Systems sharing data, still behaving badly

August 7, 2013 | by

A straight-shooting article in Healthcare Technology Online provides a overview of the EHR and Health Information Exchange (HIE) mess in the US. Essentially our major EHR systems (Cerner, McKesson, athenahealth, Greenway, Epic) don’t interchange data well, if at all–and the 600-odd practice EHRs were built on siloed designs, existing software and used proprietary formats, often in a rush to take advantage of Federal subsidy programs in Stage 1 Meaningful Use–as HTO’s EIC Ken Congdon stated, “electronic filing cabinets”–and heavily outsourced. Well, it’s now ‘uh-oh’ time as a key part of Stage 2 MU is interoperability. Basically we now have a set of what this Editor would term ‘paste ons’ and ‘add-ins’ to facilitate data exchange between systems that speak different languages (Editor’s emphasis):

…direct protocol (a standards-based method for allowing participants to send authenticated and secure messages via the National Health Information Network), as well as those developed by HL7 (Health Level Seven), a nonprofit global health IT standards organization, provide EHR users with the building blocks for exchanging data. Blue Button, an application developed by the VA that allows patients to download their own health records, is also being adopted and manipulated by EHR vendors and independent developers as a way for providers to exchange data between systems. Moreover, regional and state-run HIEs offer healthcare providers in several parts of the country a network they can join (and technology infrastructure they can leverage) to share health data with other HIE members.

Some systems work well–EHR and pharmacy systems seem to. However, EHR to EHR interfaces are up to the provider and are expensive. Sharing/translation does not mean that all information makes it over without getting ‘bruised’ or having to be reentered manually.  HIEs, acting as a focal point for data exchange, are also generally non-profit; the exchange platforms cost millions to develop and further millions to maintain–and buy-in is low, as the article states. Fixing The EHR Interoperability Mess (free registration may be required)

(Updated 8/7 pm for Editor Donna’s POV) This is what happens when you rush adoption and development processes that should take years in order to gain quick subsidy money, and non-healthcare entities (that is you, the US Government) encouraged this, distorting the process. The private and public waste of scarce healthcare funds is appalling, and the disruption to the healthcare system is unforgivable–especially in practices where doctors and managers in many cases have been sold a bill of goods, and they are revolting by changing EHRs, going back to paper or retiring. And the Government should look to itself first. Look no further than to the multiple failures of two branches of the US government, Veterans Affairs and Department of Defense, which have the responsibility for current and veteran members of our Armed Services. They have failed spectacularly in serving Those Who Have Served not only the integration of their two EHRs but also in updating their basic architecture [TTA 27 July ‘Pondering the Squandering’… and 3 Apr ‘Behind the Magic 8 Ball’ both review the sad details.] The belief that HIEs with limited funding will solve the interoperability problem is Magic Thinking. At least one move in this direction makes sense: the CommonWell Alliance of six EHR heavy hitters to work on ‘data liquidity’ [TTA 5 Mar announced at HIMSS], but this may be another ‘uh-oh’ and face saving.

With basic, necessary health and patient information stuck in systems and getting lost in translation, how can anyone rationally expect that personal data from telehealth devices will be integrated anytime soon, in any meaningful way? Does this mean that parallel, separate systems and platforms will continue to develop–and yet another wave of integration?  

Alere Connect gains FDA approval for MobileLink

August 7, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/08/topper-mobilelink1-1140×180.jpg” thumb_width=”175″ /]We had been surprised at how quiet Alere Connect, the former MedApps, has been since its acquisition a year ago. Their latest news is that their newest and quite streamlined gateway hub, Alere MobileLink, has received FDA clearance to add to its recent CE Mark certification, clearing it for introduction in both US and Europe later this year. The US announcement also indicates that it will be packaged with Alere’s INRatio 2 PT/INR Monitor as part of home patient monitoring of anticoagulant medications programs through Alere Home Monitoring. This Editor notes that anticoagulant monitoring is ‘high-value’ and for remote monitoring, fairly different. Like the earlier MedApps HealthPal, it is also ‘vendor neutral’ compatible with multiple telehealth devices for glucose meters, weight scales, blood pressure monitors and pulse oximeters. Much of the emphasis of the new Alere Connect is how it integrates tightly with Alere’s programs and Connected Health informatics, care management and accountable care solutions, which is confirmed by CEO Kent Dicks’ quote included in the release: “The Alere Connected Health platform has the ability to connect flexibly with devices and systems regardless of their manufacturer and origin. The platform captures and analyzes data with robust analytics, and then backs it up with comprehensive health management services.” No information on rollout in UK or Europe. Release.

