STSI (Scripps Translational Science Institute), directed by the famous Eric Topol, MD, is undertaking a 200-person six-month research study to determine the results of telehealth monitoring for three conditions (diabetes, heart arrhythmia and high blood pressure) coupled with an active disease management program. Half of the survey group will receive a Withings Blood Pressure Monitor, an AliveCor Heart Monitor and an iBGStar Blood Glucose Meter delivered via Qualcomm Life’s 2net Hub and Platform to a web portal or mobile device; the remainder will not but will be part of the disease management program. Subjects will be drawn from Scripps Health employees and family, which to this Editor may be stacking the deck–most employees of a health system presumably are health-conscious. Participants also include Scripps Health, HealthComp (third-party healthcare administrator which will monitor health status), Accenture and Sanofi Diabetes. Though the release promises ‘social networks’, the only reference this Editor could find is interactivity between the person and the health care team. Scripps press release. MedCityNews Hat tip to former QuietCare colleague José Molina (via LinkedIn)
Horizon Monday 12th August – ‘Monitor me’ (UK) now with tech update
A good programme exploring vital signs measurement – well worth a look. If you missed it, it is on BBC iPlayer (only available in the UK).
The 3GDoctor has collated the tech demonstrated, if you want to buy/get more info. Even offer a discount plus a ‘free ECG read’ on the AliveCor ECG device.
Analysis of the Birmingham OwnHealth service – not the bad news it seems?
The BMJ has just published an open access paper entitled “Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls” (BMJ2013;347:f4585, Steventon et Al). It reaches the rather depressing headline conclusion that telephone coaching did not reduce unplanned hospitalisations and if anything increased them.
This looks to fly in the face of the apparently less academically rigorous recent claims by the Leicester City CCG and Totally Health, that they reduced hospitalisations significantly, saving some £353,000 over a 30 week period with a cohort of between 47 & 50 patients that we reported recently.
However reading on, perhaps a key passage, in the conclusion, is (more…)
O2 – a retrospective
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/O2.jpg” thumb_width=”100″ /]With 1734 hits (and counting) the Telecareaware post on O2 Health’s telecare & telehealth withdrawal and associated comments was one of our most popular. It therefore seems appropriate to try to crystallise some important lessons from all those brilliant comments, so here’s my starter – please feel free to add your thoughts. (Almost all the comments are related to the retail telecare offering so unless specifically stated otherwise, all the following relates only to this side.)
Overall there was a huge sense of sadness that came through from many comments – many had seen the move into retail sales a confirmation that telecare had finally arrived as a mainstream technology in the UK, so a withdrawal so soon afterwards caused much grief. It was touching to see the concern for the staff too, who have worked so hard to get this venture airborne.
Although there were few comments specifically about the retail telecare kit, none were complimentary; it was seen as being single purpose, limited and hard to use. The ability to replicate the hardware functionality on a standard smartphone, (more…)
FDA publishes medical device interoperability standards (US)
While FDA is still dithering about issuing draft guidance on mHealth, it looks like medical device manufacturers can break out the champs, because FDA has now recognized 25 standards on medical device interoperability and cybersecurity. According to Bakul Patel of the Center for Devices and Radiological Health at FDA, “Making sure devices are interoperable requires the creation, validation, and recognition of standards that help manufacturers develop products that are harmonious and can “plug and play.” It’s an alphabet soup of industry standard abbreviations–IEEE, ANSI, AAMI, ISO, IEC and ASTM–and it’s purely voluntary, but various groups such as Continua and AAMI (Association for the Advancement of Medical Instrumentation) have praised this ‘first step’, and being published, it is now open for comment.
According to the Continua LinkedIn group announcement from Executive Director Chuck Parker, the 25 standards can be grouped into three categories:
- Risk management standards for a connected and networked environment
- Interoperability standards that establish nomenclature, frameworks and medical device specific communications and including system and software lifecycle processes
- Cyber security standards from the industrial control area most relevant to medical devices.
As the FierceHealthIT article cited, interoperability failure is a top 10 health technology hazard according to the ECRI Institute. One can hope the new standards can be applied retroactively to current devices which are not being patched and updated because manufacturers fear running afoul of FDA clearance regulations and counter that ‘discouragement’. [TTA 8 Aug] AAMI News, Federal Register 6 August, FDA Voice (blog article by Bakul Patel)
The five-point digital health checkup meets the FBQs
Checking up on some of the issues that the D3H crowd (Digital Health Hypester Horde) tends to skip merrily by, Dan Munro’s analysis hits several nails on the head and then some, with his points touching on our FBQs–the Five Big Questions*–we first outlined exactly three years ago (integration was added last year).
