Home telehealth now focused on the ‘superusers’ of healthcare

A noticeable trend in telehealth has to do with focusing less on the generic virtues of at-home vital signs monitoring for routine patient care and more on managing specific high-cost populations to avoid or reduce costs. Some of the impetus in the US has come from new regulations by CMS (Center for Medicare and Medicaid Services) intended to move Medicare fee-for-service (FFS) patients into a reimbursed chronic care management (CCM) model. Banner Health is Arizona’s largest private employer (which does say something about Arizona as a retirement haven) and since 2006 has been experimenting with remote monitoring since 2006. Starting in 2013 Banner piloted Philips‘ post-discharge program now called ‘Hospital to Home’ as Banner iCare, combined with Philips Lifeline PERS, but made it available to those only with a stunning five+ chronic conditions–the top 5 percent that is reputed to account for 50 percent of healthcare spend. Banner combined the tech with intense support by a multi-layered care team. At ATA they announced the following results with the initial cohort of 135 patients, now up to 500:

  • 27% reduction in cost of care
  • 32% reduction in acute and long term care costs
  • 45% reduction in hospitalizations

The article in Forbes is a bit breathless in profiling the program and the ‘superusers’ of healthcare (with a windy but false analogy from John Sculley) but provides a level of detail in the program that most articles do not. One wonders how Philips makes money on supplying what is at least $2,500 worth of kit, with peripherals that must all be Bluetooth LE. It’s also not stated, but the TeleICU and TeleAcute programs also appear to be Philips’. Video

 

A new MSc in Data Science for Research in Health & Biomedicine at UCL

Anyone interested in pursuing an education in health informatics or data science at UCL is invited to an open evening on 25th June from 4:30pm at 222 Euston Road, London. This is billed as an informal event with an opportunity to meet staff and students and to learn more about the work of the Centre for Health Informatics and Multiprofessional Education, the UCL Institute for Health Informatics and the Farr Institute.

The occasion will be the launch event for UCL’s new MSc in Data Science for Research in Health and Biomedicine. This programme is set to equip graduates for new careers in academia, healthcare organisations, pharmaceutical companies and consultancies dealing with Big Data. UCL will be working closely with NHS, research and commercial partners to deliver an innovative and practical programme that will give students real exposure to practical research in one of the top centres for data science in health and biomedicine.

Book your place here.

The potential of engaging ‘safety net’ patients via mHealth: study (US)

The Commonwealth Fund‘s just-published study on mHealth usage in a national sample of urban and rural community health centers and clinics (in US termed ‘safety net providers’ for low-income and uninsured) indicates the potential of mobile health for patient engagement in care, but yet to be achieved. Their patient population has high levels of mobile phone adoption, including text and internet. About 27 percent of the 181 providers who participated currently use mHealth in care delivery, but in basic applications such as appointment reminders. The potential observed is in chronic disease management support, health education and specific programs such as smoking cessation, weight management and medication adherence. Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics

Undermining the system an unintended consequence of telemedicine?

Telemedicine’s doctor-patient virtual consults may undermine the healthcare system, if Mass General neurologist Dr Lee Schwamm is to be believed from his comments at last week’s iHT2 Health IT Summit in Boston. Urgent care delivered by telemedicine not only commits the mortal sin of siloing data, not ‘doing an adequate job’ of passing to the primary care physician, but attracts dissatisfied doctors who want to set their own hours. And the cardinal sin: telemedicine attracts wealthier patients, paying cash, who by using these services are “…pulling dollars out of the healthcare system that are desperately needed to care for poorer patients.”

Quite a leap of logic here, when his real concern should be quick availability of patient care–not having to wait hours in a doctor’s office or ER/ED because you’re triaged as not bleeding-on-the-floor urgent. Virtual consult rates at least for now also tend to be low–$40-45 per visit–and appealing to those without insurance, not seeing a doctor on a regular basis (no chronic conditions) or anyone with a high deductible. Doctors are still also free, despite Dr Schwamm’s snark, to better utilize their time–and yes, make additional income–through signing on to telemedicine as part of their practice. So is this a lash back on a factor that’s undermining the establishment which Dr Schwamm is part of? Perhaps Dr Schwamm can explain? Stephanie Baum takes a puzzled view over at MedCityNews.

Driverless cars will cut insurance costs – is there a parallel with mHealth?

This article in the Telegraph last week has stimulated Prof Mike Short to ask whether if driverless cars can eliminate bad driving and so reduce insurance costs, mHealth can do the same for those with either or both life assurance and health insurance.

