Detecting cancer faster with a pen and smartphone camera diagnostics

Two newly developed devices promise to radically improve cancer detection–the first during surgery, and the second for the earliest signs of the jaundice symptoms of pancreatic cancer with applicability to both telehealth and telemedicine.

  • The MasSpec Pen is a mass spectrometry device (not the pen in the picture) which is intended to be used during surgery to better determine the boundary between cancerous and normal tissue. Current technology uses frozen section analysis, which takes about 30 minutes (in which the surgeons and sedated patient wait for the pathologist’s results) and isn’t always accurate in answering the question ‘is it all out?’ Using mass spectrometry analysis of a drop of water after three seconds of tissue contact, MasSpec Pen returns results in about 10 seconds with 96 percent accuracy in a test of 253 cancer patients, as well as detecting cancer in marginal regions between normal and cancer tissues that presented mixed cellular composition. It was tested on breast, lung, thyroid, and ovary cancerous and normal tissue. The team expects to start testing the new technology during oncologic surgeries in 2018. Futurity, Science Translational Medicine.
  • Over at the University of Washington’s Ubiquitous Computing Lab, researchers there expanded their jaundice detection system for babies, BiliCam, to BiliScreen, which examines the eyes for the earliest sign of jaundice. Jaundice is an early sign of pancreatic cancer as well as hepatitis and related diseases, and is conventionally screened through a professionally-administered blood test and analysis. The BiliScreen app is used with a smartphone camera and a 3D printed box that controls the eye’s exposure to light. It correctly identified cases of concern 89.7 percent of the time, compared to the blood test currently used. As a non-invasive test, it can be used repeatedly for high-risk individuals and remotely. Futurity, paper (PDF, 26 pages) presented September 13 at Ubicomp 2017, the Association for Computing Machinery’s International Joint Conference on Pervasive and Ubiquitous Computing.

Hat tip on both to former Ireland Editor Toni Bunting.

Twist up the power: carbon nanotube yarn as future power generator

click to enlargeTwist and Shout! The US Air Force Research Laboratory (AFRL) Materials and Manufacturing Directorate, in collaboration with scientists from the University of Texas at Dallas and Hanyan University in South Korea, have developed carbon nanotube-based “twistron” yarns that when coiled and paired with ionic material, become supercapacitors. These twisted bundles of individual nanotubes, each of which is 10,000 times smaller than the diameter of a human hair, when pulled and stretched generate electrical power. Ionic material can be an electrolyte, ocean water or even human sweat.

This development opens up opportunities in healthcare technology areas such as polymer-graphene thin skin adhering sensors for continuous monitoring that stretch or look like temporary tattoos [TTA 3 Feb] which need more power longer than available now.

The energy-generating capacities of the yarn were tested in a variety of interesting ways.  Researchers attached it to an artificial muscle that contracted and expanded, converting the change in temperature into electrical energy. When they were sewn into a shirt, they were used to monitor and sense changes in respiration. They were even immersed in South Korea’s Gyeonpo Sea to demonstrate how they can harvest the energy of ocean waves. The team is still working to better understand how the twistron yarns work by examining their carbon nanotube structure at the nanoscale, the three-dimensional structure of the yarns and how their structure changes when they are deformed. (The photo above left, captured by x-ray tomography, is a 3-D rendering of the coiled nanotube fibers and provides information on the structures, defects and interfaces internal to the fibers at the nanoscale.)

MedStartr Momentum 2017 – coming up 30 Nov!

click to enlargeMomentum 2017, PricewaterhouseCoopers headquarters, 300 Madison Avenue (42nd Street), NYC, 30 Nov (8.45am-5pm)-1 Dec (9am-3pm)

MedStartr/Health 2.0 NYC Momentum is back for a third year, returning to PwC’s NYC headquarters. The format is unusual because it blends nine speakers in Momentum Talks with five pitch contests and seven panels totaling over 70 participants on stage. The subject is all about driving innovation in healthcare from the wide variety of perspectives seen by patients, doctors, partners, institutions, and investors.  Speakers, sponsors and agenda are all on the main page here.

