Rounding up September’s start: AliveCor’s hyperkalemia detector, Apple’s ECG Watch, Tunstall Nordic’s EWII, steps towards a bionic eye, Philips licenses BATDOK, VistA’s international future

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”120″ /]AliveCor gets a fast track for its bloodless hyperkalemia (high blood potassium) detector through the FDA Breakthrough Device program. Working with doctors at the Mayo Clinic, they developed a way to read patterns in electrocardiograms (ECG/EKG) that track increasing potassium levels without drawing blood. While attributed in the CNBC article to AI, it seems closer to machine learning. Hyperkalemia is a condition that is seen in type 1 diabetes, chronic kidney disease, and other kidney related conditions. The device and software is at least one year away from approval including a clinical trial, even on this program which further speeds up the Expedited Access Pathways (EAP) program under the 21st Century Cures legislation. AliveCor currently markets the Kardia Band that reads ECGs.

Meanwhile, the Series 4 iteration of the Apple Watch moves further into the medical device area–and AliveCor’s ECG niche–with a built-in atrial fibrillation-detecting algorithm and an ECG, along with fall detection via the new accelerometer and gyroscope. The Apple Watch will start shipping September 21. Mobihealthnews.

Danish energy and broadband provider EWII has sold its subsidiary EWII Telecare A/S to Tunstall Nordic. EWII Telecare provides telemedicine and telehealth services on a tablet platform dubbed Netcare (video here). The EWII Telecare website is already down. Telecompaper, Tunstall Nordic release

Foundational technology for a bionic eye? The University of Minnesota has developed a method using 3D printing to create light receptors on a hemispherical surface. Printing a base of silver ink, the next layer was photodiodes of a semiconducting polymer which convert light into electricity. ZDNet

Philips Healthcare is licensing the Battlefield Airmen Trauma Distributed Observation Kit (BATDOK) technology for remote monitoring of vital signs by combat paramedics. Terms were not disclosed. BATDOK was developed by the US Air Force Research Laboratory, which sought commercialization. [TTA 6 Sept 17]  Mobihealthnews

What is generally not known about the VA’s eventually departing EHR is that it has for some years an open source version called OSEHRA VistA. Plan VI will expand VistA capability by making it compatible with different languages using Unicode and creating a reference implementation for global use. Working with non-profit OSEHRA are research groups in South Korea, China, and the Kingdom of Jordan. Release

Mayo Clinic’s Victor Montori MD calls for a ‘patient revolt’ for ‘careful and kind care’

Have a listen…This Editor has kept an eye on Dr. Victor Montori’s concept of ‘minimally disruptive medicine’ which seeks to fit the medical treatment to what the patient can handle through shared decision making, reducing the burden on both doctor and patient. He has recently published a book titled ‘Why We Revolt: A patient revolution for careful and kind care’. ‘Careful’ and ‘kind’ don’t immediately come to mind in this force-fed world of HEDIS quality scores, 31 ACO quality measures, HCAHPS hospital surveys, patient compliance, Ezekiel Emanuel, and the drive to measure every pill, footstep, and mouthful you take via your smartwatch or -phone–then ‘big data’ it.

Dr. Montori makes the case for balancing the agendas between doctor and patient, bringing back empathy, kindness, and respect in that relationship, with the goal to ensuring that “care fits into life and does not demand more than is sensible.” This 15-minute interview journeys from the medical privations Dr. Montori witnessed in his native Peru to his current work as an endocrinologist at the Mayo Clinic. You’ll want to buy the book after you listen. (And he should have included doctors in that revolt as well.) Podcast at Health News Review/Health News Watchdog.

Previously in TTA on Dr. Montori’s contrarian views: Patient non-compliance=toxic healthcare system? and Is how we are treating patients for chronic diseases (and pre-diseases) all wrong?

