Radiation from smartwatches, wearables: real, alarmist, or the NY Times?

March 20, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye has that certain half-baked radioactive ‘glow’. The healtherati are all aTwitter over a New York Times Style (!) section article that does the unthinkable–it dares to raise the question of the possible harm of radiation that wearables, including smartwatches as well as smartphones, might present to both adults and children. The writer, Nick Bilton, is a regular tech columnist.

After an unfortunate baiting for attention at the start, making an analogy of cellphone/wearable radiation to 1930s adverts with doctors ‘endorsing’ cigarettes, he for the most part tries to take a balanced approach. By the end, he lines it up like this. Bluetooth LE and Wi-Fi–no evidence of harm in adults. 3G/4G cellphone radiation–you may want to be careful. He points out that studies aren’t definitive. Older studies, such as the WHO’s, a Swedish and some European studies point to harmful (carcinogenic) effects from phones held extensively too close to the head, but nothing is definitive in causality as the CDC pointed out and additional studies have proven no conclusive evidence of harm. Conclusion–use anything 3G/4G with caution, away from the head, limit exposure by children or pregnant women. Cautious enough?

Oddly, he advocates Bluetooth headsets but doesn’t mention using speakerphone settings–and then, for the smashing windup, won’t put the Bluetoothed Apple Watch near his head. It’s a weirdly sourced (an alternative doctor the only one cited? Old studies?) and half-baked, partially tossed salad article. Consider: most wearables are–surprise, Bluetooth or Wi-Fi connected. But it does bring up the inconvenient question, only partially answered, of All Those Rads and What (If Anything) Are They Doing To Us.

What’s really interesting? The immediate, twitchy and prolonged press response. As they say in New Jersey, they are ‘jumping ugly’. (more…)

The NHS, tech, and the next 10 years – soapbox, event & call for posters

February 22, 2015 | by

As a distraction from the things that, before the advent of handheld technology, little boys used to do in the school playground when this editor was young, once in a while we would engage in the pointless debate of what would happen if an irresistible force met an immovable object.

Those debates came to mind when Graham De’Ath kindly drew this editor’s attention to the recently published Labour Ten Year Plan for Health & Care. Now Telehealth & TelecareAware knows better than to indulge in politics, however the document was notable in that it did not make any significant reference either to the demographic reality of the next ten years, or the likely role of ‘technology’ in assisting with the resultant increase in care required (the word is mentioned just once, in the commitment to: “Set up a wide–ranging review of NICE which will look at reforming the  NICE technology  appraisal process…” [actually already underway by the NIB]).  The Labour Party is far from being alone in this – readers with long memories will recall our amusement as the RCGP’s ten year forecast of the changes in GP practice where the biggest role technology was expected to play in 2022 was in remote delivery of test results.

The reality, TTA believes, will be very different: (more…)

Hackermania running wild, 2015 edition

February 11, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”300″ /]

Do we need the Hulkster Running Wild against Hacking? It’s so heartwarming to see the mainstream press catch up to what your Editors have been whinging on for the past few years: that healthcare data is the Emperor With No Clothes. Here we have Reuters and the New York Times with a case of the vapors, seeking a fainting couch. Reuters dubs 2015 ‘The year of the healthcare hack’. The FBI is investigating the AnthemHealth breach, while their counterparts UnitedHealth, Cigna and Aetna are in full, breathless damage control mode. The Times at least delves into the possibility that it was at least partially instigated by China and the People’s Liberation Army (PLA) unit that trolls for intellectual property.

Our Readers, savvy to your Editors’ warnings since at least 2010, were aware that the drumbeat accelerated this past summer. (more…)

Can the NHS be in crisis when they want to waste money like this?

January 16, 2015 | by

The Guardian had a headline yesterday: “GPs to be offered £1bn in new funds if they improve access and elderly care” Upon reading further it transpires that £250m pa is to be offered for the next four years. A clue to the rationale and preferred direction of the monies is:

“NHS England believes using the £1bn to transform existing GP surgeries and build some new premises will help reduce the pressure on hospitals buckling under the strain of unprecedented demand.”

Telehealth & Telecare Aware believes that this is totally the wrong approach. Given the huge increases in the popularity of remote consultation as we covered in our review of our 2014 predictions, surely the right focus for additional funding is to provide substantial incentives to get GPs using existing technology to consult with patients remotely? This should be allied with an advertising campaign to point out the benefits to patients of not having to visit a surgery or exchange germs with others in the waiting room plus offer reassurance that face to face appointments will always be available if the doctor thinks one is necessary.