The culmination is the award of the 2017 Grand National Challenge. Up to 25 teams will be invited to New York or the Healthcare Financial Summit 6-7 October in Las Vegas. Each winning team that enters the MedStartr Acceleration Program (MAP) will receive up to $250,000 in funding and services–and, as in all MedStartr Crowd Challenges, companies keep control of their pilots, partnerships, funds raised, investors engaged, and traction.

Registration is open–and early bird tickets are only $99. (You can’t get a better value!) More to come as we get closer to the event! TTA is a MedStartr and Health 2.0 NYC supporter/media sponsor since 2010; Editor Donna will be a host for this event and a MedStartr Mentor. Check the MedStartr page to find and fund some of the most interesting startup ideas in healthcare.

BioSensics’ Huntington’s Disease remote monitor gains NIH grant

click to enlargeWatertown, Massachusetts-based BioSensics announced that the company has received a $2.5 million, two-year grant from the National Institutes of Health (NIH) to develop a continuous remote monitor for Huntington’s disease motor symptoms. The HDWear monitor uses BioSensics’ PAMSys sensor technology tested during pilot work performed with the University of Rochester Medical Center and Teva Pharmaceuticals. The study, published in the Journal of Huntington’s Disease (2016, Vol. 5, pp. 199-206), demonstrated a wearable sensor solution for remotely monitoring the severity of upper extremity chorea in Huntington’s disease.

The study will also use the HDWear monitor for a clinical study on patient response to anti-chorea medication or subtle motor abnormalities in the premanifest stage of Huntington’s disease.

It is interesting that the press release uses ‘telecare’ for HDWear, which is not much used in the US for behavioral monitoring though perfectly correct. HDWear’s use here builds on the company’s earlier sensors-based systems for telehealth, physical activity monitoring, fall risk assessment and detection. This Editor notes that BioSensics is one of the older telehealth companies still operating (2007), and now is primarily using its devices in research studies. Drug Discovery & Development,  Release.  Hat tip to Guy Dewsbury via LinkedIn (again)

Hacking, insider actions 81 percent of healthcare data breaches: Protenus

Healthcare data security company Protenus’ monthly Breach Barometer always contains interesting–and somewhat discouraging–surprises. August’s report topped July’s for the number of patients affected, with 674,000 patients involved in 33 incidents. Over 54 percent of breaches (N=18) were due to hacking (five incidents were attributed to ransomware), with over 27 percent (N=9) were from insider error (the main cause) or wrongdoing–over 81 percent in total. The remainder were due to loss, theft, or ‘unknown’. Another interesting finding was that discoveries of hacking are relatively quick at an average of 26 days from start to finish, due to the disruption they create, while insider attacks can go on for months (209.8 days)–or years. Protenus’ July report highlighted a breach at Tewksbury Hospital in Massachusetts that went unreported for a record-setting 14 years–an insider action that affected 1,100 records. Reporting to HHS is improving with reporting to HHS, the media or state attorneys general on average of 53 days. Protenus crunches its data from databreaches.net. (If you look at their reporting on TheDarkOverlord (@tdo_hackers), including their recent threats on a small Montana school system, you’ll be scared indeed.) MedCityNews 25 Sept, 23 August   Hat tip to Guy Dewsbury via LinkedIn

Connected Health Conference 25-27 October, Boston–save $100! (updated)

Connected Health Conference, 25-27 October, Seaport World Trade Center, Boston Massachusetts

The eighth annual Connected Health Conference, is now presented by the Personal Connected Health Alliance (PCHAlliance) in partnership with Partners Connected Health, with a combined and rebooted annual meeting in Boston. The largest global conference in connected health has surfed many changes from the time it was started as the mHealth Summit (and Telecare Aware was one of the first media sponsors) in Washington, DC. This year’s theme, The Connected Life Journey: Shaping Health and Wellness for Every Generation, is centered around the future of technology-enabled health, wellness and what innovation means for over 2,000 providers, researchers, healthcare executives, and developers. CHC17’s location is now in Boston’s Innovation District versus a fairly remote part of Foggy Bottom–and early fall! (For more on CHC’s evolution, see here.)

