Patient engagement: a digital divide in health technology accessibility

August 25, 2016 | by | 2 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/09/earthquake.jpg” thumb_width=”150″ /]Guest editor Sarianne Gruber (@subtleimpact) scopes the ‘digital divide’ separating those who need health services the most from the patient engagement and other tools they need in this article. The studies are US, but the lessons apply anywhere in the world. This Editor notes that many patient engagement tools are over-designed and over-complicated for users, even if they are fairly competent and frequently use online and mobile. (I entered a ‘pilot’ of a stress reduction program which proved to be anything but–and quitting because it is invasive and the reporting is ludicrously burdensome.)

To developers: Imagine your patient engagement platform being used by a person on the less sophisticated, less educated and disconnected end of the spectrum–or by someone less able due to physical (vision, touch) or cognitive impairment. Put on bad glasses and gloves–and start. Better yet, find a few people and put it in front of them. If we can make the mental shift in developing mobile apps for Africa or India, certainly we can do so for Americans, Britons and Europeans.

What the Studies are Showing

Hallmarked as a solution to improve healthcare quality, cost and safety, studies are showing health technology is up against a “digital divide” when it comes to patient engagement. At the Internet Governance Forum, Pew Research Center’s Lee Rainie, Director of Internet, Science and Technology Research presented the Fact Tank Report discussing the “digital divide” that exists in 2016. The report documents that lower income, less educated, non-white, seniors and rural communities are the least likely to have home internet, home broadband, mobile connectors and smartphones. This summer’s medical publications, the Journal of the American Medical Association and the Journal of the American Board of Family Medicine, released studies where demographic and socioeconomic data marked the root causes to limited or no access to digital technology, thus hindering the benefits and improved outcomes it can bring to the neediest and most costly populations. Here are the highlights from each study.

Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014, a research letter submitted from Harvard Medical School’s Brigham and Women’s Hospital, appeared in the August 2, 2016, JAMA. Authors, David M. Levine, MD, MA, Stuart Lipsitz, ScD, and Jeffrey A. Linder, MD, MPH,FACP made mention that this study, based on the National Health and Aging Trends survey (NHATS), was exempted from the Partners HealthCare Human Research/IRB Committee. The research team included participates to the longitudinal NHATS survey in 2011. The participants were re-surveyed annually on everyday (nonhealth) and digital health use until 2014. The research team acknowledged that this may be the first nationally representative study to examine trends in the adoption of digital health technology by seniors age 65 years and older who are community-dwelling Medicare beneficiaries.

Here are some the reported statistics from the study: (more…)

HRSA sets $16 million fund for 4 rural telehealth grant programs (US)

August 24, 2016 | by

The Health Resources and Services Administration (HRSA), which is part of the Federal Health and Human Services (HHS) department, is making four grant programs available to support rural telehealth and quality improvement in 60 rural communities within 32 states, including a joint program with the Veterans Affairs Office of Rural Health. The four programs administered by the Federal Office of Rural Health Policy (FORHP) within HRSA are primarily three-year programs and include:

  • The largest amount, $6.3 million, will go to the Telehealth Network Grant Program: $300,000 each annually in a three-year program to 21 community health organizations for telehealth programs and networks in medically underserved areas, with a concentration on child health
  • The Flex Rural Veterans Health Access Program: $300,000 each annually in a three-year program to three organizations providing veteran mental health and other health services. This is a joint program with the VA totalling $900,000.
  • Small Health Care Provider Quality Improvement: $21 million will support 21 organizations over three years in improving care quality for populations with high rates of chronic conditions, and to support rural primary care.
  • Seven Rural Health Research Centers: $700,000 per year for four years, totalling $4.9 million, to support policy research on improving access to healthcare and population health in rural communities. (Funds that more usefully would have gone to veterans health?–Ed. Donna)

HHS release, Mobihealthnews, Healthcare IT News

Opportunity for developers – can you help asthma sufferers?

August 16, 2016 | by | 1 Comment

Asthma UK today unveils a key report that tells developers how mHealth could help asthma sufferers better. Entitled “Connected asthma: how technology will transform care”, whilst picking out a few excellent exemplars, it describes how poor the average asthma app currently is – for example only 6% of such apps provide pollution status, and only 8% cover inhaler technique.

