Billy & Lisa Graham, killed in Tunisia last Friday

So often when you read of dreadful things happening, it is easy to make light because there is no personal connection.

It is therefore with particular sadness that we have to report the untimely deaths of both Billy Graham and his wife Lisa in the shooting in Tunisia last Friday.

Billy was well loved and respected in the industry, working in Scotland as Business Development Manager for Tynetec, and previously with Chubb. As such, even if readers did not know him personally, there is a high probability that they will have attended many conferences and exhibitions where he was also present.

Telehealth & Telecare Aware sends our deepest condolences to the Graham family and friends.

“The data security fault, dear Brutus, is not China, but in the company org chart”

click to enlargeMansur Habib, PhD and cybersecurity strategist, formerly CIO for the Baltimore City Health Department, proposes that any data breach analysis should start first with a hard look at the organizational chart. If the CIO or the chief information security officer (CISO) doesn’t report directly to the CEO, the executive clearly does not place priority on IT and data security, treating it as a cost center to be restricted; in his words, they do not ’embrace cybersecurity risk as business risk’. In his 2013 doctoral research in 2013 and subsequently, Dr Habib observed that about half of US HIT and cybersecurity heads report to the chief financial officer (CFO) or some other executive like a CAO (administrative). His withering take on most CEOs are that they are more concerned with stock price (more…)

Seven safeguards for your mHealth app

With cyberattacks from all sources on the rise, and mHealth apps being used by providers in care coordination, telehealth, patient engagement and PHRs, Practice Unite, which has some experience in this area through designing customized app platforms for healthcare organizations’ patient and clinician communications, in its blog notes seven points for developers to keep in mind:

1. Access control– unique IDs assigned to each user, remote wiping of the mHealth app from any user’s device.
2. Audit controls
3. Authentication
4. Integrity controls, such as compartmentalization, to ensure that electronically transmitted PHI is not prematurely altered or corrupted
5. Transmission security: data encryption at rest, in transit, and on independently secured servers protects PHI at each stage of transmission
6. Third party app integration–must fully comply with HIPAA safeguards
7. Proprietary data encryption

But all seven points need backing from the top on down in a healthcare organization. (More in the article above)

Digital agenda items: past and future

There’s much to learn about future digital trends from an analysis of what’s happening in South Korea. For this, the Korea Communications Report provides fascinating reading. For example, the bar charts on page 56 (yes it is worth scrolling that far) demonstrate the huge surge in video usage towards hte end of last year as 4G became established. As Prof Mike Short (for whom I am grateful for this and other pointers in this post) commented “It may prompt some ideas about Broadband and higher speed Mobile could help in Healthcare – eg the Dr will see you now”.

Another really interesting resource is the EU’s Digital Agenda Scoreboard 2015: Strengthening the European Digital Economy and Society which enables you to explore all sorts of statistics about European life, and then visualise it in a variety of different ways. It will be a real help for those ‘scene setter’ slides at the start of a presentation. Highly recommended.

Another interesting pointer was the FT which had a major supplement on digital health (more…)

Apps, apps, apps – health, care, wellbeing: must-reads for developers

Last week we covered two calls for health & care app developers: the ADASS apps event, which is looking for apps presenters, and PatientView which is looking for developers’ feedback on what they need when developing health & wellbeing apps; today we focus on medical app news.

PatientView has just released the results of their previous survey entitled “What do patients and carers need in health apps – but are not getting?” This analyses the views of 1,130 patient and carer groups worldwide. The needs and challenges raised were then discussed in a multi-stakeholder meeting held to help define concepts for new apps that address patient and carer unmet real needs. An essential read for health & care apps developers.

Staying just a little longer on statistics, the CTIA resource library has some interesting primarily US-oriented items including a recent item entitled “One in Five US Consumers Use Mobile Apps for Exercise Tracking”.

As many will be aware, this editor has argued for 18 months now in these columns (& elsewhere) for an official approval process for medical apps that includes a measure of efficacy, so they can be compared, where appropriate, with other forms of intervention such as drugs (in the case of treatment for depression, anxiety and pain relief). Workstream 1.2 of the National Information Board has now published their roadmap (disclosure: this editor is on the Advisory Board of 1.2 and two others) which describes how they plan to tackle this topic.

