Losing ground: Alzheimer’s as a leading cause of death

March 25, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/Alz-bar-graph.png” thumb_width=”200″ /]This short bar chart (Change in Number of Deaths between 2000 and 2010) tells a story that your Editor did not realize. Alzheimer’s disease currently is the 6th leading cause of death in the United States overall–and where the opposite of progress has been made. Part of this could be better diagnosis, but in large part it is the aging population.

For those innovating health tech, there’s a big job to be done here: not a cure, but to support those with Alzheimer’s and vascular dementias in everyday quality of life (brain fitness, mental stimulation, activities of daily living/ADLs); to aid their caregivers in caring for them, as well as their own quality of life; and geriatric professionals in lengthening time at home and creating stimulating communities, not ‘memory care floors’. Not perhaps as fun as a fitness app, but potentially more rewarding and disruptive to the current distressing model. Graph courtesy of the Alzheimer’s Association (US)

The further adventures of the Ozcan cellphone microscope

March 23, 2013 | by

Can your phone do this? (Armed With Science) discusses how the US Army Edgewood Chemical Biological Center (ECBC) is developing cellphone-based wide-field fluorescent imaging for pathogen detection in the field, but also mentions partnering with a team at UCLA as the developers of the clip-on microscope and a small firm called Holomic LLC for a second add-on for assay purposes. Both devices sounded familiar to this Editor, and it turns out that Dr. Ayodgan Ozcan is the common denominator–and head of the team–on both (Holomic is his spinoff commercialization company). The microscope is the LUCAS [covered since its debut in May 2010] and the assay is likely the iTube [TTA 13 Dec]. Interesting that the Army not only is pushing this forward, but also the partnership.

North Yorkshire: Cash-crisis NHS chiefs write off telehealth devices

March 22, 2013 | by | 1 Comment

The Yorkshire Post (YP) picks up on the writing-down of the capital cost of the North Yorkshire and York (NYY) telehealth devices, first publicly reported in Telehealth and Telecare Aware [The ongoing cost of the NYY telehealth project exposed] and links the matter to today’s WSD QALY announcement: YP item: Cash-crisis NHS chiefs write off telehealth devices.

It was interesting to note that in its recent press release Tunstall showcases latest innovations in telehealthcare that will shape the future of service delivery Tunstall omitted to cite NYY as an example of ‘successful telehealth programmes…with NHS Gloucestershire, Birmingham City Council, and as part of the TF3 Consortium in Northern Ireland”.

WSD QALY paper published – cost worse than expected (UK)

March 22, 2013 | by | 2 Comments

Since one of the Whole Systems Demonstrator (WSD) let drop at the King’s Fund conference last March that the telehealth Quality Adjusted Life Years (QALY) cost calculation was coming out at £80,000 the actual paper has been ‘eagerly’ awaited, with speculation and concern that the calculation included management and other study-related costs that would not apply in a normal service setting. The paper is published by the BMJ today and a) such costs were excluded and b) the QALY figure is actually £92,000. Well, that’s the headline figure that is already being headlined by Pulse but, of course, the calculations are more nuanced. Foe example:

Whether telehealth is considered to be cost effective will depend on the willingness to pay for the outcomes generated. Figure 1 presents the probability that telehealth would be seen as cost effective as an addition to usual care, using an acceptability curve for different values of willingness to pay. At the £30,000 threshold (associated with NICE recommendations), the probability of cost effectiveness was 11%. Figure 1 also shows the probability of cost effectiveness if costs related to project management were excluded: at the £30,000 threshold, the probability of cost effectiveness was 17%. Indeed, this probability including management costs only exceeded 50% at threshold values of willingness to pay above £90,000. Excluding project management costs, the probability exceeded 50% only at values above about £79,000.

The discussion is also worth reading carefully, as is the final conclusion:

A community based, telehealth intervention is unlikely to be cost effective, based on health and social care costs and outcomes after 12 months and the willingness to pay threshold of £30,000 per QALY recommended by NICE. A reduced cost of telehealth per QALY may be possible by combining the effects of equipment price reductions and increased working capacity of services; On the assumption of reduced equipment costs and increased working capacity, the probability that telehealth is cost effective would be about 61%, assuming a willingness to pay threshold of £30,000 per QALY.

BMJ paper: Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial BMJ 2013;346:f1035

Related items
Mike Clark’s Updated list of WSD results papers.
Interview with Professor Martin Knapp As “telehealth” grows, experts question cost benefits Reuters.
David Brindle, in The Guardian anticipated these results last month and, in a follow up article commented “Fourteen months on from its launch, 3millionlives seems to be going nowhere. Intuitively, telecare/telehealth feels like a key pillar of the future care system. To be that, however, it does need a credible evidence base.”
3millionlives press release: 3millionlives – enabling change to benefit patients and carers. (PDF)
GP Online Telehealth ‘not good use of NHS money’, finds DH-backed study.
NHS Choices Are benefits of telehealth care worth the cost?

