Signs of a home monitoring bubble?

August 27, 2013 | by | 3 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/Ambio-health.jpg” thumb_width=”175″ /]Suddenly home-based remote monitoring is very warm, if not hot. The news of investments at all levels–from Medtronic’s purchase of Cardiocom [TTA 12 Aug] to a $525,000 third angel round investment in AmbioHealth (which this Editor doubts would have been on MedCityNews’ radar a year ago)–sounds like home telehealth is finally, finally gaining traction with investors, which have been more attracted to hospital-based and fitness monitoring. But is it the right type of traction based on reasonable expectations? We were among the first to point out in 2010 in positing the FBQs* that where the data goes, how it’s being used and who’s taking action on it was critical. Now Robert Pearl MD in Forbes is also examining the new song of home RPM and finding a few off notes (or to mix metaphors, finding a pan of fool’s gold):

That’s because some promoters of home monitoring technology believe doctors will carefully scrutinize each EKG or blood sugar reading and use the information to tailor perfect regimens for their patients. This is not how medicine works.

and

Looking at thousands of EKG tracings won’t add much value either. In fact, putting all that information into an electronic medical record (EMR) only makes it more difficult for doctors to identify other, more vital pieces of information. Instead, doctors need to understand which of a few possible patterns are happening to determine the appropriate course of action.

Dr. Pearl’s prescription is for smartphones to embed telehealth monitoring capabilities at a price point slightly above the current cost, but less expensive than stand-alone devices (more…)

So 9 out of 10 people haven’t heard of ‘telehealth’…and your point is?

August 14, 2013 | by | 3 Comments

Apparently echoing the comments about health technology awareness made in our post last week about O2 (who are, by the way, to be congratulated for their parent company’s announcement today that they are preferred bidders for two of the three smart meter regions), the HSJ has reported the results of a YouGov poll that nine out of ten adults in the UK have never heard of telehealth.  Of those over 55, the age above which use of telehealth is more likely, 92% hadn’t heard of it. (Note that the HSJ article is behind a paywall, however via a Google search on “National Telehealth Forum”, the commissioner of the survey, you can currently go past it). The National Telehealth Forum press release is .  EHI also covers the story, .

So is this a matter of serious concern?  (more…)

Analysis of the Birmingham OwnHealth service – not the bad news it seems?

August 9, 2013 | by | 3 Comments

The BMJ has just published an open access paper entitled “Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls” (BMJ2013;347:f4585, Steventon et Al).  It reaches the rather depressing headline conclusion that telephone coaching did not reduce unplanned hospitalisations and if anything increased them.

This looks to fly in the face of the apparently less academically rigorous recent claims by the Leicester City CCG and Totally Health, that they reduced hospitalisations significantly, saving some £353,000 over a 30 week period with a cohort of between 47 & 50 patients that we reported recently.

However reading on, perhaps a key passage, in the conclusion, is (more…)

O2 – a retrospective

August 8, 2013 | by | 2 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/O2.jpg” thumb_width=”100″ /]With 1734 hits (and counting) the Telecareaware post on O2 Health’s telecare & telehealth withdrawal and associated comments was one of our most popular. It therefore seems appropriate to try to crystallise some important lessons from all those brilliant comments, so here’s my starter – please feel free to add your thoughts. (Almost all the comments are related to the retail telecare offering so unless specifically stated otherwise, all the following relates only to this side.)

Overall there was a huge sense of sadness that came through from many comments – many had seen the move into retail sales a confirmation that telecare had finally arrived as a mainstream technology in the UK, so a withdrawal so soon afterwards caused much grief.  It was touching to see the concern for the staff too, who have worked so hard to get this venture airborne.

