Taking our own transformation medicine: how to integrate digital health into healthcare

An antidote to Dan Munro’s top-down and pessimistic vision of healthcare transformation (having much in common with Ezekiel Emanuel’s, see below) are two parallel prescriptions on integrating digital health into our healthcare systems and maybe, just maybe, transforming it.

The first acknowledges basic reality: we have all the health tech and funding we need right now. We are way beyond the fictional one device, app or service that will deus ex machina and transform healthcare. What we in the field need to do is integrate them, measure (and integrate) the data, get these systems and services into the home and–interestingly–seek out atypical early adopters. Your users/patients may not be the sexiest market for cocktail party chatter–older adults, the developmentally or cognitively disabled–and you’ll have to think beyond smartphone apps, but here is an opportunity to make an impact on a real, large, high-need and open market which can improve care, outcomes and reduce/redistribute cost over time. How The Digital Health Revolution Will Become A Reality (TechCrunch) Hat tip to reader Paul Costello of Viterion Digital Health.

The second analyzes a key point often neglected in healthcare discussions but well-known to students of behavior, like marketers: the patient’s perception of value. (more…)

Beyond Proteus, delaying medication release in the body–almost all the way

How to deliver medication reliably, well into the colon, to treat gastrointestinal disease most effectively? Purdue University researchers have developed an electronic drug capsule that delivers medication far into the digestive system. When triggered by the magnetic switch or electronic implant, it ‘detonates’ the capsule, releasing the medication. This delivery mechanism was tested through the stomach and into 20 feet of the small intestine. The promise is that it can deliver targeted medications farther into the colon, cost-effectively, to better treat IBS, Crohn’s and bacterial infections. The Purdue team is currently partnering with a biomedical company to take this into clinical trials. This takes the idea of Proteus’ ingested sensor to track medication one step further. Smart capsule to target colon diseases (Reuters)

Are we in the midst of healthcare disruption–or not at all?

click to enlargeIf you believe we are in the midst of a slow, tidal disruption of healthcare and the ascendancy of patient-centered care–to the point of Topolesque patient ownership–then you will be upset to tears by the contrarian assertions of Dan Munro in Forbes. He maintains that disruption isn’t what we think it is, but (and we cut to the chase here) it’s more like ‘process improvement’ and that it has to be driven by ‘K Street’ (translation: the street in Washington DC where Lobbyists Rule). Technology–patches on the flawed system. Doctors–desperately seeking to pay back their educational loans by picking the most lucrative specialties. (If they survive the internship and residency system without killing a patient or themselves; see The Misery of a Doctor’s First Days)

But..there’s more. (more…)

DARPA testing electricity to self-heal the body

click to enlargeI sing the self-healing Body Electric! With apologies to Ray Bradbury, in this Editor’s view, DARPA’s ElectRX research is almost revolutionary, yet logical. Like a pacemaker, it monitors a condition (like heartbeat) and if ‘off’ stimulates the organ through an electric shock. Scale it to a nano-sized neuromodulator and you have ElectRX. In broad terms, a tiny device, perhaps delivered by a needle, analyzes an anomaly and delivers an electrical signal to nerve pathways to correct it. For diabetics, it could stimulate insulin production; to treat depression, control inflammation in the brain; for PTSD patients, stimulate the vagus nerve for neural plasticity. Controlling inflammation has other benefits, such as in spinal injury and in TBI. While the Gizmag article spends time musing on ‘super-soldiers’ and the negative aspect, this Editor sees this research on the relationship between neural circuits and health as a significant development for both medicine and for Version 3.0 of digital health. DARPA web page on ElectRX.

