China’s getting set to be the healthcare AI leader–on the backs of sick, rural citizens’ data privacy

Picture this: a mobile rural health clinic arrives at a rural village in Jia County, in China’s Henan province. The clinic staff check the villagers, many of them elderly and infirm from their hard-working lives. The staff collect vital signs, take blood, urine, ECGs, and other tests. It’s all free, versus going to the hospital 30 miles away.

The catch: the data collected is uploaded to WeDoctor, a private healthcare company specializing in online medical diagnostics and related services that is part of Tencent, the Chinese technology conglomerate which is also devoted to AI. All that data is uploaded to WeDoctor’s AI-powered cloud. The good part: the agreement with the local government that permits this also provides medical services, health insurance, pharmaceuticals and healthcare education to the local people. In addition, it creates a “auxiliary treatment system for general practice” database that Jia County doctors can access for local patients. According to the WIRED article on this, it’s impressive at an IBM Watson level: 

Doctors simply have to input a patient’s symptoms and the system provides them with suggested diagnoses and treatments, calculated from a database of over 5,000 symptoms and 2,000 diseases. WeDoctor claims that the system has an accuracy rate of 90 per cent.

and 

Dr Zhang Qiaofen, in nearby Ren Zhuang village, says the system it has made her life easier. “Since WeDoctor came to my clinic, I feel more comfortable and have more confidence,” she says. “I’m thankful to the device for helping me make decisions.”

The bad part: The patients have no consent or control over the data, nor any privacy restrictions on its use by WeDoctor, Tencent, or the Chinese government. Regional government officials are next pictured in the article reviewing data on Jia County’s citizens: village, gender, age, ailment and whether or not a person has registered with a village health check. Yes, attending these health checks is mandatory for the villagers. 

What is happening is that China is building the world’s largest medical database, free of those pesky Western democracy privacy restrictions, and using AI/machine learning to create a massive set of diagnostic tools. The immediate application is to supplement their paucity of doctors and medical facilities (1.5 doctors per 1,000 people compared to almost double in the UK). All this is being built by an estimated 130 private companies as part of the “Made in China 2025” plan. Long term, the Chinese government gets to know even more intimate details about their 1.3 billion citizens. And these private companies can make money off the data. Such a deal! The difference between China’s attitude towards privacy and Western concerns on same could not be greater.  More on WeDoctor’s ambitions to be the Amazon of healthcare and yes, profit from this data, from Bloomberg. WeDoctor is valued at an incredible $5.5 billion. Hat tip to HISTalk’s Monday morning update.

NHS App’s pilot results: renewing prescriptions good, making appointments…not so much

The NHS App, announced at the end of 2017, piloted in September-December 2018. It started with one GP practice in Liverpool and grew to 34 practices across England, eventually growing to 3,200 registered patients, exceeding its target registration group by over 1,200. The NHS report was issued on 8 April.

  • Most used the app to view their patient records. Unless the patient had given prior consent to their GP to view their full patient record, only a summary was available through the app. This will revert to full patient records with the ability to add to the record as the default by April 2020.
  • For the pilot users, they reported positively on the app for prescription renewals; it was used for 662 repeat prescriptions and was found by 87 percent to be ‘easy and convenient’ as well as the app’s ‘most useful service’.
  • On booking appointments, the feedback was not so positive. Users had difficulty understanding the jargon used in booking.
  • They also found the two-factor authentication for security purposes annoying. For the full implementation, the development team is planning to add a biometric log in.

The NHS hopes to roll out the app to all English GP practices by July 2019. While the app became available in December on Google Play and the Apple App Store, patients have to wait for their GP to connect to it. Mobihealthnews, NHS report site

A counterpoint to this is the final closing of the Microsoft HealthVault later this year. Users will have until 20 November to migrate their data. HealthVault was one of the first services to allow consumers to record and share electronic health data. Microsoft has already shut down two related services, HealthVault Insights and the Health Dashboard. Most of these storage services have shut down (Revolution Health, Google Health, Google Fit, Dossia) with the surviving Apple Health Records and GetReal’s Lydia. Mobihealthnews

Leeds Digital Festival 2019: a two-week showcase of digital health and care

100% Digital Leeds, Tuesday 23 April – Sunday 4 May, Leeds, several venues including Co>Space North

This Editor is quite surprised at a two-week festival mainly about digital health and care in Leeds, but this program seems to have something for everyone–tech developers, interested consumers, medical staff, NHS policymakers, and many more. 