HIMSS17 dispatches: Mayo maps neonate telemedicine, Amwell-Samsung, Samsung-T-Mobile

Mayo maps out an enterprise telehealth (telemedicine) support structure. Here’s how the Mayo Clinic deployed neonatology remote telemedicine to their sites in Minnesota, Arizona, and Florida. There’s plenty of flow charts and summary points in this presentation deck around team building, staffing consistently and reporting that improves processes. Hat tip to our HIMSS correspondent on the scene, Bill Oravecz of Stone Health Innovations. Update: If you are using Chrome, you may have difficulty downloading session handouts from the HIMSS17 website Schedule pages. Try another browser. If you are interested, you may be able to obtain through contacting the two session presenters, Susan Kapraun and Jenna A. Beck, MHA, directly.

American Well and Samsung are partnering on integrating care delivery. Their joint release is low on details, but towards the end there’s an indication that American Well, its partners, and other providers and payers will be able to offer their services to Samsung customers. Other reports (Healthcare Dive) indicate the partnership is destined to enhance Amwell’s Exchange platform between payers and providers. Partners listed are Cleveland Clinic, New York-Presbyterian Medical Center and Anthem (undoubtedly resting after sparring with Cigna). Also Healthcare IT News.

Separately, Samsung also announced a partnership with T-Mobile for developing IoT in the senior care space. This would pair Samsung’s ARTIK Cloud with T-Mobile’s cellular network for Breezie, a social engagement for seniors interface built on a Samsung tablet which has apps and connects to various peripherals for post-acute care and daily living. It sounds interesting, but once again the release hampers the reporter by being as clear as mud in what it’s all about. See if you can decipher this: ARTIK Cloud permits “Amazon Alexa, Samsung SmartThings, iHealth Feel Wireless Blood Pressure Monitor and the Pulse Oximeter – to intelligently communicate with each other.” “Each Breezie interface has more than 40 preconfigured accessibility settings and sensor driven analytics to adjust for different levels of digital literacy, as well as physical and cognitive ability.” The Breezie website is far more revealing. Healthcare Dive also takes a whack at it towards the end of the above article.

Minimally disruptive medicine: a two-day intensive course at Mayo Clinic

The concept of ‘minimally disruptive medicine’ is not mainstream, but should be. MDM is designed to fit the treatment to the patient. In chronic conditions, often the expectation of the doctor, practice and hospital is to do too much. After all, there is the relentless drive to value-based care that improves outcomes and reduces costs that has at its core the absolutely relentless monitoring of delivery metrics and patient compliance (take that med, even if you can’t keep your dinner down). The frustration of the patient with chronic conditions is palpable; it’s not understood, or it’s all too much to handle. We last covered Dr Victor Montori a year ago and in 2013 as proposing that we’re thinking about patients in chronic care management all wrong; that we need to fit the treatment to the patient in order to simplify actions they need to take, to reduce the burden of illness and gain a better outcome. The two-day intensive is at the Mayo Clinic in Rochester, MN, 27-29 September. Registration here. YouTube preview video.

ATA’s daily schedule now available online

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/04/ATA-2016-promotional-image.png” thumb_width=”250″ /]Attending or interested in attending this year’s American Telemedicine Association annual meeting in Minneapolis 14-17 May? The daily Saturday-Tuesday schedule is now online here. Plenary session speakers include Nicholas Negroponte, founder of the groundbreaking MIT Media Lab and John Noseworthy, CEO of the Mayo Clinic. There are also Spotlight Sessions on Monday on ‘Consumer Stakeholders Confront Telehealth”, “Is a Prior Provider-Patient Relationship Still Required?” and “The Year in Review: Excellence in Telemedicine Research.” If you’re going, also check out their exposition floor which opens on Sunday with a late afternoon reception. Register by clicking the sidebar advert. TTA is a media partner of ATA2016.

Better’s fast fail, ending health assistance service 30 Oct

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/10/Better.png” thumb_width=”150″ /]Better is sadly not. This two-year old service that provided personal health assistance, including a real, live health assistant, to guide members through health questions, the thickets of insurance claims, finding doctors and specialists, apps and more, announced earlier this week that it was ending operations as of 30 October. While it was announced via their Twitter feed on Tuesday, most of the industry learned of it through Stephanie Baum’s article in MedCityNews today. Better formally debuted only 16 months ago [TTA 23 Apr 14] and at the time this Editor felt that it was a service in the right direction, a kind of ‘concierge medicine for the masses’ needed when individuals have to direct more and more of their own care.

