“Wearing a fitness tracker…is so 2013”

April 8, 2014 | by

So begins the Phys.org article on a stick-on fitness tracker developed by engineers at the University of Illinois at Urbana-Champaign and Northwestern University. Certainly some impressive engineering on display.

Sadly no information is included in the article on how long the tracker stays stuck on, or minor issues like battery life or cost, so I’m not planning on giving up my Jawbone UP just yet. A most interesting development though – one feels it cannot be too long before it becomes implantable and the accelerometer doubles as a power source to top up the battery. Then it will be headline news.

More apparently will be revealed in this month’s issue of Science.

Meanwhile the Vandrico database now covers 195 wearables, a huge rise from the 118 when we first wrote about the database in mid February. Accelerometers are the most popular sensor.

Can the market cope with that level of choice…with Apple still, apparently, to come?

‘Blue Blazes’ indeed: Wal-Mart’s clinic in a back room

April 7, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/10/blue-blazes.jpg” thumb_width=”150″ /] The surprise here is not that Wal-Mart is teaming with Kaiser Permanente at two locations in California (Bakersfield, Palmdale) to trial a telemedicine/telehealth clinic. Nor is it that it’s confined to KP members and Wal-Mart employees–it is, after all, a pilot (albeit for two years). It’s that they’d let a photographer take a picture of the sheer crudity of the clinic setup (left, below, click to enlarge). It likely utilizes a disused storage area or back room, where the clinic, instead of soothing, clean white or blue, is institutional tan and crammed full of plug-ins–cameras, PC screens, equipment, exposed wires, plugs and outlets. Perfect for the claustrophobic! (s/o) The modish paint and signage at the entry area outside (see article photos) only serve to set up the potential user for disappointment. The question is, why didn’t they simply rent some ready-made kiosks from HealthSpot Station [TTA 29 Oct 13 + previous] or SoloHealth (already a Wal-Mart vendor)–or others? No wonder the nurse has to drag prospects off the floor. Truly a ‘What In Blue Blazes?’ moment that does not bode well for the success of this pilot–and a puzzle given the partners. Wal-Mart shoppers: The doctor will see you now (Bakersfield Californian)[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Wal-Mart-telemedicine.jpg” thumb_width=”180″ /]

 

Medical Innovations Summit at the Royal Society of Medicine April 5 2014

April 7, 2014 | by

The RSM held another of its innovation summits last Saturday. In addition to the 13 stimulating presentations, the morning was excellently hosted by past RSM President Robin Williamson whose stand-up comedy skills are surely a close match for his well-known surgical expertise.

The first presentation, from Big White Wall, an online provider of personalised mental health services, was begun by founder Jen Hyatt. She quoted hugely impressive statistics of how 95% of users report feeling better, 80% feel able to take control of their lives and 73% share their feelings for the first time when using the wall. She described how they use a ‘social media scraper’ and algorithms to assess people’s state of mind and suggest treatment plans. Dr Simon Wilson, Clinical director, said there was good evidence that online mental health therapy is as effective as face:face.  He went on to explain in more detail how the service was provided and what steps were taken when people posted genuinely concerning material. This is a superb innovation.

This was followed by Dr Farid Khan, CEO of PharmaKure, a company that looks for  (more…)

A ‘disruptive’ US primary care delivery app with UK roots

April 7, 2014 | by

This past week, this Editor spoke with Jason Hwang, MD, one of the three co-authors of The Innovator’s Prescription and noted here recently [TTA 31 Mar]. Since leaving the executive director spot at Innosight Institute (now The Clayton Christensen Institute for Disruptive Innovation), he and a team have been developing a smartphone app, PolkaDoc, that may bring a little disruptive innovation to simple primary care. The intent is to make remote primary care for basic needs far more accessible to the general public 24/7, helping to alleviate the shortage (and workload) of US primary care physicians (GPs). The individual first installs the free app from Google Play or Apple’s App Store, answers a simple questionnaire, records a short video to confirm name and date of birth as a verifier/signature, and pays the exam fee via debit or credit card. A doctor then evaluates and prescribes, if appropriate, with prescription pickup at your local pharmacy. According to Dr. Hwang, the first use of this app will be for birth control, charging a modest $10 exam fee, exclusive of the prescription. Technically, the 24/7 coverage is achieved via asynchronous store and forward, which enables significant scalability; any participating physician may ‘see’ thousands of patients a day if desired. The app is fully HIPAA-compliant and on US-based secure servers. The ‘soft’ launch of the PolkaDoc service will start in about two to three weeks.

