The difficulty in differentiating telemedicine and telehealth

Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.

Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence

Abstracts for Med-e-Tel now online

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/04/Med-e-tel-logo.jpg” thumb_width=”150″ /]Med-e-Tel Luxembourg, one of the longest continuously running health tech conferences in Europe (from 2004, certainly enough to qualify it as a Grizzled Pioneer), will be on this week from Wednesday to Friday, but if like this Editor you’ll be unfortunately far, far away, Prof. Maurice Mars, Richard E. Scott and Malina Jordanova of the organizing International Society for Telemedicine & eHealth (ISfTeH), have published the speaker abstracts online and free (requiring only registration.) See them here.

The abstract researchers span the globe–Nigeria, Greece, Sweden, Czech Republic, Brazil, New Jersey (!)…plus several from UK (including Malcolm Fisk), Portugal, France, Spain, Italy, South Africa and Bulgaria. Orange Labs will present the data of their diabetic bike riders from the 2015 mHealth Grand Tour (MHT)–this was a high point of last November’s mHealth Summit/HIMSS Connected Health [TTA 13 Nov 15]. There’s also research on topics you don’t hear about in most conferences: smart cities, mHealth’s environmental impact, telenursing, adapting eHealth to serve those of differing abilities, even substituting smart technologies for physical restraints. So many unusual views are represented here. Also in this issue, Vol 4 (2016), is a wealth of research from Brazil.

More in the Med-e-Tel update press release.

165,000 apps, 3 bn downloads and counting: global mHealth apps study

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/11/mHealth-Developer-Economics-2015.jpg” thumb_width=”200″ /]The results of the fifth annual mHealth App Economics survey are out. Our Readers were invited to participate back in March when it was sponsored by German research firm research2guidance in collaboration with mHealth Summit Europe and HIMSS and kicked off at the Riga meeting in May.

Major apps stores reported more than 165,000 mHealth apps published by 45,000 companies, and projected 3 billion downloads by close of 2015.  Some other key findings from R2G do surprise:

  • The target for apps is DTC–chronically ill patients–with their hospitals as #2. Physicians are important, but less so than last year’s survey.
  • App publishers aims appear altruistic. 53 percent of mHealth publishers claim that their main motivation is to help people improve their medical conditions. However, 60 percent aren’t reaching their goals yet mainly due to low reach. The vast majority of apps (62 percent) mark up less than 5,000 annual downloads. (See the chart below for some possible reasons why)
  • Diagnostic apps lead in anticipated business potential until 2020. And app publishers have added medical professionals to their team.
  • What app publishers find works to change behavior is not gamification. What does: integration of provider feedback or dialogue.
  • Yet providers, such as doctors and nurses, are seen as the most threatened group by mHealth solutions.
  • A scant 3 percent of mHealth publishers generate more than $1 million–and they are far more focused on sales and brand awareness than their brethren which make little. (chart)

(more…)

mHealth Summit now HIMSS Connected Health Conference

Another sign that mHealth is now in our rear view mirrors [TTA 24 July] is that one of the main conferences on the US and international conference calendar is changing its name. Since 2009, the mHealth Summit has closed the year. Its organizing groups have changed and it’s gone international to Europe (the recent summit in Riga). Now it has been renamed (though not on the website yet) the HIMSS Connected Health Conference-an umbrella event comprising the mHealth Summit (including the Global mHealth Forum), and two new conferences:  the Cyber Security Summit and Population Health Summit.

The shift in the industry and new concerns are clearly reflected in this reorganization. Transitions were visible last year to this Editor in covering the sessions, speaking with exhibitors and attendees. It’s not about the tech anymore, but how it fits into care models, saves money/avoids costs, improves care, improves the experience–all population health metrics–and fits with other technology and analytics. (It’s also how it fits into government payment models, an endlessly changing equation.) What is surprising is the lifting of cybersecurity to equal status, given the Hackers’ Holiday that healthcare is now (see TTA here). (Also this Editor notes that last year’s Big Buzzwords, Big Data and Analytics, has faded into where it should be–into facilitating population health and we should expect, inform data security. We also note that HIMSS has stepped forward as the organizer. HIMSS release  Telehealth & Telecare Aware has been a media partner of the mHealth Summit for most years since 2009. 

