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Innovations in Healthcare
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Digital health funding up 45% in 2012

Digital health funding up 45% in 2012 | Innovations in Healthcare |

Last year was a banner year for digital health, and in 2013, it can only get better as the trends in healthcare are increasingly digital-based. In 2012, tech companies poured $1.4 billion into digital health companies, a 45 percent increase from 2011, according to a recent year-end report from healthcare technology accelerator Rock Health.  

Fifty-six percent more deals occurred in 2012 for digital health than in 2011. Rock Health's report indicates that compared to the declining investment in traditional healthcare, software and digital health funding is on its way up. Another impressive number is 134, the number of digital health companies that each raised $2 million in 2012.

Personal health tools and tracking, health consumer engagement, EMR/EHR and hospital administration all are moving toward digital, comprising one-third of all digital deals made in 2012

Inter-Growth's curator insight, January 31, 2013 12:48 PM

Though challenges remain, the trend will continue to be an increase in EMR by providers and EHR by providers and consumers.

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Four-year 100,000 genomes project, run by Genomics England... well underway

Four-year 100,000 genomes project, run by Genomics England... well underway | Innovations in Healthcare |

A project aiming to revolutionise medicine by unlocking the secrets of DNA is under way in centres across England.

Prime Minister David Cameron has said it "will see the UK lead the world in genetic research within years".

The first genetic codes of people with cancer or rare diseases, out of a target of 100,000, have been sequenced.

Experts believe it will lead to targeted therapies and could make chemotherapy "a thing of the past".

They argue that understanding DNA will soon play a role in every aspect of medicine from cancer to cardiology.

Tumours are caused by mutations in DNA which lead to abnormal cells growing unchecked.

Advances in genetics have shown that breast cancer is not one disease but at least 10 - each with a different cause, life expectancy and needing a different treatment.

Targeted drugs exist such as Herceptin, which is given only if a patient's breast tumour has a certain mutation.

The four-year 100,000 genomes project, run by Genomics England, which was set up for the purpose, is aiming to make such breakthroughs on a massive scale.


Pilots have been set up at centres across England - including sites in Newcastle, Cambridge and London - and the first genome was sequenced on 30 May.

The project has passed the 100 mark, with the aim of reaching 1,000 by the end of the year and 10,000 by the end of 2015.

Just one human genome contains more than three billion base pairs - the building blocks of DNA.

It is by looking for subtle differences between genetic codes which lead to disease that researchers believe can fuel the next big breakthroughs.

The genome of a patient's tumour will be scoured for differences with the genetic code of their healthy tissue.

People with rare diseases, usually children, will have their DNA compared with that of close relatives.

University scientists and a drug companies will be allowed to access the data for their research.


Fifteen thousand families with rare diseases will take part in the project.

Edward Sherley-Price has first-hand experience of just how little is known about some conditions.

His 11-year-old daughter Alysia has regular seizures.

She was diagnosed with a developmental delay before her second birthday, but the cause was unknown.

It took until 2013 for genetic testing to discover what was wrong - a rare genetic mutation known as STXBP1.

The family say getting a diagnosis has given them a renewed sense of optimism.

The 100,000 Genomes Project could help people like Alysia by identifying a specific mutation, which lead to taking part in future drug trials.

Sir John Chisholm, executive chair of Genomics England, said: "In Britain we were the discoverers of the structure of DNA, we were huge players in the human genome project and now the time has come for the next major step forward.

"One hundred thousand sequences is a very large step; it's a huge commitment."

Genomics England will be based at the Wellcome Trust Sanger Institute in Cambridge, which is already a world-recognised centre of genetics research.

'Every bit of medicine'

Prof Jeremy Farrar, director of the Wellcome Trust, said: "I can see a future where genetics is going to come into every bit of medicine from cardiology to oncology to infectious diseases."

He said there were already targeted therapies for some breast, lung, bowel and blood cancers.

"Twenty years from now there's going to be a plethora of those, we will have a series of mutations which academics and industry will have developed therapies for, which will be targeted at you and specific for that cancer."

He said chemotherapy, which attacks all dividing cells in the body, would be replaced with such therapies.

"We will look back in 20 years' time and think of blockbuster chemotherapy [as] a thing of the past and we'll think 'Gosh, what an era that was'."


David Cameron has announced a series of investments across government, industry and charities totalling £300m.

He said: "I am determined to do all I can to support the health and scientific sector to unlock the power of DNA, turning an important scientific breakthrough into something that will help deliver better tests, better drugs and above all better care for patients.

"I believe we will be able to transform how devastating diseases are diagnosed and treated in the NHS and across the world."

NHS England chief executive Simon Stevens said: "The NHS is now set to become one of the world's 'go-to' health services for the development of innovative genomic tests and patient treatments, building on our long track record as the nation that brought humanity antibiotics, vaccines, modern nursing, hip replacements, IVF, CT scanners, and breakthrough discoveries from the circulation of blood to the existence of DNA."

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GSK switches on to electronic medicine -

GSK switches on to electronic medicine - | Innovations in Healthcare |

The prospect of using electronic implants to treat a huge range of diseases from arthritis and asthma to diabetes and high blood pressure has taken a big step closer to reality with the backing of one of the world’s largest pharmaceutical companies.

Via Lionel Reichardt / le Pharmageek
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The Movement for Patient Access to Doctors’ Notes Is Growing

The Movement for Patient Access to Doctors’ Notes Is Growing | Innovations in Healthcare |
TTo level the playing field, some believe patients should be able to see what their doctor is writing about them. But note-sharing with mental health patients has been slower to develop.

There’s a scene in the first season of comedian Louis C.K.’s FX series Louie where he tries to describe his feelings to his therapist. When he looks at his young daughter, he says, he often sees his mother.

“So your mother, is she there?” asks the doctor. No, says the confused C.K, who expected the figurative nature of his statement to be obvious. He just “sees” her face. “Is she standing right in front of her?” the doctor asks. “Are you at your mother’s house?”

C.K.’s standards for doctors might be questionable. But at the very least, the scene shows that understanding and communication between doctor and patient can always be helped along.

The OpenNotes initiative, which seeks to enable easier access for patients to doctor’s notes, might have helped. The idea is that if doctor’s notes were more transparent, then a patient would become more involved in their own treatment. And the “playing field” between doctor and patient also is leveled somewhat.

“We doctors hide from patients what we feel about them and what we think, and I think that it is a mistake,” said Tom Delbanco, professor of general medicine and primary care at Harvard Medical School. “There is absolutely no reason patients should not know what we are thinking about them and doing.”

Delbanco said the use of OpenNotes—which he leads with Jan Walker, a registered nurse and researcher at Harvard Medical School—has grown from 13,500 patients to 3 million today.

But note-sharing with patients with mental health problems has been slower to develop. Concerns exist over whether a patient’s mental condition could worsen after reading what a psychologist has written about them, or whether a patient could feel objectified and pathologized.

“The instinct has been, ‘That’s different, mental health is different, don’t touch it’—I think that’s nonsense,” said Delbanco. “I think if you say you’re ill because your knee hurts, or I think you’re crazy because you think blue is green, you should be the first to know and my job would be to help you with that.”

Patients participating in a pilot study at the Harvard Medical School teaching hospital Beth Israel Deaconess Medical Center started note-sharing with their psychiatrists, psychologists, and social workers in March this year. Because the pilot project is still in its infancy, the data aren’t there yet. But Delbanco predicts it will take off in the same way note-sharing with the earlier patients did. And it will go beyond the United States, he said.

“The world is becoming more transparent. There are fewer secrets,” he said. “It really is an expression of that moving into medicine. I don’t see why this should be constrained by the Atlantic.”

Outside the U.S., mental health-care professionals debate among themselves how much transparency can exist between themselves and patients. The discussion often is shaped by allegiances to particular schools of thought, such as Sigmund Freud’s concept of “therapeutic abstinence.” The idea that iron-clad barriers between therapist and patient must exist, and preclude such transparency, some would argue.

Andreas Feher, a psychoanalyst and psychiatrist in private practice, said he has come up against this line of thinking many times in Germany. He doesn’t do note-sharing via a password-protected electronic patient portal but reads his notes from the previous session aloud to his patients.

“My colleagues say, ‘Those are your notes, that is none of their business.’ They think I’m crazy—I don’t really understand it,” Feher said. “In any case, it isn’t really done here. I don’t know anyone who does it. But I don’t care, I do it anyway.”