There’s little doubt in the mHealth community that technology will cut costs, and already there are (at least a few) solid examples. The big question is, can the insurance world – both life assurers & health insurers – be convinced? We know in the UK for example that BUPA is working hard on mHealth solutions, and that Aviva has tied up with Babylon (who recently won the recent AXA ‘Most Innovative Provider’ award)…and doubtless there is much more too. Obviously the situation is much further ahead in countries such as the US where health insurance is the norm.

Mike suggests that we run an insurance led event to look at techniques of prevention as well as cure/care. This could have an interesting policy dimension if the health insurers were willing to think about new measurement policies and indicate where they wish to go with data driven policies – eHealth as an opener for new policies and forms of funding? As he says, apps/wearables/connectivity are just enablers to this wider story, for which the insurance systems and their objectives need to be understood too.

DHACA is happy to participate, broker or organise such an event – we’d really welcome view from readers though first – would you be interested in taking an active part in what might just change the face of health insurance in the UK, and promote mHealth at the same time?

An important intervention on mHealth from the EU Data Protection Supervisor

At the end of last week, the EU Data Protection Supervisor (EDPS) published an excellent document entitled Mobile Health – Reconciling technological innovation with data protection. To quote the press release:

Failure to deploy data protection safeguards will result in a critical loss of individual trust, leading to fewer opportunities for public authorities and businesses, hampering the development of the health market. To foster confidence, future policies need to encourage more accountability of service providers and their associates; place respect for the choices of individuals at their core; end the indiscriminate collection of personal information and any possible discriminatory profiling; encourage privacy by design and privacy settings by default; and enhance the security of the technologies used.

The document itself contains much of interest. To this editor, who has heard many people poo-poo the importance of wellbeing data, it was good to see:

Lifestyle and well-being data will, in general, be considered health data, when they are processed in a medical context (e.g. the app is used upon advice of a patient’s doctor) or where information regarding an individual’s health may reasonably be inferred from the data (in itself, or combined with other information), especially when the purpose of the application is to monitor the health or well-being of the individual (whether in a medical context or otherwise). (Page 5)

As someone who gets concerned at turning people off sharing their health data, it was nice to see the recognition that: (more…)

National UK Telehealthcare Awareness, KFC & Wayra – three recent items

On June 3rd, UK Telehealthcare is holding their first National Telehealthcare Awareness day with events all over the country – follow the link to see what’s happening close to you!

This editor was alerted by a poster from the recently rehoused CUHTec who are supporting the  Mascot event at Merton. Other events that particularly caught this reviewer’s eye were at Welbeing/West Sussex, NEAT (remember when the N used to stand for LB Newham – now it’s Norwich) and Cair.

Next, who can resist a heading that reads KFC Tray Typer keyboard is finger clickin’ good. It turns out that KFC have created a wipe-clean tray mat that doubles as a Bluetoothed keyboard so you can continue typing without gumming up your mobile device with grease whilst enjoying their delectable fare.  Sadly these were only available in Germany, and then only for a set of new KFC openings. The plan apparently was that the mat was durable enough to get wiped down and re-used however (more…)

More evidence of confusion among clinicians over medical apps (UK) + MAUDE

A paper just published in the Annals of Medicine & Surgery entitled A UK perspective on smartphone use amongst doctors within the surgical profession also sheds some interesting light on the use of mobile apps by surgeons.

Given the recent advice to members by the RCP against the use of apps that are medical devices though not CE certified, the following finding is of especial interest, as it is widely considered that many clinical calculators meet the EU legal definition of a medical device:

…when looking specifically at senior doctors, the most common type of app utilised was clinical calculators followed by reference guides/handbooks and then drug reference guides.

The paper also confirms findings by this editor and others that clinicians are confused by the wide range of apps available and lack guidance on the effectiveness & efficacy of individual apps.

The majority of participants did not have any relevant suggestions for app development, which may suggest that there is an uncertainty over the catalogue available. Given concerns voiced in both our study and the work of others questioning the reliability of available resources, a possible solution would be the creation of a UK based app directory to outline availability with verification of performance and validity. However given the complexity of this regulation, peer review specific to the UK may have to suffice.

A short & interesting read that very much supports the need for a reference source for clinician-facing apps, and an objective measure of the benefits they deliver: recommended.

