The Commonwealth Fund‘s just-published study on mHealth usage in a national sample of urban and rural community health centers and clinics (in US termed ‘safety net providers’ for low-income and uninsured) indicates the potential of mobile health for patient engagement in care, but yet to be achieved. Their patient population has high levels of mobile phone adoption, including text and internet. About 27 percent of the 181 providers who participated currently use mHealth in care delivery, but in basic applications such as appointment reminders. The potential observed is in chronic disease management support, health education and specific programs such as smoking cessation, weight management and medication adherence. Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics Also FierceMobileHealthcare.
Undermining the system an unintended consequence of telemedicine?
Telemedicine’s doctor-patient virtual consults may undermine the healthcare system, if Mass General neurologist Dr Lee Schwamm is to be believed from his comments at last week’s iHT2 Health IT Summit in Boston. Urgent care delivered by telemedicine not only commits the mortal sin of siloing data, not ‘doing an adequate job’ of passing to the primary care physician, but attracts dissatisfied doctors who want to set their own hours. And the cardinal sin: telemedicine attracts wealthier patients, paying cash, who by using these services are “…pulling dollars out of the healthcare system that are desperately needed to care for poorer patients.”
Quite a leap of logic here, when his real concern should be quick availability of patient care–not having to wait hours in a doctor’s office or ER/ED because you’re triaged as not bleeding-on-the-floor urgent. Virtual consult rates at least for now also tend to be low–$40-45 per visit–and appealing to those without insurance, not seeing a doctor on a regular basis (no chronic conditions) or anyone with a high deductible. Doctors are still also free, despite Dr Schwamm’s snark, to better utilize their time–and yes, make additional income–through signing on to telemedicine as part of their practice. So is this a lash back on a factor that’s undermining the establishment which Dr Schwamm is part of? Perhaps Dr Schwamm can explain? Stephanie Baum takes a puzzled view over at MedCityNews.
The dilemma of design for older people
Is the best design for older people and the disabled not specifically designed for them, but an adaptation of basic good design? Laurie Orlov in one of her apt Aging In Place Technology Watch articles questions the market viability of all those specially designed products we’ve seen since, say 2008. We recall ‘smart homes’, senior desktop computers, simplified phones and the robot caregivers which never seem to get past the prototype stage [TTA 25 July 14]. Her POV is that in most cases ‘designing for all ages is feasible today’ except for healthcare–durable medical equipment (DME) and healthcare delivery (and,this Editor would add, monitoring). One of her commenters points out that not everything can be designed ‘universally’, linking to this excellent article from Smashing on guidelines for designing tech to be used by those over 50. The section on blue color perception was especially interesting, as blue is healthcare’s #1 color. I would also point out that design which avoids stigma (as in ‘it screams OLD’) and has good aesthetics also wins.
Is AARP admitting that ‘tech designed for seniors’ is not a winning notion, as this May’s Life@50+ National Event in Miami is likely the last national event they sponsor? And it would be interesting to go back to the previous ‘Live Pitches’ to see how they are doing. Ms Orlov profiles this year’s five.
Call for presentation proposals: mHealth Summit (US)
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/05/mHealth2014_logo4c_FINAL-thumb.jpg” thumb_width=”150″ /]You have till 8 June to submit a proposal for a presentation at one of the largest digital health conferences in the US, the mHealth Summit (which is same place–near Washington D.C.–but a month earlier than usual–8-11 November). This year’s theme is “Anytime, Anywhere: Engaging Providers and Patients” and centered around one of five topics: clinical care, technology, patients and consumers, research, policy or business. The co-located Global mHealth Forum has a separate submittal process. Information and submittal link. Telehealth & Telecare Aware has been a media partner of the mHealth Summit US since 2010 and the 2015 Global mHealth App Developer Economics Study presented earlier this month at mHealth Summit Europe in Riga.
‘Internet Plus’ nurturing China’s nascent digital health market
Back in April this Editor was surprised by the interest Chinese investment companies had in Scanadu–and vice versa. Two of the three, Tencent Holdings and Fosun International, led the $35 million Series B round. Scanadu in return reportedly is developing products primarily for the China market, such as a urine analyzer.