- Who has the rights to your data? You or only your doctor? (#3) And why not you?
- Need drastically improved standards of safety and security in devices. From those black hatted device hackers to the lack of updates by manufacturers and FDA‘s apparent discouragement–it may not be an an FBQ, but it impacts #5, data integration.
- Accuracy. Are these devices accurate or only ‘kinda’? How do you play off accuracy versus convenience?
- Privacy–what about it? Business models call for sale of ‘de-identified’ data which can be tracked back and re-identified. (#1) And what does your activity say about you-ooooo? (#3)
- The business model. Aside from who’s paying for the device and how much (#1, #2), #3 is still there–who’s looking at the data if you purchased the kit? And who’s liable for interpretation–and errors?
5 Point Digital Health Checkup (Forbes)
* The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.
FDA’s discouraging role in medical device security
According to a Wall Street Journal report (unfortunately firewalled), hospitals are pointing a very long finger at medical device manufacturers for not updating software and leaving devices open to breaches. Yet the manufacturers readily cite FDA’s most recent guidance as prohibiting software updates and security patches without resubmitting their devices for approval–something a spokesperson for the FDA denies as long as the update is for cybersecurity only. If the draft guidance issued in June is actually finalized, it will go the distance in helping manufacturers and hospitals. Hospitals Say Device Manufacturers Resist Boosting Cybersecurity (iHealthBeat)
Big data in healthcare’s Tower of Babel: interview with Eric Topol
A short interview in iHealthBeat with Eric Topol, MD, Lydon Newmann of Impact Advisors and Lee Pierce from Intermountain Healthcare shows the bright side of business intel/’big data’. All that structured and unstructured data collected on individuals can be put to good use by data warehousing and analysis–a success story is Intermountain’s reduction of induced births from 30 percent to 5 percent. Yet the wins outlined are single system. Eric Topol agrees with this Editor that “The problem that exists is they lack any ability to transfer information from one to the next. There’s no interoperability. So we have a Tower of Babel.” Audio (and a dissenting comment) here, PDF transcript here.
Microsoft Kinect now as sign language translator
The versatility of Microsoft Kinect continues to astound, with uses ranging from human rehab/physical therapy to equipping robots with anticipatory powers for your drink to Ellie the Virtual Analyst. Add sign language translation to this list. The latest is Chinese sign language simultaneous translation via Kinect that will permit deaf and hearing individuals to understand each other. Sign languages are their own entity with grammar and rules that make the spoken/written language nearly foreign to the user. The system developed by Chinese Academy of Sciences’ Institute of Computing Technology and Microsoft Research Asia joins the one developed for American Sign Language last year. Wired.co.uk Hat tip to Toni Bunting, TTA and TANN Ireland.
Digital Health Days (Sweden)
21-22 August 2013, Stockholmsmässan, Stockholm, Sweden
If you prefer to cool off from summer’s heat in Stockholm, the first annual Digital Health Days is “designed to provide the perfect mix of visionary expert panels, learning workshops and demonstrations of real solutions.” It is both a conference and exhibition–and looks to be diverse based on the program (in English). Speakers include Don Jones of Qualcomm, IBM hosting a presentation on Watson and certainly a different mix of companies. Events include a health hackathon and the Digital Health B2B meeting sponsored by the Stockholm Business Region Development; pre-organized one-to-one meetings bring together partners and investors for European companies. (Registration for this only is here and free). Website, registration
23andMe advertising nationally in the US (sign of the times)
23andMe, the US personal genetics company, launched Portraits of Health, the company’s first (US) television advertising campaign on 5th August.
Anyone unaware of the company and its ambitions could do worse than watch the excellent video of Anne Wojcicki’s presentation at a recent RSM innovations summit.
Whilst the NHS talks about building a 100,000 person genomic database, and the RCGP sees the most advanced medical development in the life of the average GP by 2022 will be remote delivery of test results, it seems that 23and Me is powering toward’s Anne’s goal of one million genomes sequenced.
