A ‘Smart’ and rather modest looking stethoscope may pack a big (figurative) punch. When medication does not break up kidney stones, shock wave lithotripsy is often used, but it is difficult to tell when the fragmentation process is complete. This device monitors the pulses as they echo off the stone, and by changes in sound (‘tock’ vs. ‘tick’) can confirm that the stones are shattered (any reference to Mick’s Group is unintentional but unavoidable). In clinical trials it has reported an accuracy rate of 94.7%, far above any existing tech. The Smart Stethoscope delivers no radiation, and can also be used as an assessment tool for probable response to lithotripsy. Developed by Prof. Tim Leighton (left) at University of Southampton with Guy’s and St. Thomas’ Foundation Trust (GSTT) and UK-based tech firm Precision Acoustics Ltd. which will be developing a commercial version. “Smart stethoscope” keeps an ear on kidney stones (Gizmag) Research study in Proceedings of the Royal Society A. University of Southampton announcement.
Adam Darkins, M.D., who is Chief Consultant, Care Coordination Services, Department of Veterans Affairs (VA), recently presented at the Connected Health Symposium on the efforts–and results–of the VA in what they call Clinical Video Telehealth (CVT=telemedicine), Home Telehealth (combined video and telehealth), store and forward (imaging), telemental health and more. This presentation is undated but is recent because of the Federal FY 2012 statistics cited (ending September). The VA is the largest user of telehealth services in the US with nearly 1.4 million consultations a year, over 900 sites of care and growing at 70% per year. 30% of their patients live in rural areas at long distances from VA facilities. They are also the largest database of outcomes over time, and what Dr. Darkins cites as Home Telehealth Savings is $1,999 per patient per year. Much more in this fact-packed 14 page deck. Telehealth Services in the Department of Veterans Affairs (VA) (PDF) VA telehealth services grow by 70 percent with significant utilization, cost savings (FierceMobileGovernment) Hat tip to Mike Clark.
Bio on Dr. Darkins reveals his UK roots as a trained neurosurgeon, early telehealth program director at the King’s Fund and founder member of the Royal Society of Medicine’s Telemedicine Forum.
Earlier this week, Editor Donna, in reviewing David Shaywitz’ Forbes ‘2013 awards’ article on the top book for 2012, noted that disease management (and telehealth overall) has had difficulty with determining traditional ROI. Our long-time readers might remember this editor’s lamentations on the lack of large N studies done over extended periods–the studies which are hard to finance, justify and conduct objectively, especially by early-stage companies struggling to survive. Mr. Shaywitz has graciously commented on our article here noting the ‘outsized claims’ that many programs make, and the difficulty in actually calculating valid ROI not only for health but also wellness outcomes. A further whacking on the same subject was given at the close of the 2012 mHealth Summit by Francis Collins, MD, PhD, the National Institute of Health’s (NIH) director. NIH has only conducted 20 randomized trials of mHealth, and less than half documented any clear evidence of improvement. Despite his own personal commitment (he was a test subject for AliveCor‘s heart monitor), he correctly chides us that ‘the plural of anecdotes is not data.’ Companies, the scientific/academic and healthcare ‘communities’ need to work faster. Here’s his suggestion: a national research network of millions of people, linked through electronic medical records platforms, which would create a database of real-time data. The EMR linkage is ambitious–and probably not workable due to HIPAA privacy regulations–but Ed. Donna has two additional suggestions: incentivize people to do it through a small stipend, like mystery shopping–or use crowdfunding tools to enlist subjects. NIH’s Collins says mHealth needs evidence, not anecdotes (mHIMSS)
For those of us who have food allergies, or even sensitivities, any new food or prepared dish holds a level of risk, but current testing is bulky, lab-based and for professionals only. A new device may be able to simplify the testing process with similar sensitivity, broadening usage to restaurant, facility or home settings. UCLA’s Aydogan Ozcan and a research team has developed a much shorter testing process using an attachment to an iPhone that runs the same test that a lab would. As developed, it takes about 20 minutes to process the food into a test tube sample, which is then analyzed by the iTube attachment using its camera and a smartphone app that runs an allergen-concentration test known as a colorimetric assay. The team’s study was published in Lab on a Chip (abstract). Ozcan also recently developed the iPhone based LUCAS miniature microscope which can detect E.coli [TA 2 March]. Got Food Allergies? You Can Now Test Your Meal On the Spot Using a Cell Phone (Science Daily)
