David Shaywitz, co-founder of the Boston-based Center for Assessment Technology and Continuous Health (CATCH) and advocate for humanism in digital health [TA 6 Nov], surprises in his Forbes picks for digital health company, person and book of 2012. First, the company: the EHR that dominates large hospital systems, Epic. Why? It may be awful and the bane of M.D.s, but the hospital system gets basic connectivity that chains together the bits, in a proprietary way, delivered with ‘flawless implementation’–the kind of customer services that holds every hand in MIS and HIT until the boo-boo is better. In other words, they delight the buyer. (Your marketing lesson for today.) Second, for person, none other than The Gimlet Eye’scircular bête noireVinod Khosla. Shaywitz is this-n-that about the man, believing Khosla underestimates the human factors in medicine while agreeing with him on how behind healthcare is in capturing and using basic data, much less integrating more advanced data produced by monitoring. Editor Donna and the Eye take a dimmer view, believing that much of Khosla’s ‘disruption’ is to gain notice for (OK, hype) his investments such as AliveCor’s iPhone case heart monitor (just receiving FDA Class II clearance), cellphone microscope Cellscope anddata collection/platforming Ginger.io (leading $6.5 MM in series A funding). Finally, Shaywitz’s pick for book of the year is”Why Nobody Believes The Numbers,” by Al Lewis. Disease management takes longer, saves less, has difficulty in achieving any ROI but can work out best for the patient in the long run, if we ever get there. But didn’t we know that already? Forbes article
Related: Khosla vs. Kvedar at the mHealth Summit. From Khosla, the usual ‘80% of healthcare can be delivered without doctors’, ‘50% of doctors are below average’ and most Americans today understand health information at a fifth grade level (so much for everyone being Quantified Selfers!). Kvedar argues the same points from ‘60% of healthcare costs are labor’ and that computers are better than humans at algorithmic tasks. Not much of a debate here as Khosla gets 80% of the article lineage. mHIMSS
Are you a clinician who feels overwhelmed by the jillions of one-trick-pony medical apps on your iPad? Is your day characterized by wild mood swings due to frustration (left) in not being able to customize your apps? According to this website, you could be a victim of Medical Apps Disorder*. This clever website and funny video is but a teaser for a new app in phase 3 clinical trials that promises to alleviate said symptoms. Let’s hope the cure lives up to the promise made by app developer Skyscape and info/decision support division Physicians Interactive. * Not in the American Psychiatric Association’s soon-to-arrive DSM-V, but perhaps it should be.
Get a cuppa’ and an aspirin, shut the door, turn off your phone and other distractions and get stuck into reading the free, 28-page Remote Care PLC: Developing the capacity of the remote care industry to supply Britain’s future needs report. Despite the pedestrian title it is a cracker and, despite the UK focus, it has messages for anyone in the ‘remote care’ (telecare and telehealth) industry, wherever their market is.
Given the lack of definitions and data in this arena it is as solid as any such market research could be and pulls no punches, not to mention delivering many smack-on-the-forehead moments. Hence the need for aspirin!
And if you are thinking of making a killing on the back of the 3millionlives (3ML) campaign, you may need something stronger than aspirin…the report suggests that the potential market for remote care may indeed reach 3 million – but not until 2050!
The report was authored by James Barlow, Richard Curry, Theti Chrysanthaki, Jane Hendy and Nael Taher and published by the Health and Care Research and Innovation Centre (HaCIRIC) – a collaboration between research centres at Imperial College London and the universities of Loughborough, Reading and Salford – and was funded partly through the Whole Systems Demonstrator (WSD) programme and the Engineering and Physical Science Research Council’s IMRC programme. Download it from the HaCIRIC website or directly, here (PFD).
