Telehealth in Brazil: a special JISfTeH issue

February 27, 2016 | by

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) turns to Latin America in its latest issue with a focus on the versatile ways that telehealth has been used in Brazil. Nine papers range from distance healthcare education to store-and-forward imaging to building rural telehealth networks. Brazil’s government has supported remote care initiatives with the development and implementation of projects at the national, state and municipal levels. The telehealth model primarily has been connecting universities to primary care in remote cities (of which there are many!) with an emphasis on education and assistance. Topics include the nine-year-old telehealth project in Minas Gerais between Rio de Janiero and Brasilia, and its declining use; distance learning in dentistry; usage in the Amazon region and legislation. Registration required, but the journal is open access. Hat tip to its lead editor, Prof. Maurice Mars of the University of KwaZulu-Natal, South Africa.

 

 

The widening gyre of insurers covering telehealth (telemedicine?) (US)

February 20, 2016 | by

Is a tipping point nearing? Soon? An article in Modern Healthcare that contains a heavy dollop of promotion headlines ‘telehealth’s’ adoption by insurers such as Blue Cross Blue Shield of Alabama, Anthem and Highmark. When read through, it’s mainly about telemedicine (video consults) but does touch on the vital signs monitoring that’s the basis of telehealth. Video consults through Teladoc and other services such as Doctor on Demand and American Well are gradually being reimbursed by private insurers, despite the concern that it would actually drive up cost by being an ‘add-on’ to an in-person visits. Medicaid increasingly covers it, and states are enacting ‘parity’ regulations equalizing in-office and virtual visits including, in many cases, telehealth. Yet the move for coverage is hampered by lack of reimbursement to doctors, or the perception of limited or no payment. Even Medicare, a big advocate for alternative models of care, currently pays little out for telehealth–$17.6 million on a $630 million+ program. The Congressional Budget Office is skeptical, despite the savings claimed by CONNECT for Health Act in both the Senate and House [TTA 12 Feb]. Virtual reality: More insurers are embracing telehealth

The evolution of Facebook: implications for social health

February 9, 2016 | by

The Telegraph’s recent retrospective on Facebook and its evolution from 2004’s ‘Thefacebook’ of Harvard University students to the Facebook that many of us use now, with Chat, timeline and a converged mobile and desktop design, led reader Mike Clark to drop Editor Charles a line about how healthcare isn’t maximizing social media and internet-based innovation. Recent studies have indicated that these social patient communities benefit their members. Agreed, but there are increasing qualifications–and qualms.

Back in 2014, Facebook made some noises on forming its own online health communities, a move that was widely derided as Facebook monetizing yet another slice of personal (health) data from users. While Charles has made the excellent point that “almost all good health apps are essentially the tailored interface to an internet service that sits behind it, a fact often forgotten by commentators”, Editor Donna on her side of the Atlantic has seen concerns mount on privacy, security and the stealthy commercialization/monetization of many popular online patient support groups (OSGs) which Carolyn Thomas (‘The Heart Sister’) skewers here, excepting those with solid non-profit firewalling (academic, government, clinical). Example she gives: Patients Like Me, which markets health data gathered from members to companies developing products to sell to patients. How many members, with a disease or chronic condition on their mind, will browse through to this page that says in part: “Except for the restricted personal information you entered when registering for the site, you should expect that every piece of information you submit (even if it is not currently displayed) may be shared with our partners and any member of PatientsLikeMe, including other patients.”

We’ve also noted that genomics data may not be sufficiently de-identified so that it can’t be matched through inference [TTA 31 Oct 15], with the potential for sale. And of course Hackermania Running Wild continues (see here).

For now general information sites like WebMD and personalized reference sites such as Medivisor feel more secure to users, as well as small non-commercialized OSGs and ‘closed’ telehealth/telemedicine systems.

Exploring how best to use telehealth to manage COPD – can you help?

February 3, 2016 | by

Anyone working in telehealth knows that, of the principal long term conditions to which it is applied, COPD is the most problematic, with many telehealth trials showing no significant benefit. However in various meetings, Dr Julia Bott has tantalised me by suggesting that she and Dr Hilary Pinnock may know how to use telehealth more effectively.

Therefore, on 3rd March, we are holding a small, free, meeting at the Royal Society of Medicine in London from 3pm-5pm to examine how telehealth can be used to manage people with COPD better. Present will be both Dr Hilary Pinnock (University of Edinburgh) and Dr Julia Bott (University of Surrey).

So far we have senior representatives from two major telehealth organisations attending and probably need at least three more. If you are interested, please do email this editor, charles.lowe@btinternet.com, explaining why you’d like to join us for what I suspect may prove to be a groundbreaking event.

