It seems but yesterday that Telecare Aware readers were flagging up that the £3.2 million procurement by NHS North Yorkshire and York PCT (NYY) of Tunstall telehealth monitoring equipment (including ‘free’ implementation consultancy services but plus ongoing costs of £1.7m per year) looked too hasty, too large and too soon.

But no, it is over two years since NYY PCT responds to Telecare Aware item: The £3+ million telehealth spend that has achieved…what? was published.

So it gives editor Steve no pleasure at all to point you to the following article that appeared in the Yorkshire Post today: Telehealth revolution in tatters after snub by doctors. In short, the failure of the project to take off is causing the local Clinical Commissioning Groups (CCGs) that take over responsibility for it in April to question its future. The journalist dissects the issues so I shall leave it to him or her to do that for you.

However, if the CCGs do pull the plug on the project it will be interesting to see what happens with the taxpayers’ unused telehealth equipment that Tunstall has been paid for but not yet had to deliver. Does the contract entitle them to pocket the difference? Or perhaps one of the CCGs could take delivery of the remaining equipment and make it available to other Telehealth Pathfinder sites. One final question lingers… Where is Ernst & Young (Tunstall’s implementation consultancy subcontractors) [TA Jan 2012] and its reputed £1m fee in all this?*

* “For over two years now Ernst & Young have played a major part in deploying telehealth at scale in a number of NHS regions.” E&Y press release.

From one of our frequent commenters known as “Up North and to the Right’ or UNATTR:

Tonight at 19:30 GMT on the news programme BBC Inside Out South East:

One of the challenges facing the NHS is how to care for people with long-term illnesses such as diabetes, heart defects and chronic lung problems. These patients make up around 30% of patients yet account for 70% of the NHS’s costs.Telehealth is a new scheme where patients with long-term conditions monitor themselves at home using technology rather than going into hospital.

Kent is at the forefront of the scheme with around 800 patients using telehealth. But some doctors are not convinced, citing fears over increased GP workloads and concerns about whether patients will be able to use the computer technology. Others say the NHS reforms will also make it harder for telehealth to happen.

Inside Out asks whether the government’s plans to get more people onto telehealth are likely to succeed.

BBC Inside Out South East is broadcast on Monday, 21 January on BBC One at 19:30 GMT and nationwide (for readers in the UK) on the iPlayer for seven days thereafter.

Mobile health becomes very compelling to the consumer when it has to do with safety. This IEEE Spectrum interview (transcript/podcast) with Dr. Aydogan Ozcan of UCLA follows up on our recent coverage of the smartphone-linked iTube attachment for assaying potential harmful allergens in food, but also returns to the Ozcan microscope and its multitude of uses in developing countries. Both when fully developed have the great potential to reduce costs of medical testing equipment and speedier results. Information and reporting can also lead to safety. The New York City Police Department has also gotten on the app wagon with a free citizen crime information and reporting app for iPhone. You can look up statistics, most wanted and nearest precinct information–but another feature captures anonymous tips on crime. Editor Donna wonders if this technology could be sold to other major cities such as Newark NJ, Chicago, Sao Paulo and London, where crime rates are high, to engage the citizenry and further geo-map crime faster. Springwise.com A tip of the hat to Toni Bunting of TANN Ireland

The Shine activity tracker by Misfit Wearables has garned huge interest and support (Indiegogo oversubscribed in excess of $650,000) since its debut last year. The interesting part of this article is a more exact description of its Wi-Fi interface which requires direct contact with an iPhone or Android running the app to download data and presumably upload adjustments. It’s also made from aircraft aluminum, is small (about a small cookie, two quarters or two 50p coins) and provides blinking orange light feedback. It will be interesting if Sonny Vu and John Sculley grab onto the potential in the older adult home and community market–the latter requiring perhaps some different form factors and task diversification–or simply take the easy fitness buff/’quantified self’ money and run. Misfit Shine–a sleek, new activity tracker (SingularityHub.com)

For those who may need the most assistance with their health–older adults, those with chronic conditions who have less income and/or education–will the digital health and consumer engagement advances we chronicle, debate and generally huzzah about make any real difference in their health? We have generally assumed that health tech will level the playing field by being faster, cheaper, super-functional and generally cooler. This provocative essay debates the distinct possibility that digital health and the adoption of technology may further increase health disparities despite all this. Examples are the older, even affluent person, who has difficulty coordinating their care even non-digitally and is in a spider web of confusion; the less educated person for which ‘self-empowerment’ in healthcare doesn’t blip their phone screen, much less their mind. When you review the ideal state infographic by Misfit and the Digital Health Group and try to place people like this into it, you realize the buzzy talk of ‘convergence’ zips right by these needy folk like a Boeing 787 Dreamliner back to the hangar for a battery swap.