Wednesday the 25th has a full day of pre-conference specialized sessions here, such as the Society for Participatory Medicine and Parks Associates‘ workshop, with the full conference and open exhibit hall on Thursday and Friday. Continua has a running Plugfest for those involved with Continua standards on Thursday and Friday. Also on those days is CHC’s own Health Tech StandOut! Competition featuring a group of ten finalists, free for conference registrants and the Connected Health Innovation Challenge (CHIC) (information here).

For the main website and for registration, click on the ad in the sidebar. TTA Readers save $100 on registration–use code CHC17TELE100. TTA is a media sponsor of CHC17. For updates, see on Twitter #Connect2Health and @PCHAlliance

Update: The PCHAlliance published today a research paper, Personal Connected Health: The State of the Evidence and a Call to Action. This is a meta-study of 53 studies and trials for setting an initial baseline for evidence in personal connected health. The key findings on the current state will come as no surprise–that better studies are needed that show evidence in clinical trials and real-world use. Release, study (download links)

Youth football playing may contribute to long-term cognitive, behavioral issues: BU study

An extension of Boston University’s pioneering CTE brain research [TTA 26 July] is this newly published study in Translational Psychiatry on cognitive and behavioral changes in former football players. This sampled 214 living former American football players who played high school, college or professional football and did not participate in any other organized contact sports. These players were recruited through BU’s LEGEND longitudinal research registry of living active and former contact and non-contact sports athletes to examine the short/long-term outcomes of repetitive head impacts (RHI). Participants in the program performed over time a battery of cognitive and functional tests. It also screened out those who self-reported concussion within one year of the study inception.

The findings point a very long finger at early tackle football playing in youth football programs, typically from age 5 to 14 when the brain is undergoing massive development. Below quotes are direct from the study:

  • Those who began playing football before age 12 had >2 × increased odds for clinically meaningful impairments in reported behavioral regulation, apathy and executive function, and >3 × increased odds for clinically elevated depression scores, compared with those who began playing at 12 or older.
  • Effects were independent of age, education and duration of football play.
  • Younger AFE (age of first exposure-Ed.) to football, in general, corresponded with worse behavioral regulation, depression, apathy and executive function, as well as increased odds for clinical depression and apathy.

To our knowledge, this study is the first to show a relationship between younger AFE to football and reported clinical dysfunction in a cohort that included both former amateur and professional football players. There was no difference in the effect of AFE by highest level of play. These findings validate and expand upon our previous work in a small, entirely distinct sample of former NFL players, and extend the influence of AFE to football on clinical function to former football players who only played through high school or college. Overall, this study provides further evidence that playing youth American football may have long-term clinical implications, including behavioral and mood impairments.

The study has an extensive discussion of brain development in the young and how ages 9-12 are critical. Two studies using helmet accelerometry on current youth American football players estimate 240 to 252 median head impacts per season.

There are a considerable number of caveats throughout the study, including the kind of protection available in past youth football for the average age respondent (51) and the self-reporting methodology. It is not a risk study for CTE, nor is it intended to advocate the reduction or elimination of youth football. It does advocate for more longitudinal studies. This Editor has attended at least two talks by the CTE Center’s Robert Stern, MD, and he has been never been content with limiting his study to either football or to purely concussive damage. 

Why is this research important to healthcare and to technology? (I’ll expand upon a previous closing.)

  • First, because repetitive brain trauma–concussive and sub-concussive–now has an even better-documented relationship to significant medical and behavioral conditions. This study is now another part of fundamental research to deepen our knowledge about the effects and long term brain outcomes of head trauma, whether from football, other contact sports, combat service (e.g. IED explosions), car accidents, and even repetitive actions by a person who is developmentally disabled.
  • Second, avoiding or minimizing head trauma in sports and warfare, plus correctly diagnosing and treating concussion and sub-concussion, are huge areas for technology about which this Editor has advocated for several years.
  • The message here is not that football is bad, but in the present state and starting age is played dangerously for long term brain development and the subsequent mental health of players. This does not exclude other high contact sports such as flag football, hockey and rugby–the orthopedist’s gift–and heading the ball in soccer. We need to know more, minimize it now, and both playing the game, with the aid of health tech, should be part of this.

Translational Psychiatry (Nature.com), STATNews has further analysis

Related reading: Our extensive backfile of CTE research coverage is here, including this Editor’s reports on Dr. Stern’s presentations at NYC MedTech and GCRI. 