Is digital health going to add to Digital Big Brother Watching You?

click to enlarge“They’re watching me on my phone. They’re watching me on Facebook. They’re even watching me when I want to hide. Machines are a form of intelligence, and they’re being built into everything.”–Dr Zeynep Tufekci

The world of digital health is largely based on tracking–via smartphones, wearables, watches–and analytics taking and modeling All That Data we generate. Are we in compliance with our meds? Are we exercising enough? How’s our A1c trending? Drinking our water? All this monitoring–online and offline–is increasingly of concern to Deep Thinkers like Dr Tufekci, a reformed computer programmer, now University of North Carolina assistant professor and self-proclaimed “techno-sociologist.” At IdeaFestival 2015, she took particular aim at Facebook (surprisingly, not at Google) for knowing a tremendous amount about us by our behavior, of course using it to anticipate and sell us on what we might want. The ethics of machine learning are still hazy and machines are prone to error, different than human error, and we haven’t accounted for machine error in our systems yet. Like that big health data that mistakes a daughter for her mother and drops critical health information from a patient’s EHR [TTA 29 Sep]. A thought-provoker to kick off your week. TechRepublic 

Related: The Gimlet Eye took a squint at Big Brother Gathering and Monetizing Your Big Blinking Data–data mining, privacy and employer wellness programs–back in 2013, which means the Eye and Dr Tufekci should get together for coffee, smartphones off of course. While Glass is gone, the revolt against relentless monitoring is well-dramatized in the well-watched video, ‘Uninvited Guests’. And we can get equally scared about AI–artificial intelligence–like Steve Wozniak. 

Digital health supporting daily living with autism

A developing area for healthcare tech is in the assistive technology (AT) area–in this instance to support those with autism. The spectrum of abilities and capabilities here is very wide–as are the needs. Some major challenges: organization, communication, managing stress levels, managing transitions in everyday living as a college student with autism must. Last week’s Autech 2015 at Old Trafford, Manchester spotlighted AT such as Brain in Hand, a smartphone/tablet app that touches on all three: it helps with planning daily activities, logging stress levels, providing help with coping strategies and if it is overwhelming, a direct connection to a support worker at the Wirral Autistic Society. Other promising technology includes biometric wristbands to monitor signs of stress and provide feedback to identify and work to modify the autistic person’s reactions; the Kaspar assistance robot for socializing children; the Proloquo2go tablet app which speaks for those without speech by using speech-producing icons. AT for the autistic is at the very early part of the development curve, but this Editor could see dual or triple uses for these technologies for those with TBI, stroke or dementia. Studies on cost savings are early, but the Brain in Hand test in Devon estimated a 100-200x savings: £300-500/week for social care versus £20/week for the service (but does this include the live support worker?) There’s an app for that: how assistive tech changes lives of people with autism (Guardian)

Related: on a late adult diagnosis of autism, how it is to live with it on your own (Guardian)

Connected health to help cure–physician burnout?

Here’s an interesting proposition: digital health tools such as telemedicine, telehealth and mobile health can help to reduce physician burnout. Except that if one is looking for support points in this HCI Healthcare Informatics article, one would be hard pressed. There’s no link to QuantiaMD‘s study (a 225,000-member US physician community), an inexplicable lapse. Your persistent Editor tracked it down, and found it connects the dots a bit more. It starts with the proposition that nearly half of doctors wouldn’t recommend medicine as a career to their children, then identifies a key frustration–“healthcare technologies that sap time and money are among the top reasons.” The solution? Other “emerging technologies—in the form of telemedicine, mHealth tools, and connected health devices—may actually help reverse this trend of physician burnout.” The paper then describes how telemedicine virtual visits, giving patients telehealth tools which will aid compliance and monitoring, especially with new treatments, and the opportunity to improve care all are Good Things. But not entirely convincing that these can be effective in mitigating the complex reasons why behind doctor burnout. Read the QuantiaMD study for yourself. Hat tip to Stuart Hochron, MD, JD of Practice Unite via LinkedIn

Blueprint Health’s 8th Demo Day: 8 new companies show their stuff

click to enlargeLast Friday, in the middle of a NYC nor’easter, Blueprint Health had its eighth Demo Day, where startup companies in this accelerator’s latest three-month Summer class, having worked on their innovations and developed a business plan, ‘graduate’ and ‘pitch’ their audience. There’s been a shift over the past few classes to B2B-oriented digital health, from reducing readmissions through geolocation (Position Health)  to HIPAA compliance (HIPAAfix) to streamlined billing for chronic care management (Oculus Health), but half are more consumer-oriented companies, providing more accessible genetic testing (Bind Health), workplace stress reduction (Psocratic) and point of service lending to patients with high-deductible health plans (Crediyo). The other two companies are MedPilot (simplifying patient billing and debt through electronic billing) and DocDelta (streamlining provider talent search). Annually, Blueprint Health’s invites in about 20 digital health companies with an investment of about $20,000 each, has graduated 68 companies and hosts in their space over 24 digital health companies. Release. Company profiles.

