Healthcare investment bank and advisor TripleTree has produced a ‘Viewpoint’ report on ‘the hospital of the future’, examining the proposition that the place for delivery of even acute care may not be a hospital at all due to health tech, robotics and architectural innovation (this last hearkening to TTA 22 April). “High-quality healthcare is frequently described as delivering the right care to the right person at the right time in the right place. This report focuses on the right place. It describes the ongoing evolution of healthcare real estate and offers realistic insight to the characteristics of the hospital of the future.” And rather than hospitals becoming more hotel-like, hotels may become post-surgery ‘home health’ centers. Many other intriguing possibilities in this Report (free download).
Project ECHO using telemedicine to limit, treat hepatitis C virus
Two US government agencies plus the American Medical Association (AMA) are piloting a program to better diagnose and treat the hepatitis C virus (HCV). The Centers for Disease Control (CDC) is the lead in this Arizona and Utah-based project, with the Office of the National Coordinator for Health IT (ONCHIT) and the AMA creating new clinical quality measures and clinical support tools. The objective is to identify what works to treat HCV infections and then develop a scalable methodology. The program will integrate telemedicine (video consults), public health data analysis and outreach to primary care physicians, academic centers and public health officials. CDC/ONC release/blog posting, iHealthBeat, Health Data Management. Hat tip to Editor Toni Bunting.
‘Silver’ no longer, it’s ‘Lifelong Tech’
International CES’ Silvers Summit now Lifelong Tech. An indicator that the focus in ‘aging tech’ is now less on imposing monitoring systems on older people and more on enabling people of all ages to live better is the name change of one of the ur-events of digital health. The focus is now on the 50+ (78 million strong in the US). With the drop in age is a substantial broadening of interest in technology from smartphones to longevity and social connectedness as well as the traditional safety and improved quality of life. Lifelong Tech will debut at 2015 International CES 6-9 January 2015, though the change isn’t on their materials or website yet. Organizers (Living in Digital Times) remain the same. This Editor will be seeing their short and sweet wearable tech presentation (no windy panels of corporate execs) next Wednesday. Release
Is consumer digital device engagement sticky? Or just the hype?
A wonderfully cranky essay by Laurie Orlov on her new blog Boomer Health Tech Watch might make you think The Gimlet Eye was her guest writer (see below). Ms Orlov observes the ratched-up noise level around wearables, fitness bands, smartwatches (in which your Editor will be drenched quadrophonically next Wednesday at CEWeek NYC, glutton for punishment as she is). Yes, we’re swooning around Apple Health [TTA 3 June] and having a minor swivet around Samsung’s Simband and SAMI [TTA 2 June]. The bucket of cold water in Ms Orlov’s grip is the high dropout rate among fitness band users (33-50 percent, cited from Endeavour Partners and NPD Group); this Editor will also add the devices’ relative inaccuracy, fragility and glitches [TTA 10 May]. But ‘the investor community (via the media) clearly IS being transformed, at least temporarily’ as well as outside the health industry, by a belief that these devices will push the world into Quantified Selfing for the Masses. Will wearables herald our arrival at the New Jerusalem of Health? Certainly it’s been trumpeted and tromboned by the D3H (Digital Health Hypester Horde) badly needing a fresh fave rave. But can digital health survive another Hype Curve dive? Can we? The Consumerization of Health Care — is it working?
Further in this jugular vein, Business Investor, in a superficial swipe, dubs smartwatches uncool just because they trail fitness bands by six points. They did a better job in March delving into the real challenges that wearables face: smartwatches look and feel like a brick on your wrist (Ed. D’s term), Google Glass is socially unacceptable in many quarters (banned in Silicon Valley!) and wearables are still in Early Adopter-Ville.
