Tracking ER ‘frequent flyers’ community-wide to coordinate care, reduce readmissions

“There are folks who have a life of going from emergency department to emergency department, and that’s how their day is spent,” said Sorrell, an emergency physician and administrator at Sutter Health. “It’s sad and tragic, but that’s what happens.”

Alameda County,  just south of San Francisco, spans both wealth (Berkeley)- and poverty-stricken (Oakland) – parts of California. What it has a lot of as well are ER (ED) ‘frequent flyers’ a/k/a ‘super-users’. Some can’t manage their chronic conditions, while others are looking for a meal, a warm bed, safety or human contact. What is also true is that 1) this is an expensive and largely unnecessary form of medicine and social care, 2) there’s a lot of duplicated resources being utilized which are needed elsewhere and 3) the patients aren’t receiving the right sort of care for a better quality of life.

Since a data sharing program, PreManageED, was implemented on 31 March in four Sutter Health hospitals and two Alameda Health System hospitals, two hospitals found that they shared more than 2,000 patients, with over one-third having 6+ visits to the ER in the past year. But this is more than duplicate procedures, multiple EMS calls and badly coordinated care resulting in Medicare or Medicaid penalties. The Alameda hospitals are also integrating local community clinics and social services organizations into PreManageED so they receive alerts from the hospitals when their patients/clients arrive in the ER. It turns out that many patients are receiving social services from multiple agencies–also duplicated and uncoordinated. There is an example here of a mentally ill patient who visited ERs over 900 times in three years. Over 24 separate people had provided her with medical, emergency and social services–and none of them knew what the other was doing. The Alameda County program is a step to bring these ‘frequent flyers’ down to earth and improve their outcomes. Kaiser Health News

A busy Nokia, Withings to partner with HUS/Helsinki University neurology center (FI)

Nokia Technologies, wasting no time with deploying its latest acquisition Withings, announced a new partnership with Finland’s largest neurology and leading stroke center at HUS/Helsinki University Hospital and University of Helsinki. Withings devices will be used to develop home-based remote monitoring platforms for HUS. This marks Nokia/Withings move into clinical-level monitoring from its present base in wellness devices. HUS is a five-hospital system centered on Helsinki University Hospital. Its Department of Neurology treats 14,000 patients each year at the Meilahti Hospital Neurological Outpatient Clinic, and specializes in the diagnosis, treatment and rehabilitation of diseases of the nervous system or the brain, spinal cord, peripheral nervous system and muscles. Nokia release  mHealth Intelligence

Nokia is on a roll, closing on the Withings acquisition 31 May and opening up a headquarters in San Francisco for their Digital Health business unit led by Cédric Hutchings, the former Withings CEO. A week later, they announced the Withings Body Cardio which measures in seconds weight, BMI, body composition (fat, muscle, water and bone mass), standing heart rate and PWV — a measurement that is a key indicator of cardiac health and associated with hypertension and risks of cardiovascular incidents. It will be sold only on Withings.com and Apple Stores worldwide, priced at $179.95. In early June, Nokia announced the 4th annual Open Innovation Challenge focusing on the Internet of Things (IoT) for public safety, connected automotive, industry 4.0, digital health, utilities, security and smart cities. Submissions close 15 August. The Nokia Growth Fund has a $350 million piggybank for IoT investment (and we hope secure IoT).

Nokia is also proceeding with the full acquisition of Alcatel-Lucent, establishing a 5G network  and licensing its brand name to HMD for mobile phones.

Forbes also has a fairly long disquisition on why Nokia is moving into healthcare, citing PWC’s 2014 forecast of a $ 2.8 trillion US “new health economy” in the next ten years. But our Readers saw it here first in October and April!