It’s not a totally fair comparison of course as the NHS ambition is full sequencing, whereas, as she explains in the video, 23andMe focuses on what they consider the key areas; nevertheless it’s impressive stuff and an indication of just how quickly technology is changing healthcare.
Is your body temperature looking hot? Soon you’ll be able to find out!
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/sony_vital_signs.jpg” thumb_width=”150″ /]In a Pointer to the Future, Sony has filed a US patent application describing a way to associate vital signs such as blood pressure, pulse rate or body temperature with your photographs.
The idea is to record your vital signs as you take a photo or make a recording on a smartphone (or other portable gadget such as a PDA or tablet). Readings would be gathered from strategically placed sensors within the casing of the device and could be recorded continuously or at intervals.
The sensor information would then be assigned to a tag (such as “general fitness tag”) and stored alongside the image, with the tag and/or sensor readings used to organize and sort the images.
Other types of sensors such as a GPS locator, ambient temperature sensor, or light detector, could also be integrated. In this way the tag could be a result of internal biological data combined with external factors such as current position.
As regards healthcare applications, the technology could serve as a non-threatening way for healthcare professionals and clinicians to obtain vital signs readings from patients, either in person or remotely. It could be a useful addition to face-to-face or online psychotherapy consultations, and for assessing the urgency of emergency ambulance calls.
As this filing is currently at the application stage, no patent has (yet!) been granted to Sony. The idea does however open up some interesting possibilities, not only in healthcare and for Quantified Selfers, but also in areas such as security and gaming. Also reported in Engadget.
The Berwick report on patient safety – is there a place for telemonitoring? (UK)
Reading and listening to the debates in recent days about whether the excellent Berwick report should have mandated staffing ratios, instead of leaving such guidance, as his report does, to NICE, I wondered to what extent technology had been considered to have an important role in improving patient safety.
The best example I can think of why this can be important, from my Newham days, was people prone to night-time fits that used to require dedicated human monitoring throughout the night. By installing appropriate telecare we were able both to improve patient outcomes by enabling people to sleep on their own without outside disturbance at the same time as reducing significantly the cost of night-time care: a case where technology simultaneously enabled an improved level of care and a reduced staffing level.
It was therefore reassuring to find on Page 22 under the heading “A note on staffing ratios”:
| “Our primary recommendation on staffing patterns is that NICE undertake as soon as possible to develop and promulgate guidance based on science and data. Such guidance, we assume, would include methods by which organisations should monitor the status of patient acuity and staff workload in real time, and make adjustments accordingly to protect patients and staff against the dangers of inadequate staffing. We also assume, and hope, that innovations will develop and continue in technologies, job designs, and skill mix that will and should change ideal staffing ratios, so that this role for NICE ought to be ongoing.” |
I’d hasten to add that I am not advocating general use of telemonitoring in response to the report – merely to point out that there are some specific occasions where technology can help, and those are increasing as new technologies, possibly such as smart floors, are developed.
First ‘Lucky Thirteen’ StartUp Health/GE program company sold
Breaking News
One of the ‘Lucky Thirteen’ companies, Arpeggi, which entered the joint StartUp Health/GE Ventures program back in April [TTA 4 Apr], has been sold to another early-stage company in the genetics analytics, data management and diagnostic space, Gene by Gene. It is the first acquisition of one of the joint program companies and according to StartUp Health spokesperson Nicole Kinsey, “this is a strong sign of how well the program is is working to accelerate and scale digital health startups. This new combined company will be a major competitor to companies like 23andme and will really offer the consumer market much greater access and affordability to DNA testing and sequencing services.” The Arpeggi group and tech platform will be incorporated fully into Gene by Gene, and according to Unity Stoakes, President of StartUp Health, the latter will now enter the StartUp Health/GE Ventures program. Release (PDF)
“A rose by any other name would smell as sweet” (UK telehealth)
60 Second GP today points to an article on what looks to be essentially a Simple Telehealth-type application, in this case a GP-led internet-based programme to encourage weight loss among obese patients in West Oxfordshire. What makes it newsworthy is that it never mentions telehealth, yet extolls the benefits in a manner that any telehealth project or programme manager, eager for clinical acceptance will instantly recognise, such as:
- “An internet-based programme can involve GPs in the weight loss of a large number of patients in a cost-effective manner.”
