EU ahead of US on telehealth

US law firm Epstein Becker Green analyses two key differences between the US and EU regulations affecting telehealth. First they identify the ability of health workers to treat their patients even when the patient moves to another EU state. Second is about getting health insurance companies to cover costs when health services are received abroad – it seems that insurance companies are required to do so under an EU directive whereas in the US cover is mostly state based: E.U. Way Ahead of the Game on Telehealth. Heads-up thanks to TANN England editor Chrys Meewella.

The diabetic experience: the fly in the Quantified Selfing ointment

click to enlargeQuantified Selfers (QSers) maintain that their obsessive practice not only is the be-all and end-all of leading a Healthy Life, but if only more of the hoi polloi would do it, we’d avoid doctors and healthcare costs, the seas would part and we’d bounce to the Gates of the New Jerusalem with a gleam in our eye, driving our Fords with Allergy Alert SYNC. Well, this Eye has gazed Gimlety on this entire Movement for quite a while, to the raised noses of the Healthcare Digerati, and now has found a fellow nay-sayer and nose lower-er in the unexpected pages of The Atlantic. The Eye now slaps the Head for not thinking of the following.

Who were the early adopters of QS? Diabetics. From the late 1970s on, patients were handed glucose meters in the doctor’s office, stacks of reading material and told to go forth and self-manage. Are they happy? Empowered? In control? Au contraire, mon frere!

The fact that diabetics have been doing this for years, and that they largely loathe the experience (author’s emphasis), not only serves as a caution to the vogue of self-tracking. It also offers an opportunity, serving as an object lesson in what works, and what doesn’t work, when people track their health.

Loathing Can Be Quantified as in the 2012 BMC Health-published survey where diabetics told researchers that self-monitoring was the enemy, a Sisypheian task, a perpetual Battle of Stalingrad. No wonder why they are DEPRESSED. The sheer tedium of every day, several times a day, pricking fingers with crude monitors, making the decision on to eat, what, to inject or take pills, meds that get you sick, and never, ever being ‘in balance’, feeling wrong, guilty and scared, would depress The Eye more than sitting through a Jim Carrey movie. Fine to take away a few steps with LifeScan’s VerioSync and iBGStar to send the metering to the smartphone, or to Telcare’s system, and know that hovering in the future may be the non-invasive glucose meter and fully automated insulin pumps that work with your smartphone, but… Thomas Goetz’s point: don’t expect QSing to be a panacea as hyped, do expect that emotional baggage is in the trunk of the car, and that tracking for people is WORK that is really to be avoided. And as Editor Donna continually reminds The Eye, only undertaken when it is a solution to an unavoidable job to be done. And if they don’t see the job… The Diabetic’s Paradox

Your Friday robot fix: senior housing helpers, getting more humanoid

Care Innovations, which has no stakes (thus far) in robotics, highlights what robots can do and change in the senior housing area in this (sponsored) article in Senior Housing News. Featured: the ‘Hector’ assistance robot, developed by the EU’s CompanionAble Project [TTA 23 August]; ‘Monitoring Platform 3.0’  iPad and iPhone mobilizers such as Helios [TTA 2 Oct]; as ‘little armies of telepresence’ for non-emergencies (a small mention of telecare here); solving the worker shortage [TTA 19 May 11 on Robosoft and the Kompaï care robot, which Editor Steve has been following ever since, recently updated] and enabling independence [Robot & Frank, anyone?]

But a problem with more humanoid robots like Roboy is not developing arthritis but an inherent stiffness in the joints. COMAN, from the Italian Institute of Technology (IIT), mixes in compliant joints to make them less so, and safer (pulling a robot off the floor can be hazardous for your joints!) This Humanoid Robot Gets Pushed Around But Stays on Its Feet (IEEE Spectrum) Another hat tip to Toni Bunting, TANN Ireland.