One way to start might be for the NHS to do deals with organisations like GP Access to offer technology like their askmygp to all GP surgeries for free and give large financial incentives to GPs conducting remote consultations with more than an agreed percentage of the patients on their books by year end…then raise that percentage every year for the next four years. That has got to be far cheaper than building works that will anyway become redundant soon because attitudes are changing and people will be preferring remote consultation shortly anyway! It would be much quicker to implement too.

In mitigation, the article also mentions that surgeries, apparently also “will also be expected to make much better use of technology to monitor patients’ health as a way of reducing their need to seek direct care from a doctor.” However that sounds more like a tepid endorsement of telehealth than encouragement to be radical.

Hat tip to Mike Clark

Soapbox: Why an app isn’t like a book

November 30, 2014 | by

The suggestion has been made recently at a couple of events that this editor attended that there is an unnecessary fuss over regulation of medical apps because they are just like medical books; as there is no regulation of books, why the need to regulate medical apps? . In order to try to move to a consensus, this post puts the opposite point of view, to stimulate debate. In summary the arguments of why they are different are:

  • We are familiar with books and have worked out how to deal with them;
  • Books give formulae and leave users to compute; apps do it all, often without showing their working;
  • Tablets and, especially, smartphones have screens that are smaller than books so require a different design.

This issue of course only relates to serious medical apps – something like 99.5% of all health apps available are very unlikely to do serious harm, helping people as they do record things like their fitness and their weight, and so do not require such detailed scrutiny. It is the ones that get close to, or meet, the test of being a medical device that are of particular interest here. The goal is that once clinicians are comfortable prescribing medical apps, and patients are comfortable using them, the NHS will save substantial sums by, for example replacing drugs with apps for a range of diseases where both are effective and apps are far cheaper. There are also huge benefits for clinician-facing apps – properly certified medical apps like Mersey Burns and Mersey Micro are already massively improving patient outcomes and significantly reducing NHS costs.

In more detail, books have been with us for many centuries so we are familiar with their structure, with the processes for their removal from publication if they give dangerous advice, and with the idea of specialist publications accessible by appropriate experts only – the same is not true of apps. In the event that advice in a book was dangerously wrong, (more…)

Telecare Soapbox: Falling outside the box

September 22, 2014 | by | 4 Comments

[Editor Donna’s note: Even if you have already read this great article by Steve, read on to the first comment as to ‘what happened’.]

Before you read the rest of this item, read or re-read the following two popular recent falls-related articles:

Accelerometers, false positives/negatives and fall detection (Tom Doris)

A five-point rebuttal to ‘Accelerometers, false positives/negatives and fall detection’ (Andy Schoonover)

The acceptability of false positive fall alerts and the risk of false negatives has dogged fall detection ever since the first detector was invented. It is great to see this fundamental matter still being debated on this website by experienced practitioners!

However, given that calibration of devices has, as Tom Doris points out, inherent problems however sophisticated they become, I see no one putting their finger on what I consider to be the ‘real’ issue. That is: where in the system is the intelligence that judges whether a fall is problematic or not?

Current systems place the intelligence either with (more…)

A five-point rebuttal to ‘Accelerometers, false positives/negatives and fall detection’

September 18, 2014 | by | 1 Comment

One of our most popular articles ever on TTA has been Tom Doris’ analysis of accelerometers in fall detection. His point of view is as a developer in digital health technology. For your consideration, we are posting this extended response from an executive experienced in deployment of both traditional PERS and now PERS with accelerometer-based fall detection in older adult populations.

Andy Schoonover is President of VRI, a leading provider of PERS, MPERS, and telehealth monitoring services founded in 1989. VRI currently actively monitors approximately 110,000 clients in the US–and a long-time TTA reader.

Tom Doris wrote a post on September 17th, laying out the problems with the use of accelerometers and fall detection devices especially in regards to PERS. After reading Tom’s post I felt compelled to respond with the following five points on why it’s important to continue to promote fall detection within PERS and MPERS.

1) In the 1 out of 100 case that my grandma falls and can’t physically press a button (sudden fainting due to hypoglycemia for example) would I prefer she have a regular PERS, which definitely won’t indicate a fall, or a PERS with fall detector which will more than likely indicate a fall? If it were my grandma I’d go with the “more than likely” option.

2) If my grandma had too many false positives then I’d ask her: you can use regular PERS with no fall detection or you can use PERS with fall detection where you will get called a couple more times per month. Which would you prefer? Hint: she’ll say fall detection. About 5 percent of our customers are annoyed by the false positives. (more…)

Is digital health neglecting The Big Preventable–medical errors?

