How technology can help fight elder abuse–ethically

September 9, 2015 | by

The increasing awareness of abuse of older people by their caregivers, whether at home or in care homes/assisted living/nursing homes, invites discussion of the role that technology can play. This presentation by Malcolm J. Fisk, PhD, co-director of the Age Research Centre of Coventry University, in the BSG Ageing Bites series on YouTube looks at technologies viewed by level of control and intrusiveness:

  • Social alarms, which include pull cords (nurse call) and PERS–what we think of as ‘1st generation’ telecare: high level of control, low intrusiveness–but often useless if not reachable in emergency
  • Activity monitoring, which can be room sensor-based or wearable (the 2nd generation): less control, slightly more intrusive–also dependent on monitoring and subject to false positives/negatives
  • Audio and video monitoring, while achieving greater security, are largely uncontrolled by the older person and highly intrusive to the point of unacceptability. (In fact, some feedback on tablet-based telehealth devices indicates that a built-in camera, even if not activated, can be regarded with suspicion and trigger unwanted reactions.)

The issues of consent, and balancing the value of autonomy and privacy versus factors such as cognitive impairment, personal safety and, this Editor would add, detecting attacks by strangers and not caregivers, are explored here. How do we ethically observe yet respect individual privacy? This leads to a set of seven principles Dr Fisk has published on guiding the use of surveillance technologies within care homes in the latest issue of Emerald|Insight (unfortunately abstract access only) Video 11:03. Hat tip to Malcolm Fisk via Twitter.

A Plum European app report

September 6, 2015 | by

plum logoFor a pleasant change, thanks to Prof Mike Short, we can share an excellent report on the app business in Europe with readers without explaining that to access it costs gadzillions. The Plum App Report gives a very level-headed yet exciting description of how apps are changing Europe and hints at some very exciting potential savings to realise from health apps, and elsewhere.

Accelerated Access Review – my blog

September 6, 2015 | by

As a member of the Stakeholder Reference Group of the Accelerated Access Review, this editor was recently invited to write a blog to encourage contributions to the review, the purpose of which is to identify actions necessary to accelerate the uptake of innovation into the NHS. It seemed a shame for the blog also not to be shared with TelecareAware readers, so here it is:

The Digital Health & Care Alliance (DHACA), of which I am Managing Director, has a strong interest in the success of the Accelerated Access Review, both because the majority of our 550-odd members work in SMEs whose very existence depends on the responsiveness of the health & care organisations in the UK, and because all of our members have a strong interest in improving patient outcomes & treatment efficiency.

One thing I’m going to be very interested in seeing emerge from the Review is the consensus on how innovators gather and use evidence to develop their product to meet the demands of the NHS and needs of patients. In DHACA we think we have a fairly clear idea about how our members go about this, however we can only claim to represent the digital health stream in the Review, and then only for small organisations. Allied to this is the much tougher question for many, particularly our smaller and more innovative members, of how to sell to the NHS. (more…)

What it takes to make telehealth really work

September 6, 2015 | by

In line with my fellow editor, forgive this editor engaging in a little nostalgia – going back to 2006, when the Whole System Demonstrator was a still a wonderful idea, before the competing forces of academia and management consultancy put short-term financial gain before long term patient outcome improvement. Those were the days when we genuinely believed that recording vital signs was what it was all about.

Move on nine years and it’s clear from the American Heart Association review referred to in this column recently, and subsequent articles, that one key success factor is drip-fed education. To quote:

“The amount of information that must be conveyed and the support that is necessary to counsel and motivate individuals to engage in behaviors to prevent CVD are far beyond what can be accomplished in the context of face-to-face clinical consultations or through traditional channels such as patient education leaflets,” the researchers say. “Mobile technologies have the potential to overcome these limitations and to transform the delivery of health-related messages and ongoing interventions targeting behavior change.”

This is underlined by a recent study of attempting to control hypertension using just text messaging, which was far from an unqualified success.

Another major driver of course is cost saving, as demonstrated by (more…)

NHS Expo & Testbeds – another view

September 6, 2015 | by

This year this editor went to NHS Expo in Manchester primarily to advise a US company, Humetrix, over the two day period, so got to see proceedings through a different lens.

Overall the event seemed to be much better attended than last year, in spite of the proximity to the Bank Holiday. Whereas last year the Future Care Zone was virtually deserted by both exhibitors and visitors, this year’s New Care Models Zone was buzzing. The Digital Zone was a particular attraction with some excellent talks, and the opportunity to meet many key people working in this area.