European Assistance for Innovative Procurement (eafip) Conference Manchester, Nov 24th

When this editor first saw European, Innovative and Procurement in the same title, he thought he’d misread it as one of the complaints that has been made at almost every recent meeting attended, especially those relating to the Accelerated Access Review, is how European procurement rules disadvantage small suppliers who are typically the principal source of innovation in the health & care sector.

So here’s your opportunity to hear from the experts and to make your concerns known to them, in this European Commission sponsored joint NHS England/eafip event on ICT solutions procurement.

Date is 24th November; more details here – booking for this free event will open soon apparently.

Better’s fast fail, ending health assistance service 30 Oct

click to enlargeBetter is sadly not. This two-year old service that provided personal health assistance, including a real, live health assistant, to guide members through health questions, the thickets of insurance claims, finding doctors and specialists, apps and more, announced earlier this week that it was ending operations as of 30 October. While it was announced via their Twitter feed on Tuesday, most of the industry learned of it through Stephanie Baum’s article in MedCityNews today. Better formally debuted only 16 months ago [TTA 23 Apr 14] and at the time this Editor felt that it was a service in the right direction, a kind of ‘concierge medicine for the masses’ needed when individuals have to direct more and more of their own care.

A solid start, as our Readers have seen, does not guarantee success, but this fast fail is still fairly shocking. A concern at the time was the pricing for the full service model at $49/month, which later became the family price (individuals were $19.99/month). CEO/co-founder Geoff Clapp was among the most Grizzled of Health Tech Pioneers; he had been a co-founder of Health Hero/Health Buddy from 1998 to its sale to Bosch Healthcare, a very long pull in telehealth, and he had spent much of his post-Health Hero time generously advising other startups. Yet despite the involvement of blue chip Mayo Clinic as a service provider, its financial backing from their investment arm and socially-oriented VC Social+Capital Partnership, it managed to raise only its initial seed funding of $5 million (CrunchBase).

So what happened? (more…)

76 percent of post-surgery patients prefer telehealth followup: study

A 50-patient study at Vanderbilt University Medical Center in Nashville, Tennessee found that online-only post-surgical followup was acceptable to 76 percent of patients after uncomplicated surgery (hernia repairs, laparoscopic gall bladder). These patients, all of whom had internet access and a smartphone, tablet or digital camera, took their own pictures of their surgical site and transmitted these digital images through an online patient portal established by Vanderbilt. Both patient and doctor communicated through the portal to discuss follow-up care (though not necessarily at the same time). Another plus was that the online visits took significantly less time for patients (15 versus 103 minutes) and surgeons (5 versus 10 minutes). The surgeons reported a comparable effectiveness number–68 percent–for both online and in-person visits. Clinic visits were more effective in 24 percent and online visits for 8 percent. What was also notable was that no complications were missed via online visits. The program used to analyze images, typically used in wound management, was not disclosed in the study, which was performed between May and December last year. mHealthNews, Journal of the American College of Surgeons (abstract only)

NJ Innovation Institute gains $49 million HHS grant

The New Jersey Innovation Institute (NJII), a New Jersey Institute of Technology (NJIT) corporation, has been selected as one of 39 health care collaborative networks participating in a Health and Human Services (HHS) program, the Transforming Clinical Practice Initiative. According to their announcement, NJII was selected as a Practice Transformation Network and over four years will receive up to $49.6 million for technical assistance support to help equip 11,500 clinicians in the New Jersey region with tools, information, and network support needed to improve quality of care. This is part of a $685 million HHS program awarding grants to 39 national and regional health care networks to help equip more than 140,000 clinicians with the tools and support needed to improve quality of care, increase patients’ access to information, and reduce costs. This is in addition to an $2.9 million grant from the Office of the National Coordinator for Health Information Technology (ONC-HIT) announced in August for sharing of quality data through its New Jersey Health Information Network (NJHIN). Through its Innovation Labs (iLabs), NJII brings NJIT expertise to key economic sectors, including healthcare delivery systems, bio-pharmaceutical production, civil infrastructure, defense and homeland security, and financial services. Release via Ridgewood Patch, HHS release. Hat tip to contributor Sarianne Gruber via LinkedIn.