The US Food and Drug Administration (FDA) announced the formation of the Medical Device Innovation Consortium (MDIC) with LifeScience Alley (LSA), a Minnesota-based biomedical trade association. More exactly, the MDIC consists of the FDA’s Center for Devices and Radiological Health (CDRH) and the LSA. For FDA this is unusual–according to the release it is “the first public-private partnership to promote medical device regulatory science with a focus on speeding the development, assessment, and review of new medical devices.” LSA includes in its nearly 700 organization membership the Mayo Clinic, Medtronic, St. Jude Medical and University of Minnesota. While this is about biomedical devices, if successful in 1) creating a review model and 2) speeding up the process, it will definitely impact the relations that FDA has with the connected health area, or even expand to include it. (Now if we could also get the FCC into this streamlining….) But the Feds give with one hand and take away with another, with the ACA’s 2.3% excise tax on medical devices (all those implants and stents) starting in January and IRS final regulations now released. FDA release LSA/MDIC release CBS News article
Pre-filled multi-day medication boxes (versus large dispensers meant for an external service area) are becoming increasingly common both in the community and individual home setting, but there is always the risk of an individual’s confusion in taking more than one day’s dose, or the medications all at once versus at the right time. MedMinder’s Jon model, a new seven-day wireless M2M dispenser, can be controlled by the caregiver through their monitoring website to let the individual access only the correct compartment and also at the correct dosage time. It has reminders (beeps, phone calls, emails or text messages) and notes when the compartments have been accessed, similar to its existing Maya model. Their website feature page has a brochure link, but it is for the Maya, not the Jon, model. Editor Donna also finds interesting their payment model of no upfront cost and a monthly fee. (Note to MedMinder’s marketers/general counsel: ‘medminder’ is becoming a generic term for dispensers–the MedMinder team is well advised to register their trade name.) Website release (mind the typos) Also noted is that Bosch is using MedMinder with its HealthBuddy and T400 programs.
This research evaluates how smartphones and tablet PCs at two points–2010 and 2012–have affected healthcare professionals and influenced the way they practice, including the most in-demand information. Compared are providers in the EU Big 5 and the US. Conducted by EPG Health Media (UK). Abstract. Link to full PDF (registration required)
You’ll find the design of this prototype skin sensor out of University of California, San Diego either endearingly goofy or just scary. This paper ‘tattoo’ is actually a solid-contact ion-selective electrode (ISE) made using standard screen printing techniques finished with an electropolymerization process on commercially available transfer tattoo paper. The two ‘eyes’ are actually electrodes which measure perspiration on the skin’s surface to determine stress-related changes in pH and clues to metabolic diseases such as Addison’s, or more simply fatigue or dehydration. The tattoo sticks to even wet skin. It can also measure sodium, potassium and magnesium with different sensing materials. There’s great potential for this not only in sports, but also in assisted living and rehabs where one of the most serious conditions is gradual, invisible dehydration of residents. Tattoo-based medical sensor puts a happy face on detecting metabolic problems (GizMag) Happy face tattoo does serious work (University of Toronto release)
David Shaywitz, co-founder of the Boston-based Center for Assessment Technology and Continuous Health (CATCH) and advocate for humanism in digital health [TA 6 Nov], surprises in his Forbes picks for digital health company, person and book of 2012. First, the company: the EHR that dominates large hospital systems, Epic. Why? It may be awful and the bane of M.D.s, but the hospital system gets basic connectivity that chains together the bits, in a proprietary way, delivered with ‘flawless implementation’–the kind of customer services that holds every hand in MIS and HIT until the boo-boo is better. In other words, they delight the buyer. (Your marketing lesson for today.) Second, for person, none other than The Gimlet Eye’s circular bête noire Vinod Khosla. Shaywitz is this-n-that about the man, believing Khosla underestimates the human factors in medicine while agreeing with him on how behind healthcare is in capturing and using basic data, much less integrating more advanced data produced by monitoring. Editor Donna and the Eye take a dimmer view, believing that much of Khosla’s ‘disruption’ is to gain notice for (OK, hype) his investments such as AliveCor’s iPhone case heart monitor (just receiving FDA Class II clearance), cellphone microscope Cellscope and data collection/platforming Ginger.io (leading $6.5 MM in series A funding). Finally, Shaywitz’s pick for book of the year is”Why Nobody Believes The Numbers,” by Al Lewis. Disease management takes longer, saves less, has difficulty in achieving any ROI but can work out best for the patient in the long run, if we ever get there. But didn’t we know that already? Forbes article