For long-time followers of MedApps, their HealthPal wireless hub is still being supported by Alere but will not at this point be integrated with INR monitoring. Also pending FDA clearance is a home health information tablet, Alere HomeLink.

Flashback: Integration of devices with service delivery providers was a major point brought up in our discussion of the MedApps acquisition value back in January, What a telehealth device company may be worth.  “What may be a better way is that device developers joint venture themselves from the start with health or service providers. And that those already seeking financing seek provider partners.”–Editor Donna

One step further towards smartphone-based health apps becoming autonomous

August 5, 2013 | by

It’s my contention that telehealth, or whatever it is called then, will only start to have a really significant impact on reducing the burden on caregivers when the technology begins to move from decision support to decision taking; only then will clinicians be able to disengage from needing to be involved in every decision regarding a patient’s treatment and focus on those decisions requiring significant skill and judgement. Sure there are all sorts of genuine hurdles in the way like ensuring that the decision-making process is not compromised by other genuine – or rogue – processes taking place on whatever the smartphones is called in the future that is processing and transmitting information, and there have been several recent warnings on malicious hacking of medical devices, so it won’t be happening any time soon. However, given the way so many medical processes that began with manual involvement have moved steadily towards automation, from ECG to Point-Of-Care-Testing, hopefully one day these problems will be solved.

One pointer, reported in iMedicalApps, is three trials currently underway using smartphones to control artificial pancreases to manage diabetes. The smartphones in this case are completely locked down and are only used for the decision-taking process around closed-loop insulin delivery. Nevertheless it’s a step.

Encouraging adoption of telehealth by clinicians x 3

August 5, 2013 | by

At the Royal Society of Medicine every year there is a medical students careers fair at which the Telemedicine & eHealth Section runs a stand.  Unlike other sections such as cardiology and general practice, we don’t see telehealth and other related technologies offering a career for many – the stand is purely to raise awareness because, scary as it may sound, many of the students who have visited us in recent years have never been taught about these technologies at medical school.  It is therefore good to see an article by Ben Heubl in Medcrunch, an online magazine aimed at tech-savy young doctors, discussing the reasons for slow adoption of telehealth (and telecare) which in part built on a meetup of the London Health 2.0 chapter last week.

In this context it’s also worth mentioning an article by Atul Gawande in the New Yorker on why some medical innovations spread fast, and other slowly.  He begins by contrasting the rapid adoption of anaesthesia with the slow adoption of antiseptics, both of which were discovered at about the same time.  From this he draws the lesson that where doctors see a clear benefit – in the case of anaesthesia, no longer having a patient struggling and screaming whilst being operated on – the adoption was fast.  Where the immediate benefit is harder to see and in particular it challenges the modus operandi – washing hands, sterilising instruments and replacing frockcoats caked in blood for clean white operating gowns – as with antiseptics, adoption was much slower even though the impact on patient outcomes was dramatic.   This not in any way a complete summary though – I would urge you to read this excellent piece in its entirety as there are many nuances…and important lessons for the future.

Rounding this post off, Pulse has just introduced a GP Guide to Telehealth (written and funded by MSD) which is short and to the point, balancing the UK experience of the Whole System Demonstrator with the very positive experiences of the Department of Veterans Affairs.  Much to be welcomed and with the added bonus of CPD points too.

Telecare LIN July newsletter is out

July 29, 2013 | by

The July Telecare LIN newsletter has been published and is available for download here. This month Mike has two short items on the Kings Fund congress earlier in the month and the transfer of 3ML from DH to NHS England plus the usual monthly round up of news with the top item being O2’s pull out from telecare and telehealth.

