The IREHI conference is an annual international conference organized by IEEE International and the University of Lomé. The first meeting will be in Togo and will concentrate on the crisis of care delivery in developing countries, particularly acute in rural areas. The conference will look at how information and communication technologies (ICT), including telehealth and distance care, can improve healthcare. These solutions could significantly contribute to the improvement of health education, diagnosis of diseases, the effectiveness of treatment and monitoring of the elderly, both in urban and rural areas where specialized services are still limited or sometimes non-existent. (more…)
Our Eye on Tenders, Susanne Woodman of BRE, brings to our attention two from UK.Gov’s Contracts Finder and TED, with full information at the links:
- Telemedicine Solution for Stroke Services from Nottingham University Hospitals NHS Trust. Nottingham City Hospital requires an immediate replacement for a stroke Telecart which deals with out of hours (OOH) stroke emergencies. This system allows the consultants to remotely interact with patients and staff on the stroke unit. The patient is seen in real time video and audio. Future plans, not in this contract, are for a replacement system in multiple locations. Contact is Niall Fowler of the NUH NHS Trust. Closing 26 May.
- NHS National Services Scotland Remote Health and Care Monitoring and Communication System. The procurement is intended to support the delivery of home/mobile health monitoring and video conferencing enhanced care. At a later date, this will expand to incorporate future digital telecare or wellbeing solutions. A registration of interest is required for more information, available at the Public Contracts Scotland website. Value is £ 2 million. Note: this listing is a Prior Information Notice with estimated publication 21 June. These are generally released for high-value contracts with usually a compressed application period since information has been previously published.
While telehealth is still being tested in pilot projects in primary care in Australia it is beginning to be business as usual in secondary care, particularly for out patient services in rural areas and emergency care in regional areas, according to a review of this year’s Australian Telehealth Conference (ATC 2017) which concluded on Saturday. The article in Pulse+IT, puts the difficulty of getting telehealth into primary care down to the funding model in Australia.
The much admired Australian health care service is a mixture of public and private health care with, broadly speaking, the publicly (Medicare) funded hospitals providing a universal free service and the primary care being provided by a Medicare subsidised private practice service.
Until July 2014 telehealth services received incentives under the Telehealth Financial Incentives Programme. This programme was instrumental in introducing many telehealth trials through which the medical community learned the benefits and difficulties of telehealth first hand. Although these incentives have stopped, providers still receive higher Medicare benefits for approved telehealth services listed in the Medicare Benefits Schedule (such as video consultations between specialists and patients in telehealth eligible areas). However restrictions in eligibility for Medicare Benefits for telehealth usage have been shown to reduce the potential use of telehealth facilities (see our earlier item Should Australia review restrictions on use of telemedicine?).
Topics discussed at the conference included Telestroke, Innovations (Augmented Reality, AI), delivery models and virtual care. Many of the presentations given at the ATC 2017 are available at the ATC website here.
Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the third and final article this week he’s written from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].
This Editor agrees with his POV that drowning doctors in more and more data, whether previously accessible or not, isn’t a way forward to a successful business model. The current data is overwhelming–and not interoperable with EHRs. More and more data, looking for a home….
Orlando, April 26. Yesterday, I set aside several hours to walk by the booths of the 200+ exhibitors at the ATA show. As I slowly walked the Exhibit Hall, I was struck by the large number of in-home telehealth patient monitoring devices. (Names are omitted to protect the innocent.)
Colleagues had similar reactions. When I asked about exhibitors, the most common response was “I had no idea there were so many new telehealth monitoring devices that are FDA approved or in the process of obtaining approval.”
As I wandered from booth to booth, I was also struck by the failure of so many, if not most, monitoring device manufacturers to focus on the practical uses of their truly revolutionary technologies. At each monitoring device booth, I asked the same question, “How will the data be used?” All too often, the answer was, “We provide daily patient data for physicians that have never been accessible before, and doctors receive daily graphs.”
My follow-up questions were always, “You believe busy doctors will look at data on their large patient population each day? Why don’t you provide alerts?” Again, there was a frequent answer, which was some variation of “Yes, now doctors can see daily events which will lead to extraordinary improvements in health outcomes, and we don’t want to create alert fatigue” (false positives that suggest a problem where one does not exist).
In my view, monitoring devices without suites of robust predictive analytics will fail. Doctors are already too busy, and anything that adds to their workload is immediately suspect. Moreover, we still live in a fee for service world, and now we are talking about new, uncompensated work.
