Signs of a home monitoring bubble?

August 27, 2013 | by | 3 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/Ambio-health.jpg” thumb_width=”175″ /]Suddenly home-based remote monitoring is very warm, if not hot. The news of investments at all levels–from Medtronic’s purchase of Cardiocom [TTA 12 Aug] to a $525,000 third angel round investment in AmbioHealth (which this Editor doubts would have been on MedCityNews’ radar a year ago)–sounds like home telehealth is finally, finally gaining traction with investors, which have been more attracted to hospital-based and fitness monitoring. But is it the right type of traction based on reasonable expectations? We were among the first to point out in 2010 in positing the FBQs* that where the data goes, how it’s being used and who’s taking action on it was critical. Now Robert Pearl MD in Forbes is also examining the new song of home RPM and finding a few off notes (or to mix metaphors, finding a pan of fool’s gold):

That’s because some promoters of home monitoring technology believe doctors will carefully scrutinize each EKG or blood sugar reading and use the information to tailor perfect regimens for their patients. This is not how medicine works.

and

Looking at thousands of EKG tracings won’t add much value either. In fact, putting all that information into an electronic medical record (EMR) only makes it more difficult for doctors to identify other, more vital pieces of information. Instead, doctors need to understand which of a few possible patterns are happening to determine the appropriate course of action.

Dr. Pearl’s prescription is for smartphones to embed telehealth monitoring capabilities at a price point slightly above the current cost, but less expensive than stand-alone devices (more…)

Humanising healthcare…or doctor making a ‘glasshole’ of you?

August 26, 2013 | by

dont-be-scared-your-surgeon-may-soon-wear-google-glass-in-the-operating-roomA cardiothoracic surgeon at the University of California, San Francisco recently performed surgery wearing Google’s wearable computer, Google Glass.

Dr. Pierre Theodore described his experience at the recent Rock Health Innovation Summit. During the surgery he used the glasses to compare the patient’s CAT scan images with what was in front of him. “There was a cognitive integration between what I saw in front of me and the radiographs. It was extraordinarily helpful,” he explained, likening it to driving a car and glancing in the rear-view mirror (as opposed to having to turn around to see what’s behind).

Also speaking at the event was Ian Shakil, Co-founder and CEO of Augmedix, a start-up company which is building applications for healthcare on Google Glass. According to Mr Shakil, one aim of the technology is to re-humanize healthcare so that physicians can focus on the doctor-patient encounter and cut down on the non-patient facing tasks, like taking notes and looking up medical records. 

While it’s arguable whether or not companies such as Augmedix will succeed in further humanising healthcare (picture your doctor, one eye staring at you as you explain your latest woe, the other twitching around, viewing who knows what in a Google Glass eye-piece), various applications for Google Glass do seem to have real potential for being of benefit in certain healthcare settings.

Indeed, for better or worse, there’s little doubt that Google Glass (or a similar device) will be used in many professions in the not too distant future. And according to research carried out by Augmedix, most of us are fine with that. The company asked 200 patients before a visit if they minded seeing a doctor wearing Google’s head-worn gadget, and only 3 demurred!

However, as highlighted previously by the discerning gaze of TTA’s Gimlet Eye, we might be best served not to disregard the potential for misuse and abuse with wearable ‘cybernetic headbands’ such as Google Glass, not least in a clinical setting!

Read more: Fast Company / MIT Technology Review

 

Related TTA articles: Google Glass ‘hacked’ for hospital facial recognition / Google Glass through a doctor’s eyes / Google Glass: a proper potential in healthcare

Don’t be put off by the title…take II (and take your pick II)

August 26, 2013 | by

Following on from yesterday’s post entitled “Don’t be put off by the title, or the conclusion, of this review of reviews“, Mike Clark has kindly pointed me towards another recent review of telehealth reviews entitled “Telehealth – the effects on clinical outcomes, cost effectiveness and the patient experience: a systematic overview of the literature”, this time from Salford University, authored by Dr Alison Brettle, Tamara Brown, Professor Nicolas Hardiker, Jon Radcliffe and Christine Smith.

