2020Health evaluation of the Yorkshire ‘Telehealth Hub’ project (UK)

This important report was published last Friday. Like this editor, readers will surely thank the authors for making such a disparate mixture of elements readable and for picking their way through the implications for the 3ML campaign as well as the many clinical commissioning groups (CCGs) which will take over the reins (or should that be pick up the pieces?) of the NHS across England and Wales in April.

I’m not going to attempt to summarise the report. The four-page Executive Summary contains three tables of essential findings and is the place to start. Despite, or perhaps because of, the general failure of the Telehealth Hub to achieve wider adoption locally, some significant lessons have been learned. TTA readers will, no doubt, comment on those lessons as they see them. Perhaps we should regard the work done by the Hub as a precursor to that which will be done by the 3ML Pathfinder sites. Let’s hope that they are studying this report closely and take note of this key comment by one of the Hub partners:

“When I look at the aims expressed, what strikes me is the ‘tele’ not the condition. We would write these aims differently now – whether because of learning or the fact that the environment changes. The risk now is that local CCGs only think in terms of local pathways and not the wider patient needs.”

The 2020Health evaluation of the Yorkshire ‘Telehealth Hub’ project can be downloaded from the 2020health press release Telehealth does produce savings.

Oh, and for any non-UK readers who may be confused by ‘Yorkshire’ in the title, the area covered by the Hub does not include North Yorkshire and York (NYY) which has famously failed to scale up its telehealth project also, but at more than three times the cost.

EHR backlash brewing. But one day, you’ll mine the data

On Twitter, there’s a new hashtag: #EHRbacklash  No, this Editor did not invent it (it would have been #EHRmisery), but after writing about it since November, it seems like the zeitgeist is turning, or EHRs are sliding down the Gartner hype curve….This Government Health IT article quotes managing partner Doug Brown of the Black Book Rankings research organization as stating “meaningful use incentives created an artificial market for dozens of immature EHR products” and that 31% of 17,000 EHR users surveyed would consider switching. (The actual number of practice EHRs is hundreds–respected consultants in the field have estimated about 600, and the rate of switching 50%. Adding to the problem is that many of these EHRs are offshoots of offshore IT companies, which makes customer service spotty at best. Ratings and certifications? Near meaningless.) Federal standards for ‘Meaningful Use’ fade into the distance as interoperability doesn’t seem to be baked into the EHR business model–not with hundreds of  practice EHRs fighting for miniscule share. Also HealthcareITNews.

Related articles: Confusion, consolidation and collapseMore EHR misery: EHR payment cutoff, data breachRevealed: Hospital EHRs lobbied for stimulus funding

But no worries, at one point the mining of data–the analysis of ‘big data’ generated on patients–will come from those same EHRs. Privacy concerns of course but this data can be invaluable for research: quick clinical feedback, comparative effectiveness, clinical trials, epidemiology, social acceptance of medication and similar. John Sharp in iHealthBeat reviews Electronic Health Record Data Mining — Is It a Dirty Word?

Digital health and mitigating concussion

Neil Versel’s latest in Mobihealthnews is about the role of digital health in detecting concussion: the promising tablet-based neuromuscular assessment tool NeuroAssess developed by Harvard’s Wyss Institute for Biologically Inspired Engineering, the MC10/Reebok Sports Impact Indicator (a mesh skullcap connected to sensors) and the Battle Sports Science chin strap sensor. With Neil’s example of concussion in the National Hockey League (NHL), one wonders if this tough sport–along with soccer’s concussion possibility in ‘heading the ball’ –will join with the NFL in their research efforts. (We will not discuss the multiple hazards of rugby.) Also of note is the NIH ten-year brain mapping project. Digital health gives hope for mitigating concussion damage, brain disease

Your Editors have been following progress in concussion detection and research since June 2012. Further sad confirmation of CTEBrain injury research study: progress is ‘ordered, predictable’NFL donates $30 million to FNIH for TBI researchCombating soldier TBI (continued)Combating TBI on the battle- and football fieldsDARPA/RIT’s ‘Blast Gauge’: measuring the unseen wound.

Current status of state telehealth/telemedicine legislation (US)

The American Telemedicine Association (ATA) has developed a state-by-state chart of where  telemedicine and telehealth legislation stands. The ATA has also constructed a wiki that goes in depth for each state on what is currently covered.  Chart is compiled as of 20 February and will be updated. The ATA page with the state-by-state breakdown–the wiki pages for each state, which will be periodically updated, is here.