At the same time MIT has now announced the establishment of the Hacking Medicine Institute. This will assess whether digital health products and services really work and, if they do, help them to prove their efficacy to consumers, doctors, and insurers, possibly introducing a little competition which should speed things up nicely. (For a more detailed review of the workstreams including DHACA’s involvement, go to the DHACA website blog – you will need to become a member if you aren’t already, however it’s free).

The Australians have also just produced the MARS (Mobile App Rating Scale) for ranking medical apps. They conclude that: (more…)

Two-thirds of US insured not interested in payer health apps: survey

A survey of over 1,200 insured (individual and employer plans) sponsored by research firm HealthMine and conducted by Survey Sampling International shows that only 30 percent of this group would participate in a payer-provided mobile app, despite 89 percent using a smartphone and/or tablet. Even worse, only 18 percent liked to learn health, wellness, and lifestyle information from a mobile app. It demonstrates that current apps are not compelling or engaging–and the huge paradox of payers make them less, not more, attractive. Perhaps this Editor goes out on a limb, but US insurers have a trust problem on multiple levels (as claim deniers, as impossible to deal with); apps they provide are perceived as capturing information an individual doesn’t really want them to see. Overall, users are not using their smartphones for health reference at all–well below 20 percent. The leading use is for tracking fitness (21 percent) and calorie counting (16 percent). Is it that real research on health is the province of the desktop PC, where it’s easier to find and read? They also aren’t using mobile to find their doctors, despite all the hype from ZocDoc and Vitals: 8 percent had used a doctor finder app in the past six months. Mobihealthnews, HealthITOutcomes

Google X develops health tracker–for research and clinical trials only

And it’s not for sale. The life sciences group within Google X is testing on small groups a wrist-worn device which can sense with high accuracy pulse, heart rhythm, skin temperature and environmental information like light exposure and noise levels. Bloomberg News, which appears to have broken the story, quotes Andy Conrad, head of the life sciences team at Google: “Our intended use is for this to become a medical device that’s prescribed to patients or used for clinical trials.” Obviously it will be more accurate both in hardware and in back end algorithms than what’s currently marketed via Android Wear for smartwatches. Perhaps this is meant for the ‘superusers’ of healthcare services at the top 5 percent using 50 percent of spend, the new ‘It Girls’ of healthcare, TTA 28 May)? However, he’s also projecting out 20-30 years, so health systems and researchers, do not hold your breath waiting for this to become reality. (This is also a counter to Apple’s ResearchKit.) Also Yahoo Finance and The Verge, which has a gigantic photo of a smartwatch but no caption attribution. The Verge also mentions their research in MS. Gizmodo also adds that Mr Conrad is directing the Google X Baseline project, which is doing human testing and crunching data to develop a baseline of normal human health.

More about Google X in this video interview on Tested with Astro Teller (for real), ‘captain of moonshots’ for the company, on ‘thinking big and failing quickly’. (24 minutes)

Michigan school telehealth programme wins award

At the start of last year we reported the opening of a student telehealth programme in Michigan. click to enlargeAt the time two clinics were opened in Branch County with the aid of funding from the Michigan Department of Community Health. A school based nurse funded by the programme provides the initial assessment and where necessary a consultation takes place with a physician or nurse practitioner at the Community Health Centre. The school has special assessment equipment that links via Bluetooth to equipment in the paediatric clinic so that the provider can see and hear what the nurse sees and hears.

Eighteen months on, the programme is covering two thousand and seven hundred students in three school districts and has been awarded one of four annual Ludwig Community Benefit Awards from the Michigan Health and Hospital Association according to a WTVB report. The award is presented to healthcare organizations that demonstrate community benefit by improving the health and well-being of their communities through healthcare, economic or social initiatives.

