Telemedicine consults save money, time: two-year study

A two-year (2010-12) study published in Health Affairs of 40,000 online consults via Minnesota-based integrated delivery system/insurer HealthPartners found that they reduced billing by an average of $88.03 per case (average cost: $40) and saved about 2.5 hours per patient. Patients were seen through the system’s 24/7 Virtuwell online clinic for 40 different primary care conditions, with the three most frequent being sinusitis, urinary tract infections and conjunctivitis. However, Virtuwell does not use video practitioner-patient consults, instead walking patients through an online automated interview about symptoms, medical history, allergies and medications. Then a nurse practitioner reviews each patient’s information and sends a treatment plan in a secure message, a process taking about 30 minutes. A phone call with the nurse is optional. Other results: no real increase in visits, and an episode resolution (no face-to-face visit) rate equivalent to ‘minute clinics’ at 89% to 95%. This sounds like an attractive template and option for concierge medicine, IPAs, ACOs and insurers, but needs to work around cross-state regulations. Neil Versel in Information Week, iHealthBeat, link to study abstract (Health Affairs)

Healthbox Accelerator: applications open (US/UK)

New to Editor Donna is healthcare technology accelerator Healthbox. Perhaps uniquely, they are based in US and UK–Boston, Chicago and London–with partners in all three cities; a partial list is (US) Blue Cross Blue Shield Massachusetts, Express Scripts, Ascension Health (US largest Catholic health system), California HealthCare Foundation, Walgreens and (UK) Bayer, Bupa, Guy’s and St. Thomas’ Charity, and Serco Health. In its first year, Healthbox has fostered 27 companies to refine their offerings and gain market traction including investment (portfolio companies). According to Healthbox spokesperson Abbie Ginther, the highlights of what participants receive in the 16 week program is:

  • $50,000 in seed capital
  • Strategic guidance and mentorship from leading industry experts as well as business veterans
  • Participation in Innovation Day, an event bringing together hundreds of investors, healthcare leaders and entrepreneurs to hear from the companies and how they are bringing innovative solutions to healthcare needs
  • Collaborative, open workspace for companies to use for the duration of the program

They are currently accepting applications for its 2013 programs starting with their second Boston program starting in March. Application deadline is very tight here (10 February), but applicants for London/Europe (start date TBD in spring) can register on the same link. Applications

Organizing the ‘quantified self’

gimlet-eyeThe Gimlet Eye and Editor Donna were just chatting about organizing the tidal wave of email we receive every day, when over the transom floated startup Tictrac (a takeoff on TicTac breath mints?), a ‘lifestyle monitor’ that will organize All That Data for the Determined Quant. It synchs with over 45 services, including Fitbit, Facebook, Runkeeper and Withings, to not only aggregate and correlate data (e.g. to high email use) but also manage goals such as losing weight. Not only that, it will connect the dedicated quant to outside sources such as coaches (who undoubtedly will pay per connection.) But will it organize email, mitigating our (unmeasured but very real) stress? This Startup Measures How Much Stress Email Gives You, And Helps You Reduce It (Business Insider)

Nurturing a startup culture in healthcare

Healthcare accelerators (Blueprint Health, StartUp Health, RockHealth) have lately gained most of the buzz, but incubators and ‘labs’ have been where many companies have gained their start. Phoenix, Arizona has entered the fray with SEED SPOT, featuring three healthcare-related startups among 16. While they may be able to serve up their companies ‘piping hot’ into a lower cost, supportive environment, chilly New York City has the opposite situation. Even with the advantages of world-class academic and healthcare resources, it’s been a forbidding setting for startups for years with money and attention going to e-commerce and financial businesses. The Bio & Health Tech Entrepreneurship Lab, backed by the New York Economic Development Corporation (NYCEDC), intends to change this with a first class of 20 startups. Their technologies are along a broad spectrum including wound healing, genetic testing, imaging, diabetes treatment, big data for genomics and mHealth for high-risk patients. SEED SPOT incubates health startups in Phoenix (Forbes) NYC-backed health startup lab wants to turn academics into entrepreneurs (GigaOM) Bio & Health Tech website