Although there were few comments specifically about the retail telecare kit, none were complimentary; it was seen as being single purpose, limited and hard to use. The ability to replicate the hardware functionality on a standard smartphone, (more…)

Systems sharing data, still behaving badly

August 7, 2013 | by

A straight-shooting article in Healthcare Technology Online provides a overview of the EHR and Health Information Exchange (HIE) mess in the US. Essentially our major EHR systems (Cerner, McKesson, athenahealth, Greenway, Epic) don’t interchange data well, if at all–and the 600-odd practice EHRs were built on siloed designs, existing software and used proprietary formats, often in a rush to take advantage of Federal subsidy programs in Stage 1 Meaningful Use–as HTO’s EIC Ken Congdon stated, “electronic filing cabinets”–and heavily outsourced. Well, it’s now ‘uh-oh’ time as a key part of Stage 2 MU is interoperability. Basically we now have a set of what this Editor would term ‘paste ons’ and ‘add-ins’ to facilitate data exchange between systems that speak different languages (Editor’s emphasis):

…direct protocol (a standards-based method for allowing participants to send authenticated and secure messages via the National Health Information Network), as well as those developed by HL7 (Health Level Seven), a nonprofit global health IT standards organization, provide EHR users with the building blocks for exchanging data. Blue Button, an application developed by the VA that allows patients to download their own health records, is also being adopted and manipulated by EHR vendors and independent developers as a way for providers to exchange data between systems. Moreover, regional and state-run HIEs offer healthcare providers in several parts of the country a network they can join (and technology infrastructure they can leverage) to share health data with other HIE members.

Some systems work well–EHR and pharmacy systems seem to. However, EHR to EHR interfaces are up to the provider and are expensive. Sharing/translation does not mean that all information makes it over without getting ‘bruised’ or having to be reentered manually.  HIEs, acting as a focal point for data exchange, are also generally non-profit; the exchange platforms cost millions to develop and further millions to maintain–and buy-in is low, as the article states. Fixing The EHR Interoperability Mess (free registration may be required)

(Updated 8/7 pm for Editor Donna’s POV) This is what happens when you rush adoption and development processes that should take years in order to gain quick subsidy money, and non-healthcare entities (that is you, the US Government) encouraged this, distorting the process. The private and public waste of scarce healthcare funds is appalling, and the disruption to the healthcare system is unforgivable–especially in practices where doctors and managers in many cases have been sold a bill of goods, and they are revolting by changing EHRs, going back to paper or retiring. And the Government should look to itself first. Look no further than to the multiple failures of two branches of the US government, Veterans Affairs and Department of Defense, which have the responsibility for current and veteran members of our Armed Services. They have failed spectacularly in serving Those Who Have Served not only the integration of their two EHRs but also in updating their basic architecture [TTA 27 July ‘Pondering the Squandering’… and 3 Apr ‘Behind the Magic 8 Ball’ both review the sad details.] The belief that HIEs with limited funding will solve the interoperability problem is Magic Thinking. At least one move in this direction makes sense: the CommonWell Alliance of six EHR heavy hitters to work on ‘data liquidity’ [TTA 5 Mar announced at HIMSS], but this may be another ‘uh-oh’ and face saving.

With basic, necessary health and patient information stuck in systems and getting lost in translation, how can anyone rationally expect that personal data from telehealth devices will be integrated anytime soon, in any meaningful way? Does this mean that parallel, separate systems and platforms will continue to develop–and yet another wave of integration?  

Pondering the squandering of taxpayer money on IT projects (US)

July 27, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye has been in Observation Mode this week. But this handful of Dust-In-Eye necessitates a Benny Goodman-style Ray on another US governmental ‘fail’. When it comes to IT, the government admits…

Agencies Have Spent Billions on Failed and Poorly Performing Investments

Exhibit #1: FierceHealthIT summarizes five big ones out of a 51-page Government Accountability Office (GAO) report focusing on the inefficiency of agency IT initiatives–just in healthcare.

  1. Veterans Affairs (VA) VistA EHR system transitioning to a new architecture: terminated October 2010 at a cost of $1.9 billion
  2. VA-Department of Defense (DOD) iEHR integration: as previously written about, it collapsed under its own weight for another $1 billion [TTA 8 March]

  3. DoD-VA’s Federal Health Care Center (FHCC). Opened in 2010 as a joint facility under a single authority line, but somehow none of the IT capabilities were up and running when the doors opened. ‘Jake, it’s ChiTown.’ Only $122 million.

