Breaking news – an NHS innovation failure

October 13, 2016 | by | 2 Comments

As a sad indication of the NHS’s – and the UK health & care system in general’s – inability to innovate, v-connect, previously known as Red Embedded, has made the following announcement:

“It is with great regret that we are discontinuing the v-connect service as of the 31st October 2016. I am sure that the reasons will be understandable to you but here is a short summary. The video technology has been in development for more than eleven years. The efforts to commercialise the technology, in care, have been in progress for more than seven. In that time we have developed many features that support people to live independently at home supported by a personalised set of connections and facilities matched to their needs. We were guided by the continual calls for integrated care, personalisation and care closer to  home. We have been somewhat successful in obtaining project and grant funding to facilitate this. (more…)

TTA’s Friday roundup of interesting articles, updates and weekend reads

September 16, 2016 | by

Fitbit may succeed in blocking Jawbone from selling in US? The Jawbone wins [TTA 27 July] in the US International Trade Commission court was apparently reversed due to a judge’s error for two Fitbit patents, and this may open the way for Fitbit to further block Jawbone. An additional California court action on infringement and misappropriation on trade secrets by Jawbone is headed for court in 2017. Mobihealthnews…..Maybe texting is enough? Dr Joseph Kvedar seems to think so for simple medication adherence and reminders, with reasons like the easy scaling of text messaging in EHRs, but prefers installing an app to deliver them due to the downsides of plain text messaging such as HIPAA and security. Thus we return to the logic of the desktop unit days (e.g. Health Buddy, Viterion) but delivered via smartphone. CHealthBlog….550 US primary care docs say no reimbursement, no telehealth (actually telemedicine). Usage in the past year was a scant 15 percent, with higher usage in Federally designated ‘safety net’ clinics (FQHCs) and HMOs versus PCMHs and ACOs where reimbursement by Medicare, Medicaid and private payers is far chancier. The survey was conducted by their association, the American Association of Family Physicians (AAFP). mHealthIntelligence….iHealth Andon Group buys France’s eDevice for $106 million. The aim seems to be integration of eDevice’s backend infrastructure to iHealth’s RPM devices. Mobihealthnews….A analysis of what went wrong at HealthSpot is in the new publication Telehealth & Medicine Today. A summary is that they had a business model that started out on point quite a while ago (2010) but then competitors and fresh technology ate their lunch (Editor’s term). They didn’t pivot to fit, moved too slowly and were overly wedded to their business model. A big problem was scaling costly kiosks and not finding the right places for them. While initially impressive, there was something all too elephantine about HealthSpot from the start. Our Readers interested in a Trip Down Memory Lane may read our collection of articles from 2013 here which pointed out most of the above….In the industry moves department, Peter Radsliff, whom this Editor worked with briefly on AgeTek-The Aging Technology Alliance (apparently defunct), has joined Arrayent, an IoT developer, as VP Marketing. Now that tells us something! Congrats to Peter!

And finally for a good long, but not light, read, this article in The Atlantic will give you a chilling glimpse of front-line medicine attempting to heal the carnage in Syria, using WhatsApp, texts and the simplest forms of telemedicine. A dedicated group of primarily Syrian-American doctors on a WhatsApp volunteer group called Madaya Medical Consultants uses it to perform consults with the minimal medical resources available in Syria. And yes, they know what Aleppo is.

A hybrid telehealth/telemedicine model for health systems

September 9, 2016 | by

Your Editors have been projecting that the Big Future of telecare-telehealth-telemedicine lies in integrating services, not the Big Data backend (though there’s a Big Role there). These three have to be more tightly aligned with health systems, whether ACOs/IDNs (US) or the NHS. Most of our consideration has been where they go at the end of acute care–transitional care (post-discharge/post-acute–those bed-blockers)–but here’s a different approach that puts them at the start of the care continuum. Minneapolis-based Zipnosis [TTA 13 May] has an asynchronous platform that is ‘white labeled’ for a health system and carries their branding. Their model uses pre-screening/assessment first–an ‘adaptive questionnaire’ taken online or on mobile, compiles the information, then depending on the result, returns to the patient to schedule a virtual (video/audio) consult, lab visit or referral to a physician. The smart parts are that this is completely within the the health system and integrates with their EHR, making it reimbursable. It also can be used to expand the patient base even if the care is short term or episodic.

