The ‘FDA Office of mHealth‘ bill (H.R. 6626) as sponsored by Mike Honda, Silicon Valley’s House Representative (California 17th District), which expired with last year’s Congress [TTA 18 Dec] will be revived with revisions, according to MedCityNews. (Rep. Honda will be keynoting on the second day of MedCityNews’ ENGAGE conference in Washington D.C. in June.) Formerly dubbed HIMTA (Healthcare Innovation and Marketplace Technologies Act) will now include how that office will work with the alphabet soup of other agencies: FCC, HHS, ONC, FTC. It struck this Editor in December–and later [TTA 28 Mar]–that this bill does not go far enough. In its good intentions to speed mHealth approvals by creating a framework plus monetary incentives, it is not powerful or independent enough to slice through or bypass various turfs. What would be revolutionary is simplification. Why not an independent unit that draws from FDA, FCC and HHS, but has priority and license to cut through red tape? But that would require major giving up of ground–and with this Federal Government, that ain’t gonna happen. Add to it that the most innovative work–and usage– is being done at DOD (DARPA, T2) and the VA, and the alphabet soup becomes goulash. Wall Street Journal’s Venture Capital Dispatch
Sensors for detecting substance abuse
Last week’s ATA also included a session on a test of using an already-existing sensor system–the Zephyr BioHarness–to detect substance abuse. Dr. Jin Ho Yoon, a psychologist at Baylor College of Medicine (Houston, Texas) is leading the National Institutes of Health (NIH)-funded test of tracking cardiovascular and respiratory changes in cocaine users. An in-hospital test with low levels of cocaine in saline detected a sharp increase in heart rates for the first 10 minutes after exposure, with increased heartbeat versus the control group throughout the entire 30-minute measuring period. The plus side is that it works outside hospital monitoring; the minus is that the battery in the chest strap only is good for one day. The end is to discover what triggers addicts’ relapses. The Baylor team is also evaluating the BioHarness for smoking cessation and exercise in obese patients. Mobihealthnews (extended article). GigaOm also notes the wristband iHeal from the University of Massachusetts Medical School which detects changes in the electrical activity of the skin, body motion, skin temperature and heart rate to determine when the user might be on the verge of risky behavior like substance abuse.
Apps that put you on the couch
Despite the light tone of this Editor’s headline, telepsychiatry and telementalhealth or ‘mood’ apps aren’t frivolous in the least. The US Department of Defense (DOD) National Center for Telehealth and Technology (T2) T2 Mood Tracker and BioZen are two smartphone apps for biotherapeutic feedback [TTA 14 Feb]. Virtual consults are also not brand new–but controversial, as some have used Skype which the TeleMental Health Institute in a recent Psychiatric News article has scored on privacy (as in no). Four new entrants are taking a different approach, with different models and HIPAA-compliant video consults.
- TalkSession is first establishing itself as an authority for providers via an online forum and digital magazine–then as a booking source for online therapy.
- Talktala is hosting online chats and forums moderated by therapists, and for more advanced services will charge users a $30/month subscription fee.
- iCouch allows users to search for therapists, and then via computer or iPhone visit online through the site’s HIPAA-compliant system. Interestingly 30-40 percent of its current client base is international and has 165 therapists worldwide. (International visits are an interesting loophole in practice.)
- Breakthrough is only for California residents at present, but plans to expand to Texas and other states. Patients again connect with a network of certified mental health professionals and conduct appointments via chat, email, phone or HIPAA-compliant video. Unlike the others, it has gained insurance coverage for its therapists’ services, shows real-time therapist availability and plans to enable on-demand, off-hour services.
Web therapy: 4 startups overcoming mental health taboos with technology (GigaOm) Hat tip to David E. Albert, M.D. of AliveCor.
