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Talent spotters from Novartis, charged with bringing new ideas into the organisation, are casting their net beyond biotech into the wider pool of wearable, or even edible, technology.
It's not that the world's biggest drugmaker by sales wants to make the next smart watch. Rather, its researchers are seeking fresh ways to monitor how the company's medicines are working and being taken by patients.
Chief executive Joe Jimenez, above, predicts this will be an integral part of running a big pharmaceutical company in the coming decade, as rising healthcare demand coupled with limited budgets force drugmakers to generate hard data to prove their drugs are delivering results.
The Swiss group has already taken tentative steps, signing a deal with Google in July to develop contact lenses to help diabetics track blood glucose levels or restore the eye's ability to focus.
It also has an agreement with privately held Proteus Digital Health to develop tablets containing embedded microchips that can tell if patients have taken their medication.
Its ambitions, however, stretch a lot further.
"We've done more than most but certainly not enough. You're going to see a continued focus from this company that will be quite technology agnostic," Jimenez said in an interview during a pharmaceutical conference in London.
"It may be niche today but in the future I think it is going to be front and centre as to how diseases are managed."
The interest comes at a time when technology companies are increasingly pushing from the other direction in an effort to find new ways for patients to monitor their own health and track chronic conditions using smart devices.
Businesses such as Apple, Samsung and Google are all trying to find health-related applications for their wearable products.
While drugmakers are certainly not short of demand for their medicines, as populations get older and sicker, finding the money to pay for costly new interventions is another matter.
Clashes between governments and drugmakers over pricing are becoming more common - most notably in cancer and hepatitis C treatment - and the industry acknowledges a need to move to a system of payment based on clinical outcomes, rather than a price per pill.
Jimenez is convinced remote monitoring technology will play a central role in this respect, both to help healthcare systems check if patients are improving and also to protect companies that need to ensure they are not penalised for a drug failing if a patient does not take his or her medicine.
The approach has potential to work well for a company like Novartis, which hopes to launch a new drug for the debilitating condition of heart failure next year.
"If there were a wearable device that could help the patient and their physician understand whether or not to come to the hospitals then that, together with our drug, could be a very potent combination," Jimenez said.
"It doesn't mean we will own the technologies, but it does mean the technologies will play an important role in the management of disease."
Via Philippe Marchal/Pharma Hub, Rémy TESTON
By Davey Alba 11.20.14 | 7:30 am |
Bryan Timlin always carries an iPhone and an Android phone.
The 57-year-old is an app and graphic designer with a Michigan company called OptHub, but he doesn’t carry two phones for work. He carries the iPhone because that’s what he likes, and he carries the Android because it’s what he needs.
The Android phone monitors his behavior. Five years ago, Timlin was diagnosed with rapid-cycling bipolar disorder, a mental illness characterized by four or more manic or depressive episodes a year. Some episodes, he says, can last as long as eight weeks. “Being bipolar is like jumping out of an airplane knowing you don’t have a parachute on,” he says. “You know you’re going to be hurt, but the high is so euphoric that it’s worth the risk. You can deal with the consequences later.” With his Android phone, he hopes to deal with these moments in other ways.
Bryan Timlin. courtesy Bryan Timlin
The phone, provided by researchers at the University of Michigan, includes an app called Priori that runs constantly in the background, using the phone’s microphone to analyze his voice and track when he is, and isn’t, speaking. Mania is typically marked by speech that’s loud and rapid, often with erratic leaps from topic to topic. Longer pauses or breaks can indicate depression.
At the moment, the app only collects data on his behavior. But the hope is that it eventually will use this information to warn Timlin and his doctor to an impending bipolar episode.
Priori is one of many efforts to address mental health through smartphone apps. Tools gestating within startups, academic institutions, and research clinics aim to help people manage everything from severe depression to bipolar disorder and schizophrenia. Through the discreet and continuous recording of social and physical behavior, these apps can detect changes in mental well-being, deliver micro-interventions when and where needed, and give patients a new awareness of their own illnesses. In the long run, they may even diminish the stigma attached to mental health disorders.
“The question isn’t whether or not this technology is going to be used in healthcare and monitoring individuals with psychiatric illnesses,” says University of Michigan psychiatrist Melvin McInnis, who developed Priori alongside computer scientists at the university’s College of Engineering. “The question is really: How?”
Most of these apps—which include CrossCheck, from Dartmouth Psychiatric Research Center, and Companion, from a Boston-based startup called Cogito—aren’t yet publicly available. But some projects have completed trials with small groups of patients, larger trials are underway, and preliminary results are encouraging. These apps are based on objective, contextual data, and they require little work on the part of patients.
But, certainly, there are many hurdles to overcome—most notably the potential for these tools to mislead patients and compromise their privacy. Finding ways of regulating such apps is as important as refining their technology.
“I think this will have a liberating effect, and will extend the boundaries of healthcare in a really enormous way,” says Dr. Jeffrey Lieberman, psychiatrist in chief at the New York-Presbyterian Hospital/Columbia University Medical Center. “But there are also ethical and legal principles that will need to be established.”
Companion. courtesy Cogito CorporationA Look Into the Future
In April 2013, when a bomb exploded at the Boston Marathon, Cogito was running a clinical trial of its mental health app Companion that included 100 people who happened to be in the area. “It was a look into the future of how a tool like this could sense the effect of a traumatic event in a population,” says Joshua Feast, CEO of Cogito.
Joshua Feast. courtesy Cogito Corporation
Whereas Priori tracks only speech patterns, Companion taps a smartphone’s GPS location tools, accelerometer, and light and sound sensors to record movements, social interactions, the frequency and timing of phone usage, and speech behavior. It uses this data to create a profile that seeks to describe all sorts of things a patient may be dealing with. This might include physical or social isolation, sleep or mood issues, or, indeed, extreme trauma.
Like Priori, Companion does not yet use the data it collects to trigger a response, but the marathon bombing, Feast says, showed how well such a thing could work. “We don’t know for sure if someone has a certain condition,” Feast says. “But we know what the symptoms associated with those conditions are, and we can see when they’re going up and down.”