Device vs. Device: a mobile health faceoff

MedCityNews pits unrelated mobile health devices and apps against each other in this series you may have overlooked last pre-holiday week. Some surprising winners in these eight short ‘n’ sweet matchups:

AliveCor smartphone ECG vs. DrawMD by Visible Health iPad app for general surgery patient ed

Related news: AliveCor names new CEO, experienced medical device and healthcare entrepreneur Dan Sullivan (Mobihealthnews)

Gauss Pixel App by Gauss Surgical (FDA cleared) to estimate surgical blood loss vs. BurnMedPro by Johns Hopkins Mobile Medicine

Welch Allyn iExaminer Adapter and app that connects to Ophthalmoscope (FDA cleared) vs HemaGo by NovoNordisk

MobiUS SP1 System by MobiSante, ultrasound imaging system (FDA cleared) vs. DoctorMole app by Mark Shippen

iHealth Wireless Blood Pressure Monitor companion app by iHealth Lab Inc (FDA cleared) vs. iBlueButton by Humetrix

Mobile Mim by Mim Software (FDA cleared) for image sharing vs Smartphone Breathalyzer by Breathometer

Diabetes Manager by WellDoc (FDA cleared) vs iTriage by Healthagen

AirStrip ONE by AirStrip Technologies (FDA cleared) vs Lab Counter by ZappyLab

A ‘shocking’ solution to India’s crime problem?

click to enlargeThree engineering students at India’s SRM Institute of Science and Technology in Tamil Nadu (Chennai) developed and won the 2013 Gandhian Young Technological Innovation Award given by SRISTI (Society for Research and Initiatives for Sustainable Technologies and Institutions) for a body-worn device designed to help defend women in the case of personal attack. The device is a camisole-type undergarment which is wired with sensors and electric shock circuit board at the bosom, insulated by a polymer, with attached GPS and GSM modules. Pressure in the bosom area, consistent with the usual frontal attack, triggers a 3,800 kilovolt shock [likely a notation error–probably 3.8 kV, see Comments–Ed. Donna]  up to 82 times and also activates the GPS.  The designers known collectively as SHE (Society Harnessing Equipment)–Manisha Mohan, Niladri Basu Bal, Rimpi Tripathi, the first and third listed are women–are to be commended.

India’s huge problem with male-on-female crime was highlighted at the end of 2012 with the assault of a young couple in central New Delhi, resulting in his severe injury, her rape and death. It also put an international spotlight on India’s wretchedly poor policing and law enforcement resulting in a reported reduction of tourism by at least 25 percent. The official Indian Government response was tepid at best–including ‘working on’ a prototype safety watch that would take photos and send texts in case of attack. It was TTA’s weekend outrage for 2 February for its ‘sheer howling incompetence’, stimulating quite a reader discussion. And no, this device won’t save or prevent the vulnerable (female and old) from attack, but the electrifying element of surprise may give an edge to the victim permitting a quick getaway. Digital Trends (India), Techpedia India (SRISTI), SHE team profile/submission Another hat tip to Toni Bunting, TANN Ireland.

The ‘virtual reality’ workout and a Spidey-Suit

click to enlargeAdding to the list of VR-driven workout platforms is University of Wisconsin-Madison’s CAVE (Cave Automatic Virtual Environment), which tracks muscle movements while you virtually walk (via goggles) through a room and pick up things. The CAVE researchers are using the EMG tracking information to determine what muscle movements are used in each action. (Hat tip to Toni Bunting, TANN Ireland) Not too far away in Illinois, University of Illinois-Chicago researchers have wired up a whole spaghetti-bowl of sensors from head to toe as ‘SpiderSense’ (left) which enhances spatial awareness–detecting that something is nearby for the visually impaired.

Previously in TTA, VR in physical therapy: Microsoft Kinect, West Health Institute, Fraunhofer, 15 January

GE, StartUp Health select their ‘Lucky Thirteen’

GE Ventures’ Healthymagination and accelerator StartUp Health announced, after a two-month screening process, their 13 (up from 10) companies for their joint three-year program. The 13 recipients will be mentored over the next three years  in exchange for 2 to 10 percent equity ownership by GE and StartUp Health’s Innovation Fund. They are a diverse mix including hand hygiene in hospitals, connecting patients to mental health professionals, integrating non-clinical home care observations into home health, and a device for gait and balance restoration. Short bios on companies via TechCrunch. GE/StartUp Health release (MarketWatch).

