For a US nurse’s view of telehealth (remote monitoring), see a blog by Kavita Radhakrishnan, RN, PhD. Start with this article, which is positive in tone: Can Telehealth Improve Chronic Disease Outcomes in the Community? but make sure to follow up with this item which swings the other way: Unintended Consequences: How Telehealth Can Fail to Manage Chronic Diseases.
EU ahead of US on telehealth
US law firm Epstein Becker Green analyses two key differences between the US and EU regulations affecting telehealth. First they identify the ability of health workers to treat their patients even when the patient moves to another EU state. Second is about getting health insurance companies to cover costs when health services are received abroad – it seems that insurance companies are required to do so under an EU directive whereas in the US cover is mostly state based: E.U. Way Ahead of the Game on Telehealth. Heads-up thanks to TANN England editor Chrys Meewella.
Depression warning for heart failure patients
GP Online picks up on an American study (links to original) – the implication is that early identification of the onset of depression in people with heart failure could reduce a considerable number of early deaths. Depression warning for heart failure patients. Surely it shouldn’t be too difficult to get self-reported mood trends into electronic medical records and to flag up negative changes in a timely manner. It may be more cost effective than other forms of remote symptom monitoring…
UPDATE Tuesday 26 March: There may be a connection to social isolation – also associated with depression. Social isolation ‘increases death risk in older people’ BBC item.
O2: First Help at Hand, now Health at Home (UK)
Two major launches for O2 in two weeks… First Help at Hand and now, at the Healthcare Innovations Expo, Health at Home – no wonder there were no ‘health’ mentions at the earlier launch. According to the press release, Health at Home’s secure platform allows health care professionals to “monitor patients’ readings, set bespoke symptom surveys, provide educational materials and communicate with them directly. Patients are provided with a tablet computer connected to the mobile network and pre-loaded with the Health at Home software as well as relevant smart monitoring devices including pulse oximeters, weight scales and blood pressure monitors.” Data is uploaded to O2’s servers where it is accessible to the professionals and to the patients “to learn more about their condition and how to manage it”. The charge is per patient per month with no upfront cost. Press release (PDF). Health at Home website.
O2 being what it is, we assume that the in-tablet software is CE marked (as it sounds like it would be counted as a medical device) and that O2 has all patent issues covered with the likes of Bosch. It would be nice to have those points confirmed.
Adopting Simple Telehealth (Flo) SMS reminders in general practice (UK)
Unlike its Pulse rival, GP Online is taking a more constructive approach to the matter of telecare, as evidenced by a (so far) two part series by Professor Ruth Chambers about how to use the Simple Telehealth (Florence, or Flo) SMS reminder system as part of a GP practice’s clinical pathway:
Adopting remote monitoring via telehealth in your CCG’s practices – part 1: hypertension
Adopting remote monitoring via telehealth in your CCG’s practices – part 2: inhaler reminders
Are the benefits of telehealth a myth? (BBC item, UK)
BBC News (business section) has just published a classically balanced look at telehealth in the UK, with a passing mention of the O2 Help at Hand launch. It’s a pity the article does not have a commenting system as the conclusion may be debatable. Are the benefits of telehealth a myth? Heads-up thanks to John Guyatt via LinkedIn.
On a positive telehealth note, the Public Service website has published a brief item based on recent experience in Leicester, although the title sounds rather backwards! Cold weather keeps telehealth patients out of hospital.
Satellites to bring more telehealth to the bush (Australia)
Two long-term and fast broadband satellites to be launched in 2015 will enable people living in Australia’s rural and remote areas to access more video-based health services according to NBN Co’s CEO Mike Quigley. Details in Pulse+IT item: Satellites to bring more telehealth to the bush.
Effect of telehealth on quality of life: Another WSD research publication (UK)
Quick on the heels of the telecare study from the Whole Systems Demonstrator (WSD) Programme reported here today, comes another research report, this time from the BMJ: Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial.
Here are a few quotes from the abstract:
Objective: To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions.
Conclusions: Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients.
So can we now not even say ‘Never mind the business case, that can be improved – it’s very good for patients’ sense of well being’? Heads-up thanks again to Mike Clark who is keeping an updated list of the reports as they are published.
UPDATE Thurs 28 Feb: Pulse does its usual thing with this study, but note the comment from the GP at the end: DH-commissioned report finds telehealth fails to improve quality of life.
February Telecare LIN newsletter published (UK)
Out now, the February edition of the Telecare LIN newsletter. It, together with the separate supplement, contains “over 1200 news and events links over the last month” and a reminder that if you have not registered for the ALIP showcase event in Liverpool on 5/6 March or the Healthcare Innovation Expo on 13/14 March you need to act quickly. The newsletter has more details. PDF newsletter. Links supplement. NHS reforms supplement.
UK doctors give thumbs down to ‘remote care monitoring’
The British Medical Association’s (BMA) General Practitioners Committee (GPC) has written to the Department of Health (DH) with an analysis of the results of a consultation exercise and the surveying it has done to assess GPs’ views on the effect the forthcoming changes to their contract will have on their services. The relevant points for people who wish to promote telehealth remote monitoring are paragraphs 47 – 55, starting on page 13 of the BMA’s letter to DH. (PDF) Basically they are saying ‘It’s too difficult; we don’t believe it helps ease our work or that patients like it; so we can’t be bothered and please re-think making us do it.”