Australian healthcare fund takes stake in telemedicine startup

January 23, 2016 | by

HCF, the oldest of the “Big Four” Australian health funds, has bought a 15% stake in telemedicine online doctor service startup GP2U. [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/01/HCF-logo.jpg” thumb_width=”150″ /]GP2U provide systems which helps to make remote consultations via video conferencing possible.

According to yesterday’s press release HCF will run a pilot to “ensure the service is scaled to the wider HCF membership as smoothly as possible”. In addition to providing the video conferencing platform, [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/01/GP2U-logo.png” thumb_width=”150″ /]GP2U also provides a prescription service that sends prescriptions directly from the GP office to pharmacy once the GP approves it. GP2U has agreements with three Australian pharmacy chains, Terry White Chemist, Chempro and Priceline.

HCF is a not-for-profit organisation founded 80 years ago and provides health cover for 1.5 million Australians and has a turnover in excess of AUD 2 billion. GP2U is very fortunate that such a large fund has taken a serious interest in it

Dubai starts telemedicine pilot

January 20, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/01/rp-vita-1-e1453251179139.png” thumb_width=”150″ /]I am somewhat baffled by the news this week of a telemedicine trial in Dubai. One of the seven emirates making up UAE, Dubai has an area of less than 1,600 square miles, which amounts to a square of about 40 miles – so not exactly far to travel from any place to any place else if you are in Dubai. Not the obvious place to benefit greatly from telemedicine. The press release two days ago said that the pilot will “significantly enhance the manner in which healthcare is delivered in the emirate”.

According to the release the project will use “robots” from In Touch Health (referred to as “RoboDoc” in the release). These are self-propelled six-foot tall units (similar to the one shown, I expect, which is from the In Touch Health website) with video conferencing capability so that staff in one hospital can consult experts in one or more other hospitals in real time at the patient’s bedside.

The full press release is available here.

Lessons learned from rural telehealth in Pennsylvania

January 13, 2016 | by

Several years ago, CJ Rhoads, a business professor at Kutztown University of Pennsylvania and CEO of consultancy HPL Consortium, asked Editor Steve and Donna for some background information on telehealth. According to her note last month to us, the results of her research were reported to the Pennsylvania legislature and The Center for Rural Pennsylvania (a legislative agency of the PA Assembly), in 2014 and now have been published in a more readable form by CRC Press-Taylor & Francis Group. An excerpt from their summary:

Improving the quality of healthcare, while increasing accessibility and lowering costs, is a complex dilemma facing rural communities around the world. The Center for Rural Pennsylvania believed that telehealth, the use of electronic information and telecommunications technologies to support long-distance clinical healthcare was a viable solution so it recently provided grants to conduct a thorough investigation into the factors involved.

Telehealth in Rural Hospitals: Lessons Learned from Pennsylvania reports the outcome of this year-long investigation. Illustrating telehealth implementations in rural settings, it supplies an overview of telehealth as well as an assessment of its economic impact.

The book skillfully intertwines the research and academic aspects of telehealth with helpful insights from the author.

From the table of contents, it appears to be an exhaustively researched book on telehealth and its impact in rural healthcare. It’s available to purchase on CRC’s website. Thanks to author CJ Rhoads for the heads up!

Cornwall Council to terminate BT outsourcing deal

December 23, 2015 | by

The High Court has ruled that Cornwall Council is within its rights to terminate the multi-million pound [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/Cornwall-Council.png” thumb_width=”150″ /]services outsourcing contract with BT because BT “did not provide … the service it had promised to the standard it had promised”.

Cornwall Council welcomed the High Court decision yesterday saying “The judge’s decision confirms the Council’s argument that BT Cornwall had been in material breach of the contract due to their failure to carry out services to the required contractual standards and, therefore, that we were justified in reaching the decision that we were entitled to terminate the contract.

“As a result of this decision, the Council intends to give notice of the contract before Christmas but there will be no immediate change in the arrangements as notice will not take effect until January.”

BT was awarded the 10-year contract in 2013 amid much controversy as was widely reported including here on TTA. (more…)

Federal Court denies TMB application to dismiss Teladoc case

December 22, 2015 | by

Readers may have read our article in April this year “Can State medical boards legally prevent telehealth activity?”. [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/US-district-court-1.jpg” thumb_width=”150″ /]In that article we examined the potential impact of a case brought by the Federal Trade Commission against the North Carolina State Board of Dental Examiners. The case went all the way to the Supreme Court which determined that the State Board of Dental Examiners was not protected by immunity from anti-trust law.

