A timely paper from the Nuffield Trust reminds us that the Government has committed that from April 2014 everyone who receives NHS continuing health care funding will have a right to request a personal health budget (PHB) rather than receiving commissioned services.
This will be important for some readers because (more…)
Over the past few days there seems to have been a particularly rich set of alerts related to mHealth apps (there’s even been an update to the mHealth Grand Tour website with a nice video to promote the tour that starts on 5th September). Adding to them a couple that others have kindly alerted me to, here are a few that might interest:
Let’s begin with an infographic on the rising popularity of mHealth apps that puts it all into context. However, in some countries mHealth is being held back by outdated privacy laws, and in the US lack of final FDA guidance is considered a check on progress. If you ever wondered how much data your DNA, or your most recent scan contained, (more…)
First it was two cohort studies of the same project, then two reviews of reviews, and now two new organisations have recently emerged in the telemonitoring world.
So, to that word. London Telecare has just announced it is planning to change it’s name to UK Telehealthcare and go nationwide. No ®, no ™: true independence. This follows on from the recent emergence of (more…)
In spite of gamification being at the peak of inflated expectations in the 2013 Gartner Hype Cycle, here’s a great example from the US journal Pediatrics of its use to encourage young people with cancer to improve their medication adherence. The subject was also covered in the BBC’s Click (starts 13.55 into the programme), and the Hope Labs website is here…
…which prompts the question as to where the best examples of gamification use to improve health & wellbeing are on this side of the Atlantic. (more…)
Richard Vize has written a highly-recommended article in the Guardian today entitled “GPs continue to do battle with government over telehealth”. This gives some valuable context to why publications such as Pulse continue to dredge up the historic Whole System Demonstrator (WSD) cost/QALY statistics as it did on Wednesday and Thursday last week.
TTA readers will of course be aware of the reasons why those figures are so unrepresentative of the technology from our recent post on why it’s time to bid farewell to the WSD.
Particularly pleasing is to see recognition of the role of telehealth as a means of promoting wider improvement in the way care is delivered:
“Eventually, other costs will start to fall as telehealth becomes a catalyst for wider system change. At present it is a bolt-on to a care system poorly integrated and not adapted for telehealth. It will require clinicians to work together in new ways, particularly in more effective joint working between community and hospital staff.”
Following on from yesterday’s post entitled “Don’t be put off by the title, or the conclusion, of this review of reviews“, Mike Clark has kindly pointed me towards another recent review of telehealth reviews entitled “Telehealth – the effects on clinical outcomes, cost effectiveness and the patient experience: a systematic overview of the literature”, this time from Salford University, authored by Dr Alison Brettle, Tamara Brown, Professor Nicolas Hardiker, Jon Radcliffe and Christine Smith.
This paper provides an intriguing contrast to the paper reviewed yesterday in a couple of, doubtless unrelated, ways. Firstly, whilst the word that was the subject of yesterday’s post does not appear in the title (it does appear in the text), the paper was funded by an educational grant from the organisation most often associated with that word. Secondly, the review is noticeably more positive, for example:
“There is more evidence for some conditions than others, but on the whole the trends are largely positive suggesting that telehealth is effective in:
As with our two recent posts on Birmingham OwnHealth, it looks like it’s take your pick time again.
It is perhaps just worth adding that there are also significant similarities between some of the observations made in both papers, most notably about the small size of many trials, inconsistent collection of outcome measures and the weaknesses of the methodologies currently used for assessing the effectiveness of trials of medical devices.
Whenever I see the word “telehealthcare” I feel there should be an ® or perhaps a ™ after it as it so often appears in connection with a particular organisation. However no such connection is evident is this paper entitled “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview” (published on the PLOS ONE site), especially as the overall conclusion is far from that often found in articles toting that word:
“Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.”
If you stop there though, you miss some very important points (more…)
The Kings Fund has just produced a detailed analysis of the total health & social care costs for older people admitted to hospital following a fall in Torbay over a 12 month period. This should be of serious interest to anyone writing business cases for falls-related technology or generally doing any financial calculations in that area. (Torbay has excellent integration of patient/service user records that enables this analysis to be done with great accuracy).
