Surgical telemonitoring – the next milestone for telemedicine?

The first in a series of real-time reports from American Telemedicine Association annual conference in Austin, Texas, by James Barlow, Imperial College London.

The ATA conference has just included an interesting session on surgery as the next milestone for telemedicine. While telesurgey has long been an area of interest in remote care, pressures in the health system and developments in technology are combining to create new opportunities for supporting surgeons in their work. But many of the familiar implementation challenges are also looming large. So what were the reflections from the panel and discussion?

The consensus was that we need to shift the state of the art in operating room practices from considering volume and quality to broader notions of ‘value’ embracing cost, quality and access. Hospitals will be increasingly rewarded on outcomes and patient satisfaction, and telesurgery potentially helps improve both.

Two kinds of broad telesurgery model are envisaged – the expert surgeon ‘broadcast’ their operations to a wide audience and a more 1:1 relationship where the expert is remotely located and provides support for a specific operation. The ‘new telesurgery’ will involve three things.

  1. Just phoning another surgeon for advice in the middle of an operation is no longer good enough. There will be much more collaboration between surgeons, using new collaborative tools for bringing people together at a distance. The possibility of virtual environments around the operating room is already here and should be widely embraced.
  2. Large peer-supported integrated surgery networks will emerge with surgeons paid for the time they spend providing advice or moderating discussions. Spending 10% of your time mentoring other surgeons – perhaps around the world – will become part of the norm.
  3. A pool of recognised expert mentors will develop. Mentors can be ‘in the room’ virtually during the procedure. Or they can be invited to participate in situations where there is an ‘index case’ – a rarely encountered procedure – where the pool of knowledge is spread thinly.

All this is going to clash with the inherent conservatism of surgeons and their unwillingness to change tried and trusted approaches and technologies. The big challenges for moving forward in telesurgery are:

  1. ‘Network effects’ need to kick in – there has to be a critical mass of users and installed technology to generate the biggest benefits.
  2. Inevitably there are incompatibilities in technical standards for data transfer.
  3. The focus so far has been on audio and video, but integrating patient data into telesurgery and back into patient record systems is also essential.
  4. Tools for virtual collaboration are rapidly developing, allowing crystal clear video, remote access to laparoscopic images, virtual laser pointers, and doing all this on tablets. These need to be made widely available.
  5. Reimbursement and business models – who pays for what? Can we find ways of reimbursing hospitals / surgeons providing experts? How do we schedule expert mentor time and build this into their contracts?
  6. Medico-legal. There are cross border (or cross state issues here in the US) licensing issues and big problems of responsibilities in the event of problems arising in a telesurgery procedure.

Other reports by James Barlow.

Northamptonshire NHS contracts for video consultation service (UK)

The Saypage Telehealth Platform looks like an interesting addition to the number of companies providing video conferencing services to health services in the UK but the company’s announcement would get a warmer welcome from us if were not for its classic hype-it-up press release. Just because one NHS Trust has contracted for the service does not justify the implied claim that the whole NHS is rolling it out. NHS Launches Online Video Consultations Service Using Saypage Telehealth Platform. The lesson for all suppliers is to keep it real if you do not want to undermine readers’ respect.

Wales: telehealth research participants sought

The Institute of Rural Health and Aberdeen University are to research the effect of technology on patients interactions with their home carers, and are seeking input from patients using telehealth in the Powys and Betsi Cadwaladr health board areas. Recruitment is open until the end of June and seeks patients aged 60-79 years, who are visited by a nurse or other professional carer at least once a week and are using some sort of telehealth technology to help them to manage chronic pain or another medical condition. ‘Technology’ might include the use of internet forums, phone ‘apps’, or Skype links to carers. For further information please contact Sophie Corbett at the IRH on 01686 629480. (Info via Dispensing Doctors’ Association)

US top 10 iPhone mHealth apps generate 5.5 million lifetime downloads on average

According to a reasearch2guidance blog post publicising a new report, the most successful free health and fitness apps accumulated 5.5 million downloads on average since their first appearance in the Apple App Store. However, there are significant performance gaps that highlight the importance of choosing the right platform, app category and device choice for mHealth publishers.

Police use GPS trackers to find people with dementia (UK)

According to a BBC TV report (may not be viewable outside the UK), Sussex Police has become the first force in Britain to pay for GPS tracking to help people with dementia. They are using the £27/month Mindme device.
UPDATE 2 May: Mike Clark on the 3millionlives LinkedIn group has pulled together links to items that are appearing in response to the above BBC report. For readers without access to the group they are from the Guardian; the Telegraph, the BBC and the Alzheimer’s Society. Judging by the comments on the Guardian article, the National Pensioners Convention badly misjudged the public mood on this one, and their press release muddles the issues of service funding, who should be responsible for people with dementia, and social isolation.