UK, Nordics lead best EU countries for mHealth business: survey

Respondents to research2guidance’s fifth annual mHealth Economics survey rated UK and the Nordic countries the best for mHealth market success, based on factors of market readiness and maturity including doctors and consumers. Other top countries were Sweden, the Netherlands, Denmark and Finland. Germany and France were significant because of market size and investment in healthcare. According to the survey where over 5,000 healthcare app publishers and health professionals ranked countries on multiple points, “In UK, Sweden, Denmark and Netherlands doctor’s acceptance of apps and high level of digitalization are seen as main drivers. Germany is attractive mainly because of its substantial market size and its big number of potential users.”[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/05/EU-segments.png” thumb_width=”400″ /]

Findings were presented this week at the mHealth Summit in Riga, Latvia and is the first part of a larger study on developer economics and future healthcare delivery. As a media partner, TTA participated starting in March in inviting respondents to the survey. A free download of the report is available to our readers here (minimal registration required). Release

GE moving out of the hospital EHR business–and healthcare lending?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/2000px-General_Electric_logo.svg_.png” thumb_width=”100″ /]Updated. Spring cleaning at GE continues that may affect healthcare more than EHRs. Neil Versel catches at HIMSS, if not an exclusive, close to it, by finally getting a GE exec to admit the awful truth–that they are phasing out their Centricity Enterprise (hospital) EHR. Versel: “It’s now helping customers with a “graceful transition over a number of years,” said Jon Zimmerman, general manager of clinical business solutions at GE Healthcare.” Even more remarkable, that decision was made three years ago. MedCityNews also updated their article to highlight some of their recent problems with Intermountain Health; we’ve also noted that UCSF converted to Epic after 12 years (see our Weekend Must Read).

The GE Capital exit may affect healthcare too. The other and more major part of the spring cleaning–their exit from GE Capital with the sale/spinoff of assets over the next two years–was announced over the weekend (Bloomberg). Their Healthcare Financial Services lends to healthcare entities including hospitals, life science and in senior housing/health facilities. It also houses the Healthymagination Fund, the capital source for GE Ventures, its early stage developmental arm for healthcare, software and energy. According to The Wall Street Journal, GE will retain healthcare financing to support what it makes in its GE Healthcare unit: ultrasound, imaging, patient monitoring and diagnostics industrial equipment, down to the Vscan (yes! it’s still there). We would bet that GE Ventures is safe. But does this mean that its healthcare real estate unit within Healthcare Financial Services, which lends to senior housing, skilled nursing and other medical properties, is on the block, especially as GE this weekend completed the sale of its real estate holdings? What else, we wonder, will GE sell at the right price to pull up share price–and in the longer term, the future of its manufacturing in areas like major healthcare equipment which have been facing a declining and heavily competitive US market?

Exiting the hospital EHR business makes sense for GE, but what else will it entail? While it retained a solid footprint of vendor loyalty and satisfaction (more…)

