In 2012 there was estimated to be 308,000 patients remotely monitored by their healthcare provider for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension and mental health conditions worldwide. The majority of these were post-acute patients who have been hospitalised and discharged.
As healthcare providers seek to reduce readmission rates and track disease progression, telehealth is projected to reach 1.8 million patients worldwide by 2017, according to The World Market for Telehealth – An Analysis of Demand Dynamics – 2012, a new report from InMedica, part of Wall street-quoted IHS.
In addition to post-acute patients, telehealth is also used to monitor ambulatory patients – those who have been diagnosed with a disease at an ambulatory care facility but have not been hospitalised.
However, telehealth has a much larger penetration in post-acute care as compared to ambulatory care patients as the majority of patients are only considered for home monitoring following hospital discharge to prevent readmission.
In the US, for example, 140,000 post-acute patients were estimated to have been monitored by telehealth in 2012, as compared to 80,000 ambulatory patients.
Theo Ahadome, senior analyst at InMedica, told Business Weekly: “A major challenge for telehealth is for it to reach the wider population of ambulatory care patients. However, the clinical and economic outcomes for telehealth are more established for post-acute care patients. Indeed, even for post-acute care patients, telehealth is usually prescribed only in the most severe cases, and where patients have been hospitalised more than once in a year.”
CHF currently accounts for the majority of telehealth patients; in addition to being one of the largest cost-burdens for hospitalisation, the clinical outcomes of telehealth for CHF patients are most established.
The number of telehealth patients with COPD is also projected to grow strongly as telehealth focus continues to expand to respiratory diseases. The successful results of the Whole System Demonstrator (WSD) program in the UK are serving as strong evidence-base for the benefits of telehealth for COPD patients.
However, by 2017, diabetes is forecast to account for the second largest share of telehealth patients, overtaking COPD. Home monitoring of glucose levels for diabetes patients is more established through personal glucose monitors. There is an increasing drive to integrate these monitors with telehealth systems, allowing care givers access to patient glucose data.
Over the next five years, InMedica identifies four main drivers of telehealth demand:-
• Federal-driven demand: Readmission penalties introduced by the U.S. Centre for Medicare and Medicaid Services (CMS) are driving providers to adopt telehealth as a means of reducing readmission penalties. Faced with increasing healthcare expenditure, other governments, including the UK, France and China are also promoting telehealth as a long-term cost-saving measure.
• Provider-driven demand: Healthcare providers want to use telehealth to increase ties to patients and improve quality of care. In many cases this is being done irrespective of the lack of a clear financial return on investment.
• Payer-driven demand: Telehealth is also being increasingly used by insurance providers to increase their competitiveness and reduce in-patient pay-outs, by working directly with telehealth suppliers to monitor their patient base.
• Patient-driven demand: There is currently very little demand from patients actively seeking out and requesting telehealth services from their payer or provider. Patient-driven demand is mostly limited to rural/non-metropolitan areas where there is a poor availability of clinics and physicians. As fitness awareness increases and consumers adopt personal devices to track their fitness, they will also increasingly seek professional devices to remotely track disease state
A few months ago I reviewed an app created by the American Red Cross to help educate users on first aid.
One of the most captivating features of the app, outside of the tremendous useful information, was the integration of the Game Center on the iOS version of the app.
After reviewing a section of the app on how to treat an emergency situation (e.g. bleeding), the user can then test their knowledge.
Successful completion of the quiz yields a badge that can then be posted via Twitter, Facebook, and the Apple Game Center.
This app is part of a growing trend to utilize gaming in medical education. While I have heard of using gamification to increase patients utilization of apps, I had never really appreciated it.
As such, I tried to look into other potential places where gamification could be beneficial. A paper by McCallum explored the implication of games in health, while exploring challenges and possible future research 
Expansion of gamification to patient education apps in specific disease fields could be potentially beneficial. Caffazzo et al explored the benefits of gamification incentives to increase recording SMBGs in teenagers with type 1 diabetes . Rewarding patients with iTunes music and app gift cards demonstrated increased recordings of their measurements. However, this method really boiled down to applying a reward system to patients for increasing their measurements.
In contrast, when I was at the Medicine 2.0 Conference in Boston last year, I happened to see an interesting poster being presented on pain management. The Hospital for Sick Kids in Toronto had created an app called ‘Pain Squad’ designed to help increase measurement of cancer patients pain levels for improved therapeutic management.