Curl me up

Phones have rung or buzzed since Alexander Graham Bell’s time. What if it simply…curled? That is perhaps the Phone In Your Pfuture, or something like the MorePhone. The prototype “can curl its entire body to indicate a call, or curl up to three individual corners to indicate a particular message” –phone, text or email. The thin, flexible electrophoretic display is manufactured by Plastic Logic, a UK company. Developed by a team from Queen’s University (Toronto, Canada) Human Media Lab, it will be presented at the ACM CHI 2013 (Computer-Human Interaction) conference in Paris this week. But don’t hold off on getting that Galaxy 4G…this is estimated to take another 5-10 years to market. The possibility of course is that some of its underlying technology and Plastic Logic display will find its way into other devices.  GizMag, Human Media Lab press release, main page with short video.

Jawbone definitely ‘up’ with BodyMedia acquisition

BodyMedia, mentioned earlier today in context with wireless expansion into telehealth M2M (in this case, T-Mobile) is being acquired by Jawbone (of the UP bracelet).  BodyMedia’s wearable (on the upper arm), wireless syncing body monitors, developed over 14 years and with FDA Class II approval, have primarily targeted the ‘serious’ dieter with chronic weight problems and/or a diabetes prevention need, not the occasional exerciser.  Their partnerships with Jenny Craig, Apex Gyms and a trial with Cigna employees have been tailored to this objective.  In contrast, Jawbone has consistently targeted the more casual user with fashionable wrist-worn bracelets plus a wider variety of  features such as mood, sleep, activity and food tracking. It appears the two products will be kept separate for now. The bonuses: BodyMedia’s deep technical expertise (indicated by the unusual announcement of BodyMedia’s employees joining Jawbone, badly needed by the latter in light of their product development stumbles), 87 (!) patents, a massive database of human sensor data and the Vue Patch disposable sensor developed in conjunction with Avery Dennison announced at CES. Jawbone release, Mobihealthnews article.

Related: Jawbone UP’s iOS version now can incorporate data from other devices and platforms via partnerships with IFTTT, LoseIt!, Maxwell Health, MapMyFitness, MyFitnessPal, Notch, RunKeeper, Sleepio, Wello and Withings. Wired

Previously in TTA re Jawbone: Is it Hope? Hype? Or just the Same Old Struggle?Quantified Self fail: nighty-night for ZeoQuantified Selfing as…Show & Tell?

In-car health monitoring: a Quantum of Dismay

click to enlargeThe simple pleasure of a drive, with the cheerful sound of a quiet engine purring and the pleasures of early Spring, are rapidly becoming as obsolete as no cell phone zones. Eye realized it this Sunday whilst driving in Big Blue (left, Cadillac,1955) with Waldo Lydecker to a scenic overlook on the New Jersey Palisades, where other like-minded vintage Cadillac owners unusually take pleasure in parking, eyeballing paint, chrome and upholstery, telling Cadillac tales and generally not doing very much for a few Sunday hours. But it was the drive to and from the garage that gave one pause. Blue must share the road click to enlargewith fellow vehicles of all sorts, piloted by–to be kind–distracted drivers minding their GPS, smartphones and MP3 players. Now Blue, being a mature lady, has rather a leisurely pace in gliding her 4,500 lbs both forward and to a stop, so she will mind you if you mind her with a little more room and consideration than a nippy Mercedes hussy coupe.

Thus yesterday’s article from the Telegraph (UK) adds to the Quantum of Dismay. The Gimlet Eye has already turned a very dim eye on the phenomenon of the Automotive Dashboard as mHealthy Monitor. Ford’s SYNC apps alerting you to pollen, pollution and your chances of having an asthma attack at the wheel–useful when used before travel, but blinking and beeping at 70 mph in four-lane traffic? A driver’s seat for hypochondriacs that measures blood pressure, pulse, stress and…blood glucose? (don’t ask)…may work well in the lab, but any New York, Washington, LA or London Metropolitan Area Rush Hour will produce a sound arrangement straight from the Raymond Scott book. A BMW steering wheel that measures perspiration? Ah, the Eye thought that driving your Beemer was supposed to make you glow with excitement. Is it TMBD (too much busy dashboard)? Is it TMI (information), especially if the signs are recorded? Would you then would be ‘asked’ to ‘volunteer’ said information to your insurance company and state DOT due to medical causes? Privacy concerns abound. Cars that can monitor your health–are in-car health monitors the way of the future or a step too far? (Telegraph)

Previously in TTA: Eye’s earlier dismay in More cars that will monitor your BP…and brain wavesFord SYNCs up with Allergy Alert; Editor Donna not much more pleased in Ford’s ‘car that cares’ visits CES, Syncs up HealthrageouslyYour car as mHealth platform.

