The ON World business intelligence group projects in its latest report that ‘wireless sensor networks’ (WSN) for health and wellness revenues will sharply rise to a 2017 global projection of $16 billion in revenue for 18.2 million systems shipped. This estimate excludes sports/fitness devices, which of late are hard to separate due to capabilities crossover, as we’ve seen with sleep monitoring. The report analyzed over 100 devices (list here) for aging in place, health condition self-management (60 percent of 2017 revenue, almost evenly split between cardiac and diabetes) but general wellness will continue to lead numerically (41 percent of device shipments) for consumer and clinical use. The 81 page report is based on 750 individual interviews/surveys with over 100 companies and 300 users, reviews back end comms standards (e.g. ZigBee, Bluetooth, ANT) and market sizing. It will be a tidy $1,999 budget item for a single user. ON World release, order page (including email info for free 12-page executive summary), shipment growth chart. FierceMobileHealthcare article.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/04/HealthWSNsystemShipments.jpg” thumb_width=”400″ /]Healthcare BYOD unleashed, and the consequences
A just-published Cisco study estimates that nearly 89 percent of healthcare workers Bring Their Own Device–in this case, smartphones only, so really BYOS. For employers who largely do not subsidize usage, it’s a huge benefit–overall in the eight industries studied, 90 percent of employees receive no subsidy yet 92 percent use their smartphone for work weekly. But the employees don’t bring their own good security practices. In healthcare alone (classed as a ‘sensitive industry’): 41 percent do not password protect, 53 percent access unknown/unsecured Wi-Fi networks and 52 percent don’t disable Bluetooth ‘discoverable’ mode. And this does not include iPads, Android tablets and the like which are also often left unsecured. According to FierceMobileHealthcare, which referenced a late 2012 Amcom Software study, “more than 65 percent of responding healthcare facilities do not have a documented mobility strategy in place. What’s more, 37 percent of the survey’s respondents do not have plans to implement such a strategy in their organizations.” It makes one long for the days of IT department-issued cranky CrackBerries. BYOD Insights 2013: A Cisco Partner Network Study Hat tip to David Albert, MD of AliveCor @DrDave01 for the link via Twitter.
Is there a BYOD backlash? Ken Congdon of Healthcare Technology News spoke at HIMSS 2013 on the unstoppability of BYOD and counters the naysayers.
DOD, VA stuck behind the Magic 8 Ball: report (US)
Institute of Medicine, ‘Daily Show’ rap DOD, VA for unlinked EHRs
When the US Department of Defense (DOD) and Veterans Affairs (VA) announced back on 27 February that they would not achieve their major goal since 2009 of a single EHR system by 2017, with initial test next year, for this Editor it was just another billion-dollar ‘fail’ day out of DC. FDA dithers since July 2011 on final guidance on mHealth approval–yawn. Centers for Medicare and Medicare Services (CMS) cutting back rural telemedicine consults–business as usual. Individual health insurance premiums going up 30 percent next year? We knew that was coming! So no surprise here when the Institute for Medicine of the National Academy of Sciences issued a report highly critical of both agencies regarding the needs of 2.2 million Iraq and Afghanistan veterans, with one key criticism the lack of EHR interoperability. According to iHealthBeat:
The IOM report found that:
• 49% of returning veterans have experienced post-traumatic stress;
• 48% have dealt with the “strains on family life;”
• 44% have experienced readjustment difficulties; and
• 32% have felt “an occasional loss of interest in daily activities.”
According to IOM, the federal government’s response to troops returning to the U.S. “has been slow and has not matched the magnitude of this population’s requirements as many cope with a complex set of health, economic and other challenges.”
