On the lighter side, as you’re doing your food shopping this weekend, think about the lucky souls of the Tampa Bay area who soon will be able to fit in a virtual doctor visit between picking up a dozen eggs and the laundry detergent! The BayCare Health System will be installing private rooms at select Publix supermarkets with video conference capability plus some medical diagnostic equipment, including stethoscopes and blood pressure cuffs. BayCare currently provides telemedicine and consults using the BayCareAnywhere app. The telemedicine system they are using is not disclosed.)
Publix is no stranger to telehealth/telemedicine, having earlier piloted with The Little Clinic (now owned by Kroger supermarkets) in a dozen locations, exiting in 2011. BayCare will also partner with the higi wellnessstations already in some Publix markets to send patient results to BayCare physicians (their app system is not mentioned). Based on the BayCare Anywhere pictures, their target market are busy families, young singles and couples, and older children where the supermarket is convenient and often 24/7. (But where are the older people, quite populous in FL year round, who don’t have to be online or download an app?) WLRN (radio and TV)
click to enlargePwC‘s latest study on the effect of robotics and artificial intelligence on today’s and future workforce is the subject of this BBC Business article focusing on the UK workforce. 30 percent of existing jobs in the UK were potentially at a high risk of automation by the 2030s, compared with 38 percent in the US, 35 percent in Germany and 21 percent in Japan. Most at risk are jobs in manufacturing and retail, but to quote PwC’s page on their multiple studies, robotics and AI may change how we work in a different way, an “augmented and collaborative working model alongside people – what we call the ‘blended workforce’”. Or not less work, but different types of work. But some jobs, like truck (lorry) drivers, would go away or be vastly diminished.
The effect on healthcare? The categories are very broad, but the third category of employment affected is administrative and support services at 37 percent, followed by professional, scientific and technical at 26 percent, and human health and social work at 17 percent. Will it increase productivity and thus salaries, which have languished in the past decade? Will it speed innovation and care in our area? Will it help the older population to be healthy and productive? And the societal effects will roll on, but perhaps not for some. View this wonderful exchange between Jean Harlow and Marie Dressler that closes the 1933 film Dinner at Eight.Hat tip to Guy Dewsbury @dewsbury via Twitter
Organized by BRE Conferences, this full-day event is focused on keeping elderly people well in their homes for longer, discussing areas such as improved housing, access to care, integrating social care and healthcare in the home, and (of course) funding. For registration (£95 + VAT) and more information, see the website. Hat tip to our Eye on Tenders, Susanne Woodman.
A must read on telemedicine and telehealth cost. One of our Readers, Bruce Judson, commented on our earlier coverage of RAND Health’s new study published in Health Affairs [TTA 8 Mar] finding that telemedicine virtual visits (here called telehealth) drove up utilization of care by 88 percent and cost by $45 per year for respiratory illnesses that typically resolved on their own.
He has written his own analysis based on the full study. Telehealth Costs: RAND’s Questionable Rant (Huffington Post), considers the full study and compares it to a 2014 RAND study by the same authors. Mr Judson notes inconsistencies in sampling and definitions; the illogical attachment of a waiting period cost (77 minutes=$30) to a telehealth visit (perhaps to level it with an office visit?); the misinterpretation of results; small sample size; and the fact that the CalPERS sample is ancient (2011-13), representative of a time when telemedicine (here provided by Teladoc) was a new notion. (He does not count in costs outside the study such as lost time at work or the cost of spreading infection to co-workers.)
Mr Judson, after many years in publishing, digital marketing and strategy (from when it was called ‘new media’), and currently an advisor to a UK firm investing in IoT, has cast his lot with us in health tech, heading a firm in the Hudson Valley of NY, Telehealthworks, which markets an employer telemedicine and wellness program called freshbenies. While he discloses that he’s not a disinterested observer or researcher, he has that in common with most of our Readers, who are very interested in determining the truth about costs and savings.
It looks like the long-running Jawbone v. Fitbit trade secrets show will continue in California Superior Court. Judge Richard Ulmer on Friday (24 Mar) in San Francisco ruled that the scope of the Jawbone-initiated lawsuit, charging that Fitbit and five former Jawbone employees stole trade secrets, was far larger than the dismissal handed down last October by the US International Trade Commission (ITC) in Washington, DC, rejecting Fitbit’s claim. To Bloomberg Technology, a Jawbone spokesperson crowed, “We look forward now to focusing on presenting our case to a California jury, which will not be bound by the strict procedural limitations that we faced in the ITC. We will push the case to trial as quickly as possible and are confident that justice will be done.” Fitbit is expected to appeal, but this is not good news for them if this drags out–their share price is down 72 percent from a year ago (Marketwatch)–and threatens their IP which is key to a pivot to the clinical monitoring market.
A sidebar to this is Business Insider’srecent report that one of Jawbone’s law firms, Susman Godfrey LLP, has withdrawn from three pending cases citing ‘professional considerations’, remaining on two. This Editor cannot confirm whether Susman Godfrey is representing Jawbone in the above case, as Plainsite records indicate that Skadden Arps is their counsel. The California courts website has not been updated for the case (Aliphcom Inc. v. Fitbit Inc., CGC15-546004). Previous TTA coverage 9 Feb.
click to enlargeAfter an intense and overflow attendance Hospital Innovation Programs Roundtable last Wednesday hosted by NYC’s largest urgent care, CityMD, and with eight speaker/panelists from Mount Sinai, NY-Presbyterian, Northwell, and Startup61/Melbourne Australia Health Accelerator, what could be better than doing it again in two weeks?
