TTA’s week: sleepless wearables, RSM events, 65+ smartphones, telemed for hypochondriacs?

 

We wonder about wearables, fill our calendar with events, cheer on smartphones for 65+ and VR-enhanced fall prevention training…and telemedicine for hypochondriacs?

Wearables: it’s a journey, but is it really necessary? (A smart jeans jacket and sleep trackers leave room for head scratching)
VR system integrating cognitive, physical training to reduce falls by 50 percent (Some real results in fall prevention plus video)
65+ smartphone ownership is up to 42 percent–but slumps with increased age (Some progress, but tech and cost impediments)
HealthIMPACT’s upcoming events for 2017 (US) (Single days that pack in a lot on HIT innovation–a new media partner)
Upcoming Royal Society of Medicine telehealth/health tech events and Easter Lecture (UK)
Is telemedicine attractive to hypochondriacs? (There’s a place for excessive health anxiety)
ATA 2017 Telehealth 2.0 Orlando: 15% off for TTA Readers (updated) (Book soon!)
West Virginia considers expanding prescription medication via telemedicine (Including select controlled substances)

Data is everywhere, from the future of patient-generated data to AI. Citizen Scientists and MedStartr aid innovation.  

From despair to hope? New study charts future of patient-generated data in care delivery (It’s better in 5 years. Can we wait?)
Upcoming MedStartr healthcare events in NYC; #RISE2017 videos online (Catch the next one on 5 April. If you missed #RISE2017, catch it here.)
AI as patient safety assistant to reduce, prevent adverse events (A hopeful take on an urgent issue)
#ShareTheHealth: spare Android phone processing, used fitness trackers, aid health research (Citizen Science innovations)

Previous articles of continued interest:

Telemedicine may drive up medical utilization, increase cost: RAND Health study (Yet it worked as intended)
Idaho legislature begins repeal of telemedicine abortion ban (Editor Chrys’ follow up)
Leeds, Harrogate care homes pilot telehealth system for residents (UK) (Another small test)
Technology for Aging in Place, 2017 edition preview (Some surprises here, debated)
Debate on Care Quality Commission’s position on online prescription services on Radio 4’s TODAY (UK) (Editor Charles now radio star)

A cornucopia of events and opportunities (UK/EU) (Editor Charles fills in your health tech calendar)
Tender up: Durham Smart County on Social Isolation (Due 31 March)
What is the future of digital technology in NHS England for the haves and have-nots? (Local innovation, but the funding?)
Iron Bow partners with Vivify Health for $258 million VA telehealth contract (A real competitor to Medtronic) and VA awards over $1 billion in Home Telehealth contracts–at long last (updated) (Be careful of answered prayers)

Towards 2020: Big Tech developments predicted to impact healthcare delivery (AI, machine learning, blockchain)
The King’s Fund Digital Health and Care Congress ’17–update (Preview the meeting video)


ATA 2017 Telehealth 2.0

ATA2017/Telehealth 2.0 is the world’s largest telehealth innovation & networking event, focused on how telehealth is transforming healthcare and creating competitive and cost advantages for those leveraging best practices. You’ll hear from leading healthcare providers, hospitals, physicians, associations, regulators, fast-growing startups, technology companies and industry thought leaders. Readers save 15%–and advanced registration rates are available through 25 March! (Use TelecareAware15 code when registering)


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

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Upcoming Royal Society of Medicine telehealth/health tech events and Easter Lecture (UK)

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.

More information, online learning opportunities and links on the RSM section page. (PDF).

Upcoming at the RSM is next 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 will focus 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. Open to the general public, it is a short evening program which starts at 6pm. Event link here. Hat tip to reader Jerry Kolosky via LinkedIn

Is telemedicine attractive to hypochondriacs?

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.

TTA’s week: data’s everywhere and hopeful, Citizen Scientists and Innovation, events, more

 

Data is everywhere this week, from the future of patient-generated data to AI. Citizen Scientists aid innovation. MedStartr and ATA2017 (save 15%!) events. 

From despair to hope? New study charts future of patient-generated data in care delivery (It’s better in 5 years. Can we wait?)
Upcoming MedStartr healthcare events in NYC; #RISE2017 videos online (The places to be in the next few weeks, and if you missed #RISE2017 catch it here)
AI as patient safety assistant to reduce, prevent adverse events (A hopeful take on an urgent issue)
#ShareTheHealth: spare Android phone processing, used fitness trackers, aid health research (Citizen Science innovations)

and: ATA 2017 Telehealth 2.0 Conference, Orlando: TTA Readers attend for less! (The place to be in April–more detail below)

Telemedicine may increase plan cost, the Idaho legislature takes action, aging tech 2017 trends, diabetes apps, Radio 4 CQC debate features Editor Charles, more. 