As Jonathan Linkous said to me on the first day of the ATA show, “the technology is a tool to provide the service,” not the service itself. Patient monitoring device firms must realize they are offering a service. To succeed, their services must provide actionable analysis, not more and more data. If alerts are ready for prime time, then doctors will value the devices: They can rely on the associated algorithms to indicate when an intervention (also to be compensated) is needed.
Moreover, I strongly suspect doctors would prefer a few false alerts, with algorithms biased toward safety and results that can be quickly checked via the underlying data, as compared to wading through charts looking for anomalies.
A fundamental question for anyone is “what business are you really in?” To succeed, many of the ATA exhibitors need to reorient themselves from the business of providing great technology to the business of providing great service enabled by technology.
Mr. Judson’s first article, a discussion with ATA’s Jonathan Linkous on business models for telehealth is here. The second article on Mercy Health’s catalyzing telehealth innovation at the hospital level is here.
Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the second article this week from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar]. His discussion with ATA’s Jonathan Linkous on business models for telehealth is here.
Orlando, April 25. At the ATA show, I stopped at Mercy’s booth, and spoke with Keela Davis, who is Mercy’s Executive Director, Innovation and Product Development. In the booth, was a large, inspirational display of Mercy Virtual’s high-tech, widely-reported $54 million “hospital without beds.” The facility is the nerve center for Mercy Virtual’s telemedicine programs, which include TeleICU (remote monitoring of ICUs by Mercy specialists) as well as multiple other remote services for patients in hospitals and at home.
A great deal has been written about Mercy’s groundbreaking service and large investment in this facility. I asked Davis what led to the decision to build “the hospital without beds.” She said that first, a lot of experience in telehealth proceeded the investment decision. Undoubtedly this experience was required to simply decide what should be built in a facility designed for the technology that exists today and that will undoubtedly accommodate new technologies as they arise. Second, she also said, that it reflected “a visionary” decision on the part of Mercy’s leadership to make this commitment. Now, in her words, the facility has become “a symbol of our work.”
As a student of innovation, our discussion was notable on several fronts:
First, Davis noted that now that the facility exists it serves as a catalyst for innovation. Mercy is actively considering, as might be expected, a range of new telehealth services. While Davis was quick to point out that the facility was not the only source of telehealth innovation at Mercy, she did indicate it’s the hub for innovative ideas and discussions. Organizations build on their experience, their successes, and the demonstrated commitment of management to move forward with good ideas. Mercy’s facility now provides the tangible place that facilitates ongoing growth. In short, after conquering the first level of innovation, Mercy is poised to march forward with new, groundbreaking services.
Mercy’s facility is also a warning to organizations that see the telehealth future, but hesitate to act. As Mercy gains experience, it will have a team that understands the many, complex aspects of assessing and bringing new services to market. Plus, many of the underlying capital and investment requirements associated with creating these services have already happened. In short, it will soon be difficult for other healthcare entities eyeing services in the same arenas to match Mercy’s innovation machine.
Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the first of several articles this week. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].
Orlando, April 24. Yesterday, the annual convention of the American Telemedicine Association (ATA) moved into full swing. At noon, Jonathan Linkous, ATA’s CEO, took a few minutes to talk with me. During our wide-ranging discussion, three notable themes emerged:
First and perhaps most important, Mr. Linkous believes that the future development of telehealth now stands with establishing viable business models. In his view, the speed of growth of the industry now depends on how the many participants in the healthcare system develop business models that lead to appropriate investments. He noted that this contrasts with the general focus on the evolving technology. Of course, the technology will continue to evolve and major advancements will occur for the foreseeable future. But, Mr. Linkous strongly believes that “the technology is here today.” In short, it’s now about how the technology is used and deployed. New advances will be incorporated into services and infrastructure as they occur. But, the past, telehealth is now moving into mainstream investment discussions. In his view, the leaders of every health organization are now assessing the role telehealth will play in the services they offer, and the investments they need to make now. Now, it’s about making it work. We are no longer waiting for the technology to be viable.
Second, Mr. Linkous commented on the hype surrounding the industry. He was frank in recognizing that, as with all exciting, transformative industries, the hype cycle is in full swing. One telling comment: “Unlike the past, the industry now has real revenues,” with rapidly growing businesses. In short, we may not be past the hype, but the industry is quickly moving to fulfill realistic expectations.