Historically CHF, COPD & diabetes have been regarded as the key long term conditions to manage using telehealth. When, as this editor did a few years back, a suggestion was made to try it on asthma, clinicians tended to look askance. Yet as this report shows, mHealth can do a huge amount to improve the management of asthma especially now many people have smartphones. And, bluntly, asthma kills (more…)

South Korea’s ambivalence towards telemedicine

August 10, 2016 | by

The surprising reasons why. 5.8 million South Koreans aren’t exactly tech-phobic, enjoying a nationally swift internet backbone and high personal smartphone penetration. The home of the two leading smartphone makers is pioneering mobile-first retailing and a national IoT network. South Korea (SK) also has the need–an aging population living in rural areas. Yet South Korea bans doctor-patient virtual visits in their Medical Act, and expects major demonstrations by doctors and activists when it comes up for a vote later this year in their National Assembly. Telemedicine and also telehealth/RPM may happen eventually, backed by powerhouses like SK Telecom, Samsung and LG, but will have to take into consideration some unique circumstances:

  • Cyberattacks from North Korea, which have already hit a Seoul university hospital’s software security contractor and demonstrated their system’s HIT vulnerabilities
  • The government’s glitch-ridden telemedicine pilot program with serious problems in data management, encryption and weak passwords
  • The fear that only the rich will be able to afford it–and in SK’s split system, the fear that funding may be withdrawn from the extensive network of community clinics instead of benefiting them

Medical professionals, including the 100,000 doctors in the KMA who successfully blocked telemedicine in 2014 and haven’t participated in the pilot program, are calling for “a slower, more collaborative plan of attack that establishes safety protocols and smart regulatory oversight.”  Quartz

NHS Liverpool seeks telehealth provider

August 9, 2016 | by

NHS Liverpool Clinical Commissioning Group (NHS LCCG) is soliciting a telehealth (remote patient monitoring) technology for a three-year contract. The first step for the telehealth provider is to submit a Pre-Qualification Questionnaire (PQQ) document by 5 September. If invited, providers will tender for the provision of telehealth technology services. The contract is valued at £2.4 – £14.4 million (including VAT), to start 3 April 2017 and extendable for two years after the initial three. The clinical portion–patient recruitment/assessment, back-end clinical monitoring and clinical support elements– is part of LCCG’s NHS Community Health Services provision and will be separately bid. For complete information, see the listing on the new Gov.UK Contracts Finder. Hat tip to Suzanne Woodman.

Broadband and health in USA

August 5, 2016 | by

The Federal Communications Commission (FCC) has been investigating [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/08/C2H-BroadbandMap_Gaps-America.png” thumb_width=”150″ /]the relationship between broadband and health in the US through their Connect2Health Task Force and this week it has released an online tool “Mapping Broadband Health in America”.
It is an interactive map that allows users to visualise, overlay and analyse broadband and health data at the national, state and county levels.

This tool allows easy access to existing health and broadband access data to anyone who wants to look at the possible influence of broadband access on health over a period of time or to identify gaps which may provide opportunities to develop or expand online health services.

The interactive tool allows the user change the broadband availability measure (by say proportion of coverage or download speed for example) and select a health measure such as say obesity rate or preventable hospitalisation days and shows where the selected broadband measure is satisfied, where the selected health measure is satisfied and where both are satisfied. The types of health measures are currently limited but if users find the tool useful and feedback to the FCC there may well be further expansion.

Have a play with the map here.

Changing care models to connect better with care, age at home

August 3, 2016 | by

While this Editor didn’t get to the second annual d.Health Summit in NYC this past May, the organizers Avi Seidmann, PhD & Ray Dorsey, MD [TTA 20 July] of the University of Rochester have conveniently distilled the day down to a 13-page policy paper on successful aging at home. The keynote speaker set the theme around the core needs of older people:

  • identity (“help me stay me”)
  • routine (“help me stay in control”)
  • sociability (“help me stay engaged”)
  • vitality (“help me stay physically and mentally fit”)

Innovation around healthcare delivery, mobility solutions, assistive technologies that adjust to a wide variety of needs, socialization outlets and home services can improve health and wellness while reducing costs for the healthcare system as a whole.  Impediments are regulatory, interoperability and that old devil, payments. It needs to move to ‘next generational care” where healthcare tech fully becomes an extension of the healthcare system. Can’t come soon enough. Download the PDF here. Also read contributor Sarianne Gruber’s perspectives on the conference in RCM Answers on 18 May and 24 May.

The State of the Connected Patient is a 21-page survey with plenty of bar charts of over 2,000 Americans taken in June by the Harris Poll sponsored by Salesforce, which we’ve noted here is partnering notably with Philips in the HealthSuite digital platform. Analysis is separated by boomers, millennials and Gen X.  62 percent of respondents would be open to some form of ‘virtual care’–and 52 percent of ‘millennials’ would prefer to choose a doctor who uses virtual care tools. Most are content with their primary care doctor, though that doctor may not recognize them in the street. Only a quarter actually keep track of their health records, digital and otherwise. Apps are used, but all age groups are split evenly in using a wearable if an insurance company or provider gave them to wear in exchange for (respectively) lower rates and health information access. Download PDF via EHR Intelligence.