100% Digital Leeds centers around the city’s health mission statement–“Our city’s Health and Wellbeing Strategy 2016-2021 sets out a clear vision that ‘Leeds will be a healthy and caring city for all ages, where people who are the poorest improve their health the fastest’. This includes maximising the benefits from information and technology as a key priority.”

There are 16 events planned across the two weeks as of now, with such intriguing titles as “The future for artificial intelligence in health and care – dystopian future or digital paradise – you decide!”,  a session on teen mental health and social media, “Putting the human into redesigning health and care services”, a session on design, and “Can digital offer sanctuary for refugees and asylum seekers?” which is the first I’ve seen this topic addressed.

The events are curated by mHabitat on behalf of Leeds City Council and NHS Leeds Clinical Commissioning Group (CCG). Key speakers will include representatives from the event program’s sponsor, the UK’s leading privately-owned IT and business consultancy BJSS, NHS England, NHS Digital, international speakers, academic experts, patients and citizens with first-hand experience of using digital to manage their conditions, and industry.

Much more on the Leeds Digital Festival website here including detailed descriptions of the sessions and venues. #LDF19, Twitter and Instagram @wearemhabitat  Hat tip to Anna Goddard of KC Communications for the alert.

Spring is here, so are some events to enjoy–and broaden your horizons

AI in healthcare: hope or hype? MedStartr, Rent24NYC, Thursday 18 April, 6 – 9pm

Our colleagues at MedStartr are hosting a panel discussing a hot topic: AI in healthcare. Panel and speakers include Melissa Honour, IBM Watson, Artificial Intelligence Portfolio Lead; Joseph Gough, EVP Innovation, Remedy Health;  Samantha Nazareth, MD, Gastroenterologist, writer, broadcast commentator, and healthcare analyst. More to come! Cost is $20 but there are drinks and snacks throughout. Register on Meetup. TTA is a media partner of Health 2.0 NYC and MedStartr.

Validating Your Digital Health Solution: Why, When and How. Partners HealthCare Pivot Labs, Liberty Hotel, Boston, Monday 22 April, 6-9pm

On the journey to commercializing your health tech product, there are multiple ways to test it. It can be difficult to determine where to start, how to do it and what to evaluate. During this free session, Partners HealthCare Labs will address why validating your digital health solution – whether for clinical or economic outcomes – can benefit your product. RSVP at this link.

Two coming up very soon via Aging 2.0 NYC:

Thursday-Friday 11-12 April: The Center for Research and Education on Aging and Technology Enhancement (CREATE) will hold a two-day workshop on Design For Older Adults at Weill Cornell’s Division of Geriatrics. If you are designing technology, consumer or health products, or living environments for older adults, this is a unique opportunity to network with colleagues and glean advice from leading experts in aging and design. Because of the highly interactive nature of this workshop, attendance is limited to 35 attendees. Aging2.0 members receive a discount. Email Adrienne Jaret at adj2012@med.cornell.edu or call 646-962-7153 (mention Aging2.0).

Monday, April 29: Aging2.0 and CaringKind will host the third annual Technology for Caregivers showcase from 1:30pm-7:30pm at CaringKind’s headquarters at 360 Lexington Avenue. This one-day event will give caregivers and the Aging2.0 community the opportunity to try the latest technology for caregiving and dementia, and provide startups the opportunity to showcase their products. Last year’s event was featured on CBS and saw more than 300 caregivers interact with 25 innovative startups. If you would like to have your company featured contact us at newyork@aging2.com. Register here.

And finally, we’d be remiss in not mentioning next week’s ATA19 which will be held 14 – 16 April in New Orleans at the Convention Center. Less and less referring to itself as the American Telemedicine Association, the conference is also less significant than it once was due to the specialization of health tech, the rise of HIMSS earlier in the year, as well as early fall’s Health 2.0 and the Connected Health Conference. Nevertheless, for many companies in the field it is still a must-attend if not a must-exhibit. Registration is still open here.