Asked why he did so if note-sharing was considered so unorthodox in Germany, he said it helped him remember what happened from sessions that could run up to two hours. In his experience, only about one in 15 patients ever has a problem with it, he said.

Despite how useful he found note-sharing and how much patients seemed to like it, Feher said he was skeptical it would be widely adopted in the near future.

“Here, the barriers are perceived so important,” he said. “I know therapists who won’t go to the cinema if they know a patient might be there.”

To them, note-sharing involves breaking down barriers they don’t want broken down, Feher said.

“It seems strange to me that other professionals—maybe those not even directly involved in the case—can potentially read some of these notes that the client can’t.”

“It won’t happen in my lifetime,” he said. “It’s a shame. I would have found that good.”

But cultural attitudes and prevailing schools of thought aren’t the only things tilting the debate. Bureaucratic challenges can sometimes play a role.

In most countries—including the U.S., the U.K., and Germany—patients generally have a right to access their medical records. But requesting the notes that are part of the records is often a bureaucratic process, and the rules make it difficult for clinicians simply to offer to show their notes to patients, said David Harper, a professor of clinical psychology at the University of East London.

“Most clinical psychologists work for the National Health Service (NHS). They are employees,” he said. “Therefore the notes you make don’t belong to you, technically, they belong to the secretary of state. As soon as you write them, they are NHS property.”

Harper supports transparency as the default setting, he said.

“In the U.K., care records are increasingly stored electronically, with different professionals able to read anyone’s notes,” he said. “It seems strange to me that other professionals—maybe those not even directly involved in the case—can potentially read some of these notes that the client can’t.”

But of course, any sharing with mental health patients needs to be done carefully, he said.

“If someone is feeling fairly stable mentally, and resilient, then they could read lots of different things and be OK with them,” said Harper. “But if they were feeling very vulnerable, there were some elements in the notes that might make them feel more vulnerable.”

Charlotte Marshall, a privately practicing clinical psychologist in Adelaide, South Australia echoed Harper. Sharing notes could be “counterproductive” in situations where a client has symptoms of paranoia and plans of action and safety concerns are written in them, she said.

“The clinical setting in which note-sharing is hypothetically occurring is important. For instance, notes taken in an inpatient psychiatric setting where [the client] might be detained would be quite different to notes from a private practitioner’s session on a client with an anxiety disorder,” she said.

For her personal practice, she said she didn’t see the need to share her notes “as a matter of course” and that it wasn’t common practice in Australia. She does, however, generally tell her clients they are welcome to her notes any time, she noted.

“But in my years of experience, nobody ever expressed particular interest,” she said. “I try to be as transparent as possible on my thoughts as to her thoughts on what may be going on with them. What is in my notes is unlikely to be of concern or surprise to my clients, so perhaps they don’t feel the need to see my notes.”

Marshall said she didn’t think note-sharing was becoming the norm in Australia—and how it will fare in the rest of the world is not yet clear.

However, Delbanco said the experiences of the original project have left him optimistic the movement will be taken up across the board.

“If you had told me that we would go from 20,000 to 3 million note-sharing Americans in 18 months, I would have thought you were smoking marijuana,” he said. “But it happened. Mental health notes will spread just as rapidly because it is riding on the wave of transparency. This is a global phenomenon.”

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Polymer Multilayer Tattoo for Safe, Effective Delivery of DNA Vaccines

Polymer Multilayer Tattoo for Safe, Effective Delivery of DNA Vaccines | Innovations in Healthcare |

DNA vaccines hold promise of overcoming the downsides of traditional vaccinations, potentially allowing for effective defense against HIV and other viral infections. Delivering DNA snippets that code for viral proteins into the insides of cells is a bit tricky and currently requires using electroporation to open pores within cell walls. The technique is not terribly effective and can be painful on the patients. Now researchers from MIT are reporting in Nature Materials the development of a new skin patch, which they like to call a “multilayer tattoo,” capable of delivering DNA vaccines in a more civilized fashion.

The team embedded the vaccine within multiple layers of a polymer film which sits on top of a bed of microneedles that painlessly create a passageway into the body. The polymer film begins degrading once in contact with water and safely releases its cargo.

From the study abstract in Nature Materials:

Films transferred into the skin following brief microneedle application promoted local transfection and controlled the persistence of DNA and adjuvants in the skin from days to weeks, with kinetics determined by the film composition. These ‘multilayer tattoo’ DNA vaccines induced immune responses against a model HIV antigen comparable to electroporation in mice, enhanced memory T-cell generation, and elicited 140-fold higher gene expression in non-human primate skin than intradermal DNA injection, indicating the potential of this strategy for enhancing DNA vaccination.

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Pediatric Cardiologists Turn to Clinical Analytics -- InformationWeek

Pediatric Cardiologists Turn to Clinical Analytics -- InformationWeek | Innovations in Healthcare |

A group of highly specialized healthcare providers has engaged an analytics firm and a systems integrator to build a national patient registry in hopes of speeding the development and adoption of best practices for treating critically ill patients with pediatric and congenital heart ailments.
The Pediatric Cardiac Critical Care Consortium (PC4) will tap the expertise of ArborMetrix, an Ann Arbor, Mich.-based vendor of analytics technology for acute and specialty care, and CardioAccess, Inc., which runs an international cardiology clinical outcomes database, to custom build the new national registry. PC4 was formed in 2009 with the help of a National Institutes of Health (NIH) grant, and includes experts in pediatric cardiac critical care, cardiac surgery, and cardiology from across the U.S. and Canada. PC4 aims to improve the quality of care by collecting data on clinical practice and outcomes, providing clinicians with timely performance feedback, and fostering a culture of continuous improvement through analytics and collaborative learning. The PC4 registry will focus on capturing data from each patient's medical record, then applying analytics to make patient-specific recommendations for treatment, said PC4 executive director Dr. Michael Gaeis, a pediatric cardiac intensivist at the University of Michigan's C.S. Mott Children's Hospital Congenital Heart Center.

"Data serves as the foundation of providing high-quality care to any population," Gaeis told InformationWeek Healthcare. "But data by itself is not enough." Many registries are good at collecting data, according to Gaeis, but there often is no "actionable arm." PC4 wants its registry to offer actionable ideas.
"Registries don't matter if you can't take the data and help patients," Gaeis said.


ArborMetrix will provide real-time access to information in the CardioAccess database and help identify high-performing pediatric critical care cardiology centers. "We [will be able to] disseminate information widely and provide targeted improvement to lower-performing organizations," Gaeis said. He said the registry also will help PC4 member institutions set up collaborative learning opportunities. "The research component is a real critical piece of it," he said.
PC4 is modeling its registry after those of the Northern New England Cardiovascular Study Group and several registries ArborMetrix has worked on in its home state, including the Michigan Surgical Quality Collaborative and the Michigan Bariatric Surgeons Collaborative. "I think it's a pretty tried-and-true blueprint," said Gaeis.
The University of Michigan is hosting the data coordinating center, supported by the university and residual NIH funding, according to Gaeis, and PC4 will be looking for ongoing funding.
The system is in alpha testing and should move into beta in January. Gaies said the consortium hopes to have 10 centers operational by the second quarter of 2013, "then rapidly expand." This early group includes Children's Hospital of Atlanta, Children's Hospital of Philadelphia, the Hospital for Sick Children in Toronto, the University of California-San Francisco Benioff Children's Hospital, and the recently renamed Lurie Children's Hospital of Chicago. The registry will be offered to all PC4 members, although each site will have to sign its own contracts with the vendors, according to Gaeis.

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Take A Hard Look At EHR Costs, Benefits -- InformationWeek

Take A Hard Look At EHR Costs, Benefits -- InformationWeek | Innovations in Healthcare |

Most healthcare organizations don't measure the overall success of their electronic health record (EHR) systems, according to a survey of 300 healthcare executivesby Beacon Partners, a Boston-based healthcare management consulting firm.Forty-one percent of the respondents said their organization has performance measures related directly to return on investment (POI) or goal achievement for their EHRs. Nearly the same percentage (38%) of respondents said that data analysis was most often leveraged for initiatives related to quality management and/or utilization management in their organizations.

But only 36% of respondents were satisfied with their organization's efforts to measure the value of their clinical IT systems.

Nearly 80% of the respondents said their organizations collected feedback from physicians and nurses to measure user satisfaction. The data is most often used for system enhancements and improvements (60%) and for determining training and/or support needs (55%). 