Can Big Pharmas hiring of digital execs actually ‘reimagine medicine’?

Reimagination or hallucination? In recent weeks, both Glaxo Smith Kline and now Novartis have hired digital analytics and marketing executives out of non-healthcare businesses to lead their digital transformation. For GSK, Karenann Terrell joined in the new position of chief digital and technology officer from six years as chief information officer for Walmart and CIO for pharma Baxter International. From Sainsbury’s Argos, Bertrand Bodson will be assuming the chief digital officer title at Novartis without any previous healthcare experience.

Both are expected to be transformative, disruptive, and ‘reimagine medicine’. Ms. Terrell’s experience and accomplishments appear to be the closest fit to her GSK’s job expectations of integrating digital, data, and analytics strategy with enhancing clinical trials and drug discovery, as well as improving professional and consumer interactions. Novartis’ mission for Mr. Bodson aims even higher. In addition to these, he will be ‘transforming our business model using digital technologies’, ‘reimagine (sic) medicine by leveraging digital on behalf of millions of patients and practitioners’, and ‘leading cultural change’.

Both companies have good starts in advanced technologies–GSK in AI, sensor technologies for managing COPD, and a medical device mobile app; Novartis with ‘smart pill’ Proteus, a pilot with heart medication Entresto tied to monitoring and coaching, and through its Alcon subsidiary with Google, a wired-up contact lens that detects blood glucose [TTA 17 July 14]. However, this last appears to be stalled in trials and Alcon on the block. According to the FT, Novartis is feeling the pressure to develop more digital partnerships, such as Novo Nordisk’s teaming with Glooko and Sanofi with Verily Life, all in diabetic management. Acquisitions may also be the way forward.

A significant impediment to all this integration is consumer and professional trust. If too closely tied to a pharmaceutical company or appearing to be too self-serving, remote monitoring and counseling may not be trusted to be in the patient’s (or doctor’s) best interest or objective as to better approaches. The overuse of analytics, for instance in counseling or patient direction, may be perceived as violating patient privacy–creeping out the patient isn’t helpful. The bottom line: will these digital technologies serve the patient and maintain medical best practices–or best serve the pharmaceutical company’s interests?

This Editor doesn’t question these individuals’ ability, but the organizations’ capability for change. But count this Editor as a skeptic on whether one or two digital execs can marshal the bandwidth and the internal credibility to transform these lumbering, complex, regulated, and long cycle businesses. Big Retail is fast moving by comparison. PMLive 31 July (GSK), 13 Sept (Novartis)  Hat tip to TTA alumna Toni Bunting

The REAL acute care: hurricanes, health tech, and what happens when electricity goes out

This afternoon, as this New York-based Editor is observing the light touch of the far bands of Hurricane José’s pass through the area (wind, spotty rain, some coastal flooding and erosion), yet another Category 5 hurricane (Maria) is on track to attack the already-wrecked-from-Irma Puerto Rico and northern Caribbean, thoughts turn to where healthcare technology can help those who need it most–and where the response could be a lot better. (Add one more–the 7.1 magnitude earthquake south of Mexico City)

Laurie Orlov, a Florida resident, has a typically acerbic take on Florida’s evacuation for Irma and those left behind to deal with no electricity, no assistance. Florida has the highest percentage of over-65 residents. Those who could relocated, but this Editor from a poll of her friends there found that they didn’t quite know where to go safely if not out of state, for this storm was predicted first to devastate the east coast, then it changed course late and barreled up the west (Gulf) coast. Its storm surges unexpected produced record flooding in northeastern Florida, well outside the main track. Older people who stayed in shelters or stayed put in homes, senior apartments, 55+ communities, or long-term care were blacked out for days, in sweltering heat. If their facilities didn’t have backup generators and electrical systems that worked, they were unable to charge their phones, use the elevator, recharge electric wheelchairs, or power up oxygen units. Families couldn’t reach them either. Solutions: restore inexpensive phone landlines (which hardwired, mostly work), backup phone batteries, external power sources like old laptops, and backup generators in senior communities (which would not have prevented prevent bad fuses/wiring from frying the AC, as in the nursing home in Hollywood where eight died).  Aging In Place Tech 

It’s another reason why senior communities and housing are supposed to have disaster preparedness/evacuation plans in place. (If you are a family member, it should be included in your community selection checklist and local records should be checked. This Editor recently wrote an article on this subject (PDF) that mentions disaster and incident planning twice. (Disclaimer: the sponsoring company is a marketing client of this Editor.) In nursing homes, they are mandatory–and often not executable or enforced, as this article from Kaiser Health News points out. 

