Connected Healthcare: MIT Enterprise Forum 17 Nov 2010

MIT Enterprise Forum of NYC

Wednesday, 17 November 2010

Reporter/Attendee:  Donna Cusano–Editor, North America

Is this a perfect storm for healthcare IT and consumer health? Panel moderator Raymond Falci (Managing Director, Cain Brothers) set out a ‘storm map’—a hospital IT spaghetti chart that represented ‘streamlined process’.

  • Business models in consumer health are fractured—whether payors seeking the next gen in disease management; pharmaceutical companies trying to increase falling sales; healthcare providers attempting to measure and manage risk (and will accountable care really work?); and consumers reluctant to pay for anything.
  • Prospect areas:  Monitoring chronic diseases, other remote monitoring, acute care post-discharge management, member health status and wellness monitoring.

Panel question #1: What are the obstacles and enablers to connected healthcare adoption?

Nick van Terheyden, M.D. (Chief Medical Officer, Nuance):  Prior experiments in paperless hospitals in 1990s unworkable because inability to transfer records and information.  Current EMRs and tablets take too much time.

Rob Dhoble (President, Diversified Agency Services Healthcare):  WebMD in 1990s opened up torrent of information, not always correct.  Understanding it is a problem for average person.  Video e.g. YouTube the most persuasive (and often incorrect) medium—video is ‘surrogate’ for information needed.  People gravitate to ‘authorities’ who make health information simple (Dr. Oz, Dr. Sanjay Gupta)

Rachel Block (Deputy Commissioner for HIT, NY State Dept. of Health):  State Health Information Exchanges (HIE or HIX) have been useful in delivering health information; most are getting tools (e.g. EHRs) to doctors.  Now emphasis on programs—care coordination, public health, mHealth.  Two factors supporting adoption—systems that are patient-centered, policies in standards and payments.

Teo Dagi, M.D. (HLM Venture Partners): 
The big question:  Do we really know if prevention, monitoring and information (data synthesized) make a difference in outcomes?
Adapting to change:  Physicians find adapting to change like connected health very difficult because of the way they are trained: to take care of patients, provide good technical care, take responsibility for patients, not populations.  Comparison:  NHS short visit system versus longer consult and options in individual care (US).  Other questions:  current comfort level in technology and transferring skills to technology.

Gopal K. Chopra, M.D. (CEO, Dauphin Health):  The system is so broken we have to reconstruct it.  IT is colliding with care—‘we built it so that we could bill.’  For instance:  we have not figured out how to make data actionable in workflow; we have looming shortages of time (e.g. pediatricians where many doctors are not full time through careers), versus demand (birth rate). Can we succeed in taking healthcare out of the enterprise (hospital)?

Panel question #2:  What is the revenue model for advanced technology?

Mr. Dhoble:  Accelerant will be the CMS non-reimbursement for preventable readmissions in 30 days in October 2011.  ‘Expert patient’ key factor (and can patients be ‘experts’?)  Leveraging media to increase learning of healthy behaviors and increase understanding.
Ms. Block:  Disincentive in healthcare reform.  Health may well become a ‘regulated utility’ that is based on scale.  (This was a surprising answer)
Dr. Dagi:  Questioned ‘scale’ paradigm.  We may wind up with a two tier system like the UK or a ‘shadow system’ e.g. privately paid concierge medicine because ‘scale’ does not work.

Panel question #3:  Will EHR adoptions fulfill the ‘vision’ of better quality healthcare in the short term?  (Answers here were especially surprising)

Dr. Chopra:  There is NO WAY that the January 2011 start of adoption and qualifying for meaningful use works.  If he were in private practice, he would run away from it!
Dr. van Terheyden:  Systems can’t extract information from the EHR and put into patient records as needed.
Ms. Block:  System is in overload because of other demands, such as transition to new coding standard (ICD-10).  Meaningful use is a distraction (!)
Mr. Dhoble:  All the stakeholders (pharma, imaging companies, etc.) are lobbying for too much to be included.
Dr. Chopra:  Right now, we are not practicing ‘clean healthcare’ and EHRs aren’t going to change this.
Dr. Dagi:  What is the standard of care?  This is a population question not an individual care question.  (Not clear from his remarks or my notes where EHRs fit in this comparison, though.)