The pileup of Federal ‘titanic serial IT disasters’ (US)

click to enlargeDon’t feel bad, HIT execs–the Feds are even worse. Complementary to our coverage of the increased danger of hacked health IT systems and data breaches (the trail of tears is here and here) is the oddly muted press clamor around the 4 June hacking report of the Federal Office of Personnel Management (OPM). Chinese hackers roamed around two OPM databases–personnel and security clearances–for nearly a year, according to CNN’s Senate briefing coverage. The breach likely exceeded 18 million records, though the real number may never be known. Privacy Rights Clearinghouse summarizes it and provides an interesting link to a timeline by Brian Krebs, whose independent reporting beat is IT security. Megan McArdle, a reformed IT consultant writing for Bloomberg News and independently, points at the Federal lack of urgency around having adequate IT that doesn’t fail. Example–the much chronicled failure around Healthcare.gov and the so-called health exchanges, which appear to be functioning better, but reports say they are nearly porous and hackable as they were in 2013. She notes that it’s all about ‘scorched-earth determination’ and that the direction has to come from the top, meaning the President. And ‘voters have never held Obama responsible for his administration’s appalling IT record’. A thought that should give those in telehealth and telemedicine who are working with CMS value-based program ACOs a great deal of pause. NY Post editorial via Press Reader.

Call for app presenters at the ADASS Care Apps Showcase 2015 – Monday 19 October 2015

This social care-oriented event takes place at the Carriageworks Theatre, 3 Millennium Square, Leeds, West Yorkshire LS2 3AD.

This is a unique opportunity to present to key decision-makers, funders and influencers in the adult social care sector. About 200 people in one room will be waiting to be impressed by your app to help people with social care needs and their carers. These people will be in a position to recommend or directly commission such apps (and related services). The core part of the day will be a series of 5 minute pop-up pitches to the plenary audience. Delegates will then vote with their feet to hear a more detailed presentation and take part in Q&A discussion in a break-out room.

In short, it’s a unique opportunity to sell your offer and get immediate feedback from a key audience.

There are slots for just 11 presenters and there are hundreds of apps out there being deployed and developed. Therefore, there is a selection process that is fair and transparent.

‘Care apps’ included in this event fall broadly into two types:

a) Council-managed self-service applications, e.g. citizen portals to existing case management systems, e-marketplaces, online information & advice / triage, self assessment of needs & finance.
b) Consumer apps, e.g. for: sharing tasks between informal carers promoting community sharing or time-banking for people with care needs telecare for staff to use with carers / clients special user interfaces for the elderly to easily Skype, email, etc management of care finances monitoring wellbeing.

Both types of “app” might be combined with a service of some kind by you as app provider, e.g. a telephone support service.
Excluded: apps primarily designed to diagnose or monitor specific health conditions or any app that could be designated a medical device.

For full details on how to apply and the selection process are here.
All applications are to be sent to tina.gallagher@techuk.org by close of play on Tuesday 30 June.

Alternatively if you would like to attend as a delegate you can book online at the tech_UK website.

Calling all medical app developers – please help with “Guidance and Advice Most Needed by App Developers”

UK-based PatientView, and its sister organisation, myhealthapps.net, in conjunction with Germany-based Research2Guidance, and the App Quality Alliance, need your answers to a survey to help inform the creation of guidelines designed to improve the quality and focus of health, wellness, and disability apps. This will be be launched at the European Health Forum Gastein in October 2015, which is attended by hundreds of health policymakers as well healthcare industry representatives.

The survey opens with a handful of short, anonymous, profiling questions. It then moves quickly on to 14 questions about issues that are absolutely key to the developers of health, wellness, and disability apps.

The survey will probably take a maximum of 20 minutes to complete. The results will be anonymised. If you would like a copy of the collated survey results (which will include the views of respondents who are other healthcare stakeholders), please indicate your interest at the end of the survey.

To enter the survey, please do click on Guidance and Advice Most Needed by App Developers.

Many thanks, in anticipation.

Breaking news report: Charterhouse evaluating £700 m sale of Tunstall Healthcare (UPDATED)

Breaking News

click to enlargeReuters reports as an exclusive that its sources indicate that UK private equity firm Charterhouse is considering a sale of Tunstall Healthcare Group for a possible valuation of £700 m ($1.1 bn) or more. According to this report, Charterhouse is working with JP Morgan on an exploration for a Tunstall sale in late 2015 or 2016. All three companies declined to comment.

