On 13th July this editor wrote a piece entitled “Wearables & mHealth: a few observations “ which included a paragraph on staff reductions at Medvivo which we suggested might be a part of an overall reduction in Medvivo’s engagement with telehealth. We had tried to contact the company beforehand, without success, however following publication of the story, this editor was then contacted by Andrew Cowie, Chief Executive of Medvivo. He kindly pointed that with the acquisition of Magna Careline, Medvivo’s headcount has actually increased by some 50, significantly more than the number who are en route to leaving the company. The other observation mentioned in the paragraph as supporting our concerns was, apparently, entirely coincidental (and transitory), and the following paragraph, which actually related to the BBC, was so worded that Medvivo (incorrectly) took it to refer to them. We therefore unreservedly apologise, and invite readers to check out the revised article.
RSM event on Clinical Neuroscience and Telemedicine on 24th September (UK)
Through presentations by world-class clinicians, this meeting on 24th September, will examine the wide range of ways in which telemedicine has improved patient outcomes, and reduced cost, in the field of clinical neuroscience. Older readers with long memories may recall a BT television advert from the late ’80’s featuring a neurosurgical consultant in his dressing gown and slippers studying a TV monitor in his home. A CT scan of an acute patient had been transferred in real time for a consultant decision using the ‘Intrans’ system. Since then, there have been many applications of image transfer, which has become the UK norm. This will be discussed, as well as the complexities and difficulties related to encryption.
However telemedicine has applications in a host of other clinical areas. Management of very acute neurological conditions remains the most obvious. ‘Apps’ in head injury management are now commonly used for both record and decision making and are about to be expanded further. We will also be discussing telemedicine intensive management with international experts by Skype. Acute stroke has also been transformed by thrombolytics, although the decision on who to treat must be made in local centres without recourse to neurological experts, so here again telemedicine plays a vital role.
Acute medicine is not the only field where telemedicine has a role. Long term management of disabled patients who find the distance to the specialist centre daunting is also vital. Telemedicine in neuro-rehabilitation is one of a number of areas where the techniques have found a clear place.
This is the fourth event organised by the RSM’s Telemedicine & eHealth Section this year – the previous three have all been extremely well attended; delegates have rated them highly in feedback reports. To book go here – as with all RSM events, prices are far below commercial rates as the Society is a charity dedicated to medical education and the promotion of medical advances.
Lessons to be learned from business clusters – UK report
As this editor gets regular requests for survey data and forecasts, it would be a shame not to make readers aware of Industrial revolutions: capturing the growth potential, a recent 92-page report commissioned by the Gatsby Foundation from a partnership of Centre for Cities and McKinsey. Lord Sainsbury has written the foreword.
The report focuses on the lessons to be learned from clusters because:
1. Clusters are a major contributor to growth. The 31 economically significant clusters identified in this report contain 8% of the UK’s businesses, but generate 20% of UK output (gross value added).
2. Clusters are important sources of well-paid jobs. The United Kingdom’s top 31 economically significant clusters together employ four million people – one in seven of the working population – and they offer average salaries that are typically higher than those in the surrounding region.
3. Clusters bring business advantages that cannot easily (more…)
McKinsey: digital health mythbusters
Readers will find the very readable McKinsey survey of patient attitudes to digital health valuable in helping them determine the best way forward to develop their online services.
The survey covered patients in three very different health services – UK, Germany and Singapore. Principal findings, headlined as five busted myths, were:
Myth: People don’t want to use digital services for healthcare – actually 75% of them (more…)
New consultation on monitoring of home-based care services (UK)
Undaunted by the apparent lack of interest in their multi supplier framework agreement for telecare & telehealth tender last year, the East Shires Purchasing Organisation (ESPO) is now seeking to establish a multi supplier framework agreement for the supply of systems to facilitate the monitoring by local authorities and other service commissioners and service providers of home-based care services. The framework will apparently also include solutions and products that assist in the scheduling of home care visits and the rostering of care staff.
According to the announcement, the requirement is for both stand alone and integrated systems, with various hosting options and technologies. Systems should ideally be tailored to the needs of the home care sector.