The law of ‘UFCs’
When it comes to the implementation of major healthcare technology, UFCs–or Unintended Financial Consequences–loom like Everest over the hill of ROI, particularly when the investment is in hundreds of millions and the UFCs are directly caused by it. It makes the telehealth and telemedicine initiatives in the ATA ROI ‘Jello to the Wall’ discussion below look like an argument over a penny poker game. Combine a high TCO (total cost of ownership) with a fuzzy ROI and throw in a few big UFCs such as reduced admissions/patient volume, inaccurate charging for services and declining reimbursement, and it’s ‘The Poseidon Adventure’ for many smaller, on-the-edge health systems resulting in Chapter 11. This analysis, though about an EHR implementation (Epic) at MaineHealth–a Cadillac when a Chevy would have done–is worth reading and dissecting. What Is The Opposite Of Health IT Return On Investment? HIT Consultant Hat tip to Ellen Fink-Samnick of ‘Ellen’s Ethical Lens’
Interview with Jawbone’s Hosain Rahman
A fascinating interview–not the usual corporate oatmeal–with the founder/CEO of Jawbone (the UP fitness tracker) from the early days of engineering at Stanford University, thinking about user interfaces back in the 1990s (!) with Palm Pilots and the start of Jawbone in his brother’s house which first developed noise-canceling back-of-the-ear or on the jaw headsets. The headsets led to accelerometers…and then to UP. It’s also a chronicle of an engineer who naturally segued to being an entrepreneur, and the challenges of partnering and manufacturing without getting your IP stolen. Video is 48:16, so set aside some time.
ROI in telemedicine and telehealth? Outlook unclear.
ATA 2013’s final ‘industry executive session’, presented at the late hour when most attendees are daydreaming about a comfy chair and a solid drink, tackled one of the thornier underlying questions beleaguering health tech: return on investment (ROI). Providers want hard numbers, but even that definition is…indefinite. Is it data? Is it outcomes? Is it savings? Is it reduction in spending? For two systems or populations, it can be reducing 30-day same cause readmissions for one provider or improved outcomes in home care for another, and the results are not analogous nor even cause-and-effect. As Eric Wicklund from mHIMSS put it, “that’s the challenge, and it was the primary focus of this year’s ATA conference. The pilots are gone, the possibilities and proposals are old. It’s time to target the telemedicine and mHealth programs that are working and to explain why they are…” As GlobalMed’s Roger Downey less delicately put it, “It’s like pinning Jell-O to a wall”–but getting specific as to what should be done in the market helps. Not quite as blithe as the headline. ROI? To some of the industry’s top vendors, that’s just three letters.
Of course, EHR implementation continues to be the Rodney Dangerfield of health tech, with HITECH Act ‘Meaningful Use’ interoperability goals and patient platforms only spottily achieved despite years of generous past, present and future incentive payments. Yet one ATA presenter seriously advocated the addition of telehealth/telemedicine to MU standards, recommended that Health and Human Services become the authority and to add panels for Federal standards and policy in telemedicine as there are for health IT. Adding telehealth and telemedicine to the MU scramble will surely speed implementation ;-) (See above) Why not MU for telemedicine? (HealthcareITNews)
Friday telehealth ‘snaps’
It appears that Bayer HealthCare is exiting the telehealth business with the sale of Viterion TeleHealthCare to the newly formed Viterion Corporation. According to the press release, Japan’s NSD Co., Ltd. through its US subsidiary is providing the investment and strategic support, and taking on all products and personnel. Viterion’s offerings in recent years have remained fairly static, but the Viterion release promises a change to “advancing our technology offerings, and in particular the migration to wireless and mobile applications.” Viterion also had speakers and a booth at ATA 2013.
Mobile connectivity is now reaching everywhere. Canadian companies PatientOrderSets.com, a developer of web-based evidence-based clinical checklists to specify appropriate patient treatments, acquired fliiSolutions (pronounced Fly). Its fliiTherapy connects providers and patients through a rehabilitation/exercise prescribing/tracking app. Announcement on the PatientOrderSets.com website.