More on Dauphin Health:  After the panel concluded, I spoke with Dr. Gopal Chopra who is their CEO. The early-stage company has designed a system, currently in test, that allows a parent to transmit information on an ill child via phone or web to a ‘virtual resident’ which compiles it and connects to the family pediatrician.  Treatment instructions are returned in 10-15 minutes.  The call is essentially triaged but speeds response back to the parent.  It is in test: their two basic websites are at www.dauphinhealth.com and www.dauphinmd.com.

Not all the questions in the session notes were answered…are they ever?…but an excellent evening (and any event at 30 Rockefeller Plaza is a treat!)

 

‘Economist’ on mHealth Summit

The Economist summarizes the mHealth Summit in a brief but meaty article that summarizes the massive detail presented.  Gates:  beyond the pilots, technology has to be replicable and scale up. Anta (Inter-American Development Bank): ‘We know little about impact and nothing about business models’.  Business interest is stimulated by 1) cloud computing applications, 2) US adoption of EHRs, 3) developing countries’ mHealth ideas and business models (such as mobile banking), 4) substituting technology for medical labor (Healthpoint Services and P&G support).  M-powered:  the convergence of mobile telephony and health care is underway.

News from mHealth Summit: Wednesday

Check this space for updates and links. As this will be a short day ending at 3pm, most news will be summarized in the afternoon (ET).

Breaking news from mHealth Summit (Tuesday)

Running coverage of the mHealth Summit. Check this space for updates and links.

Tuesday

Insight on what’s next from Bill Gates: mHealth, mCommerce and robots. Excellent summary of the Bill Gates afternoon keynote (no live video feed). Tip of the hat to Alex Howard of Gov20.govfresh.

HIStalk for Day 2 (and last for him): the keynotes and supersession plus a small session that included Vitality GlowCaps, PhiloMetron’s PMTS sensor patch and UCLA’s Dr. Ozcan’s LUCAS microscope [TA 21 May]. A must read for a contrarian, witty POV. Hat tip to the (anonymous) author, whom we hope finally got something decent to eat. We will miss him tomorrow.

In other news:

  • Norad (Norwegian Agency for Development Cooperation) is providing $1 million in support for the mHealth Alliance’s Maternal mHealth Initiative. Release. Announced by the Alliance’s chairman Tom Wheeler during the morning keynote. [Unfortunately, the best part of a somewhat comical morning keynote by Ted Turner expounding on his notions of world peace policy, wandering over the plains like one of his buffalo, with Mr Wheeler politely trying to corral him back to the mHealth point and his support on the UN Foundation’s work on eradication of malaria, polio and measles. After the umpteenth blatant plug of CNN and Cartoon Network, I ‘turnered’ the audio off.–Ed. Donna]
  • Healthpoint Services Global, Inc. announced this morning a partnership with The Procter & Gamble Company aimed at advancing a scalable, self-sustaining model for delivery of water, healthcare, and other benefits to underserved rural communities in developing countries. Healthpoint is a for-profit active in India, provides in rural clinics safe drinking water, access to qualified doctors via telemedicine, advanced on-site diagnostics and an on-site licensed pharmacy. In addition they equip and deploy village health workers with mobile phones.  P&G’s FutureWorks will provide financial support, people and in-kind services.  PR Newswire release
  • MedApps and CardioNet are forming a strategic alliance ‘to advance their positions in the mobile wireless medical market’.  What they are doing together is not clear from the release except for this from CardioNet’s CEO Joseph Capper:  ‘We are looking to MedApps to help accelerate our entry into additional areas of monitoring, and to extend our platform utilizing MedApps’ CloudCare™ technology.’  Terms not disclosed. BusinessWire. Related news: CardioNet yesterday announced a definitive merger agreement with Biotel, to close by 31 Dec.  This had been postponed since last year.  BusinessWire
  • More Text4Baby news: a multi-million dollar commitment from Johnson & Johnson to the National Healthy Mothers, Healthy Babies (HMHB) Coalition to expand the program both numerically and to add new features; Department of Defense and HRSA (Health Resources and Services Administration) are evaluating the program for the underserved and military families.  PR Newswire.