Previously on TTA, why GE is getting ‘imaginative’ with StartUp Health: 10 January, 7 March.

NHS needs better vision of digital patients

This item picks up on some of the issues raised by the recent NHS Innovations Expo. To quote one participant “innovations like telehealth can and will come for British NHS users — but only if the emphasis shifts from a focus on long-term care to incorporating it in the day to day running of hospitals, clinics and other patient contact points”. NHS needs better vision of digital patients Information Week UK

Whisper of the heart

Two app-related items spotted by TANN Ireland editor Toni Bunting. Connect the dots with the first to this TTA item and the second has potentially huge implications for understanding heart disease:

Related item on TANN Ireland: Gamifying meditative breathing with the Zen biosensor.

‘Wireless sensor networks’ at $16 billion by 2017

The ON World business intelligence group projects in its latest report that ‘wireless sensor networks’ (WSN) for health and wellness revenues will sharply rise to a 2017 global projection of $16 billion in revenue for 18.2 million systems shipped. This estimate excludes sports/fitness devices, which of late are hard to separate due to capabilities crossover, as we’ve seen with sleep monitoring. The report analyzed over 100 devices (list here) for aging in place, health condition self-management (60 percent of 2017 revenue, almost evenly split between cardiac and diabetes) but  general wellness will continue to lead numerically (41 percent of device shipments) for consumer and clinical use.  The 81 page report is based on 750 individual interviews/surveys with over 100 companies and 300 users, reviews back end comms standards (e.g. ZigBee, Bluetooth, ANT) and market sizing. It will be a tidy $1,999 budget item for a single user. ON World release, order page (including email info for free 12-page executive summary), shipment growth chart. FierceMobileHealthcare article.

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Healthcare BYOD unleashed, and the consequences

A just-published Cisco study estimates that nearly 89 percent of healthcare workers Bring Their Own Device–in this case, smartphones only, so really BYOS. For employers who largely do not subsidize usage, it’s a huge benefit–overall in the eight industries studied, 90 percent of employees receive no subsidy yet 92 percent use their smartphone for work weekly. But the employees don’t bring their own good security practices. In healthcare alone (classed as a ‘sensitive industry’): 41 percent do not password protect, 53 percent access unknown/unsecured Wi-Fi networks and 52 percent don’t disable Bluetooth ‘discoverable’ mode. And this does not include iPads, Android tablets and the like which are also often left unsecured. According to FierceMobileHealthcare, which referenced a late 2012 Amcom Software study, “more than 65 percent of responding healthcare facilities do not have a documented mobility strategy in place. What’s more, 37 percent of the survey’s respondents do not have plans to implement such a strategy in their organizations.”  It makes one long for the days of IT department-issued cranky CrackBerries. BYOD Insights 2013: A Cisco Partner Network Study  Hat tip to David Albert, MD of AliveCor @DrDave01 for the link via Twitter.

Is there a BYOD backlash? Ken Congdon of Healthcare Technology News spoke at HIMSS 2013 on the unstoppability of BYOD and counters the naysayers.

DOD, VA stuck behind the Magic 8 Ball: report (US)

Institute of Medicine, ‘Daily Show’ rap DOD, VA for unlinked EHRs

When the US Department of Defense (DOD) and Veterans Affairs (VA) announced back on 27 February that they would not achieve their major goal since 2009 of a single EHR system by 2017, with initial test next year, for this Editor it was just another billion-dollar ‘fail’ day out of DC. FDA dithers since July 2011 on final guidance on mHealth approval–yawn. Centers for Medicare and Medicare Services (CMS) cutting back rural telemedicine consults–business as usual. Individual health insurance premiums going up 30 percent next year? We knew that was coming! So no surprise here when the Institute for Medicine of the National Academy of Sciences issued a report highly critical of both agencies regarding the needs of 2.2 million Iraq and Afghanistan veterans, with one key criticism the lack of EHR interoperability. According to iHealthBeat:

The IOM report found that:
• 49% of returning veterans have experienced post-traumatic stress;
• 48% have dealt with the “strains on family life;”
• 44% have experienced readjustment difficulties; and
• 32% have felt “an occasional loss of interest in daily activities.”
According to IOM, the federal government’s response to troops returning to the U.S. “has been slow and has not matched the magnitude of this population’s requirements as many cope with a complex set of health, economic and other challenges.”

