Can digital health solve China’s healthcare quality, distribution problems?

July 23, 2015 | by

Earlier this year [TTA 21 May] we noted China’s interest, governmental moves and private investments in digital health as part of ‘Internet Plus’: Tencent Holdings and Fosun International led the $35 million Series B round for ‘healthcare tricorder’ Scanadu; ZTE Health; Alibaba‘s investment in data cruncher CITIC 21CN. Now McKinsey partner Florian Then analyzed for Yahoo! Finance the promise of telemedicine and telehealth in that country, and the great problems they must solve. The huge disparity of care between urban and rural hospitals drives patients to the former, regardless of long distances and inconvenience. In population health, the unhealthy habits of much of China’s population make US/UK/EU concerns look unimportant: one of every three of the world’s smokers and 300 million hypertensives live in China.

A possible telemedicine-driven solution would be for urban hospitals to support via doctor consults and email rural hospitals to get patients into the medical system locally and earlier. Education would be delivered online, probably through those 847 million mobile phones on which 83 percent of Chinese Internet users access the web (market intelligence firm IDC). China also appears to be liberalizing (more…)

Digital health startups filling the gaps in Health Canada

July 22, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/07/RCAF_roundel_WWII.jpg” thumb_width=”125″ /]Canada’s health system is nominally nationalized, but in a way that leaves large gaps in coverage–for long term, in home, specialty care and prescriptions–as well as variable by province. According to this article in HIT Consultant, VC funding is also thin on the ground, which leads to a short-term outlook. Local governments are stepping into the gap with innovation funding (similar to the Partnership for NYC) and the national government has eased restrictions on foreign investment. EHRs haven’t been a priority (skipping the troubles experienced in the US) which leaves digital health–telehealth, telemedicine and diagnostic apps–to enjoy the available talent and funding. This Editor doubts that any of the 20 profiled here will be familiar names other than possibly InterAxon which we noted at last year’s NYeC Digital Health Conference, and many tread the familiar ground of genomics, social sharing of medical images, and gamification for behavior change, but there are three unique companies in the neurological area in nerve stimulation (MyndTec), nerve disorder diagnostics imaging (NerveVision) and pharma (Oxalys.) We salute the Royal Canadian Air Force with their WW2 roundel on the anniversary of the Allied invasion of Sicily, July – August 1943

HealthSpot, Rite Aid open 25 locations in Ohio

July 21, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/07/Healthspot-station.jpg” thumb_width=”150″ /]Telehealth/telemedicine kiosk HealthSpot and retail drug chain giant Rite Aid, which announced their partnership last November [TTA 11 Nov], have now set up shop in 25 locations in three Ohio areas–Akron/Canton, Cleveland and Dayton/Springfield. Since late May, the staffed stations have treated over 5,000 customers ages 3 and above for minor and common health conditions, including cold and flu, rashes and skin conditions, eye conditions, earaches and seasonal allergies. The kiosks combine video consults with hands-on assistance in vital signs measurement from a wellness attendant, and their recording software interfaces with insurance eligibility, electronic medical records and billing systems. The network of medical professionals on the telemedicine consults are from Cleveland Clinic, Kettering Health Network and University Hospitals, with pediatric specialists from UH Rainbow Babies & Children’s Hospital. According to HealthSpot’s CEO Steve Cashman, a significant portion of early visitors are Medicaid recipients, who through a $60 station visit may be avoiding a far more expensive (~$600) ER visit. For the early stage HealthSpot it’s a major rollout, but for Rite Aid, which is not known for being as cutting edge in location design as CVS or Walgreens, it represents a significant move forward into onsite wellness services. Cleveland.com, Drug Store News. Rite Aid/HealthSpot demo video. Business Wire release.

Trusting a virtual diagnosis? 74 percent of adults wouldn’t (US)

July 17, 2015 | by | 1 Comment

It’s a matter of trust. While telemedicine is benefiting from liberalization of state regulations, proof of cost savings and consumer acceptance of mobile technologies (plus a surge in investor confidence!), there’s still the hurdle of patient confidence.

Just under 45 percent in this survey are very or somewhat comfortable with a virtual doctor’s appointment. Over 64 percent would not readily choose one over an in-person visit.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/07/Virtual-Diagnosis-by-age.jpg” thumb_width=”300″ /]

When it comes to trusting the diagnosis, almost 75 percent of the 504 respondents either would not trust it at all (29.3 percent) or would trust it less (45 percent). But the ‘would not trust’ sentiment is heavily skewed to those 45+ (left).