Neil Versel’s roundup today on FierceMobileHealthcare themed as highlights from the ‘Lollapalooza’ (annual US rock festival) of mHealth. Inspiring but sober. Dr. Louis Hochheiser’s (Humana) hopes on learning patient behaviors via mHealth and as a means of changing behaviors.   Prof. David Gustavson (Univ. WI)  on shortening the long timelines of pharma clinical trials (average 5 years) and other health/science breakthroughs (17 years!).  At Fierce’s executive breakfast, Centers for Medicare & Medicaid Services’ Medical Director Dr. Barry Straube on telehealth and HIT being ‘ripe for change’ and very important in the cultural change of bringing healthcare to the individual and away from ‘brick-and-mortar’.  Cell phones being used for maternal and child health and reducing mortality.  (Dr. Straube to retire 31 Jan 2011 after six years at CMS.  MassDevice)

Blog coverage of Day Two: Brannon Cullum in the Alliance for Youth Movements blog, Day Two highlights (including more on Mr Turner’s musings).  Do read down to Theresa Cullen of the Indian Health Service on how in health, our Native American citizens have attributes of both the developed and developing worlds, and Patricia Mechael’s ‘Top Ten Lessons for mHealth’.

Healthcare IT News hosted live blogging of Tuesday only. CoverIt Live replay (direct link to page):  keynotes by Ted Turner, the AM supersession and the Bill Gates luncheon, concluding with Aneesh Chopra’s hyperbolic pep talk.  They also picked up the tweetstream from #mHS10 after midday.

Breaking news from mHealth Summit (Monday)

Running coverage of the mHealth Summit.  Check this space for updates and links.

Monday

HIStalk conference summary.  Observant–and not above poking fun. Compared to others’ (HIMSS) focus on population health; heavy on the academics, NGOs, global health people–‘serious people getting serious education mostly working for noble causes underwritten by government money.’  See his points about 75% down on the mHealth business model or lack thereof; the general supposition is that mHealth will never be profitable.  Too extensive to excerpt here–they deserve extensive discussion.

  • Diversinet awarded a five-year contract to support expansion of the U.S. Army’s mCare telehealth-outreach program for members of the military recovering from mild traumatic brain injuries (TBI) and other wounds.  This follows the one-year pilot that started with the now-defunct AllOne Mobile that transitioned to Diversinet, the developer of the MobiSecure Health platform.  Release.   Diversinet booth #202-12, in the Qualcomm pavilion.  [Flashback to findings presented at ATA:  TA 21 May]
  • West Wireless Health Institute announced its first engineering prototype, Sense4Baby, a non-invasive fetal and maternal monitor that is portable and uploads data to the internet.  It incorporates cardiotocography, standard technology for measuring fetal heart rate and uterine contractions, which is typically administered in a clinical setting for 20-30 minutes per visit and is used in high-risk pregnancies.  Demo at their booth #205.  Release.
  • mHealth Alliance to receive a two-year, $1 million donation from HP.  This funding will assist the Health UnBound (HUB) online community and the Maternal mHealthInitiative.  Release.
  • Text4Baby has passed 100,000 subscribers–101,962–announced by Dr. Todd Park, CTO of Health & Human Services, which has also created a Text4Health taskforce on how to apply lessons learned from Text4Baby to smoking cessation, obesity and childhood health issues.  Mobihealthnews.  Park also announced ‘detailed plans for the government to launch a website featuring health data harvested from across HHS – a wealth of easily accessible, standardized, structured, downloadable data on health care at the national, state, and county levels, as well as by age, gender, race/ethnicity, and income.’ mHealth Alliance release  

Blog coverage of Day One:  Alliance for Youth Movements blog (Brannon Cullum) 1st day highlights

Mobihealthnews on morning keynote speaker Dr. Francis Collins:  increasing number of grants for mobile health research, highlights of NIH-funded applications and devices, the difference between developed and developing markets.

mHealth Summit coverage

While Telecare Aware will not attending the mHealth Summit, here is how you can follow it as it happens.  

