A not-far-from-here-and-now take on the recent film Robot & Frank may be Roboy & Mule. The Roboy (left), an advanced humanoid robot, is being developed by engineers at the University of Zurich’s Artificial Intelligence Lab in only nine months (yes, the same as a human baby) for its debut at the Zurich Robots on Tour conference 9 March 2013. Kid-sized with a cute ‘face’ and tendon-driven locomotion, its artificial muscles will eventually be covered by a soft ‘skin.’ Its purpose is to help people in everyday environments. The Mule is an un-cute Defense Advanced Research Projects Agency (DARPA) four-legged pack robot (a/k/a LS3) capable of carrying 400 lbs over 20 miles of rough terrain, taking voice commands, avoiding obstacles and even recharging the devices of the modern soldier and Marine. Its purpose is to relieve them of part of the insanely heavy loads (100 lbs.) they carry. Both robots and their underlying technologies have many imaginable assistive uses for older adults and the disabled in the home and in communities. Roboy in CNET News, PopSci. The Mule in Armed with Science. Videos on both. A New Year’s hat tip to Toni Bunting on Roboy.
The Gimlet Eye dusts off her Crystal Ball and sees yet another dozen 2013 predictions from HIT experts. Personal health records are ‘it’ for 2013, revived at last, driven by the consumer, collecting data from multitudinous sensors, sending information over exchanges (HIEs, hopefully conquering their interoperability problems), user friendly EHRs (!) reaching critical mass, but being scrutinized for incentive payments [TA 30 Nov] and interoperability, interoperability, interoperability…All big data, genome sequencing and all those goodies, gamified, predictively analyzed and maybe even care coordinated. And whither the doctors? Abandoning their independent practices and swallowed up by hospitals…until they get the vision and use technology to be financially autonomous, which is like having your cake buttered. Information Week Healthcare
The Gimlet Eye sees…affective health. Using physical data for monitoring mood has a lure to it that in stressful times says ‘consumer acceptance’ — and there’s always PTSD. Both Boston-based MIT spinoff startup Neumitra and MIT Media Lab spinoff Affectiva [TA 2 July] measure the sympathetic nervous system for leading indicators of mood, such as perspiration, motion and increased temperature, processing the data through algorithms as leading indicators of possible anxiety and sending it to a platform via smartphone. Neumitra is currently being tested at Massachusetts General Hospital to gain better information on anxiety disorder triggers. Although the Technology Review article states that both are ‘experimental,’ Affectiva will be at next month’s CES Eureka Park for early-stage/startup companies.
(to ship early 2013), you will be able to control your desktop, laptop and maybe even tablets (with USB connectivity) through hand and figure movements. Potential in healthcare could be immense: robotic surgery, rehabilitation, ability assessment, remote monitoring and socialization. Video (1:12) which only sells the ‘whiz-bang’ aspects.
The Hogeway care home near Amsterdam provides an environment for dementia sufferers which is quite unlike what we see in memory care units. It is an eight ‘house’ community built around a large enclosed courtyard where residents are free to walk and sit. Each house is structured like a large family home with eat-in kitchen and a lifestyle theme (e.g. urban) that influences the decor, food and experiences. ‘Alternate reality’ is what it is dubbed in the 1:26 video from BBC News, but what it does is give a resident understandable surroundings with appropriate stimulation and most importantly, socialization that seems to work within their limitations, for some happiness and improved quality of life. Editor Donna would have liked more observation of the residents, but appreciates that even the most discreet film crew would be profoundly disruptive of their everyday routine and potentially upsetting. It should give senior housing people in the US and UK at least a few ideas away from the isolation that tends to pervade many memory care wings. Dementia patients in Dutch village given ‘alternative reality’.
In Editor Donna’s ‘in box’:
- Much hype around Misfit Wearables, which incorporates in its bracelet and pocket clip (necklace to come) a metallic activity/aerobics tracker called the Shine, which is the size of a quarter, uploads on both iPhone 4/5 and most Android devices via Wi-Fi, and will retail in the $79-199 range when released sometime in mid-2013. It’s raised more than $500,000 on crowdfunding site Indiegogo.com, plus developer Sonny Vu is backed by partner John Sculley (remember him a century ago at Apple?), Founders Fund and the ubiquitous Khosla Ventures. Activity-Tracking Tech Moves From Wrist to Neck, With Sculley’s New Shine Necklace (AllThingsD) (This is the only mention where Sculley gets the lead!)
- Researchers at the University of Pittsburgh have successfully developed a prosthetic hand controlled by the thoughts of a quadriplegic patient detected via electrode implants in the motor cortex part of the brain. According to The Scientist, it “rivals the way an unimpaired brain directs limb movement.” Published 16 December in The Lancet. Thoughts control robotic hand (The Scientist)
- A health texting provider, Televox, claims that 34% of Americans say they are more honest discussing their health problems through automatic calls, email, or text messaging, than in a face to face conversation with a doctor, and a similar percentage felt that receiving emails, texts and voicemails from their doctor increased trust. Despite the relatively large N of the study (over 1,000), the self-reporting online poll recruited via email and the sponsorship by Televox leaves one wondering how honest or objective the study is. Mobihealthnews.
The Avera Health Network provides remote telemedicine critical care to a Midwest slice of the 10% of US doctors currently serving the 25% of Americans who live in rural areas. Avera’s services–eConsult, eICU Care, eEmergency, ePharm and eLongTermCare for nursing homes–originate in a Sioux Falls, South Dakota ‘hospital-without-patients’ which utilize telemedicine and telehealth tools. It connects to rural doctors, nurses, clinics and hospitals in South Dakota, North Dakota, Minnesota, Iowa, Wyoming, and Nebraska where the doctors are few, the distances are far and the population is aging. Avera, according to the article, is the only eICU operation of this kind in the US and possibly the world. This Atlantic article is another good news story in that you see, in relatively few words, how distance care can be truly effective and secure–as of October, they reported an 18% decrease in ambulance and helicopter transfers to major hospitals, equating to $6.6 million saved. Where ER Doctors Work Entirely Via Webcam (Using a dedicated network, not Skype!)
