Big home health win for telehealth confirms trend: must expand services, analytics

One of the most logical places for telehealth, remote care management (RCM) and transitional/chronic condition management (TCM/CCM) is with home health providers and post-acute care, yet perennially it has been on the ‘maybe next year’ list for most telehealth providers. That ‘next year’ may be getting a little closer with the news that Intel-GE Care Innovations has inked a multi-year deal (no pilot-itis here) with major (~400 facilities) home health provider Amedisys using their PC/tablet-based Health Harmony platform.

The initial focus is an ambitious one: reducing hospitalizations and ER/ED visits among patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, depression as well as patients who have two or more of these conditions (co-morbidities). The most interesting to this Editor is the parenthetical mention of analyzing ADLs (activities of daily living) with clinical data. Does this imply the engagement of their venerable ADL monitor QuietCare? (It’s something the founding company worked on circa 2006 while this Editor was there; one would think the analytics have advanced since then.) Another aspect is that Care Innovations will manage Amedisys’ complete RCM program from recruiting to logistics, data analytics and application integration services. Business Wire

What this means: Telehealth (and telecare) companies are now increasingly obliged in these big wins to provide a plethora of additional related services. Health care providers demand services beyond the monitoring technology. They want the turnkey package, from nurse evaluations, care coordination/management, to analytics and logistics.This ‘service creep’ implies alliances and mergers to add on to technological monitoring capabilities–and beaucoup financing. (more…)

Looking back over Telehealth & Telecare Aware’s predictions for 2014, part II

click to enlargeEditor Charles has treated you to a look back on his 2014 predictions, daring Editor Donna to look back on hers. Were they ‘Decidedly so’, ‘Yes’, ‘Reply hazy, try again’ or ‘My sources say no’? Read on…

On New Year’s Day 2014, it looked like “the year of reckoning for the ‘better mousetraps’”? But the reckoning wasn’t quite as dramatic as this Editor thought.

We are whipping past the 2012-13 Peak of Inflated Expectations in health tech, diving into the Trough of Disillusionment in 2014.

There surely were companies which turned up ‘Insolvent with a great idea’ in Joe Hage’s (LinkedIn’s huge Medical Devices Group) terms, but it was more a year of Big Ideas Going Sideways than Crash and Burns.

Some formerly Great Ideas may have a future, just not the one originally envisioned. (more…)

Now a sensor for healthier necks and spines (TW/CN)

click to enlargeWould you like to monitor your neck and spine as an aid to fitness, better posture and to avoid strain? This Editor, who has a history of both neck and back problems, surely would–and it’s an area not covered by current fitness monitors. Fineck, developed by the China/Taiwan company VEARI with central Taiwan’s Sport and Health Research Center at National Chung Hsing University of Taiwan, claims to have developed a waterproof, reasonably presentable (left) necklace sensor along with analytics. It will send alerts via smartphone when it determines bad body posture or too much inactivity. ‘Neck-Health’ pictures demonstrate what you should do. While not clinical grade like devices such as those from Australia’s dorsaVi, it opens a whole new pursuit for QSersFineck website. VentureBeat

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

click to enlargeOur 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…)

Unhappy endings: where even innovation cannot make a difference

This week’s sad news of the death of comedian/film star Robin Williams and his ongoing battles with addiction and depression are the center of this thoughtful article by EIC Veronica Combs in MedCityNews. Even with access to the best care and innovations such as virtual visits, Mr Williams committed suicide. The larger point made is that access and healthcare innovation don’t mean automatic adoption or a positive outcome. Some of those with chronic physical or mental illnesses choose not to change their behaviors, comply with a regimen or even to seek help, much less seek out technology or be a QSer. And some are simply beaten down and depressed by the perpetual Battle of Stalingrad that is chronic disease–ask any diabetic [TTA 5 Apr 2013]. Her conclusion is that though innovation may not help everyone, it doesn’t mean we should not pursue it. And, this Editor would add, for developers to realize that they must make technologies simple and affordable enough–‘tear down that wall’–so that those who won’t access help become fewer. (And, yes, there is a spiritual aspect of care that must be addressed–see VOX Telehealth’s work with HealthCare Chaplaincy Network TTA 25 July.)