Finally, Mr. Linkous concluded that the future growth of the telehealth industry would largely depend on the consumer. He cited a variety of factors: the growth of value-based care, the emerging influence of millennials who are comfortable with technology, and the overall consumerization of medicine.
Many industry participants have described themselves to me as B2B businesses. Undoubtedly, they are. It’s hard to refute Linkous’s conclusion: Ultimately, the growth of the industry, like the evolution of healthcare itself, will depend on consumer choices.
The T-shirted revolutionaries converge with the corporate suits. HIMSS has acquired the ten-year-old Health 2.0 conference organization. It will be operated as a strategic business unit, retaining its name within HIMSS. Current CEO Indu Subayia, MD, will join HIMSS as EVP of the Health 2.0 business unit. Co-chairman Matthew Holt is taking a more freewheeling role as a ‘globe-trotting ambassador’, co-hosting and developing the international conferences currently held in India, Barcelona Spain, and Japan. He will also co-host the US annual and Wintertech meetings in the Bay Area. Transaction terms were not disclosed.
Health 2.0 was originally founded as a ‘bleeding edge’ networking community of misfit tech developers, IT gearheads, clinician renegades, startup newbies, and intense patient advocates, soon joined by marketers, communicators, funders, journalists, academics, and others who for various reasons wanted to be part of The Shock of the New. Over time, the small gatherings of the tribes (a/k/a chapters and annual meetings) grew ever larger, along with the startups growing up (or flaming out) and increased corporate interest, while Health 2.0 developed into a sizable conference, media, and innovation consulting company with a claimed 50,000 members. HIMSS has always represented, in their CEO Steve Lieber’s words, the “more established, fully adopted technology arena”. With the acquisition, HIMSS “now has much more of a portfolio to help drive better health through IT” and, of course, a deep well of resources including dues (and sponsor/exhibit) paying companies and members.
Health 2.0 will be expanding their conference schedule and into “additive products and services” such as MarketConnect, introduced at the 2016 annual meeting as a broker for startups/emerging tech to connect with larger customers and partners, and the Digital Health Marketplace with the NY Economic Development Commission (NYEDC). Developing these services will “lower barriers, increasing access and then being a conduit for larger established organizations to tap into that early stage technology community,” according to Dr Subayia. (Update: The Catalyst division, which runs sponsored challenges, code-a-thons, and pilot programs, is not part of this transaction but will work closely with the conference team, per a Health 2.0 email 20 April.)
By expanding to the early-stage health tech community, it refreshes HIMSS, in Mr Lieber’s words, with “new directions”. They also acquire two high-profile globally-known figures in the health tech field.
Those in the health tech community are asking:
- Will this truly create an ecosystem that benefits startups and early to mid-stage health tech, fostering innovation investment–or will it accelerate the big company acquisition trend already present in the past three years?
- Will the conferences, to date fairly freewheeling affairs, change to the buttoned-up HIMSS corporate model? Many categories of attendees (e.g. full-time physicians, caregivers, volunteers) have been admitted free or at greatly discounted rates. The meetings, speakers, and networking were the focus, with exhibits and sponsorships available but in the background. Or will some of these meetings merge?
- And what of the over 75 worldwide Health 2.0 chapters, many of which charge minimal memberships and meeting fees, versus HIMSS chapters which require substantial national corporate/individual memberships to join? Will there be cooperation? What will the chapter relationship be with the now HIMSS-owned Health 2.0 in future? (Disclosure: this Editor is active in the Health 2.0 NYC chapter as a volunteer co-organizer/host)
Events are blooming like daffodils in a long-awaited Spring! Here are two coming up, organized by the Royal Society of Medicine’s Telemedicine & eHealth Section. Both are full day programs held at the RSM’s offices at 1 Wimpole Street, London.
Medical apps: Mainstreaming innovation
Tuesday 4 April 2017, 9am to 5:10pm
CPD: 6 credits
Event link: www.rsm.ac.uk/events/TEH03
To discuss the regulation, the potential use and evaluation of the introduction of medical apps in a range of healthcare situations. This event is the fifth annual medical apps event run by the Section; the previous four have all been popular. The purpose of each one has been to educate forward-thinking clinicians in the benefits of using medical apps to improve patient outcomes and reduce costs. In view of the expectation that the NHS will have an mHealth assessment operation running by next April, this event will focus on mainstreaming the use of apps within the health and care services.
