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Mobile Health: How Mobile Phones Support Health Care
Mobile Health: How Mobile Phones Support Health Care
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Technology alone won’t improve patient engagement

Technology alone won’t improve patient engagement | Mobile Health: How Mobile Phones Support Health Care |
Patient engagement ranks among the myriad challenges of health IT implementation. In part, it’s because it’s a two-way street — patients need access to their data, as National Coordinator Farzad Mostashari, M.D., said last week, and, to complete the picture of health, physicians need access to patient data coming from medical devices, exercise tracking software and other sources.

Success rides on whether patients will buy in to the notion that using technology can improve the care experience and, by extension, their health. So far, they haven’t been.

Research from the Deloitte Center for Health Solutions shows that patients are still twice as likely to use the Internet for online banking than for health tasks as simple as researching treatment options. Patient engagement through personal health record services remains difficult, too — only one patient in nine is interested in using PHR services, let alone actually doing it.

For their part, physicians aren’t setting a good example. A similar Deloitte survey shows that 46% of physicians do not use Internet tools to enhance patient care, and only one in five provide patients with the ability to view lab results or schedule appointments online.

Jack M. Chapman Jr., M.D., of Gainesville (Ga.) Eye Associates, shared this information during a discussion on improving physician-patient engagement during last week’s Georgia eHealth Summit.

To be fair, it’s wasn’t all doom and gloom. Three in five patients, regardless of age, said they’d be interested in using a wireless medical device to send information to their physician, and younger patients expressed interest in using their smartphones for that purpose. “That is a good trend,” Chapman said.

Chapman, an electronic health record (EHR) user since 1998, ranks among those who see the iPad as having a transformative effect on the patient care experience, noting that today’s medical students are using iPads instead of textbooks.

However, the tablet alone cannot solve the patient engagement dilemma. Here, again, it’s a two-way street — patients must be willing to share sensitive information with their physicians, and physicians must be willing to cede control over patient data. Technology can certainly play a vital role in the process, by making it easy for both parties to get the information they need, but true patient engagement will require a willingness to actually put that information to use.

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Mobile Health Around the Globe: US - Aneesh Chopra Talks | HealthWorks Collective

Mobile Health Around the Globe: US - Aneesh Chopra Talks | HealthWorks Collective | Mobile Health: How Mobile Phones Support Health Care |
Dr. Aneesh Chopra was a keynote speaker at the recent MATRC Summit meeting and spoke of the financial crisis in healthcare and the need for a more value-driven healthcare system:

Our government is broke HealthCare is a huge cost driverEmployers have had enough and don't want to pay for employee healthcare any moreIndividuals can no longer afford the higher and higher health insurance premiumsCommercial payers need to alignDoctors need to look at alternatives as they have less and less time and more and more patients.The Accountable Care Organization is geared towards a value-based, quality-driven model

Dr. Chopra expressed the need for increased access to care while increasing quality of care and decreasing costs and believes that mHealth can help achieve this. Examples follow:

Blue Button - A layer of authentication security on top of the internet allows patients in VA hospitals across the US to access and download their health information and share it with their providers. This facilitates transfer of EHRs allowing for a higher quality of patient care.

Cleveland Study - A recent study published in the New England Journal of Medicine comparing diabetic care in a paper environment to care in an EHR environment showed:

"Across all insurance types, EHR sites were associated with significantly higher achievement of care and outcome standards and greater improvement in diabetes care. Results confined to safety-net practices were similar."

Asthmapolis - A website that tracks asthma patients' use of their asthma inhalers, thus alerting other asthmatics of problem areas. This results in the avoidance of traveling in these problem areas, fewer asthma attacks and fewer ED visits.

CareClix - Changing the Way You See Your Doctor-Here is their statement on their homepage:

"CareClix is a comprehensive telemedicine solution. The portal provides a fully integrated telehealth solution to connect medical providers and patients worldwide. The system and interaction is HIPAA compliant and is completely confidential, enabling healthcare providers and patients to securely communicate and manage common day medical conditions.