On the stage, the politicians painted their visions and senior health & care directors explained how these were to become a reality. This week’s NHS Networks blog, a perennial favourite of this editor, commenting on comparative performances, described Tim Kelsey as “more digital even than Mr Hunt but less binary”(reminiscent of Iain Banks’ description of lawyer LL Blawke in The Crow Road as “pencil-thin and nearly as leaden”). Of particular concern to this editor’s interests was the response to Jeremy Hunt’s commitment to enabling everyone to be able to access their detailed medical record in 2016, (more…)

Telehealth patient engagement program improves orthopedic outcomes

September 5, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/09/orthocare_06.png” thumb_width=”150″ /]VOX Telehealth‘s patient engagement program with Bon Secours St. Mary’s Hospital in Richmond, Virginia, which was announced back in January [TTA 12 Jan], published results for its pilot last month, and they appear to be outstanding. VOX’s model is ‘episode of care’, over a 90-120 day span starting 30 days prior to surgery to 60-90 days post-procedure; the online/tablet platform delivers educational content, reminders and notes on potential symptoms that ties into a customizable by patient alert escalation and notification system. The goal is to reduce post-discharge complications and readmissions, in this case for hip and knee replacement patients, through managing expectations and better preparation by the patient. And the results reported are encouraging:

  • 92 percent of enrolled patients were discharged directly to home–the US average is only 30 percent
  • Length of stay dropped to 1.6 days, nearly 50 percent lower than the US average of 3.7 days. It is lower than Bon Secours’ average of two days.
  • There were 0 readmissions after 30 days, compared to the US average of 6 percent
  • Patient satisfaction was also high: (more…)

‘Frontiers Innovators’ need apply by 11 Sept (UK)

September 3, 2015 | by

As Editor Charles mentioned last month in his autumn roundup, if you would like to be considered for the Wellcome Trust’s ‘Frontiers Innovators’ program, the deadline to apply is 11 September. Ten spots are open to early-career researchers, entrepreneurs, technology developers, healthcare professionals and representatives from the pharmaceutical and medical technology industry. If selected, you will travel and accommodation to attend the ‘Digital Phenotypes – Health research in the digital age?’ meeting on 5-6 November in London, which will explore the research potential of digital health data captured outside of normal healthcare settings. More information on the meeting is here. For ‘Frontiers Innovators’, to apply, send your CV and a video message to d.phenotypes-innovators@wellcome.ac.uk by 11 September 2015.

Avoiding the FDA health IT-medical device regulatory trap for general IT companies (US)

September 1, 2015 | by

If you are an IT company in the US or internationally with services which could be useful to healthcare companies or practitioners, it’s easy to be overly specific and stray into FDA-regulated territory. The always-informative Bradley Merrill Thompson of the Epstein Becker Green law firm delineates the fine regulatory line that general purpose IT companies must observe when working with healthcare customers. First there is intended use, based on how the manufacturer intends its customer to use the product; if the customer uses it for the diagnosis or treatment of disease or other conditions, FDA will regulate it as a medical device. This is less clear than it seems, and Mr Thompson explores where a general IT company can, in the old PR adage, ‘say it safely’ and avoid falling into the unwanted medical device trap by avoiding medical feature and advice claims, and keeping the context away from medical use. The Journal of mHealth (August)–online version, optional PDF download. Hat tip to Mr Thompson via the Continua LinkedIn group. Other articles of interest in the JMH are: Scottish company HCi Viocare and its ‘smart insole’ pressure sensors for foot ulcer detection following, Northwestern University’s research around patterns of smartphone usage detecting depression (page 19) and a lengthy article on transforming patient data into actionable insights (page 34).

CVS puts a retail triple spin on telemedicine

September 1, 2015 | by

A definite boost to telemedicine providers American Well, now-publicly traded Teladoc and Doctor on Demand is retail drugstore CVS Health piloting their services through CVS MinuteClinics, starting in 2016. CVS’ release is disappointingly heavy on company quotations, light on specifics, but what can be determined is that CVS will test various arrangements, including onsite telemedicine in stores, through CVS ‘digital properties’ (presumably online or through apps) and MinuteClinic provider consults with telemedicine provider doctors. It carefully avoids referring to the three companies as ‘partnerships’ though it generically refers to them deep in the release. CVS currently has 1,000 MinuteClinic locations in 32 states and plan to grow by 50 percent by 2017; they have been testing telemedicine in about 50 clinics in Texas and California.