- “The main benefit of the programme is that it dramatically reduces the cost of face-to-face time with patients, freeing up healthcare professionals for other activities.”
Does this mean that the good GPs of West Oxfordshire have taken onboard a previous Telecareaware post “When mHealth and telehealth become ‘just healthcare’” ?
I somehow doubt it – however the article is nevertheless recommended reading for anyone wanting to sell successfully a telehealth programme to clinicians without ever mentioning the ‘t’ word.
Also worth pointing out is that a feature of the programme was to introduce some gamification – in this case via a league table of weight losers, where anonymised patients reported changes in weight, so other could compare achievements. Perhaps that’s why the authors, Professor David Brodie, Emma Doyle, Dr Jey Radhakrishnan and Dr David Shaw, report that “One of the most striking outcomes was the high number of men who lost weight (almost 90%), because men are often more reluctant to become involved in weight loss programmes”? (For another great example of gamification applied to weight loss, without the technology, see Fitfans in Hull.)
Sadly there is no information in the article on the size of the programme…and the implication seems to be that having been shown to be successful it was discontinued after 12 months.
Systems sharing data, still behaving badly
A straight-shooting article in Healthcare Technology Online provides a overview of the EHR and Health Information Exchange (HIE) mess in the US. Essentially our major EHR systems (Cerner, McKesson, athenahealth, Greenway, Epic) don’t interchange data well, if at all–and the 600-odd practice EHRs were built on siloed designs, existing software and used proprietary formats, often in a rush to take advantage of Federal subsidy programs in Stage 1 Meaningful Use–as HTO’s EIC Ken Congdon stated, “electronic filing cabinets”–and heavily outsourced. Well, it’s now ‘uh-oh’ time as a key part of Stage 2 MU is interoperability. Basically we now have a set of what this Editor would term ‘paste ons’ and ‘add-ins’ to facilitate data exchange between systems that speak different languages (Editor’s emphasis):
…direct protocol (a standards-based method for allowing participants to send authenticated and secure messages via the National Health Information Network), as well as those developed by HL7 (Health Level Seven), a nonprofit global health IT standards organization, provide EHR users with the building blocks for exchanging data. Blue Button, an application developed by the VA that allows patients to download their own health records, is also being adopted and manipulated by EHR vendors and independent developers as a way for providers to exchange data between systems. Moreover, regional and state-run HIEs offer healthcare providers in several parts of the country a network they can join (and technology infrastructure they can leverage) to share health data with other HIE members.
Some systems work well–EHR and pharmacy systems seem to. However, EHR to EHR interfaces are up to the provider and are expensive. Sharing/translation does not mean that all information makes it over without getting ‘bruised’ or having to be reentered manually. HIEs, acting as a focal point for data exchange, are also generally non-profit; the exchange platforms cost millions to develop and further millions to maintain–and buy-in is low, as the article states. Fixing The EHR Interoperability Mess (free registration may be required)
(Updated 8/7 pm for Editor Donna’s POV) This is what happens when you rush adoption and development processes that should take years in order to gain quick subsidy money, and non-healthcare entities (that is you, the US Government) encouraged this, distorting the process. The private and public waste of scarce healthcare funds is appalling, and the disruption to the healthcare system is unforgivable–especially in practices where doctors and managers in many cases have been sold a bill of goods, and they are revolting by changing EHRs, going back to paper or retiring. And the Government should look to itself first. Look no further than to the multiple failures of two branches of the US government, Veterans Affairs and Department of Defense, which have the responsibility for current and veteran members of our Armed Services. They have failed spectacularly in serving Those Who Have Served not only the integration of their two EHRs but also in updating their basic architecture [TTA 27 July ‘Pondering the Squandering’… and 3 Apr ‘Behind the Magic 8 Ball’ both review the sad details.] The belief that HIEs with limited funding will solve the interoperability problem is Magic Thinking. At least one move in this direction makes sense: the CommonWell Alliance of six EHR heavy hitters to work on ‘data liquidity’ [TTA 5 Mar announced at HIMSS], but this may be another ‘uh-oh’ and face saving.
With basic, necessary health and patient information stuck in systems and getting lost in translation, how can anyone rationally expect that personal data from telehealth devices will be integrated anytime soon, in any meaningful way? Does this mean that parallel, separate systems and platforms will continue to develop–and yet another wave of integration?
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