Drawn-out decision on the CVS-Aetna merger held up again in Federal court

“The Perils of Pauline” saga that is the CVS-Aetna merger continues. Judge Richard Leon of the US District Court for the District of Columbia twirled his mustache and announced that his court will hold a hearing in May on the merger. Practically nobody dislikes this particular $69 billion merger that’s already closed–not the companies, shareholders, Congress, the states, and not the Department of Justice, once Aetna sold off its Medicare Part D drug business to WellCare. But Judge Leon is an exception.

The Tunney Act requires the government to file proposed merger settlements as an approval of the consent decree with a Federal district court to assure they are in the public interest. Most are filed, reviewed by a judge, and approved with no hearings. Since October, Judge Leon has been examining the merger up, down, and sideways in, of course, the public interest and great attention by the press. Now a week (or more) of May hearings will commence with those who don’t like this merger, including the American Medical Association, the AIDS Healthcare Foundation, pharmacy and consumer groups.

Certainly this is long and drawn out, even for the DC district court. Even the high drama of the Aetna-Humana and Cigna-Anthem mergers took a little less time. Judge Leon continues to get coverage and the merger continues to be held up. Reuters, Fox News, Seeking Alpha

EHRs: The Bridge to Nowhere–other than despair. An investigative Must Read on ‘an unholy mess’.

If you hate your EHR, think it’s swallowing your information, adding hours to your day, and if you don’t watch it, you’ll make an error, you’re not a Luddite. You’re right. An exhaustive investigation by Fortune and Kaiser Health News (KHN) concludes that it’s ‘an unholy mess’. In fact, even if you are not a physician or clinical staff, it will make you wonder what was going on the collective brains of the digerati, Newt Gingrich, Barack Obama–and the US government–in thinking that EHRs would actually “cut red tape, prevent medical mistakes, and help save billions of dollars each year,” committing $36 billion to pursuing the ‘shovel-ready’ HITECH stimulus in the depths of the 2008-9 recession. Perhaps the shovel should have been used on a body part. Now if only those billions went towards an interoperable, useful, and national system rather than a money giveaway–which even Farzad Mostashari, then ONC deputy director and later director, now admits was “utterly infeasible to get to in a short time frame.” (Mr. Mostashari is now head of Aledade, counseling those mostly independent practices which lined up–hungry or terrified–for meaningful use EHR subsidies on how they can continue to survive.) Even the vendors were a bit queasy, but nothing was stopping HITECH. (Your Editor was an observer of the struggle.)

Now that we have been living with them for over a decade, EHRs have been found culpable of:

  • Soaring error rates, especially in medication and lab results
  • Increasing patient safety risks in lack of pass-through of critical information
  • Corporate secrecy, enforced by system non-disclosures, around failures
  • Lack of real interoperability–even with regional HIEs, which only exchange parts of records
  • Incomplete information
  • A very real cognitive burden on doctors–an Annals of Family Medicine study calculated that an average of 5.9 hours of a primary care doctor’s 11.4 hour working day was spent on the EHR
  • Alert fatigue
  • Note bloat
  • Plain old difficulty or unsuitability (ask any psychiatrist or neurologist)
  • A main cause of doctor burnout, depression, and fatigue–right up to high suicide rates, estimated at one US physician per day
  • Lack of patient contact (why the scribes are making a good living)
  • All those dropdowns and windows? Great until you click on the wrong one and find yourself making a mistake or in the wrong record.

Not even the head of the Centers for Medicare and Medicaid Services is immune. Seema Verma’s husband, a physician, collapsed in the Indianapolis airport. She couldn’t collect his records without great difficulty and piecing together. When he was discharged, he received a few papers and a CD-ROM containing some medical images, but without key medical records.

A long read for lunch or the weekend. Death by a Thousand Clicks: Where Electronic Health Records Went Wrong. Also the accompanying essay by Clifton Leaf

News roundup from all over: prescribing apps is back! Plus telemental health Down Under, GreatCall’s health tech strategy, Wessex’s diabetic sim, telehealth growth outpaces urgent care

Back to the future with prescribing apps! Early stage Xealth just gained a $11 million Series A from heavyweights such as Novartis, McKesson Ventures, UPMC, Philips, and ResMed. Clinicians can prescribe and monitor digital health care content, apps, devices, and services from within their EHR. Yet another thing to add to their 5+ hours a day in the system! Let’s hope that in staying away from certification, they are more successful than predecessors like the long-expired Happtique and the little-noticed but still in business Xcertia [TTA 6 Dec 15Release 

