Docs tickling the computer keys a turnoff to patients: JAMA

December 2, 2015 | by | 5 Comments

Health tech as perceptual barrier. A study published Monday in JAMA Internal Medicine-Online First (limited content) found that patients were noticeably less satisfied their care when the physician used the computer (e.g. EHR) during the appointment. According to Reuters, only half of the 25 visits with high computer use were rated as “excellent care” by the patients, compared to more than 80 percent of the 19 encounters with low computer use. iHealthBeat cited that physicians who spent more time on the screen:

  • Spent less time making eye contact with patients
  • Tended to do more “negative rapport building,” such as correcting patients about their medical history or drugs taken in the past based on information in their EHR.

The researchers (primarily from the University of California–San Francisco) used data from two years of visits by 47 patients to 39 doctors at a public hospital. The patients had Type 2 diabetes, rheumatoid arthritis or congestive heart failure, with some having multiple chronic conditions. What is downplayed is that the patients were considered ‘safety net’ patients with communication barriers–limited health literacy and often limited English (primary Spanish speakers). But even this special population may be pointing to an overall problem (more…)

Medstartr Momentum 2015: did you miss it? (Video)

December 2, 2015 | by

Let’s go to the video. Monday’s Medstartr Momentum/Health 2.0 NYC event was a Broadway Showstopper at Microsoft’s NYC Tech Center. Now available is a (so far) uncut video on medstartr.tv (scroll down to 11/30). There’s no play/skip bar on this, only a pause, so you may want to investigate a linked Health 2.0 NYC Livestream video page which has segmented the sessions and these have a play/skip bar.

Speakers included Susannah Fox, the CTO of HHS as well as 24 panelists, and 5 Momentum Talks representing Patients (Regina Holliday) Providers (Cheryl Pegus, NYU), Partners (Amy Cueva, MAD*POW), Institutions (Wen Dombrowski, MD, Northwell), and investors (Peter Frishauf.) There were four pitch sessions through the day featuring early-stage companies organized around Wearable Health Tech, Hospitals 2.0 and Pharma Tech 2.0. Hat tip to founder Alex Fair, his team, Steve Greene and the 15 sponsors who made it happen. TTA is a long-time media sponsor of Health 2.0 NYC.

2016: will telehealth catch on or stagnate, due to factors out of control?

November 25, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/Robert-Graham-Center-logo.jpg” thumb_width=”150″ /]Updated. Reviewing the Robert Graham Center study summarized by Editor Chrys last week, René Quashie of Epstein Becker Green, perhaps the leading law firm in the health tech area, opines that despite the great progress made by telehealth (telemedicine/virtual consults, but also remote patient monitoring), “state legal and regulatory issues, reimbursement, and provider training and education continue to be serious barriers to wider adoption of telehealth. And until the landscape evolves to address these barriers, telehealth adoption is likely to stagnate despite the great promise of telehealth holds as a tool to improve quality and access.” Yes, that old FBQ* (actually the top two) continues to be as true now as five years ago. While in closing Mr Quashie puts his trust in the ‘pull’ factor of consumers and patients “who will continue to demand better access and more innovative delivery models outside the conventional office visit,” this Editor is far less sanguine, despite having used a virtual consult app recently. It was turned to more out of sheer frustration–time pressure (work, travel), being unable to secure a timely visit with a specialist (no one seems to be taking new patients!) despite good (non-Obamacare) medical coverage, and a condition which was eminently photographable (plus $40 at hand). National Law Review  * The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.

Then again, if you read Health Populi and believe Gallup’s polling (based on a slightly skewed question), a majority of Americans aren’t thinking about delivery models or telehealth at all. They’re unhappy, and would like to hand the whole hot mess over to the government when asked if “government is responsible for ensuring that people have health insurance.” Yet the Affordable Care Act, now two years in, was supposed to do exactly that by forcing everyone to pay for a healthcare policy or else pay a punitive tax. Too many did the math; the tax penalty was cheaper, especially for those Young ‘n’ Healthy Invincibles with slim purses and other things to spend on. They were the ones who were expected to pony up premiums, use few services and generally prop up the system.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/shockedshocked.jpg” thumb_width=”150″ /]Now the American populace are shocked, shocked to find that out-of-pocket costs are way up and access is down. The same Health Populi article cites Fair Health’s spring 2015 consumer survey, finding that 33 percent of American patients felt that their out-of-pocket costs were ‘much more than expected’, with an additional 17 percent in the ‘somewhat’ category–a total of 50 percent. The contradiction of government control versus spending (and actuarial) reality is, in this Editor’s opinion, not going to be solved easily or well.

