The Economist summarizes the mHealth Summit in a brief but meaty article that summarizes the massive detail presented. Gates: beyond the pilots, technology has to be replicable and scale up. Anta (Inter-American Development Bank): ‘We know little about impact and nothing about business models’. Business interest is stimulated by 1) cloud computing applications, 2) US adoption of EHRs, 3) developing countries’ mHealth ideas and business models (such as mobile banking), 4) substituting technology for medical labor (Healthpoint Services and P&G support). M-powered: the convergence of mobile telephony and health care is underway.
12.00: The conference is just opening – check back in a couple of hours!
22:00 The aim of my reports is to give people who are unable to attend a flavor of the conference. Well, for context, with 800 people attending during the three days and over 40 companies exhibiting it is still big by UK standards. It is notable that the numbers are up despite these difficult financial times.
The opening afternoon’s plenary sessions sent a clear message that telecare call monitoring services should be looking towards telehealth monitoring as a future business opportunity. The TSA is looking to appoint someone to focus on it, and Trevor Single, TSA CEO, announced that they are aiming to produce a Telehealth Code of Practice in 2011.
Kevin McSorley from Fold Telecare in Northern Ireland gave an overview of developments during the past 15-years of the TSA and its preceding organisation. His conclusion was that 15 years is a long time for a quiet revolution…so now is the time to turn up the volume.
He was robust on the need for large scale deployments that are not driven by one-off funding, but by the strength of their business cases. People involved in telecare were, he said, reluctant revolutionaries, but he left the audience with the challenging questions: “If not us, who? And if not now, when?”
James Ferguson, professor of emergency medicine and clinical lead to the Scottish Centre for Telehealth (now part of NHS24) followed with wide-ranging examples of teleconferencing with patients in telemedicine, most of which have been covered in Telecare Aware. The main ‘takeaway’ was that in Scotland the aim is to have a national telehealth service that will focus on: people with strokes; COPD; paediatrics, and mental health. “The most difficult task” he said [speaking as a persuasive person who has experienced it], “is marketing to the organisation, not the patients.” He also added that in the future, healthcare professionals should start to feel nervous if first contact with a patient is not mediated by electronic triaging.
Chris Crockford opened the throttle on further telehealth thinking with a presentation that explained his interest in remote health monitoring as a pilot, a mountaineer and the ex-Business Development Director for McLaren F1 where the scale and complexity of real time remote sensor monitoring already exceeds anything envisaged for health purposes. He then developed the theme of the read-across to technology that people actually want to use and/or find intrusive.
He also provided the quote of the afternoon: “Age…appearing in a mirror near you soon”.
The fourth speaker was Keith Nurcombe, Head of Healthcare for O2, whose three new telehealth projects had publicity recently. (TA item) What was significant about his presentation was that the emphasis was not on the technology despite O2 being part of the Telefonica group which employs over 1,000 people across Europe who are concentrating on developing new technologies. His emphasis was, instead, on listening to the needs of the potential users (“because that’s how O2 got to be so big in the UK so quickly”) in order to make the technology into the enabler and not the driver of developments.
We learned an interesting snippet about O2’s three projects: the technology was apparently given to their NHS partners “before it was on the open market”, as a learning experience for the partners and for O2. He talked about the project in West Berkshire, where it was observed that people were staying in hospital after knee operations for days just so that they could be encouraged to do their exercises by a physiotherapist for about half an hour each day. Using technology to do the same checking and encouragement from home provides a much better outcome for everyone. [However, one can’t help but wonder whether, in the end, the need to sell services and products means that the ‘tell us what you need to do and we will work out how best to do it’ approach will turn out to be too vague to be marketable.]
Thanks to the playful and rather provocative style of the Conference Chair Roy Lilley, the afternoon was rounded off with a lively discussion between the panel and audience members, some of whom seemed slightly stunned by the emphasis on telehealth and several of whom noted that disquiet about the design of most currently available kit had been expressed by a number of speakers. Perhaps, at last, the spell of ‘it saves lives, therefore is must be good’ has been broken.
Tomorrow’s reports will concentrate on the exhibitors’ wares.
Check this space for updates and links. As this will be a short day ending at 3pm, most news will be summarized in the afternoon (ET).
- Rockefeller Foundation announces an additional $1 million in funding for the mHealth Alliance. This follows the total of $2 million in funding announced in the past two days from Norway’s Norad and HP.
- Bill Gates speech–Yahoo! News coverage. Opportunities: telemedicine, patient med reminders, simple EMRs for immunization records, robots (yes, robots). If you still can’t get enough Gates, Brian Dolan’s take in Mobihealthnews on how Gates fit vaccines with mobile phones (the birth registry) and the limited vision demonstrated in his presentation (but different in his blog?)
- Also in Mobihealthnews: FDA’s Jeffrey Shuren, Director, Center for Devices and Radiological Health on how FDA will first look at mobile devices that fit in the traditional device mold…but that there should be opportunity to experiment (lots of wiggle room here) and interoperability was a key factor; from Day 2, Patricia Mecheal of Columbia University’s ‘top ten’ list of lessons from mHealth rollouts, the most important of which is ‘It’s not about technology’. #9 on public/private partnerships may be the key, at least for now, for most. Photos from the Summit are also on the main page. (Note the link to Movements.org which was linked to in our Day 1 and 2 coverage–Ms. Brannon has not posted for Day 3 however. Neat tweet from her on a Mashable article on ‘dumbphone’ i.e. standard voice/text phone is ripe for global innovation)
- The very last session–Does mHealth extend or disrupt existing health systems?–interesting panel, discussion of change in the medical model. Live feed up till 2:45pm. Linkous of ATA, McCray of WLSA, Arletty Pinel of iCarnegie, others
Running coverage of the mHealth Summit. Check this space for updates and links.