Update: Ms Orlov just sent to this Editor a brief comment with a link to a thoughtful NY Times article not only on The Trouble with Apple’s Health App, but also how the barriers are more subtle–and more common-sensical–than the hype around how consumers are eager to register every burp on a PHR (they’re not), they don’t want to be nagged by technology (easier than your mom to be rid of) and the group that needs it most (the old, poor) has the least, for now, access to it. But largely ignored by the D3H.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”75″ /]On assignment off Cape May, New Jersey inventorying readiness of coastal defense fortifications. Just between us. Shhhh!VA reduced bed days by 59%, hospital admissions by 35% in 2013
Not all is gloom ‘n’ doom at the US Department of Veterans Affairs (VA), rightly excoriated for cooking the books on wait times for admissions, allowing an estimated 40 veterans to die waiting for care at the epicenter of the coverup, a Phoenix VA hospital, its secretary resigning. A consistent bright spot has been its use of telehealth and telemedicine, along with the Department of Defense (DOD), making them the largest US telehealth contractors. Neurosurgeon Adam Darkins, MD, who is their chief consultant for telehealth services, kept a speaking date at Tuesday’s Government Health IT Conference in Washington, DC to present encouraging results.
- The VA’s FY2013 telehealth program totaled 608,900 patients and 1.8 million telehealth episodes of care. 45 percent of the patient population live in rural areas, receiving care from 151 VA Medical Centers (VAMC) and over 705 Community Based Outpatient Clinics (CBOCs)
- 2009 to 2012 data show showed a 4 percent cost reduction after a year in a telehealth program, versus a one-year spike of 48 percent in costs for those veterans outside telehealth
- Cost savings are estimated at just under $2,000 per year per patient
- Over 41,000 patients were enabled to live independently in their homes using telehealth
- VA also leads in telemental health, with its National Center providing 2,893 video consults to 1,033 patients at 53 sites in 24 states
- The program is expanding at a rate of 22 percent per year
VA’s telehealth covers six areas: clinical video telehealth, home telehealth, (more…)
IBM Watson, get me consumer engagement
A pointer to the future for healthcare? What’s made health tech headlines is IBM Watson’s big data modeling for decision support tools in oncology and taking the US Medical Licensing Examination [TTA 10 Mar and prior] , but Watson’s capabilities are being tested in other verticals such as retail and customer service. This latest item from Direct Marketing News (!) does a once-over-lightly-from-the-press-release on their partnership with contact (call) center Genesys ‘customer experience platform’. It will further automate both telephonic and online service using Watson methodology by end of this year. Not mentioned of course is all the back end information on customer behavior. What can this mean in healthcare? Off the top of this Editor’s head, it’s proactive consumer engagement, a concept much discussed but rarely achieved without a fair degree of obtrusiveness. Trending data on fitness monitoring being sent on your smartwatch or band, interactive suggestions/reminders in diabetes management at those mid-afternoon times when you’re reaching for candy or coffee, a phone call from a real or virtual ‘case manager’ using behavioral data off your smartphone (locating you at the ice cream stand), better call center support for clinical trial research done by contract research organizations (CROs) using behavioral data….. Article
A healthcare/smartphone survey not from usual suspects
From FICO, an analytics software company best known in the US for your creditworthiness score (FICO Score), are some results on the healthcare portion of a just released cross-industry survey (with mobile banking, insurance) on smartphone usage:
- 80 percent would like to be able to interact with healthcare providers on their smartphones
- 76 percent would like to be reminded of medical appointments
- 69 percent would like to receive reminders to rearrange appointments, or be prompted to take their medication
- Texting as a push communication is preferred for all three above except for medication reminders
- 56 percent trust healthcare organisations with personal data (lower than it should be at this stage–Ed.)
- 2 in 3 want to receive medical advice through digital channels instead of visiting a doctor (cheering news for Better and online providers such as Everyday Health and WebMD)
- But presently, users do most of their research the ‘old-fashioned’ online-on-your-PC way
To get full results on the healthcare preferences of smartphone users in the US, Australia, Brazil, China and the UK, you’ll have to visit their webpage and answer five questions. Release.