September 6, 2014 | by | 1 Comment

 

Preventable medical errors persist as the No. 3 killer in the US – third only to heart disease and cancer – claiming the lives of some 400,000 people each year.

(US Senate hearing, cited in HealthcareITNews 18 July 2014)

At the end of last month, this Editor questioned the efficacy of our current state of ‘consumer engagement’ in Patients should be less engaged, not more. The ‘less engaged’ was a call for simplification: regimens and devices which were easier to use, less complicated and far easier to fit in everyday life. (Aesthetics helps too.) Back in 2013, HeartSister/Ethical Nag (and Canadian) Carolyn Thomas called for health app (and by inference consumer engagement) designers to ‘skate to where the puck is going’–as in “For Pete’s sake, go find some Real Live Patients to talk (and listen) to first before you decide where you’re going!” Often it seems like these apps and platforms are designed in a vacuum of the entrepreneur’s making. The proof is the low uptake (Pew, Parks, IMS) and the apps’/programs’ lack of stickiness after all this time (Kvedar 8 Sep blog post).

Now Laurie Orlov tells us we were looking at the wrong puck, as analysts do. First, all that ‘nudging’ and all those apps haven’t moved the needle on diabetes and obesity. Second, why are app developers neglecting that third largest killer, preventable medical errors? Add to that 400,000 yearly–over 1,000 per day–the 10,000 estimated patients every day who suffer serious complications. (more…)

‘eVisits’ save $5 billion globally this year–but are they more effective care?

August 14, 2014 | by

Deloitte and Towers Watson obviously disagree on the savings from eVisits (Deloitte) and telemedicine (Towers Watson). Deloitte’s study of eVisits projects a global savings of $5 billion in 2014. Towers Watson is estimating $6 billion in 2015 from US employers alone if there is full employee utilization of telemedicine. Deloitte is also more transparent in its estimating, for example on the $50-60 billion total addressable market for eVisits in ‘developed countries’. This Editor doesn’t see a major difference in definitions between the two; Deloitte defines eVisits as video consults plus the forms, questionnaires and photos that have become part of telehealth, but not the vital signs monitoring part.. Perhaps our readers, looking at both more closely, can discern, or confirm that Towers Watson has too rosy a picture? Deloitte‘s ’21st Century Housecall’ study (short paper) is also worth a read for presenting facts/figures on the global addressable market and for a surprising conclusion–that the ‘greater good (in developing countries) may come from saving tens of millions of lives’. Hat tip to reader Mike Clark. Clinical Innovation + Technology summary.

‘Virtual care is much more effective than brick-and-mortar care.” (Editor’s emphasis) A bold statement that Microsoft and the writer from Intel fail to back up with facts. The focus of this ‘In Health’ article is preventing readmissions. There are the usual Panglossian pointers  (more…)

Is this the last time the flat earth society will be celebrating? (UK WSD)

July 30, 2014 | by | 3 Comments

When this editor was running a telecare & telehealth programme in Surrey, there was always the dread when meeting professionals that one of the daily internet newssheets would publicise another paper about the Whole System Demonstrator (WSD) that ‘proved’ that one or other form of remote patient monitoring (RPM) cost more per QALY than a voyage on Virgin Galactic. The day was then spent unconstructively, making some or all of the points encapsulated in my original post on 22 July last year entitled “Time to bid farewell to the WSD”.

Thankfully the flow of WSD papers has since dwindled. Doubtless many hoped they had stopped for good, in view of their total irrelevance to the real world in 2014. However, on the offchance that some poor reader has found themselves being challenged about the abstract of a recent paper picked up by Pulse, on the high cost per QALY of telecare by one of the few professionals who still do not accept the value of appropriated technology, here is what you might tell them (more…)

Soapbox: Kicking the ‘Tweet the Meeting’ habit

July 24, 2014 | by | 4 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/twitterban-590×330.jpg” thumb_width=”150″ /]It’s time to go cold turkey. One of the hallmarks of being active on healthcare tech or digital health scene is Twitter. Even more than LinkedIn groups, websites and blogs, it’s how increasingly we communicate with and acknowledge each other in the field. But it has its shortcomings. It’s become a chore to follow the tweetstream in my (deliberately limited) account, because there’s all that filler. I have to scroll…and scroll…to find the ‘wanna read’ nuggets by those who post ‘the good stuff’ (and you know who you are).

The volume increases dramatically during conferences. There’s good links and photos, but increasingly it’s become a festival of incidental remarks about speakers being on (sans content links), tweets about going here and there, social pictures of lunches and dinners, selfies. Increasingly, no one puts down their phone! At sessions, instead of being riveted (or not) on the speaker, attendees are glued to their phones, furiously keyboarding and tweeting…whatever. It’s insulting to the speaker who’s trying to engage with the audience, for starters. Then there are the meetings with the tweetstream posted to the side of the stage–another distraction.  Most of all, by furiously fingering, aren’t you cheating yourself of the conference experience for which you or someone has paid dearly? Isn’t the point of being there human contact and time off the screen?

