10th Anniversary Article 2: The Decade that Laid the Foundations for Connected Care?

December 9, 2015 | by

This year, on the 10th Anniversary of Telehealth and Telecare Aware, we invited industry leaders to reflect on the past ten years and, if they wish, to speculate about the next ten. We are pleased to publish the following item from Steve Sadler, who has been Chief Technology Officer for the Tunstall Group since 1996.

My reflections on the last decade describe a laying of the foundations for ‘connected care’.

The decade has seen continued and huge pressures on health, care and housing, driven by our living longer and with increasing prevalence of long-term conditions.

We have also seen major disruptions to economies worldwide, affecting their ability to continue funding traditional models of care. The resulting public sector budget constraints are daunting, pushing us to explore technology-enabled transformation of services.

At the same time we are experiencing helpful developments in technology, prompting questions as to how we can do more with IP-connectivity, health apps, internet of things, cloud and big data analytics, to help us to shape solutions that bridge the gap between our needs and our resources.

An Exciting Beginning: So what was so special about the last 10 years? (more…)

More Federal expansion of telehealth coverage proposed in Senate (US)

December 9, 2015 | by

The Telehealth Innovation and Improvement Act (Senate Bill 2343), a bipartisan bill to expand Medicare coverage of rural telehealth, was proposed last week by Senators Cory Gardner of Colorado and Gary Peters of Michigan. It would authorize Health and Human Services (HHS) to test new telehealth programs through the Center for Medicare and Medicaid Innovation. CMMI would then evaluate new telehealth models on cost, effectiveness and care improvement. Senator Gardner’s intent is to permanently expand rural telehealth. The bill has moved to the Finance committee. Another Senate bill may be proposed before the holiday break by Hawaii Senator Brian Schatz to integrate telemedicine technology into alternative payment programs including Medicaid Advantage, a service of great utility in his state where 70 percent of the population is on one island, Oahu,  and about 30 percent is scattered over four other islands. iHealthBeat, mHealthIntelligence.

Xcertia takes another pass at app certification, but will it fly? (US)

December 6, 2015 | by | 1 Comment

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/alp-mountains-peaks-in-winter.jpg” thumb_width=”150″ /]An app developer and a healthcare/digital health innovation lab get into the certification game. Can they fly over the treacherous peaks this time? Social Wellth made good on their promise (or threat?) to get into the app vetting business this past week through announcing a partnership with Columbia University-based HITLAB at the HITLAB Summit this week to develop a certification organization known as Xcertia. Last year, Social Wellth acquired the remains of Happtique from GNYHA Ventures [TTA 12 Dec 14]. The Xcertia principles center around privacy, security, operability and content–as Happtique’s did. The intent is to not only develop a program to certify apps based on established standards, but also form a Signature Steering Committee to ensure they maintain “their definitive set of criteria for evaluating mobile health apps.” MedCityNews, release

Possible conflict of interest. It all sounds positive, but the head of Xcertia, David Vinson, is also the CEO of Social Wellth, which despite its nonprofit-ish name makes its living by developing consumer apps and “dashboards” for insurance companies, a task grandly called (from their press release) “the curation of digital health experiences by leveraging mobile health technologies that allow for integration and aggregation of all digital assets.” Social Wellth also makes quite a bit of hay on its website about app curation for its clients. (more…)

Drone ‘bots’ to help older adults in future

December 5, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/08ELDERBOT1-master675.jpg” thumb_width=”150″ /]A Saturday Robot Fix! Short article in yesterday’s NY Times about development of tiny household drones to fetch medications and do other simple tasks around the house (like cleaning). These ‘Bibiddi Bobbidi Bots’ are under development at the University of Illinois. This Editor will take several to go clean. But do they do laundry? I’d rather take the new iteration of a 4′ Robby the Robot under development in Seattle by an ex-Microsofter who founded Hoaloha Robotics. Practical? Perhaps not, says Laurie Orlov of Age in Place Technology, who’s been up and down a few hype curves. And will it help older people stay connected, even though help around the house is always appreciated? The withering comment on the Jibo robot from a 91 year old at the end of the article does put a damper on it. Still, Robby could make me a dress of sapphires any old time (as did his namesake in Forbidden Planet). As Aging Population Grows, So Do Robotic Health Aides 