Interestingly, the patient is thrust into the position as a detective who is investigating the pain they are experiencing. By being compliant, they are rewarded by increasing their rank up in the police department. Amazingly, they got a large cast of live actors from television to help encourage the patients to stay compliant! This is an amazing step and great deed.
Areas of direct gamification being explored include actual games targeted at younger crowds to increase preferable activities or discourage unhealthy practices. One group that is exploring this aspect is Truth (the group behind the anti-tobacco company movement), who put together a game called ‘Flavor Monsters.’ The aim of this game is to help deter users from smoking by bringing together a tower defense/shooter game and information on smoking and tobacco manufacturers. Whether such a tactic will actually deter users from smoking will be interesting to see in the future
The use of gamification, if used appropriately, can be a potential boon to the education of patients on medical related topics. One issue is that incentive based gaming will lose interest if maxed out by the user. However, with social media this could be refined through social rewards.
A study by Lin et al explored the use of social media in gamification and how it may impact health . This expansion of gamification for education could also be done by increasing utilization of social media such as with Facebook and Twitter. Zynga has made great strides in decreasing our daily productivity by encouraging people to pluck virtual apples on virtual farms. That alone is not what keeps users coming back. It’s the social factor that draws in others to see and participate.
Can this mentality be expanded to education for both patients and professionals? If so how could this be done? I feel these areas will be explored further in the next few years and integration into practice may become more commonplace. One area that would be great is the incorporation of healthy lifestyles with gamification. One app that I think brings this together is Zombies, Run! I mean, what can be better than ‘running’ from zombies as you collect supplies and listen to a great story? Incorporation of an RPG (or role playing game) mechanics helps increase users desire to continue to participate. Could this be done with diet or other activities as well?
Gamification as an incentive for health may be a great feature to be studied and prudently applied in the future. This may be beneficial for increasing medication adherence, or serve as an incentive for diet and exercise. Ideally, future research should center on what factors increase patient utilization of an app and analyze objective outcomes that would be pertinent for patient healthcare. I would love to hear others thoughts on where gamification can be expanded and what possible challenges we may encounter.
We face ongoing changes in Medicine today which will alter our future practice patterns. We all recognize the need for better communication with patients. If the full impact of ObamaCare is realized, this may be more of a challenge as 47 million Americans will enter the pool of insured with access to medical care. Also, statistics show 10,000 Americans are retiring each day. When coupled with a potential shortage of 100,000 doctors by 2020, we realize there will be significant challenges to meeting the future healthcare needs of our citizens.
One hopeful prospect for dealing with the changes in demand and demographics of the future is the cellphone. It is estimated that 55% of World citizenry have cellphones now, and by 2018 there will be a cellphone for every person on the planet. In the United States over 80% of the population has cellphones. We are entering an era when patients will become more involved in their own medical care and participate with their physician in this care. Aside from having access to the medical records, cellphone applications are becoming more available for disease management. Patients are already participating in chat rooms with people with similar diseases to discuss their treatment options. Patients with multiple sclerosis, for example, interact in chat rooms to discuss response to therapy and new therapy.
Aside from the rise of sensors, expanded broadband access and the ubiquity of connected and mobile devices among patients and doctors, several health-specific trends are making remote care more of a reality. More patients are coming online, meaning that fewer doctors will be needed to serve more patients; payment models are shifting from fee-for-service to managed care approaches that emphasize patient outcomes; and hospitals are under more pressure to keep re-admission rates down. Remote monitoring and communication technology could play a critical role in addressing each of those issues.
Some telehealth innovations, like the iRobot that lets doctors visit a patient’s bedside via an electronic avatar and 15-inch screen, seem like the stuff of science fiction. San Francisco-based Scanadu is developing handheld tools that have been likened to the StarTrek “Tricorder.” A recent product lets you check your temperature, blood oxygen levels, pulse and other vitals by holding the device close to your body. Then it sends the information to your smartphone, where it can be sent on to your doctor. To encourage more innovation in sensor-based mobile technology, the X Prize Foundation even developed the Qualcomm Tricorder X Prize competition (in which Scanadu is a participant). A “Magic Carpet”developed by researchers at GE and Intel, uses sensors in home carpets to monitor seniors’ activity and then predict and detect falls.
AntiSec hacker group has in its possession over 12,000,000 Apple iOS device IDs. To prove it, it has released 1,000,001 IDs to the public.
