Can State medical boards legally prevent telehealth activity?

This is the question that arises out of a recent ruling by the United States Supreme Court, not on anything related to telehealth but on teeth whitening!

The case was between the North Carolina State Board of Dental Examiners and the Federal Trade Commission. The Board had requested non-dentist teeth whitening practitioners to desist from carrying out these activities and was challenged on the grounds that the Board did not have authority to do so and was acting in an anti-competitive way. The challenge went all the way to the Supreme Court which upheld the lower court decision on the grounds that even though the Board is, in fact, an agency of the State its action must still be supervised by the State in order to enjoy anti-trust immunity. This is analysed by Eric M Fraser in the SCOTUS blog.

It is thought that the State Medical Boards in the United States also have similar rules of governance and therefore do not qualify for immunity from anti-trust law that some State agencies have. This has led to speculation that any restrictions imposed by a State Medical Board on a licensed medical practitioner with regard to the use of telehealth could be considered an anti-competitive action. (more…)

EHRs: now safety, info exchange concerns (US, AU, CA)

What’s this? EHRs reducing, not increasing safety? Reports from both the US and Australia seem to indicate another spanner (US: wrench) in the EHR works, aside from the laggardness in achieving the HITECH Act’s goals [TTA 27 Mar].

  • The Joint Commission, which is the chief US accreditation and certification body for healthcare organizations and programs, and thus to be taken very VERY seriously, released a Sentinel Event (Patient Safety Event) Alert yesterday. It warned of EHR-related adverse events affecting patient health, resulting from incorrect or miscommunicated information entered into EHRs. Interfaces built into the technology can contribute and studies have documented mixed results in the systems’ ability to detect and prevent errors. It identifies eight key factors,led by human-computer interface, workflow and communication and clinical content, that can lead to a sentinel event and three major remedy actions. While the JC does take pains to confirm the positive effects of well-designed and appropriately used EHRs, with strong clinical processes in place, it is the first ‘red flag’ this Editor can recall (more…)

The traditional PERS as ‘ancient history’

click to enlargeSomething to think about. How many families and older adults are aware that the traditional PERS emergency pendant, which has been around for at least 40 years, is sadly outdated and in fact inadequate for those at greatest risk? While major advertisers on US media such as Life Alert, Life Call, ADT and Philips Lifeline present crisis situations where the older person is on the floor and is rescued after pressing the pendant button, they barely advertise their other available products that incorporate passive fall detection and cellular, even if somewhat inadequate for soft falls or unconsciousness. Families unwisely feel ‘protected’ when paying for traditional PERS, not realizing that more advanced technology is readily available and not that much more expensive. Moreover, and only mentioned in the context of his grandmother’s fall while in senior housing, there is a distinct recalcitrance of senior housing executives to rid their apartments of the (cheap) old pendants and replace them with (pricier) passive/cellular assistance systems, much less more advanced wearables/RFID systems or mobile/watch combinations. This Editor also notes that the major drugstore chains also sell PERS; while they trumpet wellness in their advertising, they are as behind the curve in this area as senior housing. Neil Versel in MedCityNews.

For our Readers: can we compare/contrast how the UK, EU and US are still wedded to traditional PERS after 40 years, and if more advanced forms are starting to take hold? Click on the headline to see comments, including this Editor’s opining on traditional PERS as ‘cash cow’.

Another go at a joint DOD-VA EHR? (US)

As this Editor was Pondering the Squandering last week of $28 billion HITECH Act funds meant to achieve EHR interoperability but falling well short, we recalled another Big EHR Squander: the integration of the Department of Defense’s (DOD) AHLTA with the Veteran Affairs’ VistA, an iEHR effort which collapsed in February 2013 at a mere $1 billion, in addition to dysfunctional or failed upgrades in both systems at just under $4 billion [TTA 27 July 13]. For civilians, this may not sound like much for concern, but for active duty, Reserve and National Guard service members transitioning from active to civilian status (and back as they are activated), often with complicated medical histories, it means a great deal.

