NYeC Digital Health: two diverging visions of a connected future (Part 1)

December 5, 2014 | by | 2 Comments

The New York eHealth Collaborative’s fourth annual Digital Health Conference is increasingly notable for combining both local concerns (NYeC is one of the key coordinators of health IT for the state) and nationally significant content. A major focus of the individual sessions was data in all flavors: big, international, private, shared and ethically used. Another was using this data in coordinating care and empowering patients. Your Editor will focus on this as reflected in sessions she attended, along with thoughts by our two guest contributors, in Part 2 of this roundup.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/12/Topol-Compressed.jpg” thumb_width=”150″ /]The NYeC Conference was unique in presenting two divergent views of ‘Future IT’ and how it will affect healthcare delivery. One is a heady, optimistic one of powerful patients taking control of their healthcare, personalized ‘democratized medicine” and innovative, genetically-powered ‘on demand medicine’. The other is a future of top-down, regulated, cost-controlled, analyzed and constrained healthcare from top to bottom, with emphasis on standardizing procedures for doctors and hospitals, plus patient compliance.

 

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/12/Topol-tech-adoption-compressed.jpg” thumb_width=”150″ /]First to Dr Topol in Monday’s keynote. The good side of people ‘wired’ to their phones is that it is symptomatic, not of Short Attention Span Theatre, but of Moore’s Law–the time technology is now taking for adoption by at least 25 percent of the US population is declining by about 50 percent. That means comfort with the eight drivers he itemizes for democratizing medicine and empowering the patient: sensors, labs, imaging, physical examination, records, costs, meds and ‘Uber Doc’.

(more…)

Data streams of the future analyzed at NYeC Digital Health

December 5, 2014 | by

Guest columnist Sarianne Gruber (@subtleimpact) also attended the NYeC Digital Health Conference and reflects on what to do with all that data patients and devices are generating–a natural for her as she is a consultant in data analytics for Encore Health Resources. 

The New York eHealth Collaborative hosted its fourth annual Digital Health Conference at New York City’s Chelsea Piers on November 17 and 18. There I was joined by 850 health-related professionals to listen, engage and see how life science meets digital technology. No doubt we have become a digital culture. Even seated on an airplane, I noticed the gentleman next to me wearing a Fitbit, and we strike up a conversation on step and sleep data and our dislike of the new dashboard. At the conference, Keynote Speaker Dr. Eric Topol, a Cleveland Clinic cardiologist and a leading practitioner of digital medicine, shared with us his thoughts on what it means be a part of this digital revolution as a patient and a doctor. Technology changes the scope of individual care. Advances in genomics now gives us answers based on our DNA that will genetically determine the success of medications and treatments. Epigenomics, a molecular diagnostics company, can prescreen an unborn baby of a mother with cancer with a simple blood test, sequencing the DNA, to manage her therapy. I was fascinated to hear that a genomic signal sensor can detect heart attacks and warn you of this possibly fatal event, and that necklace for heart failure patients can monitor fluid status averting repeated readmissions for these patients. Dr. Topol believes that digitized 24/7 patient health data will shift the patient–doctor relationship. Bringing in your self-monitored data, eliminates “the how are you feeling questions” and instead the doctor can confirm diagnosis and start treating the patient. “Patient owning data is a foreign concept and the digital revolution ushered this in.“ (more…)

Swasthya Slate: the Indian tricorder?

December 2, 2014 | by | 1 Comment
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/12/Swat-Slate-devices2.png” thumb_width=”150″ /]Just coming to this Editor’s attention — and wondering why it hasn’t received more — is the Swasthya Slate, a diagnostic tablet pre-loaded with 33 diagnostic tests, procedural apps and diagnostic devices for health workers who have basic medical training. It was developed by an Indian startup  headed by a former member of Arizona State University’s department of biomedical informatics, Kanav Kahol. He returned home to New Delhi three years ago frustrated in his desire to develop an inexpensive, simplified diagnostic tablet for use in remote areas, using the same sensors that far more complex devices used. The ruggedized tablet, in addition to the pre-loaded tests and artificial intelligence-based apps, incorporates a four-lead ECG, medical thermometer, water-quality meter, heart-rate monitor, 12-lead ECG and sensors for blood pressure, blood sugar, heart rate, blood haemoglobin, urine protein and glucose. (more…)