Telemental health startup Lysn working to spread mental health access in Australia. In two years, it has grown to over 265 psychologists and partners with 53 GP clinics, mainly regional and rural. The creator of the service is a Canadian-born surgeon, Dr. Jonathan King, who is 35–and bootstrapped it with his own earnings and house. In The Black

A good coffee break read is an interview with GreatCall’s CEO David Inns outlining their health tech strategy for older adults, including a reboot of Lively Home (without the exclamation point) with Senior Whole Health in Massachusetts for ADL monitoring (set up by Best Buy’s Geek Squad), the predictive analytics part of HealthSense in using connectivity and monitoring to predict falls, depression, and diseases, and back to wearables with smartphones. What is interesting is the stunning claim that they can back up the “soak up 20 percent of the healthcare costs of the population that we’re working with” through these predictive analytics and monitoring by reducing long-term care expenses. (Reminds me of some of the claims we made at Living Independently!) However, if any company has the muscle to make it happen, they do. BTW, not a peep about the retail Assured Living in Best Buy stores we tried to find last year, in vain. Mobihealthnews.

Oxford Medical Simulation is partnering with NHS England to trial its virtual reality training for diabetic emergencies. The pilot is being directed by Health Education England Wessex at the Portsmouth and Southampton Hospitals. Fifty doctors will use Oculus Rift headsets to walk through Oxford’s 100 or so scenarios. Mobihealthnews.

The growth of telehealth is outpacing urgent care and retail clinics, according to FAIR Health. This healthcare nonprofit calculated a 53 percent growth rate for telehealth (defined as virtual visits) between 2016 and 2017. In contrast, urgent care use increased only 15 percent in urban areas but went flat in rural areas. Retail clinic use fell 28 percent in urban areas and with a small 3 percent increase in rural areas. The advantages of telehealth in rural areas (up 29 percent), of course, is not having to drive when you’re sick. For urban residents, the advantage is not having to leave the house. According to their analysis, the top three reasons for telehealth visits were acute respiratory infections, digestive issues and injuries, each representing 13 percent of telehealth diagnoses. Mental health, which led in 2016, dropped to fifth. Healthcare Dive

News roundup: Teladoc acquires MédecinDirect, Blue Cedar closes $17M Series B, Hill-Rom buys Voalte, Withings bolsters sleep tracking

Teladoc grows its global reach with the MédecinDirect acquisition. Paris-based MédecinDirect currently has 24/7 telehealth operations within France, with patients able to text, video, or phone GPs or specialist doctors 24/7. Terms were not disclosed and the sale is subject to regulatory approval, but expected to close within the first half of this year. Founded by François Lescure, a pharmacist, and Marc Guillemo, a digital marketer, in 2008, the company’s client base grew to more than 40 leading insurance partners and nearly half of the top 30 private medical insurers (PMIs) in France.  MédecinDirect will become the French unit of Teladoc, which now has operations in the UK, Australia, Canada, Spain, Portugal, Hungary, China, Chile and Brazil, covering 130 countries in more than 30 languages with a growing specialist base from earlier acquisitions Best Doctors and Advanced Medical. Teladoc seems to have moved on from its financial and accounting problems that marred 2018, but still is not profitableRelease, Mobihealthnews.

App security innovator Blue Cedar closes on its Series B for $17 million. New investor C5 Capital, a specialist venture capital firm focused on cyber security, joins $10 million (2016) Series A investors Benhamou Global Ventures, Generation Ventures, Grayhawk Capital, and Sway Ventures. Daniel Freeman from C5 Capital will join Blue Cedar’s Board of Directors, Blue Cedar pioneered the approach of securing data from the app to the provider location on a client’s servers or in the cloud, without the smartphone or other mobile device being managed and without additional coding. TTA last year profiled Doncaster UK-based MediBioSense Ltd. using Blue Cedar to protect their VitalPatch app [TTA 23 Jan 18] and later as a case study in how digital partnerships happen and develop [TTA 17 Feb 18]. Release, Blue Cedar blog.