Though they haven’t released them, hackers also claim the real names, addresses and cell phones in some cases accompany the UDIDs on the list, making this leak an even bigger privacy concern.
“During the second week of March 2012, a Dell Vostro notebook, used by Supervisor Special Agent Christopher K. Stangl from FBI Regional Cyber Action Team and New York FBI Office Evidence Response Team was breached using the AtomicReferenceArray vulnerability on Java, during the shell session some files were downloaded from his Desktop folder one of them with the name of “NCFTA_iOS_devices_intel.csv” turned to be a list of 12,367,232 Apple iOS devices including Unique Device Identifiers (UDID), user names, name of device, type of device, Apple Push Notification Service tokens, zipcodes, cellphone numbers, addresses, etc,” claims Antisec.
InTouch Health, a big name in telemedicine devices, and iRobot, the famous maker of robotic Roomba vacuums and battlefield robots, have teamed up to bring their respective expertise together in building a single device, the RP-VITA (Remote Presence Virtual + Independent Telemedicine Assistant).
InTouch supplied the telemedicine part and iRobot developed the motion and navigation aspects of the RP-VITA, which uses sensors and smart algorithms to help a physician move through a hospital’s complicated terrain. There’s even talk of a “single click” feature to be approved by the FDA that seems to allow the RP-VITA to autonomously navigate between patients in a hospital that the remote physician might not even know the topography of. New features introduced in the RP-VITA from the announcement:An enhanced navigation capability that enables the RP-VITA to better manage driving and navigation elements so the health care professional can put more focus on patient care tasks. State‐of‐the-art mapping and Obstacle Detection Obstacle Avoidance (ODOA) technologies allow safe, fast and highly flexible navigation in a clinical environment.An additional capability for the RP-VITA incorporates autonomous navigation and is being submitted to the FDA for 510(k) clearance. This capability will allow a remote clinician or bedside nurse to send the RP-VITA to a target destination with a single click, enabling a number of breakthrough clinical applications. InTouch Health anticipates clearance for this feature in Q4 2012.
Real-time access to important clinical data, enabling a range of new workflow improvements for physicians, nurses and other patient care team members. For example, the RP-VITA can be integrated with live patient data from the electronic medical record and is equipped with the ability to connect with diagnostic devices such as otoscopes and ultrasound. It comes equipped with the latest electronic stethoscope.A new, simple to use iPad user interface will enable quick and easy navigation to anywhere the RP-VITA needs to go, as well as interaction with the patient, family and care team.
Of the five investigative strands studied in the Whole Systems Demonstrator (WSD) trial, the first (led by a team at the Nuffield Trust) examined the impact on hospital admissions, associated costs and mortality. Results from the formal cost effectiveness study and quality of life measures are due soon. WSD results
The rigour and size of the trial (with over 3000 participants) means that it constitutes a sizeable step forward. Over a billion records of administrative data were extracted and linked to make the analysis possible. As a result we were able to look not just at the position at the start and end of key trial – but also what happened throughout the year. Algorithms were used to standardise for risk and ensure the comparisons between telehealth and control groups were not biased.
In the trial telehealth was tested for people with diabetes, chronic obstructive pulmonary disease or heart failure. Patients used technology in their own home to record items like blood glucose level and weight, and transmitted their readings to health professionals working remotely. Advocates claim that this approach helps patients manage their conditions and enables faster response from professionals when needed. As a result, telehealth may improve the quality of care while reducing the use of expensive forms of care, such as admissions to hospital.
The findings suggest that the telehealth group had 0.14 fewer emergency admissions per person per year compared to the control group. However this figure must be interpreted with caution. Admissions appeared to increase for control patients shortly after joining the trial, perhaps because these patients felt anxious after learning that they would not receive telehealth. These caveats, which are explored in more detail in the article in the British Medical Journal, suggest the impact of telehealth might be different when deployed outside of a trial setting.
Our best estimate was that telehealth reduced the cost of hospital care by around £188 per person per year. These findings also require caution, as they were not statistically significant, so could have been the result of chance. We made no conclusions about the impact of telehealth on costs – there was no evidence from the trial of a reduction of costs, but this does not mean that telehealth has no impact.