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/07/Followup.jpg” thumb_width=”300″ /]

The good news here is that when it comes to follow up with a doctor via telemedicine, the tables turn almost exactly in its favor (left).

The hope is that the last will increase acceptance of the first–and the age trend is telemedicine’s friend. Both bode well for the growth of telemedicine in the near future.

Do Patients Trust Telemedicine? (PDF) (TechnologyAdvice Research/Google Consumer Insights) Also HIT Consultant plus their infographic (hat tip to AliveCor’s David Albert MD via Twitter @DrDave01)

Telemedicine’s 25 things to know better–and Better

July 17, 2015 | by

For those of us who have been Terminology Warriors going back to the oughts (see founder and EIC emeritus Steve Hards’ summary in ‘What is Telecare’), this is a useful summary of not only what is telemedicine and who is authorized to perform it, but also how it is developing (US focus) in state law and reimbursement (private and Medicare). Despite being published earlier this month, it is already dated as reimbursement parity laws have been passed in Connecticut and Delaware [TTA 10 July]. The richly IPO’d Teladoc is omitted on the provider list in point #21; Better is anomalous as it is less telemedicine than a personal health assistance service.  25 things to know about telemedicine (Becker’s Health IT and CIO Review)

About Better: they have joined with Johns Hopkins’ Sibley Memorial Hospital Innovation Hub to provide support for orthopedic episodes of care. These generally are for a 90 day period which extends from scheduling the procedure through post-discharge recovery, and are usually tied into a bundled payment from an insurer or Medicare. Johns Hopkins press release Hat tip to CEO Geoff Clapp.

Telehealth in pediatrics: same statement, two opposing views

July 16, 2015 | by

Telehealth and telemedicine use in pediatrics is relatively limited at present and low profile. That may change with a statement published earlier this month in the journal of the American Academy of Pediatrics (AAP). It has been interpreted in two ways which are polar opposites. The first pictures telehealth and telemedicine as potentially practice-transforming (mHealth Intelligence), improving health outcomes in underserved communities through continuous care, and with high potential to benefit communication between the pediatric care team and patients in disease management. The second criticizes ‘episodic care in isolation’–telemedicine patient-doctor consults that take place with no previous relationship, history or physical exam (mHealth News)--as is the antithesis of the PCMH (patient-centered medical home) the AAP advocates. This Editor’s take: the statement supports both sides with a great deal of cautionary language. Pediatrics (full content).

Payer reimbursement for telehealth, telemedicine gains in Delaware, Connecticut (US)

July 10, 2015 | by

Two states–Connecticut and Delaware–are now requiring private commercial insurers to cover telemedicine and telehealth services at parity with in-person visits. Connecticut was first, signed into law on 22 June but not starting till 1 January 2016. It covers not only video consults but distance care delivered both synchronously and asynchronously, such as store and forward transfers, and covers remote patient monitoring. It specifically omits audio-only consults, email, texting and fax (!). The Connecticut law also requires parity of payment with in-person visits to prevent lower reimbursements. Delaware’s law was signed 7 July to take effect immediately, and based on the summary is similar in breadth to Connecticut’s. Delaware is now the 29th state to enact telehealth/telemedicine reimbursement legislation. Articles written by members of the Foley & Lardner law firm. JD Supra, Lexology

On the Federal front, Representative Mike Thompson (D-CA) and three other members of the House of Representatives introduced H.R. 2948, the Medicare Telehealth Parity Act of 2015. It would remove the current geographic restrictions for telehealth (in the Federal definition including telemedicine), expand services, expand telehealth/RPM for additional chronic conditions and expand home care service into hospice and dialysis. It is a rework of last session’s H.R. 5380 and is at very early days having gone to a Congressional committee. Unfortunately its passage has a snowball-in-July chance with Govtrack.us giving it zero chance of enactment. Rep. Thompson’s website, FierceHealthIT, ATA-Jonathan Linkous support statement.

Previously in TTA: Telehealth reimbursement makes legislative progress in Texas, US House

Michigan school telehealth programme wins award

June 27, 2015 | by

At the start of last year we reported the opening of a student telehealth programme in Michigan. [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/15_ludwig_comm_ben_award.jpg” thumb_width=”150″ /]At the time two clinics were opened in Branch County with the aid of funding from the Michigan Department of Community Health. A school based nurse funded by the programme provides the initial assessment and where necessary a consultation takes place with a physician or nurse practitioner at the Community Health Centre. The school has special assessment equipment that links via Bluetooth to equipment in the paediatric clinic so that the provider can see and hear what the nurse sees and hears.