Hill-Rom increases its technology bets with Voalte. Voalte is a mobile communications platform used by hospitals and large healthcare organizations for care teams to securely exchange information and data. The privately held company from Sarasota Florida currently serves 200 healthcare customers, 220,000 caregivers, and more than 84,000 devices. Terms of the acquisition were not disclosed but is expected to close during Hill-Rom’s fiscal third quarter of 2019. Hill-Rom, primarily known for its ubiquitous hospital beds, late last year teamed with Israeli company Early Sense to create a smart hospital bed that monitors heart and respiration rates [TTA 12 Dec 18], which ties nicely with Voalte’s monitoring. Release.

Tossing the sheets in your bed at home? The newly reconstituted Withings comes to the rescue with deepening its sleep monitoring with an upgraded sleep sensor mat that detects sleep breathing disturbances in frequency and intensity. The connected Withings Sleep app monitors sleep cycles, heart rate and snoring, displaying scores through the companion Health Mate App. Not quite a sleep apnea diagnostic, but significant breathing interruption detected during sleep could indicate the need for further investigation.  Mobihealthnews

Suddenly hot, redux: mental health telemedicine in long term care, analytics to help predict rehospitalizations in skilled nursing facilities

The positive side of telemedicine for two areas–Long Term Care (LTCF). Skilled Nursing (SNF). Two types of care facilities that don’t get a lot of excited cocktail party chatter or much respect in the health tech field. Yet the needs are there, the tech attention has returned, and apparently the money has as well.

A major provider of behavioral health services for LTCF, Deer Oaks, is turning to telemedicine (SnapMD) to expand their reach. Already working with 1,400 LTCFs in 27 states in the central to southern US, Deer Oaks has been active since 1992 in providing both psychiatric and psychological services for geriatric and disabled patients.

The problem is coverage and the lack of providers. Psychiatry is itself aging out with few young doctors in the field–as well as the uneven distribution of practitioners. Mental health is a significant concern in the older adult population, including those dealing with depression and dementia.

Deer Oaks is adding telemedicine to expand to facilities in smaller, in rural areas, to extend hours, and to reach people with limited mobility. Facilities receive equipment and training. Two significant challenges they found were the lack of tech expertise in the staff, and importantly, the reliability of Wi-Fi in those areas, which is needed at 500 kbs of bandwidth to work. This expansion fits with CMS’ extension of covered telemedicine in rural areas and FCC’s continuing Connected Care Pilot Program, San Antonio-based Deer Oaks is estimated to have over $18 million in revenue (CrunchBase) and sees their growth in this area, according to an interview in mHealth Intelligence.

Assessing developing conditions in a SNF or LTC patient and preventing readmissions will always get this Editor’s attention, as she started in the field with behavioral telemonitoring for this area.

  • Real Time Medical Systems raised at end of February $9.2 million from SunBridge Capital Management to fund the growth of their analytics software which uses EMR information plus information from clinicians in routine monitoring of resident status to alert for early changes in resident conditions. Appropriate intervention could prevent hospitalization or a more serious development. Real Time currently has 500 SNFs and 30 hospitals, for a total of about 60,000 covered residents.
  • Skilled Nursing News also notes that Call9, an emergency medicine provider that embeds first responders at SNFs to provide onsite care and reduce unnecessary transfers to ERs, has raised a stunning $34 million and is concentrating on both SNF and assisted living. It is connected with several major payers and Medicare Advantage plans.
  • More conservatively, Third Eye Health, which provides post-acute emergency telemedicine to 220 SNFs, recently raised $7 million. All these companies have claimed readmission reductions of 40 to as high as 70 percent, and savings from services such as these may be billions.

None of which gets buzzy panels at HIMSS, Health 2.0, or CES, or viral videos on the news as the plight of Mr. Quintana did [TTA 13 Mar, below] but provides a badly needed advance in care services–and savings–for LTCs/SNFs and badly needed and better care for their patient residents.

A telemedicine ‘robot’ delivers end of life news to patient: is there an ethical problem here, Kaiser Permanente?

Bad, bad press for in-hospital telemedicine. A 78 year-old man is in the ICU in a Kaiser Permanente hospital in Fremont, California. He has end-stage chronic lung disease and is accompanied by his granddaughter. A nurse wheels in an InTouch Telemedicine ‘robot’ (brand is clearly visible on the videos; KP is one of their marquee customers). The mobile monitor screen is connected to a live doctor on audio/video for a virtual consult. The doctor is delivering terminal news: that not much can be done for Mr. Quintana other than to keep him comfortable in the hospital on a morphine drip, and that he would likely be unable to return home to hospice care.