Zipnosis currently has 17 health system clients. The latest is Fairview Health Services in Minneapolis where the system test is first with their 22,000-plus employee workforce. The focus is on early detection of diabetes and heart disease. Also recently announced were two Nebraska health systems, Bryan Health and Memorial Health Care. Somebody likes the model as their Series A back in January was $17 million led by Safeguard Scientifics with participation from Ascension Ventures, the investment arm of Ascension, a large Catholic health system. mHealth Intelligence, Becker’s Health IT, HealthcareITNews,

South Korea’s ambivalence towards telemedicine

August 10, 2016 | by

The surprising reasons why. 5.8 million South Koreans aren’t exactly tech-phobic, enjoying a nationally swift internet backbone and high personal smartphone penetration. The home of the two leading smartphone makers is pioneering mobile-first retailing and a national IoT network. South Korea (SK) also has the need–an aging population living in rural areas. Yet South Korea bans doctor-patient virtual visits in their Medical Act, and expects major demonstrations by doctors and activists when it comes up for a vote later this year in their National Assembly. Telemedicine and also telehealth/RPM may happen eventually, backed by powerhouses like SK Telecom, Samsung and LG, but will have to take into consideration some unique circumstances:

  • Cyberattacks from North Korea, which have already hit a Seoul university hospital’s software security contractor and demonstrated their system’s HIT vulnerabilities
  • The government’s glitch-ridden telemedicine pilot program with serious problems in data management, encryption and weak passwords
  • The fear that only the rich will be able to afford it–and in SK’s split system, the fear that funding may be withdrawn from the extensive network of community clinics instead of benefiting them

Medical professionals, including the 100,000 doctors in the KMA who successfully blocked telemedicine in 2014 and haven’t participated in the pilot program, are calling for “a slower, more collaborative plan of attack that establishes safety protocols and smart regulatory oversight.”  Quartz

Broadband and health in USA

August 5, 2016 | by

The Federal Communications Commission (FCC) has been investigating [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/08/C2H-BroadbandMap_Gaps-America.png” thumb_width=”150″ /]the relationship between broadband and health in the US through their Connect2Health Task Force and this week it has released an online tool “Mapping Broadband Health in America”.
It is an interactive map that allows users to visualise, overlay and analyse broadband and health data at the national, state and county levels.

This tool allows easy access to existing health and broadband access data to anyone who wants to look at the possible influence of broadband access on health over a period of time or to identify gaps which may provide opportunities to develop or expand online health services.

The interactive tool allows the user change the broadband availability measure (by say proportion of coverage or download speed for example) and select a health measure such as say obesity rate or preventable hospitalisation days and shows where the selected broadband measure is satisfied, where the selected health measure is satisfied and where both are satisfied. The types of health measures are currently limited but if users find the tool useful and feedback to the FCC there may well be further expansion.

Have a play with the map here.

Changing care models to connect better with care, age at home

August 3, 2016 | by

While this Editor didn’t get to the second annual d.Health Summit in NYC this past May, the organizers Avi Seidmann, PhD & Ray Dorsey, MD [TTA 20 July] of the University of Rochester have conveniently distilled the day down to a 13-page policy paper on successful aging at home. The keynote speaker set the theme around the core needs of older people:

  • identity (“help me stay me”)
  • routine (“help me stay in control”)
  • sociability (“help me stay engaged”)
  • vitality (“help me stay physically and mentally fit”)

Innovation around healthcare delivery, mobility solutions, assistive technologies that adjust to a wide variety of needs, socialization outlets and home services can improve health and wellness while reducing costs for the healthcare system as a whole.  Impediments are regulatory, interoperability and that old devil, payments. It needs to move to ‘next generational care” where healthcare tech fully becomes an extension of the healthcare system. Can’t come soon enough. Download the PDF here. Also read contributor Sarianne Gruber’s perspectives on the conference in RCM Answers on 18 May and 24 May.