At least one Congressman who also happens to be a physician, Representative Phil Roe, MD (R-TN) wants to try, try again. According to Politico’s Morning eHealth of last Wednesday, his bill will offer “a $50 million prize to the creator of an integrated military-veteran medical records system.” plus another $25 million over five years to operate it. DOD is moving forward with an $11 billion bid for a new EHR, but Rep. Roe’s staff issued a statement that differs with the DOD’s–that the new EHR still has no provision for secure and relatively seamless interoperability with the VA system to streamline the transfer of claims. We wish the best to Rep. Roe, and hope he can overcome Congressional inertia and two huge bureaucracies amidst doubts on the DOD’s EHR award process. FierceEMR on Roe bill, award process and adoption concerns by GAO and others. Also Anne Zieger in Healthcare Dive, iHealthBeat.

Set that disease data free! A call to break down those data silos.

click to enlargeAwash in a rising sea of data generated by devices and analytics–around treatments, population health, costs–there’s a struggle to make sense of it. We’ve noted the high value and merchandisability of 23andme‘s genomic data (gained by individual user consent) [TTA 5 Mar], but our healthcare institutions which should be codifying and sharing disease and treatment data, largely do not. Those with rare or ‘orphan’ diseases struggle to find information, diagnosis, fellow patients, treatments. They sometimes win breakthroughs by, believe it or not, blogging, and having their articles widely disseminated. Reasons why? According to David Shaywitz in Forbes, they are:

  • Hospitals, even research based centers, struggle to codify their genotype and phenotype data of their patients in a meaningful way that would be usable for clinical decision making. We’ve also noted (oddly not Mr Shaywitz) the long implementation process of IBM Watson cognitive processing/decision making tools in healthcare, the concentration on single diseases and their spread into other industries plus third-party integration outside of healthcare [TTA 9 Oct 14].  (more…)

RSM’s Medical Apps one-day conference 9th April – last call

The next RSM event, entitled “Mainstreaming medical apps; reducing NHS costs; improving patient outcomes” is on 9th April, where there are still a few spaces left. This one-day conference will build on the last two years’ sell-out one-day conferences on medical apps at the RSM.

This year as medical apps are coming of age, the focus is on the critical aspects of mainstreaming them, in particular the various UK and EU regulatory issues that need managing in order to enable apps to be recommended or prescribed with confidence by clinicians. This will also include examples of ground- breaking medical apps as well as the use of electronic games to promote health and wellbeing.

Speakers on the regulatory side include, from the UK Professor Gillian Leng, Deputy Chief Executive of NICE, and Jo Hagan-Brown & Dr Neil McGuire from the MHRA, and from the European Commission Pēteris Zilgalvis, Head of Unit for Health and Well-being. Julian Hitchcock from lawyers Lawford Davies Denoon will give another of his excellent talks summarising the regulatory position from a user’s point of view, Dr Richard Brady will update us on bad apps and Julie Bretland will describe progress on the National Information Board’s work on how best to evaluate medical apps.

From the patient perspective, Alex Wyke will be talking about developing guidelines for good practice in health apps and Dr Tom Lewis from Warwick (in place of Prof Jeremy Wyatt now sadly unable to attend) will be talking about how best to evidence benefits from apps.

Describing some novel apps will be Professor Ray Meddis, on how to make an iPhone a hearing aid, Professor Susan Michie from UCL on gamification of smoking cessation, Ileana Welte from big White Wall on why mental health is such fertile ground for apps, and Ian Hay describing the challenges of using Android apps to deliver artificial pancreas-like functionality for the GSMA Brussels to Barcelona bike ride.

Should be a great day, and at the RSM’s rates, a tiny fraction of the cost of a commercially-run event!

Book here

Supplier offer

For £50/table, the RSM is also offering SMEs the opportunity to demonstrate their medical apps to the professional audience during refreshment breaks and at lunch (for more information on this offer contact Charlotte on 0207 290 3942). There are just four tables left now.

The King’s Fund’s ‘newspaper’ on health and the General Election (UK)

click to enlargeThe King’s Fund is now participating in the runup to the 7 May UK General Election with Health and the election, a Paper.li format roundup of national health issues. Much of it centers around the present and the future of the NHS, and what The King’s Fund is tracking as the deterioration in service in such metrics as waiting times for A&E, cancer care and routine operations, coupled with growing deficits. Will the NHS be a deciding factor in the election, as the ITV report seems to indicate? The King’s Fund is gathering the coverage and tracking possible answers to that question. TTA is an official supporter of The King’s Fund, and their upcoming Digital Health and Care Congress 2015 on 16-17 June. TTA readers enjoy a 10% discount when using this exclusive link.