Dartmouth professor Dror Ben-Zeev says much the same thing in discussing his app, CrossCheck. He aims to equip the app with an alert system that will actively notify patients and their medical team when they experience certain episodes related to schizophrenia.
It too uses a wide array of smartphone sensors to track patient behavior over time, and the plan is to correlate this info with behavior reported by doctors and patients. “When there’s a relapse event—meaning, if they either self-report that their symptoms are getting worse, or if they wind up in the hospital—we track back and look at the sensor data for two to three weeks before that event,” Ben-Zeev explains. “We try to see: is there something that happened in those weeks that was different from their datastream up until that point?”
These markers constitute a patient’s unique “relapse signature,” and eventually, the system should recognize these signatures ahead of time, notifying the patient and the patient’s medical team before a major episode happens. Ben-Zeev’s ultimate goal is to not only reduce the number of relapses, but also prolong the period between relapses. “We can raise the red flag,” he says.The Potential
These projects remain in the early stages. Researchers have completed a pilot study of Priori involving six people, for instance, and are now testing the app on another 30, including Timlin. They hope to gather data over the next two years.
But many researchers believe these tools can completely change how we examine and treat mental illness. Unlike with other illnesses, there is more of an ebb and flow to how patients experience symptoms, and the only way to capture it accurately is to track someone around the clock. “Otherwise, you’re getting these very blunt and all-encompassing summaries rather than the real flavor of what patients have experienced,” Ben-Zeev says.More than 60 million American adults—or one in four individuals—live with some form of mental illness.
As Ben-Zeev points out, the rise of the smartphone has—for the first time—provided a reliable means of tracking behavior in full. “The intensity and creativity of these things that are infusing the mHealth field, both the research and private sector, are directly linked to this amazing penetration of mobile phones,” Ben-Zeev says. “That’s what we’re trying to piggyback on.”
At the same time, using smartphones as a sensing tool could reduce stigma. Research has shown that many individuals with mental illness are uncomfortable using wearable devices that are conspicuous and purpose-built for research. Smartphones can add a veil of privacy.
If Ben-Zeev and other researchers successfully tap the power of the smartphone, the impact could be enormous. More than 60 million American adults—one in four individuals—live with some form of mental illness, according to the World Health Organization. Of those, nearly 14 million suffer from a serious mental illness, including schizophrenia, bipolar disorder, deep depression, or post-traumatic stress disorder. According to one study, these adults die an average of 25 years earlier than the general population.
These illnesses also affect friends, family members, and others around them. In the US, annual healthcare costs associated with these conditions exceed $30 billion.Thermometer of a Different Kind
Bryan Timlin compares Priori to a thermometer or insulin testers. It merely reads what his body is doing. And because he is aware of those readings, he’s more attuned to how he’s feeling in relation to his illness.
He also likes the app because it’s harder to cheat the thing. When he goes in for a clinical assessment, for instance, he could lie about how he’s doing to get a better evaluation—something he’s been tempted to do on occasion. And when he’s having a manic episode and feeling good, Timlin often stops taking his medication. In the moment, he believes he doesn’t need it. The app can show him that he does.As it stands, there’s no way to ensure that an app really does what it says it does.
But he also believes the app can eventually serve as an alternative to over-medication in at least some cases. “We don’t need all that we think we need,” he says. Mental illness also can be managed through diet and exercise, and he says Priori could help him find the right balance between this and medication.
But Jeffery Lieberman, of the New York-Presbyterian Hospital/Columbia University Medical Center, is quick to point out the potential for abuse. As it stands, there’s no way to ensure an app really does what it says it does. There’s no “Good Housekeeping Seal,” so to speak, for these mental health apps.
Yes, those coming out of academic institutions or professional healthcare organizations are sure to be rigorously vetting, Lieberman says. But he’s watching the private sector more closely. That’s where all the entrepreneurial energy comes from, after all. “But this is happening kind of piecemeal and ad hoc, and the question is: how can it be done more effectively and systematically?” he says.
Today, there are hundreds of medical-themed apps cluttering Apple’s App Store and in Google Play. Many of their claims are untested, and that has many medical practitioners concerned. We need a means of distinguishing the real tools from the fly-by-night variety.
Last year, the FDA released a document for guidance on medical apps, but it merely stated that the agency would focus its oversight on apps and phone attachments that make a specific medical diagnosis or turn a smartphone into some kind of instrument, like an ECG machine. There is no mention of guidelines specifically for mental health apps.Just Getting Started
Adam Haim, chief of clinical trials operations and biostatistics at the National Institute of Mental Health, says efforts to test—let alone regulate—these apps are only getting started. “You’re getting a whole host of new data from different sources, and if intervention can be made more efficient, I think practitioners would rally behind that,” he says. “But it would also require additional training, and it would be an iterative process.”
But he also says that these apps will eventually prove fruitful: “All signs are pointing toward the integration of evidence-based technology into mental healthcare.”
Timlin agrees. He’s unswervingly optimistic about Priori, and looks forward to the next six months, when he will continue to use the app as part of its clinical trial. “I’m always going to be bipolar,” he says. “But this condition can be managed.”Wired businessEditorCade MetzWriterIssie LapowskyMarcus Wohlsen
Via Alex Butler
Mobile developer GreatCall , which makes both smartphones and applications, and artificial intelligence company Automated Insights said they are partnering on a health app that helps caregivers stay informed on the well-being of aging family members.
The GreatCall Link app will provide an alert when the user of a GreatCall device contacts a 5Star agent in an emergency, the companies said in an announcement. It will include the date, time of call and type of help provided. In addition, the app provides information on daily events such as current locations, power status, and a list of activities to ensure that daily routines are normal and the device is charged and in use. It also includes a weekly narrative.
Wordsmith, the natural language generation platform from Automated Insights, uses Link data to automatically write a weekly overview with personalized insights. The software writes in plain English. Here’s two examples:
“Caregivers have told us they wish they had someone who could be there when they can’t,”Krijn van der Raadt, vice president of IT and software development for San Diego-based GreatCall, said in a statement. “This is why Link was created.”
North Carolina-based Automated Insights CEO Robbie Allen said Wordsmith will write over one billion narratives this year, ranging from finance applications to professional sports.