A solid start, as our Readers have seen, does not guarantee success, but this fast fail is still fairly shocking. A concern at the time was the pricing for the full service model at $49/month, which later became the family price (individuals were $19.99/month). CEO/co-founder Geoff Clapp was among the most Grizzled of Health Tech Pioneers; he had been a co-founder of Health Hero/Health Buddy from 1998 to its sale to Bosch Healthcare, a very long pull in telehealth, and he had spent much of his post-Health Hero time generously advising other startups. Yet despite the involvement of blue chip Mayo Clinic as a service provider, its financial backing from their investment arm and socially-oriented VC Social+Capital Partnership, it managed to raise only its initial seed funding of $5 million (CrunchBase).

So what happened? (more…)

Do startups truly threaten the ‘healthcare establishment’?

Or are successful startups fitting into their game? Chris Seper in MedCityNews paints the picture of one side of a quandary. The ‘healthcare establishment’ fundamentally and to its detriment does not understand and is threatened by the startup and innovation process. A startup may begin with an idea which is, in his words, ‘almost always flawed, sometimes deeply’. If the founders are smart, they will test their ideas, validate them and change them appropriately. If not, they will fail. But it is easier for the Establishment to point at the most egregious of the bad ideas and use them to rationalize the status quo.

But being congenital contrarians, we paint the house on the other side of the street. Has the Establishment caught up with–or in some cases, co-opted startups, making them and their funders ‘do their diligence’ and be more cautious before emerging? This Editor would argue yes, and largely for the better.

**The ‘Wild West’ days are over. A few years ago, a truly bad or deeply flawed health tech idea or could easily find funding, because it was all blank slate, new and ‘transformative’.The sexiest hooks were Quantified Self, sleep, employer health incentives, interactive coaching, genomics, app prescribing and (last) wearables. A lot of founders imagined themselves as the Steve Jobs of Healthcare, down to the black turtleneck. Now there is a history of success and failure. The railroads reached the dusty frontier towns.

**There’s now a ‘Startup Establishment’. National accelerators (more…)

A very important positive shift in attitude to digital health

Hat tip to Mike Clark for alerting this editor to a particularly important run of recent papers on digital health that suggests that we have at last turned the corner from the seemingly endless enquiries of the “does it work?” type, to asking instead “how can it be made best to work?”.

We’ll start with perhaps one of the most unequivocal papers on the benefits of telehealth this editor can remember – a review by a team from the Mayo Clinic of controlled trials between 1990 and 2014 of digital health for managing cardiovascular disease. It is entitled “Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis”. The results found were that “digital health interventions significantly reduced CVD outcomes”. It makes great reading. Another smaller academic study of an NHS Croydon implementation for both CHF & COPD also showed positive results, and strong patient appeal specifically, too.

Another paper, just published by Stephen Agboola of Partners Healthcare, and colleagues from Boston US, entitled “Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program”,  further supports the benefits of telehealth for managing CHF. However, benefits disappeared after the 120-day telehealth usage ended, as discussed by Jonah Comstock of mobihealthnews – important lessons to be learned there, relating perhaps to what follows in this post.

(Though not an academic study, it’s worth perhaps also recording en passant a Health Recovery Solutions (HRS) claim that they reduced the 30 day readmission rate for 130 congestive heart failure patients by 53%, from 8.0% to 3.8%, over a period from July 2014 to February 2015.)