Insight on what’s next from Bill Gates: mHealth, mCommerce and robots. Excellent summary of the Bill Gates afternoon keynote (no live video feed). Tip of the hat to Alex Howard of Gov20.govfresh.
HIStalk for Day 2 (and last for him): the keynotes and supersession plus a small session that included Vitality GlowCaps, PhiloMetron’s PMTS sensor patch and UCLA’s Dr. Ozcan’s LUCAS microscope [TA 21 May]. A must read for a contrarian, witty POV. Hat tip to the (anonymous) author, whom we hope finally got something decent to eat. We will miss him tomorrow.
In other news:
- Norad (Norwegian Agency for Development Cooperation) is providing $1 million in support for the mHealth Alliance’s Maternal mHealth Initiative. Release. Announced by the Alliance’s chairman Tom Wheeler during the morning keynote. [Unfortunately, the best part of a somewhat comical morning keynote by Ted Turner expounding on his notions of world peace policy, wandering over the plains like one of his buffalo, with Mr Wheeler politely trying to corral him back to the mHealth point and his support on the UN Foundation’s work on eradication of malaria, polio and measles. After the umpteenth blatant plug of CNN and Cartoon Network, I ‘turnered’ the audio off.–Ed. Donna]
- Healthpoint Services Global, Inc. announced this morning a partnership with The Procter & Gamble Company aimed at advancing a scalable, self-sustaining model for delivery of water, healthcare, and other benefits to underserved rural communities in developing countries. Healthpoint is a for-profit active in India, provides in rural clinics safe drinking water, access to qualified doctors via telemedicine, advanced on-site diagnostics and an on-site licensed pharmacy. In addition they equip and deploy village health workers with mobile phones. P&G’s FutureWorks will provide financial support, people and in-kind services. PR Newswire release
- MedApps and CardioNet are forming a strategic alliance ‘to advance their positions in the mobile wireless medical market’. What they are doing together is not clear from the release except for this from CardioNet’s CEO Joseph Capper: ‘We are looking to MedApps to help accelerate our entry into additional areas of monitoring, and to extend our platform utilizing MedApps’ CloudCare™ technology.’ Terms not disclosed. BusinessWire. Related news: CardioNet yesterday announced a definitive merger agreement with Biotel, to close by 31 Dec. This had been postponed since last year. BusinessWire
- More Text4Baby news: a multi-million dollar commitment from Johnson & Johnson to the National Healthy Mothers, Healthy Babies (HMHB) Coalition to expand the program both numerically and to add new features; Department of Defense and HRSA (Health Resources and Services Administration) are evaluating the program for the underserved and military families. PR Newswire.
Neil Versel’s roundup today on FierceMobileHealthcare themed as highlights from the ‘Lollapalooza’ (annual US rock festival) of mHealth. Inspiring but sober. Dr. Louis Hochheiser’s (Humana) hopes on learning patient behaviors via mHealth and as a means of changing behaviors. Prof. David Gustavson (Univ. WI) on shortening the long timelines of pharma clinical trials (average 5 years) and other health/science breakthroughs (17 years!). At Fierce’s executive breakfast, Centers for Medicare & Medicaid Services’ Medical Director Dr. Barry Straube on telehealth and HIT being ‘ripe for change’ and very important in the cultural change of bringing healthcare to the individual and away from ‘brick-and-mortar’. Cell phones being used for maternal and child health and reducing mortality. (Dr. Straube to retire 31 Jan 2011 after six years at CMS. MassDevice)
Blog coverage of Day Two: Brannon Cullum in the Alliance for Youth Movements blog, Day Two highlights (including more on Mr Turner’s musings). Do read down to Theresa Cullen of the Indian Health Service on how in health, our Native American citizens have attributes of both the developed and developing worlds, and Patricia Mechael’s ‘Top Ten Lessons for mHealth’.
Healthcare IT News hosted live blogging of Tuesday only. CoverIt Live replay (direct link to page): keynotes by Ted Turner, the AM supersession and the Bill Gates luncheon, concluding with Aneesh Chopra’s hyperbolic pep talk. They also picked up the tweetstream from #mHS10 after midday.
Running coverage of the mHealth Summit. Check this space for updates and links.
HIStalk conference summary. Observant–and not above poking fun. Compared to others’ (HIMSS) focus on population health; heavy on the academics, NGOs, global health people–‘serious people getting serious education mostly working for noble causes underwritten by government money.’ See his points about 75% down on the mHealth business model or lack thereof; the general supposition is that mHealth will never be profitable. Too extensive to excerpt here–they deserve extensive discussion.
