Is digital health going to add to Digital Big Brother Watching You?

October 6, 2015 | by | 1 Comment
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/10/Doctor-Big-Brother.jpg” thumb_width=”150″ /]“They’re watching me on my phone. They’re watching me on Facebook. They’re even watching me when I want to hide. Machines are a form of intelligence, and they’re being built into everything.”–Dr Zeynep Tufekci

The world of digital health is largely based on tracking–via smartphones, wearables, watches–and analytics taking and modeling All That Data we generate. Are we in compliance with our meds? Are we exercising enough? How’s our A1c trending? Drinking our water? All this monitoring–online and offline–is increasingly of concern to Deep Thinkers like Dr Tufekci, a reformed computer programmer, now University of North Carolina assistant professor and self-proclaimed “techno-sociologist.” At IdeaFestival 2015, she took particular aim at Facebook (surprisingly, not at Google) for knowing a tremendous amount about us by our behavior, of course using it to anticipate and sell us on what we might want. The ethics of machine learning are still hazy and machines are prone to error, different than human error, and we haven’t accounted for machine error in our systems yet. Like that big health data that mistakes a daughter for her mother and drops critical health information from a patient’s EHR [TTA 29 Sep]. A thought-provoker to kick off your week. TechRepublic 

Related: The Gimlet Eye took a squint at Big Brother Gathering and Monetizing Your Big Blinking Data–data mining, privacy and employer wellness programs–back in 2013, which means the Eye and Dr Tufekci should get together for coffee, smartphones off of course. While Glass is gone, the revolt against relentless monitoring is well-dramatized in the well-watched video, ‘Uninvited Guests’. And we can get equally scared about AI–artificial intelligence–like Steve Wozniak. 

Soapbox: The burning technological platform for person-centred care

September 18, 2015 | by

Rising demands of an aging population are putting increasing pressure on care providers across health and social care. But the technology and thinking that can help alleviate some of those pressures is analogue in a digital world, argues Tom Morton of Communicare247.

Analogue thinking in a digital world
Integrated, person-centred care is seen as a driving force for building public services around individual needs. It aims to bring care out of the hospital and into the community and home to cope with the growing burden of the 3 million people who will have over three long-term conditions by 2018. It will also help acute hospitals to address the ever increasing costs associated with our aging population.

Meanwhile life in our homes and communities is becoming fragmented. One in four (2.9 million) people aged 65 and over feel they have no one to go to for help and support, according to a 2015 report from Age UK and The Campaign to End Loneliness(1). With research indicating that social isolation leads to higher mortality, what point is there keeping people out of hospital, if only they are left home alone, and without the necessary support?

Person-centred care will have minimal success if we do not recognise this fact; people need someone to look out for them. And current approaches are not building the foundations that society needs to help grasp the nettle of providing round-the-clock personal care. (more…)

A day in the life of a blind business man (guest blog)

September 16, 2015 | by

Chris Lewis, the world-renowned telecoms expert and regular presenter on disability issues has kindly offered to share some thoughts with readers prior to his presentation at the Royal Society of Medicine event on the Medical Benefits of Wearables on 23rd November. This is the second of two he has written specially for TTA.

You’re blind: How do you ‘read’, join in social media and find your way around, let alone run a business?

Picture the scene: a blind man walking down the street moving white stick to and fro. He is muttering to himself while clicking a small black thing in his left hand. What is he doing? Actually, he is running his business, doing email, messaging, reading documents, checking-in for his flight and working out the best route using bus and tube to get to the airport. The black device is a mini keyboard, controlling the iPhone in his pocket and it is talking to him via his in-ear Bluetooth device….

Having been registered blind for over 30 years, I am accustomed to the regular question about how the hell do you run a business? I thought it worth while to put this down in writing both as a record of how things stand in 2015, but also as evidence of how my world has changed since the days of cumbersome magnifiers, papers being sent off to be recorded, and very clunky interfaces with early PCs.

Equipment & technology

(more…)

Accessibility arriving at the Top Table (guest blog)

September 10, 2015 | by | 1 Comment

Chris Lewis, a world-renowned telecoms expert and regular presenter on disability issues has kindly offered to share some thoughts with readers prior to his presentation at the Royal Society of Medicine event on the Medical Benefits of Wearables on 23rd November. This is the first of two he has written specially for TTA.

At this year’s Mobile World Congress (MWC) in Barcelona accessibility I took to one of the main stages for the first time. IBM, Microsoft, Google and the Mobile Manufacturers Forum (MMF) joined me to present perspectives on how accessibility is going mainstream.

I introduced the session with some of the key findings from the second Telefonica accessibility report “Digitising the Billion Disabled: Accessibility Gets Personal“. In summary, the billion disabled people represent a major spending group, combining earnings of some $2.3 Trillion and state support of $1.3 Trillion. Disabled people on average earn only 60% of their able-bodied peers and, of course, many disabled people don’t get the opportunity to work at all. 4% of children and 10% of the working population are disabled, but perhaps most striking, over three quarters of the elderly. Combine this dynamic with Douglas Adams’s theory of adopting technology getting harder as we get older and you can see the ticking time bomb of disability and age. (more…)

10th Anniversary Article 1: The Next Ten Years of Telecare

April 29, 2015 | by | 1 Comment

This year, on the 10th Anniversary of Telehealth and Telecare Aware, we have invited industry leaders nominated by our readers to reflect on the past ten years and, if they wish, to speculate about the next ten. Here is the first article, with a UK focus, by Dr Kevin Doughty.

Many of us are frustrated at how little progress there has been in the deployment and acceptability of telecare during the past decade. Yet, despite warnings that an ageing population was about to bankrupt the NHS (and health insurance schemes elsewhere in the world), and that access to social care for older people was being withdrawn at such a rate that it could only be afforded by the wealthiest in society, our health and social care systems have just about survived.

But this can’t go on, and in England over the past 12 months: (more…)

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.