Google Glass: a proper potential in healthcare

March 22, 2013 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye and your Editor have had a tête-à-tête and finally have agreed on something other than the oeuvré of Jean-Pierre Melville. The Eye remains In Revolt on Google Glass but barely…barely…concedes a proper, limited role in health. Overlooked in the overheated hullabaloo: for normal people, it can aid in actions like looking at food and counting nutritional values or ‘fullness’, sending and receiving information on fitness tracking, identifying pill bottles; for physicians, nurses and clinical staff, as an adjunct to telemedicine, visualizing monitoring on a patient and recording an exam or report. This Editor can also see potential in surgery, particularly the minimally invasive type which are camera and data-driven. This EHR Intelligence article is short and refreshingly hype-free. (But readers, rest assured that The Gimlet will continue to keep a restless eye on Mr. Brin and his devilish device’s developments.)

Clothing, watches and what’s under your skin

March 22, 2013 | by

Three from GizMag:

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/wearabletechnologiesispo-5.jpg” thumb_width=”125″ /]Health tracking may be finding an inexpensive home in your phone–but what about those clonky bracelets, clipons and pendants? Why not integrate sensors into wearables? The next generation is in development, as seen at the Wearable Technologies conference and the Innovation World Cup in Munich: Heapsylon Sensoria Fitness socks which not only tracks steps but also gait technique; the Fraunhofer Institute’s FitnessSHIRT from Germany; Kolon Heatex heat-generating fabric from South Korea; AiQ BioMan Fabric for a wide variety of monitoring from Taiwan and (my favorite) the T.Ware T.Jacket from Singapore that gives you a hug.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/samsung-smart-watch.jpg” thumb_width=”125″ /]Samsung may call the new S4 a ‘life companion’ but they are working on a Life Companion watch to match the Apple Watch rumored for end of 2013. But why this prototype looks clonky and not sleek…doesn’t incorporate Samsung’s bendable phone tech as debuted at CES….and compared to the rumored Apple Watch depicted in the article? Red herring? Samsung confirms it’s making a smart watch

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/blood-test-implant-7.jpg” thumb_width=”125″ /]The heck with the clothing and watches, implant it! A blood-testing laboratory in a 14 mm long implant is being tested to measure up to five proteins and organic acids at once, such as lactate, glucose, or Adenosine triphosphate (ATP). It provides monitoring that serves to tailor oncology medications or chronic conditions. The signal is transmitted first to a patch then a phone or computer. Drawback is that at present it only lasts one month. Researched at the Ecole Polytechnique Fédérale de Lausanne (EPFL). Tiny, personal blood testing laboratory gets under your skin

Quantified Selfers keep on reinterpreting Pew

March 22, 2013 | by

The Quantified Self has its own blog (dog bites man) and just cannot believe the recent Pew Internet Life study [TTA 29 Jan] that unsurprisingly revealed, despite the explosive takeup of smartphones in the US, that most trackers are still using their heads (49 percent) or paper tracking (34 percent). So the two QS writers question the questions, and how potential QSers may not define ‘self-tracking’ as ‘fit(ting) neatly into health’. However, survey leader Suzannah Fox of Pew details the screener and specific questions–and being plain and straightforward, there’s not much wiggle room. How people interpret ‘tracking’ may be where the problem is–that long-term, over time tracking is a quite different pursuit than getting an immediate reading (e.g. blood glucose) to make a quick decision on what to eat and dose. (see Rajiv Mehta’s comment) The state of self-tracking

Updated 25 March   Related: Laurie Orlov on Pew induces chest pains in the body of the health tech market and the low single digits of app participation over age 50. (Reinterpret this: 3% of those aged 50-64 and 1% of those aged 65+.)

FDA regulating medical apps–or not? The Hearings. (US)

March 22, 2013 | by

Much coverage of this past Tuesday-Thursday’s US House of Representatives Energy and Commerce Committee hearings on how the Food and Drug Administration (FDA) should be regulating developing mobile health technologies.  Some key issues are if the 2.3 percent Obamacare medical device tax will apply to apps (after chilling development on surgical devices–see day 1 hearings), whether FDA will ever get around to publishing a final guidance (end of year), will FDA consider smartphones medical devices (no) and if FDA should share some of the responsibility with–or give it over entirely to–the Office of the National Coordinator for Health Information (ONC) under Health and Human Services (HHS). Can FDA even keep up at this stage? (it takes them about three months on average review) and How much will regulation add to the price? are major questions. The representatives have heard from numerous leaders in the field: Tuesday, Happtique’s CEO Ben Chodor and the mHealth Regulatory Coalition’s Bradley Merrill Thompson; Wednesday, West Wireless Institute’s chief medical officer Joseph Smith; Thursday, Dr. Farzad Mostashari, National Coordinator, Health Information Technology, HHS and Ms. Christy Foreman of FDA. Mobihealthnews’ Brian Dolan live blogged from the hearings; there are also testimony statements. From these reports, the hearings have decided exactly nothing and revealed little about FDA’s inaction, but at least the issues have received some fresh air from those in the industry.