Related: Khosla vs. Kvedar at the mHealth Summit. From Khosla, the usual ‘80% of healthcare can be delivered without doctors’, ‘50% of doctors are below average’ and most Americans today understand health information at a fifth grade level (so much for everyone being Quantified Selfers!). Kvedar argues the same points from ‘60% of healthcare costs are labor’ and that computers are better than humans at algorithmic tasks. Not much of a debate here as Khosla gets 80% of the article lineage. mHIMSS
Are you a clinician who feels overwhelmed by the jillions of one-trick-pony medical apps on your iPad? Is your day characterized by wild mood swings due to frustration (left) in not being able to customize your apps? According to this website, you could be a victim of Medical Apps Disorder*. This clever website and funny video is but a teaser for a new app in phase 3 clinical trials that promises to alleviate said symptoms. Let’s hope the cure lives up to the promise made by app developer Skyscape and info/decision support division Physicians Interactive. * Not in the American Psychiatric Association’s soon-to-arrive DSM-V, but perhaps it should be.
Based on reports coming in, the mHealth Summit this week in Washington D.C. had a greater focus on the US and patient engagement than the past two years, which emphasized governmental programs and non-profit NGOs, but with a twist–insurers are moving upfront in the picture. From Aetna‘s CEO Mark Bertolini keynoting and promoting their iTriage management app to the announcement of the open CarePass mobile platform that organizes 20 smartphone apps that help consumers manage their health and fitness, UnitedHealthcare Group‘s similar OptumizeMe and even AT&T insisting it’s a payer (self-insured), the rationale is better health for consumers, better care quality–but most of all reduction of that ‘$750 billion in waste’ that exists in the current system. Here’s select early coverage to get you started. Consumers will engage if mHealth is easy, Bertolini says (mHIMSS); Mobile tools help public, private payers be more proactive, Healthcare cathedrals and the consumer health bazaar (Mobihealthnews)
Update 7 Dec: David Lee Scher, M.D., well-known US consultant and former cardiologist, outlines five reasons why payers will be playing a major role in mHealth adoption (Ed. Donna comments): they hold the purse strings (very true), they can change physician behavior (ditto), they realize importance of patient engagement (uneven), they are the largest users of patient portals (of a limited type) and can perform clinical studies (they can, but not credible without academic involvement). Why payers are critical to mHealth adoption (mHIMSS)
Neil Versel argues that Editor Donna’s question may very well be an understatement. To those of us in the technology community, the ‘button’ is a relic of an earlier time (and in the US, a reminder of an inadvertently funny ‘schlock shock’ commercial of the late ’70s). Starting in 2005, behavioral telecare elevated standards of safety (QuietCare then HealthSense, GrandCare, WellAWARE, etc.), and then fall detectors, telehealth-based care management and countless mHealth apps further raised the bar. The technology parade has passed PERS by. But to the implementers, the carers and community executives, the plain-jane PERS alert button remains a mainstay of senior housing on both sides of the Atlantic at least. Not that there are not abundant real-world alternatives. Yet more advanced ‘passive PERS’ with a fall detecting accelerometer built in (Philips Auto-Alert, Aerotel GeoSkeeper, AFrame Digital) and behavioral telecare, despite proving greater safety and proactive care metrics, are still in a low stage of adoption. But as Versel points out, PERS can no longer be considered the standard of adequate care, whether at home or in a facility–and moreover, provides little more than the false assurance of safety with the potential of a high, final and unconscionable human cost. Panic buttons for seniors must go (Mobihealthnews)
Update 7 Dec: Editor Steve, in his comments under the article, makes two points: self-reporting safety confirmations (response to automated calls and similar systems) adds another security layer for older people and disabled living alone; current accelerometer-based fall detectors often miss ‘soft’ or gradual falls, especially to the seated or slumped position
Also from Ed. Steve, continuing research in behavioral telecare’s quantification of the early detection of illness is being done by the University of Missouri at two locations in Missouri and Iowa. They are using Microsoft Kinect for gait assessment, which can predict propensity to fall, and are receiving NSF and other Federal funding for this (limited) ongoing research. Originally covered by us back in July [TA 3 July] and updated in this article from (UK) HealthCanal: Sensor Network to Protect the Elderly
Our onslaught of 2013 predictions starts with the Top Five from AT&T, cleverly timed for the mHealth Summit. From their press release supplying plenty of AT&T ForHealth focused examples (and our interpretation):
- A shift from stand-alone “unsponsored” apps to meaningful “sponsored” mHealth solutions (Here come the pharmas, insurance companies and care management companies–now if they will just pay for it and stick with it!)
