Telehealth Soapbox: Healthcare apps – welcome to the Piranha tank

Peter Kruger, owner of the Steinkrug consultancy and founder of Alphadaugters explores the dilemma that faces developers of health-related software. This item is re-published, with kind permission, from the Alphadaughter’s blog.
‘Information wants to be free’ so stated Stewart Brand, founder of the Whole Earth Catalog, back in 1984. Over the next two decades, thanks to the Internet and personal computers, a significant amount of the world’s imprisoned information was liberated. Now something similar is about to happen to healthcare: or at least the part of healthcare that is digital. This has been bought home graphically by the recent collapse of yet another online healthcare service: the sleep coach company Zeo.

It perhaps no coincidence that some healthcare IT companies are struggling just we see the release of a new generation of mobile technology. The Samsung Galaxy S4 has, as standard, a number of features mobile health companies previously had to build into their proprietary platforms. It will not be long before Samsung’s eye tracking feature appears in mhealth applications running on the Galaxy and other consumer mobile handsets. (Already Fujitsu has announced software that can check a person’s pulse rate through a tablet or smartphone camera.) Any company that has waited until their customers pressed for Apple and Android versions of their mhealth service has probably left it too late. And for those who have already ditched their proprietary platforms in favour of consumer mobile devices; (more…)

Wessex HIEC collaborate and ‘After Ruby’ telehealth and telecare education and training materials (UK)

We have reported previously on the development of support for people involved in telecare and telehealth in the south of England, via the Southampton University-based Wessex Health Innovation and Education Cluster (HIEC). They have now set up a system for online information sharing and collaboration part of which is a section for people interested in telehealth and telecare. Sign up in the top left hand corner. See also their videos recording the experiences of patients and their carers, here.
In addition, they have posted some videos from a recent training day run by Paul Rice and David Barrett who are marketing the training under the name ‘After Ruby’. Introduction and link to them here.

NHS funding – the bleak future

For anyone hoping to sell services to the NHS over the next decade, the content in this slideshow by Anita Charlesworth, Chief Economist of the Nuffield Trust is gloomy reading. Much as it is a pain using presentation software for this type of material, do pick your way through it. You might wish to have a strong drink to hand when you get to the ‘remaining gap’ on slide 9.

Anita Charlesworth: The Funding Outlook for Health Care Heads-up thanks, Roy Lilley’s newsletter.

Depression warning for heart failure patients

GP Online picks up on an American study (links to original) – the implication is that early identification of the onset of depression in people with heart failure could reduce a considerable number of early deaths. Depression warning for heart failure patients. Surely it shouldn’t be too difficult to get self-reported mood trends into electronic medical records and to flag up negative changes in a timely manner. It may be more cost effective than other forms of remote symptom monitoring…
UPDATE Tuesday 26 March: There may be a connection to social isolation – also associated with depression. Social isolation ‘increases death risk in older people’ BBC item.

‘Leading the charge in wireless health’–to where?

CNN’s visit to Quantified Selfing Land (though not said) is travelogued in a ‘What’s Next’ blog on innovation, with a piece on and by USC’s Center for Body Computing head Leslie Saxon, MD. What is so surprising to this Editor is that the video piece (note: may not be viewable from all countries)  is so theoretical and future-oriented. Even though real companies and tech are here–AliveCor’s always smart and dapper Dr. David Albert, Sonny Vu’s Misfit Shine, UnderArmour athletic wear, Zephyr–the glossy way it’s presented is that it’s ‘swell stuff that will transform the future.’ Have our ‘grizzled veteran’ readers heard this song before, let’s say about 2006?

What is more disturbing is how dismissive Dr. Saxon’s article is of evident skepticism and of her own colleagues who are, after all, going to be part of and help drive this change. She dismisses medicine as “working from a 2,000 year old paternalistic doctor-patient model” as if nothing has happened in the past few years. Oddly she juxtaposes a 2007 conference with last week’s Congressional hearings leading with “The reactions interested me because, in my experience, where there is anger, there is also fear and irrationality.” Aside from being an extreme and disparaging view of her colleagues’ (and users) motives (and perhaps some bad editing), it simply wasn’t there in the hearings. Based on reports extensively compiled here, it was exactly the opposite–acceptance. (more…)