Telemedicine may drive up medical utilization, increase cost: RAND Health study (Yet it worked as intended)
Idaho legislature begins repeal of telemedicine abortion ban (Editor Chrys’ follow up)
Leeds, Harrogate care homes pilot telehealth system for residents (UK) (Another small test)
Technology for Aging in Place, 2017 edition preview (Some surprises here, debated)
Debate on Care Quality Commission’s position on online prescription services on Radio 4’s TODAY (UK) (Editor Charles now radio star)

CHANGED DEADLINE Calling all diabetes prevention apps: may be your chance for greatness! (Our Mobile Health/NHS England–application due 15 March)
A cornucopia of events and opportunities (UK/EU) (Editor Charles fills in your health tech calendar)

Previous articles of continued interest:

#HIMSS17 roundup: machine learning, Proteus, Soon-Shiong/NantWorks’ cancer vax, Uniphy Health, more (From AI-assisted workflow technologies to the Soon-Shiong cancer vax controversy)
Here’s Howz: now electricity consumption as elder minder (UK) (Telecare 3.0?)
Utah telehealth expansion bill passes Senate and House (Lawmakers working together)
HIMSS17 dispatches: Mayo maps neonate telemedicine, Amwell-Samsung, Samsung-T-Mobile (Including IoT for senior care)

HIMSS17 news flashes: Lenovo, Orbita, Tactio, Garmin, Parallax, Entra Health, Philips, IBM (Some setbacks for Watson Health)
The Theranos Story, ch. 37: the Object Lessons for future healthcare entrepreneurs (An MBA in what not to do)

The Theranos Story, ch. 36: Their money–and time–are running out (The start of the denouement) (more…)

Telemedicine may drive up medical utilization, increase cost for respiratory illness: RAND Health

click to enlargeIs convenience the culprit? Researchers from RAND Corporation’s Health program conducted a three-year study of telemedicine (here called telehealth) usage by employees of CalPERS for respiratory illness and came to a surprising conclusion. From the study abstract: “12 percent of direct-to-consumer telehealth visits replaced visits to other providers, and 88 percent represented new utilization. Net annual spending on acute respiratory illness increased $45 per telehealth user.”

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…)

Idaho legislature begins repeal of telemedicine abortion ban

An agreement reached in the U.S. District Court in Idaho in click to enlargeJanuary 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.

Leeds, Harrogate care homes pilot telehealth system for residents (UK)

click to enlargeThe Sunnyside Care Home in Crossgates is the first of 14 local care homes in Leeds and Harrogate with a telehealth remote telemonitoring program for residents. The pilot that started before Christmas is sponsored by NHS England’s West Yorkshire and Harrogate Acceleration Zone as part of their £8m initiative to improve urgent and emergency care.

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.

Utah telehealth expansion bill passes Senate and House

The bill to expand telehealth in Utah, which was amended by a click to enlargeUtah 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.

HIMSS17 dispatch: developing a telehealth IT team in health system and multi-site networks

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.

NY’s Northwell Health Home Care partners with HRS for telehealth tablets

click to enlargeNew York State’s largest health system, Northwell Health, is partnering with Hoboken, New Jersey-based (and Blueprint Health grad) telehealth provider Health Recovery Systems (HRS) on introducing their tablets into their Home Care Network. The picture at left is of Bernard Feinstein, a 100-year-old Queens-resident Northwell Health patient, who seems to be easily using and handling the touchscreen tablet. HRS tablets are video-enabled for consults and monitor vital signs, connecting via Bluetooth to devices: stethoscope (heart and lung), pulse oximeter , blood pressure, and weight scale. If one enjoys examples of pretzel logic, the release states that Northwell’s telehealth implementation is one of the first–of Bluetooth-enabled monitoring in NY State home care and the first on Long Island. (Cable-connected telehealth systems have been commonplace since 2003, including Northwell’s home care.) The HRS partnership follows on Northwell Ventures’ $1 million Series A investment in Virginia-based telemedicine provider Avizia. Innovate LI,

Humana-Omada Health diabetes prevention program could cut $3 bn in Medicare expense: study

A study performed by insurer Humana using the Omada Health program for diabetes prevention effectively lowered weight, improved cholesterol, blood glucose and mood. 500 volunteer subjects from Humana’s Medicare Advantage program, enrolled during 2015, lost an average of 13 to 14 pounds over a year (7.5 to 8 percent). They also saw improvements in cholesterol levels, blood glucose levels and subjective measures of moods and self-care. Individuals were chosen from administrative medical claims based on metabolic syndrome diagnosis or a combination of three of four of the following diagnoses: prediabetes, hypertension, dyslipidemia, and obesity. Based on the researchers’ calculations, this type of prevention program among this group if widely implemented among overweight adults could reduce Medicare costs by $3 bn over 10 years, not only for diabetes but also heart disease and high blood pressure.

Omada Health’s program included an online small group support, personalized health coaching, digital tracking tools, and a weekly behavior change curriculum. These one-hour lessons focused on a single topic were delivered via laptop, tablet, or smartphone, and included interactive games or exercises, written reflections, and goal-setting activities. The content was approved by the CDC Diabetes Prevention Recognition Program. Data was gathered via wireless scale, pedometer for physical activity, online food intake logging and standard lab results. “In conclusion, this study demonstrated that older adults who agreed to participate in this program were able to engage meaningfully and gain important health and wellness benefits during a relatively short time frame.”

