Substantial benefits from telemonitoring trial that avoids patient involvement

September 1, 2013 | by

In a possible pointer to a future of greater benefits from telemonitoring when vital signs information is transmitted to care-givers automatically, eg from smart clothing or subcutaneous probes, Heartwire reports on the successful Dutch IN-TIME RCT involving implant-based home monitoring for patients with advanced heart failure. For those in the intervention group, in-house monitoring significantly reduced the worsening of their condition, and significantly reduced mortality, compared with the control group.

Asked why his study succeeded where others have not, (more…)

Canada’s generic road forward on health tech

August 28, 2013 | by

Canada’s federal government has stated that they have been thinking long and hard about extending digital health to more Canadians. In 2012, they commissioned and funded an independent organization, Canada Health Infoway (Inforoute Santé du Canada in the mandatory bilingual terminology) to study future healthcare needs, determine where digital health could make a difference and propose a strategic plan. After surveying 500 individual Canadians, clinicians, governments and health care administrators, national associations and vendors (a small number, it seems to this Editor), their report (PDF here) centers on five opportunities for action: (more…)

Owlet baby monitor sock moving to market

August 27, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/product_sock-Owlet.png” thumb_width=”150″ /]About nine months ago [TTA 6 Dec 12], the Owlet baby monitor in prototype won a student competition at Brigham Young University. It definitely ‘socked it” to this Editor at the time as an elegant way to monitor baby vital signs or signs of distress; it is a sensor-rich sock transmitting to a smartphone. While it still had pending patents, needed further prototyping and of course no FDA approval, I recommended “if you’re an angel looking for a highly marketable telehealth item–and with adult uses in hospitals and nursing homes–a trip to Utah may be in order.” Owlet is now seeking $100,000 in crowdfunding directly via its website and Amazon checkout (it was rejected by Kickstarter for being a baby product!) and will ship the device at an early bird rate of $159 once the funding is achieved. (more…)

At last a supportive article on telehealth! (UK)

August 27, 2013 | by

Richard Vize has written a highly-recommended article in the Guardian today entitled “GPs continue to do battle with government over telehealth”. This gives some valuable context to why publications such as Pulse continue to dredge up the historic Whole System Demonstrator (WSD) cost/QALY statistics as it did on Wednesday and  Thursday last week.

TTA readers will of course be aware of the reasons why those figures are so unrepresentative of the technology from our recent post on why it’s time to bid farewell to the WSD.

Particularly pleasing is to see recognition of the role of telehealth as a means of promoting wider improvement in the way care is delivered:

“Eventually, other costs will start to fall as telehealth becomes a catalyst for wider system change. At present it is a bolt-on to a care system poorly integrated and not adapted for telehealth. It will require clinicians to work together in new ways, particularly in more effective joint working between community and hospital staff.”

Medtronic confirms forecast direction change, the market reacts, and brains are stimulated

August 27, 2013 | by

The ‘reasons why’ we (and others like David Shaywitz in Forbes) proposed back on 12 August for Medtronic’s purchase of Cardiocom were fully confirmed by their CEO Omar Ishrak in Bloomberg (21 August) and an analysis in Forbes (24 August). However, the Forbes article continues on to dump a bucket of cold water on Mr. Ishrak’s  ‘solutions provider’ strategem (so reminiscent of 2008-9 with different companies), positing that telehealth belongs with wireless/mobile companies (Qualcomm), companies further downstream (Allscripts, a major US pharmacy benefits manager) or other technology/monitoring companies. Mr. Market held the roses though (Deutsche Bank’s reiterated hold rating in Benzinga reflecting the consensus in Yahoo Finance).

What is interesting are their advances in brain stimulation to relieve pain in two areas. (more…)

Don’t be put off by the title…take II (and take your pick II)

August 26, 2013 | by

Following on from yesterday’s post entitled “Don’t be put off by the title, or the conclusion, of this review of reviews“, Mike Clark has kindly pointed me towards another recent review of telehealth reviews entitled “Telehealth – the effects on clinical outcomes, cost effectiveness and the patient experience: a systematic overview of the literature”, this time from Salford University, authored by Dr Alison Brettle, Tamara Brown, Professor Nicolas Hardiker, Jon Radcliffe and Christine Smith.