The headline finding is that the total health and social care costs of dealing with older people who have had a fall that they have had to go to hospital for, in the year after that fall, is almost four times the immediate cost of the unplanned hospitalisation after the fall. Unsurprisingly, for those who die within a year of the fall, total costs are somewhat higher than for those who survive. Using the Kings Fund’s figures I calculate that the incremental health & social care cost of a fall is just under £7,000 (which includes both the immediate hospitalisation cost and the following years’ costs, less the previous year’s costs). This of course ignores the costs to the individual, their family and community.
Many readers will by now doubtless be wondering whether the costs of falling were reduced for those fallers who were Torbay Lifeline users as conventional wisdom is that the cost is very dependent on the length of time someone remains on the ground before being rescued. Sad to report that analysis was not done (see comments on the paper – I have requested it). Nevertheless it is a brilliant resource for anyone looking for cost information on this very important topic.
Pulse was one of the first to carry the news today, though was unable to resist the temptation to remind readers of the high cost/QALY found by the Whole System Demonstrator (WSD) programme (which was caused, as Telecareaware readers will know from a previous post, by the high cost of running the WSD RCTs and using equipment that is now some six years old). The more positive EHI post is here.
Over the past year there has been much concern about whether telehealth arrangements established by the previous PCTs might be taken forward by the CCGs; Surrey shows it can be done successfully.
(Disclosure: Charles Lowe established and ran the telehealth programme in Surrey for NHS Surrey and Surrey County Council between 2011 and 2013, including managing the tender process. He did not however adjudicate the tender – some 40 representatives of organisations in the county participated in the adjudication.)
NHS England has just launched a consultation on the future of GP practices, with a slide set of the case for change and the NHS’s underlying objectives for general practice together with an evidence pack which provides some information about current general practice and health needs.
This is important to everyone who senses that modern technology can help make a real difference to the way care is delivered because there is a serious lack of ambition (more…)
Last week we reported on the survey commissioned by the National Telehealth Forum that found that 9 out of 10 people didn’t know what the word ‘telehealth’ meant, a proportion that was worse for those who were more likely to need it. We suggested that asking a different question about whether they knew that technology could enable them to remain in their own home might give a more positive response.
Well no sooner said than (sort of) done – Invicta Telecare reported a similar-sized poll that, among many, included the finding that “more than three out of five over-65s (65%)…admit they hadn’t seriously thought about the type of care and support they would prefer as they get older during the last five years”. Other responses in the interesting survey seem to confirm that a significant number of older people are in denial of the implications of their age so are inadequately prepared to remain independent.
This clearly strengthens the conclusion from our earlier piece, and from our retrospective on why O2 pulled out of this field of the increasingly pressing need to make people aware of how technology can support independent living. Is 3millionlives the way forward?
This is obviously a topic of great interest that will undoubtedly be debated this autumn particularly at the two conferences specifically aimed at how technology can supporting people to age well, run by the Kings Fund on 22nd October and the Royal Society of Medicine on 25 and 26th November. (Disclosure: Charles Lowe is one of the organisers of the latter).
You wait for a cohort study to come along for ages, then suddenly two come along within a week of each other…of the same intervention, although with apparently different conclusions. The second paper, entitled “Analysis of the Impact of the Birmingham OwnHealth Program on Secondary Care Utilization and Cost: A Retrospective Cohort Study”, is published online in the Journal of Telemedicine and e-Health, ahead of print, with lead author Liv Solvår Nymark. (Our post on the previously-reviewed paper, whose lead author was Adam Steventon is here).
The Steventon paper found that the OwnHealth intervention “did not lead to the expected reductions in hospital admissions or secondary care costs over 12 months, and could have led to increases” whereas the Nymark paper “found difference in costs constituted (more…)
Apparently echoing the comments about health technology awareness made in our post last week about O2 (who are, by the way, to be congratulated for their parent company’s announcement today that they are preferred bidders for two of the three smart meter regions), the HSJ has reported the results of a YouGov poll that nine out of ten adults in the UK have never heard of telehealth. Of those over 55, the age above which use of telehealth is more likely, 92% hadn’t heard of it. (Note that the HSJ article is behind a paywall, however via a Google search on “National Telehealth Forum”, the commissioner of the survey, you can currently go past it). The National Telehealth Forum press release is . EHI also covers the story, .
So is this a matter of serious concern? (more…)
5 September 2013, Panoramic Hall, Square Brussels Meeting Centre
High level speakers and a goodly amount of the day committing to healthcare make this event look interesting.