Carolyn Thomas, Canada’s own ‘Ethical Nag’ and ‘Heart Sister’, describes kicking Obsessive Live-Tweeting at Conferences far more wittily in How we got sucked into live-tweeting at conferences. An excerpt:

For too long, I’d been telling myself:

–that live-tweeting isn’t a problem for me
–that I could quit anytime
–that the tweets I send to my Twitter followers while listening to a conference speaker onstage are actually interesting, high-quality messages
–that it must be okay because everybody else in the audience is doing it, too

But now I know that it’s time to quit cold-turkey.

Tunstall’s 2013 fiscal report: debt service makes short term gloomier

July 10, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Updated…Released on this ‘getaway day’ (in the US), and surprisingly only covered by the local Yorkshire Post, is the report of Tunstall Healthcare Group’s year-end closing (30 Sept 2013) results. The short term news is positive: 21 percent revenue growth to £221 million in its 2013 statutory accounts. However, this adds in the acquisition of Spanish monitoring provider Televida for £27.4m in January 2013 and the 2012 purchases of AMAC in the US and STT Condigi in Sweden. The official posture of the company, expressed by CEO Paul Stobart, is that “with continuing Government austerity measures and a fragile global economy, the business does face challenges in the short term.” And one of those challenges making for a gloomy picture is debt service. We’ll let the YP speak: “The group, which is owned by private equity house Charterhouse Capital Partners (CCP) paid £13.7m of interest in cash on its senior and mezzanine debt of £265m, as well as a total of £114.4m non-cash interest on long-dated shareholder loan notes and other loans. This results in a statutory reported loss for the group of £127.8m.” That change of nearly £350 million, which includes operating costs and other expenses, illustrates the critical consequences of debt service on the bottom line, indeed [TTA 22 May]. Many thanks to one of our reliable sources for picking up this report.

New: Founder Steve reminds us of his related (and oh, so prescient) analysis from 2010 about Tunstall’s earnings versus debt service balancing act in Telecare Soapbox: Equity capital. A cautionary tale. (Thank you Steve for adding)

It is worth a detailed read because the 2009 numbers were also ‘challenging’. Steve dug through 2009 publicly filed (in UK) numbers to reach his conclusions. In sum, “The important question is whether their underlying position is sound and reliable, or whether they are shaky. They also tell me that the robustness of a company’s cashflow is the most important survival factor.”  If I am reading the report on CompanyCheck correctly, the eye-watering negative net worth of the Group and the low cash positions of both the Group and UK are oddly reminiscent of airline financial statements when this Editor was still in that business. Do remember the object examples of Texas Air Corporation (once the world’s largest airline holding company), Pan Am and TWA!  You also have to have some sympathy for the management which was not part of getting into this ‘pickle’ now tasked with getting the company out of the barrel.

Soapbox Round 2: ‘disruptive innovation’ debate disrupts ‘the chattering classes’

June 30, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/06/img_5.jpg” thumb_width=”180″ /]It’s a Blackboard Jungle out there. Clayton Christensen rebuts Jill Lepore on most–but not all–of her views on his theory of disruptive innovation [TTA 24 June] aired in a New Yorker cover story. The forum is a follow up interview (20 June) with BusinessWeek. (Hat tip to Tom Boyle commenting on the original Soapbox. Also see a just-released HBR video interview, link below.)

Your Editor agrees with his point that his theories have been developed and updated far beyond his first (1997) book, ‘The Innovator’s Dilemma’, the only one she refers to.  (Similarly, I am most familiar with ‘The Innovator’s Prescription’ of 2008, but we’ve commented on his more recent relevant work, readily searchable here.) This is, unfortunately, her argument’s major flaw. It is akin to ceasing your review of WWII history with A.J.P. Taylor and Cornelius Ryan; as fine foundationally as they are, the scholarship and strategic debates will extend far beyond our lifetimes.

Mr Christensen in his rebuttal is appealingly modest in bringing up where he got it wrong (the iPhone), where his model has gone off (in 2002, a mathematician from Tuck demonstrating the causal mechanism as incorrect to that point) and that he still sees problems with the theory. Moreover, her strongest point is one he agrees with: (more…)

Soapbox: Is ‘disruptive innovation’ a theory gone off the tracks?