Hospitals should ‘wash their hands’ of older medical devices, OS: expert

December 5, 2015 | by

Our Readers are likely well aware that older medical devices may present a Hacker’s Holiday, but putting a very fine point on it was Kevin Fu, associate professor of electrical engineering and computer science at University of Michigan, speaking at a Healthcare IT News healthcare cybersecurity forum this week in Boston. Mr Fu pointed out that many hospitals are actively using old devices and old PC systems; one local hospital had 600 supposedly unpatched Windows XP (!) boxes deployed. Older medical devices were not designed with security in mind, which he likens to basic sanitation:

“If you’re using this old software, these old operating systems, you’re vulnerable to all that malware – that garden-variety malware – that has been out in the wild for more than 10 years.” and “This is not rocket science; this is basic hygiene. This is forgetting to wash your hands before going into the operating room. Here we have medical devices where, if malware gets through the perimeter, there is very little defense.”

The press has been concentrating on the big breaches and external hacking (they do make good copy–Ed.), and we’ve expended a lot of air on things like the EHR Wars, but the real threats are more mundane, as Ponemon and others in the field have warned for years. Software updates and infected USB flash drives can spread malware. A vendor can be a regular Typhoid Mary unintentionally corrupting systems and devices down the line.  (more…)

FDA Workshop: Collaborative Approaches to Medical Device Cybersecurity

December 5, 2015 | by

20-21 January 2016, FDA White Oak Campus, Silver Spring Maryland

Attend this free and public two-day workshop hosted by FDA on cybersecurity and medical devices highlighting “past collaborative efforts, increase awareness of existing maturity models (i.e. frameworks leveraged for benchmarking an organization’s processes) which are used to evaluate cybersecurity status, standards, and tools in development, and to engage the multi-stakeholder community in focused discussions on unresolved gaps and challenges that have hampered progress in advancing medical device cybersecurity.” Registration required (information and form here), but there is also a webcast (link available after 13 Jan) if you cannot make it to FDA.

Telecare innovator Lively acquired by GreatCall (updated)

December 5, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/Lively-sensors-600×327.png” thumb_width=”150″ /]GreatCall, which markets the popular Jitterbug simple phones and ancillary safety/security services (5 Star, mPERS) targeted to older adults, has acquired the assets of home activity personal monitoring system Lively. According to GreatCall’s press release, Lively’s technologies will be integrated into GreatCall products. These include a tastefully designed brace of self-installed in-home motion sensors, which made quite a splash when introduced in 2012, and a fairly stylish mPERS watch introduced last year. From the announcement, it’s easy to deduce that Lively was largely inactive despite partnerships led by Care Innovations: the press release on both Lively and GreatCall’s site was issued from GreatCall only and not joint contact; Lively’s last round of funding was in 2013 (only $7.3 million total, another Series A to B casualty) and there are no Lively employees transitioning to GreatCall for the good reason that there are none left (Mobihealthnews). No word on founder Iggy Fanlo’s next plans save a squib on LinkedIn saying that hardware was hard and his next move would likely be in software. With last year’s sale of AFrame Digital (with no further word from the purchaser) and BeClose now Alarm.com Wellness (not a surprise as it was built on an Alarm.com platform), as we close the year it is further confirmation that it is No Country for Small Players in digital health. Photo: Lively.

Update: Tart take from seasoned Aging Tech business observer Laurie Orlov on Lively’s rise and fall, with additional history. Her POV is that as attractive as Lively’s concept was, its business strategy should give pause to the Silicon Valley investor and entrepreneur crowd thinking this is just another kind of direct-to-consumer hardware-service sell, the long payout of any tech in this field and the opposed short time frame of VCs. It’s also not like there haven’t been a few predecessors fallen on the field, either. Aging in place tech firm Lively is out of business – what can we learn?