HIMSS Monday highlights

HIMSS is the largest US healthcare conference in the world, and Neil Versel, who has just joined the staff of MedCityNews, reported that registrations in this year’s event in Chicago were in excess of 40,000. He has a 37 minute interview with HIMSS Executive Vice President Carla Smith where they touch on CMS, Meaningful Use, EHR interoperability, data security, patient engagement and the empowered patient such as E-Patient Dave deBronkart (who will also be at The King’s Fund Digital Health conference in June). HIMSS is also showcasing on the show floor mobile health, interoperability, cybersecurity, disaster preparedness, intelligent health and the connected patient….Another sign that the Wild West days of digital health are over is the increasing oversight of the Federal Trade Commission (FTC) on non-HIPAA regulated health data collected by fitness and wellness devices. This is in addition to health apps making unsupported claims (see today’s and previous articles on melanoma detection apps) and the PaymentsMD patient billing software that was collecting a little extra patient data. This is both extra- and in addition to FDA. Mobihealthnews….. The Venture+Forum on Sunday discussed doctor burnout particularly in acute care and to ease this, focusing on the Holy Grail of proactive rather than reactive care and results rather than ‘shiny new objects’ (what this Editor has called Whiz-Bang Tech) “Doctors want clinical decision execution. Don’t give me any more tools.” Healthcare IT News….A survey by Accenture released today on doctors and EHR usage headlines good news–79 percent US doctors feel more proficient in their EHR usage than in their 2012 survey. The bad news is that other numbers are plummeting: fewer believe that EMR has improved treatment decisions (46 percent in 2015 vs. 62 percent in 2012), reduced medical errors (64 vs. 72 percent) and improved health outcomes for patients (46 vs. 58 percent). Familiarity breeds contempt? Buried way down in the release is that US physicians offering telehealth monitoring to patients has tripled since the last survey, from just 8 percent in 2012 to 24 percent now. Accenture surveyed over 2,600 physicians in six countries….HIMSS goes to Thursday, so more to come!

Participate in the 2015 Global mHealth App Developer Economics Study

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/2015-mHealth-App-Developer-Economics-study-banner.jpg” thumb_width=”250″ /]TTA readers are invited to participate in the fifth annual mHealth App Economics survey, sponsored by research2guidance in collaboration with mHealth Summit Europe and HIMSS. The study will look at the mHealth app market, how apps generate revenue, how behavior could be changed by apps, the use of APIs and sensors as well as other related topics–and is the largest industry survey on mHealth app development.

Click here to go to our exclusive link and participate in the survey. The survey is available till 26 April. Share your opinions and experience on how mHealth apps impact healthcare delivery now and in the next five years. Plus, every participant will receive the chance to win one of five free entry tickets to the mHealth Summit Europe in Riga, Latvia 11-12 May, where the results will be presented; a free copy of the 2015 report as well as the possibility to see initial results after completing the survey. Download link for the 2014 study (PDF).

TTA is a media partner of the 2015 Global mHealth App Developer Economics Study, and was a media sponsor of this year’s US mHealth Summit.

Aetna’s CarePass passing into history

Another Aetna Healthagen initiative is shutting its virtual doors–the much-touted CarePass aggregator for mobile health apps. Available to both Aetna and non-Aetna members, it incorporated leading apps such as Fitbit, Jawbone, Withings, MapMyFitness and BodyMedia. A dimming of its consumer/mobile health star which burned so brightly from late 2012 through last year was evident at this year’s HIMSS. CarePass was nowhere to be seen, and the iTriage patient engagement tool was off in the shadows [TTA 28 Feb]. From its redone website, Healthagen is increasingly concentrated on core areas for payers: ACOs, clinical decision support, data management and health information exchanges. MobiHealthNews broke the exclusive including Aetna’s confirmation and also the quiet departure of two CarePass executives from the company which took place earlier this summer. (more…)

Politico: massive hacking of health records imminent

Politico is a website (and if you’re in Foggy Bottom-ville, a magazine) much beloved by the ‘inside government’ crowd and the media ‘chattering classes’. With some aspirations to be like Private Eye but without the leavening sharp satire, the fact that they’ve turned their attention to–gasp!–the potential hackathon that is health records is amazing. They mention all the right sources: Ponemon, HIMSS, the American Medical Association, BitSight, AHIMA. In fact, the article itself may be a leading indicator that the governmental classes might actually do something about it. This Editor applauds Politico for jumping on our battered Conestoga wagon with the other Grizzled Pioneers. We’ve only been whinging on about data breaches and security since 2010 and their researchers could benefit from our back file.