Wednesday 5 April’s MedStartr/Health 2.0 NYC presentation on healthcare’s evolution will be a little more relaxed with three panelists so far, but they are rare ‘gets’: Greg Downing, DO is the Executive Director of Innovation at the US Department of Health & Human Services (HHS), an institution much in the news with Federal changes in healthcare. Jay Parkinson, MD, MPH developed the first commercial cloud-based EHR, Hello Health, back in 2008 and founded his current telemedicine company, Sherpaa Health, five years ago. Rich Park, MD is both host and the founder-CEO of CityMD. All have different views of how healthcare is evolving, so it should be both an interesting and full evening. It begins at 6 and wraps up at 9pm, with plenty of networking time.
Tickets are $35. Advance reservations are required due to building security. Ticketing is being done through the Meetup Group Health 2.0 NYC here. If you are not a member, please email MedStartr directly at members@Medstartr.com.
Videos are now online for the 22 March Hospital Innovations program and 1 March’s Rise of the Healthy Machines (#RISE2017). The latter includes keynotes, panels, and the six pitches for the Challenge. December’s #MedMo16 is also online.
TTA is a MedStartr and Health 2.0 NYC supporter/media sponsor since 2010; Editor Donna is a host for this event and a MedStartr Mentor. Check the MedStartr page to find and fund some of the most interesting startup ideas in healthcare.
Almost exactly 14 months to the day since the press release announcing a pilot of a click to enlargetelemedicine service, the first patient is said to have undergone treatment using the Dubai Health Authority’s RoboDoc telemedicine system according to Middle East North Africa Financial Network. The patient was based in Hatta Hospital and the respiratory specialists were based at Rashid Hospital Trauma Centre according to the report. RoboDoc units, from InTouch Health, have also been installed at two primary care centres in Dubai.
In a previous TTA article this editor expressed surprise that telehealth would be of interest to Dubai which is only 1600 square miles in area. Having considered the details of the implementation the interest is partially explained by the fact that Hatta is an outpost separated from the rest of Dubai, 135 km (84 miles) from Rashid Hospital.
However, the other two centres at which the RoboDoc devices have been installed, Al Bashar Health Centre (15 miles from Rashid Hospital) and Nad Al Hammar Health Centre (7 miles from Rashid) (more…)
click to enlargeIncreasingly, not in the opinion of many. We’ve covered earlier [TTA 21 Dec, 6 Feb] the wearables ‘bust’ and consumer disenchantment affecting fitness-oriented wearables. While projections are still $19 bn by 2018 (Juniper Research), Jawbone is nearly out of business with one last stab at the clinical segment, with Fitbit missing its 2016 earnings targets–and planning to target the same segment. So this Washington Post article on a glam presentation at SXSW of a Google/Levi’s smart jeans jacket for those who bicycle to work (‘bike’ and ‘bikers’ connote Leather ‘n’ Harleys). It will enable wearers to take phone calls, get directions and check the time by tapping and swiping their sleeves, with audio information delivered via headphone. As with every wearable blouse, muumuu, and toque she’s seen, this Editor’s skepticism is fueled by the fact that the cyclist depicted has to raise at least one hand to tap/swipe said sleeves and to wear headphones. He is also sans helmet on a street, not even a bike path or country lane. All are safety Bad Doo-Bees. Yes, the jacket is washable as the two-day power source is removable. But while it’s supposed to hit the market by Fall, the cost estimate is missing. A significant ‘who needs it?’ factor.
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…)
click to enlargeA virtual reality (VR) treadmill system has been developed that improves both muscle strength, coordination, and cognitive abilities to prevent falls in patients with Parkinson’s disease and dementia. Researcher Jeff Hausdorff at Tel Aviv University-Sourasky Medical Center is integrating traditional therapies that concentrate on developing muscle strength, balance and gait with cognitive factors for fall prevention: motor planning, attention, executive control, and judgment training. In a recent study of 282 patients in matched therapy groups (VR+treadmill versus treadmill alone), those who participated in the VR group fell 50 percent less after six months. The biggest improvement was seen in Parkinson’s patients. Video is below. (Photo and video from Center for the Study of Movement Cognition and Mobility). ApplySci/MIT
click to enlargeA report of progress in smartphone ownership by those over 65 years of age is mixed indeed. There’s progress–ownership is up to 42 percent of the age group, and 64 percent of these smartphone owners are users of the Internet according to Pew Research‘s 2016 study. But mitigating factors to this good news is that ownership is very much a function of income and age. According to the US Census’ American Community Survey 2015, 66 percent of those aged 65+ households with income $70,000+ own smartphones, but that declines to 33 percent in the 75+ age range and 27 percent of those 80+. Perhaps Laurie Orlov exaggerates the cost of smartphones, especially Android–this Editor has never bought an LG phone over $200 and has a miserly data plan, using Wi-Fi most of the time; Verizon has plenty of new older models at lighter prices and other carriers like Consumer Cellular and GreatCall have excellent deals. But what is true is that interest wanes with age–and that phones, especially Apple, still present legibility and usability barriers to those with low vision or hand arthritis. Ms Orlov also notes Pew’s discovery that 65+ users are less likely to secure their phones with lock codes and regularly update their apps. Aging in Place Technology Watch
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
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.
click to enlargeATA 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.
click to enlargeA frustration of everyone in healthcare and technology is the unfulfilled promise of Big Data. A study conducted by a team for NEJM Catalyst (New England Journal of Medicine) of 682 health care executives, clinical leaders, and clinicians indicates that at present, very few (<20 percent) believe that their healthcare organizations extremely or very effectively use data for direct patient care; 40 percent believe it is not very effective or not at all effective.
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).
The full report is available for download at the NEJM Catalyst link here. Also Mobihealthnews.
Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:
• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.
• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.
Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.