Neil Versel in his Meaningful HIT News article published yesterday highlighted the EHR single-system fail through, rather incredibly, a Jon Stewart Daily Show video segment called ‘Red, White and Screwed’. (Today, in American life, you know an issue has gone mainstream when it makes a ‘news/comedy’ show such as this or the Colbert Report.) This Editor is no fan for multiple reasons, but to his credit Mr. Stewart has been a strong advocate on behalf of veterans and showcases the failure of veterans’ support regularly on a segment called ‘The Red Tape Diaries’ without sparing a certain Administration from criticism. Aside from over 900,000 veterans waiting an average of 273 days for their disability claims to be processed, the icing on the cake is how the EHR ‘fail’ was announced. At 3:20 in the video, a Government Accountability Office (GAO) official drily depicts both DOD and VA as perpetrators of project mismanagement and poor oversight. And this is despite a 40 percent increase in budget from the Republican-controlled House, which confounded Mr. Stewart. The criticism goes on from there. Magic 8 Ball says ‘messed up, try again.’ DoD-VA integration failure is no laughing matter, even to Stewart Hat tip to reader Ellen Fink-Samnick, MSW of ‘Ellen’s Ethical Lens’ for featuring this article on her LinkedIn group.
Related, ironic note: the DOD’s and VA’s EHRs are respectively called AHLTA and VistA, a nostalgic touch for those of us who used the first real search engine, AltaVista, circa 1996.
Health tech grows…but where are the investors?
Health tech, digital health, wireless health, telehealth, eHealth, mHealth, connected health…while the terminology proliferates, the hype curve grows ever steeper and the conferences/cocktail parties ever buzzier, where is the investment? David Doherty’s identified 16 billionaires investing in health tech, but David Shaywitz writing in Forbes, who’s been up and down the biotech curve, is noting that VCs who should be gravitating to digital health, aren’t. This is even though they have the most experience scouting the territory: the medical problems to be solved, the stakeholders, the development curve. This isn’t to say that some are actively investing and others are observing the waters–he cites PureTech Ventures, Venrock, Fidelity Biosciences as the former–but when he cites a principal of a major biotech VC openly tweeting a withering view of most ‘digiHC’ (another term!) as without a real business model, ‘more sizzle than steak’ and ‘merely a bubble’ equivalent to (US) cleantech….it’s ‘perception is reality’ time. So before mHealth starts connecting to genomes, some successful exits need to go on the scoreboard first. Life Science VCs: Definitively Indefinite About Digital Health
Perhaps too much of consumer directed health tech focuses on how novel it all is–which can sell in the short term–with an emphasis on low-cost apps and Quantified Self trackers. But neither right now, with a few exceptions, have the push from the physician–and their advocacy requires multiple steps to achieve: awareness, trial, validation and support. Also from Forbes, Digital Health Strategy: From Novelty to Necessity. An overview of how this can work for apps is what Happtique has accomplished to date in establishing standards, a certification program and a platform to facilitate physicians in prescribing apps and backing them up with patient educational materials. App Prescribing: The Future of Patient-Centered Care (Health Care Blog)
Medicare to cut back rural telemedicine (US)
The Centers for Medicare and Medicare Services (CMS), part of Health and Human Services (HHS), talks a good game when it comes to telehealth and telemedicine as part of ‘healthcare reform’ and reducing same-cause readmissions–but gives away the real deal in bone-headed moves like this. In the US, telemedicine video consults are not reimbursable by Medicare unless one lives in a designated rural county. Because of population shifts, 97 counties are losing their rural designation, while 28 counties gain, based on Standard Metropolitan Statistical Areas (SMSAs). Thus Medicare recipients who’ve had the option of using video consults lose that option. The CEO of the American Telemedicine Association (ATA), Jonathan Linkous, has rightly been blasting this impending change, most recently here and to all who would listen (FierceMobileHealthcare), but Federal ears are on holiday. But this Editor will blast even harder and blunter: why Medicare does not include telemedicine as an cost-saving, effective and convenient option for every Medicare recipient, and encourage its use for both initial review and follow up to reduce readmissions, is (figuratively) insane. Here’s how it could be set up. Contract with a wide group of companies. Charge a $5 co-pay on initial visit. No charge on follow up. Work with seniors groups and senior centers–and the VA. Run the numbers and tweak appropriately. Americans have a government which squanders money (do not get this Editor, or The Gimlet Eye, started). With all the money being thrown at ‘pioneer ACOs’ and various awards programs, CMS can find some loose change under the couch! Hat tip to reader Ellen Fink-Samnick, MSW and her ‘Ethical Lens’ LinkedIn group joining the blast furnace.
