Korean ‘nurse droid’ being tested in nursing homes. The KIRO-M5, which resembles a pint-size (3′) version of R2D2, can wake up residents, announce meals, schedule daily exercise–and can sniff the air to alert an aide or nurse when an elderly patient needs a diaper change. The KIRO also sterilizes and deodorizes the air, and totes supplies. Developed by the Korea Institute of Robot and Convergence. Korean nurse bot sniffs the air to detect soiled diapers (GizMag)
A polymer patch delivers vaccine. Designed by MIT, a dermal patch with microneedles slow-releases vaccine DNA rather than viruses or proteins, to allow the body to build immunity. Could this open up fresh horizons on drug delivery? And with a wafer-thin transmitter, can monitor it? Polymer patches could replace needles and enable more effective DNA vaccines (GizMag)
And finally the most amazing–a prosthesis mostly out of a 3D printer. A five-year-old boy, Liam, now has a workable hand with moveable fingers made using a Replicator 2 3D printer. The fingers are attached to a brace worn over the hand, and controlled via cables and return bungees. The designers who collaborated long distance from Washington state and South Africa, have also released the design into public domain. Inexpensive home-brewed prostheses created using 3D printers (GizMag)
Once the favorite of doctors and health professionals, now completely overwhelmed by Apple, the BlackBerry 10 is widely seen as the last chance for the now eponymous company. Coming in predictive word lookup touchscreen (Z10) and keyboard (Q10) versions (addressing the accuracy problem of touchscreens, not good in healthcare data entry), the BB10 also offers a dual-mode between work and personal information–very appealing to healthcare CIOs–with supposedly fast switching between the two. Despite design and handling raves from tough customers such as ZDNet (with the usual grousing about apps), the forecast is cloudy at best; BB’s enterprise base here in the US as of Q4 2012 dropped to a distant 6%–third–behind iPhone and Android OS phones. Curiously, the UK will be first to get the BB 10 in the touchscreen version only, which hints at a slow or ‘debugging’ rollout; March for the US. From the healthcare side, Mobihealthnews. From the tech side, ZDNet: Beautiful phone playing serious catch-up; It’s all in the name
A capital way to start 2013. According to the Dallas Morning News and an SEC filing, Texas-based Intuitive Health, which this past year was in pilot with AT&T and Texas Health Resources, obviously made their case to (undisclosed) investors with a raise of $3.8 million in an equity offering at end of 2012. The Intuitive Health system uses AT&T connectivity to send patient telehealth information to providers; AT&T touted Intuitive in their 2013 predictions [TA 6 Dec]. The Texas Health Resources pilot from April 2011 to August 2012 reduced chronic heart failure readmissions by 27%. One hopes that they use part of that $3.8 million to develop their website beyond a single page with a crawl at the page bottom. MedCityNews
We had earlier this month reported on Rock Health’s digital health estimate of $1.4 billion, up 45% vs. 2011 with 20% going towards the five biggest deals of the year [TA 8 Jan]. Now Austin, Texas-based Mercom Capital Group does its own slightly lower count of $1.2 billion in VC investment in what’s termed HIT, but this is 200% higher than their prior year total of $480 million. There’s overlap but difference in their five big companies: Castlight Health (provider comparison), 23andMe (personal genetics), GoHealth (health insurance comparison), Kinnser Software (home health clinical support) and the Practice Fusion EHR. Mercom also details the M&A activity topping $7 billion with McKesson being the most active acquirer. Finally, Mobile Health Market News did its own analysis and came up with $907 million, led by ‘health care IT service’, monitoring and consumer apps (although skewed wildly from Castlight Health in this category). What is also clear is that the pace slowed in 3rd and 4th quarters–and that the pace of 2013 investment very much depends on the US economic climate and the effects of government healthcare policy. Mercom: iHealthBeat (summary), MedCityNews, Healthcare IT News. Mobile Health Market News, mHealthWatch
Despite all the discussion of inexpensive apps turning everyone into ‘quantified selfers’, adoption of tracking technology is still surprisingly slight among those who are already tracking their health indicators and exercise routines. The latest report from the Pew Internet & American Life Project surveying over 3,000 Americans indicates that 69% are already tracking a health condition for themselves or a loved one, but 49% keep the information in their heads (!), 34% use paper and 21% use technology–but that can include Excel and not necessarily an app or device with attached program such as FitBit or a PHR. Among the smartphone users, 19% have downloaded a health app for exercise, diet and weight management. According to Suzannah Fox of Pew, “We’ve been looking at health apps since 2010, and health app uptake has been essentially flat for three years.” and that the low adoption continues to surprise. Most Adults Not Using Technology To Monitor Health (iHealthBeat) Pew Internet release
Should virtual patient-doctor visits (termed here telehealth rather than telemedicine) have taken a page from the US e-commerce model to stimulate adoption? That is, to make them popular, provide an economic advantage over in-person visits? (In the US, online sellers such as Amazon initially grew because purchases largely circumvented state sales taxes, costing less.) Dr. David E. Williams proposes that payers now emulate this economic advantage by charging consumers nothing or very reduced co-pays for online visits, and/or incentivize physicians to move in-person visits to online. Aside from the cross-state licensure and medical records access problems, most payers (other than a few such as the adopters of American Well, and of course the VA) have not included or downplayed online visits in their benefits, perhaps fearing a spike in utilization as Dr. Williams mentions. But the good doctor misses a key factor–that this is not a one-way street, and that the consumer demand hasn’t materialized, despite the additional parallels of saving time and travel, which is why his argument seems to be a ‘past tense’ one. Perhaps virtual visits need to be taken outside payers into a concierge care, worksite, pharmacy clinic (enabled through a kiosk such as HealthSpot Station) or single pay model, maximizing convenience at the time of need. And we should find out why the appeal seems to be lacking–much like health app adoption. What Amazon can teach us about telehealth adoption (HealthBusinessBlog)
From one of our frequent commenters known as “Up North and to the Right’ or UNATTR:
Tonight at 19:30 GMT on the news programme BBC Inside Out South East:
One of the challenges facing the NHS is how to care for people with long-term illnesses such as diabetes, heart defects and chronic lung problems. These patients make up around 30% of patients yet account for 70% of the NHS’s costs.Telehealth is a new scheme where patients with long-term conditions monitor themselves at home using technology rather than going into hospital.