- Diversinet awarded a five-year contract to support expansion of the U.S. Army’s mCare telehealth-outreach program for members of the military recovering from mild traumatic brain injuries (TBI) and other wounds. This follows the one-year pilot that started with the now-defunct AllOne Mobile that transitioned to Diversinet, the developer of the MobiSecure Health platform. Release. Diversinet booth #202-12, in the Qualcomm pavilion. [Flashback to findings presented at ATA: TA 21 May]
- West Wireless Health Institute announced its first engineering prototype, Sense4Baby, a non-invasive fetal and maternal monitor that is portable and uploads data to the internet. It incorporates cardiotocography, standard technology for measuring fetal heart rate and uterine contractions, which is typically administered in a clinical setting for 20-30 minutes per visit and is used in high-risk pregnancies. Demo at their booth #205. Release.
- mHealth Alliance to receive a two-year, $1 million donation from HP. This funding will assist the Health UnBound (HUB) online community and the Maternal mHealthInitiative. Release.
- Text4Baby has passed 100,000 subscribers–101,962–announced by Dr. Todd Park, CTO of Health & Human Services, which has also created a Text4Health taskforce on how to apply lessons learned from Text4Baby to smoking cessation, obesity and childhood health issues. Mobihealthnews. Park also announced ‘detailed plans for the government to launch a website featuring health data harvested from across HHS – a wealth of easily accessible, standardized, structured, downloadable data on health care at the national, state, and county levels, as well as by age, gender, race/ethnicity, and income.’ mHealth Alliance release
Blog coverage of Day One: Alliance for Youth Movements blog (Brannon Cullum) 1st day highlights
Mobihealthnews on morning keynote speaker Dr. Francis Collins: increasing number of grants for mobile health research, highlights of NIH-funded applications and devices, the difference between developed and developing markets.
While Telecare Aware will not attending the mHealth Summit, here is how you can follow it as it happens.
UPDATED 9 NOV (PM)
mHealth Summit’s YouTube channel here. Posted interviews: Microsoft (Kristing Tolle), McKesson Foundation (Carrie Varoquiers), Qualcomm (Clint McClellan).
Twitter: #mHS10 (this feed is also on the streaming page)
Also on the mHealth Alliance website:
- Press briefing podcast (courtesy of 3G Doctor) focuses mainly on mHealth in the developing world and policy issues such as extending healthcare via mobile to compensate for physician shortages. A key announcement here is that Muhammad Yunus, Bangladeshi economist, Nobel Laureate and founder of the microcredit pioneer Grameen Bank, has been appointed to the mHealth Alliance board. (3G Doctor will also be there (booth #221) with a demo of their 3G Mobile Video consultations.)
- Interview with the head of Sproxil, Dr. Ashifi Gogo, on their Mobile Product Authentication system being tested in Nigeria to fight drug counterfeiting. [TA 5 Nov]
Telecare Aware is a media partner of the mHealth Summit.
David Doherty on the 3G Doctor blog has pulled together his thoughts and observations on the conference. There’s lots to delve into, as the information is organised by the companies attending. Review of the 2nd Mobile Healthcare Industry Summit, London, 21-22 September 2010.
The first day was rather disappointing but by the end of the second day I had achieved my goal and had networked with some people who have done, are doing, and plan to be doing, some remarkable things around mHealth – and that was priceless. (more…)
When we gave some free publicity to the Telehealth, telecare and new technologies in UK healthcare seminar organised by the Westminster Health Forum (supported by Bosch, but costing £190 to attend) I noted that “the most relevant of the web links appear to be broken”. It seems that this standard of organisation continued into the event itself. Despite the gift of a press pass, I’m sorry to say that the reporter who went on behalf of Telecare Aware came away frustrated by the event. Here are some comments for the organisers or anyone else intending to run such an event:
- 15 speakers in 4 hours (5 mins speaking, 5 mins questions) turns into a ‘death-by-PowerPoint-fest’ with presenters racing through their slides
- targeting publicity to avoid a mis-match between the speakers and the audience would not go amiss. In this case many in the audience knew as much as the speakers
- a 20 minute break (squeezed down to 15) is not long enough and small things – like not providing biscuits with the coffee (tough on people who skip breakfast to arrive in time for the start) – matter
- a post-event networking opportunity should be fully publicised in advance so that people do not plan to run off straight after the event
In sum, it was a manic morning where the few speakers with something new to say did not get long enough to expand on it.
Readers can download our reporter’s notes on the presentations (PDF 4 pages) here. These unofficial notes come with a ‘health warning’. He said “Trying to listen, understand, type and read what was on the screen was not easy!”
For the healthcare minded, the Consumer Electronics Show (International CES), officially kicking off Thursday (7 Jan) in Las Vegas (but all over the press with Google’s Nexus One, ‘smartbooks’/slates etc.), has a section in the LVCC’s North Hall dedicated to ‘digital health’. Unfortunately the exhibitor list in this ‘tech zone’ is a bit of a disappointment, with only Continua Alliance and GrandCare Systems of interest to our readers. The neighboring Silvers Summit ‘tech zone’ has more of interest, with Dakim (brain fitness), Jitterbug (phones), Tabsafe (med dispensing) and Wellcore (fall detection). But Continua seemingly has a child’s garden of wonders in their booth. They are demonstrating ‘the first end-to-end connected health solution based on the Continua architecture’: Nonin Medical’s wireless Bluetooth pulse oximeter sends data to a PC manager running Vignet’s Connected Health Services platform (debuting at CES-release) which is then uploaded to an IBM server. But…there’s more: A&D Medical (blood pressure and weight–see recent story on Halo partnership), Lamprey Networks, PDT, Renesas Technology, Tunstall Healthcare (Telehealth Platform–see below–and Connect) and ZyXEL are also demonstrating in the Continua booth. Continua’s release and press advisory.