Update:  Other factors may have tipped Mr Williams’ depression flare-up. The first (more…)

Tons of app health data, bound for…third parties?

click to enlarge The law of unintended consequences also applies to Quantified Selfers. Health apps seem to be reaching beyond the QS early adopters and becoming a commonplace, whether on your wrist or built into your smartphone. Apple, Google, IBM and Samsung are all in.The DH3 set (Digital Health Hypester Horde) could not be more pleased. But where is that data going? According to the US Federal Trade Commission (FTC), it’s ending up where your online data goes–profitably sold by developers large and small to your friendly data broker and onward to marketers. You may think it’s private, but it isn’t. There is the famous case of an Target (store) app used to determine whether female customers were pregnant (purchases such as pregnancy tests) and then market related and baby products to them. Commissioner Julie Brill doesn’t like the possibility that health data could be part of the Spooky Monster Mash that is Big Data. “We don’t know where that information ultimately goes,” Brill told a recent Association for Competitive Technology panel. “It makes consumers uncomfortable.” (Ahem!) From the consumer protection standpoint, the FTC would like to do something about it, and they happen to be very good at that type of regulation. Compliance will not only be an added cost of doing business, it will cut into that ol’ business plan. And you thought that the only problem around apps and the Feds was gauging risk to users. Do you have that creepy ‘Big Brother is Watching You’ feeling?  Health IT Outcomes, FierceMobileHealthcare, VentureBeat.

23andme and FDA: making nice?

In a reversal from the ‘¡No pasarán!’ (‘They shall not pass!’) position 23andme and its QS fans famously took back in the winter and spring [TTA 2 Apr, with prior links] vis-a-vis FDA on interpretation of genetic tests, this report from VentureBeat indicates that 23andme is holding out an olive branch. It’s not your usual cutting. It’s an application for Bloom’s Syndrome, a rare inherited genetic disorder, which FDA just accepted. Adding to it is that CEO Anne Wojcicki is a carrier of this disorder. VentureBeat’s speculation is that if successful, the Bloom’s Syndrome application would be the template for future test applications. The tone on both sides has grown conciliatory. For example: sitting on the same Congressional panel on healthcare last Tuesday was an FDA physician directly involved in the approval situation and Ms Wojcicki. There was a well-timed, quite emollient interview with Ms Wojcicki in the Wall Street Journal this past weekend. Certainly a factor is that 23andme is still growing, but less quickly–up 150,000 from its pre-FDA contretemps level of 550,000. And its funders, even though closely related to Ms Wojcicki, hate to wait on numbers which are certainly below projections.

Is consumer digital device engagement sticky? Or just the hype?

A wonderfully cranky essay by Laurie Orlov on her new blog Boomer Health Tech Watch might make you think The Gimlet Eye was her guest writer (see below). Ms Orlov observes the ratched-up noise level around wearables, fitness bands, smartwatches (in which your Editor will be drenched quadrophonically next Wednesday at CEWeek NYC, glutton for punishment as she is). Yes, we’re swooning around Apple Health [TTA 3 June] and having a minor swivet around Samsung’s Simband and SAMI [TTA 2 June]. The bucket of cold water in Ms Orlov’s grip is the high dropout rate among fitness band users (33-50 percent, cited from Endeavour Partners and NPD Group); this Editor will also add the devices’ relative inaccuracy, fragility and glitches [TTA 10 May]. But ‘the investor community (via the media) clearly IS being transformed, at least temporarily’ as well as outside the health industry, by a belief that these devices will push the world into Quantified Selfing for the Masses. Will wearables herald our arrival at the New Jerusalem of Health? Certainly it’s been trumpeted and tromboned by the D3H (Digital Health Hypester Horde) badly needing a fresh fave rave. But can digital health survive another Hype Curve dive? Can weThe Consumerization of Health Care — is it working?

Further in this jugular vein, Business Investor, in a superficial swipe, dubs smartwatches uncool just because they trail fitness bands by six points. They did a better job in March delving into the real challenges that wearables face: smartwatches look and feel like a brick on your wrist (Ed. D’s term), Google Glass is socially unacceptable in many quarters (banned in Silicon Valley!) and wearables are still in Early Adopter-Ville.

Update: Ms Orlov just sent to this Editor a brief comment with a link to a thoughtful NY Times article not only on The Trouble with Apple’s Health App, but also how the barriers are more subtle–and more common-sensical–than the hype around how consumers are eager to register every burp on a PHR (they’re not), they don’t want to be nagged by technology (easier than your mom to be rid of) and the group that needs it most (the old, poor) has the least, for now, access to it. But largely ignored by the D3H.

click to enlargeOn assignment off Cape May, New Jersey inventorying readiness of coastal defense fortifications. Just between us. Shhhh!