UPDATED 9 NOV (PM)

mHealth Summit website streaming video (and Twitterstream) here .  Alternate live feed is on mHealth Alliance website here.   Live only for keynotes and ‘supersessions’. 

mHealth Summit’s YouTube channel here.  Posted interviews:  Microsoft (Kristing Tolle), McKesson Foundation (Carrie Varoquiers), Qualcomm (Clint McClellan).

Twitter:  #mHS10 (this feed is also on the streaming page)

Also on the mHealth Alliance website: 

  • Press briefing podcast (courtesy of 3G Doctor) focuses mainly on mHealth in the developing world and policy issues such as extending healthcare via mobile to compensate for physician shortages.  A key announcement here is that Muhammad Yunus, Bangladeshi economist, Nobel Laureate and founder of the microcredit pioneer Grameen Bank, has been appointed to the mHealth Alliance board. (3G Doctor will also be there (booth #221) with a demo of their 3G Mobile Video consultations.)
  • Interview with the head of Sproxil, Dr. Ashifi Gogo, on their Mobile Product Authentication system being tested in Nigeria to fight drug counterfeiting. [TA 5 Nov]

Telecare Aware is a media partner of the mHealth Summit.

Telecare Soapbox: Android or iPhone: Your business. Your life. Your decision.

Jeff Brandt is one of the founders of Communication Software, Inc. He has extensive experience in mobile telecomm, online banking, and healthcare information technology. Jeff has a BS in Computer Science from the University of Oklahoma and is currently attending Oregon Health Sciences University’s school of Bio-Medical Informatics.

I wrote an article for KevinMD.com several months ago discussing the benefits of Android for the healthcare market. I also compared Android with the iPhone. I listed the iPhone’s technical shortcomings and really angered the “believers of all things Apple”. That was not my intent. Apple’s latest release of iPhone 4.0 and their new operating system (OS) 4.0 corrects many of the problems that I mentioned. The shortcomings or benefits of a device are not the focus of this article. I am going to speak to the general philosophies of the two OS and let you make up your mind on which OS is better for your healthcare facility or personal/business use. (more…)

Telecare Soapbox: Value creation–wireless health companies at the fore

Paul Sonnier, founder of the Wireless Health group on LinkedIn and co-chair of the Healthcare Communications SIG at CommNexus San Diego, has thoughts on the new definition of ‘value creation’.

During the annual Wireless-Life Science Alliance’s (WLSA) annual Investor’s Meeting held in La Jolla, California last week, I had the good fortune to hear a keynote presentation by Terrance Gregg, CEO at San Diego-based DexCom, which produces wearable continuous glucose monitoring devices. Mr Gregg alluded to challenges the company has faced over the course of its history in terms of maintaining its independence while other, more established companies eyed its technology for acquisition.

After hearing this part of the DexCom story, it occurred to me that independence and durability are the eternal challenges faced by most successful technology companies and entrepreneurs… (more…)

The Innovator’s Prescription (video)

Essentially the same presentation as his week-earlier keynote at last October’s Connected Health Symposium (see this editor’s report here), but you can now see this important presentation for yourself:  from ePatient Connections, Jason Hwang, M.D. on disruptive innovations in healthcare decentralizing care, and the historical futility of cramming new technology into old business models.  Dr. Hwang is Executive Director of the Innosight Institute and co-author of The Innovator’s Prescription: A Disruptive Solution for Health Care, with Professor Clayton M. Christensen and the late Jerome H. Grossman.  Thanks to Paul Sonnier of CommNexus (San Diego) for bringing this to our attention (and Kru Research for posting on their site).

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You can buy the book (GBP £):

The Innovator’s Prescription: A Disruptive Solution for Health Care

You can buy the book (USD $):

The Innovator’s Prescription: A Disruptive Solution for Health Care

Continua’s ‘garden of wonders’ at CES: 5 videos

For your weekend viewing:
1) RTT News interviews Jonathan Linkous of the American Telemedicine Association on how technology and healthcare are converging (4 mins)
2) Larry Chu interviews Chuck Parker, Executive Director of Continua about the alliance, for HCPlive. (7 mins)
3) Tech journo Scott Mace visits the Continua Alliance booth at CES last week–the ‘child’s garden of wonders’ we referred to. The video quality is only fair, but Mr Mace lets the demos speak for themselves. You’ll also get an idea of the Digital Health part of the expo floor. This one includes IBM demonstrating the ‘end-to-end’ solution including A&D, Roche, Eurotech; Nonin Medical and Vignet. (7 mins)
4) Also by Scott Mace, this features Tunstall, Storento (sp?) med monitoring packaging, MedApps and a chronic disease management demo by a Continua representative that includes A&D, LNI Health Link uploading to a Google Health PNR. (10 mins)
5) A crystal clear MedApps demo using a pulse oximetry reading (the subject lived.) (1 min)