Annoyingly, both CVS and the three companies improperly use ‘telehealth’ in describing their services when correctly they provide only doctor-patient video consults, or telemedicine. The clinic providers (or individuals) may be reporting vital signs data as part of the visit, but tools are not integrated. Equally annoying is CVS, in the release and in conferences, citing a paywalled study (at the not inconsiderable sum of $39.95 / €34.95 / £29.95!) in the Journal of General Internal Medicine (JGIM) of their results. If you are touting that “95 percent of patients were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care.” –well, with results like that, make some arrangements and grant access to the study! CVS release, Medscape, FierceHealthIT

Alphabet action versus diabetes with Life Sciences’ contact lens and Sanofi

September 1, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/03/google-contacts_1401174_616.jpg” thumb_width=”150″ /] Monday’s Big Story. As previously reported [TTA 25 Aug], the new Google holding company Alphabet is bringing the Life Sciences group formerly under Google X into its own company, with a new name TBD. On Monday, Life Sciences and Paris-based pharma Sanofi announced a partnership on projects related to diabetes monitoring and treatment. According to BioSpace, “at least part of the partnership will be focusing on helping Life Sciences create small, Internet-based devices that either automatically adjust insulin levels, or make suggestions based on real-time monitoring. ”

Clearly Life Sciences’ raison d’etre includes a focus on this disease, others that may relate to it, and in developing devices that others may market. Your Editors have been tracking their research for well over a year. A roundup of Life Sciences’ partnerships include more than diabetes:

**Novartis division Alcon for the glucose sensing contact lens [TTA 17 July 14, patent report 27 Mar 15 ]

** DexCom to develop a Band-Aid sized wearable for glucose monitoring, announced 15 August

**A 10 year deal with Abbvie for age-related disease exploration (which relates to the accelerated aging associated with diabetes)

**Biogen for multiple sclerosis (MS) treatments

We continue to have doubts about the practicality of the contact lens and the viability of embedded sensors in lenses, as the eyes are extremely sensitive and especially vulnerable for those with diabetes. But directionally on this disease, which is expanding almost uncontrollably worldwide, the research and devices which Life Sciences can develop for a variety of companies looks promising. Business Insider, Re/Code, Digital Trends

A trip back in time to telecare, circa 2009–and maybe the future

August 29, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/08/Cape-May-Point-fade-to-dark.jpg” thumb_width=”150″ /]As the season winds down, our thoughts turn backwards. Your Editor remembers Jersey Shore vacations, travel, great airshows, collector car shows, old friends and good times. She also remembers When Telecare Was New (2006-9) with Living Independently Group (now Care Innovations), helping to pioneer the QuietCare system in senior housing. At that time, universities like Virginia and Florida were on the cutting edge in developing smart homes and pioneering systems for monitoring health in older adults and the disabled. Those smart homes and research initiatives vanished years ago, replaced by incubators, accelerators, the size of your funding round, Big Data, wearables, IoT….

Sigh. Your Editor is in Error. The University of Missouri is still at it 12 years later with its sensor-based behavioral/activity/proactive care system in the Tiger Place assisted living community near Columbia. And it seems much the same: bed and residential motion sensors, fall detection tracked by a variety of sensors, gait analysis and analysis of activity changes (changes in behavior=changes in health, which still doesn’t excite those in senior care the way it should) . You have to admire the persistence of vision the founders/researchers have had (Marilyn Rantz, professor emeritus with the School of Nursing, and Marjorie Skubic, a professor with MU’s College of Engineering). Their research model has now spread to 13 communities and hospitals in Missouri, and they are commercializing it with a former student, George Chronis, with Foresite Healthcare to convert it into a reliable, robust assisted living/hospital monitoring/care transition system with a simpler, affordable ‘health at home’ version. Besides the nostalgia and supporting fellow ‘true believers’, what they have designed is still needed AND not achieved by RFID (a big fizzle) or ancient PERS. We can all wish them luck in a competitive and much changed market. MU researchers taking sensor system from lab to marketplace (Columbia Daily Tribune)

Previously in TTA: Quantifying early detection capabilities of telecare (July 2012) and Editor Steve’s first look in October 2009 at ‘magic carpet falls’.

Telemedicine, telehealth underutilized in pediatric care

August 28, 2015 | by

In focusing on older adults on Medicare and secondarily the disabled, the use of telemedicine and telehealth is being overlooked for chronically ill children, especially those living at distance from specialized care. Children’s hospitals Many of these seriously ill children are either covered by parents’ employer plans or, if the family is low income, state Medicaid programs. This interview with Andrey Ostrovsky, MD, an attending physician at Children’s National Medical Center in Washington DC, notes the lack of incentive for innovative care which could utilize healthcare technology profitably. There is also a Medicaid waiver approval for telehealth reimbursement used for older person care, called the 1915(c) waiver for home-based and community services, which can be used for children. FierceHealthIT

Is the fitness tracker eventually going to lose to the smartwatch? (Updated)

August 28, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/08/LG-Urbane.png” thumb_width=”150″ /][grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/08/fitbit-charge.jpg” thumb_width=”150″ /]Which one would you prefer? 

