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Technological developments in the health care sector hold great promise for delivering a better standard of care in the United States. But just because you build it doesn’t mean they will come. Doctors, that is.
Electronic prescriptions are a good example. The majority of doctors in the U.S. have no idea if the prescriptions they write actually get filled by the patient. Surescripts, for example, has a platform that lets doctors send prescriptions electronically and track when and if they are picked up.
The technology is there. But Seth Joseph, vice president of corporate strategy at Surescripts, says doctors may be reluctant to access that data and check in on a patient outside of an appointment.
“We have doctors that say ‘what would it mean from a liability perspective if doctors had access to that info and don’t take action’,” says Joseph. There are also questions around how long a doctor should wait before getting in touch with a patient about not picking up medications, for example, or what other steps they should take.
The 2009 Health Information for Economical and Clinical Health Act (HITECH Act) incentivized health care providers to adopt electronic health records (EHR) systems and use them in specific and meaningful ways. One of these is for EHR systems in one office to connect with EHR systems in another — a hospital, for example.
As a testament to how well the incentives have worked, Joseph has noted a surge in the number of EHR providers alone. His company currently connects with over 300 EHR vendors — up from just under 100 in the first quarter of 2009. By 2012, the company had seen a flood of EHR vendors, which he documented in a recent study. Considering that Surescripts was founded in 2001 and active by 2003, that’s a significant bump in a three-year period.
Some of the brightest lights in digital health will be discussing connected clinical systems at VentureBeat’s HealthBeat conference on Oct. 28 and 29.
Some hospitals and emergency rooms can already query a network of health care providers about a new patient, to see if that patient has received any prescriptions in the last 13 months and from whom. Some of these networks even have email and chat functions.
But for the most part, doctors don’t coordinate care with caregivers at other facilities using electronic systems. A general practitioner may be able to make an electronic referral specialist, but they can’t manage a patient’s overall health regimen.
As it stands, doctors are paid mainly on a fee-for-service basis, which conflicts with the whole notion of coordinated, preventative care. Rather than making doctors responsible for a patient’s overall health and incentivizing them to provide follow-up care (like checking in with doctors or services they’ve referred patients to), the current system encourages doctors to provide as many single services in a day as possible — leaving little time for follow-up care.
“We need to see payment reform,” says Joseph. He goes on to say that new legislation needs to shift doctors away from a fee-for-service model and towards incentivizing ongoing care.
This would require Congress to enact new laws that enable doctors, nurses, or case managers to focus on the whole “patient journey” whether well or sick. Until then the movement to coordinate care is not likely to progress quickly, he says.
Still, there’s promise managed care will catch on without a new law, Joseph goes on to say. Federal Medicare programs are already offering accountable care pilot programs in which health providers are paid a set amount to manage the health of a given population. Experiments in public health programs often lead to broader changes in the market.
In the coming years, we’re likely to see the health care system moving away from the fee-for-service model and toward one that prioritizes preventative and managed care. As the system transforms itself, the people in it will have to answer questions about liability, reassess the role doctors play in a coordinated care schema, and potentially create the new role of a health care manager who can utilize digital records to better supervise patient health.
Via Andrew Spong
Is Google Glass quickly falling into the waste bin of seemingly great but ultimately futile ideas?
That’s the view from PC Magazine UK, which likens Glass, and it’s seeming drift toward irrelevance, to buzzword trends of technology and the internet of yore, including VCRPlus and “the once ubiquitous ‘keyword’ employed by AOL.”
The backlash that Glass felt was high-profile (especially here in Google’s backyard) and, in a lot of ways, understandable – people simply don’t like, appreciate, or are outright hostile to the idea that their every move and every word are being recorded and transmitted to some unsecured cloud controlled by Google. The difference is important, PC Magazine writer John Dvorka notes – while other technologies faded away because they were no longer useful, Glass’s issues lay with the public perception.
“It wasn’t outliving its usefulness like VCRPlus and keywords; it was negative social pressure that made them go,” Dvorka writes, predicting that Glass will be shutdown within a year.Advertisement
Importantly, he correctly notes:
“In some ways this is a shame since a number of Google Glass applications still being developed could be useful for customer service and other business applications. Now they’ll probably never see the light.”
