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

Cambridge Community NHS Trust tenders for WSDII Local (UK)

On the face of it in these tight financial times it’s an odd move for Cambridge Community Services NHS Trust to plan to spend up to £50,000 on an evaluation of its telecare and telehealth service, especially when it is considered to be a competent one that, in 2011, generated cost savings for social care of £595,049 to £661,165 and £15,089 to £16,765 per patient in NHS costs. But the documents announcing the tender (here and here (PDFs)) makes clear the reason for the study: despite their efforts over the years there is resistance amongst local practitioners to make greater use of it and the service perceives that only LOCAL cost-effectiveness data will bring about a change of attitudes.

They have looked at the shortcomings of the Whole System Demonstrator (WSD) programme structure as revealed by its subsequent analysis and are aiming to improve on that. TA’s favourite statistician gives the thumbs up that the proposed analytical methods are appropriate and – notwithstanding the decision to refer to telecare provision as telehealth – we think it is a good and brave move to invest in this evaluation…and a nice chunk of consultancy work for someone, even if the available funding is going to be tight to do it well.

The closing date for expressions of interest is Friday next week, 22nd February. As we are as keen to see the results as they are, let’s hope the 20-month timetable holds.

Chubb launches flexible telecare hub unit ‘CareUnity’ (UK)

“Thanks to clever integrated technology, there’s no need for further investment in additional equipment if or when the user needs to upgrade. This is a major cost benefit” says David Hammond, General Manager, Chubb Community Care in the press release (PDF). The unit features multiple emergency numbers and a ‘beep to talk’ pendant that allows the user to communicate with a monitoring centre even if unable to speak or hear. It is “easy to install and is compatible with all monitoring centre equipment. A touch keypad integrated into the rear of the unit allows for simple set up and function programming.” There are Braille button identifiers for vision-impaired users and CareUnity is available as a standard telecare unit and as a ‘Plus unit’ capable of monitoring up to 41 kinds of different radio alert. As care needs change, plug and play technology will make it quick and easy to add new types of alert devices.

Chubb CareUnity Hub

Telecare and call system integration (Canada)

Telecare and sensor-based monitoring may now be occupying a smaller, quieter corner of the health tech boom, having been through its own hype curve, but worth noting is the story of Vigil Health Solutions of Vancouver BC Canada which has concentrated on sensor-based support of dementia patients living in assisted living ‘memory care’ areas, hybrid call systems and bed monitoring, hardwired systems, perimeter monitoring and resident check-in. Steve Moran’s interview with CEO Troy Griffiths touches on tech that looked like it met a need, but proved impractical; the need for unobtrusive assistance to improve the quality of life for residents with dementia; the fragmented marketplace in call systems; system integration difficulties; how Wi-Fi is not proving ideal for networking; and how fall detection is still the out-of-reach Holy Grail. (Caveat–Mr. Moran is with Vigil but also blogs on a wide variety of topics on his Senior Housing Forum) A perspective on Emergency Call Systems and Senior Housing Technology

Worcestershire’s 3ML Pathfinder tender “a step in the right direction” (UK)

eHealthInsider’s Lis Evenstad casts a jaundiced eye over the prospects for the 3ML target of 100,000 new users this year in an item Pathfinders losing their way. There is a strong signal in the item that the Pathfinder sites will now be regarded as being on target if they just get contracts in place. Given the reaction on Telecare Aware to the Worcestershire tender documents we hope that the quote from Chris Wright, the Department of Health’s programme manager for 3millionlives, that the Worcestershire tender for a managed service was “a step in the right direction” is just the official line and not what he really believes.

Oh, hang on, “a step in the right direction” can mean almost anything from ‘It’s really good’ to ‘It was a mess but it’s a start’. Yes, it’s a good phrase for an official line! As 2013 moves on it feels like the 3ML ground is getting softer and softer. Let’s hope it does not turn into quicksand. Ed Steve.

Is it Hope? Hype? Or just the Same Old Struggle?