Via Alex Butler
This week MobiHealthNews once again rounded up an up-to-date list of health and wellness apps that connect to Apple’s HealthKit, a health and fitness data exchange that makes it easier for iOS apps to share data with each other. For this week’s in-depth report, MobiHealthNews analyzed the ways in which these 137 health and wellness apps are integrating with HealthKit. Some only pull data from HealthKit, while others only push data into HealthKit for other apps to use. A good number — about 20 percent — do both.
Via Philippe Marchal/Pharma Hub, Gilles Jourquin
According to the U.K.’s Telegraph, soon British doctors might be “prescribing” more apps than medications.
A new government strategy calls for a National Health Service (NHS) app store in which approved applications that purportedly improve health and lifestyles would be kitemarked (a UK product and service quality certification mark) by the health service and may also be provided for free to those trying to improve their wellbeing.
For example, overweight patients may be recommended an app that tracks their diet and exercise and those suffering from diabetes could use an app to monitor blood sugar.
The best technology developers and chosen apps would be branded with the NHS logo. Apps currently being used include mobile systems that give parents access to their children’s immunization records, allow adults and elderly persons to schedule care visits, and offer assistance to those trying to quit smoking.
Other public health campaigns have also offered apps with recipes to encourage families to eat healthy.
Details will be announced later as part of a strategy — Personalized Health and Care 2020 – focusing on how to tailor information for patients’ needs.
Via Alex Butler, Laurent FLOURET, Celine Sportisse
As the Internet of Things becomes an actual thing, more steps are being counted, more sleep patterns are being logged, more activities are being app-ified. What isn’t appearing in the data is much common sense or ambition. Instead, developers continue flocking to a saturated market filled with hipster pet rocks, devices that gather reams of largely superficial information for young people whose health isn’t in question, or at risk.
It’s a shame because the people who could most benefit from this technology—the old, the chronically ill, the poor—are being ignored. Indeed, companies seem more interested in helping the affluent and tech-savvy sculpt their abs and run 5Ks than navigating the labyrinthine world of the FDA, HIPAA, and the other alphabet soup bureaucracies. This may be their own undoing, as there is a very real—and potentially lucrative—potential to shake up the healthcare system and frack the $2 trillion annual cost of chronic disease.
Bangled with Fitbits and Jawbones and peering through their augmented reality spectacles, the audience at D.C.’s Wearables + Things conference saw the hype cycle of the industry buckle in on itself. Peter Li, a twenty-something inventor who studied biomedical engineering at Johns Hopkins, demonstrated a fitness watch that accurately detected and counted the push-ups and jumping jacks he performed onstage. Nike’s chief scientist pooh-poohed smart watches’ most commonly collected biometrics—steps, temperature, and blood oxygen—as irrelevant to athletic performance, while promoting the importance of smart algorithms for analyzing human performance. Adidas demonstrated a heart rate monitor that clips onto its biometric sports bra. At least someone finally figured out that women already run with a band around their chest.
But then there was Kabir Kasagood, director of business development for Qualcomm Life, which manufactures the semiconductors used in many wearable gadgets. He exhorted developers to stop screwing around in a saturated market for activity trackers and embrace the red-tape and regulatory friction of the healthcare industry. “Go from the children’s table to the grown-up table,” he said. “If you’re serious about this, embrace the FDA. Learn how HIPAA works. Make sure it’s connected to the [electronic medical record] and that all the health laws are observed. There’s a tremendous dearth of innovation here. I would move away from fitness and go hardcore into health. That’s where the money is.”
Dorthy, iStrategyLabs’ shoe clip device. Maggie Winters/iStrategyLabs
The audience response was lukewarm. After all, regulation is yucky. Clinical trials are a drag. Integration with legacy systems is boring. Security requirements and limitations on how user data can be monetized? Meh. As if to prove the point, minutes later, the marketing director of iStrategy Labs demonstrated “Dorothy,” a shoe clip that allows you to click your heels together three times to call Uber. By far the biggest hit of the conference, this hacked-together prototype snowballed into an appearance on Good Morning America.
As of September 30, there were 266 wearable devices on the market (including 118 fitness wearables), with 23 slated for release before the year is out. From Silicon Valley and San Francisco to Austin and MIT, young, healthy, highly educated, mostly male entrepreneurs are developing marginally useful apps and gadgets for people just like themselves. And indeed, most of the information technologies we currently use started this way, from personal computers to the Internet and social media. The alpha geeks home-brew technologies that are taken up by early adopters and spread until your mom is on board. The Silicon Valley assumption is that health and wellness will follow that same path.
But if you follow the money, and you really understand the population with the most to gain from improvements health and wellness, that assumption falls apart. It turns out the wave of wearables adoption isn’t rolling out the same way as the web or smartphones. More than half of US consumers who have owned an activity tracker no longer use it. A third of them took less than six months from unboxing the device to shoving it in a drawer or fobbing it off on a relative.
Test For Diabetes Elderly Person, Everyday life of an independent nurse, Bagnolet, France. Diabetic patient. BSIP/UIG/Getty Images
So who’s made a long-term commitment to measuring and tracking their health? People with two or more chronic diseases. According to a Pew Foundation survey, 45 percent of US adults are dealing with at least one chronic condition. While only 19 percent of people with no chronic conditions track their health indicators, 40 percent of adults with one chronic condition do so, and 62 percent of adults with two chronic conditions do so. So far this year $2.8 billion has been spent on wearable medical devices, and that’s expected to grow to $8.3 billion in the next five years. If you took all the fitness bracelets and smart watches sold in 2014 and multiplied that retail number by six, it still wouldn’t match the $6.3 billionUS market for blood glucose test strips.
People with chronic diseases don’t suddenly decide that they’re over it and the novelty has worn off. Tracking and measuring—the quantified self—is what keeps them out of the hospital. And yet there are more developers who’d rather make a splash at a hackathon than create apps and devices for people who can benefit hugely from innovation in this area.
At some point, you’ve got to ask yourself whether it’s just the friction created by health-industry regulation—the HIPAA security rules and FDA approval (or waiver) process and the hassle of integration with legacy systems. Or is it too daunting for a twenty-something engineer to develop technology for people who aren’t like them at all? An obese diabetic on a motorized scooter? Or a frail old lady with memory loss? Or her caregiver? Someone who’s three bus transfers away from a doctor’s office?