Granddaughter Annalisia Wilharm videoed the consult. The screen is high above the bed, the doctor is wearing headphones, and is looking down. The doctor’s voice is accented and hard to understand through the speakers–is the volume low because it’s set low or due to privacy regulations? In any case, the doctor is asked time and again to repeat himself by the granddaughter as the patient cannot hear or understand the doctor. Another factor apparent on the video to this Editor is that the patient is on a ventilator–and ventilators make noise that mask other sounds.

Mr. Quintana passed away in the hospital last Tuesday 5 March, after a two-day stay.

The video has gone viral here in the US, with the family going to local press first (KTVU). The story was picked up in regional Northern California coverage and blew up into national coverage from USA Today (edited video complete with emotive background music), Fox News (San Jose Mercury News video), and picked up in media as diverse as the Gateway Pundit–if you want to get a feel for vox populi, see the comments.

Kaiser Permanente has apologized in guarded terms: “We offer our sincere condolences,” said Kaiser Permanente Senior Vice-President Michelle Gaskill-Hames. “We use video technology as an appropriate enhancement to the care team, and a way to bring additional consultative expertise to the bedside.” Also: “The use of the term ‘robot’ is inaccurate and inappropriate,” she exclaimed. “This secure video technology is a live conversation with a physician using tele-video technology, and always with a nurse or other physician in the room to explain the purpose and function of the technology. It does not, and did not, replace ongoing in-person evaluations and conversations with a patient and family members.” The family also was well aware of Mr. Quintana’s status but is equally upset at his treatment at this critical time.

Despite all this exclaiming, this Editor, an advocate of innovations in telemedicine and telehealth since 2006, finds fault with Kaiser Permanente’s deploying a telemedicine consult in this situation on the following grounds:

  • End-of-life news this serious needs to be delivered by a human. Period.
  • Despite Ms. Gaskill-Hames’s statement, the video consult was not intermediated by a human. There is someone in scrubs behind the InTouch mobile monitor, but there is no standing by the monitor nor any effort to interpret what the doctor is saying. Explaining the technology is not explaining what the patient and family can do.
  • The patient had difficulty understanding the doctor’s voice, either through hearing or language comprehension. A ventilator could be blocking or masking the audio. Even so, the audio, depending on the source, is muddy, and the video worse than you get on a smartphone. 
  • The monitor is at the foot of the bed, not close to the patient. The patient may not be able to see the monitor at that distance due to poor vision.
  • It doesn’t take much thought to believe there may be an issue of cultural inappropriateness.
  • There is no patient advocate or a chaplain present. Whether one visited later is not known.
  • Another open question: why was additional comfort care and a ventilator not available at home if Mr. Quintana was truly terminal? Did this man die needlessly in an ICU?

The popular takeaway about Kaiser, the VA, and other health systems which are deploying telemedicine by their patients is that robots are replacing doctors. We may know better, but that is what the consumer press runs with–an emotional video that, BTW, breaks patient-doctor confidentiality by showing the (unnamed, but not for long) doctor giving medical instructions to Mr. Quintana.

It is not the telemedicine technology, it is how it is being used. In this case, with insensitivity. The blame will be laid, in this shallow time, at the feet of the ‘robot’. Rightly, blame should also be laid at the feet of the increasingly ‘robotic’ practices of major health systems.

There will certainly be more to this story.

A view at some variance, but winding up in the same place, is expressed by Dr. Jayne in HIStalk.

A useful White House study released: ‘Emerging Technologies to Support an Aging Population’

Just released is the 40 page Executive Branch report on technologies with the potential to better support aging in place. Emerging Technologies to Support an Aging Population was developed by the Task Force on Research and Development for Technology to Support Aging Adults organized by the National Science and Technology Council (NSTC) and the Office of Science and Technology Policy (OSTP).

The Trump Administration has made finding solutions for an aging population–now over 15 percent of the American population–a research and development (R&D) priority to enhance the functional independence and continued safety, well-being, and health of older Americans, while reducing overall economic costs and the stress on the Nation’s healthcare infrastructure. The report identifies six primary functional areas which are critical to aging adults and which should be addressed by technology:

  1. Key activities of independent living 
  2. Cognition
  3. Communication and social connectivity
  4. Personal mobility
  5. Transportation
  6. Access to healthcare

Added to this are cross-cutting themes across two or more of these functional areas.

