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.

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 (  App Usage Has Stalled As Smartphone Users Hit Burnout (Business Insider)