Can our innovators rise to the challenge of an aging, chronically ill society whose medical costs are swamping our economy? Or will techies just click their heels together three times, and call Uber?
J.C. Herz is the author of Learning to Breathe Fire.
Most healthcare practitioners are either using telemedicine or planning to use it soon, but less than a fifth of them are being paid for those services.
Via Emmanuel Capitaine
Right now, rHEALTH is reliable for cell counts, HIV detection, vitamin D levels, and various protein markers in the body. The next challenges, according to Chan, are adding more tests, scaling up production, and going through the laborious process of getting the rHEALTH commercialized. The company is manufacturing three different models: the rHEALTH One, which will be used for translational research; the rHEALTH X, meant to be used as a kind of power tool for clinicians; and the rHEALTH X1, which will be available for consumers.
The future of harnessing inteoperability and open data in healthcare is promising if you’re open to embracing it. Validic’s Drew Schiller explains why.
The tsunami that is big data is cresting in healthcare right now. While that wave is on the horizon, healthcare providers are scrambling to figure out how they are going to survive the surge and ride the tide to their benefit. Let’s remove the poetic metaphor for a moment and talk about the reality of what’s needed to achieve that ideal: what we are talking about is HIT interoperability and whether it’s truly achievable in healthcare. Yes it is, says Validic’s Drew Schiller— if you’re open to embracing it.
Capturing that kind of data, along with its potential to promote progress, is what led Schiller and cofounder Ryan Beckland to create Validic in 2010. Validic’s platform collects data from a multitude of clinical devices, health-related apps, and wearables and securely integrates their respective data into the HIT systems. The company’s customers include providers, payers, pharmaceutical companies, and HIT vendors. Although Validic doesn’t aggregate the data it collects, it offers a tangible and comprehensive touchpoint to the external surge of data that’s created from the myriad of devices that seem to be increasing in popularity and application, both clinically and commercially.
Validic’s platform adds a data layer to HIT systems that would be tricky to upkeep internally due to updates in existing software, emerging technologies, and security and privacy issues that often plague most new HIT tools. The company’s platform is not the sole answer to interoperability, but it’s a simple yet sophisticated approach to adding big data to a healthcare entity’s HIT arsenal. It is believed that the need to extract such data, including from consumer devices, will become more prevalent as healthcare providers come to rely on population health management (PHM) and other models of value-based care for reimbursement.
Schiller says Validic has made it simple for any healthcare entity to authorize the transmission of such data to another specific healthcare provider; all it requires is a patient portal. That takes care of the HIPAA headaches associated with consumer-created data that most providers could stand to do without. Still, a debate stirs over the value of apps and consumer devices like Fitbit: are they superfluous data sources, or is there substance to the stats they store?
Related: 5 HIPAA Hurdles for Health App Developers
Beyond the Hype of Health Wearables
Of course, there is the criticism that only the truly healthy care about their health, which if true means that these devices serve very little function in managing the most at-risk patients of provider populations. However, Schiller says that isn’t a fair assumption to make, especially at this point; he has seen firsthand how adopting these commercial devices have made influential impact on consumers when it comes to their health.
With Schiller’s evaluation in mind, it would seem that the wearable’s market has a long way to go before being worn out. In fact, it may be the patients with chronic diseases who will actively participate in their healthcare as a part of their daily lives, especially with the emergence of devices that require little effort to transmit data: think ingestible smart pills, patches and implantables. It may sound a bit invasive, but such devices could become a much- respected and highly reliable part of disease management.
Deriving data from such devices is still in its infancy, but that doesn’t diminish the big wigs’ (like Apple and Google) foray into healthcare as merely a knee-jerk reaction to a commercial fad. “It’s true these devices are designed to make money, and novelty sells, but there is more to it than that,” said Schiller. “The question shouldn’t be if these sources are valuable but how it can be applied to achieve valuable insight. How can this data be applied to the big picture?”
Apple is trying to prove that point by directly working with providers. Its HealthKit tools, which were a part of Apple’s release of iOS 8 in September, are currently being used in two clinical trials at Stanford University Hospital and Duke University to demonstrate how they can aid in the management of diabetes, cancer and heart disease. “From a data perspective, there is a lot happening right now,” said Schiller. “Although such data may not reveal immediate value in an exam room, it ultimately could influence the future of the doctor-patient relationship by giving the physician more to look at, not just on an individual level, but on a population level illustrated by the trends such devices have yet to reveal.”
Schiller’s mentality about big-picture value can also be seen in his perspective on open data. There is a lot of criticism that open data isn’t reliable, squeaky-clean enough or secure enough to be a valuable data source, but the CTO says that simply isn’t true either. Open data can never play a part in the interoperability debate because it is aggregate, de-identified data. However, there are initiatives out there that are scrubbing open-data sets in an effort to add reputable validity and reveal reliable trends.
Provider Perspective and Influence
To paint that kind of big picture, you need a lot of smaller brushes moving at once, and that’s why Schiller thinks that providers need to recognize the benefit of being able to derive data from multiple external sources. Only having the means to technically serve some of your patients is a pitfall you want to avoid, as it’s really a wasted effort. The lesson here: don’t narrow your focus via technology or vendor; let technology widen the possibilities of reaching your patients.
That being said, you want to avoid lock-in with a particular platform, application or device manufacturer because it is such a nascent market. “We’ve already seen several devices come and go, like the Zeo Sleep Coach, the Nike FuelBand. We’ve already seen examples of really high-profile devices being shut down. So it’s important to make sure that you’re not locked in to tightly to anything, so you can avoid any type of market failure,” said Schiller.
In terms of integrating such data into an EMR, that can be tricky, too due to the variety of philosophies from the EMR vendors in terms of how well they work with outside data source partners. “I would encourage due diligence in terms of how best to integrate that data into the EMR so that it’s part of the patient record, as well as something that’s accessible to the physician,” said Schiller. “Again, you will need to look for flexibility to get that kind of functionality.”
Schiller believes that it’s this kind of movement that will enable both providers and HIT vendors to create the next set of solutions for healthcare.