Quantified Selfing: security and statistics

It was inevitable, but now there’s concern about your QS data’s security and hacking. With healthcare organizations having security breaches rather routinely (wander over to the Privacy Rights Clearinghouse), the Federal Government routinely fighting off ‘denial of service’ assaults and Facebook, Apple, Twitter and Dropbox joining the hacked club, how long will it be before a fitness or telehealth company is breached? Or hospitals/providers which use insecure messaging, Skype and data files? Or those 600-odd practice EHRs? From the article, Avi Rubin, the director of the Health and Medical Security Lab at Johns Hopkins University: “Any system that consists in large part of software is hackable. At some point, someone will hack a major repository of healthcare data. And it won’t be pretty.” World’s Health Data Patiently Awaits Inevitable Hack (Wired) Hat tip to David Albert, MD via Twitter

QSers also assume that tracking devices are accurate. What happens when it’s two different devices, different totals? Doesn’t matter much with pedometers, but blood glucose is a different matter. Scientific American takes on ‘informed interpretation’ of data and the sticky issue of whether a monitoring regime does more good than harm. Writer Hilda Bastian: “Human health isn’t about simple mechanics and tinkering with a few measurable levels….There is, though, potential for harm, including unnecessary and pointless anxiety. There’s value, too, in contemplating the meaning of where we’re going with this, and the consequences of adults focusing so much on our selves in this particular way.” “Every Breath You Take, Every Move You Make…” How Much Monitoring Is Too Much?  Hat tips to Carolyn Thomas, The Ethical Nag / Heart Sisters and TTA Soapboxer, and George Margelis, via Twitter.

Losing ground: Alzheimer’s as a leading cause of death

[grow_thumb image=”” thumb_width=”200″ /]This short bar chart (Change in Number of Deaths between 2000 and 2010) tells a story that your Editor did not realize. Alzheimer’s disease currently is the 6th leading cause of death in the United States overall–and where the opposite of progress has been made. Part of this could be better diagnosis, but in large part it is the aging population.

For those innovating health tech, there’s a big job to be done here: not a cure, but to support those with Alzheimer’s and vascular dementias in everyday quality of life (brain fitness, mental stimulation, activities of daily living/ADLs); to aid their caregivers in caring for them, as well as their own quality of life; and geriatric professionals in lengthening time at home and creating stimulating communities, not ‘memory care floors’. Not perhaps as fun as a fitness app, but potentially more rewarding and disruptive to the current distressing model. Graph courtesy of the Alzheimer’s Association (US)

The further adventures of the Ozcan cellphone microscope

Can your phone do this? (Armed With Science) discusses how the US Army Edgewood Chemical Biological Center (ECBC) is developing cellphone-based wide-field fluorescent imaging for pathogen detection in the field, but also mentions partnering with a team at UCLA as the developers of the clip-on microscope and a small firm called Holomic LLC for a second add-on for assay purposes. Both devices sounded familiar to this Editor, and it turns out that Dr. Ayodgan Ozcan is the common denominator–and head of the team–on both (Holomic is his spinoff commercialization company). The microscope is the LUCAS [covered since its debut in May 2010] and the assay is likely the iTube [TTA 13 Dec]. Interesting that the Army not only is pushing this forward, but also the partnership.

North Yorkshire: Cash-crisis NHS chiefs write off telehealth devices

The Yorkshire Post (YP) picks up on the writing-down of the capital cost of the North Yorkshire and York (NYY) telehealth devices, first publicly reported in Telehealth and Telecare Aware [The ongoing cost of the NYY telehealth project exposed] and links the matter to today’s WSD QALY announcement: YP item: Cash-crisis NHS chiefs write off telehealth devices.

It was interesting to note that in its recent press release Tunstall showcases latest innovations in telehealthcare that will shape the future of service delivery Tunstall omitted to cite NYY as an example of ‘successful telehealth programmes…with NHS Gloucestershire, Birmingham City Council, and as part of the TF3 Consortium in Northern Ireland”.

WSD QALY paper published – cost worse than expected (UK)

Since one of the Whole Systems Demonstrator (WSD) let drop at the King’s Fund conference last March that the telehealth Quality Adjusted Life Years (QALY) cost calculation was coming out at £80,000 the actual paper has been ‘eagerly’ awaited, with speculation and concern that the calculation included management and other study-related costs that would not apply in a normal service setting. The paper is published by the BMJ today and a) such costs were excluded and b) the QALY figure is actually £92,000. Well, that’s the headline figure that is already being headlined by Pulse but, of course, the calculations are more nuanced. Foe example:

Whether telehealth is considered to be cost effective will depend on the willingness to pay for the outcomes generated. Figure 1 presents the probability that telehealth would be seen as cost effective as an addition to usual care, using an acceptability curve for different values of willingness to pay. At the £30,000 threshold (associated with NICE recommendations), the probability of cost effectiveness was 11%. Figure 1 also shows the probability of cost effectiveness if costs related to project management were excluded: at the £30,000 threshold, the probability of cost effectiveness was 17%. Indeed, this probability including management costs only exceeded 50% at threshold values of willingness to pay above £90,000. Excluding project management costs, the probability exceeded 50% only at values above about £79,000.