  4. DoD’s own EHR, AHLTA (no VistA–that’s VA’s) still doesn’t work right; speed, usability and availability all problematic. A mere $2 billion over 13 years.
  5. VA’s outpatient system is 25 years old. Modernization failed after $127 million over 9 years before the plug was pulled in September 2009

You’ll need Iron Eyes to slog through the detail, but it is a remarkable and damning document. PDF (link)

but…there’s more. Excruciating, hair-hurting, and would be amusing if not so painfully, and expensively, inept. Malware Removal Gone Wild at Commerce… (more…)

Soapbox: Further thoughts on CarelineUK, O2 & WSD

July 25, 2013 | by

The many, excellent, comments on O2’s withdrawal of their current telecare & telehealth offerings in the UK market, most notably from my fellow editor Alasdair Morrison, have prompted further thoughts on the post about CarelineUK’s 25th anniversary earlier today: what will CarelineUK,  and other organisations like it, look like in 25 years’ time?

Perhaps the most significant change that appears to be coming in the area of telemonitoring is  (more…)

Telehealth Soapbox: Negotiating a Vendor’s Limitation of Liability Clause

May 16, 2013 | by

This is the third of an occasional series on US law and intellectual property (IP) as it affects software and systems used in health technology. This article is a ‘how to’ on achieving a more equitable liability arrangement between a company and a vendor. A standard clause a vendor uses to protect their company from liability can cause a great deal of trouble and financial heartache for a contracting company when ‘things go sideways’. Correspondingly, if you are a vendor or partner, this enables you to anticipate issues a skilled negotiator on the other side of the table will present.

Mark Grossman, JD, has nearly 30 years’ experience in business law and began focusing his practice on technology over 20 years ago. He is an attorney with Tannenbaum Helpern Syracuse & Hirschtritt in New York City and has for ten years been listed in Best Lawyers in America. Mr. Grossman has been Special Counsel for the X-Prize Foundation and SME (subject matter expert) for Florida’s Internet Task Force. More information on Mr. Grossman here.

When clients come to me to consider suing because of a tech deal that has gone bad, the single worst lawsuit killer is often the “standard” limitation of liability clause found in a vendor’s form agreement. It never ceases to amaze me how people don’t pay attention to these clauses as they blithely sign-off on a one-sided agreement. It’s just one little clause and yet it can cause so much damage.

Here’s an example of the type of provision that you’ll see in tech agreements:

“The liability of vendor to customer for any reason and upon any cause of action related to the performance of the work under this agreement whether in tort or in contract or otherwise shall be limited to the amount paid by the customer to the vendor pursuant to this agreement.”

Yes it’s heavily slanted in favor of the vendor—it’s the vendor’s form. I draft them just as one sided when I’m representing a vendor so that I protect MY client. As I always say, he who drafts sets the agenda. (more…)

Employee wellness: Carrot? Stick? Or something else?

April 12, 2013 | by

The actions of companies like CVS Caremark [TTA Telehealth Soapbox] have aimed a white-hot klieg light onto corporate wellness and the various methodologies companies are using to force a change in employees’ behaviors to positively affect their healthcare spend. Both positive and negative incentives have their pros and cons–positive incentives tied to completion of wellness ‘tasks’ seem not to work long term, penalties can be a blow to morale and verge on full-blown discrimination and lawsuits. Increasingly the price of being in a corporate health plan seems to be acceptance of ‘intrusion for your own good’ and privacy loss. On the other hand, why should health insurance be any different than home or auto, at least in the US?  The Wall Street Journal has written several non-firewalled articles on this issue in recent days: Your Company Wants to Make You Healthy; Carrots and Sticks: Which One Works The Best (infographic); If Workers Are Out of Shape, Should Companies Make Them Pay? (At Work Blog–read over 85 comments)

In terms of effectiveness, the only study this Editor has seen was published this month in the Journal of Occupational & Environmental Medicine from wellness/disease manager Healthways’ Center for Health Research, as mentioned in a secondary article by the Integrated Benefits Institute. According to IBI’s summary:

Looking at over 19,000 employees at five employers, the authors find that employees who reduced their total health behavior risks over a 12 month period—for example, by increasing exercise or improving their diet—had a lower likelihood of absence, less presenteeism [working while sick–Ed.], and better job performance.