Somewhat surprising, but it should not be, is the extent that private money tacks to the winds of official Chinese government policy. Ecns.com, the online site of the state China News Service, reports that part of the government ‘Internet Plus’ initiative will be targeted to the health and social care needs of 212 million people over 60 in China–a surprising 15.5 percent of the population. The civil affairs vice-minister has publicly advocated the use of the Internet, cloud computing and big data to transform care for the aged. Oddly, this also includes the development of ‘e-commerce’ for seniors.The language is also interesting and very careful–“The country’s population also features a large number of elderly people who are disabled and who are faced with empty nests and poverty” and a similar to the West shortage of carers. (more…)
Aetna may ‘buy into’ more analytics, digital health
Rumors now mainstreamed into press surround Aetna’s apparent interest in fellow insurers Humana and Cigna. Forbes last Friday started the ball rolling with an article last Friday focusing on the main event driving insurance payer consolidation: the transition of Medicare from fee-for-service to value-based bundled payments and accountable care organization (ACO) models. Humana has substantial Medicare business and a foot in home care (SeniorBridge), but has innovated in digital health: partnerships (Healthsense, TTA 20 Dec 13), purchases (what remained of Healthrageous, TTA 16 Oct 13), employee wellness (Vitality) and app development. Cigna is a major insurer with corporate business, but has struggled a bit in the digital health arena with the flashy-but-flopped patient engagement platform GoYou. It’s piloted telehealth to reduce readmissions with Care Innovations [TTA 7 Oct 14] and Coach by Cigna, a mobile health platform in conjunction with Samsung for the Galaxy S5 and S6 phones.
Aetna has had some success with working with ACOs, with 62 contracts covering about 1 million lives, but this Editor counts over 400 practice-based ACOs in the Medicare Shared Savings incentive program alone. Their experiment in consumer app aggregation, CarePass, came to a quiet end last August and Healthagen, their ’emerging businesses’ unit, has had some swerves in rationale including iTriage and even ActiveHealth Management, their long-time population health analytics arm. While digital health is part of it (see Mobihealthnews), (more…)
Do startups truly threaten the ‘healthcare establishment’?
Or are successful startups fitting into their game? Chris Seper in MedCityNews paints the picture of one side of a quandary. The ‘healthcare establishment’ fundamentally and to its detriment does not understand and is threatened by the startup and innovation process. A startup may begin with an idea which is, in his words, ‘almost always flawed, sometimes deeply’. If the founders are smart, they will test their ideas, validate them and change them appropriately. If not, they will fail. But it is easier for the Establishment to point at the most egregious of the bad ideas and use them to rationalize the status quo.
But being congenital contrarians, we paint the house on the other side of the street. Has the Establishment caught up with–or in some cases, co-opted startups, making them and their funders ‘do their diligence’ and be more cautious before emerging? This Editor would argue yes, and largely for the better.
**The ‘Wild West’ days are over. A few years ago, a truly bad or deeply flawed health tech idea or could easily find funding, because it was all blank slate, new and ‘transformative’.The sexiest hooks were Quantified Self, sleep, employer health incentives, interactive coaching, genomics, app prescribing and (last) wearables. A lot of founders imagined themselves as the Steve Jobs of Healthcare, down to the black turtleneck. Now there is a history of success and failure. The railroads reached the dusty frontier towns.
