What it takes to deliver sustainable global health: sustainable financing

The mHealth Alliance and consultant/research company VitalWave have published a globally-oriented study detailing what holds back mHealth from scaling up in low to middle-income countries, centering on financing. Hundreds of projects are in the field, but practically all are dependent on short-term financing or grants, and few have viable plans beyond the next grant. Projects also by their nature are stand-alone and don’t integrate in their design and delivery with other often similar projects. This study evaluates five financial models and transferring from external funding to a revenue stream from buyers. Case studies include VillageReach (maternal SMS/phone support), Switchboard (free calling network for health workers), Sproxil (drug verification), SMS for Life (SMS for anti-malarial drug distribution) and Changamka (affordable health care). Sustainable Financing for Mobile Health (42 pages)

Smart tech=dumber people?

click to enlargeIs the real goal of ‘smart gadgets’ not to help solve our problems or keep us from harm, but to fix, per the Google paradigm, the “broken” place that is the real world and the bad behavior of fools like us? (For example, not recycling properly, having too much trash, eating too fast,  too much chocolate? Then tattling to our Facebook friends so they can chide us?) Evgeny Morozov, in this discomfiting Wall Street Journal article, cuts through the Silicon Valley hype around gadgets that marry cheap sensors, software and social networks to ‘nudge’ (that hateful word)/reward/shove us to the New Jerusalem of social engineering and some developer’s nannyish idea of ‘better behavior’. Yes, there are ‘good smart’ devices that help us make decisions, lifesaving tech such as gait sensors that monitor the elderly for propensity to fall, and breath analyzers that cut the car’s ignition when the driver’s had too much alcohol, but these are being drowned out in both the public consciousness and the VC wallet by shame-making trash cans and HapiForks. Rather than empowering us, it may be… Is Smart Making Us Dumb?

Another perfect example of condescension to the end user is observed in Google’s Sergey Brin’s recent remarks during his endless flogging of Google Glass, now just Glass. Now looking down at your smartphone is ’emasculating’ (interesting choice of words) because you are ‘walking around hunched up, looking down, rubbing a featureless piece of glass’ rather than interacting. Aside from the fact that you can put it away, and that Google’s made a fair amount of coin from Nexus smartphones and tablets, it’s obvious that Glass is meant to be worn ALL THE TIME, serving up whatever Google wants you to have ALL THE TIME. Surely the California TEDx folks raved at this maximum cool, but this Editor is skeptical that this world will be actually be better with all Google, all the time. In other words, enough. Google’s Sergey Brin rips smartphones, shows off Glass (Computerworld)

Rewiring the brain through electrical stimulation on the tongue

click to enlargeWe don’t think much about it, but the rich network of nerves (and musculature) on the human tongue is also a direct route to the brain.  Now the U.S. Army Medical Research and Materiel Command (USAMRMC), collaborating with the University of Wisconsin-Madison and the NeuroHabilitation Corporation is developing and testing the Portable NeuroModulation Stimulator, or PoNS, for treatment of brain injury and related disease: TBI, stroke, Parkinson’s and multiple sclerosis. The PoNS is an electrode-covered oral device which is used for 20-30 minutes of stimulation therapy, called cranial nerve non-invasive neuromodulation (CN-NiNM). Specific stimulation patterns are paired with physical, occupational, and cognitive exercises customized for each patient. Effectively it helps to rewire the brain’s neural pathways and mitigate damaged functioning. NeuroHabilitation will be commercializing it but the US Army is testing it at hospital and veterans’ facilities, and will be spearheading FDA approval. Three articles with different looks at this: the US Army website, Popular Science and GizMag.

Health apps finally get a certification body (US)

Happtique has now published the standards it will use to certify apps under what they have dubbed the Happtique Health App Certification Program (HACP). The published final guidelines include both the Certification Standards and associated Performance Requirements, which assess operability, privacy, security, and content. Happtique, a subsidiary of GNYHA Ventures, has also brought in initial HACP Partners to serve as subject matter experts for evaluating apps: the Association of American Medical Colleges (AAMC), CGFNS International, and Intertek. While Happtique is not yet ready to evaluate medical, health or fitness apps, companies can register for a submission form and be notified when the application portal is opened for submissions.

Effect of telehealth on quality of life: Another WSD research publication (UK)

Quick on the heels of the telecare study from the Whole Systems Demonstrator (WSD) Programme reported here today, comes another research report, this time from the BMJ: Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial.

Here are a few quotes from the abstract:

Objective: To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions.