But some of those 19 factors included work-related risks such as “poor supervisor relationship, not utilizing strengths doing job, and organization unsupportive of well-being” (JOEM)–not health related at all. And the total reduction was a whopping 5 percent.

Magic 8 Ball says: ‘picture cloudy, try again’.

So perhaps the real choice has become this: adhere to employer requirements–or not have any coverage at all. There’s been a 10 point decline in Americans covered by employer-sponsored insurance, from 69.7 percent in 1999/2000 to 59.5 percent in 2010/2011 (SHADAC/Robert Wood Johnson Foundation). Much of that is also the US 7.6 percent ‘official’ unemployment rate (U-3)–but the real accelerator here is the 13.8 percent U-6 rate which counts in part-timers and the ‘marginally attached/discouraged’ who are not going to have employer insurance. The Affordable Care Act and its requirements/fees have also discouraged many smaller employers who are simply dropping insurance coverage.

So what is the bottom line? And where there are the opportunities for consumer engagement and self-maintenance linked to telehealth and mobile health which can mitigate cost? Understanding the ill-defined situation companies are in, especially in the US, will help in identifying them.

Telehealth Soapbox: Healthcare apps – welcome to the Piranha tank

March 26, 2013 | by | 1 Comment

Peter Kruger, owner of the Steinkrug consultancy and founder of Alphadaugters explores the dilemma that faces developers of health-related software. This item is re-published, with kind permission, from the Alphadaughter’s blog.
‘Information wants to be free’ so stated Stewart Brand, founder of the Whole Earth Catalog, back in 1984. Over the next two decades, thanks to the Internet and personal computers, a significant amount of the world’s imprisoned information was liberated. Now something similar is about to happen to healthcare: or at least the part of healthcare that is digital. This has been bought home graphically by the recent collapse of yet another online healthcare service: the sleep coach company Zeo.

It perhaps no coincidence that some healthcare IT companies are struggling just we see the release of a new generation of mobile technology. The Samsung Galaxy S4 has, as standard, a number of features mobile health companies previously had to build into their proprietary platforms. It will not be long before Samsung’s eye tracking feature appears in mhealth applications running on the Galaxy and other consumer mobile handsets. (Already Fujitsu has announced software that can check a person’s pulse rate through a tablet or smartphone camera.) Any company that has waited until their customers pressed for Apple and Android versions of their mhealth service has probably left it too late. And for those who have already ditched their proprietary platforms in favour of consumer mobile devices; (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…)

Telehealth Soapbox: Protecting your IP and patents online

March 7, 2013 | by

This is the second of an occasional series on US law and intellectual property (IP) as it affects software and systems used in health technology. This article is an overview of the issues surrounding and actions you should take to protect your proprietary website, software and patents. Especially for early stage companies, the last has grown in importance with ‘patent trolls’ demanding settlement fees for claimed infringement.

Mark Grossman, JD, has nearly 30 years of experience in business law and began focusing his practice on technology over 20 years ago. He is an attorney with Tannenbaum Helpern Syracuse & Hirschtritt in New York City and has for ten years been listed in Best Lawyers in America. Mr. Grossman has been Special Counsel for the X-Prize Foundation and SME (subject matter expert) for Florida’s Internet Task Force. More information on Mr. Grossman here.

Imagine if you found a portion of your proprietary software or your website in cyberspace. The only problem was that it wasn’t located at your Internet address. Let’s say that it was smack in the middle of someone else’s website and/or made available for download. You would fume and want justice.