**There’s now a ‘Startup Establishment’. National accelerators (more…)
Indian Health adopting telemedicine in Southern California for diabetes treatment
Tribal-owned Riverside-San Bernardino County Indian Health, which serves nine tribes through seven health centers in the ‘Inland Empire’ of California, is adopting telemedicine to reach Native American patients and reduce their rate of diabetes. According to an Indian Health spokesperson, Native Americans constitute the largest diabetic population in the world and are 177 percent more likely to die from the disease. In San Bernardino County alone, 13 percent of adults are diabetic, and nearly 80 percent are overweight or obese. The initial program brought endocrinologists serving other Western tribes in on video consults with doctors in Indian Health clinics. Later rollout of the program will include pulmonology, cardiology, gerontology and dermatology. The market potential for telehealth remote patient monitoring–better information and analytics for clinicians, self-monitoring training and education for patients–could be substantial here for companies willing to invest time, learning and to build relationships. California Healthline. FierceHealth IT
UK, Nordics lead best EU countries for mHealth business: survey
Respondents to research2guidance’s fifth annual mHealth Economics survey rated UK and the Nordic countries the best for mHealth market success, based on factors of market readiness and maturity including doctors and consumers. Other top countries were Sweden, the Netherlands, Denmark and Finland. Germany and France were significant because of market size and investment in healthcare. According to the survey where over 5,000 healthcare app publishers and health professionals ranked countries on multiple points, “In UK, Sweden, Denmark and Netherlands doctor’s acceptance of apps and high level of digitalization are seen as main drivers. Germany is attractive mainly because of its substantial market size and its big number of potential users.”[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/05/EU-segments.png” thumb_width=”400″ /]
Findings were presented this week at the mHealth Summit in Riga, Latvia and is the first part of a larger study on developer economics and future healthcare delivery. As a media partner, TTA participated starting in March in inviting respondents to the survey. A free download of the report is available to our readers here (minimal registration required). Release.
Really big data analytics enlisted to fight soldier suicide (US)
Suicides by US active duty soldiers have more than doubled since 2001, according to a January Pentagon report, and current prevention programs have not been that effective in reducing the over 200 reported suicides per year. Enter a huge database program called STARRS–Army Study to Assess Risk and Resilience in Service–to identify risk factors for soldiers’ mental health. The US Army not only likes acronyms, but also never does anything small–a five-year, $65 million program analyzing 1.1 billion data records from 1.6 million soldiers drawn from 39 Army and Defense Department databases. Researchers are looking at tens of thousands of neuro-cognitive assessments, 43,000 blood samples, more than 100,000 surveys, hospital records, criminal records, previous risk studies, family and job histories plus combat logs. The study, also using resources from the National Institute of Mental Health, the University of Michigan and other educational institutions, will conclude this June–and researchers are now wrestling with the privacy and moral consequences of responsibly using this data for health and in leadership. NextGov
Nano nano nano: DNA sequencers in toothbrush, phone analyze, match genetic markers
Oxford Nanopore in the UK has developed microchip sequencers that read and encode DNA by passing it through a gap in the microchip some 1.5 nanometres across – 80,000 times thinner than a human hair. A small current is passed through the DNA which encodes the genetic material into a digital record, which can be compared against disease markers– for instance, Alzheimer’s and cancer. Microchips in this size can be embedded in future in toothbrushes and smartphones. Oxford Nanopore’s current palm-sized detector is currently being used to track Ebola in West Africa. Daily Express.
Drawing a parallel between healthcare and … newspapers
…is the point that Dave Chase, who founded patient information/engagement portal Avado and sold it to WebMD in 2013 (and with them until last month), is making in this Forbes article. As newspapers found their readership leaving in droves for online websites that delivered ‘news they could use’ faster and more interestingly, healthcare systems are finding that their patients are finding healthcare services outside their bricks-and-mortar:
- Onsite workplace clinics (including telehealth/telemedicine hybrids such as HealthSpot Station–Ed. Donna)
- Direct primary care providers such as Iora Health, Qliance, DaVita’s Paladina Health
- Retail clinics: MinuteClinic, TakeCare Health
- Medicare Advantage-only programs such as CareMore [TTA 5 May] and Healthcare Partners
- Domestic medical tourism by large, self-insured companies for elective surgeries
This Editor would argue that these forces are at work even in (and perhaps because of) centralized payment systems, and are worldwide, not just in the US. Certain communities such as Rochester, NY, Dubuque IA and Seattle are focusing on lower healthcare as attractions to business–and countries such as Costa Rica, Mexico, Brazil, Singapore, Hungary and India are capitalizing on US-quality facilities and doctors to gain medical tourism for elective and self-paid surgery.
ATA’s hottest trend: advancing to Healthcare 2.0 via personalized healthcare
Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 earlier this month. This is the third of three articles on his observations on trends and companies to watch.
For those who attended the American Telemedicine Association‘s meeting in Los Angeles, the overarching trend was how a personal healthcare system is taking shape. The three pillars include: care anywhere, care networking and care customization.