One area that became obvious – and far less socially awkward – is healthcare. Glass has shown usefulness in aiding surgeons and communication between providers and ambulances, adding another tool in the growing field of medicine, among dozens of other potential applications.
Just this past September, Pristine, which specializes in developing wearable healthcare technology, raised $5.4 million to develop Glass into a “more manageable, hands-free approach to telemedicine,” esteemed MedCity News colleague Stephanie Baum reported.
And MedGift, a project at Switzerland’s Institute of Information Systems, shows medics using Glass to stream video of a patient while en route to be treated by a physician, who is then better prepared when the patient arrives.
There are literally dozens of potential applications within healthcare. It’s arguably too soon to say which ones will really stick and which ones, like Glass itself, are hype. Nevertheless, that the healthcare world is more willing to embrace Glass than the general public is an interesting role reversal: the American healthcare system traditionally has embraced consumer technologies at a far slower clip than the average consumer.
So who’s to blame? Dvorka posits that the problem resides with Google’s naiveté toward the public-at-large. Some might say arrogance.
“The company has exhibited a very cavalier attitude towards individual privacy,” Dvorka says.
It’s certainly a fair point and a widely held sentiment among those who view Glass with a disdainful eye. The writer goes on to predict that, in the near future, Google will abandon Glass due to slumping interest.
But if healthcare is any guide, perhaps it’s possible for Google to refocus the product toward those who want to work with Glass versus cavalierly trying to convince all consumers to walk around like robots recording conversations in bars and dismissing critics as mere Luddites. It’s one thing for a person in an ambulance to connect with an ER physician – that has huge potential benefit; it’s entirely another to wonder if that shot of Jameson you take at happy hour is on full public display because of some socially awkward cyborg.
It’s perhaps time that Google and other tech behemoths wake up to this basic fact. To be fair, it’s not just Google; it’s just that Glass was and continues to be literally the most visible intrusion – real or perceived – into peoples’ personal lives.
The technology itself is not the problem; the application and tone-deaf roll out is what will doom Glass, and that would be a shame given that there is some promise.
Mental Health Clinicians Enrolling in Study to Use Mobile Therapy System With Patients
SANTA BARBARA, Calif., Oct. 7, 2014
SANTA BARBARA, Calif., Oct. 7, 2014 /PRNewswire/ -- For the first time, mental health clinicians have the opportunity to preview a new mobile platform that provides them with patient data between therapy visits to accelerate diagnoses and improve care. SelfEcho, a leading developer of technology solutions for mental health, is launching and enrolling clinicians in a pilot study of its new Mobile Therapy system. Mobile Therapy collects patient data on an ongoing, voluntary basis that clinicians can access through a centralized dashboard to monitor progress and enhance treatment. The system also offers practice management tools for clinicians.
SelfEcho is enrolling selected, licensed clinicians from various mental health practice areas in the pilot study, including professional counselors, clinical psychologists, clinical social workers and marriage and family therapists. The pilot studies will be conducted in two groups of clinicians who will utilize the system within their practices, free of charge. Licensed mental health clinicians treating adult patients are eligible to participate and can find enrollment information at http://pilot.mobiletherapy.com.
"Mobile technology has incredible potential to transform mental health care treatment and we're excited to be at the forefront of bringing new applications to professionals," commented Jacques Habra, SelfEcho's co-founder and CEO. "Our goal in launching the pilot study is to give clinicians a preview of the Mobile Therapy system and to solicit their input to ensure that we're meeting the needs of their practices."
SelfEcho's Mobile Therapy is designed to empower clinicians through mobile technology by collecting patient data in a scientifically validated manner, which is then analyzed by psychology-based algorithms. Clinicians invite patients to utilize the system and then customize each user's account based on the patient's condition and treatment plan. In full compliance with HIPAA requirements, Mobile Therapy collects data actively and passively via patient self-reports and smartphone sensors. Mobile Therapy uses passive linguistic analysis technology, based on 20 years of research stemming from Professor James W. Pennebaker's work at the University of Texas at Austin.