For our UK readers, this may sound like a variation on something familiar. The ur-model is ‘DrThom‘ acquired by Lloyds Pharmacy in 2011. The eponymous service was developed by one of the partners of PolkaDoc, UK-based OB/GYN Dr. Thom Van Every, to provide sexual health services first by mail and later online. In the UK, this was a premium service at £50. According to Dr. Hwang, the objective is to adapt for the US what has been successfully done in the UK, Australia and other countries, learning from the lessons of its predecessors. With the idea that “simple things are taken care of as simply as possible”, it also matches that concept with low price to be affordable for nearly all women.

My discussion with Dr. Hwang also ranged on the app’s potential use in other healthcare areas and plausible partnerships. More to come on this, certainly.

A small compendium of potentially useful info

April 6, 2014 | by

In the process of looking for interesting items to highlight on Telehealth & Telecare Aware, occasionally we trip over info that, whilst not riveting in its own right, nevertheless may be of use to readers.  Here is a small selection of recent finds that we will add to – reader additions are most welcome too:

GP EU eHealth/telehealth penetration

The EU has recently published the results of a survey carried out last year on the penetration of eHealth & telehealth in GP surgeries across all EU countries (Croatia joined the EU during the survey) plus Iceland, Norway & Turkey. It comprises a very comprehensive executive summary, a full report, a series of individual country reports (44MB – beware) and a technical annex. Encouragingly it shows high adoption in the UK of EHRs though it’s no surprise the UK slips well down the ranks for things like telehealth adoption by GPs. (Giving extra weight to recent GPonline editorial calling for a change of culture by GPs regarding telehealth).

Reference to “N.H.S.” in the charts was (more…)

Police innovation fund – closing date 30th April 2014 (UK)

April 6, 2014 | by

Of possible interest to readers is the offer of £50m of Home Office funding for the use of innovative technology to improve policing. Interest is indicated in everything from wearables, such as body-worn cameras, to shared digital infrastructure with other services, such as health. Bids need, obviously, to involve one or more police forces and be signed off by a Police & Crime Commissioner.

Read Damian Green’s speech introducing it. Further details, including the application process, are here.

Hat tip to Prof Mike Short.

Med-e-Tel 2014 Luxembourg

April 5, 2014 | by

Next week’s Med-e-Tel (9-11 April) conference announced their final day of advance registration (today, 5 April) but if you are interested in going, please contact them directly for onsite information. The Journal of the International Society for Telemedicine and eHealth (ISfTeH), the publication of the main organizer of the conference, has published presentation abstracts in advance of the conference here. Conference website. ISfTeh April newsletter. New (7 April) overview press release. TTA is a past (and still listed as a) media sponsor of the event. If you are attending and interested in contributing coverage from one item to a day, please contact Editor Donna about arrangements. Our gentle requirements are that you send a timely report (within 72 hours) from this event. Our standard is that you can be selective and interesting rather than comprehensive. Of course you will receive writing credit, but other expenses will not be covered.  

Scanadu hitting the tech ‘glitch’ wall?

April 5, 2014 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Blog-04-04.jpg” thumb_width=”150″ /]Tricorder XPrize-qualifying Scanadu, which eventually raised a stunning $1.6 million on Indiegogo [TTA 23 May 13], has stopped delivery of units to its early backers which started on 31 March. According to its blog late this week, their readings were not working as expected for temperature, there were inconsistencies in reading scans between the Scanadu device (categorized as ‘investigational’) and the app (via the smartphone), and the manufacturing tool to make the devices broke. Scanadu CEO Walter De Brouwer stated that “We hope that this (the delay) will not be more than 8-12 weeks.” The Scanadu Scout was also submitted for FDA clearance but requires usability studies to gain approval. In this Editor’s experience, all tech devices eventually hit the ‘glitch wall’, either at or near the outset or when the system scales up. Better to fix now than later, and kudos for their C-level for being forthcoming–because most are not. Also MedCityNews.

HHS draft report on health IT framework published

April 5, 2014 | by

Another part of the 2012 FDA Safety and Innovation Act (FDASIA) clicked into place with the US Department of Health and Human Services (HHS) publishing a draft report proposing strategy and recommendations for what is rather grandly termed a “health IT framework”. Basically it defines more unified criteria, based on risk to the patient and function of what the device does, not the platform (mobile, software, etc.). It then separates products into three broad categories. Excerpted from the FDA release and the FDASIA Health IT Report:

  1.  Products with administrative health IT functions, which pose little or no risk to patient safety and as such require no additional oversight by FDA. Examples: billing software, inventory management.
  2. Products with health management health IT functions. Examples: software for health information and data management, knowledge management, EHRs, electronic access to clinical results and most clinical decision support software. This will be coordinated largely by HHS’s Office of the National Coordinator for Health IT (ONC) as part of their activities (including their current voluntary EHR certification program), but the private sector is also cited in establishing best practices.
  3. Products with medical device health IT functions, which potentially pose greater risks to patients if they do not perform as intended. Examples: computer-aided detection software, software for bedside monitor alarms and radiation treatment software. The draft report proposes that FDA continue regulating products in this last category. (Illustration on page 13 of report.)