Reflecting the chaotic way in which EHRs are often introduced, the survey found that performance measures are determined during the planning stages of EHR implementation less than half of the time. Performance measures were added after EHR implementation in at least one patient care area 32% of the time.

Just over half of responding executives said they wished that performance measures had been developed and implemented earlier in the process. The report's authors commented, "Often, the limited resources and hurried deadlines associated with EMR implementation preclude a thoughtful, strategic analysis of expected value for the substantial sums invested in clinical IT."

While the survey did not indicate how much the respondents had spent on clinical IT systems, on average, the amount must have been fairly high, judging by how far their organizations had gotten in installing EHR components. Using the seven-point HIMSS Analytics scale, the study showed that 76% of the responding organizations were at stage 3 or higher in EHR deployment.

An Accenture report last year estimated that hospitals experience an 80% increase in their IT budgets as a result of EHR implementation. Moreover, the expenses continue to be higher than they were before the EHRs were introduced, due to the cost of maintaining these complex systems.

The Beacon Partners report concluded that despite the great expense of implementing clinical IT systems, healthcare organizations "are often slow to establish strategic performance measures to determine the value obtained from investments in IT."

Alan Cudney, executive consultant at Beacon Partners, told InformationWeek Healthcare that it's extremely important to measure the ROI on investments in clinical IT systems. "It's just like any other major investment of a capital or an operating nature for a healthcare organization."

The difficulty in measuring ROI in an EHR, he said, is that it goes beyond pure financial considerations. "Hospitals typically measure ROI from a business perspective," he pointed out. "But many benefits of clinical applications fall into the realm of quality and safety that doesn't easily translate into dollars and cents."

To really understand this complex equation, he said, healthcare executives need to develop a "balanced scorecard" that provides a holistic view of where an EHR fits into an organization's strategic goals. That includes the incentives being provided to adopt the EHR, the potential penalties down the road and the organization's preparations for value-based reimbursement.

The performance evaluation should also encompass "the opportunity costs of what they're giving up by these huge expenditures," Cudney pointed out. For example, investing in an EHR might mean that the organization can't hire more nurses or purchase more equipment such as a mobile CT scanner, he said.

Cudney admitted that all of these factors make it difficult to pin down the ROI of a clinical IT system. "But we maintain that the costs are so huge of implementing EHRs and what that does to the bottom line for maintaining those systems, that you need to have a better pulse on the value that those costs are bringing strategically to the organization."

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Big Data Gets Personal as Healthcare and Life Sciences Converge

Big Data Gets Personal as Healthcare and Life Sciences Converge | Innovations in Healthcare |
Sometime in the next few years, for $1,000 or less, you’ll be able to have your entire personal genome sequenced, and the relevant genomic and medical data will fit on a thumb drive.

That will represent a remarkable advance in the march toward truly personalized medicine—but it’s also just the beginning of an even larger story.

A series of breakthroughs in medical science and information technology are triggering a convergence between the healthcare industry and the life-sciences industry, a convergence that will quickly lead to more intimate—and interactive—relationships among people, their doctors, and biopharmaceutical companies.

Big data and analytics are playing indispensable roles in fostering those enhanced relationships as they vastly enrich the remarkable but isolated wonder of genome-on-a-thumb-drive by giving healthcare providers and drug makers the ability to explore and analyze genomic and proteomic data not just for an individual but in aggregate for millions of people.

In a panel discussion last week in New York City at the Galien Forum 2012, moderator Kris Joshi, Ph.D., reminded the audience that for these advances to reach their full potential and have the greatest impact on the largest number of people around the globe, it’s essential to bear in mind that “Genomics is team sport.”

And just as in sports, deeply collaborative teams can accomplish more than individuals can, Joshi said.
“There are multiple kinds of “Omics” data being explored—genomic, proteomic, metabolomic, and more,” he said, and to achieve the best outcomes, “we can’t leave anything to the imagination.”

On top of that, huge volumes of public-domain reference data take on new meaning as they are used alongside individual patient data to offer greater context, depth, and insight, said Joshi, who is Global Vice President for Healthcare within Oracle’s Health Sciences unit.

“So, you can’t just provide care for a patient in isolation anymore—you have to look at data beyond your walls—but the reality is that most health systems are simply not set up to do that today,” said Joshi.

The big stumbling block for many health systems is their inability to properly analyze the vast stores of data they have, either because the data are isolated in disparate and incompatible systems around the organization, or because the analytical tools at hand are simply not powerful enough and sophisticated enough to handle these complex data challenges. (To see how $10-billion global healthcare enterprise UPMC is overcoming that healthcare-analytics challenge, please check out our recent column called UPMC Picks Oracle to ‘Unlock Secrets of Human Health’.)

“Health systems will have to go rapidly from a one-size-fits-all model of treatment to a more customized model, which still uses mass-manufactured but where treatments are selected for patients based on specific biomarkers,” Joshi said.

“But we can now see the next advance in personalized medicine potentially going even further, something much more personalized, like a tailor-made suit. At first, like a tailor-made suit, it is likely to be expensive and exclusive, but over time it will become a commodity that people come to expect.”

And because of the recent advances in Big-Data solutions and advanced analytics, Joshi said, “Personalized medicine on a broad scale can now be contemplated: we see it in action today in oncology with very specific, targeted treatments that are saving lives, even though from a broader perspective it might seem a bit distant.”


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IBM’s New Blue Gene/Q Supercomputer to Help Research in Health Sciences

New York State’s University of Rochester now sports the world’s fastest computer dedicated to medical research.   The IBM Blue Gene/Q clocks in at 172-teraflops (172 trillion floating point operations per second), according to thePoughkeepsie Journal, making it one of the fastest computers in a university setting.


The goal of the project is to be able to crunch through massive amounts of data that are being collected in laboratory research and electronically through digital health records.

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Plastic 'ninjas' take on deadly bacteria (IBM Research)

Plastic 'ninjas' take on deadly bacteria (IBM Research) | Innovations in Healthcare |

For decades, bacteria like the stubborn methicillin-resistant Staphylococcus aureus (MRSA) have concerned gym goers, hospital patients and staff, and parents of school children. MRSA is particularly worrisome because it is not contained and killed by commonly available antibiotics. So, the bacteria can produce painful and sometimes deadly results for those who come in contact with it. But the answer to a healthcare issue that has long baffled doctors and medical scientists alike might come from an unlikely place. At IBM Research in Almaden, California, chemists have drawn upon years of expertise in semiconductor technology and material discovery to crack the code for safely destroying the bacteria. Ninja polymers

In earlier chip development research, IBM researchers identified specific materials that, when chained together, produced an electrostatic charge that allows microscopic etching on a wafer to be done at a much smaller scale.

This newfound knowledge that characterization of materials could be manipulated at the atomic level to control their movement inspired the team to see what else they could do with these new kinds of polymer structures. They started with MRSA.

The outcome of that experiment was the creation of what are now playfully known as "ninja polymers" – sticky nanostructures that move quickly to target infected cells in the body, destroy the harmful content inside, and then disappear by biodegrading without causing damaging side effects or accumulating in the organs.

As a bonus, all of this occurs without damaging healthy cells in the area.

"The mechanism through which [these polymers] fight bacteria is very different from the way an antibiotic works," explains Jim Hedrick, a polymer chemist in IBM Research. "They try to mimic what the immune system does: the polymer attaches to the bacteria's membrane and then facilitates destabilization of the membrane. It falls apart, everything falls out and there's little opportunity for it to develop resistance to these polymers."

Making products safer

In addition to the potential use for systemic delivery of drugs, scientists suggest that additional applications for these polymers could include adding them to every day personal and cleaning solutions. Imagine being able to wipe away MRSA-strength bacteria in a surgical theater, hospital room, or even your own kitchen without using dangerous chemicals or damaging surrounding surfaces. The ideas for future applications include replacing toxins in things like deodorants and nail polishes with similar but eminently safer materials.

Through a variety of delivery mechanisms – gel, antibacterial wipes, injection or special coatings on hospital equipment – the research has the potential to stop the widespread distribution of antimicrobial agents that are found in everything from toothpaste to socks."Think about toothpaste and mouthwash–we spit it into sink, it goes into the water supply, that in turn is used on agricultural crops, or it's in the streams and oceans, and it still has these antimicrobials," Hedrick says. "Our polymers do their job and safely disappear."

