How can sensors better communicate with and regulate the central nervous system (CNS)? DARPA (Defense Advanced Research Projects Agency), which is part of the US Department of Defense, is on the case with research on miniaturized electronics suitable for chronic use for biosensing and neuromodulation of peripheral nerves in the Electrical Prescriptions (ElectRx) program. A DARPA-funded ElectRx research team led by the University of California, Berkeley’s Department of Electrical Engineering and Computer Sciences has developed what they term ‘neural dust’–a millimeter-scale wireless device small enough to be implanted in individual nerves, using ultrasound for power coupling and communication. In vivo test results on rodents have been published in the peer-reviewed neuroscience journal Neuron. A nice return to Armed With Science, which has been bereft of device or robotics news for months.
We note there is also a digital health program from the same organizers in Miami which is starting 6 September with its Demo Day on 1 December.
“Is there a doctor on board?”Having spent the first half of my career in and around the travel industry, including a three-year stint working as an advertising manager for an airline, near the top of The Worry List was the communications fallout of a Bad Outcome in-flight medical incident. When my brother took a flight to somewhere, it was also his concern–while he was familiar with emergency medicine, it was generally of the psychiatric variety. Doctors, at least in the US, are covered by ‘Good Samaritan’ laws that shield them from most liability, but most will be up in the air if an emergency presents itself.
According to the New England Journal of Medicine (NEJM) (YouTube), in-flight medical emergencies occur in about 1 in every 604 flights, which in 2013 equaled annually 44,000 in-flight emergencies with nearly 50 a day in the USA (USA Today). While cabin crews receive training, they usually don’t have specialized medical training unless they moonlight as (or were formerly) EMTs. And an airplane cabin and a flight are deceptively difficult environments–pressurized, dry, confining and with help not exactly nearby.
Now there is an app for that. AirRx was developed by a six-person team (with CSE Software) led by a physician at the University of Illinois College of Medicine at Peoria, Raymond E. Bertino, MD, a clinical professor of radiology and surgery as well as a practicing radiologist. He had the ill luck to find himself in three in-flight situations plus one where he was a patient. The app, which also works in airplane mode and without live internet, guides doctors through 23 common situations, from chest pain and seizures to emergency delivery. It is available in the Apple Store and via Google Play for $4.99, with any proceeds going to the non-profit they organized to maintain the app. According to Dr Bertino, “The only person who doesn’t know what they’re supposed to do is the doc who’s volunteering. Docs aren’t taught about this in medical school and AirRx is meant to fill the gaps.” Mobihealthnews, mHealthIntelligence, Chicago Tribune.
It certainly came as a surprise that the second fastest growing economy in the EU is–Romania. Identified in your Editor’s mind with the monstrous dictator Nicolae Ceaușescu, grinding poverty and the lost orphans (who are now lost and underground–see this horrific Daily Mail article), it has a burgeoning tech startup scene and a superior digital infrastructure including the fastest internet in Europe, achieved through a combination of post-Ceaușescu entrepreneurship and state avoidance. The Communist emphasis on what we call STEM also has paid off for both young men and especially for women as techies and developers. There are even accelerators: Innovation Labs and MVP Academy. Where Romania lags versus similarly situated Estonia and Bulgaria is native investment–angel investors are almost unknown. Being also an EU member, most of the best are lured away to attractive opportunities in other countries (including the US) at least for some time. But the low cost of development versus other digital cities like London and Berlin, educated workforce and a robust infrastructure are factors favoring Romania. Hat tip to reader Jerry Kolosky. One of the poorest countries in the EU could be its next tech-startup hub (Quartz) and the Digital City Index. (We note the photo at the top of the Quartz article is Google Chicago, not Bucharest)
Guest editor Sarianne Gruber (@subtleimpact) scopes the ‘digital divide’ separating those who need health services the most from the patient engagement and other tools they need in this article. The studies are US, but the lessons apply anywhere in the world. This Editor notes that many patient engagement tools are over-designed and over-complicated for users, even if they are fairly competent and frequently use online and mobile. (I entered a ‘pilot’ of a stress reduction program which proved to be anything but–and quitting because it is invasive and the reporting is ludicrously burdensome.)
