A good programme exploring vital signs measurement – well worth a look. If you missed it, it is on BBC iPlayer (only available in the UK).
The 3GDoctor has collated the tech demonstrated, if you want to buy/get more info. Even offer a discount plus a ‘free ECG read’ on the AliveCor ECG device.
The BMJ has just published an open access paper entitled “Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls” (BMJ2013;347:f4585, Steventon et Al). It reaches the rather depressing headline conclusion that telephone coaching did not reduce unplanned hospitalisations and if anything increased them.
This looks to fly in the face of the apparently less academically rigorous recent claims by the Leicester City CCG and Totally Health, that they reduced hospitalisations significantly, saving some £353,000 over a 30 week period with a cohort of between 47 & 50 patients that we reported recently.
However reading on, perhaps a key passage, in the conclusion, is (more…)
Overall there was a huge sense of sadness that came through from many comments – many had seen the move into retail sales a confirmation that telecare had finally arrived as a mainstream technology in the UK, so a withdrawal so soon afterwards caused much grief. It was touching to see the concern for the staff too, who have worked so hard to get this venture airborne.
Although there were few comments specifically about the retail telecare kit, none were complimentary; it was seen as being single purpose, limited and hard to use. The ability to replicate the hardware functionality on a standard smartphone, (more…)
23andMe, the US personal genetics company, launched Portraits of Health, the company’s first (US) television advertising campaign on 5th August.
Anyone unaware of the company and its ambitions could do worse than watch the excellent video of Anne Wojcicki’s presentation at a recent RSM innovations summit.
Whilst the NHS talks about building a 100,000 person genomic database, and the RCGP sees the most advanced medical development in the life of the average GP by 2022 will be remote delivery of test results, it seems that 23and Me is powering toward’s Anne’s goal of one million genomes sequenced.
It’s not a totally fair comparison of course as the NHS ambition is full sequencing, whereas, as she explains in the video, 23andMe focuses on what they consider the key areas; nevertheless it’s impressive stuff and an indication of just how quickly technology is changing healthcare.
Reading and listening to the debates in recent days about whether the excellent Berwick report should have mandated staffing ratios, instead of leaving such guidance, as his report does, to NICE, I wondered to what extent technology had been considered to have an important role in improving patient safety.
The best example I can think of why this can be important, from my Newham days, was people prone to night-time fits that used to require dedicated human monitoring throughout the night. By installing appropriate telecare we were able both to improve patient outcomes by enabling people to sleep on their own without outside disturbance at the same time as reducing significantly the cost of night-time care: a case where technology simultaneously enabled an improved level of care and a reduced staffing level.
It was therefore reassuring to find on Page 22 under the heading “A note on staffing ratios”:
| “Our primary recommendation on staffing patterns is that NICE undertake as soon as possible to develop and promulgate guidance based on science and data. Such guidance, we assume, would include methods by which organisations should monitor the status of patient acuity and staff workload in real time, and make adjustments accordingly to protect patients and staff against the dangers of inadequate staffing. We also assume, and hope, that innovations will develop and continue in technologies, job designs, and skill mix that will and should change ideal staffing ratios, so that this role for NICE ought to be ongoing.” |
I’d hasten to add that I am not advocating general use of telemonitoring in response to the report – merely to point out that there are some specific occasions where technology can help, and those are increasing as new technologies, possibly such as smart floors, are developed.
60 Second GP today points to an article on what looks to be essentially a Simple Telehealth-type application, in this case a GP-led internet-based programme to encourage weight loss among obese patients in West Oxfordshire. What makes it newsworthy is that it never mentions telehealth, yet extolls the benefits in a manner that any telehealth project or programme manager, eager for clinical acceptance will instantly recognise, such as:
Does this mean that the good GPs of West Oxfordshire have taken onboard a previous Telecareaware post “When mHealth and telehealth become ‘just healthcare’” ?
I somehow doubt it – however the article is nevertheless recommended reading for anyone wanting to sell successfully a telehealth programme to clinicians without ever mentioning the ‘t’ word.
Also worth pointing out is that a feature of the programme was to introduce some gamification – in this case via a league table of weight losers, where anonymised patients reported changes in weight, so other could compare achievements. Perhaps that’s why the authors, Professor David Brodie, Emma Doyle, Dr Jey Radhakrishnan and Dr David Shaw, report that “One of the most striking outcomes was the high number of men who lost weight (almost 90%), because men are often more reluctant to become involved in weight loss programmes”? (For another great example of gamification applied to weight loss, without the technology, see Fitfans in Hull.)
