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.

Tunstall, world leader in telehealthcare, starts to evangelize the USA

March 29, 2013 | by | 1 Comment

We are interested to note that Tunstall is starting to claim the term ‘telehealthcare’ in the USA just as we notice it starting to downplay its use in its recent UK marketing materials in favour of ‘telecare and telehealth’. (In the UK the term ‘telehealthcare’ gained ground in general usage in some parts of the country after Tunstall started to use it and, as no other major suppliers used it, they succeeded in owning it in the way that a team which has the ball in its possession ‘owns’ the ball.)

How do we know that Tunstall is about to do its telehealthcare thing in the US? Read this press release: Telehealthcare Leaders Forum Welcomes Assoc. Chief Medical Officer at Northwestern Memorial to Speak About Healthcare Innovation. American and Canadian readers will be highly amused to learn that “The Telehealthcare Leaders Forum is North America’s only educational and professional event dedicated to stimulating innovation and leadership in the emerging era of technology and healthcare delivery.”

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…)

Is ‘telemedicine’ just ‘healthcare’ yet?

October 23, 2012 | by

In English, there is a well-recognised pattern in the development of some terminologies. Beginning with the ‘old’ technology, a new descriptive element is added when ‘new’ technology comes along. In time, the new terminology is shortened – often just going back to the original. Take, for example: carriage > horseless carriage > motor carriage > car. Or, a more recent one that is still in a state of flux: telephone > phone > mobile(cell)phone > smartphone > phone. Is this happening yet with terms like ‘telemedicine’, ‘telehealth’, mhealth, etc? Some people like to think so, as in this blog post Redefining telemedicine as a routine clinical practice. However, as much as enthusiasts of the technology like to anticipate such changes and, in doing so, to ‘help them along’ (it has its origins in magic, perhaps) the weight of linguistic history indicates that such changes only happen when there is a consensus in the general population that the once-new technology is now the norm. Heads-up thanks to Bob Pyke.

Telecare Soapbox: Who can purchasers trust? (UK)

October 18, 2012 | by | 16 Comments

Editor Steve Hards frets about a dilemma for telehealth and telecare service purchasers.

Imagine that you are ‘a commissioner’ in a position to influence plans for local NHS or council spending, or you could be in a position of influence within an NHS trust, or a council.

You are acutely aware of past, current and impending funding pressures. Positive messages about telehealth and telecare technologies and their potential to facilitate changes in the way services are provided – and possibly to ease some of those funding pressures – have somehow penetrated your noisy environment.

You are reasonably convinced that services locally should ‘do something’ about it. You start convincing others. You build enough momentum to get to the point of someone drawing up a commissioning specification.

What do you put in it? (more…)

Telehealth Soapbox: When the elephant in the room has no smartphone

October 11, 2012 | by | 4 Comments

Carolyn Thomas, a Canadian writer, Mayo Clinic-trained advocate for women’s heart health and herself a heart attack survivor, observes the parade of self-monitoring and Quantified Selfing by ‘urban datasexuals’ at Stanford University’s Medicine X conference at end of September. Originally published in her blog Heart Sisters.

stanford med x conference centreShortly after arriving at Stanford University School of Medicine to attend the conference called Medicine X (“at the intersection of medicine and emerging technologies”), it hit me that I didn’t quite belong there. Maybe, I wondered, the conference organizers (like the profoundly amazing Dr. Larry Chu) may have goofed by awarding me an “ePatient Scholarship” – rather than a more tech-savvy, wired and younger patient in my stead.

Please don’t get me wrong – I was and still am duly thrilled and humbled to be chosen as one of 30 participants invited to attend MedX as ePatient scholars, generously funded by Alliance Health after we met selection criteria like “a history of patient engagement, community outreach and advocacy”.

But almost immediately, I started feeling like a bit of a fraud… (more…)

Telecare Soapbox: Let’s deal with the inequalities of the Framework Agreement (UK)

October 7, 2012 | by | 1 Comment

Regular Telecare Aware readers will know our long-standing general concern about the market-distorting effect of the UK Government’s Telecare, Telehealth and Telecoaching Framework Agreement for procuring such services. John Guyatt, Director of Solutions4Health spells out what that means from the perspective of a relatively new company in the field.

I was recently preparing a bid for a telehealth service being commissioned in the next few months, when I realised that the exercise only allowed bids from companies already in the Government’s framework agreement.

We’ve been active with products in the telehealth business for the past 18 months, but we are excluded because we weren’t providing telehealth solutions when this framework agreement was first introduced about three years ago.

That’s several generations in the technology world and therefore raises a number of issues… (more…)

Best use of telehealth and telecare (UK)

October 7, 2012 | by

Illustrating the point that even in the UK the terms telehealth and telecare are used in a variety of ways, the four EHealth Insider Awards 2012 finalists in the ‘Best use of telehealth and telecare’ category included three which were loosely ‘telecoaching’ (as defined by the National Framework Agreement) and only one which we would rate as telecare. Happily, it was the winner: NHS Lothian and East Lothian Council – telecare in care homes to reduce falls. Best use of telehealth and telecare finalists. Awards results.

New word on the block: Plesiocare

September 25, 2012 | by | 2 Comments

Picked up in a comment by Kevin Doughty, the newly coined terminology ‘plesiocare’. Do you know what it means? Do you want to know what it means? It’s ‘near-care’ as opposed to ‘telecare’. That is, technology which gives feedback straight to the carer, rather than being mediated through a call center. At least that’s this editor’s understanding. Will it be useful? Will it catch on? What do you think? (Sorry there are more questions than answers! Steve)

Telecare Soapbox: The NHS revolution – 20 years on

September 20, 2012 | by

In this Soapbox, Peter Kruger, Managing Director of Steinkrug, looks backwards at the pressures that have shaped the NHS and forwards to a different kind of future for caring.

Twenty years ago the NHS underwent something of a revolution: one that went far beyond anything the former health secretary Andrew Lansley envisaged. Technology played a key role in what was perhaps one of the largest business re-engineering projects ever undertaken. The impact of this change is still being felt; not only by patients but also by their relatives who find themselves playing the role of carers. This is opening up opportunities for a number of organisations ranging from mobile health vendors to high street pharmacies.

The following 4 minute video clip shows how most people perceived the NHS before the 1990s – complete with some old fashioned social attitudes:

[This video is no longer available on this site but may be findable via an internet search]

Only When I Laugh 1982. Watch the complete episode on YouTube

However, twenty years ago a wave of ageing baby boomers (the ones born during the 1920s, not those born in 1946) hit NHS hospital wards… (more…)