[Donna Cusano update 7 January] Live from CES–GrandCare Systems hosted their weekly open webinar/conference calls from the just-opened floor.
- Add to your visiting list: Carnegie-Mellon/University of Pittsburgh (Silvers Summit ‘tech zone’ booth #3013)–their display from their Quality of Life Tech Center is a 64 square foot room demonstrating their latest innovations, including RFID-assisted walls that change moods–color and brightness–to assist those with traumatic brain injury, plus touch screens for vital signs monitoring. (Thank you Jeff Giuggio from C-M for the short briefing).
- Wellcore (#2909) is introducing at CES their in and out-of-home fall detector, which will be marketed through the firstStreet catalog starting in March. Beyond the usual accelerometer, it uses algorithms to track and discern type of motion, delivers voice messages from their online website and will prompt to be worn. Out-of-home, the Wellcore monitor connects via Bluetooth to a cell phone. Releases.
Although this editor isn’t there, we could have an ‘inside source’ for updates…we hope that what happens in Vegas, can’t stay in Vegas!
[Donna Cusano update 8 January] According to this release, at today’s 11am keynote Qualcomm chairman Dr. Paul Jacobs was joined by Dr. Eric Topol of the West Wireless Health Institute to highlight a selection of digital medical devices, including AirStrip OB (AirStrip Technologies), Mobile Baby (Great Connection), PiiX (Corventis) and Vscan (GE Healthcare).
Boston Park Plaza Hotel
The cost of providing you with these reports has been supported by the conference organizers and the following sponsors:
Your reporter from this conference is Donna Cusano
Thurs 22 October: Morning
Apologies for the delay in posting this. Unlike yesterday when I could retreat to my room and write, the need to check out from the hotel room and end of day running for the Acela back to NYC meant writing on the train (no WiFi on Acela – why?) and (finally) at home. Drink your morning coffee and read on….it may have been like drinking from a fire hose, but it was worth every drop…DC
The first morning keynote extended the ‘Overhauling Healthcare’ theme with a ‘disruptive’ and I believe significant presentation by Jason Hwang, MD, Executive Director of the Innosight Institute. How Disruptive Innovation Will Change Healthcare was researched for and drawn from his book, The Innovator’s Prescription, co-authored with Clayton Christensen and Jerome Grossman, MD. Disruptive innovations are breakthroughs in technology that, in their adoption, upset existing business models and force decentralization of distribution or usage. Examples: computer mainframe to mini-computer to PC (PC and now smart phones being the disrupters), the transistor, and online e-commerce in travel purchasing (on the last, from personal experience, being in the wrong side of disruption is a painful place to be). Dr. Huang’s point was that it is often futile to cram new technologies into old business models. The current centralized medical center is the old business model and rapidly becoming non-viable, much like Digital Computer.
What is driving decentralization in healthcare? Technologies that enhance the ability of technicians and non-physician clinicians to perform procedures, move care into the home and provide information directly to individuals and social networks. The former medical center becomes a ‘solution shop’ – the home of highly specialized expertise for diagnosis, even with the physicians themselves becoming more generalists. The ‘value added’ process (procedures following diagnosis) and follow up care will include more technicians and nurses doing routine, skilled procedures, with physicians taking a smaller role. Consumer information? Facilitated networks will distribute information through provider and patient communities. It’s all still evolving, no one is there yet, and the new ‘value network’ needed to gain traction is still undefined. At the end of this presentation I did understand one thing; if you wake up some mornings wondering what you’ve gotten yourself into, be reassured that you have lots of company.
Take all this disruption in our semi-free markets, empower the consumer and he or she will make rational decisions for their personal health, right? Peter Ubel, MD says, “I don’t think so”. His keynote presentation, Irrational Decisions and the Limits of Free Market Medicine (drawn from his book Free Market Madness, www.peterubel.com), examined how we as individuals and even medical professionals may make our decisions quite irrationally. Negative factors are our perception of risk, how the information is presented, perception of consequences and emotions. To him free markets have their limits, freedom and well-being are to be balanced. How? Ubel suggested negative incentives (e.g. taxes) on unhealthy behaviors (high fat or calorie food) and to subsidize healthy food and behaviors (fitness centers). We returned to this topic later in Drilling Down.
These were wrapped up with a panel moderated by Robert Hanscom, JD of CRICO/Risk Management Foundation; panelists were John Glaser, PhD, John Halamka, MD of CareGroup Health System, Peter Neupert of Microsoft and Jim Tosone of Pfizer Healthcare Informatics. The bulk of the discussion was on disruptive innovation, with Dr. Glaser focusing on the complexity of issues that result, such as accountability of both institutions and patients, plus the adoption rate of PHRs, but that second and third order effects are not predictable at this point. A differing view was held by Mr. Tosone, stating that disease management models were proving to be very difficult in terms of scale and business model. Decision support systems (DSS) were a ‘hot button’: Dr. Halamka projected that DSS would help patients make decisions and Dr. Glaser predicting that some high-value aspects of care would be pushed to trained clinicians (non-physicians) with DSS as a guide, but he was also sanguine on DSS’ limitations (e.g. not radiology). Neupert’s dash of realism was on what it will take to get to personalized medicine– the great investment in IT and support needed, he could not see happening right now.