Eighteen months on, the programme is covering two thousand and seven hundred students in three school districts and has been awarded one of four annual Ludwig Community Benefit Awards from the Michigan Health and Hospital Association according to a WTVB report. The award is presented to healthcare organizations that demonstrate community benefit by improving the health and well-being of their communities through healthcare, economic or social initiatives.

The pileup of Federal ‘titanic serial IT disasters’ (US)

June 26, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/keep-calm-and-secure-your-data-4.png” thumb_width=”150″ /]Don’t feel bad, HIT execs–the Feds are even worse. Complementary to our coverage of the increased danger of hacked health IT systems and data breaches (the trail of tears is here and here) is the oddly muted press clamor around the 4 June hacking report of the Federal Office of Personnel Management (OPM). Chinese hackers roamed around two OPM databases–personnel and security clearances–for nearly a year, according to CNN’s Senate briefing coverage. The breach likely exceeded 18 million records, though the real number may never be known. Privacy Rights Clearinghouse summarizes it and provides an interesting link to a timeline by Brian Krebs, whose independent reporting beat is IT security. Megan McArdle, a reformed IT consultant writing for Bloomberg News and independently, points at the Federal lack of urgency around having adequate IT that doesn’t fail. Example–the much chronicled failure around Healthcare.gov and the so-called health exchanges, which appear to be functioning better, but reports say they are nearly porous and hackable as they were in 2013. She notes that it’s all about ‘scorched-earth determination’ and that the direction has to come from the top, meaning the President. And ‘voters have never held Obama responsible for his administration’s appalling IT record’. A thought that should give those in telehealth and telemedicine who are working with CMS value-based program ACOs a great deal of pause. NY Post editorial via Press Reader.

Telemedicine coordinators help improve user numbers in Queensland

June 11, 2015 | by

The demand for telemedicine services in south western Queensland is reported to have tripled from 8 consultations a month [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/Charleville-hospital.jpg” thumb_width=”150″ /]to about 35-40 following the appointment of coordinators who show patients how to use the service. The Queensland Government media statement issued last week quotes the coordinator at Charleville Hospital as saying 99% of people prefer the service to traveling to see a specialist face to face.

The video link service connects doctors with patients from 2 rural hospitals and one district hospital in south west Queensland. These are relatively small hospitals with 24 to 39 beds and use Flying Doctors to provide some of the facilities such as surgery. Alternative for patients, say in Charleville, could be a 7 hr 620 km drive to Toowoomba or a 8 1/2 hour 750km drive to Brisbane to see a specialist for a 10 minute appointment.

Georgia school telemedicine clinics to access EHRs

June 11, 2015 | by

Georgia Partnership for Telehealth which has telemedicine programs at about 60 schools in Georgia, [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/Georgia-Partnership-for-Telehealth.jpg” thumb_width=”150″ /]has joined the Georgia Health Information Network, the state-wide Health Information Exchange, according to a recent press release. This will enable participating schools to securely exchange healthcare information with more than 3600 Georgia healthcare providers and have access to an immunisation register.
“Our Rural School-Based Telehealth Center Initiative offers a number of benefits to students and families,” Sherrie Williams, Executive Director of GPT is quoted as saying.  “Students receive quality care without having to miss class.  Parents don’t have to leave work and lose wages to take their child to see the doctor. If a specialist visit is needed, it doesn’t require hours in the car to reach a large healthcare center; the child can be examined right from the school clinic.”

Teladoc sued by American Well

June 9, 2015 | by | 1 Comment

American Well has launched a patent infringement case against Teladoc according to a news release yesterday.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/Teladoc-logo.jpg” thumb_width=”150″ /]The 10-page submission to the courts by American Well claims the infringements to be
– accessing a data repository that stores information pertaining to medical service providers including present availability of the medical service providers for participating in a consultation
– receiving in a computer, indications that members of a pool of  medical service providers have become presently available
– receiving in the computer, a request from a consumer of services to consult with a medical service provider
– identifying in the computer, an available member of the pool
– and establishing a real-time communication channel between the consumer of services and the identified member of the pool

This author is wondering who thought this was such a novel technology as to warrant a patent? What were they thinking? Having worked on developing unified messaging systems for a mobile phone operator at the turn of the century (now that’s a scary 15 years ago) I am just picking myself off the floor after reading this.
Surely all these functions are no more than what is in every instant messaging program, dating back to 1990s? Replace the words “medical service provider” by “friends” or “contacts” and “consultation” by “chat” or “call” it seems to me you get … Skype and Face Time and more! If I am missing something I’ll be happy to be put right.