Sadly there is no information in the article on the size of the programme…and the implication seems to be that having been shown to be successful it was discontinued after 12 months.
When touting telecare and telehealth, sadly occasionally one encounters negativity, so I try to avoid negative comment myself for fear of adding fuel to the fire. However, once in a while an item appears that really does pull you up short. So TTA has decided to introduce a “What in the Blue Blazes” spot, to which reader nominations are also encouraged.
Pride of place as first entry is a new research2guidance report, Mobile Health Trends and Figures 2013-2017, which will lighten your wallet by £812 for individuals, and considerably more for multiple access. The FierceMobile summary of the report is here.
As a (free) taster, this highlights 10 key trends that it reckons will shape the mHealth market until 2017. These include:
1. Smartphone user penetration will be the main driver for the mHealth uptake
2. mHealth applications will be tailored specifically for smartphones or tablets
6. Buyers will continue to drive the market
8. mHealth market will grow mainly in countries with high Smartphone penetration and health expenditure.
There are six more penetrating insights where these come from.
A caveat on the survey methodology is that the “324 opinion leaders and mHealth app publishers” surveyed are largely with early-stage companies, with a sprinkling of consultancies and major players thrown in. Could this put a rosier picture on commercialization, market sizing and barriers than is realistically warranted?
It is of course up to our readers to determine the report’s value. In the past, research2guidance reports have been favorably reviewed in TTA for their data analysis, which is also extensive here, and these can be of value. However for this Editor, it is our first ‘Blue Blazes’ award.
It’s my contention that telehealth, or whatever it is called then, will only start to have a really significant impact on reducing the burden on caregivers when the technology begins to move from decision support to decision taking; only then will clinicians be able to disengage from needing to be involved in every decision regarding a patient’s treatment and focus on those decisions requiring significant skill and judgement. Sure there are all sorts of genuine hurdles in the way like ensuring that the decision-making process is not compromised by other genuine – or rogue – processes taking place on whatever the smartphones is called in the future that is processing and transmitting information, and there have been several recent warnings on malicious hacking of medical devices, so it won’t be happening any time soon. However, given the way so many medical processes that began with manual involvement have moved steadily towards automation, from ECG to Point-Of-Care-Testing, hopefully one day these problems will be solved.
One pointer, reported in iMedicalApps, is three trials currently underway using smartphones to control artificial pancreases to manage diabetes. The smartphones in this case are completely locked down and are only used for the decision-taking process around closed-loop insulin delivery. Nevertheless it’s a step.
At the Royal Society of Medicine every year there is a medical students careers fair at which the Telemedicine & eHealth Section runs a stand. Unlike other sections such as cardiology and general practice, we don’t see telehealth and other related technologies offering a career for many – the stand is purely to raise awareness because, scary as it may sound, many of the students who have visited us in recent years have never been taught about these technologies at medical school. It is therefore good to see an article by Ben Heubl in Medcrunch, an online magazine aimed at tech-savy young doctors, discussing the reasons for slow adoption of telehealth (and telecare) which in part built on a meetup of the London Health 2.0 chapter last week.
In this context it’s also worth mentioning an article by Atul Gawande in the New Yorker on why some medical innovations spread fast, and other slowly. He begins by contrasting the rapid adoption of anaesthesia with the slow adoption of antiseptics, both of which were discovered at about the same time. From this he draws the lesson that where doctors see a clear benefit – in the case of anaesthesia, no longer having a patient struggling and screaming whilst being operated on – the adoption was fast. Where the immediate benefit is harder to see and in particular it challenges the modus operandi – washing hands, sterilising instruments and replacing frockcoats caked in blood for clean white operating gowns – as with antiseptics, adoption was much slower even though the impact on patient outcomes was dramatic. This not in any way a complete summary though – I would urge you to read this excellent piece in its entirety as there are many nuances…and important lessons for the future.
Rounding this post off, Pulse has just introduced a GP Guide to Telehealth (written and funded by MSD) which is short and to the point, balancing the UK experience of the Whole System Demonstrator with the very positive experiences of the Department of Veterans Affairs. Much to be welcomed and with the added bonus of CPD points too.
The FT’s excellent journalist Gillian Tett has written a thought-provoking article on how increasing privacy concerns brought about by recent cyber surveillance revelations are threatening the ability to use ‘big data’ to connect specific genomic features with individual health conditions. This in turn is threatening the ability to find and improve treatments and cures for many ailments. All is not lost though; she describes a number of possible solutions, most notably a “people’s movement”.
Well worth a read even though it fits more under a wider definition of Digital Health than is conventional on TTA.