Today, Tunstall also announced their Connected Healthcare 2020 strategy with a £100 m investment over the next five years, which we reported only a few hours ago.

Tunstall has gone through multiple hands in the past ten years. Charterhouse bought Tunstall Group in 2008 for £514m from Bridgepoint Capital, which acquired it from Hg Capital in 2005 for £225 m.

An exit for Charterhouse has long been rumored in UK healthcare circles. In the dark before the Christmas 2014 holiday, Tunstall reported disappointing results for 2014 (close 30 Sept): a YOY £6 m drop in revenue and a £9.7 m drop in EBITDA.  [TTA 24 Dec 14] According to CompanyCheck, which posts financial reports for UK companies, Tunstall Group’s net worth as of that date exceeded a negative £1 bn–a steadily declining position since 2010, though with stronger cash and reduced liabilities (see Accounts page).

We’ll post updates as they’re available.

Update 25 June with some quotes from a Tunstall spokesperson from their ‘hometown paper’, the Yorkshire Post.

Tunstall invests £100 m in ‘Connected Healthcare 2020′ strategy

Tunstall Healthcare Group in UK outlined today their five-year public, global strategic vision, along with a fresh investment of £100 million during this timeframe (~£20 m per year) to transition their connected care systems over to IP and cloud technology. The initiative, dubbed Connected Healthcare 2020, is centered on:

  1. Leading the switch to IP infrastructure–transitioning away from analogue (analog) services and devices to connected digital and mobile (cellular, Wi-Fi, Bluetooth)
  2. Extending managed services–offering a wide variety of services end-to-end including full outsourcing
  3. Developing new consumer propositions through innovation–tapping into demand, often private pay, for high quality home care not provided by carers (caregivers)
  4. Developing new models of care in the home through integration–coordination of social care and healthcare

The Yorkshire Post article also points out, through their separate comments with CEO Paul Stobart, that prospective markets include developing nations with aging populations such as Mexico, South Korea and Turkey. Tunstall claims market leadership in UK, Germany, France, Spain, the Netherlands, Belgium, Sweden, Denmark, Finland and Australia, as well as fourth position in the US. The TECS (technology enabled care services) initiative will create about a dozen jobs per year at the Whitley HQ, adding to their present 650 there and their total globally of 3,500. Tunstall release

We wonder if in the US we will see more of Tunstall at events like the mHealth Summit. Tunstall Americas has a refreshed website and communications as ‘The voice of connected health’, is more strongly promoting their call/contact services and its HQ location in New York City. We’ve previously noted their recent home care acquisitions and partnership with QMedic.

Kickstarting the 1st week of summer: news from all over

No deal yet between insurer giants. Cigna turned down a $53.8 billion bid from Anthem. According to Healthcare Finance, concerns ranged from corporate governance problems, their membership in the Blue Cross Blue Shield Association, the probable chairman’s (from the Anthem side) qualifications and data security (ahem!). Given that Anthem’s 60 million record breach was an inadvertent inside job [TTA 11 Feb], the last is perfectly understandable. But the door appears to be open for the emollient of additional money (to mix a metaphor). Extra: a tart take on this from the WSJ…..Jaguar is looking to increase driving safety by reading your brain waves to detect if you are distracted or daydreaming, via sensors embedded into the steering wheel. It’s based on technology used by NASA and the US bobsled team. They are also working on mood enhancing lighting and a predictive system to speed your interactions with the dashboard to minimize eyes off the road. But will these detect if you feel good to be bad, as their adverts say? Gizmag….The FT gets into digital health via business, profiling startups such as Lyra Health, Genomics England and Heartflow, as well as 23andme and Google X (including the glucose-detecting contact lens we profiled 18 months ago. Hat tips to Eric Topol and David Doherty (mHealth Insight) via Twitter….The NY Times looks at the dark side of ‘senior independence’ with a group of NYC homebound seniors, but other than tut-tutting the desire of older mainly limited income New Yorkers to remain in familiar surroundings, our ‘national celebration of independence’ (!) and not to be institutionalized (their words), the article doesn’t offer much in the way of solutions. And solutions are badly needed for the nearly 2 million over 65 who rarely or never leave their homes, because not all of them will be in assisted living. Hat tip to Joseph Coughlin of MIT AgeLab via Twitter…. But in Australia, they’re exploring ‘future proofing’ and ‘dignity enabling’ homes for an aging population to make them more livable and accessible, via landscaped ramps, larger bathrooms, and sensor rich floors that connect to gait tracking and analysis. Smart Homes 2.0. Sydney Morning Herald…..Neil Versel over at his new MedCityNews stand reports on Doctor On Demand‘s test of tablet-based medical kiosks adjacent to the pharmacy department at four Wegman’s grocery stores here in the Northeast. Is Weis Market far behind?….And Fitbit has a bit part in ‘Law and Order’…well, not the TV show in perpetual reruns, but in a real-life case in Lancaster County, Pennsylvania which is not all Amish farms, black carriages and the so-called Amish Mafia. The police used Fitbit activity data to determine that a local resident (and Fitbit wearer), who claimed she was raped by a stranger, staged the crime scene with overturned furniture, a knife, and a bottle of vodka in her home. ABC27 News via David Lee Scher.