Of course, the writer also caveats his discussion by stating (Editor’s emphasis):

However, for innovations to significantly worsen disparities, they would have to both meaningfully improve health outcomes, and not be made available to people of lower economic status. Although the digital divide is real, access to digital tools is increasing for almost all levels of society. Payers may also eventually subsidize tools that have been shown to improve outcomes.

Hmmm…so it kinda doesn’t matter at this stage?

When Editor Donna thinks back to say, 2005, and the promise at that time on how telehealth and telecare were going to revolutionize health and independence for older adults, disabled people and those with chronic conditions, the alacrity with which much of digital health’s business model and development funding has shifted towards essentially healthy people measuring personal fitness and ‘quantified selfing’ away–analogous to what psychiatrists call ‘the worried well’–is perhaps economically sound, but disconcerting to those of us who entered the field wanting to do, let’s say, a little good. Can we pause for a moment, and consider this? Technology, Innovation, Disparities, and the Elderly (GeriTech, author Leslie Kernisan MD, a board-certified geriatrician) Hat tip to George Margelis, GM of Care Innovations Australia

The Surrey-based investment company Moonray Healthcare which bought Telehealth Solutions Limited (THSL) in early 2011 [TA item] has now acquired Wiltshire Medical Services (WMS) with the intention of bringing the two together. Press release: WMS and THSL come together to create new breed of telehealthcare provider.

Telehealth Solutions was founded in 2006 and, after a couple of years finding its feet, has since been making strong progress in the UK telehealth market. It is one of the few companies (other than Tunstall) that has benefited from the Government Procurement Service’s Framework Agreement. Wiltshire Medical Services’ core business has been to provide out-of-hours services to GPs but a while ago it extended its call centre operations into telecare monitoring. Moonray, which says it is into investment in this field to add long term value looks like it has made a smart move in arranging their marriage. Although the press release says “As part of the deal WMS will acquire Telehealth Solutions…” it is not yet clear which company will take the other’s name or whether a new brand will emerge, but a name containing something as local as ‘Wiltshire’ does not sound like a good bet.

What type of system in the US (and elsewhere) provides the best quality of care based on metrics such as care levels, medication usage and services? This article, while written with its conclusion in mind (the US consumes too many dollars in health care, yet has too many for-profit facilities that stint on care to maximize profit, thus everything in healthcare should be non-profit), does bring up interesting data as to the differences in quality of care between non-profit and for-profit hospitals and post-acute facilities, plus the broad failure of health maintenance organization (HMO) insurance plans to deliver savings as promised. Low-profit but needed areas such as psychiatric emergency care (!) and home health care tend to get shorted at for-profit hospitals and (not mentioned) insurance plans. The writer also does not mention that non-profit facilities can offset many costs through a lower tax burden and endowments. And as one of the commenters points out, according to his research, developed Asian countries have even higher levels of privatization than the US, yet take only 5% of GDP and boast better health outcomes. Health care and profits, a poor mix (New York Times)

A group at the University of Washington, in collaboration with Seattle Children’s Hospital, is measuring your heavy breathing on the phone–for health reasons. For people who are asthmatics, have chronic bronchitis or cystic fibrosis, breathing measurement is critical. Spirometers measure the power (or weakness) of their lungs. The Washington researchers first developed the SpiroSmart app to estimate the volume of air exhaled by the sound waves recorded as you breathe out. In early experiments, results were roughly comparable to a home spirometer. The next iteration, SpiroCall, is a dial-in that records that long breath of air–and early tests indicate that it preserved enough audio quality for the recorded exhalation to be used as a spirometric substitute. This indicates that any phone, even basic cellphones that older people and those in developing countries use, can remotely measure lung health or detect signs of lung disease. Tracking Lung Health With a Cell Phone (MIT Technology Review) Hat tip to Toni Bunting of TANN Ireland.

Investment bankers TripleTree and the Wireless-Life Sciences Association (WLSA) are opening nominations for the 5th Annual iAwards (my, has time flown!). Nominees will be judged this year on “uniqueness of their solution; marketplace traction; clinical, operational or consumer relevance; size of addressable market and international presence across three categories” (operational effectiveness, clinical application and consumer engagement). Get in your applications and $250 fee by 29 March; twelve finalists will be announced 19 April with three winners feted at the WLSA Convergence Summit, San Diego, 28-30 May. Overview