For mothers in the hospital temporarily separated by necessity from their babies in Los Angeles’ Cedars-Sinai Medical Center’s neonatal intensive care unit, the new Baby Time iPad app enables them to check on and interact with their newborns. This will aid the estimated 20 to 30 percent of mothers who undergo C-sections and cannot be ambulatory for 24 to 48 hours. Cedars-Sinai release. (Hat tip to TANN Ireland’s Toni Bunting)
Tunstall Americas announced at ATA the introduction of its Vi telehealth/two-way PERS unit, iVi fall detection pendant and the CEL450 home-based cellular PERS, although the blog placement is rather low-key. Release.
Telecare ‘Which?’ support grows (UK)
Yes, it’s a bit of a trade puff for the Telecare EPG, and we don’t usually do ‘we-have-a-new-customer’ items, but it is good to note that 12 local authorities in the North East have signed a licence agreement so that they can access this source of independent, subscriber-funded device comparison information. Neil Revely of Sunderland City Council is reported as saying “…Matching the service user with the best technology is becoming an increasingly difficult task. The Telecare EPG will give prescribers the tools and knowledge to take advantage of new developments…” T-Cubed news item.
Sending the right message on mHealth (Africa)
Excellent update on mHealth issues for Africa in the United Nations’ Integrated Regional Information Networks (IRIN) news website. “…the mobile phone seems to have morphed from communications device to essential life-saver. But is the evidence there yet that mHealth is an effective health delivery intervention for the developing world?” Analysis: Sending the right message on mHealth.
BT takes 3ML ‘down under’
Just when the UK’s 3millionlives (3ML) project seems to have hit the doldrums, BT has taken its model ‘down under’ to Australia. According to The Australian (part pay-walled) “BT is spearheading a multi-million-dollar push by more than 20 key private and public sector players in the healthcare industry to roll out telehealth services in Australia, mirroring a British e-health initiative to provide services to three million people within five years…BT is convening a meeting later this month of key players across the sector, including those in private, community and aged care, to sign off on bankrolling the initiative, expected to run for up to two years, to develop a framework to fast-track the rollout of telehealth services.”
It will be interesting to see if a private 3ML-type initiative without the dead hand of Ministerial blessing will fare better than the original. Of course, the connecting link between the Australian and UK initiatives is Angela Single, Chair of the UK’s 3ML Working Group who is Clinical Director of BT’s Global Telehealth and Telecare Managed Service Pratice [sic]. Will BT, with the benefit of the UK experience, be able to make a fresh start In Australia? More, is this development a sign that the UK’s 3ML investors are restless? Might it not be time for 3ML to be reinvigorated and regenerated Dr Who-like and moved to a new home?
The Australian item: BT leads big push to roll out national telehealth services.
…Meanwhile, also in Australia, a seemingly unrelated story: Telehealth projects get $20m funding boost ITNews.
The UK Government’s plans for the future funding of care home stays
If you or a family member are due to grow old in the UK after April 2016, you will find a fascinating answer to the question ‘When is a cost cap not a cost cap?’ in a thorough analysis of the current plans for the future funding of stays in care homes that comes in a blog item by BBC Money Box presenter Paul Lewis: Paying For Care – The Coalition Plans. Hat tip to Roy Lilley’s newsletter.
Telehealth can achieve 85% reduction in GP home visits (UK)
Newly re-branded Medvivo gets its publicity rolling with the announcement of headline findings from an 18-month study. The results indicate that the use of telehealth with COPD patients can help reduce:
- GP appointments by 67%
- GP home visits by 85%
- A&E attendance by 52%
- Unplanned hospital admissions by 57%
Press release: Telehealth can achieve 85% reduction in GP Home Visits.