Senior housing behind the times in tech–and more (US)

A short and extremely pointed take on how senior living communities in the US are just plain not up to speed in their management. Technology adoption is the focus, and reasons cited are:

  • Seniors and caregivers are stereotyped as the technophobes–but so are the senior care managers and staff
  • Tech is expensive, the market is small
  • New tech=early adopters, but they are few and must be the brave ones

Senior housing is also behind the times in marketing (invariably meaning sales), web presence, building design and activity programs. You’ll be wondering how they stay in business. Is this your community, or one you are selling to?  Perpetually behind the times…(Senior Housing Forum)

Healthcare data breaches show 25% fraud risk: study

For healthcare institutions, that data breach can really cost. Javelin Strategy & Research has been tracking the cost of data breaches, including healthcare, for the past ten years. Using its data across all their industries tracked (data here), the threat of identity fraud as of 2012 is up to 1 in 4, from 1 in 9  in 2010. In commenting on the big breach last year at the Utah Department of Health (780,000 records, TTA 22 Dec), a Javelin spokesperson has made some news by estimating the additional fraud cost at $406 million–and that is in addition to the estimated $9 million that the state has spent on security audits, upgrades and credit monitoring for victims.  Hackers seem to be more targeted than ever, but often even simple precautions are not taken–in Utah, the factory password to the server was never changed. A cautionary note–no, symphony–to developers and to HIT departments. Healthcare IT News, Salt Lake Tribune, Javelin release

Could iris scans be a solution? Biometrics makers, such as Safran, Fujitsu, AOptix Technologies and M2Sys Technology, are finding new customers in hospitals and large providers. HCA Holdings, the largest US for-profit hospital chain, is testing Eye Controls’ system at their private clinics in London. Medical ID theft is also a problem in the UK, with ‘shame-based theft’ (to conceal an illness) and private billing the given reasons. Iris scanning units cost about $200-300–a moderate cost. According to the World Privacy Forum, iris scanning will rule out hacking, but not ‘inside jobs’–progress of a sort. But an open question is how this integrates into current EHRs. Iris Scans Seen Shrinking $7 Billion Medical Data Breach (Bloomberg)  Editor’s note: The Gimlet Eye is…envious.

Telehealth gives patients the chance to take more control over their care

More often than not Professor Stanton Newman has been the bearer of bad tidings…the Whole Systems Demonstrator Program (WSD) hasn’t delivered the hoped-for, definitive, glowing results and he has had to see them used for telehealth-bashing by some doctors and the GP press. In an article in the GP online magazine Pulse Today, he gets the chance to bust a few myths and to reaffirm his belief that there are good reasons why GPs should consider telehealth positively. Telehealth gives patients the chance to take more control over their care. (Requires free sign up to view if you have not done previously. Worth doing.) His comments are apt in view of the remote care monitoring directed enhanced service (DES) conditions (PDF) recently published by the Department of Health. Heads-up thanks to Mike Clark.

Contra-wobbly: Aberdare Ventures bets on digital health

While the PwC tracking survey of VC investment in life sciences (including medical devices) shows definite global cooling [TTA 26 April], a $130 million venture funder is just warming up. Aberdare Ventures is one of the top three, after Qualcomm and Merck, making investments in four or more digital health companies, according to RockHealth, and moving away from other parts of life science. Funding for their present suite of seven firms is between $3 and $5 million each. The firm’s latest acquisition is partner Mohit “Mo” Kaushal from West Health. Forbes

[Unrelated editorial note: This is the 5,000th news item on this site.]

Prediction: big data saving big money

A pointer to the (US) future from the (UK’s) Emma Byrne in Forbes; four developments which will lower cost of care in the near future are big data accessible in patient data warehouses, used in personalized/predictive medicine, wellness maintenance and just-in-time medicine. No cautionary notes here about data breaches, which affect an average of 2,700 records for an average price of $2.4 million, but savings of 10 percent (or $900 per person) isn’t hay either. Scientists Save Healthcare (But They’re Not From Med School)

Update 30 April: If you are one of the many who wonder what Big Data really means, versus terminology slung like hash, endless conferences, the word ‘Hadoop’ and that worried look on your HIT department head’s face, John Loonsk, MD helps to define it in language even this Editor can understand. Start with “Specifically, big data tools facilitate pulling together great amounts of available data to support an objective whether those data were recorded specifically and narrowly for that objective or not.” Whew. Policy and implementation challenges to achieving big data outcomes (part 1) HealthcareITNews

Big Data when wayward a Big Problem: 763,000 patients at Adventist Health System’s Florida Hospital Celebration Health ER (ED) over nearly three years had their records sold by one employee with access–and the inside job continued even after he was fired. Big Lawsuit follows. iHealthBeat 

M2M revitalizing PERS, making wireless healthier

…is the surprising conviction of long-time observer Harry Wang of Parks Associates. He’s projecting that nearly all PERS will go M2M as households increasingly lose the land line, and as the current crop of older adults demands ‘anywhere’ coverage. While the numbers will be small in terms of shipping (400,000 in 2016), M2M will be the norm in five years:  more than 61 percent of PERS  in the US shipped in 2017 will feature M2M connectivity, versus only 15 percent in 2012. Wireless carriers are also pushing connectivity in both telecare and telehealth with key device partnerships: Orange and Sprint with IDEAL LIFE, Sprint and BodyMedia, AT&T with Vitality (and many others) and T-Mobile with self-install telecare BeClose.  Undoubtedly this article in e-Commerce Times is a preview to an upcoming study.