Smartwatches, fitness trackers: overload in several ways

click to enlargeDedicated Quantified Selfers, who have more than one device strapped to their arm and wrist, know that when like measurements are compared from two different devices (e.g. step counts, weight, activity, blood pressure), like stock or mutual funds, their performance will vary. Sleep trackers are among the worst offenders. But newbies just ‘into’ this may be confused. Not to worry! The prescription from Dr Kvedar is: “Expecting these consumer devices to have scientific accuracy is unrealistic. Expecting them to help you keep your activity level top of mind and measured in context from day to day is realistic and in most cases helpful.” They set a tone and help motivation, with other tools such as social groups and coaching. Reassuring words, especially as Dr Kvedar has launched Wellocracy to help individuals to understand that.

There’s of course pressure from clinicians to upgrade fitness monitor readings to clinical quality so they can use it…but absolutely no clarity on exactly how they would use it, a seemingly contradictory statement which centers on the quality of analysis and what alerts would be pushed to the clinician, who memorably has his or her ‘hair on fire trying to do what they do right now.’   (more…)

UK-centered review of mobile health tech

Perhaps it’s the focus of this US-based Editor, but other than the occasional feature in the Guardian, Times or Telegraph, there are few articles on digital health written as general audience overviews of problems to be solved and relative capabilities of devices, rather than whiz-bang gadget fests. Thus this Editor’s attention to one just published in TechAdvisor/PC Advisor. Springing off of Quantified Selfer Dr Larry Smarr’s early diagnosis of Crohn’s disease, and based on his principle of ‘devices can help us notice trends before they become serious’, the writer reviews enabling tech such as mobile ECG AliveCor; Azoi’s Wello iPhone case/Android peripheral measuring heart rate, blood pressure, temperature and lung capacity; the overabundance of unproven health apps leading to the NHS’ Choices HealthApps library [TTA 9 May 13, RSM meeting summary 22 Apr] and web-based Vitrucare from Dynamic Health Systems for long-term chronic condition management. Oddly the article mentions Qualcomm and the Tricorder X Prize without in the same (heavy) breath, Scanadu. (Ed. Note–a check of their blog indicates no update on their delayed shipments due to production problems, TTA 5 Apr) Medical apps and devices are placing the future of healthcare in the palm of our hands

Pacifying baby, taking temperature

UK developer BlueMaestro has announced a temperature-sensing baby pacifier with the somewhat obvious name Pacifi. According to Mobihealthnews (but frustratingly not on their website), the pacifier sends temperature data via Bluetooth Smart to an iPhone or Android app. Parents can record medication dosing and reminders, track temperature and medication over time, and set up an alarm when baby runs a high predetermined temperature. It’s also dishwasher safe. Pacifi joins Raiing Wireless‘ body thermometer FDA cleared in 2012 (now iThermometer) and Kinsa’s plug-in smart thermometer which took a crowdsourcing approach to local public health. It is not cleared for sale yet in the UK or US, but was shown at last month’s Mobile World Congress Barcelona and the Smart UK Project in London. Unfortunately, it may be a while before Quantified Self Moms can put it on the list for their baby showers, along with the Owlet monitoring sock, Mimo onesie and iTeddy [TTA 10 Sept]. Related: MedCityNews compares Mimo to adult sleep monitor Lark, awarding the matchup to Mimo. The real matchup is Owlet versus Mimo (see this Editor’s comment). (Also see our comments here discussing the safety of RF monitoring around babies.)

The Quantified Selfer’s Christmas form letter

click to enlarge  APPROVED by The Gimlet Eye, on assignment directing Air Traffic Control for Mr. Claus.

Dear ______,

I can see from my ______ wrist device that it’s once again time for my annual Christmas letter to update you on a number of personal facts about the past year! Lucky for you, I’ve been able to view my daily data on a variety of self-tracking devices using interactive graphs to spot trends and patterns so far.  The year raced off to a great start because I got a new ______ from Santa last Christmas. (Continued…)

Our final pre-Christmas post is from the ‘♥ Sister’ herself, Carolyn Thomas, who has written this most witty communication that you may well receive from your favorite (?) Quantified Selfer. If not, reading this you will be forearmed at holiday tables and gatherings. You will view your QS nephew or friend in a new, more tolerant light. Wearing their Google Glass, tracking the cookies and egg nog on their Fitbit or Jawbone UP, passing around the Misfit Shine, obsessing on what workout will most efficiently balance the caloric intake…. To the rescue? Spot the Dog. Fitbit, Jawbone and Shine make great chew toys, and Glass…will Spot get to it before the video hits the cloud?

