questionnaires was also available.

The full report Home Monitoring of Chronic Diseases for Aged Care is available to download here.

Broadband and health in USA

The Federal Communications Commission (FCC) has been investigating click to enlargethe relationship between broadband and health in the US through their Connect2Health Task Force and this week it has released an online tool “Mapping Broadband Health in America”.
It is an interactive map that allows users to visualise, overlay and analyse broadband and health data at the national, state and county levels.

This tool allows easy access to existing health and broadband access data to anyone who wants to look at the possible influence of broadband access on health over a period of time or to identify gaps which may provide opportunities to develop or expand online health services.

The interactive tool allows the user change the broadband availability measure (by say proportion of coverage or download speed for example) and select a health measure such as say obesity rate or preventable hospitalisation days and shows where the selected broadband measure is satisfied, where the selected health measure is satisfied and where both are satisfied. The types of health measures are currently limited but if users find the tool useful and feedback to the FCC there may well be further expansion.

Have a play with the map here.

Tech savvy ageing

Future technologies are expected to play an important role in supporting independence in later life says one of the main findings click to enlargefrom research published this week in the UK. People aged 65 and over who have not grown up with technology around them, perhaps unsurprisingly, find it more difficult to master the latest technologies initially than younger groups do and there are concerns that society could become more inactive and too reliant on technology. This are some of the other main findings given in the report ‘How Tech Savvy are We?’  from the Institution of Engineering and Technology (IET) in the UK.

Although the research was not focused on just the older age group there are some aspects which are particularly looking at this group of people.

There is no clear consensus on which of the six proposed technologies in the research would be most useful in later life – smart healthcare devices are rated most useful by 27%, whilst driver-less cars and robot help are deemed the most useful by only 10%. This suggests a possible disconnect between what industry is developing and what the public actually wants says the IET.

Commenting on the report’s findings, Chris Cartwright, Chair of the IET Information and Communications Sector, is quoted as saying: “It’s great to see strong public support and understanding for the potential benefits new technologies offer an ageing population. But it’s less encouraging that this support is still hindered by concerns around cost, lack of physical activity and loss of human contact. There is also a lack of clarity about which technologies people will find most useful, probably because they are unclear of the benefits.

(more…)

Danger in switching to pill organisers

Have you ever had one of those days when you get home from work and can’t remember anything about the drive back? I certainly have. click to enlargeYour mind is so engrossed on that knotty problem or you’re busy with a conference call.  Being on auto-pilot, we call it.

Now, we all probably know one or more people who take regular medication and use a pill organiser to help remember whether they took their medicines. When one is taking regular medication it becomes so second nature that one is sometimes on auto-pilot and without some means of checking like using a pill organiser it is so easy to lose track of whether one had the tablets at lunchtime.

Yesterday a report was published in the British newspaper, The Telegraph, about research carried out on the impact of using pill organisers and the results were rather surprising. When people who had not previously used pill organisers were switched to use organisers researchers observed that patients using the organisers were having more medical problems than a control group. Problems such as falls and hypoglycaemic episodes. What was going on? (more…)

Philips publishes new report on connected tech

click to enlargeA report published by Philips today claims that 78% of healthcare professionals believe their patients need to take a more active role in managing their health while 20% of UK patients admit to not managing their health, according to a press release. The report suggests that the result of people not paying attention to their health is increased illnesses (or “lifestyle related conditions” as the report calls them) such as heart failure and type 2 diabetes. The report then goes on to suggest that the use of “connected technology” to help manage their health should be made mandatory for some patients. Connected technology is defined as technology that enables sharing of information throughout all parts of the health system (e.g. doctors, nurses, community nurses, patients, hospitals, specialists, insurers and government) that can range from computer software that allows secure communication between doctors and hospitals, to a watch that tracks a person’s heartbeat. However, the connected technology in a case study highlighted in the press release is home based monitoring systems supplied by Philips for a classic UK telehealth trial for COPD, diabetes and heart failure.

Philips say they commissioned the Future Health Index (FHI) report to globally gauge (more…)

Telemedicine device wins Africa Prize for Engineering Innovation

A telemedicine invention called Cardio Pad developed by an engineer from Cameroon has been selected as the winning entry for click to enlargethe 2016 Africa Prize for Engineering Innovation, according to news reports  (BBC, Forbes, TechTrends, Business in Cameroon).

The winner, 24-year-old Arthur Zang (pictured with a Cardio Pad), who won the £25,000 ($37,000) on offer from the Royal Academy of Engineering in the UK,  was awarded his prize at a ceremony in Dar es Salaam, Tanzania, on the 26th of May, 2016. Zang previously won a Rolex Award for Enterprise in 2014 for the device. (more…)

Telecare Awareness Day (UK) – June 1st 2016

This Wednesday, June 1st, is National Telecare Awareness Day in the UK for 2016. This is promoted by the industry body click to enlargeUK Telehealthcare.

To mark the day, CAIR, the UK based telecare products supply company, is holding an event at their headquarters in West Yorkshire. According to information available from the Telecare Services Association, twelve of the region’s leading voices in Telecare will gather to “tackle some of the challenges facing the industry”.

Last year several activities took place to mark the day, then called National Telehealthcare Awareness Day, with events being held by CAIR, University of East Anglia’s Norwich Electronic Assistive Technology Centre (NEAT), Welbeing (an independent-living service provider) and many others.

A summary of last year’s events is available via the UK Telehealthcare website here.