Telehealth Soapbox: Time to bid farewell to the WSD?

July 22, 2013 | by | 5 Comments

TTA Contributing Editor Charles Lowe asks whether it is now time to stop looking back to the UK’s pioneering Whole Systems Demonstrator (WSD) programme.

As the person who led the bid for Whole System Demonstrator status for LB Newham back in 2006/7, this is my case that it’s time now to bid farewell to the programme, as soon as is possible.

Why?  This was a great programme that came up with some encouraging results for telehealth, and taught us a huge amount about how best to implement telehealth and telecare.  However the echoes from that long gone time are increasingly providing ammunition for the naysayers, when in reality the world is now a totally different place.  The technology is unrecognisable from that that we considered when bidding for the WSD in 2006; it is far more efficacious and far cheaper; and it can be deployed much faster & for many more conditions, opening up many possibilities not available to us when we won in 2007.  We now know much more about how to implement the technology too: in particular it delivers greatest benefit when a part of an overall programme for improving care and not, as the WSD randomised control trial (RCT) treated it, as a simple intervention, like most drugs.  In retrospect therefore there were significant weaknesses in the way the trial was run.

The continuing drip-feed of WSD results is sadly resulting in (more…)

Telemedicine in rural parts of developing countries

July 21, 2013 | by | 1 Comment

Implementing “telemedicine” in developing countries is one way to spread the availability of healthcare to the poor in remote rural areas, says an article in Unite for Sight.

Without access to advanced laboratories, healthcare workers rely on evaluating symptoms to diagnose illnesses. Even then, the shortage of trained healthcare workers, particularly in rural areas, means alternative approaches are often needed. Telemedicine in this scenario is often limited to telephone consultations with specialist consultants and image and data exchange using the internet.

The unavailability of widespread basic infrastructure is however a limiting factor – creating a new “digital divide”.

Read more about the problems surrounding getting healthcare to the poor in developing countries at Healthcare Technology in Resource-poor settings and the Guardian article Getting medicines to the poor: solving the logistics challenge.

NaviGo Health: matching doctors and patients like a dating site

July 20, 2013 | by

Here in NYC, the major success envy story for eHealthy entrepreneurs has been doctor appointment-setting website ZocDoc. With multiple rounds of funding from the likes of Goldman Sachs, it’s appeared to have unassailable ‘cred’ and ownership on a national basis. Cleveland Ohio-based NaviGo Health wants to cut a small and specialized slice of this pie through using a ‘dating model’ process. (This Editor wondered “why didn’t I think of that?”) Their platform CompassMD matches newly diagnosed cancer patients with doctors, based on how both parties answer a list of questions based on communication, decision-making, treatment and personality preferences. The founders are working out of co-working space at a Shaker Heights Ohio accelerator, LaunchHouse (built in a 1950s car dealership!), and on ‘FFF’ money attempting to snag a pilot. The website’s a home page, they tweet at @navigohealth. Can a few docs out there lend them a hand on their pilot? Maybe some crowdfunding and Health 2.0 folks to the rescue? Compatability (sic) matters: NaviGo Health puts an online dating-style twist on physician searching (MedCityNews)

VA distributing iPads to Family Caregivers (US)

July 20, 2013 | by

Back in May 2012 we noted a Veterans Affairs (VA) program for 2013 that would distribute 1,000 iPads to primary caregivers of seriously wounded veterans to facilitate care delivery and data transfer. Then called ‘Clinic-In-Hand’, it is now officially debuting as the Family Caregiver Pilot for caregivers of seriously injured post-9/11 veterans already enrolled in VA’s Family Caregiver Program. The intent is now more clearly focused on reducing caregiver stress, via  pre-loaded apps to share health information, coach patients through chronic pain and PTSD and serve up tools such as reminders and a health journal. A second, the Veteran Appointment Request Web App Pilot, facilitates appointment setting via mobile or desktop PCs for a separate test group of 600 veterans and was launched at the Washington, D.C. VA Medical Center and VA Palo Alto (California) Health Care System. According to EHR Intelligence, if successful it will be rolled out to all patients at these two VA centers with a system rollout in the future–complicated by the fact that every VA center has a different scheduling system. Meanwhile, VA’s VistA and the DOD’s AHLTA still don’t talk to each other. VA integrates mHealth into daily care, gives iPads to vets (EHR Intelligence); VA Mobile Health release (for additional details go to the left hand drop-down menu). Hat tip to Contributing Editor Charles Lowe.