Here on the US side of all things teleHealthy, mHealthy, dHealthy or just plain Health Techy, a Silicon Valley company called Jawbone, best known for its Bluetooth phone accessories and a single foray into tracking with UP, has acquired, at a price no one seems to agree on, the breezily and Big Data-ly named Massive Health. Massive’s one, heavily huzzahed contribution to the Healthy World was an app called Eatery, which would somehow decipher from snaps of your eats your habits and where you could change ’em. Jawbone, Massive–all Silicon Valley rock-star led, with veritable brass bands of hype marching behind (see GigaOM’s report). There’s a ton of press and interpretation of this acquisition being hotly debated in various forums, notably:

  • Neil Versel’s take in Mobihealthnews with his proposition that direct to consumer (DTC) beyond fitness and the ‘worried well’ is not where the money is, and that most of these heavily hyped companies would not know healthcare from their cocktail quiche. Economics and human behavior rules; he pits Massive vs. TV reward program Viggle.
  • David Doherty at the 3G Doctor Blog analyzes Neil V. point-by-point and counterpoint (in defense of Neil, to my knowledge he does not edit Mobihealthnews, and his views are often at variance with many companies covered more glowingly by other contributors)
  • David Shaywitz, MD over in Forbes puts the SV Hype Machine on the dissection table, noting the well known tendency of VCs to celebrate their exits (no matter how much cash went circling down the drain) and presents a little hope for DTC at the end.

Editor Donna (@deetelecare) is on the side of the wary and the plain ol’ weary: of the endless hype; of ‘better mousetraps’ beating paths to someone’s door; of VCs with their ‘plays on health’ (hat tip to Neil); of those who willfully ignore that the customer has ‘Who Cares’ stamped on their forehead and jolly well insists on doing things for their reasons, not yours; of developers not bringing skeptics (marketers, clinicians, your neighbor, Aunt Sadie) in at the start and frequently therein to kick holes in the proposition. It’s detrimental to real implementation whether B2B or B2 the end user. Thus it remains the decidedly unglamorous Same Old Struggle to make it work, get the direction right, get it funded, help a few people along the way and especially, not believe your own press releases. Also see initial (and revised) reporting in TechCrunch.

‘Patent trolls’: will they pounce on your company?

Ray Felts of crowdsource patent-research company Article One Partners shines a spotlight, along with mHIMSS and your editors, on the plague of what he terms ‘patent trolls’ attacking early-stage companies. Trolls are defined as non-practicing entities (NPEs) that don’t actually create or market products. Rather they buy up patents for licensing purposes and to collect related fees, but their real business is, in Mr. Felts’ words, holding up startups for settlements:

“The patent troll threatens to sue for significant royalties. The financial threat, business distraction and cost of defending the company disposes the startup to a lower settlement. Faced with possible ruin, the venture-backed company agrees to a tidy settlement of $20,000. If they instead choose to engage in a legal battle, the settlement threshold goes up, forcing them back to the initially intended amount. In the end, the startup takes the path of least resistance, and the NPE makes it up on volume.”

It also builds the war chest of the NPE to go after bigger fish, if they choose. (See related article below for example).

According to Mr. Felts, last year NPE litigation cost tech companies $29 billion, up more than 400% from 2005. For instance, Lodsys, a patent troll, has settled with 150 iOS app developers to date.

However there is hope for small companies. Knowledge is power, and he cites the Electronic Frontier Foundation (EFF) as a resource; a must read for any developer is its original work on how the US patent system is broken–failing in its basic premises with bad patents (e.g. overbroad) that have the paradoxical effect of stifling innovation. University of California Berkeley also has a controversial project on developing a Defensive Patent License to defend members from trolls. Finally, you can obtain patent liability (defense) as well as enforcement insurance (an overview by another law firm here); though not cheap, developers, angels and VCs could consider it a cost of doing business.

In Editor Donna’s view, these holdups by what one can charitably call bottom-feeders must stop, and the US patent system restored to a functional state. What do our readers think? Is a patent troll watching your business now?Venture Beat and reprinted in MedCityNews

Not quite a ‘patent troll’ but a view of an endgame?