This paper provides an intriguing contrast to the paper reviewed yesterday in a couple of, doubtless unrelated, ways. Firstly, whilst the word that was the subject of yesterday’s post does not appear in the title (it does appear in the text), the paper was funded by an educational grant from the organisation most often associated with that word. Secondly, the review is noticeably more positive, for example:

“There is more evidence for some conditions than others, but on the whole the trends are largely positive suggesting that telehealth is effective in:

  • Reducing patient mortality and hospital admissions for chronic heart failure
  • Reducing hospital admissions for COPD
  • Reducing blood pressure in hypertension, improving glycaemic control in diabetes and reducing symptoms in asthma”

As with our two recent posts on Birmingham OwnHealth, it looks like it’s take your pick time again.

It is perhaps just worth adding that there are also significant similarities between some of the observations made in both papers, most notably about the small size of many trials, inconsistent collection of outcome measures and the weaknesses of the methodologies currently used for assessing the effectiveness of trials of medical devices.

Don’t be put off by the title, or the conclusion, of this review of reviews

August 25, 2013 | by

Whenever I see the word “telehealthcare” I feel there should be an ® or perhaps a ™ after it as it so often appears in connection with a particular organisation. However no such connection is evident is this paper entitled “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview” (published on the PLOS ONE site), especially as the overall conclusion is far from that often found in articles toting that word:

“Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.”

If you stop there though, you miss some very important points (more…)

Journal of the International Society for Telemedicine and eHealth (South Africa)

August 24, 2013 | by

A heads-up to our readers: a new peer reviewed journal out of South Africa’s University of KwaZulu-Natal’s Department of TeleHealth is the Journal of the International Society for Telemedicine and eHealth. On its second edition, their content (in PDF or HTML formats) seems to be of general interest:

  • Editorial: Would a Rose By Any Other Name – Cause Such Confusion? (defining eHealth)
  • Original Research:
    • TalkMeHome: an in situ evaluation of a service to guide a lost person with dementia home safely
    • Assessing the development process of the eHealth strategy for South Africa against the recommendations of the WHO/ITU National eHealth Strategy Toolkit.
  • Invited Commentary: Telerehabilitation: Current Challenges to Deployment in the United States

The Editors are certainly an international mix: Prof. Maurice Mars, University of KwaZulu-Natal, South Africa; Prof Richard E Scott, University of of KwaZulu-Natal Director, NT Consulting, Canada; Dr Malina Jordanova, Bulgarian Academy of Sciences, Institute for Space and Solar-Terrestrial Research, Bulgaria.

Ambient Assisted Living Forum 2013

August 22, 2013 | by

The AAL Forum is billed as an annual platform for the growing “ambient assisted living” – telehealth and telecare – community in Europe to meet and discuss AAL. It is also a showcase event for people involved in the Ambient Assisted Living Joint Programme which is an initiative involving 20 EU and 3 non-EU countries, with public funding from EU and partner states. This year the Forum meets in Norrköping in Sweden from 24th to 26th of September.

The full programme, a link to the online registration web page, information on the associated exhibition and archived information on the past 4 years’ AAL Forums can be accessed from the AAL Forum website.

 

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/EKTG-logo.png” thumb_width=”150″ /]European Knowledge Tree Group Workshop

A side event at this year’s AAL Forum, this workshop will be held on the 24th of September.  The EKTG is  an  ad-hoc group concerned with the real impact of R&D in the area of ageing and “brings together users, technologists, financiers and governments”. The workshop aims to review the technology of Apps from development, opportunities, appropriateness to costs and finance. To register for the EKTG workshop visit the registration page here.

Surrey telehealth – some good news!

August 21, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/Surrey-County-council-Logo1.jpg” thumb_width=”150″ /] The announcement by Medvivo and Surrey County Council of telehealth becoming fully embedded across all six CCGs in Surrey is good news for those who believe in the benefits of telehealth.

