Is a tipping point nearing? Soon? An article in Modern Healthcare that contains a heavy dollop of promotion headlines ‘telehealth’s’ adoption by insurers such as Blue Cross Blue Shield of Alabama, Anthem and Highmark. When read through, it’s mainly about telemedicine (video consults) but does touch on the vital signs monitoring that’s the basis of telehealth. Video consults through Teladoc and other services such as Doctor on Demand and American Well are gradually being reimbursed by private insurers, despite the concern that it would actually drive up cost by being an ‘add-on’ to an in-person visits. Medicaid increasingly covers it, and states are enacting ‘parity’ regulations equalizing in-office and virtual visits including, in many cases, telehealth. Yet the move for coverage is hampered by lack of reimbursement to doctors, or the perception of limited or no payment. Even Medicare, a big advocate for alternative models of care, currently pays little out for telehealth–$17.6 million on a $630 million+ program. The Congressional Budget Office is skeptical, despite the savings claimed by CONNECT for Health Act in both the Senate and House [TTA 12 Feb]. Virtual reality: More insurers are embracing telehealth
A deserved goring of whiz-bang unicorns Theranos and Zenefits (updated)
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/08/1107_unicorn_head_mask_inuse.jpg” thumb_width=”150″ /]A blog posting this Editor wish she had written. Fred Goldstein, who is a consultant to healthcare systems focused on building accountability and improving population health, has pressed a sharp point to the sparkly bubbles surrounding two Silicon Valley billion-dollar valuation darlings, Theranos and Zenefits, on their playing fast and loose with basic regulations.
Some background for our readers. It’s a pile-on with Theranos, which has been stepped on by FDA for their nanotainers [TTA 20 Nov 15], then whacked by the Centers for Medicare and Medicaid Services (CMS) last month for ‘deficient practices’ at their California testing lab (a remedial plan has been filed this week) and likely losing its lucrative Walgreens Boots deal if problems aren’t fixed in 30 days (having already lost its program with Capital Blue Cross in the Harrisburg area of Pennsylvania). According to Bloomberg, its proprietary testing is now used in only 1 of every 200 tests. Zenefits claims to be the ‘first modern benefits broker’ with cloud-based software designed to simplify and automate such HR tasks as health insurance signups for small businesses, but its software that facilitated skating around required licensure requirements by its staff got its CEO forced out by a key investor, Andreessen Horowitz. (And it gets worse…read on….)
It’s so…whiz-bang! (Updated) Your Editors, past and present, have made hash (corned beef and otherwise) of companies promising revolutions in healthcare since our inception. ‘Whiz bang’ (more…)
A Hollywood ending? Medical center’s $17,000 ransom to recover systems from hack attack
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”150″ /]‘Hollywood’ Hulk Hogan is getting a workout! (UPDATED)
Hollywood Presbyterian Medical Center paid $17,000 (40 bitcoins) last night to hackers to regain control of its IT systems after last week’s ‘ransomware’ attack forced them offline. According to CEO Allen Stefanek, “The quickest and most efficient way to restore our systems and administrative functions was to pay the ransom and obtain the decryption key.” HealthcareITNews has the details and the full CEO letter/press release, including that no patient or employee information appears to have been compromised.
Obviously there will be more to follow including the usual opining, but in this resolution and spin, a bad precedent has been set in this Editor’s view. Labeling it a ‘low-tech’ attack shines a Klieg light (this is Hollywood after all) on the vulnerability of this hospital’s system. They now have the decryption key to the malware, but what other bad code and general mischief is buried in their systems to crop up later? Another question: was the inflated bitcoin number floated to make the paid ransom seem ‘affordable’? Is this a Hollywood ending where all is happy, or is this an episode in the continuing soap opera of ‘Hospital as Cash Machine’?
Our original article follows: (more…)
Cybathlon: six ‘great races’ challenging assistive technologies
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/160215-bike-768×463.jpg” thumb_width=”200″ /]ETH Zurich – The Swiss Federal Institute of Technology in Zurich, Switzerland–is challenging developers to a one-day Olympic-style competition using assistive technologies to navigate athletic tasks. The races, staged with ‘pilot’ athletes, test the advanced abilities of powered exoskeletons, powered arm prostheses, powered leg prostheses, brain controlled computer games, powered wheelchairs and muscle-stimulated electrical bikes (left, from last year’s competition rehearsal). The end result is to promote and showcase technologies which will be useful for the daily lives of persons with motor disabilities. The event will take place on 8 October at the Swiss Arena in Kloten, Zurich; ETH is also planning a symposium for researchers two days before the competition. ETF website, Medical News Today, GeekWire. Hat tip to Toni Bunting, TTA’s former Northern Ireland/TANN Ireland Editor.
