Remember the Quantified Selfer’s fascination with sleep tracking and all those sleep-specific devices that went away, taking their investors’ millions with them? Fitbit and many smartwatches work with apps to give the wearer feedback on their sleep hygiene, but the devices and apps themselves can deliver faulty information. This is according to a study published in the Journal of Clinical Sleep Medicine called “Orthosomnia: Are Some Patients Taking the Quantified Self Too Far?” (abstract) by Kelly Glazer Baron, MD with researchers from the Feinberg School of Medicine at Northwestern University. “The patients’ inferred correlation between sleep tracker data and daytime fatigue may become a perfectionistic quest for the ideal sleep in order to optimize daytime function. To the patients, sleep tracker data often feels more consistent with their experience of sleep than validated techniques, such as polysomnography or actigraphy.” (more…)
The HealthIMPACT series of mainly single-day events on health tech/HIT’s effect on healthcare now covers several major cities in the US. What this Editor likes about them is that they compress a great deal of information in a single day, with well-presented, relaxed panel discussions with top executives and figures in the industry. They are also held in interesting venues like the Union League Club in NYC. Panels are being hosted this year by former colleagues from Health 2.0 NYC Megan Antonelli of Purpose Events and “The Healthcare IT Guy” Shahid Shah, with new vice chair Mandi Bishop, a HIT entrepreneur who was a Challenge Competitor at #MedMo16. Here’s the HealthIMPACT schedule with links to the individual events:
Texas Medical Innovation Center | TMCx
April 4th, 2017 Receive a 20% discount off registration–use HIEB2017
Florida Hospital Innovation Lab, Werner Auditorium, Orlando, FL
May 4th, 2017
Union League Club, New York, NY
June 5th, 2017 (note that this is a new date, changed from the date on the website)
HealthIMPACT WISE/Women in Information Science Retreat
Sundance Mountain Resort, Sundance, UT
June 23-25, 2017
Matter Health, Chicago, IL
September 14, 2017
San Francisco, CA, October 7, 2017
TTA is a media partner of HealthIMPACT for 2017.
Events are blooming like daffodils in a long-awaited Spring! Here are two coming up, organized by the Royal Society of Medicine’s Telemedicine & eHealth Section. Both are full day programs held at the RSM’s offices at 1 Wimpole Street, London.
Medical apps: Mainstreaming innovation
Tuesday 4 April 2017, 9am to 5:10pm
CPD: 6 credits
Event link: www.rsm.ac.uk/events/TEH03
To discuss the regulation, the potential use and evaluation of the introduction of medical apps in a range of healthcare situations. This event is the fifth annual medical apps event run by the Section; the previous four have all been popular. The purpose of each one has been to educate forward-thinking clinicians in the benefits of using medical apps to improve patient outcomes and reduce costs. In view of the expectation that the NHS will have an mHealth assessment operation running by next April, this event will focus on mainstreaming the use of apps within the health and care services.
Digital health and insurance: A perfect partnership?
Thursday 1 June 2017, 9am to 5pm
CPD: 6 credits (applied for)
Event link: www.rsm.ac.uk/events/TEH04
This meeting will explore how digital health and insurance can be mutually beneficial by enabling insurance companies to get a better handle on the risk of their insureds. It will also explore whether these new business models might result in a new paradigm for delivering care more effectively, and to consider whether as a result the population as a whole might be better motivated to take greater responsibility for their own health and wellbeing.
Upcoming at the RSM is next Tuesday’s (28 March) 28th Annual Easter Lecture given by Matthew Syed, a columnist for The Times and author of two acclaimed books, ‘Bounce’ and ‘Black Box Thinking’. He will focus on the dynamics of a high-performance culture. Talent is significant but not enough. There is no substitute for a mindset that drives continuous improvement. Every marginal gain is vital and they build together to achieve performance excellence. Open to the general public, it is a short evening program which starts at 6pm. Event link here. Hat tip to reader Jerry Kolosky via LinkedIn
An article in MIT Technology Review takes a sideways look at telemedicine and asks if telemedicine is providing an easy route for people suffering from excessive anxiety about their health. The author, Christina Farr, suggests that the ease of contacting a doctor using telemedicine services in comparison to having to visit a doctor’s office and the ability use either insurance or direct payments makes these services more attractive to hypochondriacs (lately called those with somatic symptom disorder).