Conclusions: Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients.

So can we now not even say ‘Never mind the business case, that can be improved – it’s very good for patients’ sense of well being’? Heads-up thanks again to Mike Clark who is keeping an updated list of the reports as they are published.

UPDATE Thurs 28 Feb: Pulse does its usual thing with this study, but note the comment from the GP at the end: DH-commissioned report finds telehealth fails to improve quality of life.

February Telecare LIN newsletter published (UK)

Out now, the February edition of the Telecare LIN newsletter. It, together with the separate supplement, contains “over 1200 news and events links over the last month” and a reminder that if you have not registered for the ALIP showcase event in Liverpool on 5/6 March or the Healthcare Innovation Expo on 13/14 March you need to act quickly. The newsletter has more details. PDF newsletter. Links supplement. NHS reforms supplement.

Good Governance Institute: Telecare QA programme for Birmingham report (UK)

The Good Governance Institute (GGI) has been working with Birmingham City Council (BCC) to develop a quality assurance programme for Birmingham’s  telecare service. In October 2011 Birmingham contracted with Tunstall to increase its user numbers to 25,000 (now 27,000 according to the latest press release) in three years. Independent quality assurance was part of the commitment then. [TTA Oct 2011] The GGI has now published a report Birmingham Telecare Service: Establishing an independent quality assurance process which “documents in full the first stage of this work, and the framework for the ongoing programme.” Although dated October 2012 it has only just been cleared for release. This may be of use to the 3ML Pathfinder sites as well as telecare services. The GGI also has some user interviews on video, here. Download the report here (PDF)

Effect of telecare on use of health and social care services: latest WSD findings publication (UK)

The latest journal article containing results of the Whole System Demonstrator (WSD) programme has just been published and the conclusion is “Telecare as implemented in the Whole Systems Demonstrator trial did not lead to significant reductions in service use, at least in terms of results assessed over 12 months.” We note the “as implemented” caveat. Article, from where it can also be downloaded as a PDF: Effect of telecare on use of health and social care services. Age and Ageing. Heads up thanks to Mike Clark.

UPDATE: 6 March 2013. The GP paper Pulse’s take on the study: No evidence telecare can cut costs, says DH-funded study.

Microsoft Surface dives into mHealth, telehealth tablet market

“Not only Lync but Skype as well are becoming fairly predominant platforms for what I call ‘commodity’ telemedicine and telehealth services,” Dr. Bill Crounse, Microsoft’s senior director for worldwide health, told Pulse IT Magazine during a promotional visit to Australia. “We are seeing amazing progress at an institutional level, with people understanding and mapping out where are their patients coming from and how far are they travelling. How can we leverage this technology to better serve that population [of] patients who are being asked to travel three hours across town for a snippet of information or reassurance, when in fact this technology can be applied.”

It’s a good point, but as EHR Intelligence goes on to point out: ‘In contrast to the iPad mini, which fits neatly into lab coat pockets and has the advantage of millions of apps in the mature Apple ecosystem, the Surface Pro is a bulkier product, weighing in at two pounds and saddled with an $899 price tag. In the era of bring your own device (BYOD) healthcare, Microsoft faces an uphill battle when it comes to attracting individual physicians looking to pick up a supplementary device for their office work.’ EHR Intelligence item: Microsoft Surface dives into mHealth, telehealth tablet market.

What a difference a phone makes!

The BBC Media Action charity (formerly the BBC World Service Trust) has published an excellent – of course – ‘policy paper’ on the use of mobile phones in healthcare for “poor, illiterate and marginalised populations”. It says “…there is enough experience – and the beginnings of an evidence base – to argue that mHealth deserves serious attention from any development actor seeking to improve global health.” Not only that, it is possible for it to “scale in a cost-effective, financially sustainable way”. Download the 24-page PDF here: Health on the move.

Fast Company: not quite as fast as TA

click to enlarge The Gimlet Eye is not so much squinting at Fast Company’s 2013 ‘The World’s Top 10 Most Innovative Companies in Healthcare’ , but wondering what took them so long. Your diligent Editors picked up on some of these top innovators back in early days:

#1 Sproxil’s first mention here was March 2010; Editor Donna also interviewed Alden Zecha, CEO of Sproxil, at the Mobile Health Expo in Nov 2010

#4 Proteus was first mentioned here in September 2009 (back when the whole notion of tracking pills in the body was ‘creepy’)

#6 GE Healthcare–the laptop-portable Logiq scanner is all well and good, but The Eye wonders what happened to the portable handheld ultrasound Vscan, used heavily at the 2010 Winter Olympics?