The State of the Connected Patient is a 21-page survey with plenty of bar charts of over 2,000 Americans taken in June by the Harris Poll sponsored by Salesforce, which we’ve noted here is partnering notably with Philips in the HealthSuite digital platform. Analysis is separated by boomers, millennials and Gen X.  62 percent of respondents would be open to some form of ‘virtual care’–and 52 percent of ‘millennials’ would prefer to choose a doctor who uses virtual care tools. Most are content with their primary care doctor, though that doctor may not recognize them in the street. Only a quarter actually keep track of their health records, digital and otherwise. Apps are used, but all age groups are split evenly in using a wearable if an insurance company or provider gave them to wear in exchange for (respectively) lower rates and health information access. Download PDF via EHR Intelligence.

The global ‘state of telehealth’ according to Dr Topol: work in progress

July 20, 2016 | by

Are we approaching a ‘tipping point’ in telehealth and telemedicine within 5 to 10 years? While telemedicine (doctor-patient, hospital-hospital video consults) and even telehealth (patient monitoring generally at home) are becoming more common, Drs Eric Topol and E. Ray Dorsey see the tip coming within the decade in their New England Journal of Medicine (NEJM July, subscription required) article, moving from the early adopters to the majority. But there are still substantial barriers: interstate licensing, fragmented care, spotty state and Federal reimbursement including Medicare, wireless coverage enabling mobile monitoring, the future of the doctor-patient relationship, even the potential for narcotic abuse. They also need to move into the private sector. Somewhat misleading are the 2 million telehealth visits counted by the Veterans Health Administration; it includes the larger programs in store-and-forward information transfer and clinical video consults versus in-home telehealth.

Three trends they see paving the way to ubiquity:

  1. Moving beyond providing access to being driven by convenience and reducing cost
  2. Not just for acute conditions, but for monitoring chronic and episodic conditions (although vital signs monitoring, which is the core meaning of telehealth, has been doing so since the early 2000s)
  3. Migration from hospitals and satellite clinics to in-home and mobile applications

While the two doctors caution on risks, including breaches, they see telemedicine and telehealth increasing the delivery of care in the next ten years and spreading globally. Healthcare Informatics, Qmed

Avizia talks Telemedicine Down Under

July 20, 2016 | by

Telemedicine startup Avizia, which revealed last week its $11 million Series A fund raise, has been promoting itself through a webinar series. Unusually for a US company, it has presented panels discussing telemedicine in Canada and this month, Australia. (It also has operations ex-US in Australia and UK, and was a sponsor of SFT-15 in Brisbane last November.) The panelists were Dr. Victoria Wade (University of Adelaide), Dr Anthony Smith (University of Queensland) and Dr Sisiri Edirippulige (Queensland). Topics discussed in the hour webinar were:

  • Aging population with increased rates of chronic diseases
  • Density of care providers in urban areas, but 1/3 of the Australian population lives in rural communities
  • Government funding for telehealth video consultations
  • Incentives to expand or develop new telehealth programs
  • Increased familiarization with the technology; expectations are changing on how to obtain care

The recorded webinar is available here.

Ka-ching! $61 million to telemedicine’s Teladoc, Avizia

July 16, 2016 | by

Two ends of the spectrum. Teladoc, now reputed to be the largest telemedicine company in the US, can now access $50 million in new capital via a $25 million term loan and a $25 million revolving line of credit from Silicon Valley Bank. This is just after announcing the purchase of mobile-app-based physician locator HealthiestYou in a $125 million deal ($45 million in cash + 6.96 million shares of its common stock valued at $80 million.) Teladoc has been on a roll since 2008, with $245 million in funding up through 2015 (Accenture).