To developers: Imagine your patient engagement platform being used by a person on the less sophisticated, less educated and disconnected end of the spectrum–or by someone less able due to physical (vision, touch) or cognitive impairment. Put on bad glasses and gloves–and start. Better yet, find a few people and put it in front of them. If we can make the mental shift in developing mobile apps for Africa or India, certainly we can do so for Americans, Britons and Europeans.
What the Studies are Showing
Hallmarked as a solution to improve healthcare quality, cost and safety, studies are showing health technology is up against a “digital divide” when it comes to patient engagement. At the Internet Governance Forum, Pew Research Center’s Lee Rainie, Director of Internet, Science and Technology Research presented the Fact Tank Report discussing the “digital divide” that exists in 2016. The report documents that lower income, less educated, non-white, seniors and rural communities are the least likely to have home internet, home broadband, mobile connectors and smartphones. This summer’s medical publications, the Journal of the American Medical Association and the Journal of the American Board of Family Medicine, released studies where demographic and socioeconomic data marked the root causes to limited or no access to digital technology, thus hindering the benefits and improved outcomes it can bring to the neediest and most costly populations. Here are the highlights from each study.
Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014, a research letter submitted from Harvard Medical School’s Brigham and Women’s Hospital, appeared in the August 2, 2016, JAMA. Authors, David M. Levine, MD, MA, Stuart Lipsitz, ScD, and Jeffrey A. Linder, MD, MPH,FACP made mention that this study, based on the National Health and Aging Trends survey (NHATS), was exempted from the Partners HealthCare Human Research/IRB Committee. The research team included participates to the longitudinal NHATS survey in 2011. The participants were re-surveyed annually on everyday (nonhealth) and digital health use until 2014. The research team acknowledged that this may be the first nationally representative study to examine trends in the adoption of digital health technology by seniors age 65 years and older who are community-dwelling Medicare beneficiaries.
Here are some the reported statistics from the study: (more…)
- Only 13-14% of U.S. broadband households show interest in new health management services
- Adoption of connected healthcare devices increases 40% since 2Q 2014
The keynote and presenter lineup is here–plenty of hot topics being presented/discussed by those engaged in the daily business of health tech.
Telehealth & Telecare Aware is a media supporter of the conference for the second year. Their Twitter feeds at #CONNHealth16 @CONN_Health_Smt.
Mashing up our summer ‘tune’ list are the latest reports on ransomware attacks and data breaches:
- Banner Health’s odd breach of 3.7 million records, first testing their café credit cards then entering their patient information systems, is leading to at least one class-action lawsuit. HealthITOutcomes, Becker’s Hospital Review
- Bon Secours Health System of Maryland had a exposure of 655,000 records when a business associate of Bon Secours left patient information exposed online for four days while it adjusted its network settings. Healthcare Dive
- The Locky ransomware has been battering hospitals since the beginning of August, with phishing emails spiking on August 11. Most of this global strike is attacking healthcare, with transportation and telecom running second; countries with the highest frequency of attacks are US, Japan, and South Korea, FireEye reports. ZDNet
- Solutionary, now NTT Security, which specializes in cybersecurity services, reported last month that 88 percent of all ransomware detections in second quarter 2016 targeted healthcare. However, Cryptowall, not Locky, was the killer ransomware they spotted, accounting for nearly 94 percent of detections. Release
- Can you anticipate cyber crimes like these? ID Experts has an intriguing blog post on how you can think like a cyber thief. Part One of a promised three-part series. Updated: ID Experts disclosed earlier this week that it spun off RADAR, its two-year-old IT security and compliance company, effective 2 Aug, with a $6.2 million Series A funding. It appears that the CEO wrote the check (CrunchBase). There’s gold in dem dere cyber varmints! MedCityNews Release
- Scared enough? The Federal Trade Commission comes to the rescue with a half-day seminar on ransomware detection and prevention in Washington DC on September 7. The session is free and will be webcast (details to come). FTC release, event page
The Health Resources and Services Administration (HRSA), which is part of the Federal Health and Human Services (HHS) department, is making four grant programs available to support rural telehealth and quality improvement in 60 rural communities within 32 states, including a joint program with the Veterans Affairs Office of Rural Health. The four programs administered by the Federal Office of Rural Health Policy (FORHP) within HRSA are primarily three-year programs and include:
- The largest amount, $6.3 million, will go to the Telehealth Network Grant Program: $300,000 each annually in a three-year program to 21 community health organizations for telehealth programs and networks in medically underserved areas, with a concentration on child health
- The Flex Rural Veterans Health Access Program: $300,000 each annually in a three-year program to three organizations providing veteran mental health and other health services. This is a joint program with the VA totalling $900,000.