Views on the subject are quoted from the chief medical affairs officer at MDLive, Deborah Mulligan, and a board member of Doctor on Demand, Bob Kocher. While the first is able to relate an anecdote where a case of excessive anxiety disorder was identified and successfully referred to cognitive behavioral therapy, the latter says he isn’t aware of any patients with health anxiety regularly using the Doctor on Demand app.
Read the full article here.
ATA 2017, 22-25 April, Orlando Florida at Orange County Conference Center Our Readers save 15%–and advanced registration rates are available through 25 March! (Use TelecareAware15 code when registering)
What’s New? ATA’s Experience Zone demonstrates how management and monitoring capabilities can reduce time and costs, and first and foremost save lives. In the Simulation Area, participants can receive a 15-minute guided tour of four common environments – an ICU, ER, doctor’s office and senior living facility – to learn how telemedicine services are best utilized in these areas.
Women in Telemedicine are also highlighted in the “Women in Telemedicine: Leading the Charge of Healthcare Innovation” executive panel discussion featuring Charlotte Yeh, CMO, AARP (moderator); Julie Hall-Barrow, VP, Virtual Health and Innovation; Susan Dentzer, CEO, Network for Excellence in Health Innovation; Paula Guy, CEO, Salus Telehealth and Kristi Henderson, ATA Board of Directors, VP of Virtual Care & Innovation, Seton Healthcare Family and President & CEO, e-Health Advisors. There will also be a networking reception honoring women in the industry. ATA Release
The themes beyond the trends in telehealth which the conference will cover are:
- Consumers’ desire for devices to help them improve their health and communicate more easily with their doctors
- How the latest technologies are lowering costs, improving services/reach and are reinventing healthcare
- How doctors and healthcare systems are utilizing telehealth after hours to extend services 24/7 and are making it easier to reach patients who need them
- How virtual reality is being used to treat everything from mental illness to rehabilitation and beyond
- What’s hot, what’s not in investment opportunities–and why
More than 6,000 healthcare and industry professionals, including 1,000 C-level executives, are expected to attend this year’s event in Orlando. Our Readers save 15%–advanced registration rates are available through the end of the week (25 March). Our discount is good till registration closes. Click on the link in the advert on our right sidebar or here. Twitter: @AmericanTelemed and #T2Telehealth TTA is again this year a media partner with ATA of T2 Telehealth 2.0.
The West Virginia legislature has been considering a new bill to expand the range of medications that may be prescribed in a telemedicine encounter. The bill was passed by the House of Representatives last week and sent to the Senate for consideration.
The House Bill 2509 proposes to amend the West Virginia Medical Practice Act to enable physicians to prescribe certain controlled substances when using telemedicine technologies. According to Mobihealthnews this would specifically include medication for mental and behavioral health, although bill itself does not refer to these conditions. A note at the end of the bill states “The purpose of this bill is to permit a physician to prescribe certain controlled substances when using telemedicine technologies.”
It seems that the legislation in the US dealing with telemedicine is fragmented and becoming more so. There was the issue of whether health insurance companies would cover telemedicine consultations, then the issue of medicare and medicaid covering the telemedicine consultations, then the state medical boards refusing cross border telemedicine and now issues on individual medications that can or can’t be prescribed. This will make it increasingly difficult for those practitioners who decide to enter the telemedicine arena.It is not a sustainable approach to pass a new law on every issue relating to telemedicine. Telemedicine is merely medicine practiced via a different route and regulation and standardisation of processes associated with telemedicine should be divested to a suitably established agency overseen by the legislature, similar to how the medical boards operate. In fact, this could easily be an additional responsibility given to the medical boards.
The hope comes in a trend over the next five years (NJEM chart at left above, click to enlarge). Presently, the most useful sources of data are clinical (95 percent), cost (56 percent), and claims (56 percent). In five years, they project that the top four will be clinical (82 percent) and cost (58 percent) joined by patient-generated and genomic data (both at 40 percent). How that patient-generated data will be compiled to be useful is not described, but the hope is that “With patient-generated data and genomic data, we will be able to create true “n of 1” medicine with options specific to each patient’s needs, giving a boost to priorities such as care coordination and improved clinical decision support.”