At this stage, ESPO is keen to engage with interested parties to discuss the products and services currently available in the market, options regarding the structure of the procurement and the anticipated direction of future market developments. Those keen to participate in this market consultation are asked to contact Louis Blake on 0116 294 4055 or l.blake@espo.org, by 30 August 2014.
Although having a touch of “big brother” (more…)
Can volunteers prove that RATULS helps mitigate the effect of strokes?
RATULS, standing for Robot Assisted Training for the Upper Limb after Stroke, is a randomised controlled trial that is looking for volunteers..
The trial seeks to establish whether robot assisted training with the Inmotion robotic gym system improves upper limb function post stroke. RATULS is looking for people who have only had one stroke (between one week and five years post stroke, with moderate to severe arm weakness) to take part.
Consenting trial participants will be randomised into one of three groups
A) Robot-assisted therapy
B) Enhanced Therapy
C) Usual Care
Patients will receive therapy for 45 minutes, three days per week for 12 weeks. There is funding available for patient travel. Experience so far has shown that patients are keen to take part in the study.
For more details or to enquire about volunteering, please contact karen.dunne@bhrhospitals.nhs.uk
Wearables and mHealth: a few observations
The Telegraph reports on the creation of Amazon UK’s wearables store, following on from their US launch that we covered on April 30th. Unlike in the original US launch, locating the store is not that challenging, however it is very much a jumble of products: if you know what you want then you probably don’t need a store to find it; if you don’t, there’s precious little to guide you to find the right product.
One of the wearables they’ll doubtless think carefully before stocking is (more…)
A long-overdue robotics roundup
Focusing today on robotics in and around DARPA and the US Armed Forces, via Armed With Science. Military advances are a ‘pointer to the future’ where robotics will eventually assist older adults, the disabled and the rest of us in our daily lives. (We’ve also noted where other military protocols can work into assistive technologies–see ‘The Big Red Button’ emergency alert app.) :
- Update on the DARPA Robotics Challenge: The Phase 3-Final originally set for December will take place 4-5 June in Pomona, California due to some changes in the third round specs including an emphasis on ‘cloud robotics’ and international applicability. DARPA’s program is strictly oriented to ground operations, disaster response and human supervision. Changes in spec include full wireless, tetherless and continuous operation–the operators communicate with the robots wirelessly only including periods of latency, their power source is 100 percent onboard, and the robots must be able to complete a sequence of eight tasks and recover in a ‘challenging environment’ without outside help. Plus DARPA is throwing in a secret challenge that looks like it will be disclosed only at the final. Specs have evolved to the point where there has been a withdrawal of a finalist which is now concentrating on commercialization despite the $2 million prize. Here Come The Robots Previously in TTA: DARPA Robotics field competition (Phase 2), Robotics Challenge winners
- Robotics Secrets Revealed! In this humorous video, the Naval Research Lab’s Lucas, Octavia and PackBot set up some human furloughs (real enough) so that they get some rest. The reasoning behind their actions and the humans is explored. Robot Ruckus.
- MAST’s Mini Robots and ‘microsystems’ may be in future used to locate, identify and engage high-priority targets by increasing situational awareness. This includes drones. Emphasis more on in-field use. Unfortunately written in Pentagon-ese. The Military’s Mini Robots
- Meet a specialist in robotics. Interview with bomb disposal robot engineer Aaron O’Toole, awarded the Navy’s top engineering award in 2013. An area of his concentration is flexibility and fluidity of motion. Insights into how a developer looks at mobility and skill challenges. Meet the Scientists
The King’s Fund: International Digital Health and Care Congress
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10–12 September 2014 at The King’s Fund, London W1G 0AN
This three-day event at The King’s Fund, now in its fourth year, is a truly international Congress in attendance and speakers. It will showcase new ideas, new research and new innovations in digital health, mobile health, telehealth and telecare around these five topics.