And speaking of 2010, the Department of Health & Human Services (HHS) is doing its part to close the budget deficit by collecting data breach fines–$10 million in the past year. A goodly chunk will be coming from New York-Presbyterian Hospital/Columbia University Medical Center: $4.8 million for a 6,800 person breach (iHealthBeat) where sensitive records showed up online, readily available to search engines. And yes, we covered this back on 29 Sept 2010 when breaches were new and hushed up. Politico: Big cyber hack of health records is ‘only a matter of time’

Oddly, there is nary a mention of Healthcare.gov.

Another alliance to promote connected health

The formation of the Personal Connected Health Alliance (PCHA) by the Continua Health Alliance, mHealth Summit and HIMSS solidifies what has been a close working relationship into what will “represent the consumer voice in personal connected health.” With the three organizations having worked together for some years particularly in relation to the mHealth Summit, the PCHA will now be the Summit’s formal presenter with Continua, HIMSS and the Foundation for the NIH as partners. Clint McClellan, Qualcomm’s Senior Director of Business Development and Continua’s board chair, is the acting chair and the PCHA will be located in Arlington, Virginia. According to Rich Scarfo, Vice President of the PCHA and the developer of the mHealth Summit,“The Personal Connected Health Alliance, in cooperation with the mHealth Summit and Continua, will continue driving the industry forward by generating a new knowledge base around the personal connected health space, providing a strong and united voice on policy, regulatory issues and government relations, and advancing education and awareness for the widespread adoption of personal connected health technologies.” Continua, after a few uncertain years while it shifted from a sole mission of interoperability standards and certification to combining that with advocating personal telehealth, now enjoys a membership of roughly 200 companies and has largely shed its ‘subsidiary of Intel’ reputation. The mHealth Summit has undergone its own shifts from a focus on governmental and NGO wireless health to a much wider scope (and major expansion) courtesy of HIMSS. Certainly PCHA’s activities will bear watching with this tripartite backing. Release on HIT Consultant (hat tip to publisher Fred Pennic), mHealthNews, YouTube video

One can only speculate on PCHA’s mission overlap with another DC advocacy group, the Alliance for Connected Care. The latter, a thinly veiled lobbying group [TTA 13 Feb], has been strangely quiet, with the news section of its glossy website not updated since early March. (Lobbying is best done quietly?)

HHS draft report on health IT framework published

Another part of the 2012 FDA Safety and Innovation Act (FDASIA) clicked into place with the US Department of Health and Human Services (HHS) publishing a draft report proposing strategy and recommendations for what is rather grandly termed a “health IT framework”. Basically it defines more unified criteria, based on risk to the patient and function of what the device does, not the platform (mobile, software, etc.). It then separates products into three broad categories. Excerpted from the FDA release and the FDASIA Health IT Report:

  1.  Products with administrative health IT functions, which pose little or no risk to patient safety and as such require no additional oversight by FDA. Examples: billing software, inventory management.
  2. Products with health management health IT functions. Examples: software for health information and data management, knowledge management, EHRs, electronic access to clinical results and most clinical decision support software. This will be coordinated largely by HHS’s Office of the National Coordinator for Health IT (ONC) as part of their activities (including their current voluntary EHR certification program), but the private sector is also cited in establishing best practices.
  3. Products with medical device health IT functions, which potentially pose greater risks to patients if they do not perform as intended. Examples: computer-aided detection software, software for bedside monitor alarms and radiation treatment software. The draft report proposes that FDA continue regulating products in this last category. (Illustration on page 13 of report.)

The report also recommends the creation of a public-private entity under ONC, the Health IT Safety Center, which “would serve as a trusted convener of stakeholders and as a forum for the exchange of ideas and information focused on promoting health IT as an integral part of patient safety.” The private sector is duly noted as a ‘stakeholder’.