What’s caught my digital health interest recently

At the Royal Society of Medicine we’ve just announced our next medical apps event on 7th April next year, Medical apps; mainstreaming innovation in which we feature for the first time a presentation by Pam Kato, a Professor of Serious Games, so it’s intriguing to see the iMedicalApps review of a clinician-facing serious game, iConcur, for anaesthetists.

We also have a powerful presentation on mental health apps from Ieso Digital Health which doubtless will make the same point as has been made in previous events that online mental health services typically are more effective than face:face. The abstract to the recent Lancet paper by Dr Lisa Marzano et al, examining this topic in great detail, suggests that the academics are now a long way to working out why this is the case and offers further potential improvements; aspiring mental health app developers unable to access the full paper may consider it worth paying $31.50 (or join the RSM to access it for free).

A regular at the RSM’s Appday is Dr Richard Brady’s presentation on Bad Apps, which next year will now doubtless include mention of the FTC’s recent fifth action against an app provider, UltimEyes, with deceptively claiming they their program was scientifically proven to improve the user’s eye sight.

Moving to good apps (more…)

Part time digital project manager sought for the mHabitat team

Victoria Betton’s mHabitat team is looking for a smart and capable digital project manager to work with them on a part time basis (freelance or secondment) over the next 3-6 months. As part of a small team developing groundbreaking digital innovations in health and care, the person chosen will be responsible for bringing together a team to deliver a number of mobile app and website developments with user-centred co-design at the centre.

More details & how to apply here.

TSA Annual Conference 16th & 17th November: reminder (UK)

Logo - TSAWe have been asked to post a reminder for the TSA’s Technology-enabled Care Event of 2015. Taking place on the 16th and 17th November 2015 at the Celtic Manor Hotel, South Wales, this is a ‘must-attend’ annual event in the sector calendar.

This year’s conference is entitled Inspiring Change and Progress. It will carry three main themes throughout the two days:

  • Entrepreneurship: How to think differently to make things happen for you, your business and the sector.
  • Education: Preparing for the future of the sector, what do we need to know?
  • Evolution: What’s next for the future of technology-enabled care?

The conference will feature a host of high profile speakers who will be tasked with giving attendees the ‘need to know’ sector picture, including ministers, sector leaders, innovators, business motivators, technology gurus, and the people who benefit from using technology-enabled care.

The two day programme will be packed with stimulating presentations, challenging debates, and informative parallel sessions that will include masterclasses & interactive workshops.

The complete programme is here. A limited number of Early Bird booking rates are now available; book here.

Personal health ‘big data’ exchange is all good, right? Perhaps wrong.

Many of our recent stories have touched on ‘big (health) data’ as Achieving the Holy Grail–how it can be shared, how it can work with the Internet of Things and how poorly implemented personal health record (PHI) databases can derail national health systems (and careers) [TTA 22 Sep]. They are, after all, 1) extremely difficult to design to preserve privacy and 2) must satisfy patients’ requirements for easy use as well as privacy including opting out. But when despite all good intentions, data goes awry, the consequences can be severe.

  • A daughter applies for health insurance from Aetna, and her mother’s medications, about which she had no knowledge, are attributed to her. How? Data mining off Milliman’s IntelliScript data service which mixed up the records.
  • EHR exchange can spread errors such as a dropped critical health or medication record. One led to the death of an 84 year old woman. VA also had a problem with its EHR (not cited but likely VistA) slotting medication histories into the wrong patients’ files. An Australian hospital mixed up discharge files in electronically sending them to doctors. The more records are exchanged, the more possibility there is for propagation of errors.
  • More information is shared with third-party suppliers; survey companies are increasingly tapping into these databases to send annoying, potentially privacy-invading treatment questionnaires to individuals.

Bloomberg Business’ conclusion is that this could be a problem, but much beyond the tut-tutting doesn’t get into solutions. The Pitfalls of Health-Care Companies’ Addiction to Big Data