“A rose by any other name would smell as sweet” take II (UK)
Names again! E-Health Insider today has published a typo-prone summary of a Technology Strategy Board survey of the public’s understanding of “‘health and safety devices”. Unsurprisingly, just as most people would not know what acetylsalicylic acid is (though would be happy to take it when it was called aspirin), so only 10% knew that “‘health and safety devices” meant telecare and telehealth. Not sure I’d get that one right either.
There is better news though. The article also quotes the survey as finding that “38% of people said they did not understand the benefits for both self-care technologies and for health and care apps for smartphones and tablets” which I reckon is fantastically marvellous because it means that 62% of the population did understand the benefits of these technologies, which is a heck of a lot more than I suspect a random sample of GPs would, and shows we have been successful beyond our wildest dreams, especially if those happen to be concentrated in the oldest 62% of the population.
Sadly not all was quite so good as “…the research found that 43% of people would not consider telehealth because they would prefer to be seen by their clinician face to face.” Just as whenever in conversation someone tells me they wouldn’t share their health data, and I’ve asked whether they’d still feel like that if they were lying dying in the street and could be saved only if a clinician had instant access to that data, so I wonder if the question had been posed, as with our local surgery for non-urgent consultations, “would you prefer to wait 28 calendar days to see your clinician face to face or would you be consider remote consultation within 24 hours”, the answer might be slightly different.
The good side of course is that (more…)
Medtronic, Covidien and what it might mean for digital health
“This acquisition will allow Medtronic to reach more patients, in more ways and in more places,” Medtronic Chairman and CEO Omar Ishrak
Cover the Earth? While the healthy Medtronic offer ($42.9 billion in cash and stock) for Ireland-headquartered Covidien plc is not a ‘digital health deal’, it does point to Medtronic’s strategy which includes digital health. There is of course the obvious: growth by acquisition and integration. Acquisitions require cash, and the highly controversial change of domicile to Ireland via ‘tax inversion’ will fatten the exchequer in two ways. First is through the lower overall Irish corporate tax versus the 35 percent US tax, one of the highest in the world. Second is much more flexibility in repatriating plentiful foreign earnings at lower Irish corporate rates rather than the high US rates which Medtronic has avoided. Third is increasing dividends, which can drive up stock price and investor interest. Of interest to the latter is also that Covidien adds horizontal (and global) competitive strength to Medtronic in the clinical area–surgical, vascular, respiratory and wound care.
More Ways-More Places. Not just staples and sutures, Covidien has developed its own advanced in-hospital mobile patient monitoring in Vital Sync as well as several hospital monitoring devices in their Nellcor line. In addition to technology collaboration, the next point of integration could then be with Medtronic’s post-acute telehealth devices from Cardiocom, purchased less than one year ago. We noted at the time that it gave Medtronic entreé into the “chronic condition management continuum– not only into telehealth via Cardiocom’s devices and hubs, but also their clinical and care management systems.”
Approval will take time. Both the US and UK, through various regulatory agencies, scuppered the Pfizer-AstraZeneca deal on similar tax domiciling and competitive grounds. If it does go through, there will be a lot of reorganization. But while it digests, this Editor will be watching Medtronic for its usual pattern of making smaller ‘more ways/more places’ deals in the interim with an eye to diversifying past US-taxable medical devices. One pointer is their just-announced partnering with Sanofi to develop drug delivery-medical device combinations and care management services for diabetes patients (MedCityNews).
Related reading: Medtronic hints at more acquisitions following $43 billion Covidien deal (MedCityNews); The Medtronic, Covidien Inversion Deal Is More About Dividends Than Tax (Forbes); Medtronic agrees to buy Covidien for $42.9b in cash, stock (Boston Globe); Medtronic’s $43B Covidien deal—and Irish tax move (CNBC)
Edinburgh Global Health MSc
A quick plug for the above which is a flexible part-time distance learning programme delivered entirely online using a combination of online tutorials, multimedia interactive learning materials, peer to-peer discussion and independent study. It looks very interesting. More details are here.
Claudia Pagliari tells me that the mHealth course will be available as a stand alone option or as part of a certificate of diploma track.