Over time, clinicians can view metrics from Mobile Therapy's centralized dashboard that enables them to more efficiently diagnose, track patient progress, identify triggers and make more informed decisions about treatment planning. The dashboard also provides clinicians with HIPAA-compliant note-taking tools and will soon offer variety of insurance, scheduling and billing features to streamline and centralize practice management.
According to a recent national survey commissioned earlier this year by SelfEcho, mental health practitioners believe mobile technology applications geared to mental healthcare treatment have the ability to improve patient care and practice management. More than half of survey respondents (66 percent) believe that being able to obtain additional data on clients using mobile technology would improve their ability to treat them. Furthermore, 68 percent of clinicians surveyed felt that integrating additional data from apps for mental health tracking into therapy practices would help clinicians advance their profession.
"Many patients do not provide reliable or consistent information to their mental health professionals about their emotional well-being during the time between appointments," said Dr. Daniel Gilbert, a Professor of Psychology at Harvard University and a senior research director at SelfEcho. "Mobile technology systems like Mobile Therapy give clinicians a powerful tool to better understand what is happening in their clients' lives so they can work together to tailor treatment to patients' needs."
Based in Santa Barbara, Calif., SelfEcho www.selfecho.com applies technology in creative ways to enhance well-being, mental health and productivity. SelfEcho's suite of products includes Mobile Therapy, a web-based platform designed to empower clinicians to provide better patient care and UpJoy.org, a web-based corporate wellness application designed to improve employee positivity and productivity. Its founders and employees are committed to the bridging the gap between clinical experts within the field of psychology and the business sphere. SelfEcho's management team includes accomplished experts in psychology and award-winning entrepreneurs. SelfEcho is a project incubated and funded through the Santa Barbara start-up incubator, Noospheric.
Via Laureen Turner, Sergey Go
Via Emmanuel Capitaine
Joanna Laurson-Doube, PhD, is group account director at Mother Tongue Life, the medical arm of transcreation agency Mother Tongue Writers
Via Emmanuel Capitaine
A new app allows Google Glass to help the hearing-impaired with a real-time closed-captioning feature. Developed at Georgia Institute of Technology, the app can transcribe spoken words using the microphone of a paired smartphone.
How do patients feel about mHealth?
Via Philippe Loizon, Philippe Marchal/Pharma Hub
Both reports are available for download at:
Via Celine Sportisse
Panasonic Corporation announced it will launch a tablet-based telehealth service in November called On4Today, a non-clinical telehealth service provided to long-term care and assisted living facilities. Designed as an ‘always on’ service, On4Today bridges potential communication gaps between assisted living facility residents and their families, friends and care providers. It delivers connectivity and easy-to-use communications intended to improve staff efficiencies, reduce anxiety for residents, promote peace of mind among family and friends and encourage stronger levels of resident engagement.
The new Health and Wellness Solutions business group is part of Panasonic’s ongoing business transformation and will deliver technology solutions to the healthcare market.
With the launch of On4TodayTM, Panasonic is demonstrating the types of solutions and new generation of networked health information technologies that are enabling providers to deliver cost-effective services. Health and Wellness Solutions will leverage Panasonic’s engineering roots and technology portfolio to address the challenges associated with individual and population health management.How It Works
On4TodayTM is delivered on a tablet and the tablet connects through WiFi. The lightweight device is portable and gives residents options to manage daily activities with calendar appointments and reminders, view photos and videos, and participate in video chats and messaging. Large font size, audio and visual prompts and touch screen scrolling features simplify site navigation and message access. The service is intuitive and can be customized, depending on long care or assisted living facility needs or individual preferences.
“Quality and reliability are essential attributes for any long-term care or assisted living facility,”said Bob Dobbins, Vice President, New Business Development, who leads Panasonic’s new Health and Wellness Solutions group. “Panasonic’s health and wellness solutions reinforce the importance of those characteristics by bringing advanced technology into the care continuum to create more meaningful interactions, generate higher levels of resident well-being and reduce facility costs.”
Via Emmanuel Capitaine
According to a recent report by the CDC, from 1976 to 2006, between 3,000 and 49,000 people have died every year due to complications from the flu.
At the end of the day, Gigaom’s summary concludes, personal apps may truly hold the greatest non-medicinal potential, as they can offer symptom identification, prevention tips, recent flu activity, and vaccine finders which, all told, have the potential to reduce the spread and severity of flu outbreaks.