As to the wisdom of government involvement, there’s another developing and embarrassing ACA Big Fail.  (more…)

A StartUp Finnish for health

November 25, 2015 | by

StartUp Health expands to Finland in partnering with Finpro’s Team Finland Health. The initial StartUp Health Finland class will be five Finnish health tech startups that will be invited into the StartUp Health Academy in Helsinki, and be provided with entrepreneurial coaching and advisory services. The overall objective is to bridge the gap that Finnish companies experience to ongoing global access to investors, expertise and commercialization opportunities. Finpro is Finland´s Trade and Investment Promotion Agency. Release

‘All-in-one’ SensoSCAN medical sensor launches at HIMSS CHC

November 25, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/1110151347a.jpg” thumb_width=”150″ /]And it’s not Scanadu. Scanadu may be the ‘tricorder’ of the future, but telehealth companies are looking for a here-and-now medical monitoring device that can take the place of multiple health monitors and provide clinically accurate readings. This Editor noted Swiss-American company SensoGRAM‘s press release at last year’s mHealth Summit, but this year, in a large booth near the front of the now HIMSS Connected Health Conference expo floor, they were demonstrating production versions of SensoSCAN. The fingertip sensor, similar to a pulse oximeter, measures blood pressure, respiration rate, heart rate, and O2 saturation, plus activity levels and fall detection, and sends the information to your smartphone via app. It is being sold DTC on their website ‘for informational purposes only’ for $349.99. According to chief administrative officer Lisa D’Auria (her hand at left), they are also in clinical trials for FDA 510(k) clearance, hoping to have within less than a year, and are in progress with CE Marking. Unusually, it is manufactured in the US. Release.

Care Innovations partners with caregiver mental health app Happify

November 25, 2015 | by

Intel-GE Care Innovations announced yesterday a partnership with NYC-based Happify to integrate their mental health for caregivers app into Health Harmony by 1st Quarter 2016. Happify is a game-based app targeted to caregivers of the chronically ill to support their mental health and wellbeing through cognitive behavioral therapy, ‘positive psychology’ and conquering negative thinking. Currently it is marketed to healthcare providers and corporate wellness programs. According to the release, “By adding on access to Happify’s innovative mobile app, Care Innovations will be able to leverage state-of-the-art programs to improve the well-being of family caregivers and offer additional programs to its clients.” This is certainly an interesting integration to the typical vital signs and qualitative information gathering of patient data in thinking about the caregiver. However, we note that a previously announced partnership, with UK’s buddi announced last December, is not to be found on the CI website. Release (Business Wire)

Turn down the noise! Is it possible in a hospital?

November 25, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/sleep.jpg” thumb_width=”150″ /]Try texting and more. One of the more unfairly overlooked mHealth tools is text or SMS. While simple, the back end and integration can be complex, especially when integrated within healthcare IT systems.

In the US, one of the key metrics that hospitals are rated on in their HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems) is quietness of the hospital environment. Hospital noise is more than annoying–it is at a level that blocks healing and deprives patients of needed sleep (see study). There are door slams, people walking and talking, TVs and incessant boops and beeps from equipment. This annual survey told Inspira Health Network, a three-location hospital system in southern New Jersey, that they had a noise pollution problem.

One noise IHN hospital management could control was overhead pages–over 150 daily at their Vineland hospital. In a Quiet Hospital initiative, they replaced the overhead page system largely with a secure texting system developed by Newark, NJ-based Practice Unite, implemented by their reseller, Futura Mobility and consultant Pursuit Healthcare Advisors. Texts now go from nurses to physician smartphones, reducing overhead pages to perhaps two emergency ones daily. Scores for quietness satisfaction have improved drastically: at the Elmer hospital from 60 to nearly 100 percent, Woodbury from 45 to 56 percent, and Vineland from 55 to 62 percent.