Teladoc is now locked in a case with the Texas Medical Board (TMB) that is very similar to the North Carolina case and it too has gone along a similar path so far. In the latest development of this case, last week a Federal Court, the US District Court in Texas, denied the application by the TMB to dismiss a case brought by Teladoc that claims that the TMB broke anti-trust law.

What has brought Teladoc and the TMB to court in this way? (more…)

White paper identifies potential and challenges of telehealth

December 16, 2015 | by

Telehealth is a rapidly growing field that has the potential to help states leverage a shrinking and maldistributed provider workforce, increase access to services, improve population health and lower costs says a report published a few days ago. Called “Telehealth Policy Trends and Considerations”, the white paper from the National Conference of State Legislatures (NCSL) focuses on three areas: reimbursement of telehealth encounters, licensure for telehealth providers and patient privacy, safety and security.

This white paper is the result of a year’s work by a group brought together by the NCSL consisting of state legislators, legislative staff and private industry. The white paper provides options for state policymakers in these areas.

The paper also covers recent research into cost-effectiveness of telehealth, the impact of telecommunications connectivity and some specific examples of telehealth/telemedicine usage. Examples of effective use of telehealth includes the use of telehealth/telemedicine by the Veterans Health Administration. Another example cited is the telemedicine usage by the Unversity of Mississippi Center for Telehealth about which we have reported previously

The full 28-page report, is available to download here.

Report analyses published reporting of telehealth

December 13, 2015 | by

An agency of the US Department of Health and Human Services, the Agency for Health Research and Quality (AHRQ), has published, for peer review, a draft of a new report (a “technology assessment”) entitled “Telehealth: an Evidence Map for Decision making”. AHRQ, the report explains, “through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public and private sector organizations in their efforts to improve the quality of health care in the United States.”

The purpose of this new technology assessment is given as creating a review of the evidence available (essentially a literature review) so as to inform decision makers. The authors had identified 1,305 citations about telehealth of which 44 had been selected for this review. Unsurprisingly, the report says ” comparatively large volume of research reported that telehealth interventions produce positive results when used for communication/counseling and monitoring and management for several chronic conditions and for psychotherapy as part of behavioral health.”

It recommends additional primary research be carried out on topics such as telehealth for triage in urgent/primary care, management of serious paediatric conditions and the integration of behavioral and physical health. Finally, it recommends that telehealth research should be integrated into evaluation of new models of care and payment so that the potential of telehealth can be assessed in organizations that are implementing these reforms. (more…)

More Federal expansion of telehealth coverage proposed in Senate (US)

December 9, 2015 | by

The Telehealth Innovation and Improvement Act (Senate Bill 2343), a bipartisan bill to expand Medicare coverage of rural telehealth, was proposed last week by Senators Cory Gardner of Colorado and Gary Peters of Michigan. It would authorize Health and Human Services (HHS) to test new telehealth programs through the Center for Medicare and Medicaid Innovation. CMMI would then evaluate new telehealth models on cost, effectiveness and care improvement. Senator Gardner’s intent is to permanently expand rural telehealth. The bill has moved to the Finance committee. Another Senate bill may be proposed before the holiday break by Hawaii Senator Brian Schatz to integrate telemedicine technology into alternative payment programs including Medicaid Advantage, a service of great utility in his state where 70 percent of the population is on one island, Oahu,  and about 30 percent is scattered over four other islands. iHealthBeat, mHealthIntelligence.

Telecare innovator Lively acquired by GreatCall (updated)

December 5, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/Lively-sensors-600×327.png” thumb_width=”150″ /]GreatCall, which markets the popular Jitterbug simple phones and ancillary safety/security services (5 Star, mPERS) targeted to older adults, has acquired the assets of home activity personal monitoring system Lively. According to GreatCall’s press release, Lively’s technologies will be integrated into GreatCall products. These include a tastefully designed brace of self-installed in-home motion sensors, which made quite a splash when introduced in 2012, and a fairly stylish mPERS watch introduced last year. From the announcement, it’s easy to deduce that Lively was largely inactive despite partnerships led by Care Innovations: the press release on both Lively and GreatCall’s site was issued from GreatCall only and not joint contact; Lively’s last round of funding was in 2013 (only $7.3 million total, another Series A to B casualty) and there are no Lively employees transitioning to GreatCall for the good reason that there are none left (Mobihealthnews). No word on founder Iggy Fanlo’s next plans save a squib on LinkedIn saying that hardware was hard and his next move would likely be in software. With last year’s sale of AFrame Digital (with no further word from the purchaser) and BeClose now Alarm.com Wellness (not a surprise as it was built on an Alarm.com platform), as we close the year it is further confirmation that it is No Country for Small Players in digital health. Photo: Lively.