Improving quality of life

Looking forward, the IBM Research team, along with its collaborators from the Institute of Bioengineering and Nanotechnology in Singapore, is exploring partnership opportunities with consumer goods companies and the food industry. In addition to creating beneficial replacements for personal and industrial hygiene items, tainted food processing equipment that may provoke food-borne illness could be similarly protected with polymer coatings.

As IBM expands its expertise into new regions and develops solutions to solve some of the world's toughest problems, IBM researchers continually break new ground in science that moves beyond semiconductors, processors and chips and helps improve lives.

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Confusion and Uncertainty: Healthcare Investing in 2012

Confusion and Uncertainty: Healthcare Investing in  2012 | Innovations in Healthcare |
Over the last year, healthcare investing has become a tricky proposition. The Affordable Care Act and the Recovery Act have significantly affected the way healthcare is delivered and funded in the US. Over the course of the coming year, with an election coming up and an ongoing Supreme Court case pending, there is the potential for healthcare investing to remain turbulent.

To get a deeper understanding of the market and what could happen during the year, we spoke with Kevin Barnes, Vice President Strategy and Corporate Development at Premier Inc. He took part in our Healthcare Teleconference a few weeks ago along with Charles Anderson at Exaltare Capital.

During the teleconference, you said there’s a lot of confusion and uncertainty in the markets right now. Can you explain what you meant by that?

Kevin Barnes: I think there is confusion due to the uncertain regulatory environment that we’re in. That is with a major piece of legislation before the Supreme Court that may either get struck down completely or sent back to Congress for modification. We also have a market where health care providers are consolidating and a potential change of power in the Executive and Legislative Branches of our government. Some of that uncertainty will settle down after the elections and the ruling from Supreme Court this summer but healthcare, especially those with reimbursement risk, will continue to experience uncertainty for some time.

You also said that one major question you have is “Do you have the rights to your data in a way that allows us to expand the company the way we want to expand it?” What did you mean by that?

Kevin: The issue is with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a law that focuses on personal healthcare information (PHI). Today, everyone who walks into a doctor’s office typically signs some sort of statement allowing the provider to use your PHI. When you are a vendor to providers, you have to ask the provider what rights they have to PHI so that you can determine what you can do with the data you are sent. Supply chain data, outcome data, safety data, payor data etc. Can I take the data and clean it so that I can follow individual patients or only aggregate data? What restrictions on use are there once I have the data. Some providers will let vendors use their data but not if it is combined or benchmarked against data from the competitor provider across the street.

Data ownership in the healthcare space is unclear – the players that lock down rights to the data and find meaningful ways to use it will be the winners of tomorrow.

You also talked about how the election doesn’t seem to have a very big effect on healthcare because both candidates seem to be roughly the same on healthcare. What effects do you see happening?

Kevin: I would not say they have the same view on healthcare but their differences are not that stark and neither one of them are going to be able to cram anything down on Congress. I think the make-up of Congress is going to be more important. But as I stated earlier, the happening that will affect healthcare is the upcoming Supreme Court ruling on the 2010 Affordable Care Act. The outcome of this Supreme Court decision will have the greatest near-term impact on what happens in healthcare.

What major questions do you have in the coming year?

Kevin: Are the HIT companies really worth the high multiples? Will this exuberance continue or is there a bubble? There are a lot of factors involved, but as we bid on a number of these companies—we wonder if the multiple is staying where it is because PE needs to put their money to work instead of being true valuations.

Do you anticipate HIT multiples staying high the rest of the year?

Kevin: As an acquirer today, we hope not but we expect over the next 12 months it will probably stay high. We think there will be a correction at some point though

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"Printing" pharmaceuticals with a 3D printer

"Printing" pharmaceuticals with a 3D printer | Innovations in Healthcare |

A Nature Chemistry paper by researchers from the University of Glasgow describes a process for "printing" pharmaceutical compounds from various feedstocks, and supposes a future in which we have diagnosis/medication manufacturies at home. The process uses an off-the-shelf 3D printer technology to assemble pre-filled "vessels" in ways that create the desired chemical reaction in order to produce medicines. It's a scaled-down version of the industrial process used to manufacture drugs in bulk, and the paper's principal, Prof Lee Cronin, calls it "reactionware." From the BBC: "We can fabricate these reactionware vessels using a 3D printer in a relatively short time. Even the most complicated vessels we've built have only take a few hours.

"By making the vessel itself part of the reaction process, the distinction between the reactor and the reaction becomes very hazy. It's a new way for chemists to think, and it gives us very specific control over reactions because we can continually refine the design of our vessels as required.

"For example, our initial reactionware designs allowed us to synthesize three previously unreported compounds and dictate the outcome of a fourth reaction solely by altering the chemical composition of the reactor."

...Prof Cronin added: "3D printers are becoming increasingly common and affordable. It's entirely possible that, in the future, we could see chemical engineering technology which is prohibitively expensive today filter down to laboratories and small commercial enterprises.

"Even more importantly, we could use 3D printers to revolutionise access to health care in the developing world, allowing diagnosis and treatment to happen in a much more efficient and economical way than is possible now.

"We could even see 3D printers reach into homes and become fabricators of domestic items, including medications. Perhaps with the introduction of carefully-controlled software 'apps', similar to the ones available from Apple, we could see consumers have access to a personal drug designer they could use at home to create the medication they need."

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Google Glasses patent hints at speech-to-text display for deaf users | Ars Technica

Google Glasses patent hints at speech-to-text display for deaf users | Ars Technica | Innovations in Healthcare |
Google is bulking up on patents to protect its new augmented reality glasses project from legal attack, with at least nine new patents issued in the past week to cover various aspects of the futuristic devices. The patents provide a glimpse into what a heads-up display from Google could provide to real-life users beyond what we learned when Google unveiled Project Glass last month.

Perhaps most interestingly, one patent shows Google is working on a system to help hard-of-hearing and deaf users detect and interpret nearby sounds. The glasses' heads-up display would show arrows and flashing lights to indicate the direction and intensity level of the sound, and even display the words nearby people are speaking.

The patent, #8,183,997, was issued to Google today and is titled "Displaying sound indications on a wearable computing system." The system would integrate a speech-to-text feature that determines the text of speech and displays it for the wearer of the glasses.

We should note that the patent does not specifically mention Project Glass, or even the word "glasses." It does, however, talk about a head-mounted device including lens-frames. At one point, it mentions a "head-mounted helmet structure," which makes the whole thing sound much more bulky than the augmented reality eyeglasses Google is developing. But one of the two inventors listed on the patent, Adrian Wong, is associated with Project Glass. Additionally, several of the images included with the patent show glasses that look quite similar to the Project Glass prototypes displayed by Google last month. Here's one of them: Google hopes the technology will help people with limited hearing avoid danger. "A user may be at a crosswalk attempting to cross a street, and an oncoming car may be honking at the user in order to alert to the user that the car is driving through the crosswalk," Google notes in the patent description. "It may be helpful to indicate to the user the direction from which the honk is coming (e.g., from the left or the right), and the intensity of the honk (e.g., in order to indicate how close the oncoming car it to the user)."

Other aspects of the patent include a "finger-operable touch pad" on the head-mounted device for accepting user input and microphones spaced around the wearable device to ensure detection of sounds from outside the wearer's field of view. There would also be multiple video cameras to capture various views, and the option to "overlay computer-generated graphics in the user's view of the physical world."

In addition to speech transcription, the text indications could tell the user the source of a sound—for example, a dog, cat, human, musical instrument, or car.

Google gobbling up patents

The patent is one of six issued to Google today that seems directly or indirectly related to Project Glass. Another three were issued to Google by the US Patent and Trademark Office last week. Not all patents turn into actual technology, of course. Google hasn't provided a release date for Project Glass, and early versions may not include all features described in patents. It's also possible a version of Google Glasses specifically tailored to hard-of-hearing people could be released independently of a version targeting the majority of consumers.

Google's rush to patent the heck out of Project Glass isn't surprising. With both Google and its hardware partners facing lawsuits and patent licensing demands from competitors of Android, Google has begun playing the technology world's version of "mutually assured destruction," amassing patents to deter competitors from launching lawsuits. Legal experts say Google was late to the game in protecting Android, but the company appears to be making no such mistake with the Google Glasses.

Among the nine new patents we've mentioned, one covers a "nose bridge sensor" that automatically powers on the device, while others cover the basic physical design of the glasses and various software elements.