Hospitals can benefit from telemonitoring (US)

July 20, 2013 | by

As someone who has spent a huge amount of time attempting to persuade acute trusts in the UK that telehealth is in their interests (with, I’m glad to say, a modicum of success more recently) it is good to see this paper entitled  in the July 2013 edition of the Journal of Telemedicine & e-Health (freely accessible).  The key finding is (more…)

Apple-ologists discern ‘new’ interest in health tech and telehealth

July 20, 2013 | by

With the same obsession that Kremlinologists had during the Cold War, the Apple-ologists at 9to5Mac divine that Apple is now suddenly interested in the sensor-based fitness sector of telehealth. Recent remarks by their CEO have been examined like the mutterings of the Oracles at Delphi. Their SVP of Technologies has been spotted wearing a Nike FuelBand, just like the CEO–and by looking at his picture, he does need it! Apple Marketing folks have been examining wearables like the Jawbone UP! (naturally as competition, duh!) Far more indicative from their sources: An all-star team from semiconductors to batteries to sensors is working in secrecy on the long-awaited iWatch. Talent’s been snatched from telehealth sensor companies AccuVein (vein mapping), the recently defunct C8 MediSensors (blood monitoring), and Senseonics (embedded sensor for blood glucose).  And they are most interested in sleep tracking. iWatch’s novelty emerges as Apple taps sensor and fitness experts

Apple’s been interested all along in healthcare–and others have been interested in Apple

No surprise to TTA readers, as you’ve been tracking Apple’s and competition’s healthcare moves along with us from the start.

  • the iPad in hospitals and their preliminary tests starting in early 2011 when tablets were new and untried [TTA 8 Feb 2011]
  • Editor Steve on the Apple Smart Shoe US Patent application back in January
  • Samsung’s hype on healthcare devices and software on the new Galaxy S4–fitness tracking disruptor?
  • 5.5 million plus of health app downloads (US) from the App Store (May)
  • the development of many devices that are based on the iPhone (Misfit Shine, AliveCor‘s ECG, the Ozcan microscope and food testers only a few)
  • …though Microsoft’s Surface for healthcare back in February is likely a dud–MS just wrote off $900 million with the Surface RT, lowered its price (though only a fool with money to burn would buy it) and the Pro continues to struggle (ZDNet)

Smartwatches as the 2013-2014 tablet…and will they knock out fitness bands?

But this press focus on ‘Apple for Health’ does disguise that Apple is behind the curve, not leading it, on the watch form factor. Just like the Soviets, Apple better get a move-on or lose the race that gets serious next year. Smartwatches are fast becoming the new tablet [TTA 2 July]. One rosy industry estimate has 5 million units sold by end of 2014 (Canalys Research in Gigaom). Sony’s been there for awhile. Pebble sold 275,000 pre-orders through Kickstarter, their web store and now retail through Best Buy. This week the rumor broke among the Microsoft-ologists that they are working on an aluminum smartwatch with a 1.5-inch screen and a band out of Star Trek IV. (The comments below the TechCrunch article on the very thought of smartwatches are a good chuckle!) And undoubtedly looking over their shoulder because they’re gaining on you, contrary to Satchel Paige’s advice, are Fitbit, Jawbone and Nike, wondering if they’ll be the next Zeo.

App platforms & mobile devices: what’s hot and what’s not (free report)

July 19, 2013 | by

Readers might be interested in an excellent free report entitled “Developer Economics 3Q 2013: State of the Developer Nation” produced by VisionMobile.  Based on a survey of 6,000+ respondents from 115 countries it charts the fortunes of the different app platforms, and of the hardware suppliers on which those apps sit.

Just one quote to whet your appetite:”2013 presents an inflexion point in the evolution of app ecosystems.”

Many thanks to Professor Mike Short for the pointer.

The future of Telehealth & Telecare Aware

July 19, 2013 | by | 13 Comments

As from today I, Editor Steve, am retiring from the Telehealth & Telecare Aware editorial team. After giving it my continuous attention for eight years it is time for me to focus on my other interests such as promoting my PowerPoint addins and nurturing my fledgling web design business. From now on I shall only be helping with the tech side of running the site.