When mHealth and telehealth become ‘just healthcare’ (US)

July 25, 2013 | by

GovernmentHealthIT reports that, speaking yesterday during the first day of the World Congress on mHealth and Telehealth in Boston, US, Jonah J. Czerwinski said Veterans Affairs (VA) had managed the health of some 500,000 people using telehealth in 2012.  He expects this to rise to over 600,000 this year.  He is senior advisor to the Secretary of the U.S. Department of Veterans Affairs, where he leads the VA Center for Innovation.  That’s some endorsement for telehealth!

“It’s connected healthcare – no ‘tele-,’ no ‘m-,'” he is reported to have told the audience: “This is just healthcare.”

Picking up on the topic of automating telehealth monitoring, he also described how the VitaLink home monitoring system, one of the VA’s more promising telehealth projects, has been developed by the VA from algorithms used in the mining industry to detect when drill bits embedded deep in the earth were stressed out and ready to fail.

Soapbox: Further thoughts on CarelineUK, O2 & WSD

July 25, 2013 | by

The many, excellent, comments on O2’s withdrawal of their current telecare & telehealth offerings in the UK market, most notably from my fellow editor Alasdair Morrison, have prompted further thoughts on the post about CarelineUK’s 25th anniversary earlier today: what will CarelineUK,  and other organisations like it, look like in 25 years’ time?

Perhaps the most significant change that appears to be coming in the area of telemonitoring is  (more…)

CarelineUK celebrates 25th Anniversary

July 25, 2013 | by

Congratulations to CarelineUK on the 25th anniversary of the receipt of their first emergency call.  According to the announcement on their website they are now the largest monitoring centre in the UK, covering over 110,000 service users across the country.  Over 120 people work at their New Forest call centre which has the ability to integrate telecare & telehealth monitoring. and is compatible with digital networks.

Gestational Diabetes Telehealth trial at John Radcliffe Hospital, Oxford (UK)

July 24, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/07/John-Radcliffe-Hospital.jpg” thumb_width=”150″ /]Diabetes in pregnant women, known as gestational diabetes, is said to have significantly increased over the past 20 years and affects 1 in 20 pregnant women in the UK. This  is probably caused by an excess intake of carbohydrates, says Dr Lucy Mackillop of John Radcliffe Hospital, in an interview in Inside Health on BBC Radio 4, broadcast on 23 July 2013.

A foetus growing in a high sugar environment can lead to an overweight baby resulting in birth difficulties. Such babies may also develop problems such as diabetes in later life. Gestational diabetes also carries all the usual dangers of diabetes for mother.

If a pregnant woman has one of 5 risk factors she will be fully tested for diabetes and if she is diabetic, she will be monitored during preganancy. Monitoring typically may be a fortnightly hospital visit, but at the John Radcliffe there is a trial of 50 mothers who have been given special blood sugar meters which connect to smart phones via Bluetooth.

A daily blood sugar test result is transmitted to the hospital where software picks out patients that may need attention by a midwife, and changes to the treatment regime can be implemented if necessary. This saves many unnecessary hospital visits while giving a much more frequent review of the state of the patients.

Download the full programme from the BBC Radio 4 podcast page.

Telehealth – the RSM guide

July 24, 2013 | by | 2 Comments

Some while back a suggestion was made that the Royal Society of Medicine produced a short guide to telehealth that gave an unbiased a view as possible of the topic.

Well it’s now been published on the website and will also be available in print at selected conferences and similar gatherings.  The intention is that it can be given to clinicians, patients and other interested parties that want to know more.  It is also unashamed publicity for the RSM’s (unbiased) telehealth-related events, for those that want to know even more – the website version will be refreshed as events come & go.

I should immediately declare an interest as one of the authors – the others are Prof Brian McKinstry, Dr Richard Williams and Helen Lyndon.

Special thanks to inHealthcare and medvivo for their kind sponsorship.

Hope you like it!

Establishing high-level evidence for the safety and efficacy of medical devices and systems

July 22, 2013 | by

I have recently been made aware of an excellent publication jointly by the Royal Academy of Engineering and the Academy of Medical Sciences entitled Establishing high-level evidence for the safety and efficacy of medical devices and systems, so this post is to reach out to those like me who were previously unaware.