Pulse was one of the first to carry the news today, though was  unable to resist the temptation to remind readers of the high cost/QALY found by the Whole System Demonstrator (WSD) programme (which was caused, as Telecareaware readers will know from a previous post, by the high cost of running the WSD RCTs and using equipment that is now some six years old).  The more positive EHI post is here.

Over the past year there has been much concern about whether telehealth arrangements established by the previous PCTs might be taken forward by the CCGs; Surrey shows it can be done successfully.

(Disclosure: Charles Lowe established and ran the telehealth programme in Surrey for NHS Surrey and Surrey County Council between 2011 and 2013, including managing the tender process.  He did not however adjudicate the tender – some 40 representatives of organisations in the county participated in the adjudication.)

How best to help older people to understand the benefit of technology? (UK)

August 18, 2013 | by | 4 Comments

Last week we reported on the survey commissioned by the National Telehealth Forum that found that 9 out of 10 people didn’t know what the word ‘telehealth’ meant, a proportion that was worse for those who were more likely to need it. We suggested that asking a different question about whether they knew that technology could enable them to remain in their own home might give a more positive response.

Well no sooner said than (sort of) done – Invicta Telecare reported a similar-sized poll that, among many, included the finding that “more than three out of five over-65s (65%)…admit they hadn’t seriously thought about the type of care and support they would prefer as they get older during the last five years”. Other responses in the interesting survey seem to confirm that a significant number of older people are in denial of the implications of their age so are inadequately prepared to remain independent.

This clearly strengthens the conclusion from our earlier piece, and from our retrospective on why O2 pulled out of this field of the increasingly pressing need to make people aware of how technology can support independent living. Is 3millionlives the way forward?

This is obviously a topic of great interest that will undoubtedly be debated this autumn particularly at the two conferences specifically aimed at how technology can supporting people to age well, run by the Kings Fund on 22nd October and the Royal Society of Medicine on 25 and 26th November. (Disclosure: Charles Lowe is one of the organisers of the latter).

Birmingham OwnHealth Take II – take your pick

August 17, 2013 | by

You wait for a cohort study to come along for ages, then suddenly two come along within a week of each other…of the same intervention, although with apparently different conclusions. The second paper, entitled “Analysis of the Impact of the Birmingham OwnHealth Program on Secondary Care Utilization and Cost: A Retrospective Cohort Study”, is published online in the Journal of Telemedicine and e-Health, ahead of print, with lead author Liv Solvår Nymark.  (Our post on the previously-reviewed paper, whose lead author was Adam Steventon is here).

The Steventon paper found that the OwnHealth intervention “did not lead to the expected reductions in hospital admissions or secondary care costs over 12 months, and could have led to increases” whereas the Nymark paper “found difference in costs constituted (more…)

So 9 out of 10 people haven’t heard of ‘telehealth’…and your point is?

August 14, 2013 | by | 3 Comments

Apparently echoing the comments about health technology awareness made in our post last week about O2 (who are, by the way, to be congratulated for their parent company’s announcement today that they are preferred bidders for two of the three smart meter regions), the HSJ has reported the results of a YouGov poll that nine out of ten adults in the UK have never heard of telehealth.  Of those over 55, the age above which use of telehealth is more likely, 92% hadn’t heard of it. (Note that the HSJ article is behind a paywall, however via a Google search on “National Telehealth Forum”, the commissioner of the survey, you can currently go past it). The National Telehealth Forum press release is .  EHI also covers the story, .

So is this a matter of serious concern?  (more…)

Well someone thinks telehealth is good news!

August 12, 2013 | by | 2 Comments

Medtronic has just announced a $200m takeover of Cardiocom, the telehealth device maker.  If you can get through the paywall, the WSJ article is here (updated link not paywalled–Ed. Donna). FierceMedical quotes Medtronic as saying that “At-home monitoring is a proven method of reducing the rates of hospital readmission…and that translates to savings for payers, providers and governments.” First area of joint working is expected to be heart failure. Recent US regulations on Medicare, and increasingly insurance payers, penalize hospitals for 30-day same-cause repeat admissions. Medtronic press release.