UnaliWear Kanega assistance watch makes Kickstarter goal

click to enlargeThe UnaliWear Kanega assistance watch [TTA 18 Feb] on Wednesday closed its Kickstarter crowdfunding over the top at $110,154. It has several features to promote safety for older people or the disabled, with fall detection, GPS and stand-alone cellular/Wi-Fi connectivity, but the most unique is voice recognition and command/response. Its latest prototype is half the case size as previously, with a more attractive analog watch face, which makes it a lot more MAYA (most advanced yet acceptable–Raymond Loewy), and a major improvement in form over your typical PERS or most GPS watches. With our usual caveat (if it does what it says it does in production), we applaud Jean Anne Booth and her team for their achievement–and we’ll be watching.

The end of an era – is this Mike Clark’s last newsletter?

Ardent followers of Mike Clark’s newsletters will be saddened by the news that the current funding from Innovate UK, KTN Ltd and the Assisted Living Innovation Platform to support the extensive work he does to keep us all informed of important stuff has come to an end.

The Telecare LIN is therefore looking to its readers. To maintain a comprehensive monthly news summary going out to over 48,000 people, they are looking to crowdsource funding to support the website, content and hundreds of links and journal article references each month. They are currently looking for a number of organisations to support continuing production (including supplements, Twitter stream, archive) at around the £5k level per year. The news service, currently in its tenth year is recognised as an authoritative source and valuable resource in the UK and in other parts of the world working on digital health, telehealth, mHealth, telemedicine and telecare.

More details, and who to send the money to, are on the first page of the newsletter.

Mike will also be appearing in person (more…)

Your Friday superintelligent robot fix: the disturbing consequences of ultimate AI

click to enlargeOur own superintelligent humans–Elon Musk (Tesla), Steve Wozniak (Apple), Bill Gates (Microsoft) and Stephen Hawking–are converging on artificial intelligence, not just everyday, pedestrian robotics, but the kind of AI superintellect that could make pets out of people–if we are lucky. In his interview with Australian Financial Review, the Woz (now an Australian resident) quipped: ‘Will we be the gods? Will we be the family pets? Or will we be ants that get stepped on?’ (more…)

Google granted patent for sensor contact lens

click to enlargeOn Tuesday, Google was granted a patent for its contact lens with sensors and embedded microchip. According to Time, the patent award was uncovered by WebProNews, which seems to be focused more on the problems of Google Glass than the patent, though the abstract and a development figure is included. The patent was originally filed in September 2012. We’ve previously noted that Google is partnering with Novartis/Alcon (their eyecare division) to further develop applications. The most prominent is glucose level detection for diabetics, but there is also a huge market in correcting presbyopia and autofocusing ‘zoom’ lenses [TTA 17 July 14] Of course, Google does not admit to any of this, telling a Time reporter that “We hold patents on a variety of ideas—some of those ideas later mature into real products or services, some don’t. Prospective product announcements should not necessarily be inferred from our patents.” So we should keep blinking.

Pondering the squandering redux: $28 billion gone out the HITECH window

In 2009, the US Congress enacted the HITECH Act, as part of a much broader recovery measure (ARRA or ‘the stimulus’), authorizing the Department of Health and Human Services (HHS) to spend up to $35 billion to expand health IT and create a network of interoperable EHRs. Key to this goal of interoperability and seamless sharing of patient information among healthcare providers was achieving stages of ‘meaningful use’ (MU) with these EHRs in practice, to achieve the oft-cited ‘Triple Aim‘ of improved population health, better individual care, delivered at lower per capita cost. Financial incentives through Medicaid and Medicare EHR programs were delivered through multiple stages of MU benchmarks for hospitals and practices in implementing EHRs, information exchange, e-prescribing, converting patient records, security, patient communication and access (PHRs).