The discussion is also worth reading carefully, as is the final conclusion:

A community based, telehealth intervention is unlikely to be cost effective, based on health and social care costs and outcomes after 12 months and the willingness to pay threshold of £30,000 per QALY recommended by NICE. A reduced cost of telehealth per QALY may be possible by combining the effects of equipment price reductions and increased working capacity of services; On the assumption of reduced equipment costs and increased working capacity, the probability that telehealth is cost effective would be about 61%, assuming a willingness to pay threshold of £30,000 per QALY.

BMJ paper: Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial BMJ 2013;346:f1035

Related items
Mike Clark’s Updated list of WSD results papers.
Interview with Professor Martin Knapp As “telehealth” grows, experts question cost benefits Reuters.
David Brindle, in The Guardian anticipated these results last month and, in a follow up article commented “Fourteen months on from its launch, 3millionlives seems to be going nowhere. Intuitively, telecare/telehealth feels like a key pillar of the future care system. To be that, however, it does need a credible evidence base.”
3millionlives press release: 3millionlives – enabling change to benefit patients and carers. (PDF)
GP Online Telehealth ‘not good use of NHS money’, finds DH-backed study.
NHS Choices Are benefits of telehealth care worth the cost?

Google Glass: a proper potential in healthcare

[grow_thumb image=”” thumb_width=”150″ /]The Gimlet Eye and your Editor have had a tête-à-tête and finally have agreed on something other than the oeuvré of Jean-Pierre Melville. The Eye remains In Revolt on Google Glass but barely…barely…concedes a proper, limited role in health. Overlooked in the overheated hullabaloo: for normal people, it can aid in actions like looking at food and counting nutritional values or ‘fullness’, sending and receiving information on fitness tracking, identifying pill bottles; for physicians, nurses and clinical staff, as an adjunct to telemedicine, visualizing monitoring on a patient and recording an exam or report. This Editor can also see potential in surgery, particularly the minimally invasive type which are camera and data-driven. This EHR Intelligence article is short and refreshingly hype-free. (But readers, rest assured that The Gimlet will continue to keep a restless eye on Mr. Brin and his devilish device’s developments.)

Clothing, watches and what’s under your skin

Three from GizMag:

[grow_thumb image=”” thumb_width=”125″ /]Health tracking may be finding an inexpensive home in your phone–but what about those clonky bracelets, clipons and pendants? Why not integrate sensors into wearables? The next generation is in development, as seen at the Wearable Technologies conference and the Innovation World Cup in Munich: Heapsylon Sensoria Fitness socks which not only tracks steps but also gait technique; the Fraunhofer Institute’s FitnessSHIRT from Germany; Kolon Heatex heat-generating fabric from South Korea; AiQ BioMan Fabric for a wide variety of monitoring from Taiwan and (my favorite) the T.Ware T.Jacket from Singapore that gives you a hug.

[grow_thumb image=”” thumb_width=”125″ /]Samsung may call the new S4 a ‘life companion’ but they are working on a Life Companion watch to match the Apple Watch rumored for end of 2013. But why this prototype looks clonky and not sleek…doesn’t incorporate Samsung’s bendable phone tech as debuted at CES….and compared to the rumored Apple Watch depicted in the article? Red herring? Samsung confirms it’s making a smart watch

[grow_thumb image=”” thumb_width=”125″ /]The heck with the clothing and watches, implant it! A blood-testing laboratory in a 14 mm long implant is being tested to measure up to five proteins and organic acids at once, such as lactate, glucose, or Adenosine triphosphate (ATP). It provides monitoring that serves to tailor oncology medications or chronic conditions. The signal is transmitted first to a patch then a phone or computer. Drawback is that at present it only lasts one month. Researched at the Ecole Polytechnique Fédérale de Lausanne (EPFL). Tiny, personal blood testing laboratory gets under your skin