- Sustaining independence as people age
- Preventing and managing chronic illness effectively
- Supporting people with mental health issues
- Digitally enabling service transformation
- Innovations in technology
Wednesday’s pre-Congress session begins with lunch, a full day on Thursday concluding with an (optional) dinner and a full Friday. Our own Editor Charles Lowe will be presenting on medical apps during the 11:30 breakout session (the T2F section) at 11:30am Thursday. See here for detailed information on the Congress sessions. PDF summary including keynote speakers.
As TTA is a media sponsor of the Congress, we are pleased to offer our readers a 10 percent discount off pricing for all their registration types, including the Thursday dinner. Click here to automatically obtain the discount.
Assisted Vision: sight enhancement for the partially sighted
Dr Stephen Hicks is a Research Fellow in neuroscience and visual prosthetics at the University of Oxford. He and his team are working on a project to develop a pair of glasses to help partially [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Smart-Glasses.jpg” thumb_width=”150″ /]sighted people “see” what is in front of them.
BBC’s Johny Cassidy spoke to Hicks recently about the Oxford smart specs project for BBC’s In Touch programme. The project uses Augmented Reality (AR) to make objects in the field of vision sharper for partially sighted people. Hicks says the object is to “try to make a pair of glasses which look relatively normal to people in the environment and still provides a computer based object enhancement and object detection that would be able to be seen by people with very, very limited sight”.
The glasses use two cameras, a gyroscope, a compass and a GPS unit. The “lenses” are made of transparent OLED displays enabling the wearer to see through with any available sight and also allowing others to see the user’s eyes.
“The next step in terms of commercial development is to reduce the size of the glasses and the processing unit into something acceptable to people in day to day life”, says Hicks. The “take-home” versions are targeted to be built in autumn this year.
How much is it likely to cost? A stated goal of the project is to keep the costs down so that the maximum number of people as possible will have access to these glasses. So where possible off-the-shelf components are being used. Hicks says that a pair of glasses for less than £300 is possible compared to just under US$10,000 for the only other one that Johny Cassidy had been able to find. Google Glass, Epson Moverio and similar glasses are, of course, not functionally comparable.
Help develop ‘The Big Red Button’ emergency alert app
Help Edd Tillen design a telecare alternative
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-Red-2.jpg” thumb_width=”170″ /]We occasionally hear from one of our developer readers, and so it was at the end of June when Mr Edd Tillen wrote me about a smartphone app he is developing called ‘The Big Red Button’. It does what a typical ‘panic alarm’ app does–alert a designated person about an emergency or unsafe situation–but coordinates the response among several carers with a sister app on their phones. One person is designated a ‘responder in charge’, and the nearest in distance (based upon GPS) is the first responder. The design of the app coordinates the response and informs all responders on what is happening to its conclusion. The responder in charge also calls the casualty to get a better idea of what is happening. Mr Tillen designed the app after how the British Army handles battlefield casualty drills where everyone has a role (he’s a member of the Reserves, Royal Logistics Corps). In his capacity working in social care with the Leicestershire County Council, he also felt that smartphones, which are being more widely accepted among older persons, are a better alternative for most than expensive and home-based telecare contracts.Here’s where Mr Tillen would like YOUR help. On his website, there’s a working demo of the app. It has two different scenarios–what is seen from the casualty and also what the carer would see. He’s looking for reviewers to then fill out a consultation questionnaire, which he will use with his developer (part of the Leicestershire Tech Start Up Community) for modifications and with potential investors, who especially want to see interest from those engaged in the field prior to its projected release this Autumn. Website
LG’s Kizon child tracker debuts
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Kizon-LG.jpg” thumb_width=”175″ /] Just in time for school start in North America and Europe is LG‘s September intro of the Kizon bracelet for keeping track of your small child through an Android app. This child-friendly, colorful (but a little bulky) wristband seems to pack a lot into a one-button package: GPS/Wi-Fi tracking, 2G/3G cellular ability for the child to call out to a pre-loaded phone number and to accept calls from pre-approved numbers. And it appears to be a water and stain-resistant watch as well. LG is marketing to parents of pre-school and primary/elementary school children but pricing is not available. It’s a big change stylistically from the GPS trackers like Lok8u which have typically been marketed for primarily autistic children and others at risk. Launch will be in South Korea this week according to BBC News. Is there an opportunity to use this with older people as well?