Based on reports coming in, the mHealth Summit this week in Washington D.C. had a greater focus on the US and patient engagement than the past two years, which emphasized governmental programs and non-profit NGOs, but with a twist–insurers are moving upfront in the picture. From Aetna‘s CEO Mark Bertolini keynoting and promoting their iTriage management app to the announcement of the open CarePass mobile platform that organizes 20 smartphone apps that help consumers manage their health and fitness, UnitedHealthcare Group‘s similar OptumizeMe and even AT&T insisting it’s a payer (self-insured), the rationale is better health for consumers, better care quality–but most of all reduction of that ‘$750 billion in waste’ that exists in the current system. Here’s select early coverage to get you started. Consumers will engage if mHealth is easy, Bertolini says (mHIMSS); Mobile tools help public, private payers be more proactive, Healthcare cathedrals and the consumer health bazaar (Mobihealthnews)
Update 7 Dec:David Lee Scher, M.D., well-known US consultant and former cardiologist, outlines five reasons why payers will be playing a major role in mHealth adoption (Ed. Donna comments): they hold the purse strings (very true), they can change physician behavior (ditto), they realize importance of patient engagement (uneven), they are the largest users of patient portals (of a limited type) and can perform clinical studies (they can, but not credible without academic involvement). Why payers are critical to mHealth adoption (mHIMSS)
Neil Versel argues that Editor Donna’s question may very well be an understatement. To those of us in the technology community, the ‘button’ is a relic of an earlier time (and in the US, a reminder of an inadvertently funny ‘schlock shock’ commercial of the late ’70s). Starting in 2005, behavioral telecare elevated standards of safety (QuietCare then HealthSense, GrandCare, WellAWARE, etc.), and then fall detectors, telehealth-based care management and countless mHealth apps further raised the bar. The technology parade has passed PERS by. But to the implementers, the carers and community executives, the plain-jane PERS alert button remains a mainstay of senior housing on both sides of the Atlantic at least. Not that there are not abundant real-world alternatives. Yet more advanced ‘passive PERS’ with a fall detecting accelerometer built in (Philips Auto-Alert, Aerotel GeoSkeeper, AFrame Digital) and behavioral telecare, despite proving greater safety and proactive care metrics, are still in a low stage of adoption. But as Versel points out, PERS can no longer be considered the standard of adequate care, whether at home or in a facility–and moreover, provides little more than the false assurance of safety with the potential of a high, final and unconscionable human cost. Panic buttons for seniors must go (Mobihealthnews)
Update 7 Dec:Editor Steve, in his comments under the article, makes two points: self-reporting safety confirmations (response to automated calls and similar systems) adds another security layer for older people and disabled living alone; current accelerometer-based fall detectors often miss ‘soft’ or gradual falls, especially to the seated or slumped position
Also from Ed. Steve, continuing research in behavioral telecare’s quantification of the early detection of illness is being done by the University of Missouri at two locations in Missouri and Iowa. They are using Microsoft Kinect for gait assessment, which can predict propensity to fall, and are receiving NSF and other Federal funding for this (limited) ongoing research. Originally covered by us back in July [TA 3 July] and updated in this article from (UK) HealthCanal:Sensor Network to Protect the Elderly
Our onslaught of 2013 predictions starts with the Top Five from AT&T, cleverly timed for the mHealth Summit. From their press release supplying plenty of AT&T ForHealth focused examples (and our interpretation):
A shift from stand-alone “unsponsored” apps to meaningful “sponsored” mHealth solutions (Here come the pharmas, insurance companies and care management companies–now if they will just pay for it and stick with it!)
Hospitals and other healthcare institutions including payers will begin to move more and more healthcare data into the cloud (outrunning HIT’s ability to secure the cloud, secure internal systems, or backup when the cloud goes down)
Remote patient monitoring will move from pilots to large-scale adoption (another pilot with telehealth provider Intuitive Health and Texas Health Resources is so 2006)
Integrated mHealth applications will be created (increased interoperability–here there is some traction as hackathons to develop apps on platforms is becoming actually commonplace; the goal of Continua gets closer)
Upswing on telehealth to bridge the significant gap between physician resources and patient demand (once again in example muddying telehealth with telemedicine, but overall there is some traction; we can only hope that finally we start getting there in 2013!)