I therefore thank you, loyal readers, whose comments and communications have kept me going during these years. I’d particularly like to express my appreciation to Tynetec which has advertised with TTA since it started and has never sought to influence editorial policy or content. Thanks too to Eldercare and Air Products for their sustained advertising support in recent years.

I have very special thanks, of course, for Donna Cusano for the amount of time that she has also put in since 2009 to keep us all up to speed on developments in the US. Without her TTA would have folded several years ago.

So…I am extremely pleased to announce that as I step back Donna has agreed to step forward as TTA’s new Editor in Chief. She will be supported by a number of volunteer contributing editors: Toni Bunting, Chrys Meewella, Mike Burton, Alasdair Morrison and Charles Lowe who will be covering UK developments and introducing their own observations as often seen already in the TANN Ireland and TANN England sites and in comments. My grateful thanks to them too.

I wish Donna and the team every success. They will no doubt set about reinventing and reinvigorating TTA. Donna has already indicated that she would like to shift more towards interpreting trends and that one of the contributing editors has a post for Monday that you will not want to miss!

Best wishes to you all, Ex-editor Steve.

In changing behavior, ‘wanna’ works better than ‘hafta’

July 19, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/07/carrot-cake01.jpg” thumb_width=”150″ /]The proliferation of apps, tracking programs and devices that promise to change your life through Quantifying Yourself and lead you to the New Jerusalem of fitness and health is fascinating in number and variety. Yet why do some apps and programs do their job of changing behavior–and others, equally well-intentioned, do not? It’s all about ‘wanna’ vs. ‘hafta.’  Tracking your caloric consumption quickly turns into a ‘hafta’ drag for most (MyFitnessPal), but if you plug into a lively online community (Fitocracy), make the app easy to use and the changes gradual, plus forgive a few lapses, the same activity can start feeling rewarding and ‘wanna’. It’s all about personal autonomy, reward and control. It may be carrots rather than carrot cake, but you’re doing the choosing. Must reading for those working to develop corporate wellness programs, sticky apps and engage users. Why Behavior Change Apps Fail To Change Behavior (TechCrunch) Hat tip to reader Sandeep Pulim, MD via LinkedIn.

Related: Our April discussion of employee wellness programs, Employee wellness: Carrot? Stick? Or something else?

An example of simplification helping to increase positive behavior–and perhaps outcomes–is the recent study of the Center for Connected Health’s BP Connect program. Mobile users took their blood pressure more often than the telephone hub/device users; these older users (median age 61!) found the mobile version both easier and more convenient in portability. Overall BP scores went down moderately. Connected Health Study Finds Mobile Health Improves Patient Engagement (HIT Consultant)

Google Glass through a doctor’s eyes

July 18, 2013 | by

John Halamka, MD, CTO of Beth Israel Deaconess Hospital in Boston, writes about his experience testing Glass in the clinical environment and sees five useful areas–documentation, alerts and reminders, ED dashboards supplementing or displacing tablets, decision support (Watson, anyone?) “Just as the iPad has become the chosen form factor for clinicians today, I can definitely see a day when computing devices are more integrated into the clothing or body of the clinician.”  Not the Object of Evil painted by the consumer IT gearheads and privacy advocates.  Perhaps an ideal place for this? But is this Editor the only one who finds that ‘Meaningful Use Stage 2’ compliance (assistive technology) in the #1 position a bit odd?  The Health Care Blog (Health 2.0) Hat tip to reader Bob Pyke via LinkedIn.

Is health IT funding hot and not just warm?

July 18, 2013 | by

Mercom Capital Group has also been on the trail health IT/digital health investment trends–we last looked at their 2012 report in January— and finds the opposite from the mid-year ‘warm not hot’ RockHealth digital health investment report [TTA 9 July]. They see sizzle in the $1.1 billion invested to date ($623 million in 2nd Quarter alone) in 272 deals done, versus RockHealth’s $849 million. This may all be in the definitions and the composition of companies surveyed–they had commonality on only two of the five leading deals (the leading deal for both was Proteus, the other was Watermark). Mercom is also predicting a bullish $2 billion this year which would double their 2012 market total ($200 million lower than RockHealth’s). They both see a shift from practice-focused to consumer-focused technologies–and the concentration in deals by 11 funders. Executive summary, announcement, FierceHealthIT article.