On Ubel’s topic, it was a rational discussion on how much irrationalism there was out there and setting limits. Dr. Halamka believed that a clear set of probabilities would help patients make rational decisions; Dr. Glaser advocated DSS to set the boundaries in clinical decisions; and Mr. Tosone proposed a book sequel called “Mandated Madness” detailing the irrational decisions made by legislators and policy makers.
After a short break, we returned to man’s irrationality with Drilling Down on Mad Markets; Gentle Nudges and Behavioral Economics. Michael Barrett, JD of Critical Mass Consulting presented behavioral economics 101 [i.e. the basics] and typical biases such as conformity effect, loss aversion, anchoring and adjustment. The meaning for healthcare lies in pivoting BE for ‘prescription’ and creating ‘choice architects’ who bend the architecture of choice to produce a result, creating a small downside if you choose the other way. In public affairs, other terms used are ‘libertarian paternalism’ and the ‘nudge state’ which arrange the choices in a way to leverage them for the ‘common good’ (Cass Sunstein, 2008 CHS speaker and author of Nudge, now a policy czar in the current administration). For instance, you can limit cafeteria food consumption by not providing trays; encourage more people to use the stairs rather than elevators for extra exercise; unfortunately for fitness, many internal stairs are unsecured, thus unsafe (walk stairs with pepper spray in hand, I assume). (Comment–It all sounds rather benign, but the political process ‘nudges’ morph into ‘mandates’ all too easily.) Robert Schwarzberg, MD of Sensei described that everyone’s daily life has a conflict in values vs. health, and not to be given a choice is often a problem; also be careful in what you wish for, as you can create stigmas (e.g. overweight children singled out in school weigh-ins). Further illustrating the Law of Unintended Consequences was Laurie Orlov: ending gym in grammar schools for additional instructional time has been one more contributor to childhood obesity; living to an older age has meant more need for universal design and assistive technologies.
Thurs 22 October: Afternoon and Final
The final full breakout I attended was also with Laurie Orlov (aka Agent 99) here very firmly in her space – Get (Your House) Smart: Aging in Place, at Home, Aided by Technology. Joined by Charles Hillman of GrandCare Systems, Joe Coughlin, PhD of MIT AgeLab, Tom Ryden of North End Technologies and moderated by Marc Holland of System Research Services, this panel had much to say in their 50 minutes and could have easily filled an additional engaging 15.
This area is where much real-world tech is happening, but adoption has a long way to go.
The ‘smart house’ for Dr. Coughlin is the nexus of innovation, hardware, software and health information. It is not about devices but lifestyle and services, not about making up for health ‘loss’ but ‘gain’. The current business model is now oriented to what Medicare will reimburse (not much) and nothing is right in terms of the technology. Right now it is all about a home for those who are obviously old and frail – the paradox is that if you design a home for them, no one will buy it, including the old and frail.
Mr. Hillman approached the smart house as (Gregory) House – we’ve become masters of acute care, but not very good at assisting independent living and aging ‘responsibly’. Systems should be designed holistically and include 1) physiologic sensing (vital signs), 2) activity monitoring, 3) social connectedness and 4) home controls that light rooms at night, turn on outside lights, etc. The service he developed, GrandCare, has incorporated all four.
The smart home in Ms. Orlov’s view uses technology to more tightly connect the senior to others and to be safe, through communications and engagement, home safety and security, health and wellness and continuous learning and participation in social networks. Older people ARE interested in technology – broadband is being adopted by them in increasing numbers. But it has to be acceptable to the senior and can’t be imposed by family.
Mr. Ryden added robotics to the smart home, especially the development of small robots that can aid in everyday activities (versus the Japanese model of robopets for socialization).
Mr. Hillman pointed out that ADL (activities of daily living) monitoring is growing; currently it is largely a private pay service as LTC insurance and Medicare do not pay for it at present. LTC insurance should be paying for monitoring and other smart home assistive services, as they do for home care.
Homes, especially in this tired market, need something extra to sell and older homes need to upgrade; as Mr. Ryden put it, the ideal for technology would be ‘available at Best Buy’ and reimbursable. But the potential disrupters – home builders and remodelers–seem to avoid the older market except for ‘senior communities.’ Ms. Orlov described attempting to work with builders in her state, Florida, to create a ‘smart home’ demo incorporating universal design and technology in one of those plentiful unsold homes, and amazingly has not succeeded as of yet. (Keep trying, Laurie!)
NORCs – naturally occurring retirement communities – often need upgrading. And alternatives such as ‘intentional communities’ must be explored for the rising single population, especially those in the suburbs and exurbs. If they would realize it, the real disrupters and the new model may be via home builders, retailers and (Dr. Coughlin) utility companies. (In the US utilities are increasing selling ‘value added’ in products and services.)
Current technology is NOT fun, interactive or particularly desired to consumers. If it were, it could be a lot more appealing and useful. So where are the game designers? In fact, as Ms. Orlov pointed out, the terminology – aging – is terrifying; large companies are avoiding it in their messaging and we don’t have good terminology to replace it. Her final note: ‘patients’ are really people, and we should be referring to them that way.
