AAMI/FDA Summit on Healthcare Technology in Nonclinical Settings (US)

9-10 October 2013, Hyatt Dulles Hotel, Herndon VA

The Association for the Advancement of Medical Instrumentation (AAMI) and the US Food and Drug Administration (FDA) have organized a conference on improving the safety and effectiveness of medical technologies used in homes and other nonclinical settings, such as telehealth and mHealth. There are risks and challenges to consider as technology is placed in nonclinical environments, in the hands of individuals who are not medical professionals. There is an impressive roster of supporting international organizations, including the British Standards Institution (BSI), the Wireless-Life Sciences Alliance (WLSA), the Center for Aging Services Technologies (CAST) of LeadingAge, The Joint Commission and Continua Health Alliance. Information, agenda, registration. Hat tip to reader Rob Turpin of BSI Standards Limited.

Open mHealth tackling mHealth integration in $100,000 developer challenge

Heritage Provider Network and UCLA are presenting a $100,000 challenge to developers using open software architecture designed by Open mHealth, a non-profit startup. The goal is to encourage integratable health apps on a standard, open architecture. This is reminiscent of Continua Alliance’s efforts in setting communications standards for networked sensors (ZigBee being one) and devices, and of course there will be questions on the quality and cross-device suitability of the architecture. Registration is due by 15 March, submission 1 May and the award will be made 3-4 June at the 2013 Health Datapalooza IV in Washington, D.C. InformationWeekHealthcare Heritage application

Being amused to death?

This short article in Senior Housing Forum (US) by Steve Moran, formerly a community developer and now in the telehealth field, scores neatly and briefly on what is wrong with the ‘hotel’ model of many senior communities. Basically the extent of ‘care’ is such that a premium is placed on entertaining the residents and not in purposeful activity connected to the outside world that provides psychological reward and literally a reason for living. He says it best here:

While I believe entertainment needs to a part of every community’s activity program, I don’t believe it should be the most important part, I would argue that it should be the least significant part.

Activities programs need to start with the premise that seniors want to learn, to grow, to create and are capable of doing so.

What do you think? Let us entertain you to death (Article continuation/conclusion–don’t forget to read comments on both)

2013 crystal ball time: AT&T’s top 5 predictions

Our onslaught of 2013 predictions starts with the Top Five from AT&T, cleverly timed for the mHealth Summit. From their press release supplying plenty of AT&T ForHealth focused examples (and our interpretation):

  • A shift from stand-alone “unsponsored” apps to meaningful “sponsored” mHealth solutions (Here come the pharmas, insurance companies and care management companies–now if they will just pay for it and stick with it!)
  • Hospitals and other healthcare institutions including payers will begin to move more and more healthcare data into the cloud (outrunning HIT’s ability to secure the cloud, secure internal systems, or backup when the cloud goes down)
  • Remote patient monitoring will move from pilots to large-scale adoption (another pilot with telehealth provider Intuitive Health and Texas Health Resources is so 2006)
  • Integrated mHealth applications will be created (increased interoperability–here there is some traction as hackathons to develop apps on platforms is becoming actually commonplace; the goal of Continua gets closer)
  • Upswing on telehealth to bridge the significant gap between physician resources and patient demand (once again in example muddying telehealth with telemedicine, but overall there is some traction; we can only hope that finally we start getting there in 2013!)

Continua’s ‘garden of wonders’ at CES: 5 videos

For your weekend viewing:
1) RTT News interviews Jonathan Linkous of the American Telemedicine Association on how technology and healthcare are converging (4 mins)
2) Larry Chu interviews Chuck Parker, Executive Director of Continua about the alliance, for HCPlive. (7 mins)
3) Tech journo Scott Mace visits the Continua Alliance booth at CES last week–the ‘child’s garden of wonders’ we referred to. The video quality is only fair, but Mr Mace lets the demos speak for themselves. You’ll also get an idea of the Digital Health part of the expo floor. This one includes IBM demonstrating the ‘end-to-end’ solution including A&D, Roche, Eurotech; Nonin Medical and Vignet. (7 mins)
4) Also by Scott Mace, this features Tunstall, Storento (sp?) med monitoring packaging, MedApps and a chronic disease management demo by a Continua representative that includes A&D, LNI Health Link uploading to a Google Health PNR. (10 mins)
5) A crystal clear MedApps demo using a pulse oximetry reading (the subject lived.) (1 min)

