A question for our readers: what does it take for health tech to cross borders well?

July 26, 2013 | by | 1 Comment

In considering the culture gap surrounding Telefónica’s stumble down the pit with O2–and other projects they had that didn’t cross borders well–this Editor thought it worthwhile to ask our readers, particularly our new ones, to kick off a conversation in Comments about this observation. There seem to be national barriers in health tech. Why?

What are the factors that enable health tech companies to cross borders and be successful?

This is not a comprehensive survey by any means, but in your Editor’s experience, it appears that most health tech innovation by smaller companies stays in the country of design. When it is purchased by a multi-national organization, cautiousness takes hold. Much of the liveliness of PERS market leader Lifeline has dimmed since Philips acquired it about 2008, (more…)

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…)

Telemedicine in rural parts of developing countries

July 21, 2013 | by | 1 Comment

Implementing “telemedicine” in developing countries is one way to spread the availability of healthcare to the poor in remote rural areas, says an article in Unite for Sight.

Without access to advanced laboratories, healthcare workers rely on evaluating symptoms to diagnose illnesses. Even then, the shortage of trained healthcare workers, particularly in rural areas, means alternative approaches are often needed. Telemedicine in this scenario is often limited to telephone consultations with specialist consultants and image and data exchange using the internet.

The unavailability of widespread basic infrastructure is however a limiting factor – creating a new “digital divide”.

Read more about the problems surrounding getting healthcare to the poor in developing countries at Healthcare Technology in Resource-poor settings and the Guardian article Getting medicines to the poor: solving the logistics challenge.

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…)

Connecting mental health specialists with rural community health providers (US)

June 21, 2013 | by

A cheering development out of New Mexico is that the GE Foundation is granting $4.6 million to the University of New Mexico Health Sciences Center in Albuquerque to expand its Project ECHO (Extension for Community Healthcare Outcomes) to increase mental health expertise delivered by eight selected community health centers. In this mainly rural state, there is nearly nil access to mental health and addiction services in many areas. This model of telemedicine consults between specialists and primary care providers in these centers started with treatment for hepatitis C. Unfortunately, the telemedicine consults do not extend directly to the patient. Project Expands Reach of Mental Health Providers  Hat tip to reader Ellen Fink-Samnick of Ellen’s Ethical Lens.

Staying up at night with telemedicine (and telehealth)

June 19, 2013 | by | 1 Comment

Our readers have many things which keep them up at night, including that extra taco, but René Quashie of leading healthcare/life sciences law firm Epstein Becker Green adds a few more to the list. While muddling telemedicine (remote consults) with telehealth (vital signs tracking and monitoring), he outlines the legal pitfalls (and consequences) that both are facing: non-compliance with state prescribing and licensure laws (physical examination requirements); lack of highly developed protocols and guidelines (liability exposure); lack of greater coverage and reimbursement by payers (low credibility=low/no pay); HIPAA compliance in privacy and security (lack of protection against unauthorized data access). However, how many of these have already experienced accomodation by state regulators, or have started to modify to follow regulations?  Awake yet? This is only Part 1. Things That Should Keep the Telehealth Community Awake at Night (Part 1) (TechHealth Perspectives/EBG blog) Hat tip to reader Ellen Fink-Samnick of Ellen’s Ethical Lens.

Health tech used more by urban affluent (US)

June 18, 2013 | by

A report by the US Commerce Department’s National Telecommunications and Information Administration confirms what most of us already have assumed–that telemedicine and telehealth’s early adopters are both urban (8 percent versus 4 percent rural) and with household income above $100,000 (11 percent versus 4 percent with $25,000 or less income). The usage sampled in the study of 53,000 households in July 2011 looked at the 7 percent who go online (via PC or increasingly smartphone) to access medical records,  engage in video conferencing with a health care provider (telemedicine) or participate in remote procedures, such as heart rate monitoring (telehealth). Ethnic differences are not great but notable:  “Asian-American internet users were significantly more likely to use telemedicine than other ethnics groups, but the differences between whites, blacks and Hispanics is minimal, with white utilization at 7 percent and black and Hispanic participation at 6 percent.” iHealthBeat, Clinical Innovation + Technology overviews; USDOC study (PDF)

Saypage Telehealth introduced at West Suffolk Hospital (UK)

June 4, 2013 | by

When this editor worked for the NHS in West Suffolk – long, long ago – my colleagues and I always denied the saying that West Suffolk was ‘the graveyard of ambition’, and we pointed to numerous innovations that we introduced without fanfare into our various fields. So it is pleasing to see that the tradition appears to be continuing. The following press release describes the introduction of a hospital-to-home internet-based video link system to reduce the need for some orthopaedic patients to attend hospital to receive post-operative follow-up consultations. Significantly, it appears to be a development championed by an enthusiastic hospital consultant. We have seen over and over again that technological solutions to care pathway problems work best when they are adopted from the ground up. West Suffolk NHS Foundation Trust Launches Virtual Orthopaedics Outpatients Clinic Built On Saypage Telemedicine Platform. (Saypage press release) [Will the people who use the system be counted towards the 3millionlives (3ML) target? Oh! Silly me! No one is counting anything, and it’s an aspiration, not a target!]