A possible roadblock is the lack of interoperability of EHRs. Less than 10 years ago, the EHR was touted as The Solution to patient records and a repository of Everything. 51 percent indicate that interoperability is weak. One-third believe that ease of use and training for EHRs are also week.
Other findings indicated strong support for greater patient access to personal medical records (93 percent), fee/price information for comparison shopping (80 percent), and outcomes information listed by hospital (73 percent)–but not by doctor (55 percent).
MedStartr is sponsoring two upcoming evening events which will be of interest to our New York metro Readers. Next week’s roundtable includes participants from the Melbourne (Australia) Health Accelerator/Startup61.
The first is next week, Wednesday 22 March, starting at 6pm. The Hospitals 2.0: Hospital Innovation Program Roundtable is a discussion on how hospitals are leading innovation programs of their own and to review their progress. This will feature leaders from Mount Sinai, Northwell Health, NY-Presbyterian, Christopher Kommatas of Melbourne Health Accelerator/Startup61, and others. Location: CityMD, 1345 Avenue of the Americas (6th Avenue to the rest of us), between 54th-55th Streets, 8th Floor, NYC. Event link on Meetup here.
On Wednesday 5 April, also at CityMD and at 6pm will be Doctors 2.0: ¡Viva La Evolución! Three doctors–Jay Parkinson (Hello Health, Sherpaa), Rich Park (CityMD), and Greg Downing (HHS)–will discuss rewriting the story of care delivery and what is coming next in the evolution of care. Event link on Meetup here.
Tickets are $25 for either three-hour event. Advance reservations are required due to building security. Ticketing is being done through the Meetup Group Health 2.0 NYC at the links above. If you are not a member, please email MedStartr directly at members@Medstartr.com.
Videos are now online for 1 March’s Rise of the Healthy Machines (#RISE2017). These include keynotes, panels, and the six pitches for the Challenge.
TTA is a MedStartr and Health 2.0 NYC supporter/media sponsor; Editor Donna is a host for this event and a MedStartr Mentor. Also check the MedStartr page to find and fund some of the most interesting startup ideas in healthcare.
The 30 year old SXSW conference and cultural event has been rising as a healthcare venue for the past few years. One talk this Editor would like to have attended this past weekend was presented by Eric Horvitz, Microsoft Research Laboratory Technical Fellow and managing director, who is both a Stanford PhD in computing and an MD. This combination makes him a unique warrior against medical errors, which annually kill over 250,000 patients. His point was that artificial intelligence is increasingly used in tools that are ‘safety nets’ for medical staff in situations such as failure to rescue–the inability to treat complications that rapidly escalate–readmissions, and analyzing medical images.
A readmissions clinical support tool, RAM (Readmissions Management), he worked on eight years agon, produced now by Caradigm, predicts which patients have a high probability of readmission and those who will need additional care. Failure to rescue often results from a concatenation of complications happening quickly and with a lack of knowledge that resemble the prelude to an aircraft crash. “We’re considering [data from] thousands of patients, including many who died in the hospital after coming in for an elective procedure. So when a patient’s condition deteriorates, they might lose an organ system. It might be kidney failure, for example, so renal people come in. Then cardiac failure kicks in so cardiologists come in and they don’t know what the story is. The actual idea is to understand the pipeline down to the event so doctors can intervene earlier.” and to understand the patterns that led up to it. Another is to address potential problems that may be outside the doctor’s direct knowledge field or experiences, including the Bayesian Theory of Surprise affecting the thought process. Dr Horvitz discussed how machine learning can assist medical imaging and interpretation. His points were that AI and machine learning, applied to thousands of patient cases and images, are there to assist physicians, not replace them, and not to replace the human touch. MedCityNews
The World Community Grid is coordinated by IBM and taps into the spare processing power of potentially millions of Android smartphones and tablets. Users download an app called BOINC through the IBM site and select a research area in health or sustainability. Researchers then can use the processing power of the device at idle times to fuel processing of massive records or simulations required for research. The app operates in the background when your device is connected to Wi-Fi and at 90 percent+ charge, so it doesn’t use data or drain significant power. It has been or is currently being used for up to two million daily calculations in research initiatives for Ebola, Zika, TB and HIV/AIDS. Highlighted in the BBC News article is the new Smash Childhood Cancer project to help find cures for six types of childhood cancer, including brain tumors, liver and bone cancer. Previously, 200,000 World Community Grid volunteers contributed device power to research on neuroblastoma, which helped identify several potential treatments. The BOINC project started in 2004 and originally used spare mainframe and PC processing. It remains free to researchers in exchange for allowing other researchers to access the data. More information on the IBM World Community Grid with app download links here to put your Android device on the grid. It beats a cat video app! Hat tip to reader Guy Dewsbury via LinkedIn.