Via Emmanuel Capitaine
While mobile healthtechnologies and companies offer great promise is reaching patients and consumers, perhaps the greatest challenge is quantifying actual success versus hype and simply touting the next app.
Partners Healthcare in a blog post notes that the success of mHealth platforms is increasingly difficult to gauge or is taken from a tiny sample size. Part of the issue, however, is the fast-moving world of mobile technology contrasted with the lumbering healthcare system that is often averse to change.
The seeming breakneck speed of mobile technologies, and the entrepreneurs who tout them, make sense from a pure consumer point of view – get the minimally viable product out to market ASAP and see how often it’s downloaded. But that’s no so readily applicable with healthcare clinicians, at least not at the moment.Advertisement
More specifically, the author notes that a recent mobile health company touted the success of its program, which wasn’t named, using a 10-patient sample size over three months. That exposes obvious issues like selection bias, regression to the mean, sample size bias and, lastly, a novelty effect.
The author posits that the reason for such a seeming disconnect between mHealth advocates and the staid clinical standpoint is not hard to figure out – lives can literally be at stake when it comes to healthcare.
So how does one design a scientifically sound trial that can keep pace with the technology?
Via Celine Sportisse
I think this Paracelsus quote shared by Dr Verghese makes a great screensaver:
Via Emmanuel Capitaine
I saw another exciting news story on a mobile health intervention the other day. I honestly don’t remember the company or product, but what stuck with me was the declaration of success based on 10 patients using the product for three months. Success was touted in terms of cost reduction and resource utilization reduction in a before/after analysis. This inspired me to collect some thoughts on some of the challenges around evaluating success in mHealth.
mHealth represents the collision of two interesting worlds: mobile, which changes on what seems to be a daily basis, and health care, which changes infrequently, only after significant deliberation and usually much empirical analysis. In the tech (mobile) world, companies are talking about creating a minimally viable product (MVP), getting it out in the market, assessing adoption through metrics such as downloads and customer feedback, and iterating accordingly. This would seem to make sense in the consumer world where the goal is to sell a game, an information app or productivity app. If people use it and are willing to pay, that proves its utility, right?
There is something to this line of thinking. Empiric market success is in some ways the ultimate success, at least for those who want to make a big difference in how humanity benefits from technology.
But does this work in health care? I’m not so sure. As clinicians, we’re trained to turn our noses up at this sort of measure of success. But maybe we’re the ones who are wrong. Let me use the “10 patients for three months” example to illustrate some issues.
1. Selection bias. Virtually all pilots and trials of any sort suffer from this to some extent. These days, it seems that patient/consumer engagement is the holy grail and we all must realize that people who show up to enroll in any sort of study are already engaged to an extent. What about the people who are great candidates for an intervention (conventional wisdom says the disengaged are sicker and more costly) but are too unmotivated even to show up to enroll? Does anyone know how to handle this one?
2. Regression to the mean. This is a pesky and annoying one — and a favorite of folks trained in public health — but unfortunately it is a real phenomenon. This is the stake in the heart of virtually all before/after studies. If you follow a group of people, particularly sick ones, a certain percentage of them will get better over time no matter what you do. The more sick the starting sample, the more dramatic the effect. This is why some sort of comparison group is so helpful and why before/after studies are weak.
3. Small sample size bias. This one can go either way, meaning you can exaggerate an effect or miss one. If you want to run a proper study, find someone who has training in clinical trial design to estimate the size of the effect of your intervention, and thus the size of the sample you need, to show its efficacy. Lots of technical jargon here (power calculations, type I error, type II error, etc.), enough to make your head spin. But bottom line, you can’t really say much about the generalizability of data based on 10 patients.
4. Novelty effect. I made that up, and there is probably a more acceptable scientific term for it. But what I’m referring to is, when you take that same group of people that was motivated enough to enroll in a study and apply an intervention to them, the newness will drive adoption for a while. We see this all of the time in our studies at the Center for Connected Health (CCH). The novelty always wears off over time. In fact, I’d say the state-of-the-art in understanding the impact of connected health is one of cautious optimism because we haven’t yet done long term studies to show if our interventions have lasting effects over time. There is room for argument here, I guess, but three months is awfully short.