This virtual medical visit seeks to lower the cost of health care, reduce transportation expense, improve access to physicians and specialists, eliminate the need for duplicate lab work and testing, improve the quality of care using advanced technology and knowledgeable well-trained providers, and enhance real-time communication with a medical provider."

There are many, many more examples than just these few to tell us that mHealth and Telehealth are growing explosively, fueled by a broken healthcare system and unsustainable costs. In the following interview Dr. Chopra names 3 main drivers in the explosion of mHealth:

Release of data by the US governmentCreation of Electronic Health RecordsShift in HC payment to a value-based model

Listen to the interview and be encouraged. There is hope for a new future in HealthCare..

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Visualize This: An e-Patient’s Medical Life History |

Visualize This: An e-Patient’s Medical Life History | | Mobile Health: How Mobile Phones Support Health Care |
There is some recent thought that self-tracking or data gathering is “a manifestation of our profound self-absorption.” Sure, self-tracking is all about ‘me,’ (hence the word ‘self’) but there seems to be an undertone that people are motivated to track their data by vanity or narcissism. This may be true for some people, but there are others who are motivated by true medical necessity – diabetics needing to track their blood sugar, or people suffering from unexplained medical mysteries. I fall into the second group.

For the past 20 years I have had Myasthenia Gravis, an autoimmune disease that causes weakness. For the past 14 years I have been taking Prednisone, a corticosteriod, to suppress my immune system to help reduce my Myasthenia symptoms. Unfortunately prednisone causes a host of side effects. For the past 5 years I have been experiencing gastrointestinal problems (debilitating at times) and increased weakness. I have been to neurologists, a number of gastroenterologists, acupuncturists, and a few primary care doctors, and NONE of these folks were able to really explain what was happening to me or give me concrete advice for improving my condition.

As I was getting ready to see a new doctor, I realized that the best way to tell my story would be to create a medical “life story” timeline that reflected:

The course of my autoimmune diseaseSeverity of my gastrointestinal problemsKey moments in time when I started and stopped certain medications or took antibioticsAny significant dietary changes

I sketched out the two timelines (autoimmune and gastrointestinal) separately, and then created them electronically using Adobe Illustrator. (I’m an interaction designer by day, so fortunately I had the skills/know-how to create a somewhat legible artifact.) I used a peach color to represent gastrointestinal wellness/symptoms, and a blue color for Myasthenia Gravis.

An important note – I did create my timeline from memory. I clearly remember, almost to the day, when my severe flare-ups happened. Like others, I have had a very hard time motivating myself to track my data daily and I don’t think I can bring myself to actively do it; until passive data collection exists for my specific disorders (or until I come up with a mechanism to force myself to track how I feel each day) I might have to just work from memory.

After I completed the timeline I printed it and took it to my doctor visit.

I can’t say the doctor was overjoyed at first to see a patient-created chart, but he listened intently as I used it as a storytelling prop. It definitely helped me quickly and coherently communicate what’s been going on with me, and when I asked him if he found it useful, he said it was helpful to get him up to speed on my story. Read more about my visit on my blog.

Last month I attended the Brainstorming Design for Health workshop at the Computer Supported Cooperative Work conference, and had the opportunity to show a print-out of the timeline to another doctor. He said that most doctors inwardly groan when a patient comes in with excel data, charts, graphs, and the like – mainly because patient data may not be totally accurate, and doctors don’t want to have to take the time to learn and understand another type of documentation or visual language. But after I gave him a few seconds with the timeline, he became very excited and animated and said this was something he could understand immediately; it could actually save him time in the exam room. The main lesson I’ve taken from that experience is that there is a definite need for a patient tool that would allow them to create legible, clear, communicative visualizations (perhaps even exploratory data visualizations on a tablet or phone) so that they can:

Better understand what is happening to them and how what they do impacts how they feelBetter communicate with health care practitioners

Let’s face it, even if a doctor is wary of a patient-generated timeline, if that artifact makes the storytelling process easier for the patient & more coherent for the doctor, it adds a lot of value even if the doctor doesn’t want to take time to carefully analyze it.