Broadcast news: an injectable radio
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/injectable-radio.jpg” thumb_width=”150″ /]A possible breakthrough in implantables. How do you shrink a medical device radio enough to make it an injectable, but with a strong enough signal to reach a mobile phone? A team from University of Michigan at Ann Arbor has developed a prototype injectable radio with a tiny (1 mm) antenna (left), with an overall volume of 10 cubic millimeters (1 mm x 1 mm x 10 mm). Its signal can go a distance of 50 centimeters, including through 3 centimeters of tissue. The power source is not continuous, but builds up power over time to send a burst; the power is drawn through a photovoltaic cell sensitive to the ambient infrared light passing through the body. If it can reach production, it can be revolutionary for medical devices like pacemakers in shrinking them, and open doors for more medical implantables. IEEE Spectrum. Hat tip to Toni Bunting, TTA’s former Northern Ireland/TANN Ireland Editor.
London’s Health Technology Forum is looking for a patient treated by precision medicine
The Health Technology Forum needs your help.
For our upcoming panel session on Wednesday 24th February entitled Precision Medicine: From vision to reality, the organiser Mark Bartlett, Geneix’s CEO, is looking for a brave individual who has been treated using a precision medicine technique. This could be having had a test, genetic or otherwise, to understand the root cause of their disease or which medication/chemotherapy would be most appropriate. This is a fantastic opportunity to share your story and motivate an engaged audience, driven to solve healthcare’s most complex problems.
If you are interested please send Mark an email on mark@geneix.com with a short description of your treatment.
Even if you cannot help, do come and join us for what will be a brilliant (free) evening in the company of Mark and his co-host Elizabeth Hampson, Senior Manager (Healthcare Strategy) at Deloitte Consulting, and with Baker Botts’ legendary hospitality to follow.
Seeking input from mHealth stakeholders: 6th Global mHealth App Developer Economics Study
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/r2g-logo-blue.jpg” thumb_width=”150″ /]Research2guidance is inviting stakeholders from across the industry to share their experiences of working with and in mHealth to find out what is proving successful today and what might prove successful in the near future. Last year, over 5,000 industry experts participated in this study for the largest study on the global mHealth market. (TTA was a media partner for last year’s study.)
For the 6th edition of the Global mHealth App Developer Economics study, they are keen to find out:
- Which business models are most effective to succeed in mHealth today?
- Which app categories are most successful in meeting the demands of both patients and investors?
- What does the relationship between Health Insurers and mHealth look like in 2016?
In return they are offering participants:
- The chance to view initial results immediately after completing the survey
- A free copy of the mHealth App Developer Economics 2016 report
Take the survey here.
For anyone who has not read it yet, the excellent 2015 survey is here. (Their key findings from last November are here.) R2G press release
Weekend reading: 2nd WIN Conference papers
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/WIN-logo.jpg” thumb_width=”150″ /]Papers from last month’s WIN Conference (West Midlands Health Informatics Network) held at the University of Warwick have been released. These include keynotes and guest talks, oral presentations, posters and panels. There is a overflowing cup of research here and your interest will determine what papers are outstanding to you. For this Editor, what stood out were:
- The telehealth study on monitoring cancer treatments on chemo and biological therapies using the Bosch Health Buddy; incomplete because Bosch not only terminated support for Health Buddy before the end of the study but also did not provide complete information prior to that (pages 16-17).
- A survey of telehealth standards in North America, Australasia and Europe by Malcolm Fisk on increased flexibility, less top-down and service integration of care (healthcare-social care). (pages 18-19)
- Using a combination of a camera and the Florence (Flo) text messaging service to enable those with mild cognitive impairment/dementia to assist their self-management of memory (page 54).
Link to PDF. Hat tip to Malcolm Fisk via LinkedIn.
Running Wild: hacking now 98% of healthcare data breaches
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”200″ /]This recent study from Silicon Valley-based Bitglass security neatly notes that practically all healthcare data breaches–56 incidents and 111 million records last year–were due to hacking. Only in 2014, 68 percent were due to lost laptops and devices (58 percent calculated in JAMA, TTA 21 Apr 15) in 31 incidents. This corresponds to the Verizon finding of the risk level present in healthcare IT wherever health information is resident [TTA 10 Nov 15]. Certainly the huge breaches of 2015 (Anthem, Premera Blue Cross, Excellus Blue Cross, CareFirst) set the pace, but according to the Health IT Security article, even if the top six breaches were excluded, hacking would still be #1. Hat tip to Dr Stuart Hochron of PracticeUnite via LinkedIn.
Related: the full Verizon Data Breach Investigations Report (DBIR) for 2015 is available here.