Scaling telehealth programs: lessons from early adopters

The Commonwealth Fund, a foundation that supports health care research and makes grants to support practices and policy, has just published a compilation of three telehealth case studies from the Veterans Health Administration (VHA), Partners HealthCare/Center for Connected Health and Centura Health at Home dating back to 2004. These concentrated on reducing preventable rehospitalizations and used various aspects of telehealth/remote patient monitoring (RPM). The VHA’s was the most comprehensive (with best results in depression and mental health), Partners focused on cardiac and Centura on congestive heart failure, pulmonary and diabetes. While Commonwealth’s main point is the lessons to be learned (disruption of the status quo, the changes in processes and the time to scale), this early data is interestingly not well known–and should be. Overview, compilation PDF (note the overview has links to the full individual case studies)

Geonovo’s high performance digital telecare platform (UK)

Back in November 2011 Geonovo won the ‘Best Innovation 2011’ prize at the Telecare Services Association’s Crystal Awards ceremony at the conference for their RSP-100 Personal Safety Phone. [TA Nov 2011] Now they have announced the launch of Home Health Hub, a “groundbreaking [and futureproofed] telecommunications package specifically designed to ensure highly resilient connectivity for telecare users.” The Home Health Hub system includes:

  • A low cost telecoms and telecare package with free broadband
  • Telecare alarm phone and wireless router
  • A network management system that constantly monitors the line and router
  • A 6-hour service level agreement and engineer response

And it is available to partners/service providers. More information in the press release but you might also want to read TANN England Editor Chrys Meewella’s take on it.

Med ePad: Healthcare Unwired (UK)

This is one to watch…in June last year we noted that UK start-up Med ePad was on the scene. It has an interactive 7-inch tablet that is loaned to patients and is linked to a variety of services and reminders to enhance the ability of healthcare professionals to deliver cost-effective care and to empower patients also. Having just received additional funding from the North West Fund for Digital and Creative (managed by AXM Venture Capital) – press release – Med ePad is expected to launch some new developments soon.

COESI: Accessible website done well (UK)

Readers may be interested to see an example of a website that has gone to great lengths to make itself as accessible as possible without compromising an eye for a workable design. It’s the Centre of Excellence for Sensory Impairment (COESI). The Croydon (UK) based Centre “develops and provides integrated direct services for people with sensory and physical impairments”. Heads-up thanks to Pam Bennett. If readers know of other good examples, please post links in the comments.

Your weekend outrage: Indian government plans ‘alert device’ to stem crime

This is either the most outrageous example of ‘NIH’ (not invented here), willful ignorance or sheer howling incompetence by the Indian Government in the face of frequent personal assaults often leading to death. The Wall Street Journal India just revealed, in the blandest possible terms, that the Indian Government’s ‘department of electronic innovations’ will be working on plans to develop a prototype wristwatch by mid-year that can, when the wearer pushes the panic button 1) send a text message to police and family members, 2) has a GPS to send location and 3) shoots 30 minutes of video–for US$20-$50. As our readers will remember, an attack on a young couple in central Delhi in December, and her subsequent death from beating and rape, made international headlines in December, initiated mass protests and revealed police incompetence in fighting and prosecuting crime.

Needless to say that what immediately came to Editor Donna’s mind was that there are already several devices on the market that do precisely that for the alert functions; the two top-of-minds were Aerotel’s GeoSkeeper and Lok8U’s Freedom but this Editor is sure our readers can identify others. All the state-run telecom, ITI, need do is adopt or license the technology and market it at a low affordable price perhaps subsidized by said Government. Cheaper, better, faster.

A panic button will not save the vulnerable from attack. Any device may be ineffective in a remote area, where the police are distant or not responsive and if the wristwatch is torn off. Encouraging women to take courses in situational awareness and personal self-defense–including the proper use of self-defense weaponry such as tasers, pepper spray (Mace) or even low-load pistols–would be a lot more effective as a first line. Better policing and law enforcement would also be strong deterrents. This ‘watch’ idea is a decent tool and a backup especially for those who cannot carry said defense, and better than nothing in discouraging assaults. And video is not needed–so after the fact, hardly a deterrent and perhaps even a further incentive for a criminal to badly maim or kill a victim.

So why is the Indian Government taking its sweet time in developing, then providing, an alert and video wristwatch to mitigate crime, when ‘off the shelf’ alert versions are readily available? Is it merely a bone thrown to the protestors? Certainly those who have been victims, or are close to someone who has been, will grimace consuming this serving of oatmeal. A Wrist-Worn Answer to Sexual Attack? (Wall Street Journal IndiaRealTime) A hat tip to Toni Bunting, TANN Ireland.