The aforementioned nose bridge sensor would send a signal indicating whether the eyeglass-display is in use. This seems designed to automatically power on the glasses when worn and power them off when taken off, sensing patterns such as breathing to make that determination. A short delay is built into the power transitions, and extra sensors are placed on the eyeglasses' arms, so jolting the glasses a bit shouldn't turn them off.

"Combining information of the two signals may lead to an inference that the HMD [head-mounted display] may have been lifted from a nose of a user but are still in contact with the side of a user's head (e.g., a user may lift an HMD to rub the user's eyes or nose)," the patent states. "In one example, power state transitions may be ignored when the inference is determined."

As for the physical design, four patents covering design elements describe the overall build and look of the glasses, while other patents focus more on the software powering the device.

For example, a patent on a method and system for selecting a user interface for a wearable computing device talks about determining what a user is doing in order to serve up the most appropriate user interface. An accelerometer may detect that a user is walking upstairs, causing the system to shift the interface toward the top of the display screen.

More new patents include one describing a system for processing objects for separate eye displays, which is fairly self-explanatory, and another titled Wireless directional identification and subsequent communication between wearable electronic devices. The latter patent discusses the use of infrared beams to exchange information between two people wearing Google Glasses.

Experts on augmented reality say Google Glasses face serious technical hurdles, suggesting that the futuristic scenarios shown in the few videos and pictures Google has released to tout the project go far beyond today's capabilities. But these new
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Roche's new breast cancer drug, Kadcyla, has been criticised by the UK's health spending watchdog Nice for being too expensive Its estimated price tag of £90,000 per patien

Roche's new breast cancer drug, Kadcyla, has been criticised by the UK's   health spending watchdog Nice for being too expensive   Its estimated price tag of £90,000 per patien | Innovations in Healthcare |

Roche's new breast cancer drug, Kadcyla, has been criticised by the UK's   health spending watchdog Nice for being too expensive.

Its estimated price tag of £90,000 per patient easily makes its the most   expensive drug for advanced breast cancer that has been submitted to Nice in   recent years.

<noframes>Interactive chart: Advanced breast cancer drugs recently rejected by Nice</noframes>

It is perhaps unfair to compare Kadcyla directly with other advanced breast   cancer drugs since it is the first of its kind by delivering a powerful   chemotherapy agent directly to cancer cells.

Kadcyla has been shown to extend the lives of patients by an extra six months,   on top of the two year survival that can be achieved with the current   standard treatment. And because the drug delivers chemotherapy straight to   the cancer cells, it carries fewer side effects.

To account for this, Nice tries to adjust drug prices for the effectiveness of   the medicine using its quality adjusted life years (QALY) measurement. But   even by this scale, Kadcyla is among the more expensive treatments:

<noframes>Interactive chart: Advanced breast cancer drugs recently rejected by Nice</noframes>

Roche says it offered a discount - the exact figure has been kept under wraps   - but that it would have had to drop the price by 60pc to satisfy Nice's   value-for-money criteria.

But why was the drug so expensive in the first place?

Jennifer Cozzone, head of health economics and pricing at Roche, told the   Telegraph that the price was determined by two major considerations.

First, the "value" that the medicine represents to the entire   healthcare system, including the benefit to the patient as well as whether   the drug could help save money elsewhere by, for example, cutting hospital   admissions.

Second, the level of investment that goes into a medicine. Ms Cozzone did not   reveal the precise cost to Roche of developing Kadcyla, but said that it has   taken 30 years to develop, half of which was the basic scientific legwork   before the drug was even tested in humans.

A frequently cited figure in the drugs industry is that it costs around $1bn   (£595m) to get a drug to market. Pharmaceutical giants commonly argue that   their high drug prices are necessary to ensure they can continue to invest   in next generation medicines research.

She also argued that several other European countries, such as Finland,   Denmark, Austria, Norway, Sweden and Switzerland, have given Kadcyla the   green light. However Nice has countered that this is not a fair comparison   since patients contribute more towards the cost of their drugs in many of   these countries.

Roche now hopes that Nice will change its mind about Kadcyla and has launched   an appeal against the decision. But the underlying conundrum - that the NHS   simply cannot afford the drug industry's latest cancer medicines - will   probably require a much more radical solution.

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Tablets vs. paper: how the Philippines halved the cost of healthcare delivery

Tablets vs. paper: how the Philippines halved the cost of healthcare delivery | Innovations in Healthcare |

A project in the Philippines has reduced the cost of collecting healthcare information and delivering public health messages to the poorest families by almost half over five years, a university study has found.


ACCESS, a non-profit think tank, has trained the government’s community health teams to collect health information on families using tablets, replacing paper forms which they had been using since 2011.


The health workers can now use a mobile and web app to summarise the data collected and automatically generate reports. The City Health Office can also directly access the reports online and share them with other government agencies.

Via Andrew Spong
Andrew Spong's curator insight, July 30, 6:44 AM

A lesson in how effective technology can be in delivering great results from an HEOR perspective when legacy EHR vendors don't get in the way.

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Health Data's Future: 6 Paths to Health Data Maturity | HL7 Standards

Health Data's Future: 6 Paths to Health Data Maturity | HL7 Standards | Innovations in Healthcare |

Every year around the time of the health and government data extravaganza in Washington, Health DataPalooza, it’s reason to do an accounting of how far we’ve come in terms of accessing health data and using it as a foundation for value-based medicine. NPR says we have reached our “Awkward adolescence” (echoing Susannah Fox) with health data—lots of amazing things happening, but not a lot of impact.

Of course there’s plenty more work to do to make health data more accessible, more liquid and more private, but the progress since Health DataPalooza started less than 5 years ago is amazing, and we should take note, then come back to the paths forward.

This year, the big news was the FDA announced “OpenFDA”, available via an open API, with information on adverse drug events. Time will tell what the release will mean in terms of delivering health, but with over a thousand datasets now release by HHS alone, we are seeing a wave of new capability, even if data stories take time to tell.

Meanwhile, 80% of healthcare is now digitized, more than doubling from just a few years ago.

Samsung and Apple see the potential for accessing and harvesting health data and are moving into the fray to create personal health tracking hubs. There are many more examples showing that health data has, indeed, reached the limelight. Big health data, is now often called “the new oil”, and it’s already serving as a key resource in driving economics and powering countless new companies.

But that’s not what this post is about.

All this data is great, but it doesn’t take big data or rocket science to figure out what’s killing us, and how it might be prevented.

If you’d like to see what is killing us, check out this (small) data tool:

Stop the presses: It’s us.

You take smoking, diabetes, obesity, cardiovascular disease and alcohol out of the mix, and the vast majority of those in the developed world would live to 90+. For data to really have an impact on health, it’ll have to have an impact on us. Many of these disease are diseases of behavior. We can debate how difficult it is to change behavior, or what biochemistry, genetics or other factors drive behavior, but most of our health problems could be prevented by making different choices. Consumers are going to need to care about it and use it.

There are bright spots that this is possible. Engagement rates reach 70% among institutions who do it well, but it takes leadership.

The reorganization of the ONC without a consumer office doesn’t show a lot of confidence that they are going to lead the way.

How do we fix this?

We’re nearing the point where we’ll be able to capture someone’s vital signs every minute of every day via Samsung, Apple, and many others. Will all this measurement save us from ourselves? Can we truly get prevention, or do will we just get better at heading off problems at the last minute? While preventing heart attacks is great, as a new iWatch is rumored to do, it would be even better if we could fix the unhealthy state that makes them possible before a last-minute intervention is necessary.

With that in mind, here are my wishes and a few predictions for the next phase of health care and health technology (now forever linked) and the road to solving health care with health data:

1. We need to create tools that can actually measure and impact behavior on what goes into us, not just stats on where we are and how we’re moving.

At the end of the day, we’re going to need to measure and provide feedback on input on intake as much as output. We’ll need to not only sense motion and vital signs but also what we’re putting into our bodies in terms of food, drink and chemicals, and start to change it. There has been work on tooth sensors to measure intake and Apple and others appear to be working on hydration sensors. It’ll be exciting to see developments in these areas in the coming years.

2. We need to better understand what drives metabolic disease. Metabolism-related killers are becoming our primary killers, but many normal weight people, in addition to obese people, die of metabolic disease. There’s still a lot we don’t understand about prevention and the disease. Yet metabolic disorders such as diabetes are taking an ever-greater toll and half the country will be at risk for diabetes by 2020. That’s a lot of suffering, a lot of death, and an enormous cost.