CONNECT bill aims to extend telehealth in Medicare, save $1.8 bn over 10 years
Can it succeed where others have stalled? The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (S. 2484–whew!), introduced last week and sponsored by Brian Schatz (D-HI) and co-sponsored by five US Senators (split equally between Republicans and Democrats), seeks to expand Medicare coverage of telehealth, including remote patient monitoring and store-and-forward asynchronous data transfer beyond the presently limited rural health and chronic care/transitional care management codes. The main areas included are:
- Create a program to help providers meet the goals of the Medicare Access and CHIP Reauthorization Act and the Merit-based Incentive Payment System through the use of telehealth and remote patient monitoring (RPM)
- Expand the use of RPM for certain patients with chronic conditions
- Increase telehealth and RPM services in community health centers and rural health clinics; and
- Make telehealth and RPM basic benefits in Medicare Advantage.
The $1.8 bn savings over 10 years is an estimate generated by Avalere on the top three bullets alone, according to the Senators sponsoring the bill.
There is a companion House bill (HR 4442) , also with bipartisan sponsorship, sponsored by Diane Black (R-TN) and co-sponsored by Peter Welch (D-VT), and Gregg Harper (R-MS). But this version has a full roster of support starting with the usual suspects among association (ATA and HIMSS), payers and telehealth providers, but also from other less usual supporters such as the Health Care Chaplaincy Network, Universities of Mississippi and Pittsburgh Medical Centers, the Evangelical Good Samaritan Society and the Federation of State Medical Boards (FSMB).
Rep. Harper has also brought forth for two sessions the Telehealth Enhancement Act, which has never emerged from various committees [TTA 29 May 15]. In addition, Rep. Doris Matsui’s (D-CA) Telehealth Modernization Act of 2015 has had the same fate.
Both Senate and House bills are given by GovTrack a 1-2 percent chance of passage in an election year, so don’t bet on telehealth expansion any time soon. But the rare convergence of bipartisanship and Senate/House coordination gives one hope. HealthITOutcomes, HealthcareITNews, Sen. Thune release, Sen. Schatz summary
Spuble’s near instant speech bubbles on your iPhone
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/Spuble.jpg” thumb_width=”300″ /]Your TEC ‘charmer’ to end the week–technology enabled communication. Spuble (rhymes with ‘bubble’) is a new UK-developed app that translates speech almost instantly into large, easy to read cartoon-like subtitles on an iPad or iPhone. It uses the audio mic feature to create a large type ‘speech bubble’ to show to the listener. Gary Rolf’s impetus for it was to bring his 90 year old nan, Bett, ‘back in the conversation’ after nearly 10 years of being isolated with total hearing loss. The video on their website shows Mr Rolf with Bob, his granddad, using the app which was inspired by the subtitles on television’s ‘Coronation Street’. The simplicity of use is demonstrated in that Bob, aged a lively 96 and hardly a techie, uses it quite readily to communicate with Bett. If you have a family member (as I do and have had) with hearing loss, this can be a tool to bridge the hearing gap, especially in noisy settings or when the hearing aids chew up yet another battery and become expensive earplugs. This Editor was all set to install but (for her disappointingly) it’s not available for Android yet. Both that and multiple languages on the way according to the website. You’ll also be charmed by the video with the WWII anthem ‘We’ll Meet Again’ in the background and the very lively Bett and Bob, who enjoy their Guinness, with their inventive grandson. A small quibble–can it handle more than one speaker, and how well? Also KentOnline Hat tip to Editor Emeritus and Founder Steve.
Fitness trackers, mobile apps shown to leak sensitive data
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/09/band1.jpg” thumb_width=”150″ /]An unnerving 35-page report published by Canadian nonprofit OpenEffect, assisted by the Citizen Lab at the Munk School of Global Affairs, University of Toronto, claims that leading fitness trackers and their corresponding mobile apps are veritable sieves of personal data, inviting security breaches. Where Hackermania Runs Wild starts with lack of Bluetooth LE privacy, allowing tracking via Bluetooth even when the tracker isn’t paired to a smartphone. Then many of the companion apps leaked login credentials, transmitted activity tracking information in a way that allowed interception or tampering, or allowed users (or others) to insert false activity tracking information. The trackers studied were the Basis Peak, Fitbit Charge HR, Garmin Vivosmart, Jawbone Up 2, Mio Fuse, Withings Pulse O2 and Xiaomi Mi Band. Notably the Apple Watch 2.0 was secure. The full report is titled dramatically “Every Step you Fake: A Comparative Analysis of Fitness Tracker Privacy and Security”. Security article, study in PDF, TheStar.com. Hat tip once again to Toni Bunting, former Northern Ireland Contributing Editor.