The global ‘state of telehealth’ according to Dr Topol: work in progress

July 20, 2016 | by

Are we approaching a ‘tipping point’ in telehealth and telemedicine within 5 to 10 years? While telemedicine (doctor-patient, hospital-hospital video consults) and even telehealth (patient monitoring generally at home) are becoming more common, Drs Eric Topol and E. Ray Dorsey see the tip coming within the decade in their New England Journal of Medicine (NEJM July, subscription required) article, moving from the early adopters to the majority. But there are still substantial barriers: interstate licensing, fragmented care, spotty state and Federal reimbursement including Medicare, wireless coverage enabling mobile monitoring, the future of the doctor-patient relationship, even the potential for narcotic abuse. They also need to move into the private sector. Somewhat misleading are the 2 million telehealth visits counted by the Veterans Health Administration; it includes the larger programs in store-and-forward information transfer and clinical video consults versus in-home telehealth.

Three trends they see paving the way to ubiquity:

  1. Moving beyond providing access to being driven by convenience and reducing cost
  2. Not just for acute conditions, but for monitoring chronic and episodic conditions (although vital signs monitoring, which is the core meaning of telehealth, has been doing so since the early 2000s)
  3. Migration from hospitals and satellite clinics to in-home and mobile applications

While the two doctors caution on risks, including breaches, they see telemedicine and telehealth increasing the delivery of care in the next ten years and spreading globally. Healthcare Informatics, Qmed

Asia-Pacific telehealth set to grow to 75% to $1.79 billion in 2020: Frost study

July 16, 2016 | by

Frost & Sullivan’s Asia-Pacific Telehealth Outlook 2016-2020 is projecting that telehealth (broadly defined as telemedicine, remote patient monitoring (RPM) and mobile health), will be growing from US $1.02 bn in 2015 to $1.79 bn by 2020. Driving growth in the region are an aging population, governments building out 3G/4G mobile networks and developing favorable policies and roadmaps. However, the study found that impediments included a familiar tune of poor clinician adoption, unfavorable regulations, lagging technology and (ta-da) payment models. What’s improved? Wearables in the region have made great strides, and payment models, according to F&S, are concentrated on patient and provider pay. Not so familiar is that many Asia-Pac nations are building a Smart Cities and Smart Nation infrastructure; telehealth is a key area almost always included in a Smart City plan. The study will set you back a smart $4,950. Marketwatch release. F&S feature page.

A ‘next generation’ house call from the patient’s perspective

July 10, 2016 | by

Guest editor Sarianne Gruber (@subtleimpact) attended May’s d.health Summit on Aging in NYC. She reflects on moderator Christina Farr’s (immediately prior) direct experience with a virtual visit (convenience, proactive care–and utter frustration with her payer) and what the telemedicine ‘next gen’ provider panelists see as their advantages in fixing a fractured healthcare system.

Christina Farr had a “Next Generation” house call for the first time. The on-demand doctor’s visit provided her care and resolved the possibility of a trip to the emergency room, and best of all she felt great. Ms. Farr, an award-winning health and technology journalist, happen to have had her encounter just days prior to the d.Health Summit. Coincidentally, she was to be the moderator for a panel of prominent telehealth business leaders on this very topic. Curious after having had this experience, she wanted to know whether most cases were like hers wondering if they should go to ER, or were the visits more for routine things like coughs and colds, or did people just want a prescription. The d.Health panelists included Damian Gilbert, Founder & CEO of TouchCare (@touchcarehealth), Oscar Salazar, Chief Product Officer and Co- Founder of Pager (@getpager), Dr. Ian Tong, Chief Medical Officer of Doctor on Demand (@drondemand), and Dr. Roy Schoenberg, Co-Founder, and CEO of American Well (@americanwell).  (more…)

AHRQ ‘evidence map’ pinpoints chronic condition telehealth, telemental health (US)

July 6, 2016 | by

The US Government’s Agency for Healthcare Research and Quality (AHRQ) released a final and fairly positive report analyzing telehealth effectiveness. It was a meta-review of 58 systematic research reviews on telehealth. Criteria were that the studies could examine real time or asynchronous telehealth, onsite or at distance, and that the patient interacted with healthcare providers for the purposes of treatment, management, or prevention of disease.