Healthcare highlights at International CES

For the healthcare minded, the Consumer Electronics Show (International CES), officially kicking off Thursday (7 Jan) in Las Vegas (but all over the press with Google’s Nexus One, ‘smartbooks’/slates etc.), has a section in the LVCC’s North Hall dedicated to ‘digital health’.  Unfortunately the exhibitor list in this ‘tech zone’ is a bit of a disappointment, with only Continua Alliance and GrandCare Systems of interest to our readers.  The neighboring Silvers Summit ‘tech zone’ has more of interest, with Dakim (brain fitness), Jitterbug (phones), Tabsafe (med dispensing) and Wellcore (fall detection).  But Continua seemingly has a child’s garden of wonders in their booth.  They are demonstrating ‘the first end-to-end connected health solution based on the Continua architecture’:  Nonin Medical’s wireless Bluetooth pulse oximeter sends data to a PC manager running Vignet’s Connected Health Services platform (debuting at CES-release) which is then uploaded to an IBM server.  But…there’s more:  A&D Medical (blood pressure and weight–see recent story on Halo partnership), Lamprey Networks, PDT, Renesas Technology, Tunstall Healthcare (Telehealth Platform–see below–and Connect) and ZyXEL are also demonstrating in the Continua booth. Continua’s release and press advisory.

[Donna Cusano update 7 January] Live from CES–GrandCare Systems hosted their weekly open webinar/conference calls from the just-opened floor.

  • Add to your visiting list: Carnegie-Mellon/University of Pittsburgh (Silvers Summit ‘tech zone’ booth #3013)–their display from their Quality of Life Tech Center is a 64 square foot room demonstrating their latest innovations, including RFID-assisted walls that change moods–color and brightness–to assist those with traumatic brain injury, plus touch screens for vital signs monitoring.  (Thank you Jeff Giuggio from C-M for the short briefing).
  • Wellcore (#2909) is introducing at CES their in and out-of-home fall detector, which will be marketed through the firstStreet catalog starting in March. Beyond the usual accelerometer, it uses algorithms to track and discern type of motion, delivers voice messages from their online website and will prompt to be worn. Out-of-home, the Wellcore monitor connects via Bluetooth to a cell phone.  Releases.

Although this editor isn’t there, we could have an ‘inside source’ for updates…we hope that what happens in Vegas, can’t stay in Vegas!

[Donna Cusano update 8 January] According to this release, at today’s 11am keynote Qualcomm chairman Dr. Paul Jacobs was joined by Dr. Eric Topol of the West Wireless Health Institute to highlight a selection of digital medical devices, including AirStrip OB (AirStrip Technologies), Mobile Baby (Great Connection), PiiX (Corventis) and Vscan (GE Healthcare).


Telecare Services Association Conference Wed 18 Nov 2009

November 16-18, 2009

Hilton London Metropole, W2 1JU

The cost of providing you with these reports has been supported by the conference organisers and
Home Telehealth Limited (UK)

home telehealth limited

Quick links to workshop reports, below:
Developing a telehealth service
Tellycare – delivering telecare and telehealth via TV
Protocols – from vision to reality
Safe at Home: Mental Health Intermediate care
Telecare assessment

Wednesday 18 November

Today’s contrast: Motivation and Motivational

This morning’s programme was relatively lightweight, much to the relief of a number of attendees, I suspect. First there was a chance to catch another workshop, then some last-minute calls to exhibition stands, followed by the mystery ‘motivational speaker’.