Older adults anticipate their relationships with ‘helper’ robots: study
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/Penn-State.png” thumb_width=”150″ /]How older adults (65+) respond to the idea of ‘helper robots’ which may be a part of their future lives span a wide range. The key seems to be that they are ‘most advanced, yet acceptable’ (designer Raymond Loewy’s MAYA dictum) when they perform passive ‘physical, informational and interactional’ tasks–‘helpers and butlers’ in the researchers’ terms. Robots which kick it up a notch and are more autonomous, making its own decisions without direction, are far less acceptable and perceived as ‘robot masters’. “Seniors do not mind having robots as companions, but they worry about the potential loss of control over social order to robots.” That is a leap that goes forward, in the lead researcher’s terms, to how the media has portrayed robots as shaping older adults’ perceptions. A team from Penn State University’s Media Effects Research Laboratory surveyed 45 older adults — between ages 65 and 95 years old — at a senior citizens’ center in Pennsylvania. Published in the Interaction Studies journal. Penn State News Hat tip to our former Northern Ireland Contributing Editor Toni Bunting. On the other end of the age spectrum, an earlier study by the same lead researcher noted that older people were quite concerned about the effects of robots on young people and the desire for parental controls, lest the robots might encourage laziness and dependency. Penn State News (2014)
The evolution of Facebook: implications for social health
The Telegraph’s recent retrospective on Facebook and its evolution from 2004’s ‘Thefacebook’ of Harvard University students to the Facebook that many of us use now, with Chat, timeline and a converged mobile and desktop design, led reader Mike Clark to drop Editor Charles a line about how healthcare isn’t maximizing social media and internet-based innovation. Recent studies have indicated that these social patient communities benefit their members. Agreed, but there are increasing qualifications–and qualms.
Back in 2014, Facebook made some noises on forming its own online health communities, a move that was widely derided as Facebook monetizing yet another slice of personal (health) data from users. While Charles has made the excellent point that “almost all good health apps are essentially the tailored interface to an internet service that sits behind it, a fact often forgotten by commentators”, Editor Donna on her side of the Atlantic has seen concerns mount on privacy, security and the stealthy commercialization/monetization of many popular online patient support groups (OSGs) which Carolyn Thomas (‘The Heart Sister’) skewers here, excepting those with solid non-profit firewalling (academic, government, clinical). Example she gives: Patients Like Me, which markets health data gathered from members to companies developing products to sell to patients. How many members, with a disease or chronic condition on their mind, will browse through to this page that says in part: “Except for the restricted personal information you entered when registering for the site, you should expect that every piece of information you submit (even if it is not currently displayed) may be shared with our partners and any member of PatientsLikeMe, including other patients.”
We’ve also noted that genomics data may not be sufficiently de-identified so that it can’t be matched through inference [TTA 31 Oct 15], with the potential for sale. And of course Hackermania Running Wild continues (see here).
For now general information sites like WebMD and personalized reference sites such as Medivisor feel more secure to users, as well as small non-commercialized OSGs and ‘closed’ telehealth/telemedicine systems.
Mississippi to get VA telemed pilot amid controversy
Mississippi has led the way in telemedicine projects in southern USA for some time with the University of Mississippi Medical Center’s various successful projects [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/10/Dept-of-VA-logo.jpg” thumb_width=”150″ /]attracting well deserved funding. Now the US Secretary of Veteran’s Affairs has announced that a new pilot programme to use telemedicine to reduce wait times for new patients at VA hospitals will take place in Mississippi.
This pilot programme comes in the wake of the highly criticised wait times reported for new patients at VA hospitals in 2014. A CNN report based on internal VA documents claimed that thousands of veterans had to wait more than three months to see a specialist.
IBM automates diagnostic image analysis
“Most smart software in use today specialises on one type of data, be that interpreting text or guessing at the content [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/02/Avicenna.jpg” thumb_width=”150″ /]of photos. Software in development at IBM has to do all that at once. It’s in training to become a radiologist’s assistant” writes Tom Simonite in MIT Technology Review.
According to Simonite, the IBM software, named Avicenna, analyses diagnostic images like CT scans and the associated data such as a patient’s medical record and suggests possible diagnoses.
An example quoted was the case of a 28-year old with shortness of breath whose pulmonary angiogram images and medical history were analysed by the software. Using a family history which showed a tendency to form blood clots the software diagnosed a pulmonary embolism which was the same diagnosis an independent radiologist reached.
Simonite reports that IBM have thus far used annonymised data and are now working on commercialising the software although an independent researcher is quoted as saying that the accuracy needs to be increased before it would be a useful diagnostic tool.
Read the full article here.
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