Each of these areas are broken down into focus areas with key functional needs. From each need, the study identifies R&D topics for developing solutions. For instance, a key functional need under both independent living and healthcare is oral hygiene, and one solution is  developing systems to support personalized dental regimens.

What is attractive about this study is that it cuts to the chase in identifying the themes and the analysis leading to the R&D–and a great deal here that’s useful for developers and healthcare organizations. Hat tip to Laurie Orlov of Aging In Place Technologies, who this week also released her 2019 Technology Market Overview

 

Hackermania ‘bigger than government itself’–and 25% of healthcare organizations report mobile breaches

To quote reporter Andy Rooney, ‘why is that?’ Everyone in healthcare (with our Readers well ahead of the curve) has known for years that our organizations are special targets, indeed–by hackers (activists or not), spammers, ransomwarers, criminals, bad guys in China, North Korea, and Eastern Europe, plus an assortment of malicious insiders and the simply klutzy. Why? Healthcare organizations, payers, and service companies have a treasure trove of PHI and PII with Big Value. 

So to read in Healthcare IT News that Christopher Wray, the new director of the FBI, is saying that today’s cyberthreats are bigger than any one agency, and in fact bigger than the government itself, it gives you the feeling that the steamroller has not only run over us, but is on the second pass.

According to one reporting company, Bitglass, breach incidents were year-over-year flat (290), but the number of records affected in 2018 nearly tripled from 4.7 million to 11.5 million. Hacking finally became the top cause (45.9 percent) versus unauthorized access and disclosure (35.9 percent). Loss and theft is down to about 15 percent.

And mobile feels like that second pass. Verizon’s Mobile Security Index 2019 reports that 25 percent of healthcare organizations have had a mobile-related compromise. Nearly all hospitals are investing in mobile. In the field, doctors and other clinicians are either using issued devices or BYOD, whether authorized or not. Whether or not their organizations are using app security systems like Blue Cedar [TTA 17 Feb 18] or work with companies like DataArt on securing proprietary systems is entirely another question. Apparently it’s not a priority. According to the Verizon study, nearly half of all organizations sacrificed mobile security in the past year to “get the job done.” Healthcare Dive.

Back to Director Wray, who is urging public-private cooperation especially with the FBI, which itself has not hesitated to break encryption (e.g. Apple’s) in going after criminals’ phones.

Smartphone-based ECG urged for EDs to screen for heart rhythm problems: UK study

A UK study of patients reporting heart palpitations at Emergency Departments (EDs) compared the use of standard care at the ED versus standard care plus the use of a smartphone-based ECG (EKG) event recorder (the AliveCor KardiaMobile) to determine whether symptomatic heart rhythms were present. Often heart palpitations are transitory and triggered by stress or too much coffee, but may indicate a larger problem such as atrial fibrillation which can cause stroke, or other types of cardiac disease.

Researchers from the University of Edinburgh and NHS Lothian conducted the trial over 18 months in 10 UK hospital EDs, with a total patient group of 243. The intervention group was given a KardiaMobile and told to activate it if palpitations were felt, with results sent to a doctor. 69 of 124 reported symptomatic rhythm using the AliveCor device over 90 days versus 11 in the control group of 116. Reporting was over four times faster: the mean detection time was 9.5  days in the intervention group versus 42.9 days in the control group.

The study was funded by research awards from Chest, Heart and Stroke Scotland (CHSS) and British Heart Foundation (BHF) which included funding for purchasing the AliveCor devices. NHS England has issued statements included in the BBC News article on how they have issued AliveCor devices to “GP practices across the country as part of the Long Term Plan commitment to prevent 15,000 heart attacks, strokes and cases of dementia.” Retail pricing is US $99 and UK £99. EClinical Medicine (study) Hat tip to the always dapper David Albert, MD of AliveCor

Listening to music impairs verbal creativity: UK/Sweden university study

Take those headphones off, and think more clearly. The conventional view that music enhances creativity is being refuted by a University of Central Lancashire, University of Gävle in Sweden and Lancaster University study that has found the opposite.

When matched against respondents in library or relatively quiet natural ambient noise conditions, music listening “significantly impaired” the completion of simple but creative/problem-solving verbal tasks classified as Compound Remote Associate Tasks (CRATs), such as associating three words (e.g., dress, dial, flower), with another word (in this case “sun”) that can be combined to make a common word or phrase (i.e., sundress, sundial and sunflower). It apparently didn’t matter whether the music was instrumental or with foreign-language familiar lyrics.