- Small Health Care Provider Quality Improvement: $21 million will support 21 organizations over three years in improving care quality for populations with high rates of chronic conditions, and to support rural primary care.
- Seven Rural Health Research Centers: $700,000 per year for four years, totalling $4.9 million, to support policy research on improving access to healthcare and population health in rural communities. (Funds that more usefully would have gone to veterans health?–Ed. Donna)
When you are trying to shake things up in healthcare, sometimes enthusiasm gets mistaken for desperation.
Alex Fair is known to many of our American Readers as one of the Grizzled Pioneers of what eventually became known as Health 2.0. He’s head of a Meetup group in NYC with close to 5,000 members (Health 2.0 NYC, for which this Editor was an event organizer/producer for over a year), founder of health innovation-only crowdfunding platform Medstartr (see ‘Websites We Like’), a successful health tech event producer (MedMomentum 16 coming up 1-2 December) and a few other things in between. In short, Alex Hustles For The Cause.
One of his projects is the Major Depressive Disorder (MDD)/Depression Care Innovation Challenge with Takeda, which closed for applications last Monday. There was a last flurry of promotion via personal notes in social media and emails which is standard–well-known in style for those of us on Alex’s lists. But sometimes enthusiasm gets misinterpreted.
So a funny thing happened to me yesterday on Twitter. Someone told us that we sounded “desperate” in our tweets and posts. At first, my lizard brain said “what, I don’t want to be seen as desperate!” as if I was trying to get a date for the Junior Prom (which I did, thank you very much.) But then my mission-driven, we-have-got-to-fix-this-NOW-so-more-people-like-Jess_Jacobs-Live-longer-and-better-lives brain fired up and said, “Damn Right I’m Desperate!” The fact is that if we want to move the needle on innovation, we need to do something about it and desperate times DO call for desperate measures.
Read all about it here. If you want to change healthcare, especially in the US, you might get a little frustrated! (P.S. Along with the controversy is a calendar of upcoming NYC health tech events).
Chubb Community Care, a UK company which provides home and mobile technology enabled care solutions (TECS) for independent, assisted, sheltered and extra care housing, announced their expansion into Norway, Sweden and Finland, partnering with Norwegian equipment supplier HEPRO which provides local service and market knowledge. Their first project is in HEPRO’s home country with the new Chubb Care Call. Care Call (left) is a colorful wall-mounted mobile-connected unit with simple buttons that connects the resident to onsite staff and remote call centers in case of emergency or need for assistance. HEPRO will be installing the units in seven municipalities. Release. Earlier this summer, Chubb won a contract with Places for People to install their CareUnity at 16 independent living locations across the North West, Hull and Bristol. Care Unity is a PERS/carephone-based system that integrates a wide range of safety and security peripherals. Release
NHS National Services Scotland (a/k/a The Common Services Agency) is requesting tenders for virtual video clinics. The supplier would furnish software, hosting and support for one year in up to 50 clinics in all of Scotland or in six regions. This ‘video consulting system’ would link NSS, Health Boards and potentially other Scottish public sector Participating Authorities. The tender is due noon UK time on Monday 26 August. Further information may be found here and also at the Public Contracts Scotland website. Hat tip to Suzanne Woodman of BRE.
TechWorld gives us a short narrative on robotics history dating back to Asimov’s Three Rules of Robotics (1942), Turing’s Imitation Game (1950) and the pioneering work of several inventors in the late 1940s. There’s a brief tribute to Star Wars’ R2-D2 (Kenny Baker RIP) and C-3PO. It finishes up with AI-driven IBM Watson and Deep Mind’s AlphaGo. Breezy but informative beach reading! Hat tip to Editor Emeritus and TTA founder Steve Hards; also read his acerbic comment on Dell and Intel’s involvement in Thailand’s Saensuk Smart City
Asthma UK today unveils a key report that tells developers how mHealth could help asthma sufferers better. Entitled “Connected asthma: how technology will transform care”, whilst picking out a few excellent exemplars, it describes how poor the average asthma app currently is – for example only 6% of such apps provide pollution status, and only 8% cover inhaler technique.
