Dubai launches RoboDoc based telemedicine service

Almost exactly 14 months to the day since the press release announcing a pilot of a click to enlargetelemedicine service, the first patient is said to have undergone treatment using the Dubai Health Authority’s RoboDoc telemedicine system according to Middle East North Africa Financial Network. The patient was based in Hatta Hospital and the respiratory specialists were based at Rashid Hospital Trauma Centre according to the report. RoboDoc units, from InTouch Health,  have also been installed at two primary care centres in Dubai.

In a previous TTA article this editor expressed surprise that telehealth would be of interest to Dubai which is only 1600 square miles in area. Having considered the details of the implementation the interest is partially explained by the fact that Hatta is an outpost separated from the rest of Dubai, 135 km (84 miles) from Rashid Hospital.

However, the other two centres at which the RoboDoc devices have been installed, Al Bashar Health Centre (15 miles from Rashid Hospital) and Nad Al Hammar Health Centre (7 miles from Rashid) (more…)

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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Donna Cusano, Editor In Chief, donna.cusano@telecareaware.com, @deetelecare

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.

West Virginia considers expanding prescription medication via telemedicine

The West Virginia legislature has been considering a new bill to expand the range of medications that may be prescribed in a telemedicine encounter. The bill was passed by the House of Representatives last week and sent to the Senate for consideration.

The House Bill 2509 proposes to amend the West Virginia Medical Practice Act to enable physicians to prescribe certain controlled substances when using telemedicine technologies. According to Mobihealthnews this would specifically include medication for mental and behavioral health, although bill itself does not refer to these conditions. A note at the end of the bill states “The purpose of this bill is to permit a physician to prescribe certain controlled substances when using telemedicine technologies.”

It seems that the legislation in the US dealing with telemedicine is fragmented and becoming more so. There was the issue of whether health insurance companies would cover telemedicine consultations, then the issue of medicare and medicaid covering the telemedicine consultations, then the state medical boards refusing cross border telemedicine and now issues on individual medications that can or can’t be prescribed. This will make it increasingly difficult for those practitioners who decide to enter the telemedicine arena.It is not a sustainable approach to pass a new law on every issue relating to telemedicine. Telemedicine is merely medicine practiced via a different route and regulation and standardisation of processes associated with telemedicine should be divested to a suitably established agency overseen by the legislature, similar to how the medical boards operate. In fact, this could easily be an additional responsibility given to the medical boards.

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.

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

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

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

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

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.

Tender up: NHS Hammersmith and Fulham CCG (UK) seeking telemedicine for care homes

Susanne Woodman, our Eye on Tenders, has located a London-based one on Ted.Europa.eu worth your notice.

Who: NHS Hammersmith and Fulham Clinical Commissioning Group (CCG), on behalf of the North West London Clinical Commissioning Groups comprising of NHS Central London CCG, NHS West London CCG, NHS Hounslow CCG, NHS Ealing CCG, NHS Brent CCG, NHS Harrow CCG and NHS Hillingdon CCG is seeking to appoint a provider to deliver a 24/7, 365 day per year Telemedicine-clinical support function to support care homes initially across Central London, West London, Hammersmith and Fulham, Hounslow and Ealing Clinical Commissioning Group (CWHHE CCGs) areas.

What for: A provider to deliver a 24/7, 365 day per year telemedicine-clinical support function to support care homes initially across Central London, West London, Hammersmith and Fulham, Hounslow and Ealing Clinical Commissioning Group (CWHHE CCGs) areas.

  • This facility will be introduced to 43 residential and nursing homes across the geography covered by the CWHHE CCGs, with a phased implementation over the 3 years of the programme.
  • If the service is successful, the CCGs reserve the right to extend the provision to include residential and nursing homes and patients and carers living outside care homes in the NHS Brent CCG, NHS Harrow CCG and NHS Hillingdon CCG areas.

Tender receipt date: March 8, 2017 at 12pm

Value excluding VAT: £7 900 000.00

The procurement documents are available for unrestricted and full direct access, free of charge, at http://nhssbs.eu-supply.com (log in required)

Tender/RFI up: two more from EU-Supply (UK, IRL)

Susanne Woodman, our Reader who is our Eye on Tenders, has located two new tenders available on the EU-Supply site:

(NHSSBS)Telemedicine Advice and Guidance Service Deadline is 8 March 2017. Documents are attached and available after registration and log in. Contact Greg Reide, phone: +44-161-2123701

(CTM) Pobal on behalf of the Department of the Housing, Planning, Community and Local Government invites responses from organisations for the purpose of market research. This is a Request for Information and not a tender process. This is a market sounding exercise to obtain market information in respect of Telecare Equipment in relation to the Seniors Alert Scheme. Please refer to the Request for Information document which is available via this notice. Submissions should be sent to procurement@pobal.ie on or before 3.00pm, on Thursday the 2nd March 2017. Registration and log in required for further information.

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,

The growth of telehealth, and the confusion of terminology (US)

Becker’s Health IT and CIO Review has written up a US-centric review of recent advances in telehealth and telemedicine but kicks it off with the confusion level between the two terms. Internationally, and in these pages, they are separate terms; telehealth referring primarily to vital signs remote monitoring, and telemedicine the ‘virtual visit’ between doctor and patient, between two clinical sites, or ‘store and forward’ asynchronous exchange (e.g. teleradiology). Somehow, in US usage, they have been conflated or made interchangeable, with the American Telemedicine Association (ATA) admitting to same, and American Well simply ‘just doing it’ in relabeling what they provide. On top of it, the two are incorporating elements of each into the other. Examples: TytoCare vital signs measurement/recording into American Well’s video visit; Care Innovations Health Harmony also providing video capability.

Of particular interest to our international readers would be the high rate of US growth in telemedicine utilization from 7 to 22 percent (Rock Health survey). Teladoc, the largest and publicly traded provider, passed the milestone of 100,000 monthly visits in November and the ATA estimates 1.25 million from all providers for 2016 (Teladoc release). Other US competitors include the aforementioned American Well, MDLive, and Doctor on Demand, the latter two also selling direct to consumer. They also compete against doctor-on-house call services like Pager and Heal. Reimbursement remains an issue both privately and publicly (Medicare and Medicaid) on a state-by-state level, with telehealth experiencing significant difficulties, as well as internet access, speed, and usage by older adults.

NHS Scotland launches Attend Anywhere video consult trial

click to enlargeAnnounced earlier this month by Shona Robison, Cabinet Secretary for Health and Sport, Scottish Government at the Scottish Digital Health & Care Week and Conference is the pilot of the Attend Anywhere virtual doctor visits. The consults are through a patient’s computer, smartphone or tablet using a Google Chrome web browser. The patient logs in to the website, waits in a private video room, the provider is notified that the patient is in the queue, and when the doctor is available, the video visit will start. (See illustration at left)

Initially, the service will target video call access to up to 50 health care providers including primary care, specialist services, speech and language therapy as well as pharmacy prescription reviews. According to Attend Anywhere, the service is available now to Scots in both rural and metropolitan areas. The service was developed as part of a collaboration between NHS Scotland’s Technology Enabled Care (TEC) Programme, Melbourne Australia-based video consulting specialists Attend Anywhere, and Healthdirect Australia, supported by NHS 24 Scottish Centre for Telehealth and Telecare. The press release links to a video of the consults in use in western New South Wales, including a care home. Scottish Centre demonstration site, Scottish Digital Health Week page.  Hat tip to Chris Ryan of Attend Anywhere Australia for the original articles and corrections. His LinkedIn post here shows the Scottish Centre’s table at the conference.