Why is health care tech different than finding the MVP in the rapidly-changing, market-responsive world of mobile tech? One reason may be that we’re dealing with health and sickness which are qualitatively different than sending a friend the latest snapshot from vacation. It is cliché to say it, but lives are at stake. So we’re more careful and more demanding of evidence. Is this holding us up from the changes that need to occur in our broken health care non-system? Possibly.
It is true that a well designed trial with proper sample size is expensive and takes time. Technologies change faster than we can evaluate them.
One thing we’ve done at CCH is design studies that use a large matched data set from our electronic record as a comparator. This speeds things up a bit, eliminating the need to enroll, randomize and follow a control group. Results are acceptable to all but the most extreme purists.
What ideas do you have on this dilemma?
Joseph Kvedar is director, Center for Connected Health, Partners HealthCare. He blogs at The cHealth Blog.
Via Emmanuel Capitaine
When it comes to the future of computing, there is one major known and a principal unknown.
The known, with almost guaranteed certainty, is that the next era of computing will be wearables. The unknown, with commensurate guaranteed uncertainty, is what these wearables will be and where on your body they will live.
Apple and Samsung, for example, are betting on the wrist; Google, the face. A slew of tech companies believe clothing will simply become electronic. Yet there’s a whole new segment of start-ups that believe all of the above are destined for failure and that we humans will become the actual computers, or at least the place where the technology will reside.
Their enthusiasm is on an emerging class of wearable computers that adhere to the skin like temporary tattoos, or attach to the body like an old-fashioned Band-Aid.Continue reading the main storyRelated CoverageGadgetwise: Fashion and Functionality Meet in Smart JewelryOCT. 8, 2014Disruptions: Can the Apple Watch Woo Traditional Watch Fans?SEPT. 12, 2014Disruptions: ‘The Innovators’ by Walter Isaacson: How Women Shaped TechnologyOCT. 1, 2014Disruptions: Big iPhone 6 Bulges in All the Wrong PlacesSEPT. 24, 2014Disruptions: Science Fiction Writers Take a Rosier ViewSEPT. 17, 2014
Many of these technologies don’t look anything like today’s gadgets. Instead, they are stretchable, bendable and incredibly thin. They can also be given unique designs, to stand out like a bold tattoo, or to blend in to the color of your skin.
MC10 attachable computers. Credit John A. Rogers/The University of Illinois at Urbana-Champaign
While these wearables raise novel privacy concerns, their advocates say there are numerous benefits. Attachable computers will be less expensive to make, provide greater accuracy because sensors will be closer to a person’s body (or even inside us) and offer the most utility, as something people won’t forget to wear.
MC10, a company based in Cambridge, Mass., is testing attachable computers that look like small rectangular stickers, about the size of a piece of gum, and can include wireless antennas, temperature and heart-rate sensors and a tiny battery.
“Our devices are not like wearables that are used today, where people wear them for a little bit and then throw them into a drawer,” said Scott Pomerantz, the chief executive of MC10. “Ours are always on you. We have the smallest, most flexible, stretchable, wearable computer, and you can collect all sorts of biometric data tied to your motion.”
MC10 recently teamed up with John A. Rogers, a professor of materials science and engineering at the University of Illinois at Urbana-Champaign, who has been working for nearly a decade to perfect flexible devices that can be worn on the skin or implanted internally.
How would these gadgets work? Imagine being able to slap a few Band-Aid-size sensors to your body when you go for a run, then seeing a micro-level reading of your exercise on your phone.
Maybe you want to figure out which deodorant would be best for you. This would be done with a sticker that tracks your sweat level, then emails you a few brand recommendations. Or if you want to monitor your baby’s breathing, you would stick a little sensor on the baby’s chest that will alert you to any problems.
MC10 attachable computers.
“We’ll eventually see a more intimate integration of electronics and biological systems,” Mr. Rogers said in a phone interview. “Without that kind of intimate physical contact, it’s going to be difficult, or maybe even impossible, to extract meaningful data.”Continue reading the main storyContinue reading the main story
The health applications are enormous. Over the past year, Mr. Rogers and his team of scientists have been working with patients with Parkinson’s disease to monitor their motions, dermatologists to treat skin diseases, and beauty companies like L’Oréal to develop digital stickers that track skin hydration.