The ATA stage opened with a keynote speech by Dr Sanjay Gupta about celebrating new innovation and technology advancements. This is the year where healthcare models are being built around patients in the home to support patient autonomy.These three pillars of personalized healthcare are being made possible by disruptive technologies, wearables/implantables, social networks and analytic technologies to automate remote care. Wearables and biosensors allow patients to move anywhere without interfering with day to day schedules while allowing for optimized data collection.
Access to care anywhere has been a challenge and is becoming realized through providing cheaper wireless tools that takes it to far corners. Dr Gupta focused on the use of telemedicine for delivery of care and its utility for improving access. He endorsed it as a tool for providing care for those with limited healthcare accessibility and locally for more a mainstream solution to a larger healthcare problem. We have seen telemedicine become mainstream (more…)
Short takes for a spring Friday: wounds, babies and ‘frequent fliers’
Starting off your spring weekend….WoundMatrix, which uses generally older model smartphones to take pictures of wounds which are uploaded either to their own or to a destination clinical platform, with proprietary software that helps a clinician analyze the wound remotely and then to track healing progress, has gone international with Honduras’s La Entrada Medical and Dental facility run by non-profit Serving at the Crossroads, and in Rwanda in the care of nearly 1000 patients by the Rwanda Human Resources for Health Program, established by their Ministry of Health with the cooperation of several American universities. At ATA they also announced a new release of software. Release (PDF attached)….A BMJ (British Medical Journal) article critiquing the surge in what we call ‘telehealth for the bassinet set‘ scores the Mimo onesie (Rest Devices), the Owlet sock and the Sproutling band as taking advantage of concerned parents. It’s too much continuous monitoring of vital signs that can vary and yet be quite normal, and no published studies on benefit. A reviewer did find that Owlet is in clinical tests at Seattle Childrens and University of Arizona. MedPageToday (BMJ requires paid access)….A surprise from Philips, which we in the US associate with the Lifeline PERS. They have quietly moved into telehealth focusing on post-discharge programs that target the most costly patients, often dubbed ‘frequent fliers’ based on their frequent stays in hospital. The ‘Hospital to Home’ telehealth pilot with Banner Health in Arizona, dubbed for them the Intensive Ambulatory Care (IAC) program, focuses on the top 5 percent of complex patients which are the highest cost and most care intensive. IAC results among 135 patients over six months reduced hospitalizations by 45 percent, acute and long-term care costs decreased by 32 percent and overall cost of care by 27 percent. However, is this program continuing–or transitioning their patients? iHealthBeat, PR Newswire
Redesign of Kinect to detect, prevent Parkinson’s freezing of gait (UK)
Two researchers at London’s Brunel University have repurposed a common Microsoft Kinect game controller to detect and help prevent the freezing of gait (FOG) that is a common result of Parkinson’s disease. FOG strikes without warning–the muscles freeze and the sufferer generally falls. To both detect falls and help prevent them, the Brunel researchers mounted a laser projector on the ceiling controlled by the Kinect. If a fall happens, it initiates a video conference call to assist the person. The prevention comes in with projecting visual cues–lines ahead on the floor, which has been found to help unfreeze the muscles. According to the Brunel release, it has passed proof of concept stage and is moving to patient trials. The further proof will be if this can scale. Brunel University News
ATA trend #2: is this the ‘second generation’ of remote patient monitoring?
Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 last week. This is the second of three articles on his observations on trends and companies to watch.
During the course of the ATA conference, I was inundated with the concept of “dumb” data whereby biosensors track patient clinical data and will alarm to clinical staff if outside designated parameters. However, the call center filter between the patient’s data and physician is often a primary cause of increased unnecessary admissions. The Sentrian Remote Patient Intelligence Platform (Sentrian RPI) received recognition for its advancement in utilization of sensors, enabling healthcare providers to utilize this “dumb” data and make it “smart”. For clinicians like myself, this was a new way of looking at an age old problem: “How do we safely and comprehensively support physician decision making at a standard high enough to detect pathologies earlier and more accurately?”
Sentrian has used machine learning to support the work of a dedicated clinical team by monitoring patient data 24/7 to detect subtle signs that warn a family member or care provider of future problems through biometric patterns of thousands of patients, comparing their medical histories, vitals and health information. This novel approach to remote monitoring won Sentrian the ATA President’s Innovation Award. (more…)
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