It turns out that Teladoc also noticed something along these lines and told the patent office as much in March, according to Med City News. Not surprisingly American Well hasn’t taken too kindly to that and hence the law suit.

Let’s watch the outcome

Two telemedicine clinics open in Kenya

May 28, 2015 | by

Two telemedicine clinics have been opened in Nairobi and [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/05/kenyatta_hospital.jpg” thumb_width=”150″ /]Machakos, 63 km from Nairobi, in Kenya, according to a report in HIT Consultant. The clinics, based at the Kenyatta National Hospital in Nairobi and the Machakos Level 5 Hospital in Machakos, will provide patients in remote areas the ability to consult cancer specialists at the Kenyatta Hospital using video conferencing.

Both hospitals are state run hospitals and the telemedicine service is being funded by Merck, the international pharmaceutical company.

Merck recently acquired remote cardiac monitoring company eCardio shortly before eCardio merged with remote monitoring device maker Preventice. Previously we reported that Merck invested heavily in WellDoc when WellDoc raised $20m of funding.

Read more about the Merck project in Kenya here.

Undermining the system an unintended consequence of telemedicine?

May 27, 2015 | by | 1 Comment

Telemedicine’s doctor-patient virtual consults may undermine the healthcare system, if Mass General neurologist Dr Lee Schwamm is to be believed from his comments at last week’s iHT2 Health IT Summit in Boston. Urgent care delivered by telemedicine not only commits the mortal sin of siloing data, not ‘doing an adequate job’ of passing to the primary care physician, but attracts dissatisfied doctors who want to set their own hours. And the cardinal sin: telemedicine attracts wealthier patients, paying cash, who by using these services are “…pulling dollars out of the healthcare system that are desperately needed to care for poorer patients.”

Quite a leap of logic here, when his real concern should be quick availability of patient care–not having to wait hours in a doctor’s office or ER/ED because you’re triaged as not bleeding-on-the-floor urgent. Virtual consult rates at least for now also tend to be low–$40-45 per visit–and appealing to those without insurance, not seeing a doctor on a regular basis (no chronic conditions) or anyone with a high deductible. Doctors are still also free, despite Dr Schwamm’s snark, to better utilize their time–and yes, make additional income–through signing on to telemedicine as part of their practice. So is this a lash back on a factor that’s undermining the establishment which Dr Schwamm is part of? Perhaps Dr Schwamm can explain? Stephanie Baum takes a puzzled view over at MedCityNews.

Telemedicine in diabetes management

May 21, 2015 | by

Findings of a new literature analysis of the impact of telemedicine on diabetes management has been published in Telemedicine and e-Health.

The authors, from the University of Michigan and the University of Kentucky,  analysed 73 research publications (selected from a potential 17,000 list) published between 2005 and 2013. They conclude that although the individual research studies varied significantly in, for example, the outcomes measured, there was sufficient evidence to point to the positive effect of telemedicine.

The full paper describes the analysis methodology and gives detailed results and would be of interest to those working in diabetes management as well as those applying telemedicine to other long term conditions.

Indian Health adopting telemedicine in Southern California for diabetes treatment

May 14, 2015 | by

Tribal-owned Riverside-San Bernardino County Indian Health, which serves nine tribes through seven health centers in the ‘Inland Empire’ of California, is adopting telemedicine to reach Native American patients and reduce their rate of diabetes. According to an Indian Health spokesperson, Native Americans constitute the largest diabetic population in the world and are 177 percent more likely to die from the disease. In San Bernardino County alone, 13 percent of adults are diabetic, and nearly 80 percent are overweight or obese. The initial program brought endocrinologists serving other Western tribes in on video consults with doctors in Indian Health clinics. Later rollout of the program will include pulmonology, cardiology, gerontology and dermatology. The market potential for telehealth remote patient monitoring–better information and analytics for clinicians, self-monitoring training and education for patients–could be substantial here for companies willing to invest time, learning and to build relationships. California Healthline. FierceHealth IT