We did observe fewer deaths among the telehealth group than controls, over the 12 months of the trial (4.6 per cent compared with 8.3 per cent). This has been seen as a strong motivator to deploy telehealth but, as the BMJ's editorial pointed out, the reasons for this reduction are not yet understood. Caution is therefore required. Other randomised trials of telehealth have found increases in mortality, so telehealth may not have the same effect if deployed elsewhere.
While these findings are valuable, decisions about telehealth should be based on the complete evaluation. The other four strands have not yet published and the impacts on other patient outcomes such as quality of life are clearly important. We should not assume that fewer emergency hospital admissions mean better quality of life. Further work will report on the impact of telehealth on other services such as primary care, as well as the cost of operating the telehealth intervention – not taken account in findings published so far. However as of writing there is not yet any firm evidence that telehealth will deliver any savings to the NHS, even if the cost of the intervention is reduced to zero.
Perhaps most importantly there are critical questions on how telehealth may have different impacts on different population subgroups. The low levels of emergency admissions observed in this trial (0.68 per person per year for controls, 0.54 for telehealth patients) are a reflection of the relatively broad eligibility criteria used. The trial was open to all patients with one of the three chronic conditions, so many of the participants had relatively low or moderate levels of risk. What we do not yet know is whether for example some higher risk patients may show greater impact. If that is the case the key will be in targeting the technology to the right types of patient.
Teams headed by the Boeing Co., SpaceX and Sierra Nevada Corp. will be receiving hundreds of millions of dollars from NASA over the next 21 months for further development of spaceships capable of transporting astronauts to and from the International Space Station, knowledgeable sources told NBC News today.
NASA is to make the official announcement of the winning commercial teams on Friday morning — but NBC News' Cape Canaveral correspondent, Jay Barbree, received word from two sources who were informed of the decision in advance, on condition of anonymity. The sources did not discuss how much money any of the companies would be receiving.
This last week – the widely read Dr. Rob Lamberts lamented the usability of his Electronic Medical Record (EMR) software for his new primary care practice. It's worth reading (here) as it highlights the larger systemic problem of EMR software...
Whether they have chronic ailments like diabetes or just want to watch their weight, Americans are increasingly tracking their health using smartphone applications and other devices that collect personal data automatically, according to health industry researchers.
“The explosion of mobile devices means that more Americans have an opportunity to start tracking health data in an organized way,” said Susannah Fox, an associate director of the Pew Research Center’s Internet and American Life Project, which was to release the national study on Monday. Many of the people surveyed said the experience had changed their overall approach to health.
More than 500 companies were making or developing self-management tools by last fall, up 35 percent from January 2012, said Matthew Holt, co-chairman of Health 2.0, a market intelligence project that keeps a database of health technology companies. Nearly 13,000 health and fitness apps are now available, he said.
The Pew study said 21 percent of people who track their health use some form of technology.
They are people like Steven Jonas of Portland, Ore., who uses an electronic monitor to check his heart rate when he feels stressed. Then he breathes deeply for a few minutes and watches the monitor on his laptop as his heart slows down.
“It’s incredibly effective in a weird way,” he said.
Mr. Jonas said he also used electronic means to track his mood, weight, mental sharpness, sleep and memory.
Dr. Peter A. Margolis is a principal investigator at the Collaborative Chronic Care Network Project, which tests new ways to diagnose and treat diseases. He has connected 20 young patients who have Crohn’s disease with tracking software developed by a team led by Ian Eslick, a doctoral candidate at the Media Lab at the Massachusetts Institute of Technology.
Data from their phones is reported to a Web site that charts the patients’ behavior patterns, said Dr. Margolis, a professor of pediatrics at Cincinnati Children’s Hospital. Some phones have software that automatically reports the data.
Patients and their parents and doctors watch the charts for early warning signs of flare-up symptoms, like abdominal pain, nausea and vomiting, before the flare-ups occur. The physicians then adjust the children’s treatment to minimize the symptoms.
“One of the main findings was that many patients were unaware of the amount of variation in their symptoms that they were having every day,” Dr. Margolis said.
The Pew survey found most people with several chronic conditions said that tracking had led them to ask a doctor new questions, led them to seek a second opinion or influenced their treatment decisions.
Mr. Holt said self-tracking products and services companies formed the fastest growing category among the 2,100 health technology companies in his database. He said venture capital financing in the sector rose 20 percent from January through September 2012, with $539 million allotted to new products and services for consumers by Sept. 30.