Why a smartwatch may feel…de trop

December 2, 2014 | by

De trop —French, adjective, meaning too much, too many, unwanted

Have you noticed that many early adopters have skipped smartwatches? Other wearables such as fitness trackers have taken their place successively on the wrists of your favorite Quantified Selfer or weekend warrior. (A sign: they are now mass market at drug stores like CVS and sports stores for the holiday.) But how many people are looking forward to a special delivery of an Apple Watch, Samsung Gear S or even the well-reviewed and well-priced LG G Watch R in Santa’s pack? Having just returned from the NYeC Digital Health Conference, I saw few on the wrists of DH mavens. Smartwatches (and clothing wearables) also faded out at CES Unveiled [TTA 21 Nov], a complete turnaround from June’s event.

If you’ve been wondering too, you’ll be nodding like a bobblehead at John Nosta’s blog post in Nuvium, The Death of Wearables. (more…)

Soapbox: Why an app isn’t like a book

November 30, 2014 | by

The suggestion has been made recently at a couple of events that this editor attended that there is an unnecessary fuss over regulation of medical apps because they are just like medical books; as there is no regulation of books, why the need to regulate medical apps? . In order to try to move to a consensus, this post puts the opposite point of view, to stimulate debate. In summary the arguments of why they are different are:

  • We are familiar with books and have worked out how to deal with them;
  • Books give formulae and leave users to compute; apps do it all, often without showing their working;
  • Tablets and, especially, smartphones have screens that are smaller than books so require a different design.

This issue of course only relates to serious medical apps – something like 99.5% of all health apps available are very unlikely to do serious harm, helping people as they do record things like their fitness and their weight, and so do not require such detailed scrutiny. It is the ones that get close to, or meet, the test of being a medical device that are of particular interest here. The goal is that once clinicians are comfortable prescribing medical apps, and patients are comfortable using them, the NHS will save substantial sums by, for example replacing drugs with apps for a range of diseases where both are effective and apps are far cheaper. There are also huge benefits for clinician-facing apps – properly certified medical apps like Mersey Burns and Mersey Micro are already massively improving patient outcomes and significantly reducing NHS costs.

In more detail, books have been with us for many centuries so we are familiar with their structure, with the processes for their removal from publication if they give dangerous advice, and with the idea of specialist publications accessible by appropriate experts only – the same is not true of apps. In the event that advice in a book was dangerously wrong, (more…)

TSA Conference a great success (UK)

November 29, 2014 | by | 5 Comments

The two day 2014 TSA conference held at the Celtic Manor proved to be a great success for their new Chief Executive Alyson Bell who masterminded the event.

That this was to be a conference like no other was very apparent from the start when a solo performance from Gracie of the Zimmers opened the conference, followed by a performance by the whole group. Plenary sessions by luminaries in the digital health and care world followed, interspersed by refreshment breaks and a breakout session. Sir Bruce Keogh was sadly unable to attend in person though gave a hugely inspiring talk to camera encouraging all to use technology to deliver better care, more efficiently. (In a show of hands however, responding to a question from the conference chair, Nick Goodwin, the audience did not agree that Sir Bruce’s “fertile permissive environment for technology” was in place).

The other standout of the first afternoon was (more…)

Care Innovations harmonizes and validates

November 25, 2014 | by

Updated 27 November

In what seems to be a repackaging and repositioning of their remote care management/telehealth services, Intel-GE Care Innovations is now orchestrating Health Harmony. It appears on their promotional web page to be a bundling into that latest rave, the care continuum, but also a refreshing of separate systems developed since 2011: for the patient, an in-home tablet hub/portal for monitors and PC-based content portal once known as Connect; and for the clinician or caregiver, what was formerly called the Intel-GE Care Innovations Guide (which succeeded the Intel Health Guide). According to the CI website and press release from earlier this month, Health Harmony is an ‘optimized experience” that promotes collaboration among the patient, family, friends and care professionals and will “organize caregiving tasks, coordinate schedules, track medications, monitor vital signs and crucial health information, and quickly share information.” The release gives the impression of a launch but no information on cutting over current clients to the new system.