We wish all of our readers a marvelous Christmas Holiday, Festive Season and Happy New Year! (and thank Carolyn for the reference!–Ed. Donna)

FDA tells 23andMe genomic test to stop marketing (US)

Quantified Selfers and the D3H (Digital Health Hypester Horde) are in a swivet. This past Friday, FDA slammed the door shut on the 23andMe Personal Genome Service (PGS) saliva test. This past summer, the company broadly marketed to US consumers, including a TV campaign [Charles Lowe, TTA 7 Aug]. The FDA cease-and-desist letter cites that 23andMe never provided requested data on their July and September 510(k) filings, which are now ‘considered withdrawn’, and cites that “after these many interactions with 23andMe, we still do not have any assurance that the firm has analytically or clinically validated the PGS for its intended uses, which have expanded from the uses that the firm identified in its submissions.” The danger is that people will make medical decisions based on the testing information and that the results produced may be faulty. It appears from FierceHealthcare that the kit has actually been marketed for five years. According to MedCityNews, it is backed by Google Ventures (the CEO/co-founder is the estranged wife of Google head Sergey Brin), New Enterprise Associates, MPM Capital and the Moscow billionaire Yuri Milner. A private citizen is petitioning the White House to overrule the FDA (as if that extra-legal move would be possible, but who knows with the influence of the Googlesphere?) and states that the agency ‘grossly overstates the risks’ (also MedCityNews). As of 2 Dec there are 3,306 signatures of the 100,000 needed; one suspects this administration has bigger slices of uncooked turkey on its plate such as Obamacare and a kind-of-achieved 30 Nov deadline on Healthcare.gov, which is now clearly seen as just one problem.

The 23andMe website is still fully up and still selling kits.

Editor Donna sorts through the noise for possible reasons why:  (more…)

Humana, Healthrageous and some object lessons

The acquisition of the assets of Partners HealthCare spinoff Healthrageous by insurance and health service giant Humana is reverberating in the field in the US, particularly those in the buzziest digital health sectors. Some may look away, but a hard look provides some object lessons at the sheer unpredictability of the field for those who are innovating and attempting to shape consumer behavior and health. (Not behavioral health)

  • Healthrageous had an impressive lineage and credibility. Developed over three years at Partners HealthCare, it was spun off in 2010, PHC members on the board, leadership from well-known/regarded figures such as Rick Lee and Mary Beth Chalk–and enjoyed abundant, rapid startup funding–$12.5 million in two rounds, the last exactly one year ago, from equally impressive investors, reportedly $15 million total. No raiding the credit cards here.
  • It occupied what everyone for the past few years thought of as a sweet spot–personal health management targeted to employers/benefit managers along with health plans to lower costs that combined sensor-based telehealth data with individualized coaching and feedback–and data from a broad base of 10,000 users. (more…)

Don’t worry, there’s a wristband for that…

tactiluNot one for my Christmas list, but check out this TechCrunch review if you want to find out more about the Tikker wristwatch (which is currently doing well on Kickstarter). Tikker will calculate when you’re likely to bite the dust, based on factors like age, activity level, BMI and location.

If you’re hesitating as to how you might feel about wearing such a thing, just place a mood wristband on your other arm. (more…)

Body computing, sensors and all that data

This past week’s Body Computing Conference at University of Southern California (USC) had three sessions focusing on wearable sensors and the big names such as the well-financed Fitbit, Jawbone, BodyMedia, the ingestible sensor Proteus and Zephyr. The panels were split between the medical-grade and the consumer oriented with this report indicating some friction between the two. The notion of the Quantified Self died hard, even with Basis Science’s Marco Della Torre noting that 80% of health app users abandon them within two weeks, so the discussion moved to form factor and the ‘holy grail’ of getting the 90% of never-ever QSers to pay some attention. Of course, it’s the flood of data that has to somehow be processed (one of the FBQs) even though the doctors appear to be unconvinced of the evidence…but the ‘big data’ may be proving it after the fact. The future of wearable sensors in healthcare (iMedicalApps)