An overview of the articles/blogs to date.  Updated 23 March  (more…)

Telehealth Soapbox: A random walk through privacy, “the right to be forgotten” and health tech

March 21, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/Button-lock.jpg” thumb_width=”100″ /]Google Never Forgets, How Drones=Flying Smartphones and the Big Stick of Corporate Wellness.

Privacy. Intrusiveness…two of the key hot buttons in reactions on The Gimlet Eye’s latest sally-ho on Google Glass. While Google has been able to settle with 38 US states on Google Street View’s’ ‘Wi-Spy’ on illegally acquiring unencrypted personal data, including health data, for a bag-of-shells price of $7.3 million (iHealthBeat), the beat goes on in Europe. Spain’s data protection authority and Google are slugging it out in the European Court of Justice after Google lost in the Audiencia Nacional on whether Spanish or California (Google HQ) law regulates the continued distribution of potentially embarrassing, but long past, information. According to EURactiv.com:

The case could determine the scope of a draft EU law intended to strengthen citizens’ privacy. Rules proposed by the European Commission in 2012 and being debated by the European Parliament would give people “the right to be forgotten” – to have personal data deleted – in particular from the web.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/Cell-Phone-With-Wings.jpg” thumb_width=”150″ /]And while Glass gives the ground view, how about Dem Drones? Are they not, after all, just smartphones with wings? They take pictures, track locations and…spy. (more…)

Look at face, calculate pulse

March 21, 2013 | by | 1 Comment

Japan’s Fujitsu is developing software that measures increased pulse through changes in facial color. There’s a projected health use, but this Editor’s guess is that the real market is security systems in airports, banks and other secured sites, if Fujitsu can get it right in their anticipated year to prototype. According to the article, “a recent iPhone app from MIT [Cardiio] works similarly. MIT has also developed software that exaggerates that color change so it’s visible to the naked eye.” But don’t tell Google–they’ll put it in Glass. Smartphone Tech Measures Your Pulse By Looking At Your Face (Popular Science)

The revolt against Google Glass

March 18, 2013 | by | 7 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye’s meat-locker temperature gaze on Sergey Brin’s latest device for world domination.

Now I, the Gimlet, read with the appropriate horror Editor Donna’s version of March Madness, ‘Smart tech=dumber people‘, denying any fit in Eye Life for Google Glass. After all, one does not properly stroll down a boulevard rubbing featureless glass or mumbling Brando-like into the air, except when disdaining spectacularly bad taste in ornamentation (piercings, tattoos) and dress, or lack thereof. Thus Glass has no job to do, unless it has the ability to screen the collected works of Jean-Pierre Melville or the best roles of George Sanders on demand. However, Google does not ladle les billions into development without thoughts of further gathering the biggest of data to sell on all that is holy (or unholy) in our lives, eroding whatever privacy we have left, in order to keep Mr. Brin’s yacht in diesel and deck wax enroute to the next TEDx or remote island. Thus the Eye raises a glass to the new ‘refuseniks’ who cry ‘Stop the Cyborgs!’, rebelling against a world where “privacy is impossible and corporate control total”, cleverly inserting sharp-nailed fingers in Google’s spy-in-the-eye.  After all, WWBS? (What Would Brando Say?) Google Glass: The opposition grows (CNet)

Eye tracking to diagnose stroke: study

March 18, 2013 | by

A simple, inexpensive way to diagnose life-threatening stroke has been developed by a team from Johns Hopkins University School of Medicine. Their device–special goggles wired to a laptop with new software–is able to differentiate key eye movements that are indicative of stroke versus other conditions such as inner ear infections. The goggles (made by GN Otometrics for balance conditions) combine a USB-connected webcam and an accelerometer in the frame to track the eyeballs, while a clinician performs head impulse testing (rotating the patient’s head while he looks at a stationary object); the software interprets the subtle signs that “directly predict” stroke. The researchers dub the technique as “ECG for the eyes.” Now put this into a tablet or smartphone….  Medgadget   Johns Hopkins Medicine release

Fitting wearable, designed tech into your life

March 18, 2013 | by

Design, with a few leading exceptions generally prefaced with ‘i’, is generally kludgy in the health tech area, because ‘better mousetrap’ and off-shelf components tend to subsume design imperatives. (Has anyone seen a remotely aesthetically pleasing mousetrap other than the MiceCube?) This design discussion in Co.design (part of Fast Company) is, without saying so, marketing oriented because it is oriented to getting tech into everyday life at an affordable price. Three ways to make wearable tech actually wearable: make it beautiful (Misfit), peripheral (Guide Me Home GPS shoes), meaningful (the Pulse ring prototype). Raymond Loewy would give a thumbs-up.

