If you think that the recent announcement that the Government wants a paperless future for the NHS is just a blue sky aspiration, then you haven’t read the official press release as written by Julian Patterson on the NHS Networks site: The world’s most digital health service “A government spokesman said: ‘We’re excited about the future – and surveys suggest that more people than ever would like to experience it.” Brilliant! Heads-up thanks to Katherine Barbour of Wessex HIEC.
A US study has found that older people with hearing loss experience 30-40% greater cognitive decline over six years than their peers, bringing forward the onset of significant cognitive impairment by over three years. The connecting link seems to be social isolation… Hearing loss ‘linked to dementia’ GP Online item.
Just out on the 3ML website, a one-page document that answers questions TA readers have been asking about the 3ML Pathfinder sites, such as how they were selected, timescales, the procurement processes they will use, and how they will be evaluated. Pathfinders Update (PDF).
Press release from inHealthcare about a new addition to their range, the Watch BP Home A device which was developed by Microlife and measures blood pressure and pulse and, at the same time, detecting the abnormal rhythm which indicates atrial fibrillation (AF) – an abnormal rhythm that is responsible for 20 per cent of strokes, and significantly increases the risk of a stroke in the people that have it.
Editor Steve never posts links to items that he has not checked out…but here, for the very first time, are two. The first is an article by Prof. James Barlow. The second is a report by the Digital Policy Alliance. I anticipate that one will be interesting and one will be the ‘Same old, same old’. Am I right? Someone please read them and tell me!
First ever trial to measure how much longer people with dementia can live in their own homes with telecare (UK)
We missed the announcement by the Department of Health (DH) just before Christmas about the UK’s first ever trial (‘The ATTILA Trial’) to measure how much longer people with dementia can live safely and independently in their own homes when they are provided with a specialised telecare package. Kings College London and sites in London, Birmingham, Manchester, Newcastle, Oxford and Norwich will be involved in a £1.8m four-year randomised controlled trial, with publication expected in…2018. DH announcement. Trial details here and here. Heads-up thanks to Celia Price of JustChecking.
Following the recent announcement of their new partnership, a copy of a section of this month’s Saga Magazine courtesy of GrandCare’s blog reveals how Saga is working with GrandCare to develop a service for use by families in the UK: “We are currently piloting it in 20 or so homes and aim to have our system available in parts of the UK in the first quarter of this year and nationally by the summer.
“The UK version will have similar functionality to its American cousin, ie: a touch screen in your loved one’s home that allows them to:
- See messages, photos and videos that you, or anyone authorised by you, send them
- Make video calls (such as Skype)
- Use websites that you set up for them – at the touch of a single button
- See (and hear) medication reminders
- Take readings of things such as weight, blood pressure or glucose levels and share them with the appropriate people
“The system can also record movement around the home and send alerts – such as a text message to tell the carer on the receiving end that, say, a back door has been opened after 10pm.
“The system can be monitored using any device – a laptop, smart phone or iPad – so that family and carers can keep in touch wherever they are in the world.
“We envisage that the touch screen will cost the same as a basic PC – around £300-£400 – with a low monthly charge for the service.”
Appello asked delegates at the International Telecare and Telehealth Conference – and Twitter users following the event – to fill in the blank in the following question: “I believe what service users value most is…”. They created the video below to demonstrate their findings. It identifies that key words used by delegates were; ‘independence’, ‘reassurance’, ‘peace of mind’ and ‘convenience’.
Carl Atkey, head of Appello said: “We wanted to get real insight into how people in the telehealth and telecare industry think patients perceive telehealth. Words like ‘independence’ illustrate that telehealth and telecare can provide a real life-line to the people at the heart of the service, who often have no one else to rely on or who would like to have greater control over their long term condition. We want to obtain as many views as possible, so if you would like to tell us your opinion, tweet @talk2appello.”[This video is no longer available on this site but may be findable via an internet search]
It seems but yesterday that Telecare Aware readers were flagging up that the £3.2 million procurement by NHS North Yorkshire and York PCT (NYY) of Tunstall telehealth monitoring equipment (including ‘free’ implementation consultancy services but plus ongoing costs of £1.7m per year) looked too hasty, too large and too soon.
But no, it is over two years since NYY PCT responds to Telecare Aware item: The £3+ million telehealth spend that has achieved…what? was published.