Related: For those who want to dive deeper into rural vs. urban readmission rates (pretty much a draw), David Lee Scher, MD cites the following: from the Robert Wood Johnson Foundation, Interactive Map: The Revolving Door Syndrome; a study comparing rural and urban veterans’ admissions; and The Rural Hospital Advantage.
Diabetic foot ulcer ‘early warning’ system raises $1 million (US)
Rock Health accelerator alumnus Podimetrics raised $1 million in a second and final closing of its Series A round, according to a Form D filing with the Securities and Exchange Commission (SEC). The Boston-based company has developed a bathroom mat that in about 30 seconds of daily use, will scan the feet, collect data about blood flow, analyze it on a cloud-based platform for changes over time and also differences between feet to detect patterns that may indicate the presence of a developing ulcer. More than 90,000 people per year in the US lose a foot to diabetic ulcers at an average of $45,000 per surgery. The new funding will go towards development of new related products. MedCityNews
‘To Read’ lists for the holiday weekend
With both Easter and Passover coinciding, your Editor’s final post for the week will be a compilation of lists which are poking up like crocuses this week. A happy holiday to our readers!
- 10 High-Tech Gadgets to Help Grandma and Grandpa. Andrew Carle (Director, Program in Assisted Living and Senior Housing, George Mason University) and his updated ‘nana tech’ list: GrandCare Systems, VTech, GreatCall featured. Ignore the condescending Forbes headline.
- Five New Technologies from What’s Next Summit 2013. Laurie Orlov in Age In Place Tech looks at new entrants in the senior tech area such as CareMerge, CareSquared (virtual visits and information exchange between residents in communities and family) and SingFit (music).
- 6 Companies Cashing in on Obamacare. Like most CNN Money headlines, it’s a writer’s stretch as none of them are cashing in quite yet–most are just past startup or early-stage and are still finding their hospital readmission, insurer, physician, individual insured and health exchange markets: GoHealth, Health Recovery Solutions, Eligible, QuantiaMD, Connecture and hCentive. Since costs will be going up on average 32 percent by 2017 for insurers in the individual market, according to the Society of Actuaries–only 6 percent today but expected to balloon as smaller companies abandon ever-costlier group plans–there is a huge future market in wringing out costs.
- Which Emerging Markets Are Best Bets for Health Care Returns? If you had $1,000 to invest, what countries would be best? The answers will surprise you! From last month’s 2013 Wharton Health Care Conference.
- Four Robots That Are Learning To Serve You. Your Friday Robot Fix courtesy of National Public Radio: FURo robot tour guide, Bestic eating assistant, EPFL’s amphibious ‘salamander’, mobility devices for smartphones including Botiful, Romo and SmartBot. For more on robots, quick search TTA.
- Five Fallacies of Remote Patient Monitoring. Another list from David Lee Scher, MD which will disabuse many of their preconceptions.
- Five mobile health projects on Indiegogo. For health tech eyeing crowdfunding, here’s a list from Mobihealthnews surveying Indiegogo, which permits but does not specialize in healthcare, unlike MedStartr and Health Tech Hatch, the latter buzzing in The Hive at TEDMED 2013 16-19 April. It also illustrates the drawbacks–for the hits such as Amiigo’s app/bracelet/shoe clip fitness system, there are others that do not make goal.