No License to Steal
The Internet, like many technologies, promises substantial consumer benefits and, at the same time, invites fraud and deception. The technology is such that it’s all too easy to steal software or a whole website with a mere click.
For businesses and consumers to continue to fuel the growth of the Internet we must aggressively address the protection of intellectual property (IP) rights online. Any good business plan maps out a strategy to maximize opportunity and to handle calculated risk. So protecting your IP rights must be a core part of your business plan.
You should consider taking the following steps to minimize your company’s risks. (more…)

Telecare Soapbox: A woman died of starvation and dehydration after her home care ceased. A question for telecare services (UK)

February 6, 2013 | by | 21 Comments

Editor Steve picks up on a sad situation and poses a question.

Mrs Foster was an 81-year-old Surrey woman with dementia who lived at home supported by visits from agency carers four times a day. This appears to have been a reasonable state of affairs until the UK Border Agency closed down the agency owing to allegations that they were employing illegal immigrants. The local council had been notified in advance so that it could put alternative arrangements in place for the agency’s clients but Mrs Foster seems to have slipped through the net. Unable to look after herself, she was left starving, dehydrated and without her medication. Nine days later she was found by (more…)

Telehealth Soapbox: Securing IP–Source Code Rights and Escrow (US)

January 21, 2013 | by

This is the first of an occasional series on US law and intellectual property (IP) as it affects software and systems used in health technology. This article discusses the software developer’s rights to source code, licensing by the end user and the best ways both parties can protect themselves long-term in their transactions via software escrow.

Mark Grossman, JD, has nearly 30 years of experience in business law and began focusing his practice on technology over 20 years ago. He is an attorney with Tannenbaum Helpern Syracuse & Hirschtritt in New York City and has for ten years been listed in Best Lawyers in America. Mr. Grossman has been Special Counsel for the X-Prize Foundation and SME (subject matter expert) for Florida’s Internet Task Force. More information on Mr. Grossman here.

Source Code Escrow

It’s a nightmarish scenario. Let’s say that you’re the head of Information Technology (IT) for a hospital or a group of long-term care facilities. You pay a software development company $500,000 to create new software for your telehealth monitoring and alert system. It doesn’t matter whether the software runs locally on your servers, or in the cloud in a SaaS model. But then your developer goes bankrupt or for whatever reason and refuses to support the software. If you didn’t consider access to the source code in your agreement with the developer, you may find that you’re unemployed.

Essentially, “source code” is computer programming that humans can read. “Object code” is programming that only your computer can read. Typically, as a user, you only have access to the object code.

Software developers consider the source code to be their most valuable trade secret. With the source code, a competitor could create a competing work without incurring all of the development costs of the original developer. Source code is the lifeblood of the software development business.

From your perspective as the head of IT for that hospital or facility, you need the source code to continue the evolutionary development of your software or to fix bugs if your original developer disappears on you. If they can’t or won’t help, you’ll need to (more…)

Telehealth Soapbox: Kiss of death for telehealth adoption in the UK?

December 11, 2012 | by | 17 Comments

Editor Steve grieves for the days when telehealth in the UK had a bright future…

There is a deep irony in the latest move by the UK’s Department of Health (DH) to encourage general practitioners to adopt telehealth (remote care).

Perhaps it is because the health ministers and/or civil servants have realised that the Whole System Demonstrator (WSD) programme results have gone down like the proverbial lead balloon that they have turned to the thing which has ‘traditionally’ motivated GPs to change – money. But, as the GPs see it, the scheme they have come up with (more…)

Telehealth Soapbox: Do something great!

October 29, 2012 | by

Roy Lilley, the UK media’s highest-profile commentator on the NHS, telehealth supporter and previously chair (twice) of the TSA conference, writes a several-times-a-week newsletter commenting on events and developments in the UK that affect the NHS. It is required reading for anyone, including private sector suppliers, who need to understand what is happening in the NHS. (Sign up here) His newsletter article today, although not about telehealth, touched a particular nerve because the ‘i’ word he excoriates in the NHS context is frequently bandied about in the telehealth context. The article is reproduced here, with permission, and our thanks.

It’s annoying. Everywhere I turn it’s there; inappropriate, the wrong context and unsuitable. It’s stuck to my shoe. I can’t scrape it off. Over the last two weeks wherever I’ve been, PowerPoint presentation after PowerPoint presentation misused it and misrepresented its intent… (more…)