2016 International Conference on Successes and Failures in Telehealth (NZ)

31 Oct-3 Nov 2016, SKYCITY Convention Centre, Auckland New Zealand

click to enlargeHurry if you want to submit your abstract! The 7th Annual Meeting of the Australasian Telehealth Society (SFT-16) is actually a 4-in-one conference, held concurrently with the Global Telehealth Conference (GT 2016), the Health Informatics New Zealand Conference (HiNZ 2016), and the NZ Nursing Informatics Conference (NZNIC-16). Delegates register for one, and can attend any session in the four conferences. Topics for SFT-16 include telehealth in Australia and New Zealand, the future of clinical telehealth, the telehealth business and the state of evidence. Abstracts in the categories of scientific papers and case studies are still being accepted through Monday 4 July midnight NZ time, and according to HiNZ’s Twitter feed, extensions are available by emailing ceo@hinz.org.nz . It’s also supported by organizations including American Telemedicine Association (ATA, a TTA media partner), the University of Queensland and the International Society for Telemedicine and e-Health (ISfTeH). Registration appears not to be up yet. Website

Telemedicine finally gets some respect: WSJ

click to enlargeTelemedicine consults between doctors and with their patients are, at long last, progressing on the Long And Winding Road, according to this sizable recap in the Life and Health section of this weekend’s Wall Street Journal. The focus is on virtual visit growth in the US, but it opens with Doctors Without Borders (MSF) connecting their doctors in Africa with their specialist network worldwide. Mercy Health provides 24/7 ICU/ER support for 38 local hospitals out of a Virtual Care Center outside St. Louis manned by ICU specialists. Their results? A 35 percent decrease in patients’ average length of stay and 30 percent fewer deaths than anticipated. The important statistics here are on acceptance: 72 percent of hospitals and 52 percent of practices are finally integrating some form of telemedicine into care; 74 percent of large employers are covering telemedicine cost–yet awareness is still lagging among prospective patients, with only 39 percent familiar with it according to a recent survey. Challenges remain in reimbursement (more…)

Events last week beyond Brexit: London Technology Week, CE Week NYC

The world may have turned upside down (and around) with Brexit, but London Technology Week happened nevertheless. It’s exploded into 400 events and 43,000 attendees, with 300 attending an event at London City Hall on health tech within the NHS. (Attendees invited to contribute in Comments.) Designer Brooke Roberts, an ex-NHS radiographer who advocates the fusion of fashion and tech, debuted her brain scan-inspired knitwear, accomplished by translating scans into digital files capable of programming industrial knitting machines. According to GP Bullhound in their annual European Unicorns report, 18 of Europe’s 47 billion-dollar digital startups are now based in the UK. So who needs the EU?  TechCityNews, CNN, Yahoo Tech

click to enlargeOn the other side of the Atlantic, there was a disappointing absence of wearables and health tech at the Consumer Electronics Association’s NYC summer event, CE Week. It’s been a major feature since 2009 at International CES in January; the NYC summer show and the November CES preview had always featured a mostly local exhibitor contingent and conference content. None this year–a representative cited a mystifying ‘change in direction’. There was one lone wearable way back in the exhibit hall–MonBaby, which came in from 16 blocks uptown. The snap-on button monitor works with any garment (unlike the Mimo onesie and the Owlet sock) (more…)

Data breach cost crests $4 million: Ponemon Institute

click to enlargeThe average fully allocated cost of a data breach, according to the 2016 Ponemon Institute study (sponsored by IBM) is now over $4 million. The average global cost of every lost or stolen record is $158, but for healthcare organizations, that average cost is $355 per record, which reflects the higher street value of healthcare information. Healthcare was the second most ‘churned’ type of organization, surpassed only by financial services. Across the industries surveyed, hacking and ‘inside jobs’ caused the most data breaches overall–48 percent. (Hackermania does really run wild!) Healthcare organizations can mitigate costs by being proactive in detecting breaches early, having a CISO (chief information security officer), instituting employee training and awareness programs, deploying encryption and endpoint security plus a business continuity management plan. Ponemon/IBM website. Healthcare IT News