A tip of the hat to Laurie Orlov’s Aging In Place Technology blog and her POV on the Symposium
The last word…
The final general session launched the Journal of Participatory Medicine (online at as of 3:30pm 22 October) and its editorial staff: Jessie Gruman, PhD (co-editor), Gilles Frydman, Alan Greene, MD (deputy editor), Dan Hoch, MD, PhD and Charles W. Smith, MD (co-editor). In their words, “Participatory medicine is a cooperative model of health care that encourages, supports and expects active involvement by all parties (clinicians, patients, caregivers, administrators, payers and communities) in the prevention, management and treatment of disease and disability and the promotion of health.” The journal is open peer review, and articles can be sourced from the medical community, consumers, caregivers, employers, administrators etc. It is one more example of convergence, and appropriately was the last business of this excellent Symposium.
Boston Park Plaza Hotel
The cost of providing you with these reports has been supported by the conference organizers and the following sponsors:
Your reporter from this conference is Donna Cusano
Wed 21 October: morning
The theme of this conference is Up from Crisis: Overhauling Healthcare Information, Payment and Delivery in Extraordinary Times. So far, this observer senses little of the desperation that crisis conveys, but its corollary – great opportunity in connection and integration of the products and services out there with patients/clients and clinicians.
The conference opened, of course, with what is happening on healthcare reform on the Federal level.
The morning keynote speaker, Stuart Altman, PhD, an expert in Federal and state policy, set the tone. As head of the healthcare policy office in the Nixon administration back in 1971, when the “crisis” was that healthcare spending was 7.5% of US GDP @ $75 billion and was a factor in the infamous wage and price controls – to today when it is 17% of GDP @ $2.5 trillion, healthcare expenditures have been in one crisis after another that neither Carter, Clinton or Bush could control. He stated that costs will probably not go down – but there will be shifting from Federal spending (down) to private spending (up). Though Americans use less healthcare on average than UK/EU citizens, our prices continue to go up and Medicare costs continue to be the 800lb gorilla in the corner, with bankruptcy projected now for 2017. We need to change the payment and delivery systems, and the bills in Congress will not do much because Altman’s Law prevails – “Most every powerful constituent group favors health reform – but if it is not their plan, they prefer the status quo.” Right now, the winners appear to be hospitals, doctors, pharmaceutical/device companies and equipment manufacturers; the losers are insurance companies who will not experience the huge influx of new insureds that they were counting on.
This wasn’t a gloomy talk by any means – Dr. Altman is a great speaker and having reform put into historical context was reassuring to the audience – and he had some good news for our sector in that there will be increased incentives for home based services (Rep. Ed Markey’s “Independence at Home Program”), working with comparative effectiveness systems. But dreaded cost controls may rear their head….
The aforementioned Rep. Markey (D-MA) teleconferenced in from Washington with more on the bills and “Independence at Home” which he had included into the House healthcare reform bill. As the chair of the Telecommunications Subcommittee he also has a great deal to do with communications and interoperability of systems. One excellent point he brought up about ‘the gorilla’ as that 10% of the Medicare population has 5+ diseases, and account for 50% of the costs. We’ll have a part of managing that, as well as preserving patient privacy which is a major concern of his.
The morning networking break was jam-packed in the narrow exhibit area, so I joined Verizon’s Addressing Interoperability session with Rajeev Kapoor, Global Managing Director of Verizon’s Healthcare business. From the start in the 1970s of “laying the pipeline” to today’s broadband and FiOS systems, where Verizon is leading is in interoperability and creating a hub for secure information exchanged and levels of connectedness. His model of ‘crawl-walk-run’ illustrated that not every area of healthcare would have or need the same approach, and most of all, systems needed to be kept simple a la Apple and Google models. Applying interoperability in healthcare systems must address critical issues: identity, integrity, access to data, telemedicine analysis and human interfacing, regulatory and privacy. Most of what he had to say seemed most applicable to hospitals, clinics and medical practice, so my question was on how this model related to at-home services and applications. Home would be a ‘hub’ for information, and outside the home the cellphone would be the personal health device (including wireless handheld data devices using mobile technology, GPS, body sensors) using 4G technology.
My final morning breakout was Wireless Tech and Patient Self-Management, a panel with Ted Blizzard of the MA Medical Society, Anand Iyer, CEO of WellDoc, Rajeev Kapoor, Jorge Perdomo of Generation One and Dr. Robert Schwartzberg of Sensei. Most of the discussion extended Mr. Kapoor’s remarks, concentrating on how wireless capabilities can ‘raise the bar’ on outcomes, ease of use and interactivity. I’ll report more on this later [see just below] …must run to join Remote Monitoring in 2014.
Wed 21 October: morning (continued)
Continuing with this breakout, Wireless Tech and Patient Self-Management, the panelists looked at the business model for wireless in patient self-management from several perspectives:
- have payors (insurance companies, self-insured employers) reimburse, justified by economic savings (in fewer/shorter hospitalizations, lowering care levels (Iyer)
- in changing behaviors and delivering information, wireless tech has to be affordable; there is a blurred line between medical conditions and wellness (is obesity a disease or does this simply drive other medical conditions) which make cost savings hard to gauge (Schwartzman)
- in self-management of chronic illness, there is a delicate balance between wireless solutions and adoption by clinicians and end users; it has to prove usefulness and be end to end (Perdomo)
- again, tech has to be kept simple to be acceptable; delivery of the right information at the right time is critical for motivating the patient to adopt it. He also questioned whether the payor should be the only revenue in this model – why not the patient?
