Rounding up August’s end: ‘blended’ mental healthcare, Army’s telehealth innovation, Montefiore’s 300% ROI on social determinants, telehealth needs compliance

[grow_thumb image=”” thumb_width=”NaN” /]Our UK readers have the summer bank holiday in the rearview mirror, and our US readers are looking forward to a break over next Monday’s Labor Day holiday in the US. It’s sadly the end of the traditional summer season, though Summer, The Season lingers on for a few precious more weeks.

Here are some short takes on items of interest over the past month:

Blended care–eHealth and direct clinician care–for mental health. The NHS has been promoting online webcam and instant messaging appointments as an alternative to ease pressure and waiting times for mental health patients, but the evidence that they are effective on their own is scant. Blending digital health with F2F clinical care may be the way to go. This Digital Health News explores how the two could work together and still save time and money.

Army testing telemedicine and remote monitoring for triage. The US Army’s MEDHUB is designed to streamline communication flow between patients, medics and receiving field hospitals.  MEDHUB–Medical Hands-free Unified Broadcast–uses wearable sensors, accelerometers, and other FDA-cleared technology to collect, store, and transmit de-identified patient data from a device to a medical facility, allowing clinicians to better prepare for inbound patients and more promptly deliver appropriate treatment. The 44th Medical Brigade and Womack Army Medical Center at Fort Bragg, North Carolina have already volunteered to test the system. MEDHUB was developed by two subordinate organizations within the US Army Medical Research and Materiel Command. Army release, Mobihealthnews 

Soldier, don’t take your health tracker to the front. Or even the rear. Deployed US Army soldiers have been told to leave at home their wearable trackers or smartphone apps, government issued or otherwise, that have geolocation capability. Turns out they are trackable and heat mappable–in other words, these trackers and apps can tell you where you are. (And don’t use Google either). Mobihealthnews

Social determinants of health part of Montefiore Health System’s approach to reducing emergency room visits and unnecessary hospitalizations.  Montefiore, based in the Bronx and lower Westchester, invested in housing for the homeless through their Housing at Risk Alert System. The system noticed through their analytics that the issue was housing. Many of their ‘frequent flyers’ cycled between shelters and the ER (ED). Oncology patients were at risk for eviction. Montefiore acquired respite housing (160 days) and housing units for up to a year through organizations such as Comunilife. They claim a 300 percent return on investment. Healthcare Finance

Telehealth needs compliance health. A study from Manatt Health, a division of law firm Manatt, Phelps & Phillips, LLP, presents what readers already know–the inconsistent statutes, regulations and guidance various states are implementing around the provision of telehealth services points out the growing need for compliance assistance. Manatt Health Update (blog) 

Congressional investigation confirms NFL attempted to influence concussion, CTE research

Not shocking to our Readers. In December, sports network ESPN reported that the National Football League (NFL) refused to fund research on detecting in vivo chronic traumatic encephalopathy (CTE) from a long-term $30 million unrestricted grant to the National Institutes of Health (NIH) [TTA 23 Dec 15]. A 91-page report by Democratic members of the House Committee on Energy and Commerce, which started after the December reports, confirmed that the NFL improperly attempted to shape the research after the grant, violating NIH peer-review process policies that stipulated no grantor interference. The NFL specifically objected to the objectivity of Boston University’s Robert Stern, MD heading up the $16 million project before the award in 2015, then tried to redirect the money, so to speak, in-house–to a group including Dr. Richard Ellenbogen, a member of the league’s panel on brain injuries and their bid for the project. Ultimately, the NFL withdrew the funding from the NIH, which went ahead with it. The project was awarded to BU, the Cleveland Clinic, Banner Alzheimer’s Institute (Arizona) and Brigham and Women’s Hospital in Boston.

The Congressional report’s six major conclusions were highly critical of the NFL in several ways and also scored the Foundation for the NIH for not acting as a ‘buffer’:

  1. The NFL improperly attempted to influence the grant selection process at NIH.
  2. The NFL’s Head, Neck and Spine Committee members played an inappropriate role in attempting to influence the outcome of the grant selection process.
  3. The NFL’s rationalization that the Boston University study did not match their request for a longitudinal study is unfounded.
  4. FNIH (Foundation for the NIH) did not adequately fulfill its role of serving as an intermediary betweenNIH and the NFL.
  5. NIH leadership maintained the integrity of the science and the grant review process.
  6. The NFL did not carry out its commitment to respect the science and prioritize health and safety.

When the grants were announced in September 2012 [TTA 7 Sept 12], there was great cheer that finally the NFL had decided that denial was, to use the old joke, a river in Egypt, and to do something about it. This also followed Army research on TBI being supported by the NFL. The first indicator that the funds were going elsewhere, as we noted a year later, was that a year later the Sports and Health Research Program (SHRP) funds were going to other medical problems like joint diseases and sickle cell anemia. While worthy, it had not been the prime publicized objective of the funds. The Congressional committee report also details how the NFL tried to steer the research away from Dr Stern, one of the leading researchers in the field, citing his support of players who refused to accept the CTE settlement in 2014. Beyond the NFL, research on CTE and concussion will impact any contact sports as well as the military and other head traumas. This Editor has previously reported on Dr Stern’s CTE research presentations in NYC and from other researchers in the field; search on NFL and Dr Stern both in current index and the back file. Congressional report,, New York Times.