RecycleHealth and #ShareTheHealth is a crowdfunded research/wellness project that aims to put used fitness trackers back to work for those who wouldn’t normally buy them at retail: older adults with chronic disease, veterans’ organizations working to reduce PTSD, inner city running clubs, and more. Developed by Tufts University School of Medicine assistant professor Lisa Gualtieri, Ph.D., RecycleHealth has cleaned and refurbished over 1,000 donated fitness trackers which have been used in three research studies on how wearables affect behavior change and clinical outcomes. The three and future rounds of crowdfunding help with postage (donor and new user) and refurbishment. So far the research has covered hypertension and Type 2 diabetes. Future studies are planned for how wearable activity tracker data can be used in clinical visits for actionable physician counseling and wearables’ therapeutic role in assisting veterans recovering from mental health and other concerns. Dr. Gualtieri’s Tufts crowdfunding site is here, but this Editor discovered her through LinkedIn. (And hope that she will not mind our borrowing her hashtag!)
The study examined 2011-2013 claims information for over 300,000 people insured through the California California Public Employees’ Retirement System, which despite the name provides health benefits to active state employees as well as retirees. It targeted common acute respiratory infections (sinus infections, bronchitis and related) to determine patterns of provider utilization and the change after the introduction of telehealth. Of that group, 981 used the Teladoc system for video consults, adopted by CalPERS in 2012.
The objective of the study was to determine whether the telehealth visits were new care or substituted for other types of care such as doctor, clinic, or ED visits. Even though the telehealth services were far cheaper–about 50 percent lower than a physician office visit and less than 5 percent the cost of a visit to the ED–they did not make up for the calculated 88 percent rise in utilization.
Similar results were reported by RAND in last year’s research on retail clinics, which estimated that 58 percent of visits for low-severity illnesses were new and not shifted from EDs or doctor’s offices. What is in common? Convenience. Convenience opens up greater use. If you have a store down the street, you may pop in daily versus once-weekly.
Updated: Some further insights from Mobihealthnews were that the study stated that telehealth visits may be more likely to result in additional costs, such as follow-up appointments, testing or prescriptions. In other words, the telehealth visit starts off less expensive, but the standard of care in follow-up adds to that initial cost.
The RAND recommendation is thus not a surprise: make more telemedicine visits a shift from office or ED to restrict telemedicine growth. Raise the cost of co-pays for the service to reduce demand. On the ‘high side’, encourage ED ‘frequent flyers’ to use telehealth services instead. Pass the painkillers. Health Affairs (abstract only; paid access required for full study), RAND Health press release.
Analysis: instead of self-doctoring, and suffering at home and in the workplace, the small group of CalPERS policyholders in the study actually used their new benefit to check their health–as intended! The additional cost is not staggering; (more…)
An agreement reached in the U.S. District Court in Idaho in January this year overturned Idaho’s ban of prescription of abortion-inducing drugs during a telemedicine consultation (see our previous article).
The settlement of the case before Chief District Judge B. Lynn Winmill, brought by Planned Parenthood of the Great Northwest and the Hawaiian Islands, required the Idaho legislature to repeal the laws that made such prescriptions over telemedicine consultations illegal. The repeals have to be carried out by the end of the 2017 session, else Judge Winmill will declare the laws unconstitutional and unenforceable, according to Mobi Health News .