Update: Tart take from seasoned Aging Tech business observer Laurie Orlov on Lively’s rise and fall, with additional history. Her POV is that as attractive as Lively’s concept was, its business strategy should give pause to the Silicon Valley investor and entrepreneur crowd thinking this is just another kind of direct-to-consumer hardware-service sell, the long payout of any tech in this field and the opposed short time frame of VCs. It’s also not like there haven’t been a few predecessors fallen on the field, either. Aging in place tech firm Lively is out of business – what can we learn?

Big home health win for telehealth confirms trend: must expand services, analytics

December 5, 2015 | by

One of the most logical places for telehealth, remote care management (RCM) and transitional/chronic condition management (TCM/CCM) is with home health providers and post-acute care, yet perennially it has been on the ‘maybe next year’ list for most telehealth providers. That ‘next year’ may be getting a little closer with the news that Intel-GE Care Innovations has inked a multi-year deal (no pilot-itis here) with major (~400 facilities) home health provider Amedisys using their PC/tablet-based Health Harmony platform.

The initial focus is an ambitious one: reducing hospitalizations and ER/ED visits among patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, depression as well as patients who have two or more of these conditions (co-morbidities). The most interesting to this Editor is the parenthetical mention of analyzing ADLs (activities of daily living) with clinical data. Does this imply the engagement of their venerable ADL monitor QuietCare? (It’s something the founding company worked on circa 2006 while this Editor was there; one would think the analytics have advanced since then.) Another aspect is that Care Innovations will manage Amedisys’ complete RCM program from recruiting to logistics, data analytics and application integration services. Business Wire

What this means: Telehealth (and telecare) companies are now increasingly obliged in these big wins to provide a plethora of additional related services. Health care providers demand services beyond the monitoring technology. They want the turnkey package, from nurse evaluations, care coordination/management, to analytics and logistics.This ‘service creep’ implies alliances and mergers to add on to technological monitoring capabilities–and beaucoup financing. (more…)

Flo and ANNIE: text messaging with a personality to improve health (UK/US)

December 2, 2015 | by

Flo–the Florence Simple Telehealth text messaging system–is well known to our UK Readers as a successful initiative of the NHS. Over the past five years, starting from a test with NHS Stoke on Trent, it has been used by more than 30,000 people in over 70 health and social care organizations to help them monitor their health in areas as diverse as managing diabetes, living with COPD and managing breast feeding. Flo is customized by the clinician for the individual patient on questions, information, and speaks to the patient with a sometimes sassy ‘voice’ to help keep him or her on track. The Health Foundation has spotlighted Flo (named after Florence Nightingale) in ‘The Power of People’ with an overview page here and the video ‘Telehealth with a human touch’.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/1109151630.jpg” thumb_width=”150″ /]nhssimple, a Social Enterprise is now tasked with developing the Flo program and since 2013 has partnered with the Veterans Health Administration in the US to develop a counterpart. Named ANNIE after Lt. Annie G. Fox, Army Nurse Corps, who was the first woman awarded the Purple Heart for her actions at Pearl Harbor, the VA is shortly testing it at four sites with intent to roll out nationally in 2016. This Editor has seen two presentations by Neil Evans, co-director of VHA connected health, in 2014 and this year at mHealth Summit (HIMSS Connected Health–see left). The Health Foundation video also includes an interview with Dr Wyatt Smith, prior Deputy CIO of the US Military Health System, and mentions the VHA. Hat tip to Phil O’Connell, Global Lead of nhssimple, for the update.

‘All-in-one’ SensoSCAN medical sensor launches at HIMSS CHC

November 25, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/1110151347a.jpg” thumb_width=”150″ /]And it’s not Scanadu. Scanadu may be the ‘tricorder’ of the future, but telehealth companies are looking for a here-and-now medical monitoring device that can take the place of multiple health monitors and provide clinically accurate readings. This Editor noted Swiss-American company SensoGRAM‘s press release at last year’s mHealth Summit, but this year, in a large booth near the front of the now HIMSS Connected Health Conference expo floor, they were demonstrating production versions of SensoSCAN. The fingertip sensor, similar to a pulse oximeter, measures blood pressure, respiration rate, heart rate, and O2 saturation, plus activity levels and fall detection, and sends the information to your smartphone via app. It is being sold DTC on their website ‘for informational purposes only’ for $349.99. According to chief administrative officer Lisa D’Auria (her hand at left), they are also in clinical trials for FDA 510(k) clearance, hoping to have within less than a year, and are in progress with CE Marking. Unusually, it is manufactured in the US. Release.