mHealth is perceived as having the potential to be effective in changing behavior which will be effective in controlling chronic diseases such as diabetes, according to the mobile trade group GSMA in their latest white paper. The lead finding in this global study is that “89% of practitioners, 75% of patients and 73% of consumers believe that mHealth solutions can convey significant benefits.” While the finding may sound like the ‘perception is reality’ early-hype curve stuff, it’s being backed up by studies like the Clinical Therapeutics study earlier this year on how text (SMS) reminders significantly improved diabetics’ medication adherence and the just-published text4baby study of 90 women in a Fairfax County, Virginia Health Department program. Attitudes and behavior were measured among a primarily Hispanic new mother group, and text4baby had a significant effect on increased agreement with the attitude statement “I am prepared to be a new mother” and increased negative attitudes concerning alcohol consumption. GSMA: mHealth perceived globally as effective, Study: text4baby effectively helps new moms (FierceMobileHealthcare)
This past week, brain injury once again has made sad headlines in the US this weekend with the public suicide of an NFL linebacker, following his murder of the mother of his child. Reportedly, Jovan Belcher of the Kansas City Chiefs had been recently concussed, was on painkillers and had been drinking the prior evening. Thus the release of an academic research study on chronic traumatic encephalopathy (CTE), a progressive disorder that occurs as a consequence of repetitive mild traumatic brain injury such as experienced by contact sport athletes and soldiers, could not be more timely. Published in this month’s Brain: A Journal of Neurology (Oxford Journals), a research team drawn from the Boston VA, Boston University and the Mayo Clinic details the four progressive stages of CTE with symptoms progressing from headache and loss of concentration to dementia, depression, and aggression. This was based on (post-mortem) analysis of 85 brains — 64 athletes and 21 military veterans with a history of repetitive concussions. 68 had CTE and the group also had other neurological diseases. The study was funded by seven organizations, including the VA, the National Institute on Aging–and the NFL. Certainly this will be a key reference in the NFL-funded research being started by the FNIH and the US Army-NFL helmet sensor program to help detect cumulative injury [TA 7 Sept]CTE a Progressive Condition, Brain Study Shows (MedPageToday) The spectrum of disease in chronic traumatic encephalopathy (Brain): Abstract and full study (PDF)
Students at Brigham Young University in Utah have developed a prototype ‘smart sock’ for babies that alerts for low levels of blood oxygen, irregular heartbeat and stopped breathing during sleep. This is to help detect for early signs of SIDS (Sudden Infant Death Syndrome) or other dangerous situations. The information is sent to a smartphone app that serves as the alert monitor. The Owlet Baby Monitor won first place and crowd favorite awards, with cash prizes totaling $6,000, at the Student Innovator of the Year competition. The inventors have filed for a patent (pending), more prototypes and testing, and undoubtedly FDA, but if you’re an angel looking for a highly marketable telehealth item–and with adult uses in hospitals and nursing homes–a trip to Utah may be in order.“Smart Socks” Helps Parents Sleep Easier (Smart Phone Healthcare) BYU news release (video)
The Independent is planning a major supplement on telecare and telehealth in late January 2013. Any supplier companies interested in promoting themselves in the available remaining space in the supplement should contact Dominic McWilliam, Project Manager at Mediaplanet by email.
There are a complex set of issues buried under the obvious angles on which the newspaper concentrates. They concern historical patterns of provision, changed technology and people’s expectations. ‘Too expensive’ 999 cords axed from sheltered homesThe Mirror.
TA readers will wonder whether the Health Service Journal (HSJ) can deliver anything fresh or worth reading in its 19-page supplementWe have the technology ? an HSJ supplement on telehealth. Well, it’s a comprehensive roundup of what’s happening in the UK and an in-depth introduction if the recent Canadian piece is too lightweight. More interestingly, it contains two articles on an often overlooked topic; telehealth in prisons and in offender management.
November was a busy month for the 3millionlives (3ML) team, as reported in their November newsletter (PDF). They have also released a video, below. (7½ minutes) The video contains interviews with doctors, patients and a nurse. It was made to be shown at the Making Sense of Commissioning conference held on 27 November 2012 at the Royal College of General Practitioners, London, which may explain the focus on telehealth and the absence of any references to the contribution telecare technologies can play in supporting people at home.
“Doris has had her telecare equipment, including her Supra KeySafe, successfully installed around her home. But now she is in danger! Our Heroes need you to direct them safely from their secret headquarters to Doris’s house. Along the way they must collect as many of Supra’s service packages as possible. Every week Supra UK is giving a C500 KeySafe to one player.” Play the Supra Heroes game here. (Editor Steve’s score? Don’t ask!)
The point of this game may baffle non-UK readers…in short, it is an online game to introduce people to some of the resources that are around for making better use of key safes which, if fitted at a property, allow people responding to a telecare alarm call to enter someone’s house without having to batter the door down. It follows on from Supra UK’s game ‘Save Doris‘, released last year.
From Dr. Kendall Ho, Director of the eHealth Strategy Office, University of British Columbia, there’s a balanced overview of – and good introduction to – technology in personal health/wellbeing, with some sensible tips at the end. Modern technology allows users to take charge of their health. Vancouver Sun.
Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:
• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.
• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.
Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.