Post-market device surveillance – boring though very important
Thanks to Claudia Pagliari for passing me a news item from the Diabetes Technology Society, announcing that the Steering Committee has been assembled for its Surveillance Program for Cleared Blood Glucose Monitors. To quote:
“This program is intended to identify poorly performing blood glucose monitoring products on the market. This surveillance program will provide an independent assessment of the performance of cleared blood glucose monitors following Food and Drug Administration (FDA) clearance. The program will generate information that can assist patients, healthcare providers, and payers in making informed product selections. The information will also be provided to FDA, which is the government agency that regulates these products.”
So why is this so important? Well one of the things this Editor discovered when doing research into how to encourage GPs to recommend medical apps is that none of the existing organisations that evaluate medical apps appear to recognise adequately that every change of operating system, every upgrade in functionality needs to be carefully checked to ensure the app is still as safe and effective as it was when the app was first evaluated. For example, some apps such as Mersey Burns check that the mobile is running the required operating system superbly; most don’t.
“After a product has been cleared for use by the FDA, there is currently no systematic post-market surveillance program that monitors for ongoing product quality post-clearance. Poorly performing BGM system can interfere with the ability of people with diabetes to reliably monitor their blood glucose levels, and make correct decision based upon the readings. Inaccurate readings can lead to incorrect actions and therefore to adverse outcomes. Ongoing efforts by the FDA to improve accuracy standards for pre-market clearance would be undermined if performance was not maintained post-market. Therefore, a post-market surveillance program is critically important to ensure the accuracy of cleared products for people with diabetes.”
So hats off to the Diabetic Technology Society – let’s hope others pick up this excellent initiative, particularly for medical apps. As David Klonoff, M.D., founder of Diabetes Technology Society and a Clinical Professor of Medicine at University of California, San Francisco said “This surveillance program will provide a significant benefit to both patients and manufacturers”.
Anyone doubting the benefits of clinical mobile access, read on…
Yes of course it is a survey produced by a supplier, so possibly a trifle biased, however EU News’s item on the benefits of mobile access by community health people makes a very strong case for good access to clinical information when visiting patients that makes sense.
Notable quotes include:
Lack of access to patient information in real-time is affecting the ability of 88% of community health workers to perform their roles…
70% of participants said mobile working technology had resulted in greater patient involvement in care and the management of conditions, and had also improved the quality of visits, with more time focused on treatment.
Almost a fifth of respondents said they spent more than ten hours a week, the equivalent of more than two hours per day, on a combination of travelling back to base to file reports, and other administrative tasks – time that could be spent providing enhanced patient care or home visits.
mHealth: a salmagundi of items
Overloaded with Horizon2020 proposal adjudication and conference management (including the first DHACA members’ day on 11th July), this editor has been unable to do much Telehealth & Telecare Aware blogging. However the interesting items have continued to attract my attention and Prof Mike short (especially), Alex Wyke and Nicholas Robinson have continued to add further to the pile (huge thanks to all). So much seems worth highlighting: where to start? Perhaps with the 18 factors to make telemedicine a success, enumerated by the EU-funded Momentum project. Telecare Aware readers will be unsurprised by all 18, which look pretty basic. However many will notice obvious absences, such as the need to adduce evidence of the success of the intervention. Gluttons for punishment will find much more (more…)
Medvivo comes of age (UK)
A year after this editor began his three year stint with Telehealth Solutions, we had a corporate near-death experience, as money got very tight waiting for that first big telehealth order (thankfully it came, courtesy of NHS Norfolk). In those days of reduced salaries, and few employees, we could only dream of becoming a full service remote healthcare monitoring organisation.