The report also recommends the creation of a public-private entity under ONC, the Health IT Safety Center, which “would serve as a trusted convener of stakeholders and as a forum for the exchange of ideas and information focused on promoting health IT as an integral part of patient safety.” The private sector is duly noted as a ‘stakeholder’.

The report was developed by FDA “in consultation” with ONC and, not unexpectedly, the Federal Communications Commission (FCC). Another recommendation (page 28) is the establishment of a ‘tri-Agency memorandum of understanding (MOU)’ to further determine their working relationship in this area. There’s a 90 day comment period on the 34 page report, which is perfect for weekend reading (!) How this onion will eventually be peeled, rather than quartered, remains to be seen, as does anything emanating from Foggy Bottom.  FDA release. Report. FierceMobileHealthcare.

Update 8 April: A good summary of criticism and approval of the framework to date appears in iHealthBeat from the California Health Care Foundation. The two US Senators sponsoring the PROTECT Act [TTA 28 Feb, 6 Mar] stated there is still too much regulation of low-risk technologies, and Bradley Thompson of Epstein Becker/mHealth Regulatory Coalition believes the report is weak on the issues around clinical decision support software. With praise: HIMSS, Health IT Now Coalition and ACT, which claims to represent about 5,000 mobile application developers and IT firms, but has no locatable website.

Previously in TTA: FDA finally issues proposed rule simplifying medical device classification

Picture murky: 23andMe and the FDA

April 2, 2014 | by | 2 Comments

Genetic testing company 23andMe seems to be in no rush to resolve its differences with the FDA, and the digitalhealtherati a/k/a D3H (Digital Health Hypester Horde) are wondering why. In late November, 23andMe executives undoubtedly had a depressing Thanksgiving when the FDA ordered them to stop providing health reports (interpretation of genetic results) and marketing kits. Four months later, 23andMe continues to sell its kits for $99, providing only raw genetic data and ancestry reports–and according to its 31 March blog posting, will do so for the foreseeable future as they complete the regulatory review process. The blog quoted CEO and co-founder Anne Wojcicki, “My main priority is resolution with the FDA,” but actions speak louder than words–and the FDA isn’t talking. The FDA standard is still validation–the company has to analytically and clinically validate 23andMe for its intended uses, which is why the FDA took action against them in the first place.

  • Is the lack of urgency more about continuing to gather raw genetic and health data unimpeded? Ms Wojcicki had widely stated her real aim was to build a 25-million-strong database (Fast Company).
  • Is the real revenue stream of the company not the kits but in monetizing a massive database, selling it to researchers and others (Matthew Herper in Forbes)–the Google model which Ms Wojcicki is quite familiar with? Consider that there’s $126 million into the company, that is a lot of $99 kits.

Most companies in this situation would be imploding. This one is not. Interestingly. FierceMedicalDevices, The Verge

Previously in TTA: all you ever wanted to know about the 23andMe kerfuffle in FDA tells 23andMe genomic test to stop marketing (including this Editor’s analysis of their pre-FDA website with copy breathlessly expressing potentially life-saving or critical lifestyle changing claims, countered by legal ‘educational use’ boilerplate) and The inevitable: class action lawsuit against 23andMe (a check of the Ankcorn blog has no updates)

AliveCor community screening test finds atrial fibrillation in 1.5% (AUS)

April 2, 2014 | by | 2 Comments

A year-long pilot program in Australia to screen for for atrial fibrillation (AF) found new, previously undiagnosed AF in 1.5% of those tested. The SEARCH-AF study used the AliveCor Heart Monitor ECG  to test 1,000 customers 65 years and older through community screening in suburban Sydney pharmacies. Pharmacists used the AliveCor device, attached to an iPhone, to transmit 30-60 second ECG recordings to study cardiologists. If AF was suspected, the follow-up was a GP review and a 12-lead ECG performed. AF is the most common heart rhythm abnormality and puts an individual at five times the risk for stroke (National Stroke Association). Early diagnosis and treatment cost savings are straightforward: over $20,000 (~£12,400) for prevention of one stroke. (This Editor’s opinion–it’s an understatement.) Per the study summary:

The incremental cost-effectiveness ratio of extending iECG screening into the community, based on 55% warfarin prescription adherence, would be $AUD5,988 (€3,142; $USD4,066) per Quality Adjusted Life Year gained and $AUD30,481 (€15,993; $USD20,695) for preventing one stroke. (“Feasibility and cost effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies”, Thrombosis and Haemostasis, Ben Freedman, MD et al., 1 April online (subscription access required for full study)

15 new AF diagnoses per 1,000 may not sound high, but using the above estimate, this type of community screening using AliveCor or a similar device translates to a cost saving of over $310,425, assuming that all undiagnosed AF resulted in a stroke. Even if less, it is a nice return on investment, health and future outcomes. (This Editor invites more accurate cost analysis.) AliveCor release (San Francisco Business Times). Additional coverage CNet Australia. The George Institute for Global Health Australia project page which extends the study to GP clinics. 