Whilst writing, Prof Mike Short has also drawn my attention to a related, very short, article entitled To Be or not to Be a Medical Device: Is the Regulatory Framework a Safety Rope or a Fetter? which thankfully concludes that:

Certainly, adhering to the standards listed <in the article> massively increase administrative overhead in research and development, extend the “time to market” and causes increased costs. However, this is the price to pay for success to reach the goal: Impact on patient care. Therefore, the answer to the question in the title of this article is: Software can be a medical device and from this point of view, we have to accept administrative overheads – and the regulatory framework can be a useful guide-line.

Perhaps more interestingly though it includes reference to the FDA’s ‘Manufacturer and User Facility Device Experience (MAUDE) which records product problems (obviously in the US), including those for medical software. Wouldn’t it be great if the EU had such a database for medical apps?

The dilemma of design for older people

Is the best design for older people and the disabled not specifically designed for them, but an adaptation of basic good design? Laurie Orlov in one of her apt Aging In Place Technology Watch articles questions the market viability of all those specially designed products we’ve seen since, say 2008. We recall ‘smart homes’, senior desktop computers, simplified phones and the robot caregivers which never seem to get past the prototype stage [TTA 25 July 14]. Her POV is that in most cases ‘designing for all ages is feasible today’ except for healthcare–durable medical equipment (DME) and healthcare delivery (and,this Editor would add, monitoring). One of her commenters points out that not everything can be designed ‘universally’, linking to this excellent article from Smashing on guidelines for designing tech to be used by those over 50. The section on blue color perception was especially interesting, as blue is healthcare’s #1 color. I would also point out that design which avoids stigma (as in ‘it screams OLD’) and has good aesthetics also wins.

Is AARP admitting that ‘tech designed for seniors’ is not a winning notion, as this May’s Life@50+ National Event in Miami is likely the last national event they sponsor? And it would be interesting to go back to the previous ‘Live Pitches’ to see how they are doing. Ms Orlov profiles this year’s five.

Call for presentation proposals: mHealth Summit (US)

click to enlargeYou have till 8 June to submit a proposal for a presentation at one of the largest digital health conferences in the US, the mHealth Summit (which is same place–near Washington D.C.–but a month earlier than usual–8-11 November). This year’s theme is “Anytime, Anywhere: Engaging Providers and Patients” and centered around one of five topics: clinical care, technology, patients and consumers, research, policy or business. The co-located Global mHealth Forum has a separate submittal process. Information and submittal linkTelehealth & Telecare Aware has been a media partner of the mHealth Summit US since 2010 and the 2015 Global mHealth App Developer Economics Study presented earlier this month at mHealth Summit Europe in Riga.

Telemedicine in diabetes management

Findings of a new literature analysis of the impact of telemedicine on diabetes management has been published in Telemedicine and e-Health.

The authors, from the University of Michigan and the University of Kentucky,  analysed 73 research publications (selected from a potential 17,000 list) published between 2005 and 2013. They conclude that although the individual research studies varied significantly in, for example, the outcomes measured, there was sufficient evidence to point to the positive effect of telemedicine.

The full paper describes the analysis methodology and gives detailed results and would be of interest to those working in diabetes management as well as those applying telemedicine to other long term conditions.

‘Internet Plus’ nurturing China’s nascent digital health market

Back in April this Editor was surprised by the interest Chinese investment companies had in Scanadu–and vice versa. Two of the three, Tencent Holdings and Fosun International, led the $35 million Series B round. Scanadu in return reportedly is developing products primarily for the China market, such as a urine analyzer.

Somewhat surprising, but it should not be, is the extent that private money tacks to the winds of official Chinese government policy. Ecns.com, the online site of the state China News Service, reports that part of the government ‘Internet Plus’ initiative will be targeted to the health and social care needs of 212 million people over 60 in China–a surprising 15.5 percent of the population. The civil affairs vice-minister has publicly advocated the use of the Internet, cloud computing and big data to transform care for the aged. Oddly, this also includes the development of ‘e-commerce’ for seniors.The language is also interesting and very careful–“The country’s population also features a large number of elderly people who are disabled and who are faced with empty nests and poverty” and a similar to the West shortage of carers. (more…)

Aetna may ‘buy into’ more analytics, digital health

Rumors now mainstreamed into press surround Aetna’s apparent interest in fellow insurers Humana and Cigna. Forbes last Friday started the ball rolling with an article last Friday focusing on the main event driving insurance payer consolidation: the transition of Medicare from fee-for-service to value-based bundled payments and accountable care organization (ACO) models. Humana has substantial Medicare business and a foot in home care (SeniorBridge), but has innovated in digital health: partnerships (Healthsense, TTA 20 Dec 13), purchases (what remained of Healthrageous, TTA 16 Oct 13), employee wellness (Vitality) and app development. Cigna is a major insurer with corporate business, but has struggled a bit in the digital health arena with the flashy-but-flopped patient engagement platform GoYou. It’s piloted telehealth to reduce readmissions with Care Innovations [TTA 7 Oct 14]  and Coach by Cigna, a mobile health platform in conjunction with Samsung for the Galaxy S5 and S6 phones.