Threat hunting is also emphasized in a second Ponemon study sponsored by Raytheon, which recommended offensively hunting down threats to data security, and defensively setting up a security barrier to protect patient data and care systems. With nation-state attacks (think China and Russia), ransomware, compromises due to IoT (add outdated software), and physical data theft, the game is now complete control rather than plain ol’ disruption. After the attack, when most healthcare organizations finally get into gear on cyberthreats, is far too late. Ponemon/Raytheon ‘Don’t Wait’. Healthcare IT News

The healthcare future according to Britons before London Technology Week

click to enlargeMore robots than people, VR visits to the GP and 3D printed human organs were among the predictions in a survey of over 2,000 British adults. Also in their collective vision in the next 20 years (2036) were communications devices being embedded inside the human body (37 percent), a cloned human born by that year (50 percent), clothing connected to the internet (50 percent) and more driverless cars than conventional models. The study was conducted by SMG Insight and YouGov, commissioned by London & Partners, the Mayor of London’s promotional company, in the runup to London Technology Week through 26 June, highlighting London as a global technology hub. According to their release, an EY report ranked London as second only to Silicon Valley as the most likely place to produce the world’s next tech giant. The event also promotes Imperial College London’s Foresight team and their Tech Foresight 2036 on 24 June.  Also ITPro.

Robot greeter on the job at Ostend, Belgium hospital–and those killer robots

click to enlargeThis humanoid (but not Terminator-like, its developers are careful to say!) robot is currently on the job as a receptionist at Ostend, Belgium hospital AZ Damiaan. Equipped with healthcare-oriented software developed by local company Zora Robotics, the Aldebaran/SoftBank Robotics’ demure Pepper robot stands 1.2 meters (just under 4 feet), speaks 19 languages and works for about 20 hours on a single charge. Pepper communicates via its tablet interface but also is responsive to actions and emotions in what SoftBank calls a natural and intuitive way. The Pepper robot was first deployed in the hospital’s maternity area. The video has an awwwww…. illustration of a newborn grasping Pepper’s fingers. Previously, the toddler sized Nao robot worked with patients at AZ Damiaan for physical therapy. (Nao robots have also been featured in modern dance and as greeters at Japanese hotels and banks.) Reuters (video 1:51)

click to enlargeThis is a far more benign take on robots than the Daily Mail‘s recent screamer that “Killer robots are ‘quickly moving toward reality’ and humanity only has a YEAR to ban them” which conflates drone weaponry (human guided) with ground robots (human guided). As of now, They’re Still Puppets (more…)

Unintended consequences: American Well loses, loses patent, to Teladoc

On Tuesday, the Federal District Court of Massachusetts not only dismissed the American Well patent infringement lawsuit against Teladoc, but also invalidated American Well‘s patent, held by co-founder Dr. Roy Schoenberg since 2009. It was invalidated on the grounds that the claims in the patent were “too abstract” to be patentable and do not “amount to an inventive concept.” American Well is appealing the court decision.

Teladoc started this call-and-response in March 2015 by petitioning the USPTO (US Patent and Trademark Office) to invalidate several American Well patents. (AW claims to hold 28 patents and 22 pending applications). Shortly before Teladoc’s IPO on the New York Stock Exchange last June, American Well sued Teladoc on patent infringement. Those in the industry saw an effort to scupper the IPO. Our Editor Chrys at the time took a decidedly jaundiced view of American Well’s grounds for infringement:
This author is wondering who thought this was such a novel technology as to warrant a patent? What were they thinking? Having worked on developing unified messaging systems for a mobile phone operator at the turn of the century (now that’s a scary 15 years ago) I am just picking myself off the floor after reading this.
Surely all these functions are no more than what is in every instant messaging program, dating back to 1990s? Replace the words “medical service provider” by “friends” or “contacts” and “consultation” by “chat” or “call” it seems to me you get … Skype and Face Time and more! [TTA 9 June 15]
No matter, the result was yesterday’s double shot of a decision. In addition, three Teladoc complaints against American Well‘s patents to invalidate them are still in progress with the USPTO. A triple, anyone? MedCityNews, Teladoc press release, American Well press release
All this is despite the sobering facts that telemedicine has been unprofitable to date–and that IP wars have unintended consequences. (more…)