Update: A test of the Health Harmony system in a hospital environment to reduce readmissions is underway with liver transplant patients at the University of Cincinnati Medical Center.  The shocking fact is that 50 percent of transplant readmissions occur within seven days of discharge. Instead of being discharged with a booklet and an exam one week later, the patients daily self-monitor vital signs (blood pressure, glucose, temperature), pain level and answer programmed questions. The clinical team reviews their data for 90 days post-discharge and can also do video consults. Currently eight patients are being monitored in the program with up to 20 projected through April 2015. Liver transplant bundled payments are approximately $250,000 with surgery being $180,000 of it, so there is an immediate benefit to the hospital system.

Another interesting development in Roseville, California is the expansion of the CI Validation Institute, announced in June, (more…)

CES Unveiled New York

November 21, 2014 | by

11 November, New York

The annual event that is CES Unveiled in New York City is meant to be a nanoparticle-scale preview of International CES in Las Vegas, 6-9 January.  It’s a smörgåsbord of what used to be called ‘consumer electronics’ and now is all about innovation–a taste of everything from ever-smarter video and audio to sensors, smarter homes with IoT (the cutely named Internet of Things), Big Data, robotics and (drum roll) Digital Health and the Quantified Self (QS). This Editor regrettably missed the opening briefing by Shawn DuBravac, CEA’s Chief Economist and Senior Director of Research which would likely touch on his areas of the innovation economy and disruption along with the other four 2015 trends to watch: big data analytics, immersive entertainment content, robotics and digital health. (CEA helpfully provides the 30-page white paper here.)

The exhibitors at the Metropolitan Pavilion did not fully represent the trends, however. (more…)

Wearables blog – update

November 17, 2014 | by

Since this editors’ piece on wearables four days ago there has been a stream of news about interoperability of various apps, resulting in frequent updates to the original blog, to the point where it was beginning no longer to resemble the original.

Chris Bergstrom of WellDoc has now kindly pointed me to the Mobihealthnews item on Samsung’s digital health partners announcement, and to his company’s specific interoperability announcement with Samsung, enabling activity and other data to be obtained from other Android apps to help those with diabetes to manage their condition better.

WellDoc of course developed the first prescription app – this item from mHealthWatch in turn based on a Telegraph article that suggests that GPs in the UK will shortly be prescribing apps for patients in large quantities. The source of the Telegraph’s intelligence is none other than Personalised Health and Care 2020, the recently published NHS document that we covered extensively yesterday, which was perhaps a tad less optimistic about medical app take-up.

Personalised health & care 2020 – required reading! (UK)

November 16, 2014 | by | 1 Comment

The NHS’s National Information Board (NIB) this week published its long awaited document on its plans for personalising health and social care activities, with a strong England focus. It breaks new ground for such a document in many ways (not least that when you put ‘apps’ or ‘telehealth’ or a myriad of other terms into the search engine, you get many hits!).

Before describing at some length why this editor considers the document to be so important, it is of course important to recognise that there will be an election in six months’ time so both the funding and the priorities of the NHS may well change before it has even got beyond the very first set of commitments. A further point is that, were the NHS to meet all the commitments it has made, even in recent years, it would be a very different organisation to that that it is: commitment do not necessary result in delivery.

The document is subtitled “A framework for action” which is a good description. it contains many individual commitments. However few are are sufficiently (more…)

Friday fun spot (UK)

November 14, 2014 | by

In case any UK reader is unaware of the NHS Networks Editor’s Blog, we just thought we’d draw your attention to this Friday’s excellent example. Every week Julian Patterson comes up with a wonderfully amusing take on some aspect of the NHS; this week’s is particularly good. Sadly the intricacies and absurdities of the UK’s NHS are so great as perhaps to make many of the references incomprehensible to those from overseas (for this week, a working knowledge of the BBC’s internationally-viewed Dr Who series helps as well).

The item is nothing directly to do with telecare or telehealth (where there’s been enough excitement elsewhere this week), although occasionally, if you sign up for the NHS Networks weekly letter, you will catch a useful item on some aspect of digital health…as well as not missing next week’s Editor’s Blog.

Are wearables starting to deliver?

November 13, 2014 | by

If you caught the recent Wired article entitled Wearables Are Totally Failing the People Who Need Them Most, you may have felt a sense of deep depression that a sector growing as strongly as it is is apparently delivering so little real health benefit (you may also be depressed to see the world of apps developers described as “From Silicon Valley and San Francisco to Austin and MIT…” although remember the North American-based Major League Baseball is called the World Series). The thrust of the article is that young people are developing wearables for people like them, who are then stopping using them within a few months, whereas those with long term conditions (LTCs) who are not the target customers are actually the ones using wearables consistently. As they say: (more…)

New TSA Chief Executive appointed shortly before their conference begins (UK)

November 13, 2014 | by | 2 Comments

The TSA has provided us with the following announcement this morning:

“TSA GEARS UP FOR EVOLVING SECTOR WITH NEW LEADERSHIP

Telecare Services Association is excited to announce that Alyson Bell will be taking over leadership of the industry body, as part of radical changes to lead, represent and promote the evolving sector.