This paper provides an intriguing contrast to the paper reviewed yesterday in a couple of, doubtless unrelated, ways. Firstly, whilst the word that was the subject of yesterday’s post does not appear in the title (it does appear in the text), the paper was funded by an educational grant from the organisation most often associated with that word. Secondly, the review is noticeably more positive, for example:

“There is more evidence for some conditions than others, but on the whole the trends are largely positive suggesting that telehealth is effective in:

  • Reducing patient mortality and hospital admissions for chronic heart failure
  • Reducing hospital admissions for COPD
  • Reducing blood pressure in hypertension, improving glycaemic control in diabetes and reducing symptoms in asthma”

As with our two recent posts on Birmingham OwnHealth, it looks like it’s take your pick time again.

It is perhaps just worth adding that there are also significant similarities between some of the observations made in both papers, most notably about the small size of many trials, inconsistent collection of outcome measures and the weaknesses of the methodologies currently used for assessing the effectiveness of trials of medical devices.

Don’t be put off by the title, or the conclusion, of this review of reviews

August 25, 2013 | by

Whenever I see the word “telehealthcare” I feel there should be an ® or perhaps a ™ after it as it so often appears in connection with a particular organisation. However no such connection is evident is this paper entitled “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview” (published on the PLOS ONE site), especially as the overall conclusion is far from that often found in articles toting that word:

“Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.”

If you stop there though, you miss some very important points (more…)

Medivizor patient info site goes public with additional information

August 24, 2013 | by

Medivizor, which was one of the better discoveries of our CE Week (NYC) coverage and the H20NYC/Healthcare Pioneers evening back in July [TTA 3 July], has moved out of what was a largely private beta to what they interestingly term a ‘public beta’. The site provides individualized content, understandable by the layman, for subscribers on a larger group of diseases which were on track for this fall: lung, colorectal, breast, and prostate cancer, as well as melanoma, diabetes, coronary artery disease, hypertension and stroke. The goal is to improve doctor-patient communications by better patient education. Another important feature is a “personalized system for matching individuals with specific clinical trials available worldwide.” Company release, Xconomy article.

A related New York Times article is an appreciation of how physicians are overwhelmed by information and that “doctors also need a skilled docent to help walk them through all that curated data.”  Healing the Overwhelmed Physician

Journal of the International Society for Telemedicine and eHealth (South Africa)

August 24, 2013 | by

A heads-up to our readers: a new peer reviewed journal out of South Africa’s University of KwaZulu-Natal’s Department of TeleHealth is the Journal of the International Society for Telemedicine and eHealth. On its second edition, their content (in PDF or HTML formats) seems to be of general interest:

  • Editorial: Would a Rose By Any Other Name – Cause Such Confusion? (defining eHealth)
  • Original Research:
    • TalkMeHome: an in situ evaluation of a service to guide a lost person with dementia home safely
    • Assessing the development process of the eHealth strategy for South Africa against the recommendations of the WHO/ITU National eHealth Strategy Toolkit.
  • Invited Commentary: Telerehabilitation: Current Challenges to Deployment in the United States

The Editors are certainly an international mix: Prof. Maurice Mars, University of KwaZulu-Natal, South Africa; Prof Richard E Scott, University of of KwaZulu-Natal Director, NT Consulting, Canada; Dr Malina Jordanova, Bulgarian Academy of Sciences, Institute for Space and Solar-Terrestrial Research, Bulgaria.

Addicted to mobile health? Telepsychiatry to the rescue!

August 23, 2013 | by

Dr. Joseph Kvedar of Boston’s Center for Connected Health counted himself in this Editor’s camp as annoyed by the mHealth hype (inflicted by those we’ve dubbed the D3H—Digital Health Hypester Horde), and far more of a believer in SMS for health programs. His blog post is a ‘kind of edge’ towards thinking that mHealth can be habit-forming. In the CCH’s own clinical trials, more participants have smartphones (tracking the general population’s adoption) even with the lag among those with chronic disease (maybe a question of affordability?) and want apps. And then he sees the pattern of people checking their smartphone obsessively, like budgies with bells and mirrors….along with a study that indicates that patients with a passive sensor to upload blood glucose measurement, rather than pushing a button, were “significantly more adherent to their plan and had better health outcomes.” Not having to do something in the Diabetic’s Perpetual Battle of Stalingrad is addictive? Well, this is edging towards a nomination for ‘What in the Blue Blazes?” Could mobile health become addictive? (CHealth Blog) Hat tip to reader Bob Pyke via Twitter