So what are the outcomes from this experience?

My new doctor has helped me resolve my most serious stomach issues, and it has been awesome to have some relief after years of discomfort and anxiety.

I can say that visualizing my history has helped change my behavior. Seeing the high number of times I took antibiotics in a short time period, and learning from my doctor that such repeated use of antibiotics causes overgrowth of yeast and bad bacteria, has helped me escape the antibiotic trap. Whereas a year ago I was calling my doctor for antibiotics every few months (they helped, but only for a month or so), now I work on adhering more carefully to a no-carb diet.

My goal is to keep pursuing this idea and work toward creating a tool for patients so they can at least assemble their own health timeline, and perhaps even track their data more regularly. I am holding interviews with patients, patient caregivers (or parents), and people who are active self-trackers; if you are interested in donating about 30 minutes of your time, email me at kathryn.mccurdy at

Here are links to the 2 blog posts I wrote about my experience w/this timeline:

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IBM’s Watson evaluating evidence-based cancer treatment options

IBM’s Watson evaluating evidence-based cancer treatment options | Mobile Health: How Mobile Phones Support Health Care |
IBM’s Watson, first made famous for defeating two human champions on Jeopardy, has a new role at Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute in Los Angeles, California.

Watson will be advising oncologists, using an enormous database of both Cedar-Sinai’s own historical data and current records as well as current medical literature to formulate recommendations.

Also involved is Nuance Communications, who’s speech and imaging recognition software will be integrated into the applications to be developed.

The imedicalapps team has previously discussed the healthcare implications of Watson and its ability to affect patient outcomes. While we have also discussed some of its limitations, Watson’s new role at Cedars-Sinai is the first tangible example of what it can potentially do.

The aim is nothing short of extraordinary – to take not only the full wealth of medical knowledge in reference texts, clinical trials, case reports, and other research but also use all local, national, and even international data sources to come up with an individualized evidence-based recommendation.

“Working with speech and imaging recognition software provider Nuance Communications, IBM said the supercomputer can assist healthcare professionals in culling through gigabytes or terabytes of patient healthcare information to determine how to best treat specific illnesses. For example, Watson’s analytics technology, used with Nuance’s voice and clinical language understanding software, could help a physician consider all related texts, reference materials, prior cases, and latest knowledge in journals and medical literature when treating an illness.”

A critical feature, then, is the quality of the data – but even the most rigorous randomized controlled trials have their detractors who point out the extensive exclusion criteria, debatable statistical designs, and other features that make room for the “art” of medicine. It will be interesting to see how the physicians and developers tackle this issue because the quality of the recommendations will ultimately hinge on the quality available to the algorithms they develop.

Steve Gold, director of worldwide marketing for IBM Watson Solutions, believes that Watson will be apt at giving recommendations to physicians to prescribe treatments that have the best outcomes.

“For example, between the first and second prescribed treatments of a cancer patient, 50% of the time the prescribed medication changes for the second treatment based on the patient’s reaction to the initial treatment. Watson may be able to better prescribe initial treatments based on past patient data and information specific to the patient being treated.”

“May” is certainly the operative word, but we are optimistic that Watson will soon provide extraordinarily valuable input and insights that are likely to improve patient care.
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Getting Doctors to Think About Costs

Getting Doctors to Think About Costs | Mobile Health: How Mobile Phones Support Health Care |
My first formal lesson on health care costs occurred one afternoon on the wards when I was a medical student. The senior doctor in charge, a silver-haired specialist known for his thoughtful approach to patient care, had assembled several students and doctors-in-training to discuss a theoretical patient with belly pain. After describing the patient’s history and physical exam, he asked what tests we might order.

