IBM gives sensor-based in-home behavioral tracking a self-driving car ‘spin’ in the UK with Cera Care

In-home behavioral tracking of older adults, which was a significant portion of telecare circa 2007 up until a few years ago, may be getting a new lease on life. The technology in this round is the same as what guides self-driving vehicles–LiDAR or Light Detection and Ranging, which uses laser light pulses to map images of movement and surroundings. 

In this model, IBM Research will use the LiDAR information and their machine learning to establish normal patterns and also to observe behaviors that may indicate a potentially dangerous condition or situation. The LiDAR pilot will be in 10-15 households in the UK starting in June. IBM is partnering with early-stage UK home care company Cera Care on the reporting and linking with care staff on alerts on changes in behavior that may predict a more acute condition. 

Many of the privacy issues that dogged predictive behavioral telemonitoring via networked infrared motion sensors, as well as in-home cameras, are present with LiDAR monitoring. Unlike 2007, five states have ‘nanny cam’ laws that prohibit cameras within skilled nursing facilities without patient consent (Senior Housing News) Another issue: expense. LiDAR sensor setups cost up to $1,000 each, and at least one per room is needed. Far cheaper setups are available from the Editor’s long-ago former company, QuietCare, if one can still purchase them for the home from Care Innovations; Alarm.com, UK’s Hive Link, and Google may get into the act with their Nest connected home tech.

Senior housing may open up a new market for LiDAR, which is wilting in the autonomous vehicle (AV) area as it’s proven to be rather buggy on real roads with real drivers. Certainly the housing and care market is growing and destined to be huge, with over-60s growing from 900 million in 2015 to 2 billion worldwide in 2050, while for-hire caregivers are shrinking by the millions.  Business Insider, Reuters

Despite recruiting, Babylon Health’s GP at hand still on hold in Birmingham (UK); CEO steps down at rival Push Doctor

GP at hand, Babylon Health’s NHS app and service for scheduling patients with local GPs, was expected to roll out in Birmingham, but the Hammersmith and Fulham CCG, from which Babylon operates, continues to halt its the expansion since the beginning of this month on patient safety concerns.

The app, which schedules patients with GPs and requires registration that effectively changes what we in the US call ‘attribution’, was set to add GP surgeries in Birmingham starting this month and was setting up an HQ at Badger House, an out-of-hours GP services provider based in Birmingham’s inner city. GP recruitment had started, according to Pulse, in late July. Patients would register in Babylon’s host practice Dr. Jefferies and Partner in southwest London through NHS’ out-of-area registration scheme.

The objections to Babylon’s expansion came initially from Paul Jennings, the chief executive of Birmingham and Solihull CCG. According to Digital Health, “he wrote to Hammersmith and Fulham to lodge a formal objection to the expansion. He argued the digital service was “not yet robust or tested for a national service to be delivered from a single practice outside of Birmingham”. Hammersmith and Fulham then stated that “further information is required to provide assurance on the safety of patients” before the Birmingham roll-out could be approved. 

This is despite the release of a equality impact assessment by Verve Communications on behalf of Hammersmith and Fulham finding mainly positive results, such as GP at hand “more likely to address most barriers than traditional GP services” in 10 out of 11 protected groups” and that “carers may benefit from [the] use of GP at Hand as this will allow them to consult a primary care practitioner whilst continuing with their care responsibilities.” The new Health Secretary Matt Hancock, a major advocate of technology in care, is himself registered with Babylon. Mobihealthnews

(If you are in the UK, you can hear it straight from Babylon’s CEO Ali Parsa, interviewed by Roy Lilley of nhsmanagers.net, on 10 September at the RSM.)

Rival telemedicine service Push Doctor is also undergoing changes with CEO and co-founder Eren Ozagir’s departure. It appears that he and the board had a difference around company direction, with the board recommending a cut of 40 jobs (Sunday Times). Their COO, Wais Shaifta, became acting CEO in July. In June 2017, a report by the Care Quality Commission (CQC) found the service to be delivering unsafe care via antidepressant and blood thinner prescriptions being given without requisite blood tests and monitoring. Digital Health

Tender Alerts: Staffordshire’s £70m contract, Yorkshire and The Humber test

Susanne Woodman, our Eye on Tenders, alerts us to two tenders, the first which will definitely pique our UK Readers’ attention with its size and duration. The second is for a proposal using TECS and telemedicine as an alternative to emergency services.

  • Staffordshire: This is a huge seven-year contract to create the Support For Independent Living In Staffordshire (SILIS) Service to enable older and disabled adults to age in place in their current homes. “A key aim of the Service is to help Individuals to make changes to their home environment that will prevent the need for more costly interventions, such as admission to hospital or residential care, following life crises.” The Service will improve upon existing services in Assistive Technology (AT) including referral to telecare providers.