Big home health win for telehealth confirms trend: must expand services, analytics

December 5, 2015 | by

One of the most logical places for telehealth, remote care management (RCM) and transitional/chronic condition management (TCM/CCM) is with home health providers and post-acute care, yet perennially it has been on the ‘maybe next year’ list for most telehealth providers. That ‘next year’ may be getting a little closer with the news that Intel-GE Care Innovations has inked a multi-year deal (no pilot-itis here) with major (~400 facilities) home health provider Amedisys using their PC/tablet-based Health Harmony platform.

The initial focus is an ambitious one: reducing hospitalizations and ER/ED visits among patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, depression as well as patients who have two or more of these conditions (co-morbidities). The most interesting to this Editor is the parenthetical mention of analyzing ADLs (activities of daily living) with clinical data. Does this imply the engagement of their venerable ADL monitor QuietCare? (It’s something the founding company worked on circa 2006 while this Editor was there; one would think the analytics have advanced since then.) Another aspect is that Care Innovations will manage Amedisys’ complete RCM program from recruiting to logistics, data analytics and application integration services. Business Wire

What this means: Telehealth (and telecare) companies are now increasingly obliged in these big wins to provide a plethora of additional related services. Health care providers demand services beyond the monitoring technology. They want the turnkey package, from nurse evaluations, care coordination/management, to analytics and logistics.This ‘service creep’ implies alliances and mergers to add on to technological monitoring capabilities–and beaucoup financing. (more…)

Flo and ANNIE: text messaging with a personality to improve health (UK/US)

December 2, 2015 | by

Flo–the Florence Simple Telehealth text messaging system–is well known to our UK Readers as a successful initiative of the NHS. Over the past five years, starting from a test with NHS Stoke on Trent, it has been used by more than 30,000 people in over 70 health and social care organizations to help them monitor their health in areas as diverse as managing diabetes, living with COPD and managing breast feeding. Flo is customized by the clinician for the individual patient on questions, information, and speaks to the patient with a sometimes sassy ‘voice’ to help keep him or her on track. The Health Foundation has spotlighted Flo (named after Florence Nightingale) in ‘The Power of People’ with an overview page here and the video ‘Telehealth with a human touch’.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/1109151630.jpg” thumb_width=”150″ /]nhssimple, a Social Enterprise is now tasked with developing the Flo program and since 2013 has partnered with the Veterans Health Administration in the US to develop a counterpart. Named ANNIE after Lt. Annie G. Fox, Army Nurse Corps, who was the first woman awarded the Purple Heart for her actions at Pearl Harbor, the VA is shortly testing it at four sites with intent to roll out nationally in 2016. This Editor has seen two presentations by Neil Evans, co-director of VHA connected health, in 2014 and this year at mHealth Summit (HIMSS Connected Health–see left). The Health Foundation video also includes an interview with Dr Wyatt Smith, prior Deputy CIO of the US Military Health System, and mentions the VHA. Hat tip to Phil O’Connell, Global Lead of nhssimple, for the update.

Docs tickling the computer keys a turnoff to patients: JAMA

December 2, 2015 | by | 5 Comments

Health tech as perceptual barrier. A study published Monday in JAMA Internal Medicine-Online First (limited content) found that patients were noticeably less satisfied their care when the physician used the computer (e.g. EHR) during the appointment. According to Reuters, only half of the 25 visits with high computer use were rated as “excellent care” by the patients, compared to more than 80 percent of the 19 encounters with low computer use. iHealthBeat cited that physicians who spent more time on the screen:

  • Spent less time making eye contact with patients
  • Tended to do more “negative rapport building,” such as correcting patients about their medical history or drugs taken in the past based on information in their EHR.