3. We need to prepare for the fight of a generation. Metabolic diseases are killing us in ever-larger numbers. The more we measure what’s driving costs, as we collect more and more Health Data, we’re going to run straight into a very big wall of conclusion: sugar is killing us.

With the release of FedUp, the idea of sugar as a culprit for our health care woes is starting to hit the mainstream.  If the fight against control of tobacco was tough (and by no means won), the fight against sugar will be 10x harder.

4. We need to correlate outcomes and environment. That means we need to understand what networks behavior of the health care system.  We’ll learn a lot from the 125,000 people who die per year from not adhering to their medications. Why aren’t they taking them on time? What’s preventing people from treating themselves?

For that we need to understand things at a systems level and better correlate with the social determinants of health. As Atul Gawande pointed out, yet again, at health DataPalooza, the overall vulnerability of a population is what’s drives our biggest health costs. The intersection of socio-economic/social determinants and network behavior will help us solve major hotspots, major sources of cost and suffering.

5. This one might be obvious, but we need to be better at predicting with data. EHRs like their name implies, are records, focused on the past. We need electronic health systems that are predictive. Apple and Samsung or others will do it, and they appear to be correctly focused on a new kind of technology for the new business model of health care, focused on risk spread among all players (and value place on prediction).

Dave Chase, CEO of Avado,  now part of WebMD, issued a stern warning to healthcare providers and their approach to healthIT on Susannah Fox’s blog:

“Just as it was easy to dismiss Google, craiglist, ebay, groupon, foursquare, facebook, etc. so too are the Iora Healths, Caremores, HealthCare Partners, Edison Health, One Medical, Surgery Center OK, Paladina Health, etc. ,but their value proposition is compelling. All of those players are deploying health IT in a radically different way than incumbents. Those orgs and their supporting technology take it for granted that patients are a core member of the care team, have access to their data and generally are using IT for competitive advantage.”

6. We need better rules on ownership and rights around health data, we could start with a Health Data Bill of Rights. In the consumer space, the rise of Snapchat and Whatsapp are indicative of a rise in the awareness and need for privacy. In health care, it will take time, but as health data gets “consumerized” with Apple and Samsung entering the fray, I predict the needs will become more and more apparent.

We need to work on rules and awareness to make health data more private and at the same time more easily exchanged. I don’t know exactly what that will look like but I, like many others, get the sense the answer may come through the blockchain. Fred Wilson at Union Square Ventures sees it as driving the next big investment cycle, after social and now mobile. He says, “our 2014 fund will be built during the blockchain cycle”. More on that in an upcoming post.

What do you think? What do we need to solve health care with health data?

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A 3D Printed Cast That Can Heal Your Bones 40-80% Faster | TechCrunch

A 3D Printed Cast That Can Heal Your Bones 40-80% Faster | TechCrunch | Innovations in Healthcare |

It looks like something from the Borg (read, cool), but it’s actually a cast for healing bones.

The Osteoid, created by Turkish student Deniz Karasahin, incorporates 3D printing and ultrasonic tech to make healing a broken bone more bearable.

The idea of ultrasonic healing vibrations to heal bones (and other wounds) has been around for a while. But the problem was doctors couldn’t get past the plaster cast to apply the vibrational therapy.

Take a look at the pic below and you’ll see the Osteoid’s skeletal design allows ultrasonic drivers to be placed directly on the skin.


The Osteoid is just a prototype at the moment. However, future production will enable each individual to have a custom-fitted cast.

Combine this cast with the accompanying low-intensity, pulsed ultrasound (LIPUS) bone stimulator system (shown above) and, according to Karasahin:

For single 20 minute daily sessions this system promises to reduce the healing process up to 38% and increase the heal rate up to 80% in non-union fractures.

The only downside is you won’t be able to get your friends to sign it anymore.


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Cleveland Clinic CEO: Four ingredients in our 'secret sauce' - The Advisory Board Daily Briefing

Cleveland Clinic CEO: Four ingredients in our 'secret sauce' - The Advisory Board Daily Briefing | Innovations in Healthcare |
In an interview with Business Insider last week, Cleveland Clinic CEO Delos Cosgrove outlined factors that contribute to the renowned health system's success.
AttractiveHealthcare's curator insight, December 14, 2012 4:34 AM

Un modèle pour la France ?

Jeffrey Benabio's curator insight, January 8, 2013 9:23 PM
One-year contracts and annual reviews: Universal data sharing: Creating an infrastructure around the patient: Small changes matter: 
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Mapping future health: patient, provider, pharma perspectives

Mapping future health: patient, provider, pharma perspectives | Innovations in Healthcare |

The future patient will be:

Committed to self management. The future patient is aware of the fact their personal health future is most likely to be conditioned by preventative strategies rather than treatment after the fact. The future patient is self-aware, and whilst they may not always abstain from actions that have health impacts, or engage in risky behaviours, they do so as a personal microchoice that they account for to themselves rather than expecting their decision to be ameliorated by external agencies. The future patient appreciates that informed choice trumps informed consent. The future patient will become who they are.

Health privileged. The future patient appreciates that whilst access to good healthcare should be a right, good health itself is a privilege and should be treated as such. The future health consumer aspires to maintain or attain good health in the same way that the historical retail consumer has aspired to the acquisition of commodities on the basis of their appreciation that health is the most precious possession of all.

Quantified. The future patient practices and advocates the collection and redistribution of the data that streams from their body among their healthcare team (and perhaps further, if they see a collective/personal benefit) not just to manage their day-to-day health or to optimise the management of chronic disease, but to inform the advancement of future health research through the processing of data on a planetary scale.

The future provider will be:

Fully participatory. The future provider’s default assumption is that the patient will participate fully in all decisions that are made about their health. The future provider will see it as a duty of care on their part to encourage the patient to self-identify as a shared decision maker, and a co-creator of their own care.

A committed innovator. The future provider will facilitate those expectations that the future patient brings to the point of care. They will provide access to health records. They will expect and encourage patients to research their own conditions. They will be looking to deploy proven innovations within the point of care as soon as their benefits have been proven. The future provider talks constantly about the ways in which facial recognition technologies could welcome patients to their practice, how non-invasive sensor technologies will revolutionise health, how artificial intelligence in the consulting room is an adjunct to their practice rather than an insult to their professionalism, how healthcare information should be prescribable, and dream along with their patients of the time when the personalised, genomic EHR is a reality.

Digitally integrated. The future provider continually seeks to refine and improve the reach of their professional digital presences to the communities they serve at a local level, and perhaps beyond. They endeavour to find ways of using digital technologies that improve the frequency and quality of professional connections with patients with a view to supporting health behaviours, improving compliance and working cooperatively towards better patient outcomes.

Two out of three future pharma requirements are primarily internal rather than external objectives. Future pharma will be:

Visible expertise. Future pharma will be the most open, available and discoverable source of gold standard information about their own products and the disease areas they work in. Future pharma works tirelessly to make all data about their medicines available in a balanced, approvable way in online environments and platforms that the communities of interest which they serve are most likely to find and use it. Future pharma’s default expectation is that it has an ethical responsibility to proactively and openly disseminate all information about its products from clinical trials onwards.

Socially evolved. Future pharma drives the precepts of social business through its enterprise and uses social technologies and the attitudinal dispositions that underpin them to the fullest. Future pharma fully appreciates that its future financial success is contingent upon rather than threatened by observing policies of openness wherever possible, and has reoriented its business away from the traditional conceptual frameworks within which its activities had formerly been configured.

Postmarketers. Future pharma has reconfigured the means whereby it talks about and shares information concerning its products and services to the point that they no longer resemble ‘marketing’ activity as it was formerly understood. Future pharma’s former dominant marketing behaviours and the contexts within which they were practiced have become residual. Future pharma now listens actively to patient and professional needs and responds quickly and openly. Future pharma’s goal state is to anticipate needs, not to directly influence behaviours. Future pharma appreciates that its further success will reside in sublimating everything other than its irrepressible desire to innovate and promote the science it practices.

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NHS Information Strategy: Patient feedback and social media

NHS Information Strategy: Patient feedback and social media | Innovations in Healthcare |
One of the most compelling images from the Olympic opening ceremony was the tribute to the NHS, unifying a Britain that is increasingly a digital nation. This digital future lies at the heart of the NHS Information Strategy, which seeks to transform our experience of care by using feedback from patients, users and communities to improve services.