- Hospitals and other healthcare institutions including payers will begin to move more and more healthcare data into the cloud (outrunning HIT’s ability to secure the cloud, secure internal systems, or backup when the cloud goes down)
- Remote patient monitoring will move from pilots to large-scale adoption (another pilot with telehealth provider Intuitive Health and Texas Health Resources is so 2006)
- Integrated mHealth applications will be created (increased interoperability–here there is some traction as hackathons to develop apps on platforms is becoming actually commonplace; the goal of Continua gets closer)
- Upswing on telehealth to bridge the significant gap between physician resources and patient demand (once again in example muddying telehealth with telemedicine, but overall there is some traction; we can only hope that finally we start getting there in 2013!)
mHealth is perceived as having the potential to be effective in changing behavior which will be effective in controlling chronic diseases such as diabetes, according to the mobile trade group GSMA in their latest white paper. The lead finding in this global study is that “89% of practitioners, 75% of patients and 73% of consumers believe that mHealth solutions can convey significant benefits.” While the finding may sound like the ‘perception is reality’ early-hype curve stuff, it’s being backed up by studies like the Clinical Therapeutics study earlier this year on how text (SMS) reminders significantly improved diabetics’ medication adherence and the just-published text4baby study of 90 women in a Fairfax County, Virginia Health Department program. Attitudes and behavior were measured among a primarily Hispanic new mother group, and text4baby had a significant effect on increased agreement with the attitude statement “I am prepared to be a new mother” and increased negative attitudes concerning alcohol consumption. GSMA: mHealth perceived globally as effective, Study: text4baby effectively helps new moms (FierceMobileHealthcare)
This past week, brain injury once again has made sad headlines in the US this weekend with the public suicide of an NFL linebacker, following his murder of the mother of his child. Reportedly, Jovan Belcher of the Kansas City Chiefs had been recently concussed, was on painkillers and had been drinking the prior evening. Thus the release of an academic research study on chronic traumatic encephalopathy (CTE), a progressive disorder that occurs as a consequence of repetitive mild traumatic brain injury such as experienced by contact sport athletes and soldiers, could not be more timely. Published in this month’s Brain: A Journal of Neurology (Oxford Journals), a research team drawn from the Boston VA, Boston University and the Mayo Clinic details the four progressive stages of CTE with symptoms progressing from headache and loss of concentration to dementia, depression, and aggression. This was based on (post-mortem) analysis of 85 brains — 64 athletes and 21 military veterans with a history of repetitive concussions. 68 had CTE and the group also had other neurological diseases. The study was funded by seven organizations, including the VA, the National Institute on Aging–and the NFL. Certainly this will be a key reference in the NFL-funded research being started by the FNIH and the US Army-NFL helmet sensor program to help detect cumulative injury [TA 7 Sept] CTE a Progressive Condition, Brain Study Shows (MedPageToday) The spectrum of disease in chronic traumatic encephalopathy (Brain): Abstract and full study (PDF)
Students at Brigham Young University in Utah have developed a prototype ‘smart sock’ for babies that alerts for low levels of blood oxygen, irregular heartbeat and stopped breathing during sleep. This is to help detect for early signs of SIDS (Sudden Infant Death Syndrome) or other dangerous situations. The information is sent to a smartphone app that serves as the alert monitor. The Owlet Baby Monitor won first place and crowd favorite awards, with cash prizes totaling $6,000, at the Student Innovator of the Year competition. The inventors have filed for a patent (pending), more prototypes and testing, and undoubtedly FDA, but if you’re an angel looking for a highly marketable telehealth item–and with adult uses in hospitals and nursing homes–a trip to Utah may be in order. “Smart Socks” Helps Parents Sleep Easier (Smart Phone Healthcare) BYU news release (video)