David Shaywitz, co-founder of the Boston-based Center for Assessment Technology and Continuous Health (CATCH) and advocate for humanism in digital health [TA 6 Nov], surprises in his Forbes picks for digital health company, person and book of 2012. First, the company: the EHR that dominates large hospital systems, Epic. Why? It may be awful and the bane of M.D.s, but the hospital system gets basic connectivity that chains together the bits, in a proprietary way, delivered with ‘flawless implementation’–the kind of customer services that holds every hand in MIS and HIT until the boo-boo is better. In other words, they delight the buyer. (Your marketing lesson for today.) Second, for person, none other than The Gimlet Eye’s circular bête noire Vinod Khosla. Shaywitz is this-n-that about the man, believing Khosla underestimates the human factors in medicine while agreeing with him on how behind healthcare is in capturing and using basic data, much less integrating more advanced data produced by monitoring. Editor Donna and the Eye take a dimmer view, believing that much of Khosla’s ‘disruption’ is to gain notice for (OK, hype) his investments such as AliveCor’s iPhone case heart monitor (just receiving FDA Class II clearance), cellphone microscope Cellscope and data collection/platforming Ginger.io (leading $6.5 MM in series A funding). Finally, Shaywitz’s pick for book of the year is”Why Nobody Believes The Numbers,” by Al Lewis. Disease management takes longer, saves less, has difficulty in achieving any ROI but can work out best for the patient in the long run, if we ever get there. But didn’t we know that already? Forbes article

Related: Khosla vs. Kvedar at the mHealth Summit. From Khosla, the usual ‘80% of healthcare can be delivered without doctors’, ‘50% of doctors are below average’ and most Americans today understand health information at a fifth grade level (so much for everyone being Quantified Selfers!). Kvedar argues the same points from ‘60% of healthcare costs are labor’ and that computers are better than humans at algorithmic tasks. Not much of a debate here as Khosla gets 80% of the article lineage. mHIMSS

Based on reports coming in, the mHealth Summit this week in Washington D.C. had a greater focus on the US and patient engagement than the past two years, which emphasized governmental programs and non-profit NGOs, but with a twist–insurers are moving upfront in the picture. From Aetna‘s CEO Mark Bertolini keynoting and promoting their iTriage management app to the announcement of the open CarePass mobile platform that organizes 20 smartphone apps that help consumers manage their health and fitness, UnitedHealthcare Group‘s similar OptumizeMe and even AT&T insisting it’s a payer (self-insured), the rationale is better health for consumers, better care quality–but most of all reduction of that ‘$750 billion in waste’ that exists in the current system. Here’s select early coverage to get you started. Consumers will engage if mHealth is easy, Bertolini says (mHIMSS); Mobile tools help public, private payers be more proactive, Healthcare cathedrals and the consumer health bazaar (Mobihealthnews)

Update 7 Dec: David Lee Scher, M.D., well-known US consultant and former cardiologist, outlines five reasons why payers will be playing a major role in mHealth adoption (Ed. Donna comments): they hold the purse strings (very true), they can change physician behavior (ditto), they realize importance of patient engagement (uneven), they are the largest users of patient portals (of a limited type) and can perform clinical studies (they can, but not credible without academic involvement).  Why payers are critical to mHealth adoption (mHIMSS)

Neil Versel argues that Editor Donna’s question may very well be an understatement. To those of us in the technology community, the ‘button’ is a relic of an earlier time (and in the US, a reminder of an inadvertently funny ‘schlock shock’ commercial of the late ’70s). Starting in 2005, behavioral telecare elevated standards of safety (QuietCare then HealthSense, GrandCare, WellAWARE, etc.), and then fall detectors, telehealth-based care management and countless mHealth apps further raised the bar. The technology parade has passed PERS by. But to the implementers, the carers and community executives, the plain-jane PERS alert button remains a mainstay of senior housing on both sides of the Atlantic at least. Not that there are not abundant real-world alternatives. Yet more advanced ‘passive PERS’ with a fall detecting accelerometer built in (Philips Auto-Alert, Aerotel GeoSkeeper, AFrame Digital) and behavioral telecare, despite proving greater safety and proactive care metrics, are still in a low stage of adoption. But as Versel points out, PERS can no longer be considered the standard of adequate care, whether at home or in a facility–and moreover, provides little more than the false assurance of safety with the potential of a high, final and unconscionable human cost. Panic buttons for seniors must go (Mobihealthnews)  

Update 7 Dec: Editor Steve, in his comments under the article, makes two points: self-reporting safety confirmations (response to automated calls and similar systems) adds another security layer for older people and disabled living alone; current accelerometer-based fall detectors often miss ‘soft’ or gradual falls, especially to the seated or slumped position 

Also from Ed. Steve, continuing research in behavioral telecare’s quantification of the early detection of illness is being done by the University of Missouri at two locations in Missouri and Iowa. They are using Microsoft Kinect for gait assessment, which can predict propensity to fall, and are receiving NSF and other Federal funding for this (limited) ongoing research. Originally covered by us back in July [TA 3 July] and updated in this article from (UK) HealthCanal: Sensor Network to Protect the Elderly

mHealth is perceived as having the potential to be effective in changing behavior which will be effective in controlling chronic diseases such as diabetes, according to the mobile trade group GSMA in their latest white paper. The lead finding in this global study is that “89% of practitioners, 75% of patients and 73% of consumers believe that mHealth solutions can convey significant benefits.” While the finding may sound like the ‘perception is reality’ early-hype curve stuff, it’s being backed up by studies like the Clinical Therapeutics study earlier this year on how text (SMS) reminders significantly improved diabetics’ medication adherence and the just-published text4baby study of 90 women in a Fairfax County, Virginia Health Department program. Attitudes and behavior were measured among a primarily Hispanic new mother group, and text4baby had a significant effect on increased agreement with the attitude statement “I am prepared to be a new mother” and increased negative attitudes concerning alcohol consumption. GSMA: mHealth perceived globally as effective, Study: text4baby effectively helps new moms (FierceMobileHealthcare)

November was a busy month for the 3millionlives (3ML) team, as reported in their November newsletter (PDF). They have also released a video, below. (7½ minutes) The video contains interviews with doctors, patients and a nurse. It was made to be shown at the Making Sense of Commissioning conference held on 27 November 2012 at the Royal College of General Practitioners, London, which may explain the focus on telehealth and the absence of any references to the contribution telecare technologies can play in supporting people at home.

3ML is also showing up alongside the Digital First initiative as one of six ‘high impact innovations’ on the NHS innovation website. Coverage of the Digital First launch seems to have confused many commentators. Not just the UK press, but in the US too, e.g. FierceHealthIT: U.K. telehealth model, smartphone prescribing unlikely to take hold in U.S. mHiMSS: Adoption of mHealth technologies: UK vs. USA.