Telemedicine startup Avizia, on the other hand, closed a healthy $11 million Series A round from Blue Heron Capital (as lead–CrunchBase) and then announced a partnership with video provider Vidyo to be compatible with their addressable video platform. From a start in telemedicine carts, Avizia now has new apps for mobile devices and secure messaging for doctors within hospitals. Modern Healthcare, MedCityNews

Telemedicine, telehealth and ‘Healthy India’

July 12, 2016 | by

While we in the West and much of Asia/Pacific can parse the differences in wearables, tablets vs. smartphones and debate the accuracy of EHRs, far simpler issues dominate the application of health tech in places like India. Some are familiar–connectivity and preconceived notions of staff acceptance–and others are familiar to those of us who work in developing countries, such as interrupted power and a lack of trained people. Telemedicine and the reading of vital signs in telehealth has been part of the Indian scene for years–16 according to the article–but only in the past three years have remote consults been used more frequently. In the past year, over 100 patients have been saved by telehealth centers at two locations operated by Apollo TeleHealth in Himachal Pradesh, a province where the average patient travels up to 50 km for primary care and 250 km for secondary care. It is state-subsidized in a public-private partnership, but Apollo is already tracking over 15 months 3,000 teleconsults, providing emergency care to at least 200 people and saving Rs 15 lakh ($22,400 or £17,100).

The greatest impediment, according to the joint managing director of Apollo Hospitals Enterprise Limited (and the author), is the resistance to change–a familiar one. Telehealth services: A prescription of technology that saves lives, saves costs (Hindustan Times)

Aarogya Bharat, or Healthy India, is a ‘roadmap’ to enable India’s growth and prosperity by improving health for India’s population. Most Indians pay out of pocket, (more…)

A ‘next generation’ house call from the patient’s perspective

July 10, 2016 | by

Guest editor Sarianne Gruber (@subtleimpact) attended May’s d.health Summit on Aging in NYC. She reflects on moderator Christina Farr’s (immediately prior) direct experience with a virtual visit (convenience, proactive care–and utter frustration with her payer) and what the telemedicine ‘next gen’ provider panelists see as their advantages in fixing a fractured healthcare system.

Christina Farr had a “Next Generation” house call for the first time. The on-demand doctor’s visit provided her care and resolved the possibility of a trip to the emergency room, and best of all she felt great. Ms. Farr, an award-winning health and technology journalist, happen to have had her encounter just days prior to the d.Health Summit. Coincidentally, she was to be the moderator for a panel of prominent telehealth business leaders on this very topic. Curious after having had this experience, she wanted to know whether most cases were like hers wondering if they should go to ER, or were the visits more for routine things like coughs and colds, or did people just want a prescription. The d.Health panelists included Damian Gilbert, Founder & CEO of TouchCare (@touchcarehealth), Oscar Salazar, Chief Product Officer and Co- Founder of Pager (@getpager), Dr. Ian Tong, Chief Medical Officer of Doctor on Demand (@drondemand), and Dr. Roy Schoenberg, Co-Founder, and CEO of American Well (@americanwell).  (more…)

2016 International Conference on Successes and Failures in Telehealth (NZ)

June 29, 2016 | by

31 Oct-3 Nov 2016, SKYCITY Convention Centre, Auckland New Zealand

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/HiNZ16_SFT16_AUCKLAND_1000_x-1.jpg” thumb_width=”100″ /]Hurry if you want to submit your abstract! The 7th Annual Meeting of the Australasian Telehealth Society (SFT-16) is actually a 4-in-one conference, held concurrently with the Global Telehealth Conference (GT 2016), the Health Informatics New Zealand Conference (HiNZ 2016), and the NZ Nursing Informatics Conference (NZNIC-16). Delegates register for one, and can attend any session in the four conferences. Topics for SFT-16 include telehealth in Australia and New Zealand, the future of clinical telehealth, the telehealth business and the state of evidence. Abstracts in the categories of scientific papers and case studies are still being accepted through Monday 4 July midnight NZ time, and according to HiNZ’s Twitter feed, extensions are available by emailing ceo@hinz.org.nz . It’s also supported by organizations including American Telemedicine Association (ATA, a TTA media partner), the University of Queensland and the International Society for Telemedicine and e-Health (ISfTeH). Registration appears not to be up yet. Website