Although it’s important to discern value from a technical means, it’s also important to talk about that evaluation from human perspective. Schiller says that Validic chooses what applications to integrate into their platform based on the needs of their customers but he does not like to dismiss the value of any data source. “Any data that a patient generates in healthcare is relevant and important,” he said. “Now, that does not necessarily mean that it’s Validic’s role to analyze that data. What we try to do is connect the right apps and devices for our customers. Because of that, our roadmap is largely customer-driven. It’s driven by use cases and it’s driven by priorities.”
So how does all this perspective and potential promote achieving interoperability? Well, Schiller raises some excellent points with Validic’s approach and perspective regarding the data now disseminating upon healthcare. Interoperability is addressed not in a solitary solution, but by applying data layers that can be easily managed and mitigated when issues occur without causing greater upset to a larger HIT system. As Schiller noted, healthcare data has historically lived in silos, but what Validic is demonstrating is that connecting those silos can be easier through a solution that allows you to keep your system separate but seamlessly connected with external data sources. The takeaway: there is an undeniable agility and simplicity in a digital health platform like Validic that should not be overlooked.
As for the groundswell of data and discerning what’s truly valuable, Schiller says it’s really simple: “Value is a matter of perspective. We need to change the way we look at data. If we are going to change things on a big-picture level, you shouldn’t count anything out just yet. There is real value out there, both existing and emerging from new technology. To find it, you need the tools that will help you focus on what’s most valuable to you.”
Via Emmanuel Capitaine
Via Celine Sportisse, eMedToday, Chanfimao
With recent advances in technology, visits by patients to Germany's well provisioned physical therapy centers may soon become a thing of the past. Instead, they may find themselves completing their therapy at home -- in front of their televisions.
The respected Fraunhofer Institute in Berlin has developed MyRehab, a form of physical therapy that enables patients to conduct their exercises at home. The system uses a special camera, a television and sensors built into a chest strap. An avatar leads the patient through the exercises and cameras and sensors monitor whether the patient has completed them correctly. The platform even makes it possible for a doctor or physical therapist to communicate with the patient using a live Internet video connection.
MyRehab is just one example of what many believe will be the next Internet revolution: the digitalization of healthcare. After smartphones transformed the ways in which we communicate, move and shop, medicine appears to be next.
Internet giants like Google are currently preparing to make large investments in the sector. In the United States alone, some $3.5 billion ($4.38 billion) is expected to be invested this year in healthcare-related start-ups. The market is no longer limited to gimmicky items like health wristbands or Bluetooth-connected tooth brushes. New applications are focusing on real medical care, from giving birth to treating cancer.
There are numerous examples in Germany of companies taking advantage of the surge in information technology, particularly the rapid proliferation of smartphones, to explore the opportunities in what many believe will become a fast-growing sector.
A New Doctor-Patient Relationship
Thousands of health-related apps are already available on smartphones today. There are programs to measure blood pressure or to analyze a child's development. Some claim to be able to detect autism and one app called Clue even purports to be able to predict a woman's next period as well as her ovulation window for the sake of pregnancy planning. Another app can allegedly scan vacation photos for signs of a rare form of eye cancer.
A new era of online medicine is emerging, one that could provide a great deal of advantages to doctors and patients alike. But it is also likely to raise a number of important questions about which medical services can best be enhanced through digitalization. There are ethical issues, too, like who will be held liable if something goes wrong? Will the new digital services create greater transparency or will they just turn patients into data-obsessed hypochondriacs? And perhaps most pressing, will patients be required to pay for the online offerings themselves or will health insurance companies pick up at least part of the tab?
One thing is certain: Smartphone medicine is going to transform the relationship between doctors and patients.
Take the example of Klara, an app for skin conditions that operates under a simple premise. The patient takes two smartphone photos of the rash or liver spot in question, uploads them and answers a few questions. Within two days, patients receive a response, either a tentative diagnosis or even a warning from a doctor that, for example, skin cancer is a possibility and the patient should consult a physician within two weeks' time. The app has already been downloaded around 135,000 times, at a cost of €29.
Simon Bolz, a developer for the Berlin-based start-up, says that the company has succeeded in reviewing around 98 percent of all photos sent in. Currently, Munich's Technical University is also reviewing the reliability of the diagnoses provided. The company believes that a large share of its revenues in the future will come from customers outside of Germany. Already today, around 20 percent of requests have come from abroad. For its services, Klara takes a cut of a little less than 50 percent, with the slightly larger half going to dermatologists working with the company. Thus far, health insurers in Germany are not reimbursing their customers for using the Klara service.
When asked if he thinks algorithms will one day be able to replace doctors in diagnosing patients, Bolz says he doesn't know. Instead he prefers to discuss how much more comfortable the actual work of providing medicine will become in the future. "Soon, doctors might even be able to telecommute from home two days a week using a tablet," he says.
First, though, medical professionals will have to work through some prickly ethical issues. Currently, professional guidelines stipulate that doctors cannot act exclusively through "print or communications media," meaning virtual care may not replace a physical visit to a doctor. Klara skirts this problem by using vague language and describing a diagnosis as a "medical opinion".
Franz-Joseph Bartmann, a surgeon with the Chamber of Physicians in the northern German city of Flensburg, says his organization views businesses like this "openly, but critically." He doesn't see any need at the moment to take action to stop the companies from providing virtual medical services. Given that there are plenty of qualified doctors to go around, he believes few people are going to "give up personal contact with their doctor in favor of a smartphone."
Still, a new generation of patients is emerging. Blogs about specific illnesses, X-rays posted to Instagram, Facebook groups dedicated to medical conditions: All of that has long since become commonplace. Furthermore, a large percentage of doctors have stated in polls that they have sought information about certain diagnoses on the Internet. Some say it has even prevented them from making mistakes. Patients too seek medical advice on the Web.
In response, start-ups like the Lübeck firm Patientus want to give doctors an office in cyberspace. Patientus provides an application that looks like Skype but can do considerably more. Company founder Nicolas Schulwitz originally wanted to become a doctor but ultimately wound up working for a health insurance company. He found it surprising that there was no video conferencing system in existence that was tailored specifically to healthcare professionals. He began developing one in 2011.