After 4 and a half years of leading TSA, its current Chief Executive Trevor Single, will be leaving to pursue other opportunities. Trevor commented: “The organisation (more…)

Reforms, restructuring at Veterans Affairs announced (US)

November 13, 2014 | by

A new Secretary, but the same old process? New Secretary of Veterans Affairs (VA) Robert McDonald is quickly finding out that cleaning house at a government agency is not quite as straightforward as at Procter & Gamble, where he had been CEO. Since being confirmed by the Senate in late July, he has had to fight the fires of multiple scandals, beginning with the Phoenix VA ‘secret’ veterans care wait list leading to uncovering disastrous delays in care at VA regions across the nation. As of this week, and convincingly timed around Veterans Day, McDonald announced a reorganization of the VA to the Washington Post–a restructuring of the VA around the creation of:

  • A new customer service organization across the entire VA, headed by a “chief customer service officer” reporting to McDonald
  • A standardized regional framework meant to streamline partnering and coordination
  • Realignment of internal business processes into a shared services models to improve efficiency, reduce cost and increase productivity
  • Collaboration with partners to create a national network of Community Veteran Advisory Councils

Heads are rolling, but slowly. There are pending disciplinary actions affecting at least 35 employees and perhaps as many as 1,000 employees upcoming. (more…)

Short-shorts for an autumn Friday

November 13, 2014 | by

As we in the US get our first, much too early blast of Polar Vortex this season with New York area temperatures dipping into the 30s F with a snow alert tonight, we should reminisce about what seems only a few weeks ago when the keyword was ‘short’….

Coming up short in the data breach this past Monday was Anthem Blue Cross of California with their TMI emailer–containing in the subject line specific targeting/sorting patient information that direct marketers love, but don’t want you to know they see, such as “Don’t miss out — call your doctor today; PlanState: CA; Segment: Individual; Age: Female Older; Language: EN; CervCancer3yr: N; CervCancer5yr: Y; Mammogram: N; Colonoscopy: N”. Ooops!…Another day, not quite another breakthrough for Mount Sinai Hospital here in NY, which had your typical laptop theft compromising over 10,000 records but fortunately not SSI or insurance information….More alarming were the malware/hacker attacks. In North Carolina, Central Dermatology of Chapel Hill was compromised by malware in a key server. And further south, Jessie Trice Community Health Center of Miami, Florida was hacked by a criminal identity theft operation accessing personal data of almost 8,000  patients.  iHealthBeat, also Privacy Rights Clearinghouse, NY Times (Anthem)

A short opinion piece in HealthWorks Collective promisingly leads with:

What if we paid for patient recovery rather than just patient services? What if we paid to treat patients rather than just conditions? What if we paid to personalize care rather just population health quality measures? (more…)

Tunstall adopts new Tactio in patient management

November 13, 2014 | by

Tunstall Healthcare is partnering with Canadian mHealth developer Tactio Health Group in what is a distinct first for them: creating a mobile care management system that is 1) smartphone-based for the patient and 2) prominently integrates non-Tunstall apps and devices. The patient uses the smartphone and the Tactio-developed mTrax app to collect a wide spectrum of data–everything from activity, sleep, pregnancy, body fat and mood tracking to the traditional constellation of vital signs. This uploads to the care provider’s tablet mPro Clinical App which overviews, details and reports the data for each patient and patient groups in care. The data comes from well-known mHealth apps outside the Tunstall world: BodyMedia, Fitbit, Fitbug, Garmin, Jawbone UP, Medisana and Wahoo Fitness, as well as connected (presumably Bluetooth) medical devices from A&D Medical, Mio, iHealth, Telcare, Withings and Nonin. Tunstall has also added two-way patient coaching and  health journal features.

Tunstall’s positioning for what they call Active Health Management or AHM is “supported self-management” and “shift(ing) from reactive care to cost-effective active care.” (more…)