VA losing CIO, CTO (US)

The US Department of Veterans Affairs (VA) has two critical vacancies, just announced: CIO Roger Baker and CTO Peter Levin are both leaving the agency after three years. Their resignations come in the midst of major initiatives: Levin’s ‘Blue Button’ PHR (personal health record), mobile telehealth technologies for suicide prevention and oncology; Baker’s adoption of mobile devices and streamlined claims processes. The VA is also coping with the thousands of Iraq and Afghanistan veterans flooding into the system requiring high levels of care, as well as aging  veterans of the Korean, Vietnam and Gulf (I) Wars. No word in this article on what will come next from either Baker or Levin, or the VA, which is unusual. Healthcare IT News

Where’s the data for global public health improvement?

An recent Austin, Texas TEDx presentation by Joel Selanikio, MD, CEO of DataDyne Group ‘shining the light’ on the paucity–not the deluge–of data in global public health, and the antiquated, inefficient way health data in this setting continues to be gathered–as in multiple paper forms. Dr. Selanikio was using Palm Pilots for gathering and transmitting data in 1995 (!) when he worked for the US Centers for Disease Control (CDC). He advocates cutting out the middlemen (like surveyors, consultants) by creating cloud-based software (Magpi, formerly known as EpiSurveyor) that pushes forms to phones (even Symbian which is still quite dominant in large parts of the world) for users in the field. The rich data (perhaps not ‘big data’ yet) can be used for far better analysis: health exam documentation, crime reporting, education reporting (UK charity Camfed), questionnaires and more. Video (16:22).

‘The big picture’, minus hype, of mobile in health

Refreshingly free of hype, and in fact rather dry, is the commentary of  Deborah Estrin, professor of computer science at Cornell NYC Tech (soon to be your Editor’s neighbor), at the 2013 annual meeting of the American Association for the Advancement of Science in Boston chaired by Google’s Vint Cerf. Essentially any phone can be a data platform; her focus is on converting apps to data streams, gauging frequency of use and GPS data for movement. Sensibly, she advises ‘scaling down’ apps to make them useful to individual patients. Undoubtedly she’s read the statistics on abandoned apps, estimated at about 95%–and that most everyone uses the same old apps, Google, Facebook, YouTube, Gmail etc. for about the same time as in 2011. But then she goes into how mobile can keep track of ‘digital exhaust’ a/k/a pollution…. Mobile Devices Linked to Better Health (BioScienceTechnology.com)  App Usage Has Stalled As Smartphone Users Hit Burnout (Business Insider)

Revealed: Hospital EHRs lobbied for stimulus funding (US)

Man Bites Dog! The New York Times just discovered that not only did large EHR companies lobby for the health records mandatories that were part of the 2009 Federal ‘stimulus’ bill–along with ‘Meaningful Use’ subsidies–but also they also won big in hospital sales. This article focuses on Cerner, Allscripts (which bought Eclipsys) and Epic, and the 60% + gain these companies have made in sales since. It touches on the sticking point of non-interoperability, but not at all on the chaos at the practice level where the Big Three (nor the unmentioned GE Centricity) largely do not play. Here is where 600-odd companies, many of them offshored IT outfits, also around 2005 started to peddle various EHRs which were first software, now cloud-based. It took off after 2009 as well, to primary care doctors worried about Federal regulations–or missing out on years of subsidies and MU payouts. (more…)

MMRGlobal IP infringement lawsuits, allegations continue

Personal Health Record (PHR) patent holder and penny-stock company MMRGlobal [TA 10 Feb] continues to keep law firms in the US, Australia and now Singapore very busy with various complaints of patent infringement, demanding monetary damages, a permanent injunction and presumably, a lucrative licensing deal. Last week, MMRG filed in US District Court, Central District of California against health giant WebMD for their online PHR, claiming that from meetings dating back to 2007, WebMD incorporated “features and functionality that are the subject of MMR’s patents”. Today’s MMRG press release now highlights the Singapore Ministry of Health (with associated health agencies)which MMRG alleges uses PHR vendors which violate various patents–which just happen to be owned by MMRG in Singapore.  (more…)

Telecare Aware Updated

Notice: The site was migrated to more secure software yesterday.   There are some known problems, particularly with video links, but these will be fixed soon.

Other than those, if you are browsing the site and find any links that no longer work, please email me a note of the item you found them in.  Thank you for your patience. Ed. Steve