Healthcare highlights at International CES

For the healthcare minded, the Consumer Electronics Show (International CES), officially kicking off Thursday (7 Jan) in Las Vegas (but all over the press with Google’s Nexus One, ‘smartbooks’/slates etc.), has a section in the LVCC’s North Hall dedicated to ‘digital health’.  Unfortunately the exhibitor list in this ‘tech zone’ is a bit of a disappointment, with only Continua Alliance and GrandCare Systems of interest to our readers.  The neighboring Silvers Summit ‘tech zone’ has more of interest, with Dakim (brain fitness), Jitterbug (phones), Tabsafe (med dispensing) and Wellcore (fall detection).  But Continua seemingly has a child’s garden of wonders in their booth.  They are demonstrating ‘the first end-to-end connected health solution based on the Continua architecture’:  Nonin Medical’s wireless Bluetooth pulse oximeter sends data to a PC manager running Vignet’s Connected Health Services platform (debuting at CES-release) which is then uploaded to an IBM server.  But…there’s more:  A&D Medical (blood pressure and weight–see recent story on Halo partnership), Lamprey Networks, PDT, Renesas Technology, Tunstall Healthcare (Telehealth Platform–see below–and Connect) and ZyXEL are also demonstrating in the Continua booth. Continua’s release and press advisory.

[Donna Cusano update 7 January] Live from CES–GrandCare Systems hosted their weekly open webinar/conference calls from the just-opened floor.

  • Add to your visiting list: Carnegie-Mellon/University of Pittsburgh (Silvers Summit ‘tech zone’ booth #3013)–their display from their Quality of Life Tech Center is a 64 square foot room demonstrating their latest innovations, including RFID-assisted walls that change moods–color and brightness–to assist those with traumatic brain injury, plus touch screens for vital signs monitoring.  (Thank you Jeff Giuggio from C-M for the short briefing).
  • Wellcore (#2909) is introducing at CES their in and out-of-home fall detector, which will be marketed through the firstStreet catalog starting in March. Beyond the usual accelerometer, it uses algorithms to track and discern type of motion, delivers voice messages from their online website and will prompt to be worn. Out-of-home, the Wellcore monitor connects via Bluetooth to a cell phone.  Releases.

Although this editor isn’t there, we could have an ‘inside source’ for updates…we hope that what happens in Vegas, can’t stay in Vegas!

[Donna Cusano update 8 January] According to this release, at today’s 11am keynote Qualcomm chairman Dr. Paul Jacobs was joined by Dr. Eric Topol of the West Wireless Health Institute to highlight a selection of digital medical devices, including AirStrip OB (AirStrip Technologies), Mobile Baby (Great Connection), PiiX (Corventis) and Vscan (GE Healthcare).

 

Telecare Soapbox: Can the ‘old old’ have best lives when the pressure is to isolate them?

Donna Cusano is currently a healthcare services, wellness and supportive technologies marketing consultant based in New York City. Previously she was Vice President, Marketing, for Living Independently Group (QuietCare Systems). The following Soapbox item was triggered by the How the ‘Old Old’ can have best lives item.

So much of our emphasis in the technology area has been to keep seniors active that we tend to ignore planning for and helping seniors (and their families) to manage their last and usually inevitable years of increasing frailty, and the role that technology in the service of care can play. I don’t know of many cultures that support the ‘old old’ and those that have (Asian Indian, Chinese, Japanese) are increasingly not. Here is a moral, right opportunity for both healthcare and technology. I will make a similar case for the disabled and the support telecare/telehealth can be for them as well.

Unfortunately I think the trend towards treating the ‘old old’ – or even the just old – INhumanely is on the rise, despite… (more…)