Related links: What is Saypage Telehealth? and Saypage User Guide.

Med-e-Tel 2013 presentations available

May 17, 2013 | by

Copies of the presentations at Med-e-Tel 2013 (10-12 April 2013) are now available. Click on the ‘full presentation’ links to access the presentations. The Med-e-Tel Knowledge Resource Center also still contains the presentations from previous events (2002-2012). You can access the Resource Center here.

The Med-e-Tel 2013 proceedings, published as Global Telemedicine and eHealth Updates – Knowledge Resources, Vol. 6, 2013 (610 pages) are now also available for purchase. It contains 133 short papers of presentations that were submitted for the Med-e-Tel 2013 conference program. To order a copy contact info@medetel.eu.

Apps that put you on the couch

May 11, 2013 | by

Despite the light tone of this Editor’s headline, telepsychiatry and telementalhealth or ‘mood’ apps aren’t frivolous in the least. The US Department of Defense (DOD) National Center for Telehealth and Technology (T2) T2 Mood Tracker and BioZen are two smartphone apps for biotherapeutic feedback [TTA 14 Feb]. Virtual consults are also not brand new–but controversial, as some have used Skype which the TeleMental Health Institute in a recent Psychiatric News article has scored on privacy (as in no).  Four new entrants are taking a different approach, with different models and HIPAA-compliant video consults.

  • TalkSession is first establishing itself as an authority for providers via an online forum and digital magazine–then as a booking source for online therapy.
  • Talktala is hosting online chats and forums moderated by therapists, and for more advanced services will charge users a $30/month subscription fee.
  • iCouch allows users to search for therapists, and then via computer or iPhone visit online through the site’s HIPAA-compliant system. Interestingly 30-40 percent of its current client base is international and has 165 therapists worldwide. (International visits are an interesting loophole in practice.)
  • Breakthrough is only for California residents at present, but plans to expand to Texas and other states. Patients again connect with a network of certified mental health professionals and conduct appointments via chat, email, phone or HIPAA-compliant video. Unlike the others, it has gained insurance coverage for its therapists’ services, shows real-time therapist availability and plans to enable on-demand, off-hour services.

Web therapy: 4 startups overcoming mental health taboos with technology (GigaOm)  Hat tip to David E. Albert, M.D. of AliveCor.

ROI in telemedicine and telehealth? Outlook unclear.

May 10, 2013 | by | 2 Comments

ATA 2013’s final ‘industry executive session’, presented at the late hour when most attendees are daydreaming about a comfy chair and a solid drink, tackled one of the thornier underlying questions beleaguering health tech: return on investment (ROI). Providers want hard numbers, but even that definition is…indefinite. Is it data? Is it outcomes? Is it savings? Is it reduction in spending? For two systems or populations, it can be reducing 30-day same cause readmissions for one provider or improved outcomes in home care for another, and the results are not analogous nor even cause-and-effect. As Eric Wicklund from mHIMSS put it, “that’s the challenge, and it was the primary focus of this year’s ATA conference. The pilots are gone, the possibilities and proposals are old. It’s time to target the telemedicine and mHealth programs that are working and to explain why they are…” As GlobalMed’s Roger Downey less delicately put it, “It’s like pinning Jell-O to a wall”–but getting specific as to what should be done in the market helps. Not quite as blithe as the headline. ROI? To some of the industry’s top vendors, that’s just three letters.

Of course, EHR implementation continues to be the Rodney Dangerfield of health tech, with HITECH Act ‘Meaningful Use’ interoperability goals and patient platforms only spottily achieved despite years of generous past, present and future incentive payments. Yet one ATA presenter seriously advocated the addition of telehealth/telemedicine to MU standards, recommended that Health and Human Services become the authority and to add panels for Federal standards and policy in telemedicine as there are for health IT. Adding telehealth and telemedicine to the MU scramble will surely speed implementation ;-) (See above) Why not MU for telemedicine? (HealthcareITNews)

Telemedicine advances in Latin America

May 7, 2013 | by

Some welcome news out of the ATA 2013 meeting are the advances that telemedicine is making in Latin America and the Caribbean. Honored at ATA’s Sunday session were Jennifer Lopez and her eponymous family foundation for funding telemedicine outreach in Puerto Rico and Panama via the Children’s Hospital of Los Angeles (CHLA). In Puerto Rico, the work is concentrating on pediatrics genetics, and a monthly clinic that counsels four families per session. In Panama, the emphasis is on extending pediatric care beyond Panama City to the low-serve country areas through Panama City’s three major hospitals. The point is that the Lopez Family Foundation is only the start in the region, and that other healthcare providers and funding entities should be joining in kicking off development (Telefónica should be noting) HealthcareITNews