Digital health and insurance: A perfect partnership?
Thursday 1 June 2017, 9am to 5pm
CPD: 6 credits (applied for)
Event link: www.rsm.ac.uk/events/TEH04
This meeting will explore how digital health and insurance can be mutually beneficial by enabling insurance companies to get a better handle on the risk of their insureds. It will also explore whether these new business models might result in a new paradigm for delivering care more effectively, and to consider whether as a result the population as a whole might be better motivated to take greater responsibility for their own health and wellbeing.
This past week at the RSM was Tuesday’s (28 March) 28th Annual Easter Lecture given by Matthew Syed, a columnist for The Times and author of two acclaimed books, ‘Bounce’ and ‘Black Box Thinking’. He focused on the dynamics of a high-performance culture. Talent is significant but not enough. There is no substitute for a mindset that drives continuous improvement. Every marginal gain is vital and they build together to achieve performance excellence. Event link here.
An article in MIT Technology Review takes a sideways look at telemedicine and asks if telemedicine is providing an easy route for people suffering from excessive anxiety about their health. The author, Christina Farr, suggests that the ease of contacting a doctor using telemedicine services in comparison to having to visit a doctor’s office and the ability use either insurance or direct payments makes these services more attractive to hypochondriacs (lately called those with somatic symptom disorder).
Views on the subject are quoted from the chief medical affairs officer at MDLive, Deborah Mulligan, and a board member of Doctor on Demand, Bob Kocher. While the first is able to relate an anecdote where a case of excessive anxiety disorder was identified and successfully referred to cognitive behavioral therapy, the latter says he isn’t aware of any patients with health anxiety regularly using the Doctor on Demand app.
Read the full article here.
The study examined 2011-2013 claims information for over 300,000 people insured through the California California Public Employees’ Retirement System, which despite the name provides health benefits to active state employees as well as retirees. It targeted common acute respiratory infections (sinus infections, bronchitis and related) to determine patterns of provider utilization and the change after the introduction of telehealth. Of that group, 981 used the Teladoc system for video consults, adopted by CalPERS in 2012.
The objective of the study was to determine whether the telehealth visits were new care or substituted for other types of care such as doctor, clinic, or ED visits. Even though the telehealth services were far cheaper–about 50 percent lower than a physician office visit and less than 5 percent the cost of a visit to the ED–they did not make up for the calculated 88 percent rise in utilization.
Similar results were reported by RAND in last year’s research on retail clinics, which estimated that 58 percent of visits for low-severity illnesses were new and not shifted from EDs or doctor’s offices. What is in common? Convenience. Convenience opens up greater use. If you have a store down the street, you may pop in daily versus once-weekly.
Updated: Some further insights from Mobihealthnews were that the study stated that telehealth visits may be more likely to result in additional costs, such as follow-up appointments, testing or prescriptions. In other words, the telehealth visit starts off less expensive, but the standard of care in follow-up adds to that initial cost.
The RAND recommendation is thus not a surprise: make more telemedicine visits a shift from office or ED to restrict telemedicine growth. Raise the cost of co-pays for the service to reduce demand. On the ‘high side’, encourage ED ‘frequent flyers’ to use telehealth services instead. Pass the painkillers. Health Affairs (abstract only; paid access required for full study), RAND Health press release.
Analysis: instead of self-doctoring, and suffering at home and in the workplace, the small group of CalPERS policyholders in the study actually used their new benefit to check their health–as intended! The additional cost is not staggering; (more…)
An agreement reached in the U.S. District Court in Idaho in January this year overturned Idaho’s ban of prescription of abortion-inducing drugs during a telemedicine consultation (see our previous article).
The settlement of the case before Chief District Judge B. Lynn Winmill, brought by Planned Parenthood of the Great Northwest and the Hawaiian Islands, required the Idaho legislature to repeal the laws that made such prescriptions over telemedicine consultations illegal. The repeals have to be carried out by the end of the 2017 session, else Judge Winmill will declare the laws unconstitutional and unenforceable, according to Mobi Health News .
Idaho legislature has accordingly started the process of removing the single line from the Telehealth Access Act which bans the prescription of abortion inducing drugs and repealing the law requiring the doctor to be physically present at the consultation when prescribing the drugs. This is to be achieved via the new House Bill 250, sponsored by the State Affairs Committee, named simply An Act relating to Abortion. The bill was introduced last Friday.