Well, we can send Dr. K to a connected psychiatrist for a session of e-therapy.  (more…)

Eye diagnostics a hot mHealth area

August 23, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /] The Gimlet Eye spied earlier this week that California startup iCheck Health Connection, which has a series of mobile app patents around eye diseases, has raised $750,816 of a $3.6 million offering (SEC filing) in what is presumably an angel round of funding. What was surprising in the Mobihealthnews article were their five patents around eye diagnostics: video games meant to monitor retinal diseases and visual field loss in glaucoma,  as well as “eccentric photorefraction, pupillary light reflex and the corneal light reflex eye screening tests in infants and young children.” The Eyes seem to have it lately with MIT Media Lab’s EyeNetra spinoff in July filing with the SEC their raise of $2 million of a $2.5 million round for their Netra-G app and attachment, which measures nearsightedness, farsightedness and astigmatism [TTA 9 July], Sensormed Triggerfish’s diagnostic contact lenses [TTA 31 July] and eye tracking as a stroke diagnostic [TTA 18 March]. Only last night Editor Donna at Health 2.0 NYC’s ‘Killer Apps for Healthy Living’ (KA4HL) saw Joshua Weiss, CEO of app developer TeliApp present his latest project, a mobile slit lamp sleeve that would fit over a standard smartphone and view the inside of the eye in clinical quality. (The office slit lamp is distinctly not mobile and costs between $2,500 and $5,000.)  The app would also enable a non-opthamologist/optometrist to flag eye issues as well as permit remote diagnosis in a home visit, in emergency response or by combat medics. It just went on crowdfunder MedStartr for a $16,000 funding towards an anticipated $160,000 raise for a prototype. (See Josh’s presentation at KA4HL here–registration required–at 01:50:57)

Contributing Editor Charles adds: there’s also an impressive mHealth app just announced in the UK that was developed by doctors in London and Glasgow to help diagnose serious eye conditions in the developing world called the Portable Eye Examination Kit (PEEK).  Around 39 million people around the globe are blind, 90% of them in low income countries; 80% of cases could apparently be avoided if health workers could reach them with affordable equipment.  PEEK is set to replace standard ophthalmology kit costing more than £100,000 with a £300 smartphone producing equally good results.

Trained health workers first assess a patient’s vision by flashing progressively smaller letters onto the screen.  Then they use the camera to check the lens of the eye for cloudy cataracts.  Finally, by attaching a special clip to the camera and switching on the flash, they are able to check the retina at the back of the eye for diseases such as diabetic retinopathy.  The images can be sent back to a hospital for assessment, along with the precise GPS coordinates of the patient’s location so they can be found later and treated.

An update on the MOBISERV Kompaï project takes some flak

August 23, 2013 | by

A long (and in need of editing), anodyne article on the European tech website Cordis updating the status of the EU/UK robotics project known as MOBISERV and the Kompaï companion robot, has generated a bit of controversy in the mHealth LinkedIn group (membership required). Group manager David Doherty, better known for his mHealthInsight (3GDoctor) website, objects to the design, the time and funds spent on it, and more. To summarize his points:

  • It’s a waste of money on a device and R&D which could have been used on more targeted solutions to real problems
  • A ‘touch screen robo-vehicle’ may not be usable by an older person who has trouble with smartphones or tablets for cognitive or mobility reasons
  • Mobile and other companies are already surpassing the EU project in both innovation and R&D in the job to be done; example Samsung’s gesture control and the LiquidWeb Brain Control brain interface from Italy. (And the ever-popular speech recognition in the here-and-now)
  • It’s a closed system versus open innovation, where other developers especially those on Kickstarter build in access (SDK–software development kits). Example is Romo, the small wheeled desk robot for the iPhone. (However, Editor Steve in his coverage of Kompaï in early days reported that its SDK is open source TTA 4 May 10)

We will leave side-taking to our readers, but David’s points are strongly worth considering, as this project has taken at least four years and perhaps more, and funding–who knows? (Editor Donna notes that Editor Steve followed Kompaï since 2010 in articles such as Kompaï by Kompaï, the Dutch TV video, and experiments in gesture-based control for those with strokes and similar impairments.)