This ‘n’ that in the news

Two new reports from mHealth Alliance highlight research gaps, misdirection: While not related to the recent PLOS Medicine meta-analyses, both mHA reports criticize the lack of rigor and quality study designs. The first critiques current mHealth efforts in the maternal, newborn and child health (MNCH) area; the second surveys the global mHealth ecosystem, with the preponderance of projects in sub-Saharan Africa versus Asia and Latin America. FierceMobileHealthcare (links to both reports) PROST8CARE text service supporting prostate cancer patients: Messages from side effects to food and diet tips will be timed with treatments to help advanced cancer patients as they undergo chemotherapy. Developed by Mobile Commons with sponsorship by Sanofi US and the Prostate Cancer Foundation….Your smartphone may help manage chronic pain: A Norwegian study of smartphone-enabled interventions of 112 subjects during chronic pain rehabilitation, using written daily diaries for four weeks with therapist review and one in-person session, indicated improved and sustained self-management. FierceMobileHealthcare, Journal of Medical Internet Research full text article... iMPak Health adopting HealthSaaS Connected Outcomes Platform: This will link the Kraken medication management system to mobile apps. HealthSaaS will also work with this JV between the Meridian Health System of central New Jersey and Sweden’s Cypak on mobile apps that forward patient biometric data to the iMPak Connect Portal currently in development. Release….Update on Philips’ next-gen PERS, Philips GoSafe: Premiered at CES 2013 [TA 11 Jan], this cellular/GPS/fall detector (AutoAlert) model will now hit the US market in late March. As previously reported, Philips will be selling the system direct to consumer outright for about $150 with $50/monthly for service. It’s an upper-end product meant for a younger, more active market. LeadingAge.

Engaging the patient: a tutorial

From a physician’s POV (point of view), ten points on how to best engage patients–and only the last five involve technology. David Lee Scher, MD’s Digital Health Corner continues his series of ‘fives’ with Five Ways of Achieving Patient Engagement: Part 1: WITHOUT Technology and Five Ways of Achieving Patient Engagement: Part 2: WITH Technology. Part one focuses on communication (including Twitter, though the psychiatrists just ran out the door…) and that technology is an adjunct tool, not a ‘solution’, must include the caregiver and must be connected. Key insight: smart health tech developers include patients and providers in all phases of development.

DocCom awarded grant by the Technology Strategy Board (UK)

DocCom has developed hospital-based social networking software and has been awarded a grant of £207,000 by the Technology Strategy Board (TSB) to accelerate its development. The aim is to improve clinical workflow by sending alerts and responses directly to clinicians’ smartphones. DocCom’s founder and Managing Director Dr Jon Shaw said “As a doctor, I have experienced first-hand the difficulties that clinicians face in accessing clinical data in an efficient and timely fashion – and the dire results that lack of clinical data can have for patient care.” Rather dire press release: Enterprise social networking for healthcare leader DocCom awarded Technology Strategy Board grant.

Getting into a state of BioZen (US)

From those wonderful folks who brought you the ‘Apps for the Army’ (A4A) 2010 winning T2 Mood Tracker [TA 13 Aug 10] is the BioZen. The latest development of the Department of Defense’s (DOD) National Center for Telehealth and Technology (T2) connects multiple sensors–electroencephalogram (EEG), electromyography (EMG), galvanic skin response (GSR), electrocardiogram (ECG or EKG), respiratory rate, and skin temperature–to a free Android app to help the user master therapeutic biofeedback. Along with physical measurements are brain wave measurements for tracking and cognitive states, with the app automatically generating graphical feedback. BioZen, The Biofeedback Mobile App (Armed With Science) BioZen T2 page  Updated Armed With Science feature 28 Feb provides updates on T2 Mood Tracker.

Interactive help with dental hygiene (Gremany)

For most of us, brushing our teeth is part of the daily routine; though we may not brush to our dentist’s standards, we generally get the job done. For someone with learning disabilities or dementia, the routine can be filled with gaps, leading to loss of dental (and other) health. This bit of artificial intelligence dubbed TEBRA monitors each of the many steps in tooth brushing and helps guide the user when a step is missed. Developed by a team at Germany’s Bielefeld University, it’s currently in test locally and will be presented at the International Conference on Health Informatics in Barcelona, Spain next week. This is a possible model for other behavior guidance systems–perhaps a partnership between TEBRA and the HAPIfork? Time to rinse! AI assistant helps clean your teeth (New Scientist) Hat tip to TANN Ireland’s Toni Bunting.

Six misperceptions…or perceptions?…of telemedicine

The usually quite articulate CEO of the American Telemedicine Association (ATA) needed to get “rewrite!” or call for an “editor!” before posting this article in mHIMSS. The way this reads initially, you expect six misperceptions to be cited (in bold) and refuted. Instead, each point states the corrected perception, then explains. This tends to ‘oatmeal’ his valid points, especially #3 (healthcare professionals are not the enemy–take that, Vinod Khosla!), #5 (which disposes of the ‘better mousetrap’ paradigm) and #6 (consumer expectations for payment of serious healthcare services (vs. fitness apps). No one expects CEO Linkous to be quite as er, feisty, as your Editors or as sardonic as The Gimlet Eye, but the setup carried through would have made his points far more vivid. Six misperceptions about the telemedicine market