Samsung Galaxy S4’s S Health: fitness tracker disruptor?

March 15, 2013 | by

The much-heralded second quarter intro of the Samsung Galaxy S4 mobile phone is, according to multiple reviewers, a sustaining innovation (improvement). But embedded in it is a disruptive innovation to the fitness app sector dominated by Fitbit, Jawbone Up, Nike FuelBand and a raft of low-cost/free tracking apps.  It’s S Health, which according to Gizmodo’s incredibly detailed review monitors key activities and sleep (Editor emphasis):

Holy crap, Samsung put a health tracker in its phone! Which is actually a great idea. S Health is an app that will track your steps, stairs climbed, and the ambient temperature and humidity, plus track your food intake and estimate calories consumed/burned. You can even track sleep with an optional accessory (see below). Fitbit and co. should be nervous, although I’m curious to see what kind of ding this puts on your battery life.

and

There are also a bevy of accessories that complement the S Health app. There’s a wristband you can wear independently of the phone (in case you prefer running without it), which will track your steps and monitor the quality of your sleep. It will then sync wirelessly with the app. There’s also a connected scale and heart rate monitor. Again, this isn’t good news for smaller fitness tracking companies.

The Verge has the S Health slide (grainy photo) presumably from the Samsung debut presentation. (Better photos over at CNet; photo here is courtesy of 3G Doctor–see below)

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/03/s-health-via-device-foused-message1.png” thumb_width=”250″ /]If the implementation is high quality (and some commenters have issues with Samsung), Fitbit et al. could themselves be disrupted straight out of their (current) business model and consumer market, just like they did to Zeo.  S Health integrates–it’s already on your phone, it largely does what they do and gets the fitness tracking job done (‘Total Reports’) for most who are interested for free, even without the few available accessories. No downloading and going to Amazon or Best Buy to buy a raft of expensive accessories to make it work with your phone. No annual $49 membership so you can access your data.  Worst of all for the current crop of fitness trackers, not one–not even Nike–can beat the Samsung international distribution network and only Nike beats Samsung on brand recognition. Is it a deal-maker for consumers? Probably not, but it gets much much closer to the customer. Also a few things that Samsung has introduced–the Air View/Air Gesture eye tracking and gesture control–have great potential for app designers in other aspects of fitness and health.

We’ll have to wait and see–not too long– if other smartphones (HTC, Apple, LG, even BlackBerry) add fitness tracking. If I were Fitbit or Nike, this Editor would be hopping like an Easter Bunny to cut a licensing/partnership deal with them. BlackBerry with Nike FuelBand….

Related articles: Dan Munro over at Forbes cheers Samsung on in Latest Samsung Smartphone Adds Health Functions, Sky News adds the international perspective. CNet reports accessory pricing: S Band and Body Scale at $99.99 each, Heart Rate Monitor at $69.99. Update 18 March: Lt. Dan opines at HISTalk on What it means for healthcare and mHealth [WARNING 31 Aug 2014: linked page may now be infected with malware] –the market pushing for bigger smartphones that blur the line between phones and tablets, the navigation capabilities of Air View for EMR. A cold-waterish review/comments at iMedicalApps doesn’t think much of the native temp/humidity feature (your Editor begs to disagree); again a commenter brings up Samsung’s track record of weak software, but agrees that Era of mobile health tracking definitively arrives. Hat tip on these two updates to the 3G Doctor, David Doherty, via LinkedIn’s mHealth group. ZDNet notes Samsung’s Knox software to separate personal and business use on one phone, along with SAFE for enterprises.

And do read David Doherty, the 3G Doctor for a further dissection and projection of the S4’s capabilities in features like its camera, the humidity/temperature sensor, the aforementioned Air View/Gesture, the dual video, Smart Scroll for eye testing and even the recharging pad as particularly friendly to healthcare use — and users. Samsung takes S Health centre stage at Galaxy S4 launch and Will Samsung’s Smart Scroll turn the world upside down for mHealth Regulators? (mHealth Insight)