Wearable-computer advocates are also giddy about the infinite style possibilities. “It turns out that the mechanics of these devices are 100 percent compatible with kids’ standard temporary tattoos,” Mr. Rogers said. Meaning, they can be made to look like tattoos, with each segment containing different sensors.
Anke Loh, the chairwoman of the fashion department at the School of the Art Institute of Chicago, has been experimenting with making the attachable computers look like body art. “You see these patches and you really want to put them on your skin, even without knowing what the function is,” Ms. Loh said, noting that most wearable computers today are clunky and ugly. “There’s a lot of potential to combine fashion and technology.”
On a more futuristic front, scientists at the University of Tokyo have been working on an “e-skin,” which, as you may have guessed, is an electronic skin that sits on top of real skin. It looks like a flexible and stretchable sheet of plastic wrap, yet contains lots of health-related sensors.
In another iteration of e-skin, scientists are working to add a layer of LEDs, turning it into a functional screen that sits on the body.
Digital skins offer numerous applications, not only in monitoring a user’s health, but also as a visual user interface. They can be used on lifelike prosthetics and even replace smartphones one day. (Imagine your forearm as a touch-screen display.)
But don’t throw aside your smartwatch or say goodbye to Google Glass just yet. It will be a while before our wearable future becomes known.
Via Philippe Marchal/Pharma Hub
Notwithstanding HealthKit’s aborted launch due to a software bug, digital health companies have jumped at the opportunity to integrate their products with Apple AAPL +0.51%’s HealthKit, a hub of personal health data that consumers can display in Apple’s new Health app in iOS 8. Many are betting that the tech giant has the clout and reach to make Health an indispensable tool for patients looking to engage with their doctors outside the clinic. “It’s going to be the biggest health release ever,” says Daniel Kivatinos, a founder of electronic health record provider drchrono.
It might take some time for doctors still struggling with electronic health records to widely accept the deluge of data HealthKit brings, but many companies don’t want to be caught flat-footed. Soon after Apple announced HealthKit in June, HealthLoop went to work to integrate its software. The start-up allows doctors to check in with their patients between visits, especially post surgery, to follow their progress. Patients who underwent joint replacement, for example, can now opt to share with their doctors who prescribe HealthLoop, the number of steps they took or their temperature from trackers and blue-tooth enabled devices uploaded through HealthKit. A lack of activity or a spike in fever, can prompt a clinician to intervene. “HealthLoop is able to wrap these streams of biometric data with clinical context,” says Jordan Shlain, founder of HealthLoop and a practicing internist.
The application of biometric data in a defined clinical context, such as hypertension or diabetes, is critical in determining the success of monitoring devices with health care providers, as well as patients who are motivated to engage because of illness. “If data comes in and is not actionable, no one is going to bother,” says Michael Blum, a cardiologist at the University of California, San Francisco, and director of its Center for Digital Health Innovation, which validates tracking devices in a clinical setting.
iHealth Labs, a subsidiary of Chinese medical equipment company Andon Health, which Apple chose as a partner to pilot HealthKit, sells FDA-approved wireless blood pressure and glucose monitors, among other tracking tools. Data from blood pressure cuffs are uploaded onto mobile devices, such as the iPhone and iPad, and are currently used in clinical studies at UCSF, and the VA Medical Center in San Francisco.
iHealth’s chief marketing officer Jim Taschetta says Apple introduced the company to electronic health records vendors Epic Systems and UK-based EMIS Group, as well as Stanford University, and Duke Medicine. To test HealthKit, Duke incorporated readings from iHealth blood pressure monitors into its Epic patient portal. Epic has integrated its MyChart with HealthKit, but it is up to its customers to decide whether they want to enable sharing. Taschetta is encouraged to see a handful of health care leaders adopt HealthKit. “The odds are in our favor to see widespread adoption,” he says.
Other companies tying into HealthKit include electronic health record providers Cerner CERN +0.29%, drchrono, and athenahealth .
Via Tictrac, Sébastien Letélié