There are six borough and district councils involved, with the potential for use by nine more. The contract is valued at £70 million to start April 2018 with renewal points, ending in March 2025. Deadline is Wednesday 1 November at noon. Much more information (you’ll need it) on TED EU-Tenders Electronic Daily

  • NHS Greater Huddersfield & North Kirklees CCG: This tender is for the provision of a technology-assisted, rapid access service offering an alternative to hospital-based A&E services. Market test site is in Kirklees for residents of a care home. Requirements are:
    • A 24/7 clinical teleconsultation service delivered via secure video link into residential/ nursing homes, that is utilized instead of patients having to be taken to the local A&E department.
    • A service that provides clinical consultation not a logarithm based approach like 111.
    • A fully managed technical service utilizing bespoke laptops with HD cameras and with 4G SIM or broadband.

The CCG may also commission an accountable care organization (ACO) for this care in future, to which this contract would transfer. Deadline is 5pm on Friday 20 October to brenda.powell@greaterhuddersfieldccg.nhs.uk. More information on Gov.UK.

Equivocal long term telemonitoring studies released by Telemonitoring NI, U. of Wisconsin

The HSC Public Health Agency for Northern Ireland and Queen’s University Belfast have released an evaluation of the six-year (2011 – 2017) Remote Telemonitoring Service for Northern Ireland (RTNI). The Centre for Connected Health and Social Care (CCHSC) launched the Telemonitoring NI project in 2011, which enrolled over 3,900 patients with COPD, diabetes, weight management, stroke, heart failure and kidney problems in both telehealth (vital sign) and telecare (behavioral) monitoring. The study period was through 2015, but the program continues to be implemented by all five NI Health and Social Care (HSC) Trusts across a range of chronic conditions. 

The Northern Ireland findings were at best equivocal. While the qualitative data gathered from patient, carer, and clinician focus groups and interviews were positive in terms of engagement and on reassurance–to be able to carry on with their lives as usual–the quantitative data did not confirm gains in effective care.

Although there were a number of testimonials from the participants in the patient focus groups regarding
reduced hospitalisations and a reduced need to attend outpatient clinics, this did not carry through to
the data obtained in the effectiveness aspect of the current evaluation. In general terms, the number
of hospitalisations, length of hospital stay and outpatient clinic attendance (and therefore overall cost
of healthcare provision) did not differ between the quasi-control ‘never installed’ group and any of the
groups who received some amount of telemonitoring. The results, where they were statistically
significant, were largely driven by an anomalous result for the heart failure ‘never installed’ group. (page 17)

The Executive Summary, Telehealth, and Telecare Reports are available for free download on the HSC R&D Division website. Many thanks to former TTA Ireland Editor Toni Bunting for the information, summary, and researching the previous TTA coverage below.

This is the second discouraging study on the long term effectiveness of patient monitoring released in the past month. A five-year, 140,000 patient/90 provider study conducted by the University of Wisconsin found that giving patients the option of telemedicine, instead of being more convenient for the provider, created new issues. It increased office visits by six percent, added 45 minutes per month of additional visit time to practices, and reduced the number of new patients seen each month by 15 percent. For the patient, the researchers found “no observable improvement in patient health between those utilizing e-visits and those who did not. In fact, the additional office visits appear to crowd out some care to those not using e-visits.” The study suggested that the telemedicine visits could be made more effective by structured questions prior to the visit. (This approach has been taken by telemedicine provider Zipnosis with adaptive online interviews and patient triage.) Mobihealthnews

Previous commentary by TTA’s Editor Emeritus Steve Hards on the procurement of the NI Remote Telemonitoring Service:

http://archive1.telecareaware.com/the-long-and-winding-road-that-leads-to-your-doorin-northern-ireland/
http://archive1.telecareaware.com/african-elephant-ecch/
http://archive1.telecareaware.com/remote-telemonitoring-northern-ireland-service-tender-long-list-mystery/
http://archive1.telecareaware.com/short-listed-companies-rtni-service/
http://archive1.telecareaware.com/northern-ireland-remote-monitoring-servicegoes-to-tf3/

 

Telehealth Soapbox: Medical device tax finally under fire; implications many (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/09/gizmodo-the-top-10-rube-goldberg-machines-featured-on-film-rube-goldberg.jpg” thumb_width=”180″ /]A key part of the Rube Goldberg (or Heath Robinson)-esque funding of the Accountable Care Act (ACA, a/k/a Obamacare) is a punitive medical device tax of 2.3 percent levied on gross sales (not profits) of hip, knee, cardiac implants, many dental materials, diagnostics such as scanners, radiotherapy machines, catheters and more. Since it went into effect on 1 January, it has raised $1 billion according to the Medical Imaging & Technology Alliance, the Advanced Medical Technology Association and the Medical Device Manufacturers Association in July–for a program that does not start till 2014. According to The Hill, senior Senators Orrin Hatch, Barrasso and Hoeven are pushing for a repeal amendment to be attached to the stopgap spending bill. The reasons why the tax deserves to be tossed out on its ear are: (more…)

Substantial benefits from telemonitoring trial that avoids patient involvement

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…)