Although the attendee numbers were down on the previous days, there was no discernible lack of motivation amongst the people thronging the workshops and the exhibition. The ‘motivational speaker’ turned out to be Sir Ranulph Fiennes who talked about the nature of personal motivation with many humourous examples from his personal life and then went on to give some insight into what went into a couple of his amazing expeditions. He charmed everyone by downplaying the awfulness of the situations he found himself in and by letting his photos hint at that aspect. [Notes to self: a) Never volunteer for an expedition anywhere cold – more agony than ecstasy! b) Donate to his charity efforts when the opportunities arise.]

And the winners are…

tynetec winners

Alyson Bell, TSA Director, averts her eyes as she pulls out the name of Tynetec’s 30th birthday draw winners, who are:

1. Lynda East (Enhanceable) Wii Fit
2. Loraine Simpson (New Progress HA) IPOD Nano
3. Helen Gillivan (London Borough of Bromley) Champagne
4. Charlotte Walton (Cheshire West & Chester Council) Red Wine
5. Allyson McLeod-Hardy (Your Homes Newcastle) White Wine
6. Lesley Thomas (Salford City Council) Chocolates

Workshop reports


Tuesday afternoon. Reporter: PAUL MITCHELL, Independent Consultant

This mega-workshop built on the plenary session presentation earlier in the day from Dr Janice E Knoefel on Managing Chronic Medical Conditions by Telehealth amongst New Mexico veterans.

Professor Russell Jones of Brunel University chaired the workshop with considerable panache and vigour, but the star of the show was supposed to be the technology.

First up, Professor James Barlow of Imperial College, dealt with emerging evidence from pilots and research into the efficacy of telehealth, or what he termed ‘Remote Care’ in patients’ own homes. He lamented the huge volume of pilots worldwide (over 9,000) but the lack of mainstreaming of remote care. He acknowledged some small pockets of excellence, but observed that they tended not to spread into general practice. He diagnosed some barriers to progression into mainstream healthcare, which included:

  • A lack of integration between partners
  • The absence of obvious business cases for investment
  • Evaluations which were not sufficiently robust
  • PCTs which have switched resources away from special programmes to fund deficits elsewhere
  • Support for individual applications of telehealth but a lack of systemic adoption

He finished with a plea to change the system now to mainstream remote care.

Next up was Angela Single of Choose Independence consultancy, speaking about the nurse-led programme of health monitoring in South East Essex using community matrons in the absence of GPs’ willingness to get involved. In effect, the nurses decided to go it alone. They have so far achieved 80 cases of patient monitoring at home within four months of initial programme deployment. This involved developing robust systems and procedures for rapid procurement and deployment of telehealth equipment with full nurse support. Using a call centre setting to monitor health lifesigns data has forced the development of systems in ways for which they had not been designed. Most importantly, the programme has challenged traditional practices such as routine visiting and monitoring of patients. Patients are prioritised for attention, not necessarily involving physical visits, on the basis of triage. The procedures remain flexible to adapt to changing circumstances, such as accommodating delays by some patients in administering their medicine and measuring their personal health data in cold weather.

This was followed by Pam Bradbury and Dr Nicholas Robinson of NHS Direct. Their theme was telecoaching in Birmingham East and North PCT area by Pfizer Health Solutions, the PCT, and NHS Direct. Each partner has a well defined role to perform in this model of community-based health care, which has been integrated with the PCT’s model of delivery to patients with long term conditions. It includes a telephone-based care management process, with phone consultations that can last up to half an hour. There is a field team of 38 whole time equivalents composed of a mix of health coaches and nurses, supporting 4,800 patients.

The levels of discovery from this telehealth approach are said to be considerable. Results include a 48% reduction in hospital admissions and 53% fewer visits to A&E in this patient group.