One doctor-in-training proposed blood work. A fellow student suggested a urine test. Another classmate asked for abdominal X-rays.

My hand shot up. “A CAT scan,” I crowed with confidence. “I’d get a CAT scan!”

There was complete silence. Everyone turned to stare at me.

The senior doctor coughed. “That’s an awfully expensive test,” he said, a grimace appearing on his face. Another student asked him just how much a CT scan cost, and he shifted uncomfortably in his seat and shrugged. “I don’t really know,” he said, “but I do know that we can’t just think about the patient anymore.” He took a deep breath before continuing, “We are now being forced to consider costs.”

That was 20 years ago, when the managed care movement was first in the headlines. Today his lesson still rings true, as doctors continue to struggle to reconcile cost consciousness with quality care. And doctors-to-be are not getting much help in learning how to do so.

But one nonprofit organization, Costs of Care, and the young doctor who created it are determined to change that.

Over the last two years, Dr. Neel Shah, a senior resident in obstetrics and gynecology at Brigham and Women’s Hospital in Boston, has been collaborating with medical educators and health care economists at Harvard Medical School and at the Pritzker School of Medicine at the University of Chicago to create a series of videos and educational materials designed to help medical students and doctors-in-training learn to make clinical decisions that optimize both quality of care and cost. With support from the American Board of Internal Medicine, these educational modules, called the Teaching Value Project, could represent a significant breakthrough in how medical students learn to be conscious of costs.

The patchwork of payment patterns that mark the American medical system makes it particularly difficult to teach young doctors. Net costs for treatments and medications vary depending on region, payer and even specific hospitals, so medical students and trainees often end up learning what is relevant only to their particular workplace. They might learn to prescribe a certain drug for diabetes because it is cheaper in their hospital formulary, only to discover later that the reverse is true in a different hospital or after policies have changed.

“When learning is haphazard like this, it’s hard for young doctors to see the entire picture,” said Dr. Vineet Arora, an assistant dean at Pritzker who is working on the Teaching Value Project.

Cost variations aside, it can also be a challenge simply to get hold of precise costs for patients. Dr. Shah recalls one woman who refused to get a potentially lifesaving ultrasound until she knew how much it would cost her. Her doctors and nurses “sweated out every minute,” concerned she would collapse at any moment, said Dr. Shah, before finally hunting down a figure later that afternoon, and the patient consented to paying the $600 cost.

The Teaching Value Project uses a rough pricing hierarchy rather than exact dollar figures to gauge costs, similar to the approach at well-known restaurant or travel search sites, which helps young doctors avoid getting mired in price variations and hairsplitting details. When combined with the project’s lessons on common cost errors that doctors make, the pricing hierarchy can bring clarity to clinical decisions.

For example, a young doctor might plan on ordering an ultrasound of the heart, or an echocardiogram, for an otherwise stable patient in the hospital because the wait for inpatients is shorter. But if that doctor also knows that echocardiograms are much less expensive when administered to outpatients, he or she might instead decide to wait and order it after discharge.

Similarly, a team of trainees might believe they are being cost-conscious by debating whether to get a battery of moderately expensive tests for a patient in the intensive care unit. But then they might learn that the time they are devoting to the debate is actually costing more than the tests themselves because of the expense of keeping the patient in an I.C.U. bed even a few extra hours.

“Zagat has figured it out,” Dr. Shah said. “Knowing whether it’s one, two or three dollar signs can be enough to influence behavior.”

The group recently posted an introductory video, a tongue-in-cheek look at what hotels would be like if they were run like hospitals. At the “Hotel Hôpital,” prices are never listed; concierges order expensive cabs pre-emptively, or “prophylactically,” even if you don’t need one; and no one working in the back office can decipher your surprise $20,000 hotel bill.