While the cost reduction estimate is exactly that, other studies directionally confirm health improvement and savings: the National Diabetes Prevention Program (NDPP) which is the model for the Omada program, the BMJ/Noom Health study, and the Fruit Street/VSee telehealth program being used by St. Jude Children’s Research Hospital, University of South Florida and University of Michigan. mHealth Intelligence, study (full text in Journal of Aging and Health/Sage Journals)

TytoCare remote diagnostics comparable to in-person exam results: study

click to enlargeA study of the Tyto Care remote diagnostic device, conducted by Schneider Children’s Medical Center and the Sackler School of Medicine, found that the quality of readings by Tyto Care was ‘on par’ with in-person medical exams using conventional otoscopes and stethoscopes. Ears, heart, lungs and throats of 137 children aged 2-18 seeking care from the emergency department of a tertiary care facility were examined first conventionally and then again by a second remote physician using exam data captured by the TytoCare all-in-one device and attachments. Using standard statistical methods, the results were compared and the study reported “good to excellent agreement for all exams conducted using TytoCare and conventional exam tools, with a p-value <.001.” The study also recorded a separate five-point measure of patient experience and results averaged 4.4 and 4.5 out of 5 (excellent). No adverse events were recorded.

What is lacking in the release are the diagnoses of the young patients, but presumably those results will be presented with the final study. Formal presentations will be at the Israel Society for Clinical Pediatrics (HIPAK) meeting on 8 February in Tel Aviv and at the American Telemedicine Association (ATA) conference 23-25 April in Orlando, Florida. This positive report on efficacy will also aid their rollout with American Well, announced at the end of 2016 [TTA 2 Dec]. Harry Wang at Parks Associates in their blog also named TytoCare one of the two standouts of CES 2017–and the other, Partron (Croise) is not yet on the market.

Tender up: NHS Shared Business Services (SBS) (UK)

Susanne Woodman, our Reader who is our Eye on Tenders, has found this on the Gov.UK contracts finder site:

Lease of telehealth equipment and peripherals by NHS Shared Business Services. Tender # is RA212802. Location is listed as postal code M50 2UW which is Salford, Lancashire. No value assigned. The RFQ expires on Monday 20th February at 12pm. Questions accepted until Wednesday 15th February 2017 at 12:00 with responses returned by Friday the 17th. Quote procedure and more information is via Multiquote.

British Journal of Cardiology (BJC) Digital Healthcare Forum’s inaugural meeting

28 April, 9:30am-5pm, Royal College of Obstetricians and Gynaecologists, London 

Henry Purcell of the BJC was kind enough to post us with information on the first-ever BJC Digital Healthcare Forum. Organized by the BJC in association with the NHS, the Digital Health and Care Alliance (DHACA), and the Telehealth Quality Group, it is a novel ‘hands on’ meeting to assess if digital medicine can fill gaps in healthcare provision throughout the NHS. It is also in response to the massive pressures which winter has wrought on NHS health and social services. The Forum was designed by clinicians and leaders in healthcare informatics for UK commissioners, doctors and other HCPs involved in the management of long-term conditions (cardiovascular, obstructive pulmonary disease, diabetes etc.), as well as those engaged in health informatics, IT, and Trust CEOs. Speakers include Dr Malcolm Fisk of De Montfort University, our own Charles Lowe of DHACA, Professor Tony Young, National Clinical Director for Innovation (NHS England) and many more experts in digital health and care. For the latest information and to register, see the event website or the attached PDF.

What are the impacts of NHS CCGs forcing disabled and LTC patients into care homes? (UK)

click to enlargeCare for elderly and disabled goes off the tracks again. A report in the Health Service Journal (subscription required), covered in an opinion piece in the Guardian, indicates that thousands of patients who are disabled and also those who require long-term care may be forcibly put into care homes (US=nursing homes) rather than being treated and maintained in home care. According to the HSJ, “Freedom of Information (FOI) requests from campaign group Disability United found that 37 NHS clinical commissioning groups (CCGs) in England were introducing rules about ongoing care that could force up to 13,000 people with health conditions into care homes.” CCGs due to NHS cuts have been setting limits on financing home care, between 10 and 40 percent above the care home option. In other words, where a care home is cheaper, the CCG will withdraw payment for home care, and unless the individual can self-pay or has an advocate who can organize a care plan, that person may be involuntarily moved.

The word ‘institutionalization’ deservedly strikes fear on both sides of the Atlantic as a recipe for patient decline, physical and verbal abuse, theft and generally bad care. It’s a blunderbuss solution to ‘bed-blocking’ which we discussed here [TTA 7 Sep 16]–the care plan becomes ‘move ’em out’. By going this way in policy, NHS England is going counter-trend, against more personalized care delivered in home settings, and setting an unfortunate trend for other countries like the US.

Outside the scope of the article, but in this Editor’s thoughts, is the knock-on effect it will have on the UK’s developers and providers of telehealth and telecare services/TECS designed to support home care. Many of these technologies are in a transition period to the greater capabilities (and freedom from land line) of digital from analogue care, which was discussed in TTA here. Cutting domestic demand may not only be critical not only to companies’ survival, but also to their expansion in the (now far more open to the UK) US market. Readers’ thoughts?