With 77% of British households connected to the internet and 59% regularly using social networks, online feedback will become increasingly important. Yet, our experience at Dell reveals a range of responses by care organisations to this cultural change. At one end of the spectrum we see some organisations that are reluctant to engage, perhaps through fear of loss of control, potential misuse, network security concerns, or confidentiality issues.

We see others experimenting with social media, for example, through: blogs, Twitter, Facebook and YouTube; guiding people to high-quality, evidence-based information like NHS Choices; encouraging patient support networks; involving communities in co-producing services; and sharing professional expertise. Examples include MHChat (mental health), SWSCmedia (social work and care), WeNurses (nursing), OTalk (occupational therapy) and #nhssm, a community for care professionals and those, from the public or private sector, interested in healthcare and social media, to share ideas and expertise on topics such the use of social media during epidemics.

In response to exponential growth in social media use during crises, the American Red Cross recently worked with Dell to launch its Digital Operations Centre, which uses innovative social media aggregation and analysis tools, supported by training for staff and volunteers, to identify trends, anticipate and respond to public needs and connect people with resources during emergencies.

Changing attitudes to social media are perhaps best illustrated by Patient Opinion, a non-profit organisation which allows patients to provide feedback on their experiences of care and health service staff to respond. Resulting service improvements are reported, moving closer to the full integration of social media into care.

However, these initiatives have raised issues which may prevent the effective use of social media in delivering the Strategy’s aims.

As detailed information on patients and users is collected, safeguards to ensure security, privacy, appropriate ownership, access and control assume greater significance. This is evidenced by the Caldicott review on confidentiality, the Department of Health’s guidance on information governance and the requirement to adopt common standards.

Social media have changed the ways our lives are accessible to others. For care professionals, blurring boundaries between public, private and professional raises potential risks in maintaining confidentiality, ethical boundaries and public trust; encouraging online feedback may also place the public in a vulnerable position.

The codes of conduct expected of care professionals are equally applicable online, however new circumstances also arise. The General Medical Council, the British Medical Association and the Nursing and Midwifery Council have issued guidance on the appropriate use of social media to help address this.

Care organisations also remain mindful of a digital divide, where 5.7 million British households are without an internet connection. These people tend to be older, with low incomes, disabilities or long-term conditions and may have a high requirement for care.

Face-to-face and online feedback will need to be captured, combined and analysed to deliver the Strategy’s aims. This will be complex: the NHS provides 1 million interactions every 36 hours and journeys of care can cross a range of services from multiple organisations.

To overcome these challenges, at a time when the NHS has to find efficiency savings of £15-£20 billion, will require care organisations to implement strategies which clearly demonstrate how investment in patient feedback and social media delivers service improvement.

Andrew Jackson, healthcare IT consultant and social media professional at Dell.

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A croudsourced project for cancer research. This is the way forward!

A croudsourced  project for cancer research. This is the way forward! | Innovations in Healthcare |

Cancer researchers often find themselves flooded by the amount of data they have to sift through in their projects. Often, this data is in a form that computers find hard to process and analyze, such as pathology slides from tumor biopsies.Cancer Research UK, finding itself loaded with a couple million slide images, decided to outsource the analysis to you, the anonymous online volunteer who always wanted to help with cancer research, but is instead an ophthalmologist. Partnering with Zooniverse, a project that allows anyone to help with looking at NASA’s data, the Cell Slider site, after a short prep, asks volunteers to count irregular cells and quantify how stained they are for every image presented. Each image is run through five unique volunteers to improve data confidence and each volunteer is rated in the background by the site based on the accuracy of previous image runs.

Each sample in the database has been stained to highlight the differences between ordinary cells, such as white blood cells, and irregular, cancerous cells. One slide has around 120 tumour samples, but these are broken down into 16 sections so the public is looking at a tiny subsection of the full dataset when they view each image on Cell Slider.

In the case of the breast cancer samples, the yellow colour represents the level of the oestrogen receptor (ER) protein present in the cell, a normal protein that in excess attracts too much oestrogen, which stimulates cancer cell division and tumour growth. Around 70 percent of breast cancers are classed as ER positive. Hormone therapies are helpful in treating this type of cancer — drugs such as tamoxifen effectively slot into the oestrogen receptors to block oestrogen, preventing it reaching and feeding the cancer. This is usually only effective if there are high ER levels, and that’s where Click to Cure comes in.

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Want A Diagnosis For Your Mysterious Medical Condition? Ask The Crowd

Want A Diagnosis For Your Mysterious Medical Condition? Ask The Crowd | Innovations in Healthcare |
Crowdsourcing is quickly becoming a popular way to solve problems--even DARPA, home of the U.S. military’s most futuristic projects, is crowdsourcing new ideas. But until recently, certain things--like medical diagnoses--were generally left to professionals.

Take the case of Simon Turkalj and his wife (he requests that she remain anonymous). About two years ago, Turkalj’s wife was in her third trimester of her third pregnancy. After delivering the baby, Mrs. Turkalj began experiencing seizures. They would disappear periodically, only to return later. The seizures are still happening today. The Turkalj’s have sought help from a number of doctors, including a team at Stanford, to no avail. No one seems to know why Mrs. Turkalj, a physician herself, keeps getting seizures. "To have a seizure, it blunts your intellect. At this point, there is no way she can go back to being a physician," says Turkalj.

Instead of letting his wife languish while doctors ponder what to do, Turkalj is presenting the problem to the Internet at large. He recently created up a Facebook page, dubbed Mom’s Medical Mystery, with links to all the relevant facts: all of the relevant medical records; a Wiki with symptoms, confirmed and suspected conditions, and ruled out conditions; and progress updates. "I’m throwing down all my cards on this one," says Turkalj.

The Mom’s Medical Mystery page has picked up 362 likes since its launch on June 26. There are however, just 15 members on the wiki.

This isn’t the first attempt to crowdsource a medical diagnosis via the Internet. Patients do it all the time on medical message boards. A doctor made headlines two years ago when he crowdsourced a diagnosis on Twitter. And UCLA researchers have created a game to crowdsource malaria diagnoses.

We’ll be watching to see if anyone figures out

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Patient-driven healthcare in the era of health reform — True North Reports

Patient-driven healthcare in the era of health reform — True North Reports | Innovations in Healthcare |
A workshop that presents how patients and consumers of healthcare services, doctors and other healthcare providers in Vermont will be affected by the healthcare reforms passed by Governor Peter Shumlin and legislators in Montpelier.” That is how the Green Mountain Patriots and Vermonters to Economic Health billed a workshop titled “Patient-driven healthcare in the era of health reform” they sponsored this past Wednesday night at UVM’s Aiken Center. The audience was encouraged to:• Gain a point of view different from the current media-driven story.

• Learn how to influence thedirection of Healthcare Re-form.

The following speakers addressed a near capacity audience:

Jeff Wennberg, Vermonters for Health Care Freedom: His topic was the current status of healthcare reform and Green Mountain Care in Vermont. He pointed out that the number of uninsured in Vermont make up about 7% of the population, with half of that amount eligible for government provided health care, but choose not to go that route. The question he raised waswhy have the government take over the whole system to address a matter that impacts one half of 7%?

Dr. Robert Letovsky, Chair, St. Michael’s College Business Administration & Accounting told stories of his personal and professional experiences under Canada’s single-payer and the U.S. system as well as economic and financial considerations for Vermonters. He pointed out that, when the government takes over health care, it becomes yet one more item on the government’s budget and political special interests drive health care policy. This has led to a doctor shortage and a rationing of care in Canada.

Dr. Robert Emmons: Clinical Associate Professor, UVM examined the ethical issues with reform that affect the doctor-patient relationship. In doing so, he gave examples from a few composites of actual clinical cases of how the third party payment system impacts the that relationship.

Dr. Dan McCauliffe: Adjunct Clinical Professor of Dermatology, Univ. of NC; Practicing Dermatologist, Rutland explained the effects that Green Mountain Care would have on patient wait times and rationing of services. He outlined ten factors that will affect the access to care and pointed out that the exodus of doctors and other care providers from Vermont has already began.

