Health Technology: Driving Innovation, Improving Patient Outcomes

London, Tuesday 26th Feb 2013

Will provide delegates with insights on how technology can transform the NHS, their organisation and lead to better patient outcomes. Delegates will learn about the role of technology in the changing NHS landscape. There are some ‘limited discounted rates’ of £275+VAT per public sector delegate and £445+VAT per private sector if you contact organiser Paul Tyreman directly, by email or phone: + 44 (0) 161 200 8625 . Website for details.

‘Right meds at right time’ dispenser

Pre-filled multi-day medication boxes (versus large dispensers meant for an external service area) are becoming increasingly common both in the community and individual home setting, but there is always the risk of an individual’s confusion in taking more than one day’s dose, or the medications all at once versus at the right time. MedMinder’s Jon model, a new seven-day wireless M2M dispenser, can be controlled by the caregiver through their monitoring website to let the individual access only the correct compartment and also at the correct dosage time. It has reminders (beeps, phone calls, emails or text messages) and notes when the compartments have been accessed, similar to its existing Maya model. Their website feature page has a brochure link, but it is for the Maya, not the Jon, model. Editor Donna also finds interesting their payment model of no upfront cost and a monthly fee. (Note to MedMinder’s marketers/general counsel: ‘medminder’ is becoming a generic term for dispensers–the MedMinder team is well advised to register their trade name.) Website release (mind the typos)  Also noted is that Bosch is using MedMinder with its HealthBuddy and T400 programs. 

AskSARA goes mobile

It is a long time (March 2009 and September 2011) since we drew attention to the UK Disabled Living Foundation’s brilliant AskSARA ‘self-assessment’ and recommendation system which contains much useful advice and links to specific items of equipment for older and disabled people. It includes a telecare-related section and could be a good starting point for professionals who lack specific telecare training and who are asked to recommend equipment. (The reports do come with warnings about getting appropriate ‘live’ help.)

However, now is a good time to point readers back to AskSARA because it has now started to give a better, app-like experience to users reaching the site from a smartphone. Users can now go through the self assessment easily without any horizontal scrolling or straining to see small text. The ensuing report is also clear and can be printed out or a link can be emailed for viewing on a larger screen device later. However, the telecare information is a little buried – one has to choose the ‘Daily Activities’ topic tab and then ‘Help in Emergencies’ to start the self assessment. Worth exploring, though.

3ML: Discussion of future of telehealth with GP critics (UK)

Last week the GP’s publication Pulse held a ’roundtable’ discussion session on the issues for GPs around telehealth. It was funded by the 3millionlives (3ML) team, commissioned by the Department of Health (DH) 3millionlives (3ML) programme, and editorially controlled by Pulse to a brief agreed with 3ML. The 3ML contingent was headed by Paul Hitchcock who is the NHS workstream lead for 3ML at DH.

If you are interested in telehealth it is worth reading for some snippets from Professor Stan Newman and the ever-sceptical GP Margaret McCartney, and for the indication of the direction for 3ML from Paul Hitchcock “From my perspective at the Department of Health, our immediate next step is much closer engagement with the GP community than we’ve achieved to date.” This looks like it was a reasonable start, but will Pulse articles become less negative about telehealth from now on? The future of telehealth in Pulse – free registration required. Heads-up thanks to Mike Clark.

A tattoo sensor to delight–or scare–kiddies

tattoosensor 1You’ll find the design of this prototype skin sensor out of University of California, San Diego either endearingly goofy or just scary. This paper ‘tattoo’ is actually a solid-contact ion-selective electrode (ISE) made using standard screen printing techniques finished with an electropolymerization process on commercially available transfer tattoo paper. The two ‘eyes’ are actually electrodes which measure perspiration on the skin’s surface to determine stress-related changes in pH and clues to metabolic diseases such as Addison’s, or more simply fatigue or dehydration. The tattoo sticks to even wet skin. It can also measure sodium, potassium and magnesium with different sensing materials. There’s great potential for this not only in sports, but also in assisted living and rehabs where one of the most serious conditions is gradual, invisible dehydration of residents. Tattoo-based medical sensor puts a happy face on detecting metabolic problems (GizMag) Happy face tattoo does serious work (University of Toronto release)

Some ‘awards’ for 2012 digital health

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’s circular bête noire Vinod 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 and data collection/platforming (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

Do you suffer from M.A.D.?

content-bubble-2Are 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.

One Report to rule them all… (UK)

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).

Patient engagement and payers new theme of mHealth Summit

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)

PERS buttons obsolete…and dangerous?

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

2013 crystal ball time: AT&T’s top 5 predictions

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!)