Neil Versel in his Meaningful HIT News article published yesterday highlighted the EHR single-system fail through, rather incredibly, a Jon Stewart Daily Show video segment called ‘Red, White and Screwed’. (Today, in American life, you know an issue has gone mainstream when it makes a ‘news/comedy’ show such as this or the Colbert Report.) This Editor is no fan for multiple reasons, but to his credit Mr. Stewart has been a strong advocate on behalf of veterans and showcases the failure of veterans’ support regularly on a segment called ‘The Red Tape Diaries’ without sparing a certain Administration from criticism.  Aside from over 900,000 veterans waiting an average of 273 days for their disability claims to be processed, the icing on the cake is how the EHR ‘fail’ was announced. At 3:20 in the video, a Government Accountability Office (GAO) official drily depicts both DOD and VA as perpetrators of project mismanagement and poor oversight. And this is despite a 40 percent increase in budget from the Republican-controlled House, which confounded Mr. Stewart. The criticism goes on from there. Magic 8 Ball says ‘messed up, try again.’  DoD-VA integration failure is no laughing matter, even to Stewart  Hat tip to reader Ellen Fink-Samnick, MSW of ‘Ellen’s Ethical Lens’ for featuring this article on her LinkedIn group. 

Related, ironic note: the DOD’s and VA’s EHRs are respectively called AHLTA and VistA, a nostalgic touch for those of us who used the first real search engine, AltaVista, circa 1996.

Health tech grows…but where are the investors?

Health tech, digital health, wireless health, telehealth, eHealth, mHealth, connected health…while the terminology proliferates, the hype curve grows ever steeper and the conferences/cocktail parties ever buzzier, where is the investment? David Doherty’s identified 16 billionaires investing in health tech, but David Shaywitz writing in Forbes, who’s been up and down the biotech curve, is noting that VCs who should be gravitating to digital health, aren’t.  This is even though they have the most experience scouting the territory: the medical problems to be solved, the stakeholders, the development curve. This isn’t to say that some are actively investing and others are observing the waters–he cites PureTech Ventures, Venrock, Fidelity Biosciences as the former–but when he cites a principal of a major biotech VC openly tweeting a withering view of most ‘digiHC’ (another term!) as without a real business model, ‘more sizzle than steak’ and ‘merely a bubble’ equivalent to (US) cleantech….it’s ‘perception is reality’ time. So before mHealth starts connecting to genomes, some successful exits need to go on the scoreboard first. Life Science VCs: Definitively Indefinite About Digital Health

Perhaps too much of consumer directed health tech focuses on how novel it all is–which can sell in the short term–with an emphasis on low-cost apps and Quantified Self trackers. But neither right now, with a few exceptions, have the push from the physician–and their advocacy requires multiple steps to achieve: awareness, trial, validation and support. Also from ForbesDigital Health Strategy: From Novelty to Necessity. An overview of how this can work for apps is what Happtique has accomplished to date in establishing standards, a certification program and a platform to facilitate physicians in prescribing apps and backing them up with patient educational materials. App Prescribing: The Future of Patient-Centered Care (Health Care Blog)

Tunstall, world leader in telehealthcare, starts to evangelize the USA

We are interested to note that Tunstall is starting to claim the term ‘telehealthcare’ in the USA just as we notice it starting to downplay its use in its recent UK marketing materials in favour of ‘telecare and telehealth’. (In the UK the term ‘telehealthcare’ gained ground in general usage in some parts of the country after Tunstall started to use it and, as no other major suppliers used it, they succeeded in owning it in the way that a team which has the ball in its possession ‘owns’ the ball.)

How do we know that Tunstall is about to do its telehealthcare thing in the US? Read this press release: Telehealthcare Leaders Forum Welcomes Assoc. Chief Medical Officer at Northwestern Memorial to Speak About Healthcare Innovation. American and Canadian readers will be highly amused to learn that “The Telehealthcare Leaders Forum is North America’s only educational and professional event dedicated to stimulating innovation and leadership in the emerging era of technology and healthcare delivery.”