Another solution good for all: purchase 200-400 watt battery packs that recharge with solar panels, AC, and car batteries (AARP anyone?). Campers and tailgaters use these and they range below $500 with the panels. Concerned with high-power lithium-ion batteries and their tendency to go boom? You’ll have to wait, but the US Army Research Laboratory and University of Maryland have developed a flexible, aqueous lithium-ion battery that reaches the 4.0 volt mark desired for household electronics without the explosive risks associated with standard lithium-ion power–a future and safer alternative. Armed With Science

Telemedicine and telehealth are not being fully utilized to their potential in disaster response and recovery, but the efforts are starting. Medical teams are starting to use telehealth and telemedicine as adjunct care. It has already been deployed successfully in Texas during Harvey. Many evacuees were sent to drier Dallas and the Hutchinson arena, where Dallas-based Children’s Health used telemedicine for emergency off-hour coverage. Doctor on Demand and MDLive gave free direct support to those affected in Texas and Louisiana through 8 September, as well as Teladoc, American Well, and HealthTap for a longer period to members and non-members. Where there are large numbers of evacuees concentrated in an area, telemedicine is now deployed on a limited basis. Doctor on Demand releaseSTAT News, MedCityNews 

But what about using affordable mobile health for the thousands who long term will be in rented homes, far away from their local practitioners–and the doctors themselves who’ve been displaced? What will Doctor on Demand and their sister telemedicine companies have available for these displaced people? What about Puerto Rico, USVI, and the Caribbean islands, where first you have to rebuild the cellular network so medical units can be more effective, then for the longer term? (Can Microsoft’s ‘white space’ be part of the solution?)  

One telehealth company, DictumHealth, has a special interest and track record in both pediatric telehealth and global remote deployments where the weather is hot, the situation is acute, and medical help is limited. Dictum sent their ruggedized IDM100 tablet units and peripherals to Aster Volunteers who aid the permanently displaced in three Jordanian refugee camps in collaboration with the UNHCR and also for pediatric care at the San Josecito School in Costa Rica. In speaking with both Amber Bogard and Elizabeth Keate of Dictum, they are actively engaging with medical relief agencies in both the US and the Caribbean. More to come on this.

Now EHR data entry 50% of primary care doctors’ workday: AMA, University of WI report

click to enlargeWhere’s the doctor? Typing away! A fact of life doctors have agonized on over the past ten years–even great advocates like Robert Wachter, MD above at NYeC last year–is the clerical burden of EHRs and patient data entry. A late 2016 time and motion study in the ACP Annals of Internal Medicine (AMA, Dartmouth-Hitchcock, Australian Institute of Health Innovation) noted a mere 49.2 percent of ambulatory physicians’ time spent on EHR and desk work. Mayo Clinic (above) has been tracking both the burnout and the burden as 50 percent (above).

Now we have a new three-year study published in the Annals of Family Medicine led by the University of Wisconsin Medical School tracking EHR data entry as 52 percent: 5.9 hours of an 11.4 hour workday. This includes allied clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounting for 2.6 hours, close to 50 percent of the 5.9 hours daily.

Is there a way out? The study’s recommendations were:

  • Proactive planned care
  • Team-based care that includes expanded rooming protocols, standing orders and panel management
  • Sharing of clerical tasks including documentation, order entry and prescription management
  • Verbal communication and shared inbox work
  • Improved team function.

Much of this sounds like burden shifting to deal with the EHR, not a redesign of the EHR itself, but the commentary in AMA Wire makes it clear that it was shifted in the first place by the EHR designers from other staff to the doctor for direct entry. Other time savings could be realized through moving to single sign-on (versus dual entry passwords) to advanced voice-recognition software. (UW release)

The earlier ACP study excerpt in NJEM Journal Watch has physician comments below the article and they blast away: (more…)

Want to know effectiveness of telehealth, interoperability? NQF reports take their measure.