The segment that needs self-management the most – older people – have the largest issues with devices; these need to be made acceptable with simple phones and M2M wireless in handheld devices. For this group, the technology has to work right the first time out of the box. The final issue discussed was data security – a regulatory issue that the FDA is going to be involved with within the next few months.
Wed 21 October: Afternoon
As much as I’m covering, I’m also missing some. A general session that I missed (to file the morning report) was Nicholas Christakis MD of Harvard Medical School on how social networks affect health for good or ill – for example how obesity can spread in a cohort group, and also using social networking to reverse certain trends (thanks Charlie Hillman, CEO of GrandCare, for this report).
On to Remote Monitoring in 2014. In projecting out their respective areas, the panelists Terry Duesterhoeft, President of Honeywell HomMed, Sandra Elliot, Director of Meridian Health (NJ), Don Jones, Qualcomm VP and Randy Williams, MD, President of Pharos Innovations, led by Steve Brown, CEO of 3banana, had views at variance on how adoption, payment sourcing and technology would look in five years. Duesterhoeft noted how Honeywell technology had already moved from the elderly to serving the chronic disease population, and how SaaS was key to integrating HomMed and other devices. Jones looked forward to new classes of devices, biosensors of the ‘band aid’ type and using wireless technology to ‘collapse space and time’. Williams defined the future question as how to most effectively change behavior around chronic disease and using connectivity in social networking and via healthcare providers to facilitate. Sandra Elliott’s model was consumer based – using data to change behavior around ‘pain points’, integrating social interaction and starting this process in the physician’s office – a phrase of hers was “where there’s pain, there’s gain” – and it has to be what the patient will pay for. On maintaining that changed behavior, Williams emphasized the role of trusted relations, routinizing and incentivizing the behavior and the need to ‘keep it simple.’
‘Wow’ session of the day
At the afternoon networking break, dropped in on the intriguingly named Remote Patient Monitoring: from Warfare to Homecare, presented by the even more intriguingly named Blue Highway. Blue Highway is the R&D arm of Welch Allyn. David Eilers and James DelloStritto presented their concept and technology in test: personal status monitoring (PSM) via thin, wafer-like bio-sensing materials or small SD card-like body monitors/recorders. For military use (developing in conjunction with Lockheed Martin), these multiple sensors in helmets, body armor, clothing and boots capture pressure, motion, respiration, heartbeat, gait, and probable action or position (e.g. running, lying down etc.), relaying the PSM information to a medic who can identify wounded or ‘down’ soldiers, predict problems (limping) and when coming to aid, gauge distance. If technically possible we will get their video embedded on this website next week. David Schieffelin, CEO of 24Eight, has partnered with Blue Highway to develop this PSM technology and concept for civilian healthcare, particularly fall detection AND prevention via gait tracking (aka The Holy Grail), through wearables such as bracelets, belt clips, shirts and insoles. For this observer, this was the ‘wow’ session of the day.
Wrapping up the day were three general session presentations by Mark Bard of Manhattan Research (Analyzing Digital Health by the Numbers), Joe Kvedar, MD of the Center for (Connected Health at Scale) and to close, a panel analyzing these presentations.
Attendance for this two day session was confirmed today at over 1000.
Additional product coverage from today’s meetings to come next week: Alcatel-Lucent/SaskTel, Meridian Health, iGetBetter, more.
CCH’s Achievement Awards for distinguished service to healthcare and commitment to HIT innovation were presented to John Glaser, PhD, VP and CIO of Partners HealthCare System, and Jay Sanders, MD, CEO of the Global Telemedicine Group. Both were panelists during the Symposium.
Fora TeleHealth System – Diabetes
Fora‘s parent company is Taiwanese Taidoc. At MedTrade they were exhibiting their homecare devices, their Telehealth Gateway, and their Diabetes Information Management System. The picture shows the new end-user device, the hub and, on the poster behind, the internet-based data montioring system.
Korea was well represented at MedTrade, and DMT‘s US arm was exhibiting its video-based telecare system. The picture shows one end of the setup – a set-top-box with built in camera and, on the TV screen, split views or the areas being monitored.
It was good to meet LogicMark‘s CEO Mark Gottleib after having followed the development of the company via press releases on Telecare Aware. LogicMark sells its ‘FreedomAlert’ (no-contract, no-call center ‘programmable 2-way emergency pendant communicator’) in the US via retailers rather than directly to the public. The photo shows the base unit settings that enable the user to choose their preferred dialing sequence and whether or not to call the emergency services, answering one of the initial criticisms raised by a Telecare Aware reader.
Philips’ new medication dispenser
This was spotted on my way past the Philips stand which was concentrating on respiration issues, but had an example of the recently announced cordless phone-based alert system (see Telecare Aware item). The handset can be seen on the right. What caught my eye, though, in the light of the recent discussion about medication dispensing devices, was the huge coffee machine sized medication dispenser by its side. Unfortunately there was no representative of Philips Lifeline present on the stand but their website confirms that the device includes remote monitoring of the dispensing. You may want to watch the video on that page.