Editor Chrys on background:
The idea of using mobile phones for tracking kids goes way back to around 2003. The earliest service I know of was one called Child Locate and was launched in the UK by Jon Magnusson. It was intended for parents to track kids (or rather their phones) on a map on the internet. Child Locate has now morphed into Mobile Locate and tracks any mobile device and claims 100,000+ users.
The other service that comes to mind straight away is Disney Mobile – Disney’s MVNO over Sprint. In 2006 Disney launched what seems a great idea at the time – a service for parents to track kids – the Family Center. Similar to Child Locate this service allowed parents to locate the mobile on a map, plus limit call and text spending. It was launched with two handsets, one from, wait for it – LG and the other from now almost bankrupt third largest Korean handset company Pantech. So LG was dabbling in this in 2005/6. Disney Mobile had plans to expand to UK over the O2 network though that never materialised. Disney Mobile closed down a year later.
The Kizon may look cute at first glance but it is definitely not unobtrusive. When my neighbour’s 18-month-old is playing Peppa Pig incessantly on her iPad I think LG’s marketing department is behind times thinking they can get a Western kid to be tracked by her dad for everyone to see. Make no mistake Korea and Japan are the leading nations for high tech consumer products but the psychology of those countries don’t work here. Having worked for a leading Japanese company I have seen this from the inside. If this takes off in London I’ll eat my hat – even if I have to buy a hat to eat!
Eye feels the pain of Google’s Brin and Page
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /] Oh, the discomfort that Sergey and Larry must be feeling being grilled interviewed by “billionaire venture capitalist Vinod Khosla” (grudgingly respected in TTA 30 May) at one of his eponymous Summits. Here they are with Google Glass in all sorts of adaptations from Parkinson’s to gait improvement to surgery [see multiple TTA articles here], a ‘moonshot on aging and longevity’ dubbed Calico [TTA 19 Sept 13] and even a contact lens to measure blood glucose in tears [TTA 17 Jan]. All good stuff with Big Change potential. Instead they whinge on about how the health field is so regulated, and all the cool stuff you could do with the data but for that privacy thingy (those darn EU, UK regulations and in US, HIPAA). Page to Khosla: “I do worry that we regulate ourselves out of some really great possibilities that are certainly on the data-mining end.” Brin to Khosla: “Generally, health is just so heavily regulated. It’s just a painful business to be in. It’s just not necessarily how I want to spend my time.” Gee. Whiz. What is apparent here is a lack of personal respect for us ‘little folks’ privacy and our everyday, humdrum lives.
Advice straight from The Gimlet Eye: My dear boys, you’ll just have to get people’s data with that old-fashioned thing, permission. (And you’d be surprised that many would be happy to give it to you.) Or if it’s all too painful, Sergey can play with his superyacht, latest girlfriend and follow his estranged wife Anne Wojcicki’s 23andme‘s ongoing dealings with the FDA. At least she’s in the arena. Google leaders think health is ‘a painful business to be in’ (SFGate) Mobihealthnews covers their true confessions, with an interesting veer off in the final third of the article to Mr Khosla’s view of Ginger.io’s surprising pilot with Kaiser and then to WellDoc’s Bluestar diabetes therapy app–the only one that is 510(k)Class II and registered as a pharmaceutical product [TTA 10 Jan]. Also interesting re the Googlers’ mindset is a SFGate blog piece on Larry Page’s attitudes towards leisure and work in a Keynes-redux ‘vision of the future‘. < work + > people may= >leisure, but certainly<<<$£€¥ for even the well-educated and managerial!