Dr Mike Short, vice president of R&D at Telefonica Europe focused his presentation on challenging the trend of proliferating data hubs in the home. These could soon include dedicated hubs for telehealth, games consoles (e.g. Wii), broadband wi-fi, and smart utilities meters. He sketched a connected world in which, by 2013, there may be more mobile phones in the world than people; who have readily taken up new information and communications media such as Google, Facebook, and Twitter. He also reported a prediction that e-Health spend in Europe will double to 50 billion euros by 2010. Against this backdrop of exponential growth of information hubs in the home, he dangled the unspoken question of why we needed to introduce new dedicated health systems into the home when we already have all this other technology at our disposal which can be adapted for that purpose?

The final presentation was from Dr Justin M Whatling, Chief Clinical Officer for BT Health. He revisited the barriers to mainstreaming telehealth posited at the start by Professor James Barlow, and added some more:

  • A care model trapped in servicing high cost patients with existing conditions, rather than prevention
  • Silo budgets and services
  • Lack of organisational capacity and willingness
  • No clear agency to take the lead

He then observed a perception of less value for money as telehealth systems become more complex and costly. Customers for telehealth, he thought, are oriented to buying devices rather than services and outcomes. Suppliers are reinventing the wheel with competing systems which are not integrated into mainstream healthcare. He also noted the proliferation of closed systems and software, which leads to organisations being locked into particular devices and a lack of choice. This has particularly affected the ability of SMEs to compete in this market.

Would there be more take-up if costs were lower? Your correspondent pondered where all this was leading. The solution, it seems, is achieving economies of scale and re-using sunk costs in existing investments. These include existing IT systems under the NPfIT programme, out of hours services, and consumers/patients’ own investments in mobile phones, televisions, etc. Again, the unspoken question was being asked: are dedicated home health hubs necessary?

In conclusion, the presentations seemed to express confidence that some new models of service have got it right in establishing new ways of working in supporting patients at home, but doubted the wisdom of investments in dedicated health hub systems. These new models of patient support are up and working now, but the prospect of few or single multi-purpose information hubs in the home seem tantalisingly just out of reach in a possible future.


Tuesday afternoon, covering ‘Looking Local’ TV service from Kirklees Council. Reporter Steve Hards

Actually, it’s only ‘telecare and telehealth’ if you work with a very broad definition, i.e. giving localised health information via a dedicated channel on people’s TVs. However, the approach is interesting in that the channel can be delivered via a number of means: dedicated set top box; Sky box; Wii interface; Virgin cable.

The principle is simple. For a £12,000 annual licence (plus £3,000 content bureau cost if required) a provider council is set up with a basic ‘starter kit’ set up. There are various plugins that can be added, such as one that feeds local bus times; a jobs feed from JobCentrePlus; Council Tax payments; doctor appointments and repeat prescriptions.

More information: http://www.lookinglocal.gov.uk

There are 89 councils currently using the service. One workshop attendee made the point that many telecare customers are being discouraged by councils from taking up Sky and Virgin cable services owing to their incompatibility with their telecare equipment.

Reporter Steve Hards

Mike Piggott, Project manager BT, started by talking about the 21CN rollout and refinements introduced as a result of their pilot experience and working with TSA. One key point is that there have been no issues for telecare providers where they have been prepared. BT expects the change to be complete in 2011. Some devices – mostly over 8 years old – do not work well owing to transmission delays. There are published results for 159 devices: http://www.switchedonuk.org. (Ambers = partial fails – talk to the manufacturers re the level of risk.) Lots of info re the migration on the site, additional queries can be sent to cpe21@bt.com.

Dave Foster, Commercial Director, Tynetec. The potential for system failure increases with complexity of the call routing, and telecare alarm calls are typically complex routes owing to the use of non-geographical (0800) numbers. Some non-BT digital network providers exclude reliable social operation on their networks… a user’s change of telecoms provider may put the operation of their system at risk.The new British standard BS8521 (pubished May 2009) defines the telecare protocols (the identifying signals generated by devices). The standard will facilitate interoperability between manufacturers and has some built in futureproofing. So any unit meeting this standard will communicate with the software of any monitoring centre that also complies. It’s an analogue protocol and a digital ‘IP’ protocol is in development.