Five years on, $28 billion of that $35 billion has been spent–and real progress towards interoperability remains off in the distance. This Editor has previously noted the boomlet in workarounds for patient records like Syapse and OpenNotes. Yet even the progress made with state data exchanges (e.g. New York’s SHIN-NY) has come at a high cost–an estimated $500 million, yet only 25 percent are financially stable, according to a RAND December 2014 study. (more…)

Chronic care management with telehealth (US)

Our readers, especially those in the US engaged with medical practices, might be interested in reading a two-part interview with Editor Donna by occasional TTA contributor Sarianne Gruber. We discuss the new model for Chronic Care Management (CCM) now included in what the Federal Government (CMS-Center for Medicare and Medicaid Services) pays physicians for Medicare patient visits and services. Telehealth, or in CMS terms remote monitoring, can play a vital role in the provision of care coordination, assessment, documentation, patient access and facilitation of self-management as part of the care plan, culminating in better outcomes at lower cost. Published in the new RCM (Revenue Cycle Management) Answers, a spinoff of HITECH Answers. Part 1.  Part 2

National telehealth plan to improve rural health called for in Australia

Ahead of the forthcoming Australian Telehealth Conference 2015, one of the speakers has spoken to the media partner of the conference, Australian Aging Agenda Technology Review. In an article published on the Aging Agenda website, the speaker, Dr Shannon Nott, is quoted as saying “There needs to be a telehealth plan put in place in Australia. We need to start looking at telehealth and say this is something we should seriously invest in. We need to look at it and get it right from the start; that includes getting it right for indigenous communities [and] getting it right for rural and remote communities”.

Nott is said to have spent four months last year researching telehealth in rural and remote Alaska, Canada and Brazil including indigenous communities. The article quotes him as saying “In Alaska for every dollar that they spend on telehealth software and programs they save $10.50 in travel alone in terms of healthcare costs. Not to mention the hospital admissions avoided, the GP admissions avoided.”

click to enlargeThe Australian Telehealth Conference 2015 takes place on the 23rd and 24th of April in Sydney.

NHS Apps Library embraces mental health…and Mole Detective vanishes

Thanks to Mike Clark for pointing this editor to the breaking news that the NHS Mental Health Apps Library has now gone live. It features online tools, resources and apps that they claim have a proven track record of effectiveness in improving mental health outcomes.

It is accessible through the NHS Choices platform, a website that gathers over 40 million visits per month, 9.7 million of which are to pages on depression; 6 million per month to stress and 9.4 million to anxiety.

This is likely to be a major benefit to those who have difficulty obtaining access to face:face mental health services, especially as a number of presentations in the Royal Society of Medicine have suggested that online mental health services can often be more effective (more…)

Data breaches top 120 million since 2009 (US)

click to enlarge“The medical industry is years and years behind other industries when it comes to security.”–Dave Kennedy, TrustedSEC CEO.

We admire the Washington Post for arriving at the conclusion we did in 2010–that healthcare organizations are uniquely vulnerable to cyberattack because of the high value of patient data, and an often lighter level of HIT security. But now we get the finger wag that ‘it’s only going to get worse.’ (Beyond 120 million breached records?) Data security, of which HIPAA patient information protection is a part, wasn’t primary for years, especially in organizations overwhelmed with transitioning EHRs, getting EMRs to speak with EHRs, Meaningful Use, new care and payment models, 30-day readmissions and ‘oh, by the way, how will we get paid?’ The Premera Blue Cross (Washington state) breach of 11 million records was the second largest in healthcare history (after Anthem Health‘s February bunker buster of a breach). Most breaches are from stolen laptops or shared/easy to guess passwords (or none at all)–but these have not been in the millions. Premera’s theft took place on 5 May 2014 and was only discovered in January; it included SSIs, bank information, claims data, patient name/address and date of birth. Those affected were in California and Alaska primarily, but also included Federal employees.

But Premera can’t say they were not warned. The US Office of Personnel Management’s Office of the Inspector General (OPM OIG) independently audited Premera in April 2014 detailing several vulnerabilities, including a lack of timely patch implementations, a lack of methodology to “ensure that unsupported or out-of-date software is not utilized” and insecure server configurations, and the need to upgrade physical access controls in their data center. FierceHealthIT

Premera’s medical files data may expose other payers, which in turn may legally come after Premera, according to FierceHealthIT.

Only now are health systems and practices focusing on securing all information  (more…)