There’s been an increase in doubt about the efficacy of telemedicine (virtual visits) and telehealth (vital signs monitoring) as a result of the publication of two recent long-term studies, one conducted by the University of Wisconsin and the other by CCHSC for Telemonitoring NI [TTA 13 Sep]. These follow studies that were directionally positive, and in a few cases like the VA studies conducted by Adam Darkins, very much so, but mostly flawed or incomplete (low N, short term, differing metrics). What’s missing is a framework for assessing the results of both. In an exceptionally well-timed announcement, the National Quality Forum (NQF) announced their development of a framework for assessing the quality and impact of telehealth services. 

In a wonder of clarity, the NQF defines telehealth’s scope as telemedicine (live patient-provider video), store-and-forward (e.g. radiology), remote patient monitoring (telehealth), and mobile health (smartphone apps). Measurement covers four categories: patients’ access to care, financial impact to patients and their care team, patient and clinician experience, and effectiveness of clinical and operational systems. Within these categories, NQF identified six areas as having the highest priority for measurement: travel, timeliness of care, actionable information, added value of telehealth to provide evidence-based practices, patient empowerment, and care coordination. Finally, the developing committee identified 16 measures that can be used to measure telehealth quality.

The NQF also issued a similar framework for interoperability, a bête noire that has led many a clinician and developer to the consumption of adult beverages. Again there are four categories: the exchange of electronic health information, its usability, its application, and its impact—on patient safety, costs, productivity, care coordination, processes and outcomes, and patients’ and caregivers’ experience and engagement. And it kept the committee very busy indeed with, from the release, “53 ideas for measures that would be useful in the short term (0-3 years), in the mid-term (3-5 years) and in the long-term (5+ years). It also identified 36 existing measures that serve as representative examples of these measure ideas (sic) and how they could be affected by interoperability.”

Both reports were commissioned and funded a year ago by the US Health & Human Services Department (HHS). We will see if these frameworks are extensively used by researchers.

NQF release, Creating a Framework-Telehealth (download link), Creating a Framework-Interoperability (download link), Mobihealthnews 

AARP/Rock Health 2017 Aging in Place $50K Challenge–deadline 2 Oct!

One week to go! The 2017 Aging in Place Challenge, sponsored by the AARP Foundation and Rock Health, is calling for digital health companies to improve the lives of vulnerable seniors (their words, not this Editor’s) and reduce unnecessary healthcare utilization for older Americans. The Challenge is interested in four areas:

  • Reducing hospital readmissions
  • Avoiding penalties from providers
  • Providing post-acute care assistance
  • Increasing overall patient satisfaction

Another requirement: competitors should have “a good handle on product-market-fit and an ARR (annual recurring revenue) of at least $100K.”

Apply now through 2 October, with the top five finalists to be announced on November 6. The pitch event will be at Rock Health in San Francisco during the week of December 11th with one winner selected. More information and application link here.

September Health 2.0 NYC/MedStartr events–hurry!

If you are located in the NYC metro area, two Health 2.0 NYC/MedStartr meetings are coming up very soon!

Endless Summer Social–Friday 22 September, 6 pm, Spark Labs, 25 W. 39th Street, 14th Floor

Grab your surfboard and celebrate the end of summer next week at the MedStartr Labs Beta site embedded within Spark Labs’ new Bryant Park co-working space in midtown. Organizer Alex Fair promises good food, a great selection of beer and wine (courtesy of MedAux), a few presentations and awards, plenty of participation from members of the NYC health tech community, and tours of the new MedStartr beta site. Register at the Meetup site here.

Mental Health Innovations Summit–Thursday 28 September, 6-9pm, CohnReznick LLP, 1301 6th Avenue

One in every five adults in America experiences some form of a mental illness. Nearly one in 20, or 13.6 million, adults in America live with a serious mental illness. We aren’t replacing retiring psychiatrists. Mental health resources are maldistributed across the country. These problems call for new approaches. Panelists and presenters include leaders in the field and six early-stage companies presenting. Register at the Meetup site here.