"With our service, the doctor pays for his ability to use the Web presence," says Schulwitz, adding that access to the platform costs medical professionals around €100 per month. He says that it is particularly helpful for acquiring new patients. "You could also pick up the phone, but being able to see each other is completely different," he says. The platform even includes a virtual waiting room that patients must visit before their consultation. The Patientus platform also can be used for check-ups, thus saving the patient time and the hassle of driving to the doctor's office. It also allows doctors to hold office hours from any location.
One Berlin start-up is working on an even wider-ranging service by providing a virtual personal physician who is available 24 hours a day, seven days a week.
Should the model become popular, algorithms could soon at least partially replace a doctor's assessment. An app called OneLife, for example, arose directly out of the delivery room. Developers learned from clinics that expecting mothers often ask about the availability of WIFI when choosing the hospital where they would like to give birth. "A generation is coming that doesn't even want to set aside their mobile phones while giving birth," says OneLife founder David Schärf.
When Berlin-based OneLife launches in December, its product will initially be little more than a digital pregnancy journal into which a mother-to-be can enter observations she deems pertinent, from mood swings to pain levels. There is also room for 3-D ultrasound scans, which can then, of course, be shared with friends. The app also provides suggestions, for example that smoking husbands try to quit. But the main attraction is that the course of the pregnancy can be searched for certain patterns, perhaps enabling the prognostication of potential complications. Should one be found, the app will be able to send warnings to users. Should, for example, a patient note that she is experiencing bleeding, the app will urge her to see her doctor right away due to the danger of a premature birth.
Ultimately, Schärf would like to see OneLife expand into a kind of life-long medical service, with checkups, blood tests, operation details and allergies being saved in the -- presumably secure -- cloud. This data will enable the recognition of patterns. As an extra, diagnoses and findings will be explained in language comprehensible to lay people. "We began with the issue of pregnancy because it is one that is fundamentally positive. But why shouldn't a cancer patient also be able to use this kind of app?" says Schärf.
Analyzing large quantities of data has long since become something of a trend in medicine. The IBM super-computer Watson is able to search through 200 million pages of scholarly papers within three seconds on the search for information relevant to specific patients. "Thanks to computer capabilities like this, it will be possible in the near future to offer treatments to only those patients who will genuinely benefit from them and to protect others from the serious side-effects that such invasive therapies sometimes produce," says Chamber of Physicians official Bartmann.
But will it really make patients healthier to have a smartphone continuously collect data and monitor a person's health? Giovanni Maio, doctor and medical ethicist at the University of Freiburg, is skeptical. Data that is essentially collected at random is often only of limited use, he points out. "A good doctor collects a small amount of data, but the correct data," Maio says.
Fitness wristbands and smart watches that can count steps, measure heart rate and determine the amount of calories burned are relatively useless from a medical perspective. But the smartphones of today can already do much more than that -- at an affordable price. They can monitor glucose levels, for example. With the addition of a small clip, they can act as pulse oximeters, measuring the blood's oxygen content. A small, matchbox-sized attachment can even perform EKGs.
"Anyone suffering from heart disease gets extremely worried at even the slightest irregularity. But you also don't want to be calling the ambulance all the time either," says Jens Beermann, a cardiologist near Hamburg and the founder of Cardiogo. For a membership fee of €1,975 per year, patients receive a mini EKG device that can be carried in the pocket of one's pants. No matter where patients are in the world, they can perform a quick test as needed and send the results to a cardiologist.
Doctors on the other end can quickly access the patient's records and analyze the incoming EKG before calling the patient and explaining their findings. If needed, they can also provide necessary patient information to medical personnel on site. Two such calls per year are included in the subscription, with subsequent calls costing €95 each.
'Patients Want It'
Markus Müschenich is something of a thought leader in the German medical start-up branch. A pediatrician by training, he used to be a managing board member at Sana, a corporation that operates dozens of hospitals across Germany. He has since founded an association that is intended to support the application of digital technologies to healthcare.
"I have no doubt that good medical practice in the future will involve the Internet," he says. Online services, he adds, may make many elements of healthcare cheaper and they could offer the last resort for places where healthcare is unavailable. But he also sees another reason why the trend toward digital medicine is unstoppable.
"Patients want it," he says.
Adrian Cunning’s startup, ThriveStreams, has released its first product, according to CNET.
The newly released app takes a gamified approach to mood tracking for those with conditions such as depression and bipolar disorder. Cunning was diagnosed as bipolar in 2002 and has said that his own battle with the disorder inspired him to serve others with mental health struggles.
The app, ThriveTracker, collects data on activities such as meditation, exercise, journaling, as well as tracking therapy attendance and quality and amount of sleep. Users can chart their moods, anxiety, and irritable levels in order to analyze trends and make connections between moods and behaviors. Consistent users can earn rewards such as samples, gift cards, and MP3 downloads. The rewards are meant to incentivize consistent data entry.
The app is aimed at those whose moods vary more dramatically than usual, but can be used by anyone.
ThriveTracker app is free and compatible with iOS 7 and later, with Web and Android versions expected soon.
Via Alex Butler, dbtmobile
Michael JohnsenA new national survey shows that while the majority of people (64%) believe sexual health correlates with overall satisfaction in life, more than a quarter shy away from addressing challenges with their doctor. read more...
Via Emmanuel Capitaine
Dive Brief:The Affordable Care Act's second enrollment period began Saturday, Nov. 15, and had a lot to prove, with memories of last year's flawed technological launch of Healthcare.gov top of mind. 100,000 Americans signed up for coverage on Saturday, with many qualifying for federal subsidies that kept their premiums under $100 a month. "The vast majority of people coming to the site were able to get on and do what they were intending to do," Health and Human Services Secretary Sylva Burwell said Sunday. A total of 500,000 people signed onto the website in its first day. Speaking after midterm elections when Republicans regained Congress, President Obama said the Americans who "sat on the sidelines, in part because of our screw-ups on Healthcare.gov" now have the opportunity to partake in a working system that got a makeover after lessons learned from early failures last year.Dive Insight:
Read more: http://www.digitaltrends.com/wearables/samsung-simband-health-wristband-news/#ixzz3JMFG1xAq
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Via Emmanuel Capitaine
IBM recently announced a partnership with upstart genetics company Pathway Genomics to create a Watson-powered app to provide personalized health information based on a patient’s genetic profile, data collected from personal health trackers, medical literature, and whatever other information it can get its hands on.