One of the greatest misconceptions I had when I first got involved in telecare was that the main reason that people don’t adhere to their medication regime is that they forget to take their medicine – therefore all they need is an automated pill dispenser or perhaps even an alerting system and all will be well. If only it was so simple!
In reality there are all sorts of reasons, such as (more…)
Medtronic has just announced a $200m takeover of Cardiocom, the telehealth device maker. If you can get through the paywall, the WSJ article is here (updated link not paywalled–Ed. Donna). FierceMedical quotes Medtronic as saying that “At-home monitoring is a proven method of reducing the rates of hospital readmission…and that translates to savings for payers, providers and governments.” First area of joint working is expected to be heart failure. Recent US regulations on Medicare, and increasingly insurance payers, penalize hospitals for 30-day same-cause repeat admissions. Medtronic press release.
Editor Donna: The announcement of Medtronic’s (#4 in worldwide revenue) acquisition of Cardiocom (both Minnesota-based companies) created quite a stir in the US as Medtronic is a ‘traditional medical device’ company best known for its implantables: cardiac shunts, stents, heart valves, pacemakers, insulin pumps and interestingly, a wide range of neurostimulators for different conditions. Now with the acquisition of Cardiocom, Medtronic moves into the post-implant/post-discharge/post-diagnosis chronic condition management continuum– not only into telehealth via Cardiocom’s devices and hubs, but also their clinical and care management systems. $200 million in cold cash is a fair bet even though Medtronic’s market cap is north of $55 billion. Medtronic has to see the opportunity to make a bottom line difference to providers and payers. It is also reacting to a narrowing in its profitable core market–medical devices are now taxed, there have been recent product defect-related ‘scandals’ tarring the industry, and there is pressure to reduce pricey device costs to fit a cost-constrained environment, driven by the new healthcare ‘scheme’ (in both the British and American English senses!) Forbes‘ David Shaywitz has a smart take on it today (though he won’t hold his breath for the pharmas to follow), as well as VC TripleTree’s Chris Hoffman ‘connecting the dots’ and coming up with what we’ve been talking about for some time–integration making sense. It is also most definitely a shot over the bow for major competitors such as Alere, Bosch and Philips plus a raft of smaller companies which have been working with a scattering of hospital discharge areas, integrated delivery systems, ACOs and home health agencies, looking nervously over their shoulder–and other leading medical device companies such as Stryker, BD, Baxter and yes….GE. (Bosch also sued Cardiocom on patent infringement this time last year [TTA 7 Aug 2012]; presumably as this suit was not announced as settled or decided, Bosch is now dealing with a company its own size!)
It also should be noted that Medtronic’s CEO, Omar Ishrak, is well acquainted with home health. Mr. Ishrak was formerly the CEO and president of GE Healthcare through mid-2011–and the driver behind making what was an ultimately failed bet in getting GEHC into home health. That was in 2008-9 with a tiny company called Living Independently Group, developer of a telecare system called QuietCare, which ultimately went to the Care Innovations JV with Intel. (Disclosure: I was head of marketing at the time of the acquisition.) Like GEHC, Medtronic is acquiring a closely-held company in a very different line of business with drivers quite unlike its own; they are retaining the former CEO as a general manager of the division but whether other management or the brand name will survive is not disclosed.
Whilst on the subject of telehealth devices, Heartwire reports a meta-analysis of 52 studies that shows that just measuring your blood pressure regularly results in a significant reduction in both systolic and diastolic levels after six months. Sadly the paper itself in the latest issue of the Annals of Internal Medicine is behind a paywall so it’s not possible to try to understand how the final comment in the synopsis of the paper on the Annals website that: “Additional support enhances the BP-lowering effect.” fits with the comment in Heartwire that “Low-strength” evidence from 13 studies comparing self-monitoring plus additional support vs self-monitoring alone “failed to support a difference” between the two strategies.”
Meanwhile back in the UK, Medvivo has become the first company to be accredited to the telehealth elements of the TSA’s Integrated Code of Practice. Sadly the TSA website will only release the Code to members (TTA isn’t one) or those aspiring to achieve accreditation (TTA fails on that one too) so it’s not possible to make meaningful comment. However the prospect of a Battle of the Codes is looking up with word from Malcolm Fisk that the final version of the European Code of Practice for Telehealth Services will be available for all to read and download on the TeleSCoPE website within a month. There has been talk of a third code being developed too…
Most Recent Comments