#9 TelaDoc profiled by Editor Steve in June 2008 and (unhappily so with their press releases) in August 2008

Those which have escaped scrutiny, but should be in our scope, are #3 D-Rev and #5 Dexcom.

(Editors: Nobody’s perfect!)

 

PHRs, ‘meaningful use’ and patent infringement (US)

MMRGlobal CEO Robert Lorsch’s interview by HIStalk today is a fascinating follow-up to our recent stories in several areas. First is the story of how he came to found MMRGlobal, and how this personal health record (PHR) stores both electronic ‘hard copy’ and user-entered health history data which is generally accessible. It is a little different than Microsoft Health Vault or the late and unlamented Google Health, with access based on a 10-digit telephone number ‘lifeline’ and a subscription model. MMRG claims 750,000 members to date. While MMRG’s legal track record has raised quite a few health tech industry eyebrows almost to the hairline, your Editor has to admit their actions are quite different from your usual non-operating ‘patent troll’ which preys on vulnerable early-stage companies [TA 10 Feb].  MMRG’s big legal actions are to hook ‘big tunas’–Walgreens, WebMD–plus ‘investigations’ of the Australian and Singapore Governments, based on its seven US and international patents building up in their portfolio since 2005. They have also announced similar scrutiny of Microsoft and AARP for their projected joint PHR. [TA 10 Feb, 20 Feb]

But…there’s more. Mr. Lorsch proceeds to draw the proverbial line in the sand for hospitals and practices which intend to achieve Stage 2 Meaningful Use (MU) compliant EHRs this year into 2014. Stage 2 MU has at least five core measures that depend upon patient access, one of which requires a patient-facing portal that permits viewing, downloading and transmitting their own health information.  (Useful bite-sized explanation by Dr. Rowley at HITECH Answers.) MMRGlobal is taking the stance that they believe that any of these portals which store information, or are full PHRs, infringe on their patent portfolio:

If somebody complies with that Stage 2 Meaningful Use, we believe that they will infringe on one of seven patents that we have issued in the US Patent Office an additional patents that we have issued in 12 additional countries around the world. What we have done is we’ve gone to the hospitals, providers, vendors, laboratories, and we’ve said, “Look, if you’re going to comply with Stage 2 Meaningful Use or you’re going to offer products and services that enable healthcare professionals to meet Stage 2 Meaningful Use, they’re probably going to infringe on one of our patents.”

We’re suggesting that they license those patents at very reasonable license fees, such that whatever they decide to do to comply with Stage 2, Stage 3 Meaningful Use, they have a license – a safe harbor — that they’re grandfathered in, where they never have to be concerned about infringement on any of our patents or other intellectual property. If those same hospitals say, “Are there any other ways to address this?” they could also use our products — our MyMedicalRecords products, our professional products — which are embedded with licenses for the technology.

The interview then proceeds to the money points: how hospitals, especially non-profits, and associations can ‘reasonably’ (again) pay to MMRG (or negotiate on behalf of members) those licensing fees, or simply buy the MMRG PHR.

Which leaves this Editor with a question: these systems are supplied by major companies: Cerner, Epic, McKesson, GE. The hospitals and large practices are only system users, albeit with considerable user HIT customization. If the PHR is part of the Epic, Cerner (etc.) system, and the hospital buys the system, isn’t the true source of the patent infringement the supplier, not the end user? Or is this MMRGlobal’s strategy to avoid being a snack for some very large and aggressive sharks? It remains….fascinating. HIStalk Interviews Robert Lorsch, CEO, MMRGlobal  Hat tip to reader Vince Kuraitis via Twitter.  Also to be noted are the on-fire comments under the article which clarify many of the US patent issues, and possible defense strategies which hospitals and associations/groups may follow.

Update 28 Feb: The latest MMRGlobal pre-HIMSS press release announces ‘going mobile’ with their own wellness app, built with MyVitaLink (note that website indicates a restructuring) that ties into their PHR, and their collaboration with Alcatel-Lucent. Second graph puts mobile companies on infringement notice.