Smartphone and sensors the latest ‘medic’ for diagnosing battlefield TBI

[grow_thumb image=”” thumb_width=”150″ /]Finally a more reliable device for combat medics to screen for TBI in the field. The US Department of Defense, before its EHR bombshell (so to speak) yesterday, issued this short Armed With Science article on a sensor-smartphone for quick field diagnosis of TBI. The FDA-cleared BrainScope Ahead 200 marries an Android smartphone with a headset and disposable sensors to measure brain electrical activity, The app in the smartphone then analyses the brain data using algorithms to correlate them to elements relating to TBI. Currently, most combat-related TBI tests are subjective, based purely on symptoms such as headaches, nausea and light sensitivity. The only ‘objective’ test would be a CT scan in a medical facility well off the front lines, which means time wasted in a definitive diagnosis. This is being implemented by the Army Medical Research and Materiel Command at Fort Detrick, Maryland.

Really big data analytics enlisted to fight soldier suicide (US)

Suicides by US active duty soldiers have more than doubled since 2001, according to a January Pentagon report, and current prevention programs have not been that effective in reducing the over 200 reported suicides per year. Enter a huge database program called STARRS–Army Study to Assess Risk and Resilience in Service–to identify risk factors for soldiers’ mental health. The US Army not only likes acronyms, but also never does anything small–a five-year, $65 million program analyzing 1.1 billion data records from 1.6 million soldiers drawn from 39 Army and Defense Department databases. Researchers are looking at tens of thousands of neuro-cognitive assessments, 43,000 blood samples, more than 100,000 surveys, hospital records, criminal records, previous risk studies, family and job histories plus combat logs. The study, also using resources from the National Institute of Mental Health, the University of Michigan and other educational institutions, will conclude this June–and researchers are now wrestling with the privacy and moral consequences of responsibly using this data for health and in leadership. NextGov

Testing the ‘blast response’ of synthetic bone

While protection against concussive and sub-concussive head blows that lead to brain trauma (TBI) and may lead long-term to chronic traumatic encephalopathy (CTE) is being developed in several areas, by DARPA, US Army research, universities and the NFL‘s helmet providers, the final test has to involve cranial bone similar to those belonging to 20-30 year olds. Testing on humans is out of the question, deceased animal and older human crania are dissimilar and surgical implants do not react like real bone.  The US Army Research Laboratory (ARL) along with university partners are developing synthetic cranial bone that behaves like real 20-30 year old bone when subjected to combat-intensity blasts, for testing devices to mitigate the adverse effects and/or track the effects of those blasts.  Armed With Science

US Army mCare app’s most-liked feature: appointment reminders

A two-year study on the mCare mobile messaging app used to support ‘Wounded Warriors’, published in the June issue of Telemedicine and e-Health, found that the most popular use of this US Army-implemented program was the appointment reminders (85 percent). 70 percent continued app usage for six months, with the same percentage using it multiple times per week, making the app very ‘sticky’. Other features were wellness tips, care team reminders, care team messaging and announcements. Average participation was 48 weeks. ‘My Appointments’ was created about halfway through the study (January 2010) and other rolling changes were made. The regional US Army Community-Based Warrior Transition Units (CBWTU), which coordinate care for soldiers who receive outpatient care in civilian facilities due to distance from military facilities (and Guard/Reserve status), enrolled 497 veterans in five states who required at least six months of complex care. Satisfaction was high, with 78 percent of soldiers stating that mCare improved their experience in the transition unit, and half of the 75 care teams reporting that they saw an improvement in appointment attendance among patients using mCare.  The results are strong and mCare continues to be used by the Army. The study was headed by Col. Ronald K. Poropatich, MD, Deputy Director of the Telemedicine & Advanced Technology Research Center (TATRC).

Unlike most other research studies, this one had some unusual hurdles to overcome. There were significant changes in ownership of mCare’s contracting company during the main study period (May 2009-April 2011, with a follow on study completed December 2012). First developed by AllOne Mobile [TTA 20 Nov 2009] with security provided by partly-owned Diversinet, AllOne ‘zeroed out’ of business halfway through the study [TTA 20 April 2010], with Diversinet picking up the program after a legal wrangle. mCare was named one of the US Army’s ‘Greatest Inventions’ in September 2011. Diversinet itself, after a seemingly successful period having its MobiSecure platform adopted by AirStrip [TTA 24 Feb 2012], a five-year, $5 million Canadian distribution deal [TTA 14 Jan 2011] and continuing military contracts, could not pull itself into financial health and was acquired by ‘velocity of big’ IMS Health for a small $3.5 million last AugustAdditional study coverage in Mobihealthnews and iHealthBeat.

Robotic leg prosthesis controlled by thigh muscles

An experimental prosthesis which redirects the nerves from the thigh muscle to a lower robotic leg, and translates them into knee and ankle movements, is a major advance that makes the prosthesis more like a natural leg in walking and navigating stairs. According to MedPageToday, “the system links nerves in the thigh — including some for missing muscles in the lower limb — to a processor that decodes the signals and guides the motion of the prosthesis.”  The nerve data helps to eliminate mechanical errors that can cause falling. The robotic leg is being developed with an $8 million grant from the US Army (more…)

‘For realsie’ take 2: DARPA seeking Warrior Web ‘super suit’ (US)

[grow_thumb image=”×283.jpg” thumb_width=”175″ /]The US Defense Advanced Research Projects Agency (DARPA) continues its work on its version of an exoskeleton, called previously a ‘mech suit’ and in this article a ‘super suit’, to ease the load on soldiers who routinely carry 80-100lbs in the field and rough terrain. They are now up to ‘Web Task B’ which pulls together the ‘Task A’ components into a prototype ‘fully integrated undersuit system’ that ‘significantly boosts endurance, carrying capacity and overall soldier effectiveness—all while using no more than 100 watts of power.’ (Concept at left, DARPA photo)  Proposals can be in one or more of five areas specified. Proposer’s Day was today, but information is here and proposals are due by 4 October. Hey DARPA! Where’s My Super Suit? (Armed With Science) Previously in TTA: ‘Warrior Web’ becoming a ‘for realsie thing’ [11 June]