The wording of the bill emphasises the the view that the state believes that abortions induced by medicines prescribed via telemedicine consultations constitute “substandard medical care and that women and girls undergoing abortion deserve and require a higher level of professional medical care”. Planned Parenthood has said that it objects to this statement that telemedicine provides substandard care according to Boise Weekly.
The bill has made rapid progress having had its second reading yesterday and is currently filed for the third reading.
The Yorkshire Evening Post profiles one of the residents, Mavis Robinson, who has motor neurone disease (MND). She was helped over the festive (US=holiday) season when her condition began to decline based on her vital signs monitoring which appears to be administered by staff. They were then able to obtain medication for pain before the situation escalated. Ms Robinson can discuss her health with the nurse based on the telehealth information. Telehealth information was also used to involve a family member in care for a patient nearing the end of their life. Unfortunately this Editor has been unable to determine what system is being used in the pilot. (Can one of our Readers enlighten us?–Ed.) Based on the closing quote from Sue Robins of NHS Leeds West CCG, it’s also an example of the NHS local strategy mentioned in The King’s Fund blog [TTA 17 Feb] for local areas to pilot and share the knowledge.
Debate on Care Quality Commission’s position on online prescription services on Radio 4’s TODAY (UK)
Friday’s BBC Radio 4 TODAY breakfast show has two segments discussing the Care Quality Commission‘s public warning on online prescription services and potential danger to patients. The first is a short interview of Jane Mordue, Chair of Healthwatch England and independent member of the CQC (at 00:36:33-00:39:00). The second, longer segment at 02:37:00 going to 02:46:30 features our own Editor Charles Lowe, in his position as Managing Director of the Digital Health and Care Alliance (DHACA), debating with Sandra Gidley, Chair of the Royal Pharmaceutical Society (RPS) English Board. The position of the RPS is that a face-to-face appointment is far preferable to an online service, whereas Mr Lowe maintains that delays in seeing one’s GP creates a need for services where a patient can see a doctor online and receive a prescription if necessary. The quick response allays anxiety in the patient and provides care quickly. Both agreed that a tightening of guidelines is needed, especially in the incorrect prescribing of antibiotics, and that there is no communication between patient records. Mr Lowe notes that GPs have always been comfortable with a telephonic consultation but are far less so with telemedicine consults via Skype. Here’s the BBC Radio 4 link available till end of March.
In the US with 24/7/365 telemedicine services such as Teladoc, MDLive and American Well, there is a similar problem with patient records in many cases except for history that the patient gives, but this is an across the board problem as the US does not have a centralized system. The prescribing problem is less about antibiotics, though MRSA/MSSA resistant superbugs are a great concern. According to Jeff Nadler, CTO of Teladoc during his #RISE2017 presentation here in NY attended by this Editor, Teladoc has a 91 to 94 percent resolution rate on patient medical issues. Of that 9 percent unresolved, 4 percent are referred, 2 percent are ‘out of scope’, 1 percent go to ER/ED–and 2 percent of patients are ‘seeking meds only’, generally for painkillers. Teladoc’s model is B2B2C, which is that patients access the service through their health plan, health system, or employer.
The bill to expand telehealth in Utah, which was amended by a Utah Senate committee on February 14th (see previous TTA article) has now been passed by both the Senate and the House of Representative in the state. The amended bill was passed by the Senate on Thursday last week and by the House the next day according to the Utah government website.
The original bill, HB154, sponsored by Rep. Ken Ivory, had a controversial clause restricting the prescription of abortion medication during a telemedicine consultation. The amendment removed this restriction on the basis that such restrictions have been successfully challenged in the courts in other states.
The bill is now being “enrolled” and is expected to be signed into law in due course.
Reader Bill Oravecz of Stone Health Innovations is attending HIMSS17 in Orlando, and was kind enough to forward a ‘hot off the presses’ link to this presentation deck given by Jay Weems of Avera eCARE (downloadable as PDF). The subject is ‘Telehealth Workforce Offers Unique Competencies & Opportunities’ and covers how telehealth/telemedicine IT is developed in a health system, mentoring rural originating sites in building proficiencies, and Avera’s experience in supporting a 13-state, multi-system, multi-specialty network. This is more about telemedicine (virtual consults) but offers lessons in developing both in a B2B model.
Update If you are using Chrome, you may have difficulty downloading session handouts from the HIMSS17 website Schedule pages. Try another browser.