Kent is at the forefront of the scheme with around 800 patients using telehealth. But some doctors are not convinced, citing fears over increased GP workloads and concerns about whether patients will be able to use the computer technology. Others say the NHS reforms will also make it harder for telehealth to happen.
Inside Out asks whether the government’s plans to get more people onto telehealth are likely to succeed.
BBC Inside Out South East is broadcast on Monday, 21 January on BBC One at 19:30 GMT and nationwide (for readers in the UK) on the iPlayer for seven days thereafter.
For those who may need the most assistance with their health–older adults, those with chronic conditions who have less income and/or education–will the digital health and consumer engagement advances we chronicle, debate and generally huzzah about make any real difference in their health? We have generally assumed that health tech will level the playing field by being faster, cheaper, super-functional and generally cooler. This provocative essay debates the distinct possibility that digital health and the adoption of technology may further increase health disparities despite all this. Examples are the older, even affluent person, who has difficulty coordinating their care even non-digitally and is in a spider web of confusion; the less educated person for which ‘self-empowerment’ in healthcare doesn’t blip their phone screen, much less their mind. When you review the ideal state infographic by Misfit and the Digital Health Group and try to place people like this into it, you realize the buzzy talk of ‘convergence’ zips right by these needy folk like a Boeing 787 Dreamliner back to the hangar for a battery swap.
Of course, the writer also caveats his discussion by stating (Editor’s emphasis):
However, for innovations to significantly worsen disparities, they would have to both meaningfully improve health outcomes, and not be made available to people of lower economic status. Although the digital divide is real, access to digital tools is increasing for almost all levels of society. Payers may also eventually subsidize tools that have been shown to improve outcomes.
Hmmm…so it kinda doesn’t matter at this stage?
When Editor Donna thinks back to say, 2005, and the promise at that time on how telehealth and telecare were going to revolutionize health and independence for older adults, disabled people and those with chronic conditions, the alacrity with which much of digital health’s business model and development funding has shifted towards essentially healthy people measuring personal fitness and ‘quantified selfing’ away–analogous to what psychiatrists call ‘the worried well’–is perhaps economically sound, but disconcerting to those of us who entered the field wanting to do, let’s say, a little good. Can we pause for a moment, and consider this? Technology, Innovation, Disparities, and the Elderly (GeriTech, author Leslie Kernisan MD, a board-certified geriatrician) Hat tip to George Margelis, GM of Care Innovations Australia
The Shine activity tracker by Misfit Wearables has garned huge interest and support (Indiegogo oversubscribed in excess of $650,000) since its debut last year. The interesting part of this article is a more exact description of its Wi-Fi interface which requires direct contact with an iPhone or Android running the app to download data and presumably upload adjustments. It’s also made from aircraft aluminum, is small (about a small cookie, two quarters or two 50p coins) and provides blinking orange light feedback. It will be interesting if Sonny Vu and John Sculley grab onto the potential in the older adult home and community market–the latter requiring perhaps some different form factors and task diversification–or simply take the easy fitness buff/’quantified self’ money and run. Misfit Shine–a sleek, new activity tracker (SingularityHub.com)
Mobile health becomes very compelling to the consumer when it has to do with safety. This IEEE Spectrum interview (transcript/podcast) with Dr. Aydogan Ozcan of UCLA follows up on our recent coverage of the smartphone-linked iTube attachment for assaying potential harmful allergens in food, but also returns to the Ozcan microscope and its multitude of uses in developing countries. Both when fully developed have the great potential to reduce costs of medical testing equipment and speedier results. Information and reporting can also lead to safety. The New York City Police Department has also gotten on the app wagon with a free citizen crime information and reporting app for iPhone. You can look up statistics, most wanted and nearest precinct information–but another feature captures anonymous tips on crime. Editor Donna wonders if this technology could be sold to other major cities such as Newark NJ, Chicago, Sao Paulo and London, where crime rates are high, to engage the citizenry and further geo-map crime faster. Springwise.com A tip of the hat to Toni Bunting of TANN Ireland
This is the first of an occasional series on US law and intellectual property (IP) as it affects software and systems used in health technology. This article discusses the software developer’s rights to source code, licensing by the end user and the best ways both parties can protect themselves long-term in their transactions via software escrow.