TTA has been a MedStartr and Health 2.0 NYC supporter/media sponsor since 2010; Editor Donna is active as co-organizer/host and a MedStartr Mentor. 

Keeping it cool: LifeinaBox mini fridge for meds goes Indiegogo

click to enlargeThe LifeinaBox two-pound mini-refrigerator for medications has debuted today (13 Sept) with a crowdfunding raise on Indiegogo. Since our 3 July article, the company headed by Uwe Diegel in France has determined its delivery date (June 2018) and directed all pre-orders previously made on the website to the Indiegogo US site. The goal is $50,000 over the next month on a flexible raise (funds are kept even if goal is not met), so this is clearly a test of market demand. The website and the Indiegogo site are beefed up considerably with the basic unit now at $180 for early birds (still available) and $250 with a battery pack. Prototype units run on 110 or 220 volt AC current, external battery pack, or car charger, and are monitored via app. As back in July, this Editor thinks that solutions for specific, even narrow, but important problems are absolutely on trend in this uncertain environment–and the more important (painful?) they are, the better for the company. Hat tip to CEO/founder Uwe Diegel.

Equivocal long term telemonitoring studies released by Telemonitoring NI, U. of Wisconsin

The HSC Public Health Agency for Northern Ireland and Queen’s University Belfast have released an evaluation of the six-year (2011 – 2017) Remote Telemonitoring Service for Northern Ireland (RTNI). The Centre for Connected Health and Social Care (CCHSC) launched the Telemonitoring NI project in 2011, which enrolled over 3,900 patients with COPD, diabetes, weight management, stroke, heart failure and kidney problems in both telehealth (vital sign) and telecare (behavioral) monitoring. The study period was through 2015, but the program continues to be implemented by all five NI Health and Social Care (HSC) Trusts across a range of chronic conditions. 

The Northern Ireland findings were at best equivocal. While the qualitative data gathered from patient, carer, and clinician focus groups and interviews were positive in terms of engagement and on reassurance–to be able to carry on with their lives as usual–the quantitative data did not confirm gains in effective care.

Although there were a number of testimonials from the participants in the patient focus groups regarding
reduced hospitalisations and a reduced need to attend outpatient clinics, this did not carry through to
the data obtained in the effectiveness aspect of the current evaluation. In general terms, the number
of hospitalisations, length of hospital stay and outpatient clinic attendance (and therefore overall cost
of healthcare provision) did not differ between the quasi-control ‘never installed’ group and any of the
groups who received some amount of telemonitoring. The results, where they were statistically
significant, were largely driven by an anomalous result for the heart failure ‘never installed’ group. (page 17)

The Executive Summary, Telehealth, and Telecare Reports are available for free download on the HSC R&D Division website. Many thanks to former TTA Ireland Editor Toni Bunting for the information, summary, and researching the previous TTA coverage below.

This is the second discouraging study on the long term effectiveness of patient monitoring released in the past month. A five-year, 140,000 patient/90 provider study conducted by the University of Wisconsin found that giving patients the option of telemedicine, instead of being more convenient for the provider, created new issues. It increased office visits by six percent, added 45 minutes per month of additional visit time to practices, and reduced the number of new patients seen each month by 15 percent. For the patient, the researchers found “no observable improvement in patient health between those utilizing e-visits and those who did not. In fact, the additional office visits appear to crowd out some care to those not using e-visits.” The study suggested that the telemedicine visits could be made more effective by structured questions prior to the visit. (This approach has been taken by telemedicine provider Zipnosis with adaptive online interviews and patient triage.) Mobihealthnews

Previous commentary by TTA’s Editor Emeritus Steve Hards on the procurement of the NI Remote Telemonitoring Service:

http://archive1.telecareaware.com/the-long-and-winding-road-that-leads-to-your-doorin-northern-ireland/
http://archive1.telecareaware.com/african-elephant-ecch/
http://archive1.telecareaware.com/remote-telemonitoring-northern-ireland-service-tender-long-list-mystery/
http://archive1.telecareaware.com/short-listed-companies-rtni-service/
http://archive1.telecareaware.com/northern-ireland-remote-monitoring-servicegoes-to-tf3/