This week’s announcement of the acquisition of Magna Careline shows how things have changed in just five years. After being acquired by Moonray Investors, (more…)
Enterprise wearables for clinical health–and more
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/Evena-veins-620×454.jpg” thumb_width=”150″ /]This ZDNet story technically has only one wearable in health–the Evena Medical Eyes-On Glasses which help medical staff find that vein (left) and is being trialled at Stanford University Medical Center. The other four profiled are being used in businesses as wide-ranging as engineering, restaurants, retail stores and manufacturing, but they are being used in the ‘here and now’: Abeseilon work-stream video; Google Glass for reviewing/recording work, training and coaching; the Theatro Wearable Computer ‘targeted’ messager; and, somewhat Big Brother-ish, the Hitachi Business Microscope, an RFID-like device the size of an ID card that captures employee interactions and collaborations. A savvy HIT developer or implementer could, as has been done with Glass, find different uses for the other three in hospitals, home care or practices.
And you’ll be surprised what made TechRepublic’s list of wearables’ 10 biggest flops. (Already!)
Apple Health, minus the ‘book’, announced
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/healthkit-apple-wwdc-2014-87_verge_medium_landscape.jpg” thumb_width=”170″ /]Breaking and developing… Apple announced their long-rumored health tracking app [TTA 22 Mar] this morning at their WWDC (World Wide Developers Conference) in San Francisco. The consumer app is called Health (not Healthbook) and the developer platform HealthKit which are both part of iOS8 for iPhones and iPads in the fall. HealthKit facilitates pulling in of health data from third-party developers so that all health-related information for the consumer user is in one ‘hub’, similar to what Apple’s Passbook app does now as a ‘virtual pocket’ for airline boarding passes, movie tickets and coupons. Apple’s Craig Federighi, senior VP of software (pictured, courtesy of The Verge), made the announcement of the app and platform as part of the broader debut of iOS8 this morning.
Already on board is Mayo Clinic with an app that logs information like blood pressure, tracking normal range and it appears from reports that a severe enough deviation will initiate a contact with medical professionals. Nike was prominently featured as an app provider, further confirming that it’s leaving the hardware to their close corporate partner now that it’s out of the FuelBand business [TTA 22 April]. Epic Systems, a leading large system (hospitals/practices) EHR, appears to be integrating integrating its personal health record (PHR) with HealthKit, “suggesting a framework for getting information collected via HealthKit into patients’ MyChart (Epic PHR–Ed.) app.”
Editor Donna wonders if the still-in-early-days Better iPhone health personal assistant app (PHA), developed in conjunction with and backed by the aforementioned Mayo Clinic [TTA 23 Apr], will prominently integrate into Health. (We’ll cover when this develops, as we think it will–but mum’s their word for right now.)
In Mashable, the news was applauded by the CEO of leading app MyFitnessPal as a big validation. In his opinion, Apple would work with the existing field of apps and devices. Leading fitness bands Jawbone and Fitbit had no comment. Fitbit was shown during the presentation: CNET (one of six pictures here) and The Verge (article below). The latter makes the excellent point that Jawbone, Fitbit and the Nike FuelBand have all been sold in Apple’s stores.
The speculation is that Health will be a key part of the features of the iWatch to come, but Mashable in quoting Skip Snow of Forrester Research does bring up a significant wrinkle. Bluetooth LE as a network protocol chews up a lot of battery power, and bigger batteries make for clunky devices. Not exactly the Apple design ethic. Could it be that what’s delaying the iWatch is development of a new, more power-efficient network standard?
Update 3 June: With iOS8 having apps communicating with each other, have the Apple-oids opened the door for a Happy Hacking Holiday? Stilgherrian in ZDNet points out that the ‘attack surface’ in info security-ese just got a whole lot larger. A future ‘oopsie’?
Hat tip to Editor Toni Bunting
More information: Mashable can’t stop mashing stories: Apple Reveals iOS 8: Interactive Notifications, Health App and More, Apple Gets Into Fitness Tracking With Health App and HealthKit for iOS 8, Apple’s First Step Into Health Tracking Is Small But Powerful. Mobihealthnews gets into the act noting Epic’s involvement: Apple reveals tracking app HealthKit and partners with Mayo Clinic, Epic. The Verge positively is on said verge with Apple HealthKit announced: a hub for all your iOS fitness tracking needs.
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