 

Aetna introduces Healthagen brand for health tech, ACO businesses

US health insurer Aetna announced Friday a new business unit under a name not used since 2011–Healthagen, the name of the company that developed the iTriage consumer symptom research/health provider locator app purchased by Aetna in December of that year. In the Healthagen division will be current units that were grouped under the less smartly named Aetna Emerging Business:  iTriage, ActiveHealth Management (population health management), Medicity (health information exchange), Practice iQ (to transition independent physician groups into value-based care models) and a slightly rebranded Accountable Care Solutions (ACS) from Aetna (large hospital systems, integrated delivery networks/IDN and hospital ACOs). The formal premiere will be at the HIMSS annual conference in New Orleans, 3-7 March, along with a new Healthagen website to follow. According to Aetna SVP Joseph Zubretsky, over $1 billion was invested to acquire and build the Healthagen businesses. New titles as well: Emerging Businesses CEO Charles E. Saunders, M.D., is now Healthagen CEO; in addition, Nancy Ham recently joined Medicity as CEO. As a ‘pointer to the future,’ it indicates that this insurer is willing to establish a separate brand and division that represents connecting, not siloing, services and tech that benefit both providers and consumers–and to keep the identity fairly, but not wholly, separate from Aetna. They also did not let a good coined name they own go to waste. Aetna press release

Related reading: Neil Versel in InformationWeekHealthcare

Bosch Healthcare, GreatCall strategically partner (US/Canada)

Last week, Bosch Healthcare in the US announced a strategic partnership with GreatCall, best known for its Jitterbug simplified mobile phone/call plans and 5 Star mobile-based urgent response/PERS services targeted to the senior consumer. The joint offering is to be rolled out later this year (Bosch/GreatCall release). Bosch’s mobile moves should come as no surprise to our readers, who learned late last fall that Bosch had developed a similar mobile strategic partnership with Doro, the GreatCall of Europe, for Germany and Switzerland initially [TA 16 Nov 12].  Bosch US also added a partner last fall in the hot area of medication compliance, MedMinder, whose Maya mobile-based medication reminder system is integratable with Bosch’s in-home Health Buddy and their T400 clinical Telehealth System [TA 26 Oct 12].  You could say that this indicates that Bosch is ‘mobilizing’ its monitoring into consumer-friendly platforms both in North America and Europe.

Update 27 Feb: David Doherty pointed out on his mHealth group on LinkedIn (members only) that judging by these moves, Bosch is positioning itself as a substantial ally to mobile companies seeking to add telehealth features, which has proved to be a sticky issue for the latter. (Editors’ note: if you are a LinkedIn member and not a member of David’s mHealth group, we recommend joining it for the topics and discussions.)

Related: On his mHealth Insight blog yesterday, David notes Doro’s survey indicating that 50% of over 65+ are interested in smartphones. As a result, Doro is introducing a featurephone that incorporates cloud-based smartphone features, along with an secure online control portal accessible by the user and authorized others. This contradicts the direction that mobile companies are taking here in the US:  the target market for smartphones ends at about 45, so load up those smartphones with complexity, incomprehensible apps (‘cool stuff’) and expensive plans.  If applicable to the increasingly saturated US market, there’s an opportunity to open up the market by taking down barriers–phone, plan cost, visibility and ease of use, adding off-phone control access. Is this a message for GreatCall?  

UK doctors give thumbs down to ‘remote care monitoring’

The British Medical Association’s (BMA) General Practitioners Committee (GPC) has written to the Department of Health (DH) with an analysis of the results of a consultation exercise and the surveying it has done to assess GPs’ views on the effect the forthcoming changes to their contract will have on their services. The relevant points for people who wish to promote telehealth remote monitoring are paragraphs 47 – 55, starting on page 13 of the BMA’s letter to DH. (PDF) Basically they are saying ‘It’s too difficult; we don’t believe it helps ease our work or that patients like it; so we can’t be bothered and please re-think making us do it.”

However, this reaction has to be seen in the context of the response as a whole. The BMA (as the doctors’ ‘union’), has a particular need to spin the results in the most negative way and the survey was undertaken at a time when GPs’ morale has been low and, on page 1, the BMA summarises the complete findings as:

“An overwhelming 88% of GPs responding to our survey with some awareness of the proposed contract imposition agreed with the statement that they personally will be less able to offer good quality care to their patients as a result of this imposition. Of the 58% of GPs who said they were prepared to take action and who expected to make changes as a result of the imposition:

54% said they expected their practice to have to reduce access to patients.
– 91% of these said that GPs would not be able to see patients for routine appointments as quickly as they currently do
– 72% thought they would have to reduce the number of consultations offered to free up time for the new workload
– 75% expected to reduce the range of services offered to patients.
82% expected to have to make changes to staff working hours or employment
52% expected to reduce their use of locums

Heads-up thanks to Mike Burton.