It’s not a surprise as this Editor cannot work with music on for any length of time since her attention goes to the music versus what she’s working on. This is despite a misspent girlhood where she studied for exams listening to WABC’s Cousin Brucie and Scott Muni hosting New York’s Top 40 pop music. (Maybe teen brains are different?)

It’s mentioned here because music is frequently used in tech applications–in the design of music therapy in cognitive treatment and with memory-impaired seniors–and devices like Alexa at home and music in work environments are becoming pervasive. Thinking clearly and music listening may not be compatible for most people. But active listening to music alone can be quite pleasant, rather than as a background to multitasking. How listening to music ‘significantly impairs’ creativity (AAAS EurekAlert!), Lancaster University release/videos here, research study (Wiley) 

RSM’s Medical apps: mainstreaming innovation with Matt Hancock

This event on 4 April run by the Royal Society of Medicine’s Digital Health Section continues the successful series started by this editor (now no longer involved) seven years ago. It will examine the growing role that apps are playing in healthcare delivery.

Join colleagues to hear renowned speakers, including the Secretary of State for Health and Social Care, Matt Hancock, discuss the current and future part apps can play in the NHS and broader healthcare industry. We will hear Wendy Clarke, executive director at NHS Digital talk about the new NHS app. As apps move from concept to pilot to practice, demonstrating efficacy becomes increasingly important, so will be looking at how we can best assess clinical effectiveness. It is well recognised that poorly designed software can hamper rather than enhance healthcare. Matt Edgar Head of design for NHS Digital will talk of the importance of good design in medical apps, and how it can improve patient and clinician experience. The use of cutting edge technology in healthcare necessarily opens new regulatory and legal issues. We are pleased to have our legal counsel, Julian Hitchcock back to share his experience with this, with a particular focus on the use of artificial intelligence in healthcare. We will also be examining the importance of interoperability, as medical apps become more mainstream, and how to make this happen. We have some presentations, too, from new and established medical start-ups, showcasing the transformative effects these new technologies can have. Finally, we will take a look at what the future may hold with futurologist Lewis Richards, Chief Digital Officer of Servest.

Aims:

This meeting aims to: 

  • Encourage clinicians to consider medical apps when deciding on an appropriate intervention
  • Aid understanding of the medicolegal issues around medical app use
  • Reduce the fear, uncertainty and doubt about the use of medical apps

Objectives:

By the end of this meeting, delegates will be able to,

  • Have an understanding of the current state of the art of medical apps
  • Explain the latest position on regulation and endorsement of medical apps
  • Have an appreciation of how to assess the clinical effectiveness of medical apps. 

Book here – best to book soon too, as currently the RSM has not allocated the largest lecture theatre to the event so it will almost certainly sell out.

Suddenly hot: chronic condition management in telehealth initiatives at University of Virginia and Doctor on Demand

Chronic condition monitoring is suddenly hot. UVA has been a telehealth pioneer going back to the early oughts, with smart homes, sensor based monitoring, and remote patient monitoring. Their latest initiatives through the UVA Health System focus on preventing or managing chronic conditions. It will include remote monitoring for patients with diabetes, screenings for patients with diabetic retinopathy, home-based cardiac rehabilitation programs for heart failure patients and streamlined access by primary care physicians to specialists through electronic based consults. The program will also include specialized trainings for health care providers.

The programs are being funded by a $750,000 grant from the federal Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health. UVA press release, Mobihealthnews

Mobihealthnews earlier noted that Doctor on Demand, a smaller commercial telehealth company, is also expanding in the management of chronic conditions through a new service, Synapse, that creates a digital medical home for personal data. This data can include everything from what is generated by fitness trackers to blood pressure monitors. The data can be directly shared with a provider or across health information exchanges and EMRs. Doctor on Demand plans to use this longitudinal data to identify gaps in care and increase access to healthcare services–and also integrate it into existing payer and employer networks.

This Editor recalls that this was a starting point for telehealth and remote patient monitoring as far back as 2003, but somehow got lost in the whiz-bang gadget, Quantified Self, and tablets for everything fog. Back to where we started, but with many more tools and a larger framework.