The convergence of health systems with technology (US)

August 23, 2013 | by

Intermountain Healthcare has been well-known for its proactive approach to healthcare models–it moved early to a fixed-fee integrated delivery system (IDS), helped to pioneer the evidence-based healthcare approach and was an early adopter of EMRs. It was one of the main providers cited in the influential The Innovator’s Prescription written by Clayton Christensen, the late Jerome Grossman, MD and Jason Hwang, MD. It’s now further backing technology development and integration through its new Healthcare Transformation Lab. Founding members Xi3 and Intel, and ‘collaborators’ Dell, CenturyLink, NetApp, and Sotera Wireless are participants in the new 20,000 square foot facility at Intermountain’s lead hospital in Murray, Utah. Some of the prototypes already being readied are the ‘patient room of the future’, 3D printing of medical devices for testing purposes, a watch-form handwashing sensor, a ‘life detector’ for patient vital signs (an outgrowth of ViSi Mobile TTA 23 Aug 12?), a mobile vital signs monitor/data collector for use by helicopter rescue teams, an alert system for at-risk for suicide patients based on increased heart rate, and more. What seems to be missing are innovations related to the specific needs of older, frailer patients. Release. The extensive coverage is indicative of Intermountain’s influence in healthcare far beyond Utah: Healthcare IT News, FierceHealthIT, iHealthBeat, Salt Lake City Tribune. Will other health systems follow in influencing and funding health tech?

Falling in Torbay – a mine of useful information (UK)

August 22, 2013 | by | 2 Comments

The Kings Fund has just produced a detailed analysis of the total health & social care costs for older people admitted to hospital following a fall in Torbay over a 12 month period.  This should be of serious interest to anyone writing business cases for falls-related technology or generally doing any financial calculations in that area. (Torbay has excellent integration of patient/service user records that enables this analysis to be done with great accuracy).

The headline finding is that the total health and social care costs of dealing with older people who have had a fall that they have had to go to hospital for, in the year after that fall, is almost four times the immediate cost of the unplanned hospitalisation after the fall.  Unsurprisingly, for those who die within a year of the fall, total costs are somewhat higher than for those who survive.  Using the Kings Fund’s figures I calculate that the incremental health & social care cost of a fall is just under £7,000 (which includes both the immediate hospitalisation cost and the following years’ costs, less the previous year’s costs). This of course ignores the costs to the individual, their family and community.

Many readers will by now doubtless be wondering whether the costs of falling were reduced for those fallers who were Torbay Lifeline users as conventional wisdom is that the cost is very dependent on the length of time someone remains on the ground before being rescued.  Sad to report that analysis was not done (see comments on the paper – I have requested it). Nevertheless it is a brilliant resource for anyone looking for cost information on this very important topic.

Surrey telehealth – some good news!

August 21, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/Surrey-County-council-Logo1.jpg” thumb_width=”150″ /] The announcement by Medvivo and Surrey County Council of telehealth becoming fully embedded across all six CCGs in Surrey is good news for those who believe in the benefits of telehealth.

Pulse was one of the first to carry the news today, though was  unable to resist the temptation to remind readers of the high cost/QALY found by the Whole System Demonstrator (WSD) programme (which was caused, as Telecareaware readers will know from a previous post, by the high cost of running the WSD RCTs and using equipment that is now some six years old).  The more positive EHI post is here.

Over the past year there has been much concern about whether telehealth arrangements established by the previous PCTs might be taken forward by the CCGs; Surrey shows it can be done successfully.

(Disclosure: Charles Lowe established and ran the telehealth programme in Surrey for NHS Surrey and Surrey County Council between 2011 and 2013, including managing the tender process.  He did not however adjudicate the tender – some 40 representatives of organisations in the county participated in the adjudication.)