So it gives editor Steve no pleasure at all to point you to the following article that appeared in the Yorkshire Post today: Telehealth revolution in tatters after snub by doctors. In short, the failure of the project to take off is causing the local Clinical Commissioning Groups (CCGs) that take over responsibility for it in April to question its future. The journalist dissects the issues so I shall leave it to him or her to do that for you.
However, if the CCGs do pull the plug on the project it will be interesting to see what happens with the taxpayers’ unused telehealth equipment that Tunstall has been paid for but not yet had to deliver. Does the contract entitle them to pocket the difference? Or perhaps one of the CCGs could take delivery of the remaining equipment and make it available to other Telehealth Pathfinder sites. One final question lingers… Where is Ernst & Young (Tunstall’s implementation consultancy subcontractors) [TA Jan 2012] and its reputed £1m fee in all this?*
* “For over two years now Ernst & Young have played a major part in deploying telehealth at scale in a number of NHS regions.” E&Y press release.
From one of our frequent commenters known as “Up North and to the Right’ or UNATTR:
Tonight at 19:30 GMT on the news programme BBC Inside Out South East:
One of the challenges facing the NHS is how to care for people with long-term illnesses such as diabetes, heart defects and chronic lung problems. These patients make up around 30% of patients yet account for 70% of the NHS’s costs.Telehealth is a new scheme where patients with long-term conditions monitor themselves at home using technology rather than going into hospital.
Kent is at the forefront of the scheme with around 800 patients using telehealth. But some doctors are not convinced, citing fears over increased GP workloads and concerns about whether patients will be able to use the computer technology. Others say the NHS reforms will also make it harder for telehealth to happen.
Inside Out asks whether the government’s plans to get more people onto telehealth are likely to succeed.
BBC Inside Out South East is broadcast on Monday, 21 January on BBC One at 19:30 GMT and nationwide (for readers in the UK) on the iPlayer for seven days thereafter.
For those who may need the most assistance with their health–older adults, those with chronic conditions who have less income and/or education–will the digital health and consumer engagement advances we chronicle, debate and generally huzzah about make any real difference in their health? We have generally assumed that health tech will level the playing field by being faster, cheaper, super-functional and generally cooler. This provocative essay debates the distinct possibility that digital health and the adoption of technology may further increase health disparities despite all this. Examples are the older, even affluent person, who has difficulty coordinating their care even non-digitally and is in a spider web of confusion; the less educated person for which ‘self-empowerment’ in healthcare doesn’t blip their phone screen, much less their mind. When you review the ideal state infographic by Misfit and the Digital Health Group and try to place people like this into it, you realize the buzzy talk of ‘convergence’ zips right by these needy folk like a Boeing 787 Dreamliner back to the hangar for a battery swap.
Of course, the writer also caveats his discussion by stating (Editor’s emphasis):
However, for innovations to significantly worsen disparities, they would have to both meaningfully improve health outcomes, and not be made available to people of lower economic status. Although the digital divide is real, access to digital tools is increasing for almost all levels of society. Payers may also eventually subsidize tools that have been shown to improve outcomes.
Hmmm…so it kinda doesn’t matter at this stage?