Related: A sobering article in Wired depicts the ‘series A crunch’ affecting now over-valued Silicon Valley tech startups moving from overly generous angel and private investors to hard-nosed venture capital companies. Part of the problem is, ironically, accelerators, which polish start-up founders’ presentation and business planning skills to the point where they look better than they should to angels, and perhaps get more than they should. Investors are still ‘dabbling in digital health’ (RockHealth’s POV), and that may actually be…healthy. A Fleet Street (or NY Post)-worthy lurid headline: The Screams of Crushed Startups Echo Across Silicon Valley

End of life care: emotions and facts (UK)

July 16, 2013 | by

Not telehealth directly but of concern to those in the field because of the links to people with long term conditions…

While the UK media is leaping on the current ‘bash the Liverpool Care Pathway’ bandwaggon, the end of life care experts at King’s College’s Cicely Saunders Institute have taken a more balanced view. In an insightful 30 minute podcast members of their team discuss questions such as:

  • What is the problem the LCP review tried to address?
  • What are the known research facts?
  • What can people do in advance of when they are no longer able to make decisions?
  • What are the implications for professional training?
  • What are the funding and practical inequities in the current health system?
  • What is the cost of care to families?

KCL press release here. Podcast here. Related TTA item, May 2013.

Funding: the concentration continues

July 15, 2013 | by

The funding concentration trend apparent in RockHealth’s latest survey [TTA 9 July] is not contradicted by latest bits of news:

  • PracticeFusion, a free physician, web-based and ad supported EMR, is rumored to be raising $60 million from what Venture Beat last week termed “a New York-based investment firm, not one of the usual (local) Silicon Valley suspects.” Now we can suppose that sources would be silent unless the deal was signed, sealed and delivered. The leaks can also be strategic ones. (PracticeFusion has also introduced PatientFusion, a PHR with added functions of booking appointments and leaving doctor feedback–which puts it squarely in ZocDoc’s increasingly challenged, but extremely well-funded territory. (We advise them to put aside a few dollars for the inevitable MMRGlobal challenge as well.) Having raised $34 million less than one year ago, the funding is clearly going to updating ‘Meaningful Use’ requirements, the patient portal and to be determined growth.
  • Chicago-based Caremerge just raised $2.1 million for its mobile apps for coordination of long term care (LTC) between providers, doctors and families. (MedCityNews)  It claims to be the first-ever integrated mobile and web solutions provider for this market. It does answer a crying, not-terribly-glamourous need in senior care, and it’s also interesting that two of the key investors are from Poland and Switzerland. But Caremerge has deep roots in GE-land: one of its founders came from GE Healthcare IT Solutions and it’s currently part of the StartUp Health/GE Healthymagination program–which accepts only companies further along in their development for their $250 million fund, and takes a generous slice of equity for advisory services rendered. [TTA 10 Jan, 7 March, 4 April]
  • Health tech accelerator Blueprint Health announced its latest class–and they are increasingly not in the earlier pattern of true startups in need of guidance to appeal to angels and VCs. Five of the ten companies already have customers, versus two in the previous class. Is this mission creep? According to an article in Gigaom, their co-founder has said that they are not deliberately looking for more ‘mature’ companies, but are nonetheless accepting them. Of course, early stage companies that have already gotten into the market have a greater chance of success and look better on the record of any accelerator program. Another trend is B2B rules. Only one of the picks is consumer focused (health coaching) and another is engaged in employee wellness rewards adopted by companies.

Are these pointers to the future, at least in the US?

  1. Nascent maturity and realism in business plans–the horizon narrowing
  2. The continued collapse of practice EHRs into a few trusted providers [Doctor backlash brewing, TTA 22 Feb]
  3. With less funding to go around, and with few companies moving from A to B to C rounds, will future investment and development go to those who have already gained traction in customers and previous investment–and somehow got to that stage with the help of angels and crowdfunding?
  4. Is it the end of the Quantified Self consumer device buzz? These investments, and the past quarter’s, are largely in the surer, more VC-acceptable water of B2B tech.