Moving on then to a paper by Trisha Greenhalgh and colleagues entitled “What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services”. This paper concludes that (more…)

Follow up: Xerox invests in HealthSpot Station kiosks (US)

The day after this Editor posted on telehealth/virtual consult kiosk HealthSpot Station‘s new partnerships with Mayo Clinic and major drug retailer Rite Aid, Xerox announced their investment in the company. Xerox is not a business services organization one immediately associates with healthcare technology, but perhaps not anymore, based on this quote from Connie Harvey, Xerox’ chief operating officer of Commercial Healthcare: “HealthSpot is at the center of healthcare’s shift to a patient-centered model of care, and our investment in the company demonstrates Xerox’s commitment to transforming traditional healthcare into a high-value delivery system for patients, providers and payers.” Xerox will also be supplying BPO–business process outsourcing–services for cloud hosting, system integration, claims eligibility and claims submissions. But there’s more…. (more…)

Telehealth kiosk HealthSpot gains trials with Rite Aid, Mayo Clinic

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/05/Healthspot-stationbooth.jpg” thumb_width=”150″ /] HealthSpot Station, which was one of the higher points of this past May’s ATA, in the past month has announced two significant pilots. The retail pilot is with Rite Aid, the US’ third largest drug store chain (4,600 stores), with telehealth/telemedicine kiosks located in select Rite Aid locations in Ohio–Akron/Canton, Cleveland and Dayton/Springfield areas. The usage of the kiosks will be limited to common health conditions, such as cold, earaches, sore throat, sinus infections, upper respiratory infections, rashes, skin and eye conditions. HealthSpot Station kiosks are enclosed, free-standing units which use both video consults and real-time interaction with telehealth devices for remote diagnosis. They connect to a network of board-certified medical professionals at Cleveland Clinic and other major health systems across Ohio. Start date and duration were not disclosed.

This follows the October announcement with Mayo Clinic of an in-house pilot in Austin and Albert Lea, Minnesota with approximately 2,000 Mayo Clinic Health System employees (more…)

All that Quantified Self data? Drowning doctors don’t want to see it.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/08/reduce-documentation1.jpg” thumb_width=”150″ /]Our long-time readers will remember Questions # 3, 4 and 5 of The Five Big Questions (FBQ*). They have not lost their salience as doctors are rejecting the not-terribly-accurate ‘telehealth’ data [TTA 10 May] generated by popular fitness trackers such as Fitbit, Misfit Shine and Jawbone. We do note that Apple’s Health/HealthKit has trotted out alliances with Mayo Clinic and Epic Systems (EHR) on apps and integrating data into an PHR [TTA 3 June], as well as Samsung’s SAMI [2 June] funding a University of California (UCSF) research center and (of course) Google. But this article confirms (more…)

Apple Health, minus the ‘book’, announced

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/06/healthkit-apple-wwdc-2014-87_verge_medium_landscape.jpg” thumb_width=”170″ /]Breaking and developing… Apple announced their long-rumored health tracking app [TTA 22 Mar] this morning at their WWDC (World Wide Developers Conference) in San Francisco. The consumer app is called Health (not Healthbook) and the developer platform HealthKit which are both part of iOS8 for iPhones and iPads in the fall. HealthKit facilitates pulling in of health data from third-party developers so that all health-related information for the consumer user is in one ‘hub’, similar to what Apple’s Passbook app does now as a ‘virtual pocket’ for airline boarding passes, movie tickets and coupons. Apple’s Craig Federighi, senior VP of software (pictured, courtesy of The Verge), made the announcement of the app and platform as part of the broader debut of iOS8 this morning.

Already on board is Mayo Clinic with an app that logs information like blood pressure, tracking normal range and it appears from reports that a severe enough deviation will initiate a contact with medical professionals. Nike was prominently featured as an app provider, further confirming that it’s leaving the hardware to their close corporate partner now that it’s out of the FuelBand business [TTA 22 April]. Epic Systems, a leading large system (hospitals/practices) EHR, appears to be integrating integrating its personal health record (PHR) with HealthKit, “suggesting a framework for getting information collected via HealthKit into patients’ MyChart (Epic PHR–Ed.) app.”

Editor Donna wonders if the still-in-early-days Better iPhone health personal assistant app (PHA), developed in conjunction with and backed by the aforementioned Mayo Clinic [TTA 23 Apr], will prominently integrate into Health. (We’ll cover when this develops, as we think it will–but mum’s their word for right now.)