As described in a recent Popular Science article, it would go something like this. A diabetic patient would open the Panorama app and ask it a question. Using its natural language processing capabilities to process the question, Watson would then come up with answer based on information it retrieves from published medical literature & guidelines as well as patient specific genomic data, health history, and even personal health data like recent activity information or blood glucose measurements. Pathway’s CEO Michael Nova describes it like this,
That’s a pretty impressive claim, highlighting both the remarkable potential and apparent risks with an app like Pathway. Nova suggests that the app will be available some time in the middle of 2015. While its possible that there is extensive testing being undertaken now to ensure the safety of an app that could provide such specific and potentially high risk recommendations, its more like that this app will be crafted to avoid FDA oversight.
And while some may point to the implementations of Watson in supporting care decisions elsewhere in medicine like oncology, there’s one big difference here. Those applications give recommendations to a “learned intermediary” like a physician or nurse – someone who takes this advice in conjunction with clinical specifics and their own knowledge to make the actual decision. Here, the recommendation would be going directly to the patient and is slated to be highly personalized, unlike say a simple Google search.
Regardless of what the actual scope and capabilities of the released app end up being, the integration of the veritable mascot of “big data” with the smartphone is something of which healthcare professionals should take note.
Satish Misra, MD
Satish is a Cardiology Fellow at the Johns Hopkins Hospital. He is a founding partner and Managing Editor at iMedicalApps. He believes that mobile technology can change the way healthcare is delivered and that iMedicalApps is a platform through which clinicians can be empowered to lead the charge.
Via Celine Sportisse
This is the fourth edition of our yearly study on the state and the future of mobile healthcare. In this year’s report we have asked more than 2,000 mobile health app developers, health managers, project managers etc.
Via Emmanuel Capitaine , Lionel Reichardt / le Pharmageek, dbtmobile
Diabetes is rampant in India – 60 million-plus Indians are currently living with the disease and one million die from it each year. Furthermore, Indians tend to get the disease at an earlier age – often in their 30s and 40s – during their prime earning years.
In September, Arogya World announced that we have reached more than 1,000,000 people from all over India with a series of 56 diabetes prevention and education text messages in 12 languages, fulfilling a Commitment we made at the 2011 Clinton Global Initiative (CGI) Annual Meeting. Analysis of the program is ongoing, but initial results look very promising.
Following the program, consumers’ awareness of diabetes and its complications increased, and promising trends in behavior change included:an 11% increase in daily exercise,a 15% increase in the intake of 2-3 servings of fruits a day,and an 8% increase in 2-3 servings of vegetables a day.
Prevention is Key
Photo Credit: Nokia
The WHO says that approximately 80% of heart disease and diabetes and 40% of cancers can be prevented through healthy lifestyles such as avoiding tobacco use, eating healthy foods and increasing daily physical activity. We decided to “go big” with mDiabetes because we know that it is a sustainable and scalable model for disease prevention that can be rolled out in countries around the world. And mobile phones are our technology of choice because they are widely used globally – with about 900 million cell phone subscribers in India alone.
How mDiabetes Works
In 2012, Nokia Life helped Arogya World recruit 1,052,633 consumers who opted-in to receive mDiabetes text messages. Messages were provided free to subscribers twice a week for six months. Participants came from all over India and a variety of socio-economic backgrounds.
Arogya World developed the 56 text messages with Emory University in late 2011, based on science and behavior change theory, and then, with Ipsos, consumer-tested them in simulated conditions as well as in the real world. Nokia Life provided the translation and transmission infrastructure, and transmitted more than 56 million mDiabetes text messages to the consumers throughout 2012.
We’re Not Done Yet
After we complete analysis of the first million, Arogya World plans to scale-up the program to reach and help millions more in India and beyond. Future plans include partnerships with global health organizations, governments and private sector partners to expand the program even farther. We’re also exploring the development of a diabetes prevention “app” for consumers, as well as multimedia content on complications of diabetes and other non-communicable diseases.
mDiabetes, the largest diabetes prevention mHealth program in the world, was designed and implemented by Arogya World in partnership with Nokia Life. Other partners include Emory University, Johnson & Johnson, and Ipsos.
Tags: CGI, Diabetes, health, mDiabetes, mobile, mobile health, NCDs, nutrition, Oct13, WHO
Via Olivier Janin
By Consumer Reports November 3
The modern health-device craze started with pedometers that simply tracked the number of steps you took in a day. Now there are hundreds of gadgets that you can slap on your wrist or tuck into your pocket.
They sync up to your smartphone and track everything from blood pressure and calories burned to how stressed you are and how well you slept last night.
But how effective are those gadgets in keeping you healthy? “That’s the big question,” says Steven Steinhubl, a cardiologist and director of the digital medicine program at Scripps Health in La Jolla, Calif.
He says published research shows that some devices on the market still have kinks to iron out. For example, one lets you take a photo of a skin lesion with your smartphone and tells you whether it’s cancerous. But it got the diagnosis wrong a third of the time.
The devices that experts say are most useful right now are those that help monitor common, chronic conditions. For example, a study at the University of Florida found that home blood pressure monitors and blood glucose meters gave doctors valuable information to help them treat people with hypertension and diabetes.
The Fitbit One activity tracker counts steps and logs calories. (Courtesy of Fitbit)
The devices also helped patients get more involved in their own care.
In a study published in the Annals of Thoracic Surgery, older patients recovering from heart surgery wore activity trackers, which are devices that count steps taken and calories burned.
The patients who took the most steps early on had shorter hospital stays. The researchers concluded that trackers might motivate patients to move more after surgery, which can speed recovery.
Here are three devices that Consumer Reports found accurate in its tests. All can be synced to your computer, smartphone or both, though sometimes that requires buying other software.
Blood pressure monitor: iHealth Dock BP3, $100
What it does: Allows you to track and store your blood pressure and heart-rate results on your iPhone or iPad and to share the information with your doctor. It also offers a blood pressure risk indicator and a detector for irregular heartbeats.