The researchers (primarily from the University of California–San Francisco) used data from two years of visits by 47 patients to 39 doctors at a public hospital. The patients had Type 2 diabetes, rheumatoid arthritis or congestive heart failure, with some having multiple chronic conditions. What is downplayed is that the patients were considered ‘safety net’ patients with communication barriers–limited health literacy and often limited English (primary Spanish speakers). But even this special population may be pointing to an overall problem (more…)

Medstartr Momentum 2015: did you miss it? (Video)

December 2, 2015 | by

Let’s go to the video. Monday’s Medstartr Momentum/Health 2.0 NYC event was a Broadway Showstopper at Microsoft’s NYC Tech Center. Now available is a (so far) uncut video on medstartr.tv (scroll down to 11/30). There’s no play/skip bar on this, only a pause, so you may want to investigate a linked Health 2.0 NYC Livestream video page which has segmented the sessions and these have a play/skip bar.

Speakers included Susannah Fox, the CTO of HHS as well as 24 panelists, and 5 Momentum Talks representing Patients (Regina Holliday) Providers (Cheryl Pegus, NYU), Partners (Amy Cueva, MAD*POW), Institutions (Wen Dombrowski, MD, Northwell), and investors (Peter Frishauf.) There were four pitch sessions through the day featuring early-stage companies organized around Wearable Health Tech, Hospitals 2.0 and Pharma Tech 2.0. Hat tip to founder Alex Fair, his team, Steve Greene and the 15 sponsors who made it happen. TTA is a long-time media sponsor of Health 2.0 NYC.

2016: will telehealth catch on or stagnate, due to factors out of control?

November 25, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/Robert-Graham-Center-logo.jpg” thumb_width=”150″ /]Updated. Reviewing the Robert Graham Center study summarized by Editor Chrys last week, René Quashie of Epstein Becker Green, perhaps the leading law firm in the health tech area, opines that despite the great progress made by telehealth (telemedicine/virtual consults, but also remote patient monitoring), “state legal and regulatory issues, reimbursement, and provider training and education continue to be serious barriers to wider adoption of telehealth. And until the landscape evolves to address these barriers, telehealth adoption is likely to stagnate despite the great promise of telehealth holds as a tool to improve quality and access.” Yes, that old FBQ* (actually the top two) continues to be as true now as five years ago. While in closing Mr Quashie puts his trust in the ‘pull’ factor of consumers and patients “who will continue to demand better access and more innovative delivery models outside the conventional office visit,” this Editor is far less sanguine, despite having used a virtual consult app recently. It was turned to more out of sheer frustration–time pressure (work, travel), being unable to secure a timely visit with a specialist (no one seems to be taking new patients!) despite good (non-Obamacare) medical coverage, and a condition which was eminently photographable (plus $40 at hand). National Law Review  * The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.

Then again, if you read Health Populi and believe Gallup’s polling (based on a slightly skewed question), a majority of Americans aren’t thinking about delivery models or telehealth at all. They’re unhappy, and would like to hand the whole hot mess over to the government when asked if “government is responsible for ensuring that people have health insurance.” Yet the Affordable Care Act, now two years in, was supposed to do exactly that by forcing everyone to pay for a healthcare policy or else pay a punitive tax. Too many did the math; the tax penalty was cheaper, especially for those Young ‘n’ Healthy Invincibles with slim purses and other things to spend on. They were the ones who were expected to pony up premiums, use few services and generally prop up the system.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/shockedshocked.jpg” thumb_width=”150″ /]Now the American populace are shocked, shocked to find that out-of-pocket costs are way up and access is down. The same Health Populi article cites Fair Health’s spring 2015 consumer survey, finding that 33 percent of American patients felt that their out-of-pocket costs were ‘much more than expected’, with an additional 17 percent in the ‘somewhat’ category–a total of 50 percent. The contradiction of government control versus spending (and actuarial) reality is, in this Editor’s opinion, not going to be solved easily or well.