Update 4 Feb: Here’s a combination that in a right-side world might seize the imagination of the Indian Government: pepper spray, blinding light, quick photo that is then sent via Android smartphone to authorities. Stop/divert attack, get evidence and send to the police. Devised by three students from Cornell University for their ‘Design for Microcontrollers’ course, it may be far from finished work but even starting at this point, the turnaround to a workable, inexpensive defense/notification tool might be far shorter than the magic watch, and do more. Article (The Next Web) and the students’ project PDF. Another tip o’ hat to Toni Bunting.

Worcestershire Pathfinder pre-tender docs: Tender is the Stitch-up

Frankly, the last thing I [editor Steve] want at 7.00am on a Friday when I’m about to prepare the day’s alerts email (sign-up box above), is to receive documents that demand to be read and for an item to be written. But ‘thanks’ to a reader that is what I’m now doing. I therefore apologise that the alerts email is late this morning.

Late last Wednesday night I published a link to the 3millionlives (3ML) website which had published a document by Worcestershire County Council, prepared in October 2012, that set out its ‘business case’ for tendering its telecare and telehealth service as a 3ML Pathfinder Site. Yesterday it attracted nine highly critical comments from four TA readers. If you have not done so yet, read the item and the comments, now running onto two pages.

The two documents the aforementioned reader sent me are Worcestershire’s follow-on documents that are part of the formal pre-tendering process: the Prospectus (PDF) and the Pre-Qualification Questionnaire (PQQ) (Word Document). The latter is for return by the end of February if you are interested in bidding.

So what, on the basis of early morning skim-reading, has compelled me to write this item? (more…)

Is mHealth delivering in developing countries?

For the past few years, mHealth has been advocated, quite plausibly, as a key part of improved public health in low to middle-income countries. Cell phones are ubiquitous in African countries, and in the West there’s news of potentially revolutionary apps and clinical device attachments at least every month. Now here is another one of those pesky review studies, published in the Journal of Medical Internet Research. While not dumping a cold bucket of water on these high hopes, the review certainly points out the need for more rigor. Studies to date are heavy on process documentation, few demonstrate impact on outcomes, and lack scale. Most programs involved text/SMS messaging or support tools for community health workers. The review was authored by a team from the Malaria Consortium (UK, Uganda), the Institute of Global Health, University College London, and the London School of Hygiene and Tropical Medicine. Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review (JMIR) Also iHealthBeat and FierceMobileHealthcare

Brace yourself #2: global telehealth to reach 1.8 million patients by 2017

InMedica (IMS Research) drops another shoeful of data in its latest publication ‘Analysis of Demand Dynamics’ [TA 4 Jan] by predicting a global rise to 1.8 million patients annually by 2017, up from 308,000 patients in 2012 remotely monitored by their providers. The majority of currently monitored patients have congestive heart failure (CHF) followed by chronic obstructive pulmonary disease (COPD), but by 2017 InMedica projects that COPD will be surpassed by diabetes. InMedica release

Related: A large N (8,000) study finally on telemedicine virtual visits published by JAMA Internal Medicine compares the quality of patient care between ‘e-visits’ and in-person visits. Patients had sinus infections and urinary tract infections and were surveyed between January 2010 and May 2011. For both patient groups, 7% or less returned for another consultation within three weeks. This suggests that both forms of visits have the same quality–and the e-visit cost 21% less. JAMA 14 January. Institute for HealthCare Consumerism (also InMedica)

A review of 75 mHealth consumer studies

Not just one, but two major analyses of mHealth studies to date. Published in PLOS Medicine with the 42-study review of mHealth as used by health professionals [TA 18 Jan] is a separate review, by the same team, of 75 studies evaluating disease management outcomes and behavior change in health care consumers. Like the review of professional studies, the outcomes are inconclusive and inconsistent due to study quality. What was promising was perhaps the simplest: “Text messaging interventions increased adherence to ART (antiretroviral therapy) and smoking cessation and should be considered for inclusion in services.” The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review (PLOS Medicine) The much-discussed Scientific American article, App’d to Fail: Mobile Health Treatments Fall Short in First Full Checkup