HealthSpot, Netsmart ally for telemedicine kiosks

May 7, 2013 | by

HealthSpot, which debuted its staffed telemedicine/telehealth Stations at CES 2013 (and this Editor previewed at CES New York in November), is partnering with behavioral health EHR/practice/clinical case management software provider Netsmart to add that capability to its kiosk consults. Announced at ATA yesterday, the MedCityNews article is sketchy on exactly how this will be integrated–will it be an option or will select kiosks be dedicated to behavioral health only–but this is likely a first for telementalhealth (another term in our lexicon!) Kiosk placements can be especially useful in rural areas which have a paucity of mental health/psychiatric providers (see TTA on Forefront TeleCare’s ATA announcement). It also follows this year’s ATA theme of telemedicine to more effectively serve rural US areas. HealthSpot also announced a pilot with Nationwide Children’s Hospital in its hometown of Columbus, Ohio; their CEO claims it has orders for 150 units in hand for its now three health system partners. Surprisingly, as of April they are already at Series C funding with a $10.4 million financing (of a $20 million offering) from giant Cardinal Health and other private investors.

NHS telemedicine system for strokes hailed a success

May 6, 2013 | by | 1 Comment

A few weeks late in the posting, but relevant to the telemedicine collaboration issues raised by Professor James Barlow’s report from the ATA 2013: Over the last 18 months a telemedicine system set up to help stroke patients by the NHS Cumbria & Lancashire Cardiac and Stroke Network (CSNLC) has provided 24-hour access to thrombolysis treatment from remote specialists. The telestroke network serves eight hospitals that serve a population of 2.2 million. NHS telemedicine system for strokes hailed as a success (ComputerWorld) Heads-up thanks to Alistair Hodgson.

Surgical telemonitoring – the next milestone for telemedicine?

May 6, 2013 | by

The first in a series of real-time reports from American Telemedicine Association annual conference in Austin, Texas, by James Barlow, Imperial College London.

The ATA conference has just included an interesting session on surgery as the next milestone for telemedicine. While telesurgey has long been an area of interest in remote care, pressures in the health system and developments in technology are combining to create new opportunities for supporting surgeons in their work. But many of the familiar implementation challenges are also looming large. So what were the reflections from the panel and discussion?

The consensus was that we need to shift the state of the art in operating room practices from considering volume and quality to broader notions of ‘value’ embracing cost, quality and access. Hospitals will be increasingly rewarded on outcomes and patient satisfaction, and telesurgery potentially helps improve both.

Two kinds of broad telesurgery model are envisaged – the expert surgeon ‘broadcast’ their operations to a wide audience and a more 1:1 relationship where the expert is remotely located and provides support for a specific operation. The ‘new telesurgery’ will involve three things.

  1. Just phoning another surgeon for advice in the middle of an operation is no longer good enough. There will be much more collaboration between surgeons, using new collaborative tools for bringing people together at a distance. The possibility of virtual environments around the operating room is already here and should be widely embraced.
  2. Large peer-supported integrated surgery networks will emerge with surgeons paid for the time they spend providing advice or moderating discussions. Spending 10% of your time mentoring other surgeons – perhaps around the world – will become part of the norm.
  3. A pool of recognised expert mentors will develop. Mentors can be ‘in the room’ virtually during the procedure. Or they can be invited to participate in situations where there is an ‘index case’ – a rarely encountered procedure – where the pool of knowledge is spread thinly.

All this is going to clash with the inherent conservatism of surgeons and their unwillingness to change tried and trusted approaches and technologies. The big challenges for moving forward in telesurgery are:

  1. ‘Network effects’ need to kick in – there has to be a critical mass of users and installed technology to generate the biggest benefits.
  2. Inevitably there are incompatibilities in technical standards for data transfer.
  3. The focus so far has been on audio and video, but integrating patient data into telesurgery and back into patient record systems is also essential.
  4. Tools for virtual collaboration are rapidly developing, allowing crystal clear video, remote access to laparoscopic images, virtual laser pointers, and doing all this on tablets. These need to be made widely available.
  5. Reimbursement and business models – who pays for what? Can we find ways of reimbursing hospitals / surgeons providing experts? How do we schedule expert mentor time and build this into their contracts?
  6. Medico-legal. There are cross border (or cross state issues here in the US) licensing issues and big problems of responsibilities in the event of problems arising in a telesurgery procedure.

Other reports by James Barlow.