As to the wisdom of government involvement, there’s another developing and embarrassing ACA Big Fail.  (more…)

A StartUp Finnish for health

November 25, 2015 | by

StartUp Health expands to Finland in partnering with Finpro’s Team Finland Health. The initial StartUp Health Finland class will be five Finnish health tech startups that will be invited into the StartUp Health Academy in Helsinki, and be provided with entrepreneurial coaching and advisory services. The overall objective is to bridge the gap that Finnish companies experience to ongoing global access to investors, expertise and commercialization opportunities. Finpro is Finland´s Trade and Investment Promotion Agency. Release

‘All-in-one’ SensoSCAN medical sensor launches at HIMSS CHC

November 25, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/1110151347a.jpg” thumb_width=”150″ /]And it’s not Scanadu. Scanadu may be the ‘tricorder’ of the future, but telehealth companies are looking for a here-and-now medical monitoring device that can take the place of multiple health monitors and provide clinically accurate readings. This Editor noted Swiss-American company SensoGRAM‘s press release at last year’s mHealth Summit, but this year, in a large booth near the front of the now HIMSS Connected Health Conference expo floor, they were demonstrating production versions of SensoSCAN. The fingertip sensor, similar to a pulse oximeter, measures blood pressure, respiration rate, heart rate, and O2 saturation, plus activity levels and fall detection, and sends the information to your smartphone via app. It is being sold DTC on their website ‘for informational purposes only’ for $349.99. According to chief administrative officer Lisa D’Auria (her hand at left), they are also in clinical trials for FDA 510(k) clearance, hoping to have within less than a year, and are in progress with CE Marking. Unusually, it is manufactured in the US. Release.

Care Innovations partners with caregiver mental health app Happify

November 25, 2015 | by

Intel-GE Care Innovations announced yesterday a partnership with NYC-based Happify to integrate their mental health for caregivers app into Health Harmony by 1st Quarter 2016. Happify is a game-based app targeted to caregivers of the chronically ill to support their mental health and wellbeing through cognitive behavioral therapy, ‘positive psychology’ and conquering negative thinking. Currently it is marketed to healthcare providers and corporate wellness programs. According to the release, “By adding on access to Happify’s innovative mobile app, Care Innovations will be able to leverage state-of-the-art programs to improve the well-being of family caregivers and offer additional programs to its clients.” This is certainly an interesting integration to the typical vital signs and qualitative information gathering of patient data in thinking about the caregiver. However, we note that a previously announced partnership, with UK’s buddi announced last December, is not to be found on the CI website. Release (Business Wire)

Turn down the noise! Is it possible in a hospital?

November 25, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/sleep.jpg” thumb_width=”150″ /]Try texting and more. One of the more unfairly overlooked mHealth tools is text or SMS. While simple, the back end and integration can be complex, especially when integrated within healthcare IT systems.

In the US, one of the key metrics that hospitals are rated on in their HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems) is quietness of the hospital environment. Hospital noise is more than annoying–it is at a level that blocks healing and deprives patients of needed sleep (see study). There are door slams, people walking and talking, TVs and incessant boops and beeps from equipment. This annual survey told Inspira Health Network, a three-location hospital system in southern New Jersey, that they had a noise pollution problem.

One noise IHN hospital management could control was overhead pages–over 150 daily at their Vineland hospital. In a Quiet Hospital initiative, they replaced the overhead page system largely with a secure texting system developed by Newark, NJ-based Practice Unite, implemented by their reseller, Futura Mobility and consultant Pursuit Healthcare Advisors. Texts now go from nurses to physician smartphones, reducing overhead pages to perhaps two emergency ones daily. Scores for quietness satisfaction have improved drastically: at the Elmer hospital from 60 to nearly 100 percent, Woodbury from 45 to 56 percent, and Vineland from 55 to 62 percent.

Where the interesting integration–and workload reduction–happens is that those nurses can also make a stat consult request to a physician via Inspira’s EHR which is then sent to the physician’s phone. It also leaves an audit trail so that completion can be tracked. Lab results also can be sent to the EHR or phone, depending on physician preference, and patient round lists to residents’ phones. According to Healthcare IT News, these features have been adopted by affiliated medical practices; it has improved response times, patient consults and EHR updates, plus reduced patient stays. Health Data Management, HIT Consultant (Photo Cambridge Sound Management from their article on sound masking in hospitals.)