The first full meeting of the London Health Technology Forum has been hastily arranged for 6th August at the offices of Covington & Burling, the international legal firm. There is no charge for attendance, and our sponsors have kindly laid on a drinks reception after the formal part of the evening – how could you resist if you will be in London then?
There will be three speakers:
Dr Vinod Achan, is a top cardiologist at Frimley Park Hospital in Surrey who will be talking about how he uses technology to improve patient outcomes
Me – I will be talking about the challenges of evidencing the benefits of medical technology, with particular reference to this and other reasons for O2’s recent withdrawal from this market.
And thirdly a well-known commentator on digital health devices has been invited to be our third speaker – we are awaiting his confirmation.
Talks will be short, leaving plenty of time for debate and questioning.
The programme kicks off with arrival and networking from 6pm. Proceedings will end at or before 9pm.
More details, and how to book for this event, are here. Note that the maximum the room can handle is 40 people, so book early to avoid disappointment, as the saying goes.
Please note that for security purposes only those who have booked will be allowed access.
The alpha version of the CDEC Open Health Data Platform offers a tantalising glimpse into what big data can do to improve healthcare. This site uses data from sources like the Health and Social Care Information Centre (HSCIC) and shows how it can be turned into visualisations and analysis to answer specific health-related questions.
The initial release, which focuses on a small number of datasets including data about GP prescriptions and diabetes prevalence to show the extent of diabetes treatment in the UK, is a request for comment from the UK innovator community. Specifically sought are views on functionality to include and the future data sets to incorporate.
The outline business case for developing the tool suggests potentially many profitable opportunities particularly for micro-enterprises and SMEs.
An extremely exciting venture, much to be encouraged.
Echoing last week’s “the world has moved on” post on the WSD, the 3G Doctor (David Doherty) has an excellent opinion piece on how AGE UK should spend the money given to it by Google for making it to the final six in the Global Impact Challenge that supports British non-profits using technology to tackle tough problems.
In discussing Age UK’s current plans to use the money to teach older people about the internet he says: “For the £500,000 AGE UK would spend on training 16,000 seniors they could give away (at retail price!) 10,000 of the latest designed for senior 3G CameraPhones from Doro. Works straight out of the box. No training required.”
Elsewhere on his site he has an interesting take too on the reasons behind O2’s announcement last week.
Just tripped over this interesting item by Dana Pirvu on the Epstein Becker website favourably contrasting the EU approach to regulating telehealth with the US approach: well written and concise…and nice to see that Europe is ahead in this area. It was posted in April but still seems very relevant.
The ELSI Smart Floor underfloor sensing laminate is a thin laminated copper based sensor that offers some potentially very valuable benefits. According to the website, the capacitative sensing technology can be used to trigger alerts created by patient movements. Examples given are:
There’s no indication of price or the difficulty of installation; one presumes it would be best suited for hospitals and residential care establishments as a permanent installation. There’s also no indication of sensitivity and the danger of false alerts – it’s clearly got to be pretty sensitive to pickup changes in the capacitance of a floor so false alerts is a topic I’d want to explore before making an investment.
That said, it looks to be a very exciting development, that does not require users to wear devices, cannot be fiddled with or switched off by users and, sadly equally important, cannot easily be tampered with by cleaning staff or require regular replacement (as opposed for example to bed sensors).
There would also seem to be the benefit that the output could be used for ADL (activities of daily living) monitoring too (though there is no mention of equipment that this Finnish company provides that could do that).
Clearly this will potentially have other applications in addition to monitoring frail people – the website, under ‘ongoing developments’ also mentions:
This seems a most exciting addition to the array of sensors available, particularly because it requires nothing to be worn and cannot easily be disabled or wear out.
GovernmentHealthIT reports that, speaking yesterday during the first day of the World Congress on mHealth and Telehealth in Boston, US, Jonah J. Czerwinski said Veterans Affairs (VA) had managed the health of some 500,000 people using telehealth in 2012. He expects this to rise to over 600,000 this year. He is senior advisor to the Secretary of the U.S. Department of Veterans Affairs, where he leads the VA Center for Innovation. That’s some endorsement for telehealth!
“It’s connected healthcare – no ‘tele-,’ no ‘m-,'” he is reported to have told the audience: “This is just healthcare.”
Picking up on the topic of automating telehealth monitoring, he also described how the VitaLink home monitoring system, one of the VA’s more promising telehealth projects, has been developed by the VA from algorithms used in the mining industry to detect when drill bits embedded deep in the earth were stressed out and ready to fail.
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