However, this reaction has to be seen in the context of the response as a whole. The BMA (as the doctors’ ‘union’), has a particular need to spin the results in the most negative way and the survey was undertaken at a time when GPs’ morale has been low and, on page 1, the BMA summarises the complete findings as:
“An overwhelming 88% of GPs responding to our survey with some awareness of the proposed contract imposition agreed with the statement that they personally will be less able to offer good quality care to their patients as a result of this imposition. Of the 58% of GPs who said they were prepared to take action and who expected to make changes as a result of the imposition:
54% said they expected their practice to have to reduce access to patients.
– 91% of these said that GPs would not be able to see patients for routine appointments as quickly as they currently do
– 72% thought they would have to reduce the number of consultations offered to free up time for the new workload
– 75% expected to reduce the range of services offered to patients.
82% expected to have to make changes to staff working hours or employment
52% expected to reduce their use of locums
Heads-up thanks to Mike Burton.
2020Health evaluation of the Yorkshire ‘Telehealth Hub’ project (UK)
This important report was published last Friday. Like this editor, readers will surely thank the authors for making such a disparate mixture of elements readable and for picking their way through the implications for the 3ML campaign as well as the many clinical commissioning groups (CCGs) which will take over the reins (or should that be pick up the pieces?) of the NHS across England and Wales in April.
I’m not going to attempt to summarise the report. The four-page Executive Summary contains three tables of essential findings and is the place to start. Despite, or perhaps because of, the general failure of the Telehealth Hub to achieve wider adoption locally, some significant lessons have been learned. TTA readers will, no doubt, comment on those lessons as they see them. Perhaps we should regard the work done by the Hub as a precursor to that which will be done by the 3ML Pathfinder sites. Let’s hope that they are studying this report closely and take note of this key comment by one of the Hub partners:
“When I look at the aims expressed, what strikes me is the ‘tele’ not the condition. We would write these aims differently now – whether because of learning or the fact that the environment changes. The risk now is that local CCGs only think in terms of local pathways and not the wider patient needs.”
The 2020Health evaluation of the Yorkshire ‘Telehealth Hub’ project can be downloaded from the 2020health press release Telehealth does produce savings.
Oh, and for any non-UK readers who may be confused by ‘Yorkshire’ in the title, the area covered by the Hub does not include North Yorkshire and York (NYY) which has famously failed to scale up its telehealth project also, but at more than three times the cost.
‘The big picture’, minus hype, of mobile in health
Refreshingly free of hype, and in fact rather dry, is the commentary of Deborah Estrin, professor of computer science at Cornell NYC Tech (soon to be your Editor’s neighbor), at the 2013 annual meeting of the American Association for the Advancement of Science in Boston chaired by Google’s Vint Cerf. Essentially any phone can be a data platform; her focus is on converting apps to data streams, gauging frequency of use and GPS data for movement. Sensibly, she advises ‘scaling down’ apps to make them useful to individual patients. Undoubtedly she’s read the statistics on abandoned apps, estimated at about 95%–and that most everyone uses the same old apps, Google, Facebook, YouTube, Gmail etc. for about the same time as in 2011. But then she goes into how mobile can keep track of ‘digital exhaust’ a/k/a pollution…. Mobile Devices Linked to Better Health (BioScienceTechnology.com) App Usage Has Stalled As Smartphone Users Hit Burnout (Business Insider)
Revealed: Hospital EHRs lobbied for stimulus funding (US)
Man Bites Dog! The New York Times just discovered that not only did large EHR companies lobby for the health records mandatories that were part of the 2009 Federal ‘stimulus’ bill–along with ‘Meaningful Use’ subsidies–but also they also won big in hospital sales. This article focuses on Cerner, Allscripts (which bought Eclipsys) and Epic, and the 60% + gain these companies have made in sales since. It touches on the sticking point of non-interoperability, but not at all on the chaos at the practice level where the Big Three (nor the unmentioned GE Centricity) largely do not play. Here is where 600-odd companies, many of them offshored IT outfits, also around 2005 started to peddle various EHRs which were first software, now cloud-based. It took off after 2009 as well, to primary care doctors worried about Federal regulations–or missing out on years of subsidies and MU payouts. (more…)
MMRGlobal IP infringement lawsuits, allegations continue
Personal Health Record (PHR) patent holder and penny-stock company MMRGlobal [TA 10 Feb] continues to keep law firms in the US, Australia and now Singapore very busy with various complaints of patent infringement, demanding monetary damages, a permanent injunction and presumably, a lucrative licensing deal. Last week, MMRG filed in US District Court, Central District of California against health giant WebMD for their online PHR, claiming that from meetings dating back to 2007, WebMD incorporated “features and functionality that are the subject of MMR’s patents”. Today’s MMRG press release now highlights the Singapore Ministry of Health (with associated health agencies), which MMRG alleges uses PHR vendors which violate various patents–which just happen to be owned by MMRG in Singapore. (more…)
The Telecare & Telehealth Virtual Exhibition
Visit the stand by clicking on it. Happy browsing!
Policy on telehealth practice by ASHA (US)
Janet Brown, for the American Speech Language Hearing Association made this comment about its policy on ‘telehealth’, posted on Google Video. It’s good to see that she shows a sensitivity to the uncertainties of the terminology.
What a great way to make policy announcements!
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