Historically CHF, COPD & diabetes have been regarded as the key long term conditions to manage using telehealth. When, as this editor did a few years back, a suggestion was made to try it on asthma, clinicians tended to look askance. Yet as this report shows, mHealth can do a huge amount to improve the management of asthma especially now many people have smartphones. And, bluntly, asthma kills (more…)
Rarely do we hear beyond India and Japan in Asia-Pacific health tech. But here comes Thailand with the Saensuk Smart City developed with prestigious partners Dell and Intel Microelectronic (Thailand)
Saensuk is a Thai municipality with 46,000 registered local residents, 15 percent of whom are 65+, as well as a touristic area around the Bangsaen beach. The Smart City is a three-year public-private partnership with the first aim of supporting older people in their homes through IoT-powered applications including health monitoring (RPM) of vital signs, fall detection, emergency notifications, environmental monitoring and safety tracking.The targeted number for the pilot is between 30 and 150 homes in the initial phase. Residents, for instance, are given a smartwatch that alerts for falls and also conveys information at entry into the program. Intel-based systems from Dell aggregate and analyze the large amounts of health data generated daily.
Visiting nurses, fairly common in Thailand, (more…)
Tunstall Healthcare has been, quite untypically (for years) and aseasonally, burning up the newswires with press. The first we’ll mention is from Tunstall Americas announcing the availability of smoke detection sensors as part of their their newly introduced Vi+ and the CEL mobile PERS. The units when triggered by heat or smoke sound an audible alarm and generate an alert over to the 24/7 monitoring service. Like last week’s announcement of ambient temperature sensing, there’s nothing revolutionary here but these add-on features are extremely helpful to older people who use these systems. It also is a bit of sales upsell for their growing network of local home monitoring monitoring dealers/services [TTA 3 Aug]. Tunstall release.
We’ve also noted a new surge of activity in Australia (the Staying Strong telehealth pilot) with vital signs monitoring using the myclinic telehealth hub in the homes of older Aboriginal and Torres Strait Islander peoples. In the UK there is the PegasusLife new Malt Yard assisted living development for care alarms, Wakefield District housing and providing extra care services at Hare Hill-Rochdale Boroughwide Housing (RBH). Roundup here on their press page. For their LTC work at Tameside Hospital NHS Foundation Trust Community Services, Tameside and Glossop Clinical Commissioning Group (CCG) and Tameside Metropolitan Council (TMBC), Tunstall UK won the HealthInvestor Technology Provider of the Year Award. Tunstall telehealth solutions reduced hospital admissions by 38 percent or £2.7m where mymedic was used. Release
The Veterans Health Administration (VHA) is formally reaching out to the private sector to explore switching from its current, pioneering EHR system, VistA (also referred to as CPRS, Computerized Patient Record System) to a commercial system. Their ‘feeler’ is an August 5 and 8 notice in FedBizOpps.gov titled 99–TAC-16-37877 * RFI – VHA supporting COTS EHR REQUEST FOR INFORMATION (RFI), Solicitation Number: VA11816N1486. This requests information on business support for transitioning to a commercial-off-the-shelf system (COTS–don’t governments love acronyms?–Ed.) and closes 26 August, which is not a lot of time even for an RFI.
VHA has been under extreme pressure from Congress to modernize its EHR, lately in July hearings before the Senate Appropriations Committee. EHR replacement is also in line with the Congressionally-mandated, now concluded Commission on Care’s recently published recommendations on a total, top-down reorganization of VHA, including a sweeping reorg of their HIT management. The VHA strategy appears to be that while they are walking down the road to replace VistA and have already spent to assess where they are with KLAS and other EHR consultancies (spending $160,000+ on surveys), they are essentially ‘kicking the can down the road’ to the next administration (POLITICO’s Morning eHealth, 14 July).
Current state is to continue to upgrade VistA through late 2018, though the closely related Department of Defense’s Military Health System is in the long process of cutting its homegrown AHLTA over to Cerner-Leidos as MHS Genesis, awarded last August, with a first trial in the Pacific Northwest later this year (HealthcareITNews, Ed. emphasis). Of course, it will take the VHA years to roll it out; there are close to 9 million veterans enrolled in the closed system that is the VHA. FCW, Morning eHealth 10 August
Love EHRs or hate them, the sheer size of the VHA and its growing concession that VistA won’t do in caring for American veterans makes it clear that the future of EHRs is in private systems from major developers–a field which is winnowing out to The Few (take that, GE). (more…)