Aetna has had some success with working with ACOs, with 62 contracts covering about 1 million lives, but this Editor counts over 400 practice-based ACOs in the Medicare Shared Savings incentive program alone. Their experiment in consumer app aggregation, CarePass, came to a quiet end last August and Healthagen, their ’emerging businesses’ unit, has had some swerves in rationale including iTriage and even ActiveHealth Management, their long-time population health analytics arm. While digital health is part of it (see Mobihealthnews), (more…)

Do startups truly threaten the ‘healthcare establishment’?

Or are successful startups fitting into their game? Chris Seper in MedCityNews paints the picture of one side of a quandary. The ‘healthcare establishment’ fundamentally and to its detriment does not understand and is threatened by the startup and innovation process. A startup may begin with an idea which is, in his words, ‘almost always flawed, sometimes deeply’. If the founders are smart, they will test their ideas, validate them and change them appropriately. If not, they will fail. But it is easier for the Establishment to point at the most egregious of the bad ideas and use them to rationalize the status quo.

But being congenital contrarians, we paint the house on the other side of the street. Has the Establishment caught up with–or in some cases, co-opted startups, making them and their funders ‘do their diligence’ and be more cautious before emerging? This Editor would argue yes, and largely for the better.

**The ‘Wild West’ days are over. A few years ago, a truly bad or deeply flawed health tech idea or could easily find funding, because it was all blank slate, new and ‘transformative’.The sexiest hooks were Quantified Self, sleep, employer health incentives, interactive coaching, genomics, app prescribing and (last) wearables. A lot of founders imagined themselves as the Steve Jobs of Healthcare, down to the black turtleneck. Now there is a history of success and failure. The railroads reached the dusty frontier towns.

**There’s now a ‘Startup Establishment’. National accelerators (more…)

After a long absence, a What the Blue Blazes award…or is that two?

blue-blazesThough recently threatened, the Telehealth & Telecare Aware What the Blue Blazes award has not been presented for some while, so it was kind of PC Magazine to draw our attention to an AT&T Innovation Day special of a Connected Car Seat that texts the car’s owners if it detects a child has been left in the car when the car temperature exceeds a pre-set level. When this editor’s two daughters were babies, leaving a dog in a car on a hot day was considered unacceptable, let alone a child, so to introduce a facility that may notify car owners of children at risk of overheating would seem to be the ultimate in irresponsible encouragement (most text messaging services of course guarantee neither delivery, nor maximum elapsed time to delivery, even if a parent happens to have their phone handy, & it’s switched on, & not on silent).

Now if the car was to persist in blowing its horn if it detected a car owner trying to leave a baby alone still strapped in the car on a warm day, or automatically phoned the police to report an overheating child left alone in a car, that might make more sense. (In Europe, the latter option – calling the police – couldn’t be simpler, as an add-on to eCall, the new automatic car emergency service being introduced across Member States in the next two years.)

Meanwhile in Jordan, a woman recovering from a caesarian section operation on April 24th, troubled by persistent vibrations in her womb (more…)

Indian Health adopting telemedicine in Southern California for diabetes treatment

Tribal-owned Riverside-San Bernardino County Indian Health, which serves nine tribes through seven health centers in the ‘Inland Empire’ of California, is adopting telemedicine to reach Native American patients and reduce their rate of diabetes. According to an Indian Health spokesperson, Native Americans constitute the largest diabetic population in the world and are 177 percent more likely to die from the disease. In San Bernardino County alone, 13 percent of adults are diabetic, and nearly 80 percent are overweight or obese. The initial program brought endocrinologists serving other Western tribes in on video consults with doctors in Indian Health clinics. Later rollout of the program will include pulmonology, cardiology, gerontology and dermatology. The market potential for telehealth remote patient monitoring–better information and analytics for clinicians, self-monitoring training and education for patients–could be substantial here for companies willing to invest time, learning and to build relationships. California Healthline. FierceHealth IT