Where the interesting integration–and workload reduction–happens is that those nurses can also make a stat consult request to a physician via Inspira’s EHR which is then sent to the physician’s phone. It also leaves an audit trail so that completion can be tracked. Lab results also can be sent to the EHR or phone, depending on physician preference, and patient round lists to residents’ phones. According to Healthcare IT News, these features have been adopted by affiliated medical practices; it has improved response times, patient consults and EHR updates, plus reduced patient stays. Health Data Management, HIT Consultant (Photo Cambridge Sound Management from their article on sound masking in hospitals.)

165,000 apps, 3 bn downloads and counting: global mHealth apps study

November 25, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/mHealth-Developer-Economics-2015.jpg” thumb_width=”200″ /]The results of the fifth annual mHealth App Economics survey are out. Our Readers were invited to participate back in March when it was sponsored by German research firm research2guidance in collaboration with mHealth Summit Europe and HIMSS and kicked off at the Riga meeting in May.

Major apps stores reported more than 165,000 mHealth apps published by 45,000 companies, and projected 3 billion downloads by close of 2015.  Some other key findings from R2G do surprise:

  • The target for apps is DTC–chronically ill patients–with their hospitals as #2. Physicians are important, but less so than last year’s survey.
  • App publishers aims appear altruistic. 53 percent of mHealth publishers claim that their main motivation is to help people improve their medical conditions. However, 60 percent aren’t reaching their goals yet mainly due to low reach. The vast majority of apps (62 percent) mark up less than 5,000 annual downloads. (See the chart below for some possible reasons why)
  • Diagnostic apps lead in anticipated business potential until 2020. And app publishers have added medical professionals to their team.
  • What app publishers find works to change behavior is not gamification. What does: integration of provider feedback or dialogue.
  • Yet providers, such as doctors and nurses, are seen as the most threatened group by mHealth solutions.
  • A scant 3 percent of mHealth publishers generate more than $1 million–and they are far more focused on sales and brand awareness than their brethren which make little. (chart)

(more…)

Is Theranos’ ‘blood testing for all’ a responsible selling proposition?

November 20, 2015 | by

Theranos’ recent troubles on their blood testing (Walgreens halting expansion, FDA halting nanotainers as ‘uncleared medical devices’ and last week chain grocery/drugstore Safeway dropping their $350 million deal for 800 locations) have been well covered in media both here and elsewhere. But what if their Unique Selling Proposition–that people should have the ‘basic human right’ to order up their own inexpensive blood tests and then be responsible for their own interpretation–is counter-productive for many patients? After all, it’s what Theranos has been organized and raised $400 million+ on. Dr Robert Wachter of UCSF, who is no top-down Ezekiel-esque ‘nanny stater’, lends a caution: “There are a lot of companies, including Theranos, that have an interest in making you believe that more data will magically make you healthier. It won’t, at least not in the short-term.” When is ’empowerment’ confusing without recourse to interpretation? Some results are easier to read than others. Does having the data make the average person healthier for real? Personally, this Editor would welcome the ability to walk into her local Walgreens and order up a few to see what’s up–but then again she can do her own research and ask a doctor or nurse to help. Who can (inexpensively) close the interpretation gap? Theranos is wrapped in scandal but goes hard to change laws to its advantage (Mashable)

NYeC honors four at annual gala

November 20, 2015 | by

The NY eHealth Collaborative, which develops policies and standards supporting NY state-wide initiatives in healthcare information/data exchange, including the development of the SHIN-NY (Statewide Health Information Network -NY), Wednesday night honored four major NY-based forces in healthcare in New York City. Steven Safyer MD, CEO of Montefiore Health System, Jason Gorevic of telemedicine provider Teladoc, Thomas Mahoney MD of Finger Lakes Health System and Lisa Perry of Community Health Care Association, NYS. While award ceremonies usually don’t come bearing insights, Dr Safyer’s was succinct in what health systems face: that price is compressing over time and that it’s about managing that, not ‘managing care’ which is the usual shorthand. NYeC News.  This Editor missed the usual event in conjunction with the gala, NYeC’s Digital Health Conference, and hopes it makes a reappearance next year. NYeC also partners with the Partnership Fund for NYC in the three-year old New York Digital Health Accelerator (NYDHA) which has six companies in its 2015 five-month program.