The interest in fitness bands has quantifiably and substantially diminished since January, according to Argus Insights’ survey of online consumer reviews (!)–and since the debut of Apple Watch. And while Fitbit maintains its leadership in the band category (sorry Jawbone, though Editor Charles won’t be), the rising preference is for smartwatches like the Apple Watch and Android wear such as the Moto 360 and the LG Watch Urbane (pictured). While there’s a substantial price difference between smartwatches (~$350 versus under $150), and both Apple Watch and LG’s watches (versus LG bands) have limited fitness capability, there’s few new developments in fitness bands to create excitement. There have been enough problems with fitness band reliability, breakage, rising prices and a boredom with design to diminish interest while new brands enter the market, and smartwatch prices come down slightly. For the price, users also want more out of their watches. Neil Versel in MedCityNews.

Updated: Apple Watch, with 3.6 million units sold in 2nd quarter was immediately behind Fitbit with 4.4 million, according to IDC’s Worldwide Quarterly Wearable Device Tracker. 2 of every 3 smart wearables (capable of running third-party apps) was an Apple Watch. Another sign of the coming divide between fitness bands (which will be sold on price and fitness focus) and smartwatches (which will be sold on versatility as well as fitness justifying the higher price).  IDC release

Also by Mr Versel is a memorial to telemedicine pioneer  Dr ‘Red’ Duke. As a surgical resident at Parkland Hospital, he was on the team which saved the life of Texas Governor John Connally, shot with President John Kennedy in November 1963.

Integrating inexpensive lab testing, imaging to EHR–and vice versa

August 28, 2015 | by

In the Dr Eric Topol patient-driven world, personal lab testing would be walk in, keep retail hours and not even need a doctor’s order. That is the model for Theranos, a well-funded low cost blood testing company operating 43 centers in California, Arizona (no doctor order needed) and one Pennsylvania Walgreens. Their latest alliance is with EHR physician practice giant Practice Fusion, which claims about 112,000 doctors actively using its cloud-based, ad supported platform, claims to be the fastest growing US EHR with at present 100 million patient records. The Theranos reporting app, which also connects patients with doctors who can help interpret the results (MD Connect) integrates with other EHRs (though not listed) and now the results will also show in their Practice Fusion patient record. Practice Fusion is also integrating imaging center RadNet‘s results.

Since the late 2000s, Practice Fusion has historically been the game changer in cost (one of the first in the cloud) and in catering to smaller practices. They are good at managing their hype, but as Neil Versel points out, there’s been a CEO ‘change-lobsters-and-dance’, there are questions about revenue and their awaited IPO seems far away, especially given the recent market upset. Hospital EHRs Cerner, Epic and NextGen now all have lower-cost practice versions that integrate with hospital versions. An American College of Physicians (ACP) 2014 survey identified that Practice Fusion is third (and tied with others) among most used practice EHRs behind Epic and eClinical Works, though strongest in solo practices. On the polar opposite of Mr Versel’s skeptical article is this breathless Forbes piece which confuses partnerships with acquisitions. Perhaps self-made billionaire Theranos CEO Elizabeth Holmes may decide to buy Practice Fusion!

Two events of interest, especially to digital health entrepreneurs

August 26, 2015 | by

Prof Mike Short has drawn my attention to two events taking place in October:

‘The cupboard is bare: how technology can address key unmet needs in mental health’ – Cambridge Wireless Healthcare SIG event – this half day Cambridge event om 13th October, hosted by Philips Research Laboratories and jointly sponsored by TTP and Plextek, will explore the needs from the perspective of the healthcare professional and patient. More details here; book here.

6th Discovering Start-Ups Competition – a brilliant opportunity to win some really valuable prizes to get your start-up really started up, pitching to an elite panel of business leaders from Deloitte, Google, BT, IBM, Cambridge Angels, London Business Angels, Qualcomm Ventures, Samsung and more. Finals will be held at Deloittes in London on 21st October. Note entries have to be submitted by 14th September at the latest.

 

Apps and wearables – developments over the summer

August 26, 2015 | by

Trying at least temporarily to distract this editor’s attention from his recent unfortunate experience with Jawbone technology, here are some interesting app and wearables snippets received over the summer.

We begin with news of the first CE certified mole checking app, SkinVision which rates moles using a simple traffic light system (using a red, orange or green risk rating). The app lets users store photos in multiple folders so they can track different moles over time. It aims to detect changing moles (color, size, symmetry etc.) that are a clear sign that something is wrong and that the person should visit a doctor immediately.

This contrasts with the findings of a paper published in June examining 46 insulin calculator apps, 45 of which were found to contain material problems, resulting in the conclusion that :”The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control.”, which to say the least of matters is worrying. (more…)