Use of broadband opens up many greater possibilities for interactive monitoring communications but, of course, it will take quite some time to become universal.

Charles Henderson, consultant for TSA. Future consumers will demand telecare that is totally interoperable, flexible and cheap. UK providers have to work in the global context – Continua Alliance (not an open standards organisation), etc. And this has to be done in the context of providers’ delivery and installation processes. Who is going to arbitrate? The technology is the tip of the iceberg.


  • It’s not just about 21CN, but ‘Next Generation Networks’.
  • Manufacturers will not be able to cope to deliver new, standard-compliant devices if service providers wait until the last minute to update.
  • Current, IP-based systems may not comply with future IP protocols but standard-compliant analogue devices will continue to work over digital networks.

Workshop: SAFE AT HOME: Mental Health Intermediate Care, Herefordshire
Presenters: Andrew Morris, Integrated Commissioning; Cheryl Poole, Older People’s Mental Health Services; Jodie Thomas, Care Facilitator, Specialist Intermediate Care.
Reporter: PAUL MITCHELL, Independent Consultant

This joint initiative between the PCT and Council targeted people at home with dementia. Domiciliary care services in 2007 had lacked the skills to support people with dementia, and care packages were continually breaking down, resulting in admissions to institutional care. The solution was a partnership specialist intermediate care service which commissioned home support from specially trained domiciliary care staff (Sure Care).

The carer teams support individuals to regain or maintain their skills, but can intervene when risk levels rise to help prevent or manage a crisis. Using ‘Just Checking’ technology to track the patient’s movements around their home (motion sensors in rooms), roving night teams can access Just Checking reports on smart phones whilst on the move, and respond to alerts during a crisis. The presenters were keen to emphasise the collaborative approach with the care provider, whose staff are trained to help them to understand dementia and how to support individuals with such conditions.

A group of users were tracked for 12 months to dispel the myth, then prevalent amongst carers, that people with dementia cannot learn to manage their conditions.

  • 78% of the group were still living in the community after 6 months (57% at 12 months).
  • Only 5% needed 24 hours per week support at home
  • Over half received less than 7 hours support per week.
  • Costs of the service were £79k, with savings in excess of £100k over alternative services.

Lessons learnt included:

  • Partnership working is essential
  • Technology must be fully integrated with care processes
  • Care must be person-centred, individualised
  • All care staff must be equipped with specialist skills
  • Ethical approach: always act in the individual’s best interests where consent cannot be meaningfully given
  • Be flexible about the 6 weeks rule for intermediate care

Reporter FREDERIC LIEVENS, Med-e-Tel

The workshop started off with a short overview of Telecare in Barnet, where Guy is part of the two-person telecare team. They provide coordination, support, advice, guidance and training.

In Barnet, telecare training is standardly provided right across the board throughout the NHS, PCT’s, acute hospitals, OTs, specialist nurses, etc. So the assessment process can actually be done by any of them and they can, of course, refer back to the telecare team for assistance.

The telecare catalogue in Barnet consist of only two providers of lifeline services and two providers of stand alone systems. It’s a limited, but tried and tested offer, which seems to cover most of the needs. And if the offer does not suit a person’s particular needs, they will go off-catalogue to source other solutions.

The workshop then split up in four smaller discussion groups around two questions:

  • What makes for a good telecare assessment?
  • What information needs to be determined in the assessment?

The following suggestions and reflections came out of the discussions:

  • look at needs, environment and abilities/limitations of the person
  • assessor needs to have sufficient knowledge about available technolgies, how they work (through training)
  • ongoing assessment/reviews are necessary (is once a year – as stated in the TSA COP – enough?)
  • importance of informed choice
  • look at eligibility criteria
  • take into account previous assessments (eventually also non-telecare-related assessments)
  • think about risk management
  • use robust protocols

Main information that needs to be obtained is:

  • what equipment is available to serve specific needs
  • capacity of a person to operate equipment
  • what person can and can’t do
  • what outcomes are expected

For more info, contact telecare@barnet.gov.uk and look at their website on http://www.barnet.gov.uk/telecare (incl. An introduction to Telecare Services that takes people through some telecare basics, eligibility criteria and assessment procedures – http://www.barnet.gov.uk/telecare-booklet-2008.pdf). Guy also has an interesting site at http://www.smartthinking.ukideas.com.


home telehealth limited

Telecare Soapbox: Can the ‘old old’ have best lives when the pressure is to isolate them?