Idaho legislature has accordingly started the process of removing the single line from the Telehealth Access Act which bans the prescription of abortion inducing drugs and repealing the law requiring the doctor to be physically present at the consultation when prescribing the drugs. This is to be achieved via the new House Bill 250, sponsored by the State Affairs Committee, named simply An Act relating to Abortion. The bill was introduced last Friday.
The wording of the bill emphasises the the view that the state believes that abortions induced by medicines prescribed via telemedicine consultations constitute “substandard medical care and that women and girls undergoing abortion deserve and require a higher level of professional medical care”. Planned Parenthood has said that it objects to this statement that telemedicine provides substandard care according to Boise Weekly.
The bill has made rapid progress having had its second reading yesterday and is currently filed for the third reading.
The Yorkshire Evening Post profiles one of the residents, Mavis Robinson, who has motor neurone disease (MND). She was helped over the festive (US=holiday) season when her condition began to decline based on her vital signs monitoring which appears to be administered by staff. They were then able to obtain medication for pain before the situation escalated. Ms Robinson can discuss her health with the nurse based on the telehealth information. Telehealth information was also used to involve a family member in care for a patient nearing the end of their life. Unfortunately this Editor has been unable to determine what system is being used in the pilot. (Can one of our Readers enlighten us?–Ed.) Based on the closing quote from Sue Robins of NHS Leeds West CCG, it’s also an example of the NHS local strategy mentioned in The King’s Fund blog [TTA 17 Feb] for local areas to pilot and share the knowledge.
Industry analyst Laurie Orlov previews her annual review of ‘Technology for Aging In Place’ on LinkedIn with six insights into the changes roiling health tech in the US. We’ll start with a favorite point–terminology–and summarize/review each (in bold), not necessarily in order.
“Health Tech” replaces “Digital Health,” begins acknowledging aging. This started well before Brian Dolan’s acknowledgment in Mobihealthnews, as what was ‘digital health’ anyway? This Editor doesn’t relate it to a shift in investment money, more to the 2016 realization by companies and investors that care continuity, meaningful clinician workflow, access to key information, and predictive analytics were a lot more important–and fundable–than trying to figure out how to handle Data Generated by Gadgets.
Niche hardware will fade away – long live software and training. Purpose-built ‘senior tablets’ will likely fade away. The exception will be specialized applications in remote patient monitoring (RPM) for vital signs and in many cases, video, that require adaptation and physical security of standard tablets. These have device connectivity, HIPAA, and FDA (Class I/II) concerns. Other than those, assistive and telehealth apps on tablets, phablets and smartphones with ever-larger screens are enough to manage most needs. An impediment: cost (when will Medicare start assisting with payments for these?), two-year life, dependence on vision, and their occasionally befuddling ways.
Voice-first interfaces will dominate apps and devices. “Instead we will be experimenting with personal assistants or AI-enabled voice first technologies (Siri, Google Home, Amazon Alexa, Cortana) which can act as mini service provider interfaces – find an appointment, a ride, song, a restaurant, a hotel, an airplane seat.” In this Editor’s estimation, a Bridge Too Far for this year, maybe 2018. Considerations are cost, intrusiveness, and accuracy in interpreting voice commands. A strong whiff of the Over-Hyped pervades.
Internet of Things (IoT) replaces sensor-based categories. Sensors are part of IoT, so there’s not much of a distinction here, and this falls into ‘home controls’ which may be out of the box or require custom installation. Adoption again runs into the roadblocks of cost and intrusiveness with older people who may be quite reluctant to take on both. And of course there is the security concern, as many of these devices are insecure, eminently hackable, and has been well documented as such.
Tech-enabled home care pressures traditional homecare providers – or does it? ‘What exactly is tech-enabled care? And what will it be in the future?’ Agreed that there will be a lot of thinking in home care about what $200 million in investment in this area actually means. Is this being driven by compliance, or by uncertainty around what Medicare and state Medicaid will pay for in future?
Robotics and virtual reality will continue — as experiments. Sadly, yes, as widespread adoption means investment, and it’s not there on the senior housing level where there are other issues bubbling, such as real estate and resident safety. There are also liability issues around assistance robotics that have not yet been worked out. Exoskeletons–an assistance method this Editor has wanted to see for several years for older adults and the disabled–seems to be stalled at the functionality/expense/weight level.
Study release TBD