Telecare pioneer Alertacall receives National Business Awards-UK honor

November 17, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/Alertacall-logo1.jpg” thumb_width=”150″ /]Alertacall received the ‘Highly Commended’ distinction in the Market Gravity Innovation category at the Lloyds Bank National Business Awards UK. The company was cited over eight other finalists for its ‘OKEachDay’ phone check-in service in a field of over 150 other competitors in various business areas. Founded in 2004, Alertacall was one of the Grizzled Pioneers of UK telecare and lately has expanded into housing management with its Housing Proactive system. The winner was DNAFit, which integrates genomics into nutrition and fitness. The National Business Awards were announced in a ceremony on 10 November keynoted by astronaut (and second man on the moon) Buzz Aldrin and addressed by Prime Minister David Cameron. Scotland’s Digital Health & Care Institute was the other digital health finalist; DHI is an incubator for 85 live projects also funding academic research with a combined level of over £3 million. Awards page (click on Market Gravity Innovation), Alertacall release

Care Innovations finds a home in Mississippi

November 17, 2015 | by

The Intel-GE Healthcare joint venture, Care Innovations, last week inked a full five-year deal with the University of Mississippi Medical Center to use remote care management tools, such as their Health Harmony telehealth platform, in the home setting to reduce readmissions and ER/ED use. The chronic medical conditions they will be tracking are congestive heart failure, diabetes, chronic obstructive pulmonary disease (COPD), asthma, and hypertension. According to Healthcare Finance, the RPM, data analytics and application integration services they are developing may be offered outside the state. This follows on reported positive results produced by a statewide population health program, the Diabetes Telehealth Network, involving both CI and UMMC’s Center for Telehealth. The results for the six-month first phase of the remote care management program, which included 100 Mississippians with diabetes: a 1.7% average A1C reduction, zero hospitalizations and ER visits, and a savings of $339,184 over six months. The CI and UMMC goal is to enroll 1,000 patients per month through 2016, and to save $189 million in Medicaid cost among diabetics alone.  Care Innovations release. Health Data Management. This follows on GE Healthcare’s acquisition of healthcare consultancy Camden Group [TTA Nov 12]

Pilot Health Tech: call for applicants 18 December (NYC)

November 17, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/Pilot-Health-Tech-logo.png” thumb_width=”150″ /]The New York City Economic Development Corporation (NYCEDC), in partnership with Health 2.0 and now Blueprint Health, are calling for joint applicants for the third annual Pilot Health Tech NYC. The program invites innovative healthcare companies and “host” partners (mainly providers) to jointly apply by 18 December for $1 million in competitive commercialization awards. If chosen, these will pilot together to validate a technology solution for commercial use or investment.There are 10 awards across three categories: complex systems, scalable solutions and turnkey projects. Application is here; they also have a Q&A Webinar at noon on 1 Dec to ask questions about the funding program and details about the application process. Prior program winners include GeriJoy, QoL, Nonnatech, Flatiron Health, eCaring and Canopy Apps.

mHealth Grand Tour: ‘magical’ for cyclists, clinical level information for diabetes

November 13, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/1111150945.jpg” thumb_width=”200″ /]