When Editor Donna thinks back to say, 2005, and the promise at that time on how telehealth and telecare were going to revolutionize health and independence for older adults, disabled people and those with chronic conditions, the alacrity with which much of digital health’s business model and development funding has shifted towards essentially healthy people measuring personal fitness and ‘quantified selfing’ away–analogous to what psychiatrists call ‘the worried well’–is perhaps economically sound, but disconcerting to those of us who entered the field wanting to do, let’s say, a little good. Can we pause for a moment, and consider this? Technology, Innovation, Disparities, and the Elderly (GeriTech, author Leslie Kernisan MD, a board-certified geriatrician) Hat tip to George Margelis, GM of Care Innovations Australia
The Shine activity tracker by Misfit Wearables has garned huge interest and support (Indiegogo oversubscribed in excess of $650,000) since its debut last year. The interesting part of this article is a more exact description of its Wi-Fi interface which requires direct contact with an iPhone or Android running the app to download data and presumably upload adjustments. It’s also made from aircraft aluminum, is small (about a small cookie, two quarters or two 50p coins) and provides blinking orange light feedback. It will be interesting if Sonny Vu and John Sculley grab onto the potential in the older adult home and community market–the latter requiring perhaps some different form factors and task diversification–or simply take the easy fitness buff/’quantified self’ money and run. Misfit Shine–a sleek, new activity tracker (SingularityHub.com)
Mobile health becomes very compelling to the consumer when it has to do with safety. This IEEE Spectrum interview (transcript/podcast) with Dr. Aydogan Ozcan of UCLA follows up on our recent coverage of the smartphone-linked iTube attachment for assaying potential harmful allergens in food, but also returns to the Ozcan microscope and its multitude of uses in developing countries. Both when fully developed have the great potential to reduce costs of medical testing equipment and speedier results. Information and reporting can also lead to safety. The New York City Police Department has also gotten on the app wagon with a free citizen crime information and reporting app for iPhone. You can look up statistics, most wanted and nearest precinct information–but another feature captures anonymous tips on crime. Editor Donna wonders if this technology could be sold to other major cities such as Newark NJ, Chicago, Sao Paulo and London, where crime rates are high, to engage the citizenry and further geo-map crime faster. Springwise.com A tip of the hat to Toni Bunting of TANN Ireland
This is the first of an occasional series on US law and intellectual property (IP) as it affects software and systems used in health technology. This article discusses the software developer’s rights to source code, licensing by the end user and the best ways both parties can protect themselves long-term in their transactions via software escrow.
Mark Grossman, JD, has nearly 30 years of experience in business law and began focusing his practice on technology over 20 years ago. He is an attorney with Tannenbaum Helpern Syracuse & Hirschtritt in New York City and has for ten years been listed in Best Lawyers in America. Mr. Grossman has been Special Counsel for the X-Prize Foundation and SME (subject matter expert) for Florida’s Internet Task Force. More information on Mr. Grossman here.
Source Code Escrow
It’s a nightmarish scenario. Let’s say that you’re the head of Information Technology (IT) for a hospital or a group of long-term care facilities. You pay a software development company $500,000 to create new software for your telehealth monitoring and alert system. It doesn’t matter whether the software runs locally on your servers, or in the cloud in a SaaS model. But then your developer goes bankrupt or for whatever reason and refuses to support the software. If you didn’t consider access to the source code in your agreement with the developer, you may find that you’re unemployed.
Essentially, “source code” is computer programming that humans can read. “Object code” is programming that only your computer can read. Typically, as a user, you only have access to the object code.
Software developers consider the source code to be their most valuable trade secret. With the source code, a competitor could create a competing work without incurring all of the development costs of the original developer. Source code is the lifeblood of the software development business.
From your perspective as the head of IT for that hospital or facility, you need the source code to continue the evolutionary development of your software or to fix bugs if your original developer disappears on you. If they can’t or won’t help, you’ll need to (more…)
The Surrey-based investment company Moonray Healthcare which bought Telehealth Solutions Limited (THSL) in early 2011 [TA item] has now acquired Wiltshire Medical Services (WMS) with the intention of bringing the two together. Press release: WMS and THSL come together to create new breed of telehealthcare provider.
Telehealth Solutions was founded in 2006 and, after a couple of years finding its feet, has since been making strong progress in the UK telehealth market. It is one of the few companies (other than Tunstall) that has benefited from the Government Procurement Service’s Framework Agreement. Wiltshire Medical Services’ core business has been to provide out-of-hours services to GPs but a while ago it extended its call centre operations into telecare monitoring. Moonray, which says it is into investment in this field to add long term value looks like it has made a smart move in arranging their marriage. Although the press release says “As part of the deal WMS will acquire Telehealth Solutions…” it is not yet clear which company will take the other’s name or whether a new brand will emerge, but a name containing something as local as ‘Wiltshire’ does not sound like a good bet.
For your weekend reading, this overview of 42 mHealth studies monitoring use by health professionals is accessible not only in full text, but also has multiple (downloadable) comparison charts and plenty of related reading. The findings will come as no surprise: current studies are limited, show only modest benefits, diagnosis based on mobile photos showed a reduction in diagnosis accuracy, SMS (text) appointment reminders show some benefit. High-quality trials measuring clinical outcomes are needed. The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis (PLOS Medicine) Hat tip to reader David Lee Scher, MD.