- NEW 29 March 16 Billionaires Investing in mHealth Continues to Grow. David Doherty’s mHealth Insight roundup which includes the new $97 million fund started by two founders of RIM/BlackBerry, Mike Lazaridis and Doug Fregin; unfortunately no phone numbers or emails!
If not FDA to regulate mHealth, then who?
For those looking for alternatives to FDA approval of mobile health or medical apps, some organizations have been tossed into the Suggestion Box. It’s a veritable alphabet soup of abbreviations, starting with ONC (Office of the National Coordinator for Health Information Technology). There’s the private sector review entity initially created for EHR certification with the formation of CCHIT (Certification Commission for Healthcare Information Technology, part of HHS) or what CCHIT has now become, a private/federally monitored model. There’s also the FTC (Federal Trade Commission) which pulled an acne treatment app of the market, and the ever-popular FCC (Federal Communications Commission) which has been searching for a Director of Health Care Initiatives and after all has millions to dole out in the Health Care Connect Fund. Neil Versel’s latest over at Mobihealthnews focuses in on this (omitting the FCC), considers the suggestion by Thomas Santo, MD in a recent column at KevinMD that medical industry associations (AMA–American Medical Association, ACP–American College of Physicians, etc.) should also be involved with health tech tools, to the extent of a rating system or even endorsement–and argues against it. (This excludes Happtique’s certification program standards/performance requirements.) But since both FDA and the FCC are involved, now separately, in most things mHealthy, and at least one proposed bill (HIMTA) would create an FDA Office of Mobile Health, why not have a joint office as a single point of contact? FDA regs would remain the same, but the review would encompass both medical effectiveness and wireless issues.
Rock Health’s guide to FDA for the health tech entrepreneur (US)
In 26 slides, Rock Health has neatly summarized for those unfamiliar with the FDA approval thickets (99% of us) on what is a regulated health tech product and is not. Instead of a MEGO (my eyes glaze over) experience (familiar to all those who’ve sledded through the FDA website), there are simple examples in how to determine what class your device falls into (I, II, III) and what you need to do to gain approval. It also clearly defines the substantial difference between 510(k) premarket submission and the far more complicated PMA premarket approval–and the fact that after approval, FDA will forever be in your life. It also notes that other approvals such as FCC may be required and many other tips on how to make the process easier and less garment-rending for your organization. Features comments from Chris Bergstrom of WellDoc and Geoff Clapp, who co-founded Health Hero which is now Bosch Health Buddy. SlideShare link
Smart pill bottles 2.0
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/pill_bottle_small-4e1e1544a6de186dda09ddee4027d127.jpg” thumb_width=”150″ /]Back in 2009, this Editor was wowed by pill container-reminder Vitality GlowCaps, and has been cheered by its recent developments in developing a reminder pouch for non-pill medications. Now NYC-based startup AdhereTech adds to the med reminder picture through a specially designed compact bottle for pills or liquids that not only has lights, speakers and a built-in 45-day-long battery, but also is fully M2M–each bottle connects from anywhere via cellular 3G and LTE with no base station required. Thus the containers can be used by those ‘on the go’. Sensors in the containers also measure humidity and opening/closing–but what’s new here is providing a measurement of pills/liquids remaining in the bottle. This is done by measuring the capacitance, or stored charge, along the container walls, without actually touching the meds. Alerts are planned to be customizable in type and style (lights, chimes, emails, text). Testing is planned initially with Walter Reed Army Medical Center, Wake Forest University and University of Pennsylvania against standard containers on whether it increases adherence for a variety of disease conditions. The AdhereTech team is initially targeting use of the containers for specialty medications which require accurate dosing and where adherence is critical. Thanks to founders Josh Stein and Michael Morena for clarifications. This Pill Bottle Is a Smartphone Wannabe (Wired)
IBM, EME, UCLA fighting TBI
Another IBM-related item, this time on IBM using big data analytics software (but not Watson) developed in conjunction with Excel Medical Electronics (EME) used to alert for signs of dangerous brain pressure increases in traumatic brain injury patients. The UCLA Department of Neurosurgery will be analyzing real-time streams of vital signs collected from bedside monitors at the Ronald Reagan UCLA Medical Center ICU to spot subtle changes in the patient’s pulse, blood and intracranial pressure, heart activity and respiration. These changes can alert for dangerous high-risk increases in brain pressure. UCLA Relies on Breakthrough ‘Big Data’ Technology from IBM To Help Patients with Traumatic Brain Injuries (IBM release) Hat tip to Toni Bunting of TANN Ireland.