He attributed the rise to a “perceived increase in consumer interest in wellness and tracking in general, and the expectation that at-home monitoring of all types of patients will be a bigger deal under the new accountable care organizations,” as President Obama’s health care law takes effect.
But even an enthusiast like Mr. Jonas said he saw “a dark side to tracking.”
“People who are feeling down may not want a tracking device to keep reminding them of their mood,” he said.
With all the attention given to Virgin Galactic’s impressive list of famous future space tourists, SpaceShipTwo’s impressive research capabilities for microgravity experiments have been largely overlooked.
According to SpaceShipTwo’s Payload Users Guide, the vehicle will be capable of carrying up to 1,300 lbs. (600 kg) of experiments into space, where they will experience 3 to 4 minutes of high-quality microgravity in a pressurized, shirt-sleeve environment. Small experiments can also be mounted on the exterior of the vehicle.
As physicians find a role for social media in their medical practices, they discover challenges: Protect privacy and maintain boundaries. According to a survey published in 2011 in the Journal of General Internal Medicine, 94% of medical students, 79% of residents and 42% of practicing physicians reported some use of online social networks, nearly all for personal reasons. Among the practicing physicians, 35% said they had received a "friend" request from a patient or family member—and 58% of those who had received those "friend" requests said they always rejected them.
A recent article at Healthcare Collective takes the position – in asking the question, “What’s the Matter with Mobile Health Apps Today?” - that most mobile healthcare apps aren’t used, at least not beyond an initial download and trial, after which the apps are discarded as quickly as they were downloaded. The article also noted that healthcare apps have appeared in record numbers of late – from just under 3,000 to just over 13,600 of them. Most of these apps focus on personal healthcare, and most of them are redundant in terms of what they do – some do certain things better than others, but most are destined for the delete bin.
At the 2012 Consumer Electronics Show (CES) held in January 2012 there was an entire exhibiter space dedicated to mobile healthcare. We noted a potentially useful collection of applications, especially some that appeared to us to do a rather good job of checking vitals and keeping track of them. As we roamed the aisles, it turned out that there was one exhibiter – UnitedHealth Group, a rather major name in the health insurance industry – that had a significant booth there. Why?
Nick Martin, vice president of innovation, research and development at UnitedHealth Group says, “At UnitedHealth we believe that we need to use mobility to create a tight bond with our policyholders. Users know how to put their mobile devices to work, and this provides us with a means to communicate closely with them. We engage our users through experiences and interactions that are typically fun for the user, but that ultimately lead us to teach our clients how they can achieve savings on medical costs. Our mobile apps are accessible anytime and anywhere, but more specifically, they give our users the freedom to engage with us when they want to.”
“In our case it isn’t simply about providing some sort of health app that substitute for such things as tracking blood pressure,” Martin continued. “In our case we are looking to specifically provide real financial and medical benefits. It becomes a differentiator for us – and as long as we provide real value, the users keep coming back and using the apps.”
For Martin, the apps aren’t simply a means to earn a few pennies on an app download. The use of mobile apps is a specific healthcare driver that aids in direct user engagement, and one that will continue to grow significantly, not just for UnitedHealth, but for its competitors as well. From this perspective mobile health apps are doing extremely well.
Doctors and Mobile Apps
The Ottawa Hospital in Ottawa, Ontario, Canada is an example of a healthcare provider that has deployed an iPad mobile app - not for consumers but for doctors. The app, a computerized physician order entry (CPOE) system, was deployed to more than 1,000 doctors. The goal Ottawa specifically had was to change the process that had evolved for doctors to gain information about patients – a process that involved keeping doctors glued to computers rather than keeping them out in the field, so to speak, where they could visit in meaningful ways in face to face conversations with their patients.
Once the doctors became mobile through the iPad and the CPOE app, there was an immediate, measureable and very positive impact in the doctor-patient relationship. Doctors were able to gain substantial valuable time back, time that was then devoted entirely to face-to-face patient visits on a daily basis. Patients were able to sense a difference in terms of the quality of engagement, and doctors were able to specifically hone in on what patients needed right at the point of their interactions.
Having iPads in hand, providing immediate patient information, vitals, and other valuable insights literally at their fingertips changed the doctor-patient relationship from a reactive to a proactive one. Proactive engagement, in turn, allowed patients – as well as other family members – to collaborate on medications, treatment alternatives and medical reviews. Ottawa Hospital officials say that engaged patients take a much stronger interest in their own treatments, a perhaps subtle but significant change that increases overall treatment benefits.