Guilt and money: the manipulative side of fitness tracking

Show me the money! The bottom line of fitness apps can now be cash rewards, much like many credit cards. There’s FitCoins that exchange into bitcoins, the digital currency much in the news and recognized by some legitimate (and non legitimate) retailers; Pact which makes you invest in your goals with a pool of others, rewarding you if you make them, deducting from your account if you do not; GOODcoins which rewards you only with ‘positive things’ (no chocolate or anything that contributes to, say, global warming). But after all, you should only bask in the glow of doing GoodThings for yourself, eh? Getting paid to stay fit (Ozy)

But then there’s always guilt. Fitness tracking is on the way of becoming so omnipresent that it becomes a part of you. Beyond the wrist, fitness clothes, implants and digital tattoos or bandages will be tattling (via your smartphone or directly) on your vital signs, activity and weight gain from too much to eat at dinner. On one hand this can be a good thing in shaping behavior. A study by two researchers associated with University College London and Ashfield Business School, Berkhamsted found many positives in Fitbits shaping female wearers’ behaviors, with 76 percent self-reporting healthier eating habits (more…)

Breaking news confirmed: Bosch exiting healthcare and telehealth in US–UPDATED

Breaking News–UPDATED with Bosch response

Bosch has confirmed they are closing their telehealth business in the US. Please see their statement at the end of this article.

A home care industry newsletter, along with our own reliable industry sources, have confirmed the recent industry discussion that Bosch Healthcare, since January a solely US operation, is winding down its business without a definite turnover to a buyer. This Editor, in calling various departments in their Palo Alto, California offices for confirmation on Thursday, was (when she reached a human being) forwarded to HR where she could leave only voice mail. An email to marketing also received no response. All sources indicate that staff layoffs took place last Monday.

Editor’s Note: Bosch’s official press response follows this article. We have also made certain corrections to this article (see in red).

  1. The Home Care Technology Report, published by industry consultant Tim Rowan, on Wednesday posted two articles stating that Bosch laid off nearly all of its staff on Monday (15 June) save for customer service and some key operating areas. His information indicated that Health Buddy sales–new and existing orders–have been terminated. This includes orders placed through its McKesson partnership. Non-VA service will be terminated in 60 to 90 days.
  2. Home Care Technology also reported that Bosch’s business with the Veterans Health Administration (VA) will be maintained through April 2016, which is near to the contract end in May, but no new units will be delivered. The original contract was with Health Buddy hub developer Health Hero Network, sold to Bosch in 2008With the later acquisition of ViTel Net, Bosch developed into one of the two leading VA Home Telehealth remote monitoring hub suppliers–the other being Cardiocom. VA Home Telehealth is the largest telehealth program in the US with over 156,000 patients (Federal Year 2014) (Ed. Note: VA has a third authorized and active VA supplier, Viterion).

As Mr Rowan did, this Editor will speculate on the reasons why there is this reported exit without a sale or spinoff, despite the substantial VA and other healthcare placements of Health Buddy. Our take is somewhat different than his: (more…)