IBM discovers telecare as “Solutions for an Aging Population”
IBM, along with its ad agency Ogilvy, produced this four-minute, expensively produced ‘ad-doc’ (umentary) on the trial of (drum roll) a remote monitoring technology for elder care in Bolzano, Italy as part of their Smarter Cities initiative. Yes, it’s telecare, brushed up, dressed in blue and looking spanking new again! The story of Zita, a elderly woman and seamstress who lives in a lovely apartment in a hill town your Editor wouldn’t mind moving to, is the exemplar of both Italy’s growing aging population (23.5 percent are over 65) and how to accomodate both the older person living at home to ease the hard realities of aging cost impacts on local social services. IBM’s system and sensors (blue sensor box perched on the refrigerator at 2:34) appear to be unique in design. The rest will sound familiar. At about 3:00, “The sensor’s job is to recognize any abnormalities you can understand if someone could show signs of illness and eventually send an alarm to social services personnel.” Even the malapropism on the sensors recognizing abnormalities (see the web platform graphing at 3:14) and Nicola Palmarini of IBM’s remark “Preventing events means we avoid catastrophic events–dangerous for people…” were features/benefits your Editor worked with for QuietCare back in 2006-7. There’s nothing really new here except that IBM is trying what Care Innovations, HealthSense and GrandCare already have. But will IBM’s backing of telecare, which has been largely sidetracked to assisted living in the US and pushed to the side by consumer mobile health and apps, gain a new lease on life? Can we hope? Or are we back to the Same Old Struggle? Adweek article on IBM’s ad-doc.
[This video is no longer available on this site but may be findable via an internet search]Doctor, organize thy apps
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/Omnio-Home-31-229×300.jpg” thumb_width=”200″ /]You know there are a lot of physician-directed apps when a startup develops an app to organize apps. Omnio by Physicians Interactive promises to help the harried doc with an iPad identify the most relevant resources for the specialty and tag the most used everyday. They also plan to take a page from LinkedIn and design a home page with an activity wall. What is mystifying is that they do not have a native e-prescribing app yet, but a quick look at their website indicates that Physicians Interactive’s bread-‘n’-butter is advertiser-supported sampling and mobile media promotion/marketing. PI release. Virtual “black bag” iPad app to help healthcare professionals customize reference material, tools (MedCityNews)
Aging in America 2013: conference report
Joop Koopman, reporting for Bayard Presse, has generously shared with us (in English) his report on the annual conference of the American Society on Aging, which took place in Chicago 12-15 March. Commentary on presentations by Aging in Place Technology Watch’s Laurie Orlov, gerontologist Ken Dychtwald, Mary Furlong’s What’s Next Summit preceding ASA, AARP, Scott Collins of LinkageConnect, Caring.com and Louis Tenenbaum. Technologies: Care Innovations, GrandCare Systems and Philips. Communities: OnLok Lifeways, Avenidas (virtual). PDF (10 pages)
Joop Koopman is an experienced writer/journalist, with a background in Catholic media (as editor and publisher), baby boomer-oriented marketing, as well as public relations serving both commercial and non-profit clients and causes. He currently provides a stable of European magazines catering to the 50-plus audience with information on US marketing trends. He is fluent in Dutch and French.
‘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.
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