Bob Gaydos, Digital Benefits Advisor: Explored the nature of our current insurance system, pros and cons and how it affects medical care. He also laid out alternatives to reforms currently pushed by Vermont’s legislators. In doing so he argued that we will either have to gain control over our own health care costs, or the government will do it. No one is controlling costs at present and there are no other options to either individuals gaining control, or the government doing so. There are numerous examples of how government control of health care costs end up with actual increase in costs as it encourages mere people to access the system whether they need it or not. On the other hand, giving individuals more control over their health care decisions has proven to be effective in controlling costs.

The fact that the health care industry is one of the few in which technological advances result in actual cost increases. In just about every other field, technological advances result in a decrease in cost. This indicates that the market for health care has a problem. The speakers all agreed that the fundamental problem driving health care costs is the third party payment system and the solution was to remove the third party and empower health care consumers with the information needed to make their own decisions in a truly open market. On the other hand, the advocates of Green Mountain Care see the problem as the fee for service system itself. The fact that the two sides do not agree on the fundamental cause driving higher health care costs, is a big reason why they are talking past each other. Jeff Wennberg noted that, if the problem was actually the fee for service system itself, we would see the same problem of rising costs in other industries. The fact that we do not, would indicate that the fee for service system is not the problem and that we really need to back up and correctly identify the actual problem before trying to propose a solution.

Dr. Letovsky pointed out that to believe in the possibility of a market actually working, one must believe that consumers are generally capable of making the right choices about their own health care given adequate information. There is an opinion among some the single payer advocates that the average person is not intellectually capable of making such decisions for themselves, but the members of the appointed board are intellectually capable of making such decisions for all of us. Dr. Emmons argued that he has discovered during his years of practice that the average person is more than capable of making decisions on matters related to their own health.

In the end it looks like we are faced with two irreconcilable viewpoints. One the one hand their is the belief that the average person is capable of making his own decisions given adequate information and that the problems with our high cost in health care are related to a payment system that introduces a third party into the doctor-patient relationship. The other side does not believe that the average person is capable of such decisions and sees the problem in the fee for service system itself. Instead of exposing the public to a debate on these two points of view, we are rushing down a path that takes the second point of view for granted and not allowing for any dissent from those premises.
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Using digital collaboration to help beat cancer

Using digital collaboration to help beat cancer | Innovations in Healthcare |
"Imagine a world where 100,000s of people playing a simple game-based app on their smartphones or social networks or computers were at the same time analysing data and helping to beat cancer. Think Citizen Science meets Angry Birds.

Now imagine you could make it happen in 48 hours."

So began Open Labs, an exciting digital collaboration for cancer research. Gathering last weekend at the Science Museum, almost 50 volunteers joined Good For Nothing to code, communicate and help beat cancer.

Cancer Research UK presented two major research bottlenecks, one involving the classification of tumour cells, and the other around spotting anomalies in genetic code. For all the algorithms in the world, there is nothing more reliable here than the human eye, but that takes precious time. The challenge was to develop ways to crowdsource this data analysis, to speed up the development of new cancer treatments. Put simply, we wanted to create simple games that could help to save lives.

Together we created the prototypes for mobile and web-based apps that could enable millions of supporters in the UK to contribute meaningfully to cancer research. We also created communications concepts for getting people engaged: campaign strategies, branding identities, designs, storyboards, video mash-ups, copy, pitch presentations and more.

The project stood on the shoulders of the Citizen Science Alliance. Launching their Galaxy Zoo website in 2007, astrophysicist Chris Lintott and his Oxford University colleagues asked the public to help classify photos of galaxies. Within 24 hours of its launch, the site was receiving 70,000 classifications an hour, and in the first year more than 50 million classifications were made. The project is still going strong, alongside similar Citizen Science ideas like finding planets and transcribing papyrus.

Here's what we learned:

1. People are awesome.

Not just because they gave their weekend to this project, some coding through the night, or because they were talented enough to create things that really work. But because the commitment in that room was feverish. These collaborations occur regularly, sometimes for large-scale innovations, other times developing a website or a simple app for smaller charities. People do good.

Cancer Research UK came with hearty market research, which told us that 20 million people in the UK would give their time to using these apps. Together with the data from Galaxy Zoo, it also told us that context is critical: the more people understand the scientific reasoning, the more they'll engage.

Going a little deeper, the research suggested that the best motivation for using these apps was to genuinely help save lives. Despite the current trends, gamification felt like it was trivialising the cause. They wouldn't mind a little acknowledgement or a few gameplay elements, but too much would be counterproductive. People engage because they care.

2. Ego halts innovation.

There was no hierarchy. No one was defined by their role. Open Labs brought together some of the world's leading cancer researchers, the most talented programmers, top communications designers, computing students and people just wanting to help out – and they organised themselves very nicely indeed. It felt like the culture of a new start-up: everyone pitching in wherever, just to make something amazing.

We removed the meeting minutes and the management structure for a few hours, and replaced them with coloured sharpies and sweets. There was zero mention of budget constraints. And not once was an idea labelled impossible. Cancer cells looked uninspiring in shades of brown and grey, so they were recoded to bright blue and pink. Genetic data points looked like waveform, so for fun they were converted into musical notes, and for the first time ever we 'listened' to a chromosome. At the end of a genetic run, supporters were asked to 'pass the baton' to a friend, tagging someone on Facebook or Twitter – an idea that could lend itself beautifully to much charity campaigning. And so the creativity flowed.

3. Doing beats talking.

On Friday night we heard an overview of the aims for the weekend, and roughly sorted ourselves into groups. On Saturday morning we fired questions at the scientists, threw ideas onto paper, and worked out what skills we had among us. By lunchtime we were hacking APIs, developing web and mobile clients, sketching wireframes and identifying branding concepts. Sunday was all about pulling the ideas together.

How many months might it take to reach this point in our Monday-to-Friday workflows? Here it took two days. What we created was not the finished product, but creative and technical visualisations of what might be possible. We produced tangible prototypes that Cancer Research UK can now build upon. And we're still buzzing.

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Mobile Phones Cut Malaria Response Time From Weeks to Minutes

Mobile Phones Cut Malaria Response Time From Weeks to Minutes | Innovations in Healthcare |
Using mobile phones to report malaria outbreaks in Africa has been stunningly effective — reducing the government response time to an outbreak from four weeks to three minutes, according to a new report.

HP, along with partners Positive Innovation for the Next Generation (PING) and Clinton Health Access Initiative (CHAI), and mobile network provider MASCOM, announced the results of the first year of a mobile disease response pilot program last week.

“We see technology having a profound impact on disease surveillance, which has a highly antiquated process,” says Paul Ellingstad, HP’s director of global heath.

According to Ellingstad, it can take three to four weeks to send a list of sick patients to a district health clinic and then to the Ministry of Health of a respective country. Electronically automating disease surveillance speeds up the communication time to three minutes, meaning the government can immediately send bed nets and and alert citizens to take precautions.

Some 1,068 notifications were reported to Ministry of Health officials since the program first rolled out in June 2011 in Botswana’s Chobe region. Healthcare workers have been trained to use mobile devices to collect malaria data and report outbreaks to authorities.

The collected data is then plotted on a geo-tagged map, providing health workers context for their responses. Using the program’s technology, 89 potential outbreaks were identified during the pilot year. Speed isn’t mobile’s only advantage to the dated paper process. Ellingstad says reporting potential cases of malaria has increased from about 20% to 93% compliance.

“This is an example of the role technology can play in fundamentally transforming and improving existing programs within the public health sector,” Ellingstad says. “What’s critical in doing so is partnering with governments and other leading NGOs to appropriately implement technology, rather than providing technology and letting the process sort itself out.”

HP and CHAI have also started working with Kenya’s Ministry of Health and are in talks with Mozambique’s government to continue their expansion. Kenya’s government is already using the platform to track the spread of 11 diseases, including malaria. Botswana’s government hopes to add another 16 diseases in the near future.

HP and PING plan to open another 20 health facilities in Botswana by June 1 and an additional 80 by October 2012. In August, the program will begin tracking other diseases, starting with multi-drug resistant tuberculosis.

PING, a Botswana-based NGO, plans to develop a game-like mobile phone tutorial, to ease the training of new health workers.

When it comes to future uses of mobile phones in public health, Ellingstad says he feels like the sky’s the limit.

“Mobile phones in the health space feels like the Internet and e-commerce in 1994 and 1995,” he says. “Right now, we know it’s a connection point, since 5.7 billion people have access to a mobile phone. With that sort of pervasiveness, you can provide health information, education and prevention to millions at risk of death.”
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