£12m project to up the game on home sensor data for health and wellbeing (UK)
The University of Bristol has just released news of a new interdisciplinary research collaboration (IRC) led by the university, together with the Universities of Southampton and Reading. It has been awarded a £12 million grant by the Engineering and Physical Sciences Research Council (EPSRC). They will work in partnership with Bristol City Council, IBM, Toshiba and Knowle West Media Centre. The IRC, known as SPHERE (Sensor Platform for HEalthcare in a Residential Environment), will develop home sensor systems to monitor the health and wellbeing of the people living at home. [So far, so 2002.]
But the press release goes on to make it clear that they do not intend to develop new sensors but to improve ways of analysing data from existing systems. “The IRC’s vision is not to develop fundamentally-new sensor technologies for individual health conditions but rather to impact all these healthcare needs simultaneously through data-fusion and pattern-recognition from a common platform of non-medical/environmental sensors at home…The system will be general-purpose, low-cost and accessible. Sensors will be entirely passive, requiring no action by the user and suitable for all patients, including the most vulnerable. An example of SPHERE’s home sensor system could be to detect an overnight stroke or mini-stroke on waking, by detecting small changes in behaviour, expression and gait. It could also monitor a patient’s compliance with their prescribed drugs.” [So far, so 2005 but perhaps the available technology these days is more up to the job. Let’s hope so.]
NHS Choices Apps Library
If you Google ‘NHS Apps Library’ the early results that come back after those to the library itself are predominantly from US publications. Perhaps we in the UK under-appreciate the potential benefits. The reason I mention this is that while TTA has given the Apps Library a couple of passing mentions during the past month or two, we have not – as one sharp eyed reader pointed out – given it the attention it deserves. So, by way of amends, here are some relevant links:
- The NHS Apps Library itself.
- A helpful article from NHS England: Introducing the Health Apps Library.
Mysteriously, the 12 apps recommended in the following enthusiastic US article: UK NHS launches 12 patient decision support apps do not seem to be listed in the library. Perhaps the author mistakes the BMJ for the NHS, or perhaps they are published or endorsed by a different part of the NHS…
I’ll be happy to take recommendations for links to good articles on the Library. Ed. Steve.
Who’s exhibiting at ATA?
More from the American Telemedicine Association conference, by James Barlow.
A tour of the cavernous exhibition hall at the Austin Convention Center and a rigorous back of envelope analysis of the catalogue reveals where the corporate action is: of the 229 or so exhibitors, the runaway top health condition targeted by companies is (surprisingly?) mental health, with 34 exhibitors. Cardiology, diabetes and the other conditions forming the basis of remote care trials around the world all make an appearance, along with other familiar tele-applications.
The 2013 Exhibitors League Table:
Mental health and telepsychiatry (34 exhibitors)
Telecardiology (16)
Telestroke (16)
Paediatric telehealth (16)
Diabetes management (15)
Teleneurology (14)
Teledermatology (10)
Telerehabilitation (6)
Telehospice / palliative care (4)
Oncology (3)
Teledentistry (3)
‘Infectious disease management’ (2)
And by application? Home healthcare (63 exhibitors) beats mHealth (49) – well served with its own conference circuit – with ‘remote monitoring'(48) and ‘videoconferencing’ (36) hot on their heels.
Telemedicine advances in Latin America
Some welcome news out of the ATA 2013 meeting are the advances that telemedicine is making in Latin America and the Caribbean. Honored at ATA’s Sunday session were Jennifer Lopez and her eponymous family foundation for funding telemedicine outreach in Puerto Rico and Panama via the Children’s Hospital of Los Angeles (CHLA). In Puerto Rico, the work is concentrating on pediatrics genetics, and a monthly clinic that counsels four families per session. In Panama, the emphasis is on extending pediatric care beyond Panama City to the low-serve country areas through Panama City’s three major hospitals. The point is that the Lopez Family Foundation is only the start in the region, and that other healthcare providers and funding entities should be joining in kicking off development (Telefónica should be noting) HealthcareITNews
Most Recent Comments