It is a major step forward in applying engineering methodology to evaluating the effectiveness of medical devices & systems and, even more important, ensuring their ongoing safety.  Those of us who have participated in a substantial randomised control trial such as the Whole System Demonstrator (see earlier post today) will take great interest at what follows the quote: “For pharmaceutical innovation, the randomised controlled trial is the acknowledged gold standard for creating a body of high-quality evidence. But designing clinical trials to establish the evidence for medical devices has proven more problematic.”

(Included in the paper is the observation  that the ultimate health improvement device when you leave an aeroplane that is in the air – the parachute – has never been proven by an RCT.)

Finally just to return to an earlier comment, the report makes the point that because medical devices can be changed far more often than the composition of a drug, the importance of appropriate safety monitoring is absolutely critical, an issue that is becoming increasingly relevant as penetration of telehealth (in particular) and telecare increases.  Whilst  we might choose to ignore the different nature of medical devices when assessing a trial, we cannot ignore the different nature of medical devices when designing and putting in place appropriate safety systems.

Telehealth Soapbox: Time to bid farewell to the WSD?

July 22, 2013 | by | 5 Comments

TTA Contributing Editor Charles Lowe asks whether it is now time to stop looking back to the UK’s pioneering Whole Systems Demonstrator (WSD) programme.

As the person who led the bid for Whole System Demonstrator status for LB Newham back in 2006/7, this is my case that it’s time now to bid farewell to the programme, as soon as is possible.

Why?  This was a great programme that came up with some encouraging results for telehealth, and taught us a huge amount about how best to implement telehealth and telecare.  However the echoes from that long gone time are increasingly providing ammunition for the naysayers, when in reality the world is now a totally different place.  The technology is unrecognisable from that that we considered when bidding for the WSD in 2006; it is far more efficacious and far cheaper; and it can be deployed much faster & for many more conditions, opening up many possibilities not available to us when we won in 2007.  We now know much more about how to implement the technology too: in particular it delivers greatest benefit when a part of an overall programme for improving care and not, as the WSD randomised control trial (RCT) treated it, as a simple intervention, like most drugs.  In retrospect therefore there were significant weaknesses in the way the trial was run.

The continuing drip-feed of WSD results is sadly resulting in (more…)

Hospitals can benefit from telemonitoring (US)

July 20, 2013 | by

As someone who has spent a huge amount of time attempting to persuade acute trusts in the UK that telehealth is in their interests (with, I’m glad to say, a modicum of success more recently) it is good to see this paper entitled  in the July 2013 edition of the Journal of Telemedicine & e-Health (freely accessible).  The key finding is (more…)

In changing behavior, ‘wanna’ works better than ‘hafta’

July 19, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/07/carrot-cake01.jpg” thumb_width=”150″ /]The proliferation of apps, tracking programs and devices that promise to change your life through Quantifying Yourself and lead you to the New Jerusalem of fitness and health is fascinating in number and variety. Yet why do some apps and programs do their job of changing behavior–and others, equally well-intentioned, do not? It’s all about ‘wanna’ vs. ‘hafta.’  Tracking your caloric consumption quickly turns into a ‘hafta’ drag for most (MyFitnessPal), but if you plug into a lively online community (Fitocracy), make the app easy to use and the changes gradual, plus forgive a few lapses, the same activity can start feeling rewarding and ‘wanna’. It’s all about personal autonomy, reward and control. It may be carrots rather than carrot cake, but you’re doing the choosing. Must reading for those working to develop corporate wellness programs, sticky apps and engage users. Why Behavior Change Apps Fail To Change Behavior (TechCrunch) Hat tip to reader Sandeep Pulim, MD via LinkedIn.

Related: Our April discussion of employee wellness programs, Employee wellness: Carrot? Stick? Or something else?

An example of simplification helping to increase positive behavior–and perhaps outcomes–is the recent study of the Center for Connected Health’s BP Connect program. Mobile users took their blood pressure more often than the telephone hub/device users; these older users (median age 61!) found the mobile version both easier and more convenient in portability. Overall BP scores went down moderately. Connected Health Study Finds Mobile Health Improves Patient Engagement (HIT Consultant)