Quantified Selfers keep on reinterpreting Pew

The Quantified Self has its own blog (dog bites man) and just cannot believe the recent Pew Internet Life study [TTA 29 Jan] that unsurprisingly revealed, despite the explosive takeup of smartphones in the US, that most trackers are still using their heads (49 percent) or paper tracking (34 percent). So the two QS writers question the questions, and how potential QSers may not define ‘self-tracking’ as ‘fit(ting) neatly into health’. However, survey leader Suzannah Fox of Pew details the screener and specific questions–and being plain and straightforward, there’s not much wiggle room. How people interpret ‘tracking’ may be where the problem is–that long-term, over time tracking is a quite different pursuit than getting an immediate reading (e.g. blood glucose) to make a quick decision on what to eat and dose. (see Rajiv Mehta’s comment) The state of self-tracking

Updated 25 March   Related: Laurie Orlov on Pew induces chest pains in the body of the health tech market and the low single digits of app participation over age 50. (Reinterpret this: 3% of those aged 50-64 and 1% of those aged 65+.)

FDA regulating medical apps–or not? The Hearings. (US)

Much coverage of this past Tuesday-Thursday’s US House of Representatives Energy and Commerce Committee hearings on how the Food and Drug Administration (FDA) should be regulating developing mobile health technologies.  Some key issues are if the 2.3 percent Obamacare medical device tax will apply to apps (after chilling development on surgical devices–see day 1 hearings), whether FDA will ever get around to publishing a final guidance (end of year), will FDA consider smartphones medical devices (no) and if FDA should share some of the responsibility with–or give it over entirely to–the Office of the National Coordinator for Health Information (ONC) under Health and Human Services (HHS). Can FDA even keep up at this stage? (it takes them about three months on average review) and How much will regulation add to the price? are major questions. The representatives have heard from numerous leaders in the field: Tuesday, Happtique’s CEO Ben Chodor and the mHealth Regulatory Coalition’s Bradley Merrill Thompson; Wednesday, West Wireless Institute’s chief medical officer Joseph Smith; Thursday, Dr. Farzad Mostashari, National Coordinator, Health Information Technology, HHS and Ms. Christy Foreman of FDA. Mobihealthnews’ Brian Dolan live blogged from the hearings; there are also testimony statements. From these reports, the hearings have decided exactly nothing and revealed little about FDA’s inaction, but at least the issues have received some fresh air from those in the industry.

An overview of the articles/blogs to date.  Updated 23 March  (more…)

Telehealth Soapbox: A random walk through privacy, “the right to be forgotten” and health tech

[grow_thumb image=”” thumb_width=”100″ /]Google Never Forgets, How Drones=Flying Smartphones and the Big Stick of Corporate Wellness.

Privacy. Intrusiveness…two of the key hot buttons in reactions on The Gimlet Eye’s latest sally-ho on Google Glass. While Google has been able to settle with 38 US states on Google Street View’s’ ‘Wi-Spy’ on illegally acquiring unencrypted personal data, including health data, for a bag-of-shells price of $7.3 million (iHealthBeat), the beat goes on in Europe. Spain’s data protection authority and Google are slugging it out in the European Court of Justice after Google lost in the Audiencia Nacional on whether Spanish or California (Google HQ) law regulates the continued distribution of potentially embarrassing, but long past, information. According to

The case could determine the scope of a draft EU law intended to strengthen citizens’ privacy. Rules proposed by the European Commission in 2012 and being debated by the European Parliament would give people “the right to be forgotten” – to have personal data deleted – in particular from the web.

[grow_thumb image=”” thumb_width=”150″ /]And while Glass gives the ground view, how about Dem Drones? Are they not, after all, just smartphones with wings? They take pictures, track locations and…spy. (more…)

Products and advice for personal safety and independent living on show in West Midlands (UK)

25 March – 6 April, The Mall, Sutton Coldfield
Products will be on show in The Mall throughout the week, together with workshops demonstrating how adopting and using simple devices and gadgets can have a profound effect upon improving the lives of people living alone or requiring increasing support in particular. The Gadget Hub, as it will be known, has been inspired by Richard Haynes of The Community Gateway and is being delivered in partnership with Our Place Community Hub. Volunteers are being recruited to oversee the project and funding is being sought to support its progression into a successful retail business. It is hoped that Gadget Hub (which has been selected for the finals of the Mall’s Retail Factor competition) will become a regular presence in The Mall. Press release (PDF) for details.