Following on their October heads-up on AirStrip Technologies working with Toronto-based Diversinet on security relating to AirStrip’s use with the US government, the two have formally announced a licensing agreement where Diversinet’s mobiSecure SDK platform will be used for secure messaging in AirStrip’s mHealth application suite. This enables AirStrip military, government and commercial customers to comply with Federal security requirements. Diversinet recently received the FIPS 140-2 validation for their cryptographic technology underpinning their MobiSecure platform which is required for US and Canada government use [TA 18 Oct]. Earlier this month, they announced the mobiHealth Wallet, which allows patients to create unique health profiles and configure/integrate data from compatible apps. Diversinet/AirStrip release mobiHealth Wallet release
Editor Donna’s note: Non-US readers will note the reference in the mobiHealth Wallet release to the Federal ‘Blue Button Initiative’ which, in plain language, simply enables users of personal health records (PHRs) to download their health information as an ASCII text file. Various Federal entities such as the VA, Department of Defense and CMS have all signed on. Our friend The Gimlet Eye is ‘barrel rolling’ at this bit of jargon which is, in certain quarters, being tossed around with insider abandon. And it comes complete with cute logo!
The year should not conclude without at least one last look at data breaches. This article from HealthWorks Collective samples three but they are ‘doozys’–in the millions and all hacking. Over at Privacy Rights Clearinghouse, if you select only healthcare and tick all breaches save payment card fraud, there are 207–with the most serious belonging to Alere [TA 30 Nov], Gulf Coast Healthcare Services and the California Department of Healthcare Services all with breaches including SSI and over 10,000 records. Not a good leading indicator for 2013.
Just released by LeadingAge CAST (Center for Aging Services Technologies) is a ‘vision video’ that demonstrates how various technologies interact in the life and medical situation of one 83 year old woman. What is more, every bit of health tech in the story is available right now. Sharp-eyed viewers will see Care Innovations’ QuietCare and Philips LifeLine (but not the Auto-Alert) but the telehealth hub and the EHR are not identified. (List your guesses in Comments.) It was also put together with the assistance of many other organizations, notably Selfhelp Innovations and their Virtual Senior Center. CAST page and videos (downloads available) Heads-up thanks to CAST Executive Director Majd Alwan.
The much touted HIMTA (Healthcare Innovation and Marketplace Technologies Act, H.R. Bill 6626) as introduced by Silicon Valley’s Representative Mike Honda, if passed would establish an Office of Wireless Health at the FDA for starters. Then it adds layers, like cake: establish specific mhealth software responsibilities for the Health Information Technology Research Center (new?), ‘Challenge Grants’ and prizes for IT developers, an HHS department supporting mHealth developers on designing in line with privacy regulations, workforce retraining, provider loans and tax incentives. The intent is spelled out in the HealthWorks Collective article–Rep. Honda’s public statement is that it would only seek to clarify current regulations, especially privacy, for mHealth developers and reduce barriers to entry, but read to the bottom which then states the intent is to reshape the mHealth industry. Also see Rep. Honda’s press release.
In Editor Donna’s view, it only serves to add another gaggle of chefs in the mHealth government kitchen, which is already packed with FDA, FCC, HHS and NIH elbowing for burners and oven space.
But…there’s more. The FCC just announced their search for a new Health Care Director to head up their initiatives, involving a lot more than sorting out spectrum policy. There’s delicate maneuvering between more working groups with initials than pumpkin or mince pies at Christmas Eve dinner. There’s doling out the ‘Health Care Connect Fund’ for broadbanding providers including a pilot in SNFs (skilled nursing facilities a/k/a nursing homes), etc. But nothing about better, longer studies that might prove things like ROI and better outcomes necessary to gain adoption in the far bigger, wider private market.
Conclusion: The only companies which will be able to advantageously sort out this tangle are those with batteries of lawyers on call, thus putting paid to Rep. Honda’s stated objective of encouraging startups. The only small saving grace is that H.R. 6626 was introduced in a Congress that is ending in three weeks (thus will die and presumably be reborn next year). And there are far higher ‘cliffs’ that need climbing…out of.
Related: Speaking of cliffs, David Lee Scher, MD approaches the one with the HEALTHCARE sign, looks over the edge, and sees a pile of money tossed over it willy-nilly. The healthcare cliff.
Telecare, telehealth and socialization system developer GrandCare Systems announced today that they are the recipient of the 2012 Frost & Sullivan Best Practices award for North American Elderly Health and Wellness Customer Value Enhancement. The awards “recognize companies in a variety of regional and global markets for demonstrating outstanding achievement and superior performance in areas such as leadership, technological innovation, customer service, and strategic product development.” Editor Donna is pleased to see this recognition go to this independent pioneer (and former competitor) in the field! Press release (PR Newswire)
This short article in Senior Housing Forum (US) by Steve Moran, formerly a community developer and now in the telehealth field, scores neatly and briefly on what is wrong with the ‘hotel’ model of many senior communities. Basically the extent of ‘care’ is such that a premium is placed on entertaining the residents and not in purposeful activity connected to the outside world that provides psychological reward and literally a reason for living. He says it best here:
While I believe entertainment needs to a part of every community’s activity program, I don’t believe it should be the most important part, I would argue that it should be the least significant part.
Activities programs need to start with the premise that seniors want to learn, to grow, to create and are capable of doing so.
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)