Your weekly robot fix: ingestible robot fetches swallowed button batteries, more

click to enlargeA research team drawn from MIT, the University of Sheffield and the Tokyo Institute of Technology has developed an ‘origami’ robot to aid in the location and fetching the result of a common and potentially fatal incident–swallowed button batteries or other foreign objects. The robot is swallowed in a capsule which dissolves. It then unfolds its dried pig intestine appendages and is directed by external magnetic fields towards the battery, attaches to it and safely moves through the digestive system. Another potential use is to patch wounds or deliver medicine to a specific location. Unlike other robots, it is untethered and moves freely, propelling itself through a ‘stick-slip’ motion, and is resistant to acidic gastric fluids. Next steps for the team are to equip it with sensors and to perform animal and human in vivo testing. ZDNet

Nosocomial hospital infections may also get a good zapping by disinfecting robots. In an 18 month test at Lowell (Massachusetts) General Hospital, robots with pulsing xenon high-dose ultraviolet light from Xenex Disinfection Services disinfected the Lowell Hospital ORs nightly in addition to routine chemical disinfection. The study estimated that they avoided an estimated 23 infections at a cost savings of one life and $478,000. MedCityNews.

Robotics in healthcare will also be part of the five tracks centered on informatics available to attendees of HEALTHINFO 2016, August 21 – 25, 2016 in Rome’s H10 ROMA CITTA,  organized by IARIA (International Academy, Research, and Industry Association). More information here.

And if you wonder if humans will be able to find work when robots take over everything (maybe we just go to conferences and have a guaranteed income?), take comfort (or not) in this interview with one of the two authors of Only Humans Need Apply: Winners and Losers in the Age of Smart Machines, a new book by Thomas Hayes Davenport and Julia Kirby. “One is to work alongside smart machines, and complement their activity. The other is to dip into what smart machines are unlikely to be able to do any time soon.” The emphasis on STEM education may be misplaced as many of these jobs will be replaced by AI. In healthcare, they predict that automation will displace specialists and empower GPs, leaving room for ultra specialization in combinations not thought of today. Robots beware: Humans will still be bosses of machines (TechRepublic)

The difficulty in differentiating telemedicine and telehealth

Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.

Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence

Unhappy endings? HealthSpot’s remains to Rite Aid, Theranos’ story to Hollywood

HealthSpot Station’s assets to Rite Aid, minus the ‘froth’. On Monday, drug store chain Rite Aid won the US Bankruptcy Court in Columbus, Ohio’s mandated auction for the inventory, most assets and IP for its entry bid of $1.15 million. According to Columbus Business First (subscription only), a touted second bid by a central Ohio investor group was $1 million–and stayed right there with no second bid. This group had invested $650,000 before HealthSpot entered Chapter 7. A dark horse third bidder, which came in at the last minute, never put money on the line.

The Ohio business group leader, local assisted living facility owner Paul Gross, interestingly maintained his faith in the kiosk concept to Columbus Business First in an earlier interview, rapping the prior management for squandering approximately $47 million (more, given Xerox‘s never-disclosed investment) on office furniture, lavish executive salaries and misbegotten marketing (quoted in MedCityNews). 25 of the kiosks were in Rite Aid locations in Ohio and others with Cleveland Clinic, but there are 137 still ‘in the box’. Perhaps ‘misbegotten’ should be applied to the concept (kiosks too big, expensive) and not the marketing communications, which in this Editor’s professional judgment were strong and appealing, but ran into the ‘lipstick on a pig’ wall.

One wonders what Rite Aid, in the throes of its own difficult merger with Walgreen Boots Alliance, will do with the assets. TTA’s earlier stories on HealthSpot.