These are but two of numerous examples of where the real value in mobility is to be found in the healthcare industry. Whether engaging with an insurance company, a pharmacy or a doctor (or a nurse or an intern…you get the picture), mobility drives immediate engagement with caregivers. It is the immediate engagement between the caregiver and patient that makes the difference.
Other mobile app examples include those that provide secure, real time patient data – an extremely valuable service in the emergency room, those that monitor patients through their mobile devices, and those that communicate real time information – whether between doctor and patient, or doctor and doctor in consultative situations.
The bottom line is that consumer apps that do very simple things are of likely very little value – and simply not worth talking about. Those that aid doctors, emergency rooms, nurses, and so on, and those that drive better patient-health provider/doctor engagement or that monitor health from the perspectives described here, are the real mobile applications that matter in any discussion of mobile healthcare.
Tony Rizzo has spent over 25 years in high tech publishing and joins HealthTechZone after a stint as Editor in Chief of Mobile Enterprise Magazine, which followed a two year stretch on the mobile vendor side of the world. Tony also spent five years as the Director of Mobile Research for 451 Research. Before his jump into mobility Tony spent a year as a publishing consultant for CMP Media, and served as the Editor in Chief of Internet World, NetGuide and Network Computing. He was the founding Technical Editor of Microsoft Systems Journal.
In the beginning there was the triode, a vacuum-tube that heralded the early age of electronics. However, this age was limited because the triode was relatively bulky, required a lot of energy and, since it was made of glass, extremely fragile. Its replacement, the solid state field-effect transistor, was perhaps the greatest technological leap of the 20th century. The transistor reduced the size & power load of electronics while simultaneously improving their durability.We are now entering a new age of electronics, one in which new materials and interconnects have made circuit assemblies flexible (‘Flextronics‘) and, as a result, embeddable. We at Medgadget have been closely following flextronics as well as its subfield of wearable electronics, or “wearatronics,” over the last few years. The fundamental concept is that flexible electronic arrays may be embedded into textiles in order to, for example, measure the wearer’s vital signs or even generate and store power. In this post we would like to provide one timely example and two resources that you may use to learn more about wearatronics and stay ahead of the curve:
MC10, a leading company developing flexible electronics, informed Medgadget that it has signed an R&D contract with the US Army Natick Soldier Research, Development, & Engineering Center (NSRDEC) to “develop solar cells that are directly integrated into the fabric cover of combat helmets and rucksacks.” We have covered MC10 before because of their work on adding conformal electronics to medical devices, such as catheters and stents, and are interested by this new partnership that more directly relates to embedding electronics into textiles. Their CEO, David Icke, explains the recent move:
Soldiers today carry a lot of high-tech gear, but often go long periods of time without access to power. MC10 is providing a renewable power source that doesn’t add to the heavy load our soldiers already carry.
Given MC10′s existing partnerships with Reebok, Mass General Hospital, and others, we can expect to hear more about their work in the field of wearatronics.
In terms of the resource to learn more about wearatronics, our colleagues at GigaOm just released a research briefing earlier this week entitled “The wearable-computing market: a global analysis.” One highlight from the report is that the wearatronics market for just health and fitness products is estimated to reach 170 million devices within the next five years. We’ve quoted the report summary below:
What do Google’s Project Glass, Zephyr Technology and the Hug Shirt have in common? All are examples of wearables: computing devices that are always on, always accessible and easily worn on the body. With the growth of sensors and microelectronics, the potential uses of wearable-computing technologies now reach to health and fitness, gaming, fashion, disabilities and augmented reality. Most importantly, the widespread adoption of wearables will drive the form function and market for mobiles in vital ways. This report provides a historical background, an overview of the technologies in the wearables market and possible future trends as the market expands.
As shipments go, it was routine — about half a ton of supplies — except it was delivered by the first commercial flight to the International Space Station. SpaceX partnered with NASA in this new model, the brainchild of Elon Musk, who's behind Tesla electric cars as well. He left South Africa at 17, earned two U.S. undergraduate degrees and then made serial piles of dough pioneering online payment systems, including the one that became PayPal. Musk's persona inspired aspects of Tony Stark in the"Iron Man," but Musk's aspirations seem more like Buzz Lightyear's — to infinity, and beyond.