From the HIMSS Connected Health Conference (CHC)/mHealth Summit

The last Executive Spotlight/keynote on Wednesday morning stepped outside most of this year’s CHC content, first for presenting a European mHealth program and diabetes patients not as overweight, inactive and co-morbid but as athletes. Presented by Benjamin Sarda, Head of Marketing for Orange Healthcare, the mHealth Grand Tour has developed in three years from a fully organized, challenging 2,100 km Brussels-Barcelona ride primarily (but not exclusively) for cyclists with Stage I and II diabetes as a test bed for blood glucose monitoring under extreme exercise, to a 1,500 km Brussels-Geneva three-stage tour with even greater ascent, extreme monitoring and also a full spectrum of vital signs feedback via smartphone to the riders. This past September, 24 riders accumulated 7 million measurements. The cyclists used these measurements (left) [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/1111150950.jpg” thumb_width=”200″ /][grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/Orange-phone-grand-tour.jpg” thumb_width=”200″ /]to help manage their food intake, blood glucose, performance and overall wellness. The data is currently being analyzed by France’s Society of Diabetes (SFD), but an early result is that medication compliance was 97 percent. Some had difficulty (with a 22,000 meter climb, who wouldn’t?) but the app helped them manage their ride and what they can do that day. Orange’s interest as a telecom is obviously data but their work with multiple research and mHealth partners (including the Personal Connected Health Alliance which is part of the CHC) and with organizations like the JDRF are part of their big scale. It also represents a ‘jump shift’ in thinking about what is possible in living with diabetes.

What happened in between? Plenty! (More coverage to come.)

90% of industries have had PHI data breach: Verizon (HIMSS Connected Health)

November 10, 2015 | by

Reporting from the HIMSS Connected Health Conference (CHC)

Cybersecurity is one of the three central themes of this year’s HIMSS CHC, and excellent timing for releasing the highlights of Verizon’s first ever PHI (Protected Health Information) Data Breach Report. This is a spinoff of their extensive, eight years running international Data Breach Investigations Report (DBIR). 

It’s not just your doctor’s office, hospital or payer. It will be no surprise to our Readers that the healthcare sector is #7 in breaches–but that a PHI breach may come from non-healthcare (in US, HIPAA-covered) sources. This Editor spoke with Suzanne Widup, the lead author of the PHI Report and an info security/forensics expert, and included in that 90 percent are workers’ compensation programs, self-insured companies, the public sector, financial/insurance companies and–as a damper on this highly competitive (but hard to gauge results) area–wellness programs. Most organizations, according to Ms Widup, aren’t even conscious that they are holding this information and need to specially protect it from intrusion, as “PHI is like gold for today’s cybercriminal.”

Consistent with other authoritative tracking studies like Ponemon Institute’s and ID Experts’, the threat is from within: physical theft and loss, insider misuse and ‘miscellaneous’ account for 77 percent of theft. And as Bryan Sartin, managing director of Verizon’s RISK team noted in his keynote today, attacks take over a seven-month period on average to even be noticed. The breaches are long term, start small and sneaky. 2/3 of organizations don’t find out on their own, only when it starts to affect other partners. (Surprise!) Despite the proven Chinese and Black Vine involvement in several high profile, high-volume data hacks (Anthem), and ‘brute force’ hacks that make headlines (iCloud last year), the average breach is an inside job where “assets grow legs and walk off” in Dr Widup’s words, or privilege misuse.

When I asked Ms Widup about the Internet of Things (which is moving high on the hype curve, from what your Editor has experienced to the nth degree at this conference), she confirmed that this is an area that needs extra cybersecurity protection. (more…)

A diagnosis of why digital health startups die–an old (and new) story

November 6, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/upside-down-duck.jpg” thumb_width=”150″ /]For years now, your Editors have championed integration of data and system interoperability–search on these terms and you’ll find a wealth of articles and views. This Editor also included how data is integrated in patient records as the Fifth Big Question (FBQ) in 2012 [TTA 8 Aug 13]. Many digital health companies, not just startups, have failed at the data integration (and security) tasks, whether with EHRs, hubs, billing and practice management systems or with other devices. (Let us not forget that the initial impetus for Continua back in 2007, the US state/regional HIXs and for HL7 now, was to have common data and interchange standards.)

So there’s no real element of surprise here by John Sung Kim’s pleading in TechCrunch re ‘integrating into legacy systems’ and the troubles his own startup DoctorBase encountered in what he tactfully puts ‘political and technical hurdles’ encountered. But then the velvet gloves come off about EHRs and their less-than-scrupulous idea of ‘partnerships’. (more…)