Tunstall’s 2013 fiscal report: debt service makes short term gloomier
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Updated…Released on this ‘getaway day’ (in the US), and surprisingly only covered by the local Yorkshire Post, is the report of Tunstall Healthcare Group’s year-end closing (30 Sept 2013) results. The short term news is positive: 21 percent revenue growth to £221 million in its 2013 statutory accounts. However, this adds in the acquisition of Spanish monitoring provider Televida for £27.4m in January 2013 and the 2012 purchases of AMAC in the US and STT Condigi in Sweden. The official posture of the company, expressed by CEO Paul Stobart, is that “with continuing Government austerity measures and a fragile global economy, the business does face challenges in the short term.” And one of those challenges making for a gloomy picture is debt service. We’ll let the YP speak: “The group, which is owned by private equity house Charterhouse Capital Partners (CCP) paid £13.7m of interest in cash on its senior and mezzanine debt of £265m, as well as a total of £114.4m non-cash interest on long-dated shareholder loan notes and other loans. This results in a statutory reported loss for the group of £127.8m.” That change of nearly £350 million, which includes operating costs and other expenses, illustrates the critical consequences of debt service on the bottom line, indeed [TTA 22 May]. Many thanks to one of our reliable sources for picking up this report.
New: Founder Steve reminds us of his related (and oh, so prescient) analysis from 2010 about Tunstall’s earnings versus debt service balancing act in Telecare Soapbox: Equity capital. A cautionary tale. (Thank you Steve for adding)
It is worth a detailed read because the 2009 numbers were also ‘challenging’. Steve dug through 2009 publicly filed (in UK) numbers to reach his conclusions. In sum, “The important question is whether their underlying position is sound and reliable, or whether they are shaky. They also tell me that the robustness of a company’s cashflow is the most important survival factor.” If I am reading the report on CompanyCheck correctly, the eye-watering negative net worth of the Group and the low cash positions of both the Group and UK are oddly reminiscent of airline financial statements when this Editor was still in that business. Do remember the object examples of Texas Air Corporation (once the world’s largest airline holding company), Pan Am and TWA! You also have to have some sympathy for the management which was not part of getting into this ‘pickle’ now tasked with getting the company out of the barrel.
One week to go to the first (free to attend) DHACA-Day July 11th
On July 11th, the free-to-join Digital Health And Care Alliance (DHACA) will be holding it’s first members’ day. The primary aim of DHACA-Day is to kick start operational activity within the Alliance. DHACA will respond to members’ priorities through the vehicle of Special Interest Groups (SIGs), which members are free to join in accordance with their interests. DHACA SIGs will generally follow the requirements gathering processes, leading to the generation of assets in the form of Interoperability Profiles, Guidance, Informational Briefings, and Reference Material.
Key to getting off to a good start will be the optimum selection and scoping of SIGs, and so during DHACA-Day we want firstly to hear from members, and then collectively to propose and define the priority SIGs from the key issues emerging.
To begin the process, the morning will comprise a range of motivational speakers talking on key topics such as integrated care, citizen identity, technology enabling care services and future challenges.
The event is being held in the DTG offices very close to Vauxhall tube station and is free to attend – sign up here for a great day!
Medicare dis-incentivizes home health care in ACA’s name (US)
When it comes to home health care, the C in CMS (Centers for Medicare and Medicaid Services) should perhaps stand for ‘contradiction’. According to recent reports appearing in the pre-holiday ‘dead zone’ of late last week, CMS has decreed that it must save, as part of a four-year plan under ACA, $58 million (0.3 percent) in fiscal 2015 (starting 1 Oct) from home health agencies which were formerly touted as a great way to save money. To put this in perspective: in 2013, Medicare paid about 12,000 home health agencies $18 billion to provide services to 3.5 million patients. In the US, Medicare has always had more restrictive rules for home and community-based services (HCBS); state-administered (but Federally subsidized) means-tested Medicaid still pays for the vast majority of long-term care (well over 60 percent, according to another Federal agency, Housing and Urban Development [HUD]), which strikes many observers as one pocket to another. So where are the contradictions?
- Conundrum #1: CMS has emphasized post-discharge, post-acute care as part of reducing acute care costs, exemplified in the penalty for 30-day same-cause readmissions. Nursing home expenditure is at least three times more costly than in-home LTC (a conservative estimate used by HUD).
- But CMS plans to cut Medicare home health funding in total so fewer people may receive it at all or less of it even if needed. What will be their alternative, and the effect on outcomes? (more…)
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