The abstract’s conclusions are positive for remote patient monitoring (RPM) for chronic conditions and for telemental health:

  • Positive outcomes came from the use of telehealth for several chronic conditions and for psychotherapy as part of behavioral health
  • The most consistent benefits were when telehealth was used for communication and counseling, plus remote monitoring in chronic conditions such as cardiovascular and respiratory disease
  • The improvements were in outcomes such as mortality, quality of life and reductions in hospital admissions

POLITICO’s Morning eHealth has additional and most interesting background. The AHRQ was tasked by two Senators, John Thune (R-SD) and Bill Nelson (D-FL) to analyze telehealth for effectiveness through a literature review and “to give a government’s view – not an industry-funded study or a poorly-conducted academic study – on what the technology could do if, for instance, Medicare paid for more of it.” The December draft seemed to be ambiguous on telehealth studies to date, citing uneven quality and the poor definition of telehealth. (more…)

2016 International Conference on Successes and Failures in Telehealth (NZ)

June 29, 2016 | by

31 Oct-3 Nov 2016, SKYCITY Convention Centre, Auckland New Zealand

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/HiNZ16_SFT16_AUCKLAND_1000_x-1.jpg” thumb_width=”100″ /]Hurry if you want to submit your abstract! The 7th Annual Meeting of the Australasian Telehealth Society (SFT-16) is actually a 4-in-one conference, held concurrently with the Global Telehealth Conference (GT 2016), the Health Informatics New Zealand Conference (HiNZ 2016), and the NZ Nursing Informatics Conference (NZNIC-16). Delegates register for one, and can attend any session in the four conferences. Topics for SFT-16 include telehealth in Australia and New Zealand, the future of clinical telehealth, the telehealth business and the state of evidence. Abstracts in the categories of scientific papers and case studies are still being accepted through Monday 4 July midnight NZ time, and according to HiNZ’s Twitter feed, extensions are available by emailing ceo@hinz.org.nz . It’s also supported by organizations including American Telemedicine Association (ATA, a TTA media partner), the University of Queensland and the International Society for Telemedicine and e-Health (ISfTeH). Registration appears not to be up yet. Website

The difficulty in differentiating telemedicine and telehealth

June 15, 2016 | by

Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.

Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence

Philips publishes new report on connected tech

June 8, 2016 | by | 1 Comment
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/Future-health-index-e1465426741815.jpg” thumb_width=”150″ /]A report published by Philips today claims that 78% of healthcare professionals believe their patients need to take a more active role in managing their health while 20% of UK patients admit to not managing their health, according to a press release. The report suggests that the result of people not paying attention to their health is increased illnesses (or “lifestyle related conditions” as the report calls them) such as heart failure and type 2 diabetes. The report then goes on to suggest that the use of “connected technology” to help manage their health should be made mandatory for some patients. Connected technology is defined as technology that enables sharing of information throughout all parts of the health system (e.g. doctors, nurses, community nurses, patients, hospitals, specialists, insurers and government) that can range from computer software that allows secure communication between doctors and hospitals, to a watch that tracks a person’s heartbeat. However, the connected technology in a case study highlighted in the press release is home based monitoring systems supplied by Philips for a classic UK telehealth trial for COPD, diabetes and heart failure.

Philips say they commissioned the Future Health Index (FHI) report to globally gauge (more…)

Telemedicine device wins Africa Prize for Engineering Innovation

June 1, 2016 | by

A telemedicine invention called Cardio Pad developed by an engineer from Cameroon has been selected as the winning entry for [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/05/Cardio-Pad-2.jpg” thumb_width=”150″ /]the 2016 Africa Prize for Engineering Innovation, according to news reports  (BBC, Forbes, TechTrends, Business in Cameroon).

The winner, 24-year-old Arthur Zang (pictured with a Cardio Pad), who won the £25,000 ($37,000) on offer from the Royal Academy of Engineering in the UK,  was awarded his prize at a ceremony in Dar es Salaam, Tanzania, on the 26th of May, 2016. Zang previously won a Rolex Award for Enterprise in 2014 for the device. (more…)

Telecare Awareness Day (UK) – June 1st 2016

May 30, 2016 | by

This Wednesday, June 1st, is National Telecare Awareness Day in the UK for 2016. This is promoted by the industry body [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/05/UKTelehealthcare-Awareness.png” thumb_width=”150″ /]UK Telehealthcare.

To mark the day, CAIR, the UK based telecare products supply company, is holding an event at their headquarters in West Yorkshire. According to information available from the Telecare Services Association, twelve of the region’s leading voices in Telecare will gather to “tackle some of the challenges facing the industry”.

Last year several activities took place to mark the day, then called National Telehealthcare Awareness Day, with events being held by CAIR, University of East Anglia’s Norwich Electronic Assistive Technology Centre (NEAT), Welbeing (an independent-living service provider) and many others.

A summary of last year’s events is available via the UK Telehealthcare website here.