Donna Cusano is currently a healthcare services, wellness and supportive technologies marketing consultant based in New York City. Previously she was Vice President, Marketing, for Living Independently Group (QuietCare Systems). The following Soapbox item was triggered by the How the ‘Old Old’ can have best lives item.

So much of our emphasis in the technology area has been to keep seniors active that we tend to ignore planning for and helping seniors (and their families) to manage their last and usually inevitable years of increasing frailty, and the role that technology in the service of care can play. I don’t know of many cultures that support the ‘old old’ and those that have (Asian Indian, Chinese, Japanese) are increasingly not. Here is a moral, right opportunity for both healthcare and technology. I will make a similar case for the disabled and the support telecare/telehealth can be for them as well.

Unfortunately I think the trend towards treating the ‘old old’ – or even the just old – INhumanely is on the rise, despite… (more…)

Telecare Soapbox: Northern Ireland’s ‘unhappy first birthday’ approaches

We are now approaching a year since Northern Ireland’s Centre for Connected Health published its Prior Information Notice (PDF) for a large-scale, province-wide remote patient monitoring service.

It’s not a happy first birthday because, as far as anyone can tell, the procurement process is not likely to come to a satisfactory conclusion any time soon.

For us on the outside it is hard to tell whether this is due to the complicated nature of the task, or incompetence, or a mixture of both.

However, as a matter of opinion, it didn’t help that the tender invitation did not include information that the selection criteria would exclude ‘small’ suppliers with relevant experience, some of whom committed resources to prepare a bid for a process in which they later discovered they would not be allowed to participate… (more…)

Telecare Aware’s Terminology Campaign

What’s the problem?

Multiple meanings of the words ‘telecare’, ‘telehealth’, ‘telemedicine’, etc. abound. Conversely, similar concepts have many names. As a consequence:

  • Professionals use their preferred terminology and confuse journalists
  • Journalists’ misconceptions spread public confusion
  • Speed of adoption of the technology is retarded
  • People suffer without appropriate monitoring systems
  • Suppliers have to work harder to thrive
  • The development of new technologies falters

What’s the solution and where will it come from?

I used to believe that the matter would evolve towards a solution. However, I now see it evolving towards greater confusion. We have reached a situation where a standard, internationally recognised taxonomy and set of definitions needs to be agreed and adopted.

However, it is no one’s responsibility to take on this task. The only organisation that has a broad base of worldwide technology suppliers and which has a remit to develop any international standards (albeit only in the health technology arena at the moment) is the Continua Alliance. It is in the Alliance’s members’ long term interest to tackle this problem.

What role will Telecare Aware play?

During 2008 Telecare Aware will post links to news items that illustrate the problems. I am happy to open up these pages to everyone who is interested in this issue and invite contributions by way of articles and comments. Although I have some views about how words should be applied in this field (see the What is Telecare page, for example) I am more concerned that an international consensus is formed than I am about promoting my particular usage.

Where shall we start?

Start with this excellent blog posting by Guy Dewsbury: The Language of Telecare. It begins: “I am not sure about you, but I think it is time to resurrect the debate about terminology. I have recently been to a number of conferences and at these events people use the words Telecare, Telehealth, Telemedicine and Assistive Technology…

Then move on to this article Telecare, telehealth and assistive technologies – do we know what we’re talking about? Doughty, K et al, published in the Journal of Assistive Technologies (Volume 1 Issue 2, December 2007) and made available to Telecare Aware readers by kind permission of Pavilion Journals (Brighton) Ltd.

Steve Hards