Mobile alerting trials for public emergencies (UK)

April 2, 2014 | by

This service potentially will be used in the UK (as in other countries) to alert people in a particular area via their mobiles of an emergency and may give them appropriate instructions on what to do. The service does not require the government or anyone else to know individual mobile numbers – it works on all mobile devices within an area defined by the emergency.

Three trials were run last autumn, working with three of the UK’s biggest mobile network operators to test different technical approaches for such a system. Two different approaches were tested as part of the trials:

  • cell Broadcast service (CBS): the broadcast of a text-type message to all handsets in a defined area
  • location-based SMS messaging: all numbers in a specific location receive a traditional SMS message

Of the two, (more…)

Catching up with Medivizor

April 2, 2014 | by

This Editor had a quick catchup this week with Medivizor’s CEO and co-founder, Tal Givoly, at the introduction of Eco-Fusion (a personalized wellness/tech fusion service founded by Dr. Oren Fuerst, Medivizor executive chairman and co-founder; more on this when it goes to market). One of the better discoveries of our July 2013 CE Week NYC coverage and the H20NYC/Healthcare Pioneers evening [TTA 3 July], Medivizor’s USP is that it provides free, personalized, research-level information on serious or chronic health conditions based on specific user information. The user benefit is increasing pertinence to the specific condition and less time spent researching. Still in what they term a ‘public beta’, they have expanded (as promised) to cover 400 medical conditions in 10 domains, such as cancer, cardiovascular, infertility and diabetes, and are growing their community of users and forum interactions. Medivizor has also published a compendium of 10 of the most important breast cancer research papers published in 2013 into a free eBook. 

The role of spiritual care in PTSD and TBI

April 2, 2014 | by

Online ‘ChatWithAChaplain’ service also debuts

In our focus on technology, particularly on how it can assist in determining risk or helping patients to better manage the effects of PTSD and TBI, we neglect the critical role of personal spiritual care. In the military, the first line of this type of care are chaplains. This excellent 100 page handbook issued by the US Navy’s Chaplain Corps and their Bureau of Medicine and Surgery is a brief for chaplains explaining the medical and psychological nature of PTSD and TBI, how they can provide service members with culturally appropriate spiritual care, and how they integrate it with the mental health team’s work. For those outside the military working with approaches to these conditions, it is a wealth of medical and treatment information in one place–and will influence your thinking. It was co-authored by The Rev. George Handzo, VP for Pastoral Care Leadership and Practice at The HealthCare Chaplaincy Network, a nonprofit healthcare organization which helps people in distress from illness and suffering find comfort and meaning. HCCN is a leader  (more…)

How insecure can health data get? Very.

April 2, 2014 | by

Gigaom is one of our go-to sites for enthusiastic whiz-bang health gadget coverage (and more), but here’s the downside of all those devices: all that data. And it’s not only not secure, but also getting more insecure. Grégoire Ribordy of Swiss encryption company ID Quantique makes some key (and scary) points on the data breaches looming–and he doesn’t mention that block of Swiss cheese Healthcare.gov once:

  1. One-stop storage for your total health records and data, an idée fixe among government and single-payer theoreticians, just makes it one-stop-shopping for hackers.
  2. Richer health data means more to steal and exploit.  There’s also the illegal use of genetic information for employment discrimination–hard to enforce regulations, easy to misuse personal data.
  3. Biological crime isn’t just a future plot of ‘Law & Order.’ Criminals can target patients with specific conditions–or healthcare workers can make money on the side by supplying accident victim data to personal injury attorneys, as recently happened in NY. For prominent people, their sensitive health information can be leaked to the press for profit. (more…)

AKTIVE Conference 2014

April 1, 2014 | by

Technology, Care and Ageing: Enhancing Independence

8-9 April, University of Leeds, UK

Sponsored by AKTIVE, a project that started at the University of Leeds’ Centre for Care, Labour and Equalities (CIRCLE) in 2011, next week’s conference it is focused on understanding the impact telecare technology has on the everyday lives of older people who are prone to falls or who suffer from cognitive impairments (including dementia) and the people who support them to live at home. AKTIVE 2014 brings together researchers, industry, voluntary sector and local authorities interested in the role of telecare and other technologies in supporting older people at home. Our Contributing Editor Charles Lowe will be presenting on Wednesday the 9th, 11:15am – 12:30pm, on ‘How Activity of Daily Living (ADL) Monitoring is at last coming of age’ as part of a Forward Vision for Telecare. Full program. Information and registration (may still be available–we are checking)