Best for: Older adults, whose blood pressure can vary; people whose blood pressure tends to spike when tested in a doctor’s office (a condition called white-coat hypertension); people with diabetes, for whom blood pressure monitoring is important.
The Accu-Chek Aviva Expert monitors blood glucose and includes a built-in bolus calculator. (Courtesy of Accu-Chek)
Blood glucose meter: Accu-Chek Aviva Expert, $20
What it does: Stores up to 500 readings of your blood glucose levels and calculates averages over time. Users can flag their results as pre- or post-meal for reference.
Best for: People with Type 1 or Type 2 diabetes who take insulin.
Activity tracker: Fitbit One, $100
What it does: Counts steps, logs calories, monitors sleep and tells you how close you are to meeting daily health goals. It also has a clock and an alarm.
Best for: People who want a motivational tool to help them become more active.
Copyright 2014. Consumers Union of United States Inc.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.
By Ronald Musoke
Dr. Eddie Mukoyo, the Assistant Commissioner, Resources, at the Ministry of Health has said Uganda's remarkable fight against epidemics such as Ebola and Marburg is to a large extent down to the ministry's swift adoption of mobile health applications.
Dr. Mukoyo was speaking at this month's Mobile Monday Kampala (MoMoKla) event, a community of mobile industry visionaries and mobile application developers who meet every first Monday of the month to network, share ideas, best practices and trends from global markets.
This month's event hosted by ThoughtWorks, a global custom software company based at Nakawa's Business Park dwelt more on how mhealth tools have helped to contain outbreaks like Ebola in Uganda.
Mukoyo said November's topic could not have come sooner considering that the Ebola epidemic has ravaged three West African countries of Guinea, Liberia and Sierra Leone. Other outbreaks have been reported in Nigeria, Senegal and Mali over the last three months.
Many global health experts say the Ebola epidemic partly escalated in West Africa because of the respective governments' failure to deal with the local people's suspicion and mistrust. A rapid mobile-phone response from these governments could have helped to cut back on the infection rates.
At the moment, the World Health Organization (WHO) says although the official death toll is said to be hovering around 5,000, the number is likely to be three times higher.
Among the dead are 244 healthcare workers--a stark reminder that supporting frontline health workers is vital and there is critical need to establish a more robust communications and data collection system between health workers and their supervisors as they address priority needs.
At the Mobile Monday event held on Nov. 3, Mukoyo said some of the mobile application innovations that are being hatched in Kampala's hubs had in recent years become valuable in the fight against epidemics like Ebola and Marburg.
One of the latest innovations that have come in handy at the ministry is the District Health Information System (DHISII) which is an open source, web-based software platform that captures, analyses and disseminates data.
The Ministry is banking on this UNICEF-supported project to form a core pillar of the country's eHealth Information System.
According to Edward Bichetero, the Systems Administrator at the health ministry, this has been useful in producing weekly surveillance reports on the most infectious diseases from all government health facilities in all the 112 districts of Uganda.
"Using this system, all [government] health facilities have to deliver the reports to the Ministry of Health every Monday morning," he said.
Mukoyo said by deploying various Mobile applications, the ministry is now focused on providing the appropriate level of service 'anytime,' 'everywhere' for 'everyone.'
Besides improving upon the number of health workers and providing medicine and other medical supplies at a cheaper cost, the ministry is focusing on reducing infections and health events in the individual and the community.
It is doing this by reducing the distance travelled to access a public or private facility; the time to diagnose a medical condition in an individual or community and by reducing errors in diagnosis.
Mukoyo said significant investments have been made in a variety of the health ministry's owned systems, including DHISII, iHRIS, CHMS and RapidPro.
"These tools are now beginning to work in an integrated environment," he said.
"By developing a strong information system at the household, community, facility, district and national levels, this will provide the foundation for real time information sharing."
Mukoyo said with the rapid adoption of these mobile devices and applications, the health ministry and partners are now able to interact more directly with communities, and respond much quicker, than in the past years.
As an example, Mukoyo said the ministry's mTrac Anonymous Hotline was receiving over 2,500 reports per week in October after a case of Marburg was confirmed and the resource centre was able to provide the Epidemiological Surveillance Department with regular updates on potential new outbreaks, all of which were immediately investigated and turned out not to be Marburg.
Mukoyo noted that the health ministry is now coming up with a strategy to utilize existing mobile applications to fight disease burden.
In future, he said, the ministry is planning to get an innovation hub supported by students studying in all Uganda's academic institutions and link the hub to households, communities, districts and the national health facilities.
In the next three months, the ministry together with its partners will deploy the community management system in five districts as a pilot project. The tools are supposed to dramatically improve the appalling health indices in Uganda.
The mobile application developers at the forum gave insights into how the healthcare ecosystem works, described existing and emerging tools and policies, and how developers can make it more efficient using existing infrastructure through harmonization of tools.
They argued that tools such as the DHISII, iHRIS, Rapid Pro if integrated through emerging health standards can provide the backbone for the entire country's communication and strategic health information network.
According to Ismail Wadembere, the Informatics Manager at Intrahealth, an organization that is implementing the USAID-Uganda Strengthening Human Resources for Health project, the Rapid Pro is a tool that is being developed to serve as the national communications engine, pulling in data from health workforce registries and sending data back into national databases, such as DHISII.
Many mobile health experts say the improved visibility afforded by these tools and adoption of emerging standards, will allow integration of systems to provide enterprise level management of healthcare and better preparedness for earlier detection of possible outbreaks by improved surveillance methods and, in turn, enable a smarter, more rapid response by health officials to any perceived threat.
The experts also agree that by leveraging existing infrastructure, tools, with an enterprise level healthcare infrastructure management approach, this could provide opportunities for improving efficiency, thus providing better healthcare.
"The hope is that the more circumspect view afforded by the use of these new tools, in adherence to the new standards, will allow for earlier detection of possible outbreaks, by better surveillance methods, that, in turn enables a smarter, more rapid responses by officials to contain the threat of an outbreak," noted a brief on the topic.
Via Alex Butler, Chanfimao