Some encouraging and unusual developments with Aetna and Cigna around weight loss and wellness. In December, Aetna unveiled Passage, a fitness app it developed with Microsoft, which takes the user on virtual tours of running or biking in Barcelona, New York or Rome, with real-time photos of those locations, restaurant recommendations and historical facts along the route. Cigna has bundled four apps for nutrition, exercise, and mind and body relaxation free to the first 20,000 downloaders. For instance, the most popular, Fooducate, helps users grade the nutrition in their groceries and offers more healthy alternatives. The sudden interest in consumer engagement, after languishing for the past year or so, is due to the imminency of the ACA (Accountable Care Act a/k/a ‘ObamaCare’). Prevention increasingly equals savings and is easier to achieve with apps being further along the curve than even last year. Apps latest bid by health insurers to manage wellness (American Medical News)

Health 2.0 and the New York eHealth Collaborative invite designers and developers to submit prototypes for a secure portal that will present 19.5 million New Yorkers with their individual PHR while educating them about health data privacy rights. Developers have a chance to win up to $15,000 (first place). Submission deadline is 11 April; New Yorkers will vote on the best prototypes through 21 April. Overview and registration form

EHRs are rapidly becoming the Rodney Dangerfield of eHealth (‘I don’t get no respect’). No surprise to any doctor or clinical staff who uses them–but the realization has dawned that it has actually made charts more labor intensive. “I think we’ve sort of made the paper chart electronic, but what we’ve done almost nothing of is automation.” has to be one of the drollest quotes of the past few years (Dr. Donald Rucker, VP and chief medical officer of Siemens Healthcare USA). Instead of using computers to automate, EHRs make records even ‘stickier’. Hospitals like it because it helps capture billing more accurately. MDs aren’t technophobes (a common accusation) but “they’re not going to embrace any technology that makes them less efficient”. Neil Versel takes a ‘gimlety’ look at the subject in his comments on this TEDMED webcast (1 hour recast here) in InformationWeek Healthcare.

And the think tank RAND Corporation adds to the pile-on, with RAND rethinking its optimistic 2005 analysis of $81 million in HIT savings that fed the proliferation of EHR companies and Federal subsidies. Expected savings haven’t materialized, and productivity, interoperability plus quality benefits haven’t been achieved by existing systems, according to Dr. Arthur L. Kellermann, one of the authors of the analysis published in this month’s Health Affairs (abstract only). A list of shortcomings as long as the East River are discussed far more critically in commentary featured in the NY Times, Charles Webster, MD’s EHR blog on how you get to the ‘iron triangle’ of unstable software (hat tip to Vince Kuraitis), and Brian Ahier’s commentary on (this is a first) Google+.

Health 2.0 has now released their January hour-long podcast which previews their 2013 US 7th Annual conference 29 September-3 October which will be at the Santa Clara Convention Center (California), a look forward to Health 2.0 Dubai in two weeks and India in February. It will take you a while to get past the ‘adverts’ to how telehealth and health tech can better work with hospitals to improve care and care transitions (Marco Smit at about 11:00). (Warning, it is also a little kludgy in loading.)

More CES articles and roundups:

Some ways to put digital health in action at CES: turn the techies into health tech ambassadors by giving them devices to wear during CES and doing a competitive tally of their results, with an award from a prestige panel; test a smoking cessation program (and similar); include in CES the culture change partners such as health systems and data analysts who can actually make that flood of device data into something useful. Interesting POV. How entrepreneurs, execs can take advantage of the techies at CES (MedCityNews)

UnitedHealthGroup is looking to connect its beneficiaries to healthy lifestyles, through tools such as adapting ‘DanceDanceRevolution’ to a classroom setting, mobile apps, cost estimators and rewards programs. Unfortunately, it will need to be more exciting to consumers than as presented at the Digital Health Summit, if this article is to be an indicator. UnitedHealth Group makes waves at CES (mHIMSS) The Forbes article (next) goes into more detail on their 4,000 square foot and more importantly, the global $60,000 Breakthrough Health Tech Challenge prize to help people more effectively manage chronic health conditions.

And finally, the fork making all the news. After you’ve traipsed hundreds of miles of aisles, sat in on your 75th presentation, and have sensory overload to the nth degree, Editor Donna can understand those covering CES for falling all over the HAPIfork from HAPILABS rather than, say, a massage table (legitimate, readers!!) Yes, it was a CES finalist. Yes, it’s a great ‘little engine that could’ story involving a young entrepreneur with a charming French accent. Yes, it’s buzzy because it’s buzzes (literally) if you are eating too fast and uploads your consumption metrics to your smartphone. But it’s a gadget….which still needs funding, which undoubtedly it will get. Launching February on Kickstarter with a Q2 to-market projected (in time for Valentine’s Day?) The Fork That Buzzed CES 2013 (Forbes)