Last fall/autumn (23 Oct), we noted that one company has developed the interesting tactic of going after users of health tech to gain fees. This was the curious case of one penny-stock company, patent holder and personal health record (PHR) developer MMRGlobal, sending out 250 letters per week to EHR/EMR users–practices, hospitals and notably pharmacies–to notify them of possible patent violations they were committing by using their contracted system, without licensing fees paid to MMR Global, and offering them licenses. As of late November the total was over 1,000. (FierceEMR, 28 Nov 12)

The evident aim of this fishing expedition was not to collect pennies from petite practices or pills from your local pharmacy, but to collect evidence of use for claims of patent violations from developers and large organizations. According to FierceEMR based on their November release, MMRG has signed license agreements valued at more than $30 million.

Here are the big tunas they are setting on the hook:

  • At the end of January, the company filed suit against Walgreens in US District Court, claiming that Walgreens’ “Manage Your Prescription Service” infringes on MMRG’s patents and seeks not only an injunction but also to collect fees. (FierceEMR, 5 Feb; company announcement 31 Jan)
  • In Australia, MMRG is investigating the National eHealth Transition Authority (Nehta), the federal/state entity rolling out a PHR, for infringement on patents it holds in Australia (The Australian, updated, 12 Feb, MarketWatch press release 5 Feb)
  • Posted 8 February on the MMRG Facebook page, they will also investigate the Microsoft HealthVault/AARP partnership, adapting HealthVault for AARP Health Record, for “any possible infringements”
  • And posted 7 Feb on Facebook, is this company also seeking to go into the insurance business? “Also very close to seeing the day when MMR Patent Infringement Protection is offered as part of underwriters Medical Malpractice Insurance coverage for hospitals.”

The timing is interesting, in that on 9 Jan (press release), they received approval for two more patents (with 57 claims, same as Heinz varieties) to their previous five in portfolio, and the release widely trumpets their global patents/pendings.

In December, Healthcare Holdings Group, a small Florida-based EHR company–one of those 600-odd in the US market–licensed for five years the patents around the MMRG PHR, MyMedicalRecords. This EHR had developed its own PHR and patient portal, AccessMyRecords. The announcement by the HHG CEO was not partnership language:

“In spite of the fact that our two companies regularly compete in the marketplace, we recognize the importance of MMR’s Patent Portfolio as we approach requirements under the HITECH Act mandating the use of Personal Health Records and Patient Portals by 2014. Therefore, for the benefit of our clients and shareholders, we have made the decision to license the technology at this time. Although we approach the market differently, we both have a mission to provide seamless connectivity between patients and physicians.The Agreement with MMR is consistent with HCH’s position to enhance and support industry-wide standardization efforts. HCH will launch its MU-1 compliant EHR at HIMSS13.” (HealthcareITNews, 18 Dec)

Unlike NPEs as defined by Mr. Felts, MMRG evidently seems capable of marketing its own system in conjunction with a licensee, Interbit, announcing 6 Jan that the MMR portal will be used in a Michigan hospital. The company CEO is also very active with governmental entities, based on activities posted on the MMRGlobal Facebook page, which is there for anyone to see with a Facebook account–and will be sitting in the audience for the State of the Union address.

There is a long road between lawsuit and settlement (especially in the US contingency system), but the activities of this company give us a view of a particularly audacious endgame.

IBM Watson’s open for healthcare business, claiming 90% accuracy

IBM Watson, which has been digesting the big data of healthcare for the past two years, is finally going to market with its oncology decision-making tool developed in conjunction with New York’s Memorial Sloan-Kettering and insurer WellPoint. According to Forbes, WellPoint’s chief medical officer Samuel Nussbaum claims that providers make accurate treatment decisions in lung cancer cases only 50% of the time, but Watson can make accurate decisions 90% of the time. WellPoint for now is the sole reseller of Interactive Care Insights for Oncology. Initial customers for the lung cancer application include WestMed Practice Partners and the Maine Center for Cancer Medicine & Blood Disorders. The other tools, the WellPoint Interactive Care Guide and Interactive Care Reviewer, is for WellPoint’s pre-authorization and utilization management, the arcane business of determining fair and appropriate treatment that they will pay (less) for. Watson has also been on a diet; it runs 240% faster on the cloud or a server about the size of a pizza box. IBM’s Watson Gets Its First Piece Of Business In Healthcare (Forbes) After a year of medical school, IBM’s Watson passes first milestone (ZDNet)