In Mashable, the news was applauded by the CEO of leading app MyFitnessPal as a big validation. In his opinion, Apple would work with the existing field of apps and devices. Leading fitness bands Jawbone and Fitbit had no comment. Fitbit was shown during the presentation: CNET (one of six pictures here) and The Verge (article below). The latter makes the excellent point that Jawbone, Fitbit and the Nike FuelBand have all been sold in Apple’s stores.

The speculation is that Health will be a key part of the features of the iWatch to come, but Mashable in quoting Skip Snow of Forrester Research does bring up a significant wrinkle. Bluetooth LE as a network protocol chews up a lot of battery power, and bigger batteries make for clunky devices. Not exactly the Apple design ethic. Could it be that what’s delaying the iWatch is development of a new, more power-efficient network standard?

Update 3 June: With iOS8 having apps communicating with each other, have the Apple-oids opened the door for a Happy Hacking Holiday?  Stilgherrian in ZDNet points out that the ‘attack surface’ in info security-ese just got a whole lot larger. A future ‘oopsie’?

Hat tip to Editor Toni Bunting

More information: Mashable can’t stop mashing stories: Apple Reveals iOS 8: Interactive Notifications, Health App and MoreApple Gets Into Fitness Tracking With Health App and HealthKit for iOS 8Apple’s First Step Into Health Tracking Is Small But Powerful. Mobihealthnews gets into the act noting Epic’s involvement: Apple reveals tracking app HealthKit and partners with Mayo Clinic, Epic. The Verge positively is on said verge with Apple HealthKit announced: a hub for all your iOS fitness tracking needs.

Getting ‘Better’ with a personal health assistant

Is Better going to where better healthcare should be?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/pha.jpg” thumb_width=”150″ /]Making its formal debut last week was Better, an iPhone app (Android to come) developed in conjunction with and backed by the Mayo Clinic. The aim of Better is to deliver information and care no matter where people are located. The analogy co-founder/CEO Geoff Clapp uses is ‘AAA (RAC or AA=UK) for healthcare’ but it seems to be a bit more developed than emergency tows and TripTiks. In its free version, it provides complete access to Mayo Clinic educational content tailored to the user’s interests and provides access to a personal health record (PHR) for the family. In the $49/month premium version, Mayo provides 24/7 national access to a personal health assistant available by phone and video. The PHAs can coordinate your and your family’s providers, help navigate your insurance and billing and coordinate follow up care. If needed, the PHA can connect the user with a Mayo Clinic nurse who can explain symptoms, potential causes and recommend next steps. The paid version also provides a symptom checker, built with algorithms and using the Mayo database.

According to Mr Clapp (interviewed in Mobihealthnews), Better is ‘early’ and trying to define a market. He is encouraged by remarks such as “I’m not sure I totally get it and not sure the world is ready for this” which is similar to what he heard when co-founding Health Hero (now Bosch Health Buddy) in 1998 (among the most Grizzled of Grizzled Pioneers). Also in this interview, he cites a focus on underserved disease groups such as Crohn’s Disease and cystic fibrosis where help is not generally available; eventually they will also move toward telemedicine. Since the sale. he has been mentoring companies at Rock Health. Better has raised $5 million to date between Mayo and Social+Capital Partnership and is located in Palo Alto, California. It’s an interesting spin on concierge medicine–can it be considered ‘concierge healthcare for the masses?’ Given the pedigree and the partners, we expect to hear bigger, better things from Better in the next few months. Also MedCityNews,  the PSFK Labs blog and FastCompany. Video (YouTube)  Hat tips to Bob Pyke, Editor Toni Bunting

Fitbit as clinical assessment tool: Mayo Clinic

Not unexpected, but sooner than one would think given the relative newness of fitness trackers. A Mayo Clinic study published in the September issue of the Journal of Thoracic Surgery (abstract) monitored a group of elderly patients who had elective major surgery, were older than 50 (that’s elderly?) and were expected to be in the hospital from 5 – 7 days. The Fitbit was worn on a disposable ankle strap given their limited mobility. Data went first to the Fitbit website then over to a dashboard for clinical use. Patients were also tracked when they went home, home with home health assistance or to skilled nursing/rehab. Day 2 seemed to be a critical breaking point (more…)