Telemedicine finally gets some respect: WSJ

June 28, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/06/long-windy-road.jpg” thumb_width=”250″ /]Telemedicine consults between doctors and with their patients are, at long last, progressing on the Long And Winding Road, according to this sizable recap in the Life and Health section of this weekend’s Wall Street Journal. The focus is on virtual visit growth in the US, but it opens with Doctors Without Borders (MSF) connecting their doctors in Africa with their specialist network worldwide. Mercy Health provides 24/7 ICU/ER support for 38 local hospitals out of a Virtual Care Center outside St. Louis manned by ICU specialists. Their results? A 35 percent decrease in patients’ average length of stay and 30 percent fewer deaths than anticipated. The important statistics here are on acceptance: 72 percent of hospitals and 52 percent of practices are finally integrating some form of telemedicine into care; 74 percent of large employers are covering telemedicine cost–yet awareness is still lagging among prospective patients, with only 39 percent familiar with it according to a recent survey. Challenges remain in reimbursement (more…)

The difficulty in differentiating telemedicine and telehealth

June 15, 2016 | by

Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.

Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence

Telemedicine device wins Africa Prize for Engineering Innovation

June 1, 2016 | by

A telemedicine invention called Cardio Pad developed by an engineer from Cameroon has been selected as the winning entry for [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/05/Cardio-Pad-2.jpg” thumb_width=”150″ /]the 2016 Africa Prize for Engineering Innovation, according to news reports  (BBC, Forbes, TechTrends, Business in Cameroon).

The winner, 24-year-old Arthur Zang (pictured with a Cardio Pad), who won the £25,000 ($37,000) on offer from the Royal Academy of Engineering in the UK,  was awarded his prize at a ceremony in Dar es Salaam, Tanzania, on the 26th of May, 2016. Zang previously won a Rolex Award for Enterprise in 2014 for the device. (more…)

Are virtual visits consistent and effective? JAMA-published study raises doubts.

May 13, 2016 | by

A medical/health policy team from University of California-San Francisco (UCSF) studied virtual telemedicine visits and found a “significant variation in quality.” Over a year, 67 trained standardized patients over 599 visits presented their symptoms to the eight largest telemedicine (video and phone) providers (not named in the abstract). Their illnesses were common and acute: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain and recurrent female urinary tract infection. Based on their metrics, histories and physical exams were completed only 70 percent of the time; key management decisions adhered to accepted guidelines 54 percent of the time. Rates of guideline-adherent care (best practices) ranged from 206 visits (34.4 percent) to 396 visits (66.1 percent) across the eight websites. Wide variations were also found in diagnosis of pharyngitis and acute rhinosinusitis, with clinicians adhering to guidelines anywhere from 12.8 percent to 82.1 percent of the time. JAMA Internal Medicine, May issue, published online 4 April: Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits (abstract only without subscription)

The type of telemedicine they studied were the typical live, real-time video appointments. Another ‘virtual care platform’ provider, Zipnosis, offers a contrasting way. They claim that the live simulacrum of the in-person appointment is lacking, and what’s needed is an asynchronous approach–‘store-and-forward’ information in what they call an “online structured, adaptive interview” integrated with health systems’ services.

In preview information released to press and as a letter to JAMA just prior to the start of the American Telemedicine Association’s (ATA) annual meeting, Zipnosis offered its own, far more positive study. Their review of 1,760 patient encounters (more…)