June 24, 2014 | by | 2 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”200″ /]Having publicly stood as a huge fan of Clayton Christensen’s theories of disruptive innovation, particularly the ‘broken circle of innovation’ as an explanation of our current economic stagnation (if not ‘stagflation’ which was a hallmark of my early adulthood and yes, now) and disruption in healthcare (even if it hasn’t started yet because it’s been sidetracked), this Editor was prepared to savage, demolish and otherwise lay waste to a New Yorker article by Jill Lepore (a Harvard professor of American History, for Pete’s sake).

Having read and digested the article, I am surprised in largely agreeing with Prof. Lepore. She brings forth certain weaknesses and concerns I had about the entire Weltanschauung of disruptive innovation, first as an overarching theory equivalent to Darwin’s theory of evolution. There is a veritable industry around disruptive innovation which she outlines, reminding me that hype of this type around any theory I find profoundly irritating because theories are just that–to be reality checked early and often, just like voting in the 1930s in Jersey City, New Jersey. Prof. Lepore then points out where fellow Harvard Prof. Christensen didn’t paint the complete picture (e.g. Bucyrus, US Steel) and–to me quite importantly–discounts external events and even aggressive, defensive business strategy (as Ron Hammerle’s Soapbox on sidetracked innovation pointed out). Many of Prof. Christensen’s acolytes ignore history (and business strategy) altogether in a near-religious form of Determinism-by-Innovation.

There is also another circle–a circular logic prevalent in Mr Christensen’s theories summarized aptly by Ms Lepore: (more…)

Disruptive innovation in healthcare hasn’t begun yet: Christensen

March 31, 2014 | by | 6 Comments

Clayton Christensen, as many of our readers know, pioneered a theory of disruption in business models and a three-step cycle of innovation (empowering, sustaining and efficiency, now quite broken indeed). With two other writers, he applied these theories to healthcare in the 2009 book ‘The Innovator’s Prescription’ which this Editor heard co-author Jason Hwang, MD present in 2009 at the Connected Health Symposium and at a private meeting in 2011. One would think that we’d be well into disruption, which is part of the empowering innovation cycle and which the authors championed in the book as underway.

The surprise at the end of this Mobihealthnews article on his recent presentation at “Better Health” in Boston, a McKesson-sponsored meeting series, was not what constitutes disruption, but that it has not really started yet, four years later. This will be much to the surprise of many successful and unsuccessful companies (Misfit Shine, ZocDoc, Zeo, 23andMe) and health plans which have stoutly touted their products and services as The True Disruptors. Sorry, you may be only a part of the Big Shift: decentralization. Decentralization will push out parts of healthcare off the hospital (more…)

The future of doctors

January 23, 2014 | by

The Economist this week has an important leader and report on the future of work that has key implications for technology adoption by clinicians.  It is well worth reading in full. For those who cannot, the very basic issue raised is that technology is again replacing labour with capital. In the past this has always resulted in higher value jobs being created. This time though, there are many suggesting that it might just be different: some people will run out of road.

The Economist article does not go into the detail of many individual professions, however the description of the types of work most suited to this next wave of automation does cover much of the field of medicine (as, coincidentally I argued recently in my predictions for 2014). A particularly relevant section in the article is:

The machines are not just cleverer, they also have access to far more data. The combination of big data and smart machines will take over some occupations wholesale;

…which supports my contention:

And just think too, what correlations a single system overseeing the treatment of tens of thousands of people, with access to regular vital signs and other information on progress for each one of them, might be able to spot to enable it to improve patient care, that elude the best of GPs treating far fewer. Doubtless increasing genomic analysis & knowledge will enhance this too. –

So how should doctors react? Clearly one view, which seems still to be the minority approach (and that Telehealth & Telecare Aware is really all about trying to encourage) is to use existing technology, like telehealth and mHealth, to improve healthcare and reduce its cost. Automation is expensive so investors will look for those professions where the expected returns are highest; with this approach, the greatest benefits from automation will lie in other professions, so the greatest impact of automation on the medical profession will be delayed.

The alternative, which still seems to be the majority view, is to argue for the continuation of current practice and ignore the benefits of technology (and ignore the evidence that demographic changes will mean that the ratio of careworkers to those requiring care will render the current system infeasible anyway). That way will keep the cost of care relatively high and promote a crisis in the delivery of healthcare relatively soon, making early profound medical automation particularly attractive.

Of the two, from a patient point of view, earlier rapid automation looks superficially attractive although the chaos of rapid change will likely create many challenges that make it less attractive – let’s hope that the leaders in the medical profession, and those who appoint them, read the Economist this week and recognise the benefits to them (as well as to patients) of early technology adoption.