Dr Kevin Doughty, an advisor for Centre for Usable Home technology, was the main speaker with an excellent presentation and good solid reasons why there has to be some radical thinking around the services the industry provides.
Dr Stephen Brewster, University of Glasgow, gave an excellent overview of their MATCH Project which is looking at different (quite radical) ways of communicating with computers using ‘earcons, tactons and aromacons’. Brilliant far-reaching stuff.
Unfortunately it went downhill from there on in, with ‘The Man From The Ministry’, Brian Kerr, telling us in no uncertain terms that we were in the risk business and then presenting the 10 or so government bodies and certifications we would need to pass before we could even consider selling product to the ‘institutions’. Ideal motivation for SMEs! David Kelly, the retiring MD of Tunstall who chaired the question session asked if this was why they (Tunstall) were only allowed to sell 40-year-old solutions…at last an admission in public. The answer was a shrug.
When it was suggested by a member of the audience at question time, that ‘it would seem that the only way to make changes in your departments, would require some form of nuclear explosion’, the reply was also a shrug.
One of the consultant speakers, Lynn Blair, pointed out that an aircraft carrier takes a couple of hours to change course (not quite true), so we need to be patient. I wondered which government body she works for!
Best of all was Graham Worsley of the Technology Strategy (Strategy?) Board who has a £50m budget which he wants to squander spend on one really big UK-wide trial of some sort, to be determined. No doubt backing the highly mobile and innovative aircraft carriers such as BT and IBM to develop products and services in this space. At question time it was suggested that such large, well entrenched organisations are about as innovative as Tunstall and that perhaps he should reconsider and use smaller, agile motor torpedo boats (the SMEs) who will adapt their products quickly to address the users’ problems and not try to adapt the users to their products.
November 16-18, 2009
Hilton London Metropole, W2 1JU
The cost of providing you with these reports has been supported by the conference organisers and
Your reporter from this conference is Steve Hards
Mon 16 November: Afternoon
As I headed towards the conference venue I sensed it will be a conference of contrasts. The London November gloom is swept aside by a burst of sunshine as I pass a rain-soaked Hyde Park where the strewn leaves and twigs attest to last night’s poltergeist party. Moving up the Edgeware Road, and into the venue, the contrast is one of unordered bustle to well-ordered bustle. A lunch buffet is being served in the exhibition area where 40 companies are settling in and gearing up to greet, talk and demonstrate.
Next contrast – this high-tech conference has no free wi-fi. The twitterstream is going to be very quiet, I think.
The theme of the afterrnoon’s session – older people, carers, and their responses to technology. Carer, consumer, commissioner …. consumers to be the commissioners in future? However, as Simon Roberts from Intel said, “There’s no Moore’s Law for culture change – it takes a lot longer and a lot more effort”
So it started with Dame Joan Blakewell, broadcaster, journalist and the UK Government’s ‘Voice of Older People’ (1st year report published today) reminding the audience what is is like to be old. Inside you feel the same, but the outside is letting you down, sending ‘wrong messages’ to people around. You resist, but technology is hard for older people and they don’t get it right. She identified a main issue as being how do we handle the 15 year transition from the current older people to a generation of older people who are comfortable with technology. She pointed out that “installation isn’t half the battle – it’s just the first step”.
Imelda Redmond CE Carers UK. (family carers/caregivers) Current care systems are based on underlying assumption that there will be a daughter nearby, ready to pick up the caring. In the UK the people who get services are getting better services than before, but fewer and fewer people qualify. Carers really benefit from telecare, and she chanenged the industry to focus less on social services and health commissioners as they are not flexible enough – there needs to be more input from mass market companies supermarkets and DIY stores, etc.
Dr Simon Roberts (an anthropologist and Intel’s lead for technology reseach for independent living). There is an inherent problem in the ways we construe older people as users of technology – often using ‘my mum’ as stand in for all mums. That is there’s no evidence, just assertion. It’s becoming increasingly meaningless to consider age as confering certain charateristics. Increasing use of Facebook and mobile phones by people over 65. (Intel developed a touch screen phone as a research tool and – discovered that ‘simple’ quickly becomes ‘boring’. So his message was ‘Design for us not them’. Consider the technology’ s appeal – tactile qualities – display- desire… Design and deliver with soul.
Stephen Wey from York’s Centre for Assistive Technology and Enabling Environments (CEEAT) “Let’s talk telepartnerships rather than telecare.” Technology should bring the world closer, and ethical considerations should be a help, not a hinderance.
David Behan Director General for Social Care, UK’s Department of Health. Talked about forthcoming changes int he UK’s system of social care, particularly the Personalisation Agenda (Google it) and what technology can contribute. The current system is not fit for the 21st century, There are lots of ideas on how to change it, but how will the changes be paid for?
Contrast of the day: Aspiration v Reality
News from exhibitors
HTL in China
Following from the Home Telehealth Limited press release, a photo of the HTL team with their Chinese hosts.
Tynetec contract in Scotland
Tynetec has announced a substantial contract with Scottish homes provider Trust Housing for the provision of eqipment and monitoring services. Press release. (PDF)