Mark Grossman, JD, has nearly 30 years of experience in business law and began focusing his practice on technology over 20 years ago. He is an attorney with Tannenbaum Helpern Syracuse & Hirschtritt in New York City and has for ten years been listed in Best Lawyers in America. Mr. Grossman has been Special Counsel for the X-Prize Foundation and SME (subject matter expert) for Florida’s Internet Task Force. More information on Mr. Grossman here.
Source Code Escrow
It’s a nightmarish scenario. Let’s say that you’re the head of Information Technology (IT) for a hospital or a group of long-term care facilities. You pay a software development company $500,000 to create new software for your telehealth monitoring and alert system. It doesn’t matter whether the software runs locally on your servers, or in the cloud in a SaaS model. But then your developer goes bankrupt or for whatever reason and refuses to support the software. If you didn’t consider access to the source code in your agreement with the developer, you may find that you’re unemployed.
Essentially, “source code” is computer programming that humans can read. “Object code” is programming that only your computer can read. Typically, as a user, you only have access to the object code.
Software developers consider the source code to be their most valuable trade secret. With the source code, a competitor could create a competing work without incurring all of the development costs of the original developer. Source code is the lifeblood of the software development business.
From your perspective as the head of IT for that hospital or facility, you need the source code to continue the evolutionary development of your software or to fix bugs if your original developer disappears on you. If they can’t or won’t help, you’ll need to (more…)
For your weekend reading, this overview of 42 mHealth studies monitoring use by health professionals is accessible not only in full text, but also has multiple (downloadable) comparison charts and plenty of related reading. The findings will come as no surprise: current studies are limited, show only modest benefits, diagnosis based on mobile photos showed a reduction in diagnosis accuracy, SMS (text) appointment reminders show some benefit. High-quality trials measuring clinical outcomes are needed. The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis (PLOS Medicine) Hat tip to reader David Lee Scher, MD.
What type of system in the US (and elsewhere) provides the best quality of care based on metrics such as care levels, medication usage and services? This article, while written with its conclusion in mind (the US consumes too many dollars in health care, yet has too many for-profit facilities that stint on care to maximize profit, thus everything in healthcare should be non-profit), does bring up interesting data as to the differences in quality of care between non-profit and for-profit hospitals and post-acute facilities, plus the broad failure of health maintenance organization (HMO) insurance plans to deliver savings as promised. Low-profit but needed areas such as psychiatric emergency care (!) and home health care tend to get shorted at for-profit hospitals and (not mentioned) insurance plans. The writer also does not mention that non-profit facilities can offset many costs through a lower tax burden and endowments. And as one of the commenters points out, according to his research, developed Asian countries have even higher levels of privatization than the US, yet take only 5% of GDP and boast better health outcomes. Health care and profits, a poor mix (New York Times)
A group at the University of Washington, in collaboration with Seattle Children’s Hospital, is measuring your heavy breathing on the phone–for health reasons. For people who are asthmatics, have chronic bronchitis or cystic fibrosis, breathing measurement is critical. Spirometers measure the power (or weakness) of their lungs. The Washington researchers first developed the SpiroSmart app to estimate the volume of air exhaled by the sound waves recorded as you breathe out. In early experiments, results were roughly comparable to a home spirometer. The next iteration, SpiroCall, is a dial-in that records that long breath of air–and early tests indicate that it preserved enough audio quality for the recorded exhalation to be used as a spirometric substitute. This indicates that any phone, even basic cellphones that older people and those in developing countries use, can remotely measure lung health or detect signs of lung disease. Tracking Lung Health With a Cell Phone (MIT Technology Review) Hat tip to Toni Bunting of TANN Ireland.
The Central Standard Timing ‘e-ink’ watch will, when it goes into production, be the world’s thinnest watch at 0.80mm and wholly assembled in USA (take that, Switzerland). Its high visibility, basic colors and stainless steel band (in three preliminary sizes) makes it cool–and ‘Mick and Tina’ cool (when costs go down from the current projected $170) for the older adult or vision impaired market. It’s always on and charged/adjusted at the base station. What would be interesting if this technology, or the watch itself, eventually incorporates things like fall detection or pulse monitoring. PSFK article. CST Kickstarter page (where it is oversubscribed at nearly $450K). Another hat tip to Toni Bunting of TANN Ireland.
Investment bankers TripleTree and the Wireless-Life Sciences Association (WLSA) are opening nominations for the 5th Annual iAwards (my, has time flown!). Nominees will be judged this year on “uniqueness of their solution; marketplace traction; clinical, operational or consumer relevance; size of addressable market and international presence across three categories” (operational effectiveness, clinical application and consumer engagement). Get in your applications and $250 fee by 29 March; twelve finalists will be announced 19 April with three winners feted at the WLSA Convergence Summit, San Diego, 28-30 May. Overview