Theranos the Movie, starring Jennifer Lawrence. Co-starring Walgreens? ‘Hunger Games’ star Jennifer Lawrence has reportedly agreed to star in ‘The Big Short’ director Adam McKay’s adaptation of the story. (Fortune) Certainly there is a resemblance to CEO Elizabeth Holmes Frogeyed Sprite (‘Bugeyed’ to us Yanks–Ed.) crossed with Steve Jobs. Ms Lawrence has already played a young, aggressive, come-from-nada inventor of household gadgets in ‘Joy’. The Theranos story is appearing to be the ‘Joy’ story in reverse. Suggested title: ‘The Royal Scam’? (credit Steely Dan, circa 1974). ‘Less Than Zero’ (Bret Easton Ellis) is taken, now describing Ms Holmes’ net worth according to Forbes.

Mr McKay will be ripping from the headlines in progress, should the movie actually be made. (more…)

Philips publishes new report on connected tech

click to enlargeA report published by Philips today claims that 78% of healthcare professionals believe their patients need to take a more active role in managing their health while 20% of UK patients admit to not managing their health, according to a press release. The report suggests that the result of people not paying attention to their health is increased illnesses (or “lifestyle related conditions” as the report calls them) such as heart failure and type 2 diabetes. The report then goes on to suggest that the use of “connected technology” to help manage their health should be made mandatory for some patients. Connected technology is defined as technology that enables sharing of information throughout all parts of the health system (e.g. doctors, nurses, community nurses, patients, hospitals, specialists, insurers and government) that can range from computer software that allows secure communication between doctors and hospitals, to a watch that tracks a person’s heartbeat. However, the connected technology in a case study highlighted in the press release is home based monitoring systems supplied by Philips for a classic UK telehealth trial for COPD, diabetes and heart failure.

Philips say they commissioned the Future Health Index (FHI) report to globally gauge (more…)

Tunstall’s Innovation Centre virtual tour

click to enlargeTunstall Healthcare Group’s release for 1 June’s Telecare Awareness Day was a virtual tour of their Innovation Centre physically located at their Whitley, Yorkshire head office. It’s divided into five TECS-related ‘zones’: integrated care, connected home, development room, app bar and workshop. There are explanatory comments below, which help because the virtual tour has a measure of clunkiness. The marketing purpose of the Innovation Centre? It “provides a unique, dedicated space to define the challenge and help accelerate the development and design process to evolve the next generation of digital connected healthcare, create new innovations and service models that genuinely meet the needs of commissioners and consumers.” (Whew!) It’s also kind of a cool space to get feedback from customers, users and partners, which this Editor suspects is the real reason why it was developed. But overall, both the Centre and the virtual tour are good ‘showcase’ ideas that demonstrate both product and thought leadership.

Worthing MarketPlace Wednesday 8th June 2016 (UK)

click to enlargeFresh from last week’s National Telecare Awareness Day on 1 June, UK Telehealthcare is sponsoring a bonus MarketPlace today (8 June) in conjunction with the West Sussex County Council at the Charmandian in Worthing, West Sussex. 36 companies including Tynetec, CAIR, Doro, Tunstall and others we mention are listed for five hours of exhibition and activities starting at 10 am. UK Telehealthcare information and flyer at left above.

Chris Lewis – the hyper-connected individual meets the healthcare system (guest blog)

Chris Lewis, a world-renowned telecoms expert and regular presenter on disability issues has kindly offered to share some further thoughts with readers. 

At the Great Telco Debate last year, one of the biggest laughs was when my co-host Graham Wilde was attacked for buying his wife a FitBit, implying she needed to lose weight! The success of these so-called health tracking devices, and their associated apps, is an indication of how wearables, combined with smart phones and tablets, are beginning to change our behaviour and our lives.

Outside the healthcare industry, these devices with their life-changing outputs are seen as wondrous. However, inside the healthcare sector, they are often dismissed as being toys providing inaccurate and misleading information.

The consumer electronics industry, with its dynamic gadget crazy geeks, coming up against the established healthcare profession, with its hospitals and insurance organisations, represents a key battleground for us all. Regulation in the medical area is rife, and so it should be. Consumer electronics is a considerably more liberal environment. So we have the challenge of making money and identifying new markets on the one hand, whilst accurately treating people with illness and disabilities on the other.

In previous articles (and here(more…)