A ‘mobilized’ artificial pancreas breakthrough?

August 20, 2013 | by

Neil Versel (again) profiles a mobile platform that may be the start of the end of the Continuing Battle of Stalingrad for type 1 diabetes patients.  The prototype system, Diabetes Assistant (DiAs), is a closed-loop system which combines a modified Android phone with wirelessly connected wearables attached on the skin–Dexcom glucose monitors and Insulet OmniPod insulin pumps- to effectively act as an artificial pancreas. It was developed by University of Virginia’s Center for Diabetes Technology with funding via The Juvenile Diabetes Research Foundation and the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases. Findings of the 20 patients monitored were initially presented at June’s American Diabetes Association’s annual scientific meeting and published in the July edition of the journal Diabetes Care (PDF does not require subscription). The system was designed by an international team:  Sansum Diabetes Research Institute in Santa Barbara, Calif., University of Padova in Italy and the University of Montpellier in France.  Tests continued with summer campers and the integration of Bluetooth LE into the connectivity system.  Mobihealthnews article.

But can this small miracle of a system be hacked–and can providers be held accountable? This scary thought of ‘harm or death by hacking’, with the example given of an insulin pump gone awry–was tagged at the 2011 Hacker’s Ball, a/k/a Black Hat USA by Jerome Radcliffe [yes, in TTA back in August 2011]. The late Barnaby Jack was also on the medical device hack track. The danger is only now entering the consciousness of medical administrators and the industry press in mainstream venues such as Information Week. Are Providers Liable If Hacked Medical Device Harms A Patient? (Healthcare Technology Online). Also Kevin Coleman in Information Week tells more about the liability providers may find themselves in if they don’t update their systems.

Both the diabetes closed-loop systems under development (Diabetes Assistant is one of three) and the hacking threat were addressed by Contributing Editor Charles earlier this month [TTA 5 August] in his examination of how systems should move from decision support to decision taking in order to truly reduce patient or caregiver burden.

Health tech scenes we DON’T want to see

August 20, 2013 | by | 2 Comments

The real reasons for wellness monitoring in the corporate world, as seen through the eyes of the Dilbert comic strip. Could this be CVS Caremark or the average employer in five years or less? [TTA 12 April] Hat tip to Neil Versel in his Meaningful HIT News; note comment from our own Contributing Editor from Australia, George Margelis, on algorithms missing the healthcare point.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/192722.strip-Dilbert.gif” thumb_width=”650″ /]

Future GP consultation – boring but very important (England)

August 19, 2013 | by | 2 Comments

NHS England has just launched a consultation on the future of GP practices, with a slide set of the case for change and the NHS’s underlying objectives for general practice together with an evidence pack which provides some information about current general practice and health needs.

This is important to everyone who senses that modern technology can help make a real difference to the way care is delivered because there is a serious lack of ambition (more…)

How best to help older people to understand the benefit of technology? (UK)

August 18, 2013 | by | 4 Comments

Last week we reported on the survey commissioned by the National Telehealth Forum that found that 9 out of 10 people didn’t know what the word ‘telehealth’ meant, a proportion that was worse for those who were more likely to need it. We suggested that asking a different question about whether they knew that technology could enable them to remain in their own home might give a more positive response.

Well no sooner said than (sort of) done – Invicta Telecare reported a similar-sized poll that, among many, included the finding that “more than three out of five over-65s (65%)…admit they hadn’t seriously thought about the type of care and support they would prefer as they get older during the last five years”. Other responses in the interesting survey seem to confirm that a significant number of older people are in denial of the implications of their age so are inadequately prepared to remain independent.

This clearly strengthens the conclusion from our earlier piece, and from our retrospective on why O2 pulled out of this field of the increasingly pressing need to make people aware of how technology can support independent living. Is 3millionlives the way forward?

This is obviously a topic of great interest that will undoubtedly be debated this autumn particularly at the two conferences specifically aimed at how technology can supporting people to age well, run by the Kings Fund on 22nd October and the Royal Society of Medicine on 25 and 26th November. (Disclosure: Charles Lowe is one of the organisers of the latter).