Editor Donna: The announcement of Medtronic’s (#4 in worldwide revenue) acquisition of Cardiocom (both Minnesota-based companies) created quite a stir in the US as Medtronic is a ‘traditional medical device’ company best known for its implantables: cardiac shunts, stents, heart valves, pacemakers, insulin pumps and interestingly, a wide range of neurostimulators for different conditions. Now with the acquisition of Cardiocom, Medtronic moves into the post-implant/post-discharge/post-diagnosis chronic condition management continuum– not only into telehealth via Cardiocom’s devices and hubs, but also their clinical and care management systems. $200 million in cold cash is a fair bet even though Medtronic’s market cap is north of $55 billion. Medtronic has to see the opportunity to make a bottom line difference to providers and payers. It is also reacting to a narrowing in its profitable core market–medical devices are now taxed, there have been recent product defect-related ‘scandals’ tarring the industry, and there is pressure to reduce pricey device costs to fit a cost-constrained environment, driven by the new healthcare ‘scheme’ (in both the British and American English senses!) Forbes‘ David Shaywitz has a smart take on it today (though he won’t hold his breath for the pharmas to follow), as well as VC TripleTree’s Chris Hoffman ‘connecting the dots’ and coming up with what we’ve been talking about for some time–integration making sense. It is also most definitely a shot over the bow for major competitors such as Alere, Bosch and Philips plus a raft of smaller companies which have been working with a scattering of hospital discharge areas, integrated delivery systems, ACOs and home health agencies, looking nervously over their shoulder–and other leading medical device companies such as Stryker, BD, Baxter and yes….GE. (Bosch also sued Cardiocom on patent infringement this time last year [TTA 7 Aug 2012]; presumably as this suit was not announced as settled or decided, Bosch is now dealing with a company its own size!)

It also should be noted that Medtronic’s CEO, Omar Ishrak, is well acquainted with home health. Mr. Ishrak was formerly the CEO and president of GE Healthcare through mid-2011–and the driver behind making what was an ultimately failed bet in getting GEHC into home health. That was in 2008-9 with a tiny company called Living Independently Group, developer of a telecare system called QuietCare, which ultimately went to the Care Innovations JV with Intel. (Disclosure: I was head of marketing at the time of the acquisition.) Like GEHC, Medtronic is acquiring a closely-held company in a very different line of business with drivers quite unlike its own; they are retaining the former CEO as a general manager of the division but whether other management or the brand name will survive is not disclosed.

Whilst on the subject of telehealth devices, Heartwire reports a meta-analysis of 52 studies that shows that just measuring your blood pressure regularly results in a significant reduction in both systolic and diastolic levels after six months. Sadly the paper itself in the latest issue of the Annals of Internal Medicine is behind a paywall so it’s not possible to try to understand how the final comment in the synopsis of the paper on the Annals website that: “Additional support enhances the BP-lowering effect.” fits with the comment in Heartwire that “Low-strength” evidence from 13 studies comparing self-monitoring plus additional support vs self-monitoring alone “failed to support a difference” between the two strategies.”

Meanwhile back in the UK, Medvivo has become the first company to be accredited to the telehealth elements of the TSA’s Integrated Code of Practice. Sadly the TSA website will only release the Code to members (TTA isn’t one) or those aspiring to achieve accreditation (TTA fails on that one too) so it’s not possible to make meaningful comment. However the prospect of a Battle of the Codes is looking up with word from Malcolm Fisk that the final version of the European Code of Practice for Telehealth Services will be available for all to read and download on the TeleSCoPE website within a month. There has been talk of a third code being developed too…

Analysis of the Birmingham OwnHealth service – not the bad news it seems?

August 9, 2013 | by | 3 Comments

The BMJ has just published an open access paper entitled “Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls” (BMJ2013;347:f4585, Steventon et Al).  It reaches the rather depressing headline conclusion that telephone coaching did not reduce unplanned hospitalisations and if anything increased them.

This looks to fly in the face of the apparently less academically rigorous recent claims by the Leicester City CCG and Totally Health, that they reduced hospitalisations significantly, saving some £353,000 over a 30 week period with a cohort of between 47 & 50 patients that we reported recently.

However reading on, perhaps a key passage, in the conclusion, is (more…)