The report was developed by FDA “in consultation” with ONC and, not unexpectedly, the Federal Communications Commission (FCC). Another recommendation (page 28) is the establishment of a ‘tri-Agency memorandum of understanding (MOU)’ to further determine their working relationship in this area. There’s a 90 day comment period on the 34 page report, which is perfect for weekend reading (!) How this onion will eventually be peeled, rather than quartered, remains to be seen, as does anything emanating from Foggy Bottom.  FDA release. Report. FierceMobileHealthcare.

Update 8 April: A good summary of criticism and approval of the framework to date appears in iHealthBeat from the California Health Care Foundation. The two US Senators sponsoring the PROTECT Act [TTA 28 Feb, 6 Mar] stated there is still too much regulation of low-risk technologies, and Bradley Thompson of Epstein Becker/mHealth Regulatory Coalition believes the report is weak on the issues around clinical decision support software. With praise: HIMSS, Health IT Now Coalition and ACT, which claims to represent about 5,000 mobile application developers and IT firms, but has no locatable website.

Previously in TTA: FDA finally issues proposed rule simplifying medical device classification

HC2014

19-20 March 2014, Manchester Central, Petersfield, UK

For over 30 years, HC has delivered thought leadership; informing and educating its audience on the how the latest innovations in technology support the increasing demands within healthcare. HC2014 will address all the current healthcare reforms with a number of themes referring to the call for paperless NHS by 2018. Key sessions will demonstrate technology to support Patient Engagement, Safer Hospitals and Integrated Care. Conference and exhibition presented by the BCS, The Chartered Institute for IT, in partnership with HIMSS. Conference keynoters include Tim Kelsey, NHS England; Andrea Sutcliffe, Care Quality Commission; Mike Pringle, Royal College of GPs; Kingsley Manning, HSCIC. Information and registration. Hat tip to reader Louise Sinclair. If there are TTA readers planning to attend, we are once again inviting you to contribute an article or a compilation of impressions. This can be filed within 72 hours of the close of event; alternatively, during or at day’s end/start. If you are interested, please email EIC Donna here (donna.cusano@telecareaware.com). It is expected that you can be selective and interesting rather than comprehensive. You will be credited of course but expenses and article will not be covered. 

 

Digital Health Summit–Istanbul

18-19 September 2013, Maslak Sheraton Hotel İstanbul

Health tech is definitely spreading worldwide and this conference in Turkey is proof.  Full summit agenda and sponsors are at this link (PDF in English). David Doherty, the 3G Doctor, is speaking on an ‘introduction to mHealth’ as well as Rainer Herzog, Managing Director at HIMSS Analytics Europe. But not easy to register…main website is unfortunately in Turkish with no English option and no obvious place to register! Extreme digging turned up one page in English. If you’re intent on attending, best to call Project Coordinator Mert Akbulut: +90 533 598 17 71 or email dhs@dhsturkey.com

Toward a better understanding of US care models

HIMSS’ publishing arm, which has grown to several publications including ones we cite frequently, such as HealthcareITNews and GovernmentITNews, is launching an online site, Future Care, that will focus solely on “new and innovative models of care that improve individual and community well-being, while also reducing healthcare costs.” It has original material plus pickups from HIMSS Media’s other publications, and is supported by IBM’s Smarter Care initiative. (Related to its Smarter Cities initiative and telecare in Bolzano?) The current selection focuses on whether  ACOs are set up to fail (Center for Connected Health’s Dr. Joseph Kvedar rebuts Clayton Christensen and colleagues in the WSJ), outpatient care, readmissions and the utilization of big data. Of note is Merck Vree Health’s mHealth post-discharge care management program, TransitionAdvantage, which represents a change from its initial focus on diabetes management. There’s also the expected helping of IBM-related content including Watson and some IBM white papers. For designers and implementers seeking a better understanding of care and payer models for health tech workflow, this site pulls together a wide scope of information.