The group expects to complete its first full Teaching Value module this summer, with more planned over the next few years. It also hopes to collaborate with professional medical organizations to help raise cost consciousness among more established practicing physicians.

All involved are quick to acknowledge that as appealing as the approach may be, the Teaching Value Project represents only a beginning for medical students and trainees. “Our goal isn’t for them to master the entire topic before graduating,” Dr. Arora said. “It’s to get them thinking about how to integrate cost consciousness into practice.”

Dr. Shah added: “At the end of the day, what we are talking about is spending our patients’ money in a way that is both ethical and pragmatic. To do that, we will all need to create a culture where it becomes awkward not to think about cost.”
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mHealth as an Investment Thesis The Need Promise Mystery

mHealth as an Investment Thesis The Need Promise  Mystery | Mobile Health: How Mobile Phones Support Health Care |
The total investment in mHealth-related companies in 2011 was more than twice the total in 2010. Whatrsquos causing this increased interest in the mHealth space Find out on mHealth Zone.
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What’s the future for self-tracking? |

What’s the future for self-tracking? | | Mobile Health: How Mobile Phones Support Health Care |
Stephen Wolfram’s essay, The Personal Analytics of My Life, begins: “One day I’m sure everyone will routinely collect all sorts of data about...
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Medical Devices in This Year’s Georgia Tech InVenture Prize Contest

Medical Devices in This Year’s Georgia Tech InVenture Prize Contest | Mobile Health: How Mobile Phones Support Health Care |

Each year at Georgia Institute of Technology (Georgia Tech), students in the engineering fields participate in a contest of the best inventions and product concepts called The InVenture Prize. This year two of the six finalists are medical devices, Re-Hand a software assisted home-use hand assessment and rehabilitation device, and the CardiacTech, a chest retractor for bypass surgery.

This evening, Georgia Tech will be hosting presentations where inventors can explain their devices to a panel of judges. David Pogue, a tech column writer for the New York Times will be the moderator for the contest. The video of the event will be broadcast live online starting at 7pm EDT.


What’s up for grabs:

A cash prize of $15,000 for first place or $10,000 for second place.
A free U.S. patent filing by Georgia Tech’s Office of Technology Licensing (each valued at approximately $20,000) for both the first and second place winners.
Automatic acceptance to the summer 2012 Class of Flashpoint, a Georgia Tech startup accelerator program.
In addition, a $5,000 “People’s Choice” award, provided by the Georgia Tech Research Corporation, will be presented. The live audience and broadcast viewers will have the opportunity to help select the winner of this award by voting on the Internet or texting in their favorite finalist.

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The Hindu : Sci-Tech / Technology : Mobile devices change web access patterns, says study

The Hindu : Sci-Tech / Technology : Mobile devices change web access patterns, says study | Mobile Health: How Mobile Phones Support Health Care |

Mobile devices — smartphones and tablets — that had a windfall sales year in 2011 are shaping an online landscape in which consumption patterns are rapidly changing, according to research agency comScore's report, ‘2012-Mobile Future in Focus,' which was released on February 23.

Based on mobile markets, primarily the U.S., the United Kingdom, France, Germany, Italy, Spain, Japan and Canada, the report lays out a road map for trends likely this year. Central to the theme is the spike in the use of mobile devices — smartphones and tablets — as a gateway to access the web.

The trend is most visible in Singapore, where it is estimated that mobile devices account for nearly 11.5 per cent of the web traffic.

The U.K. and the U.S. come second and third at 9.5 and 8.2 per cent. India figures eighth in the list, with 5.1 per cent of the web traffic through mobile devices. With nearly 100 million internet users, in terms of actual numbers, India should rank as one of the biggest markets in terms of potential.

Health apps popular

Health ranks as one of the key segments of interest for smart mobile device users. In the U.S. as well as key European segments, access to the web through Apps gained parity with access through mobile web browsers, the report notes. Health Apps is the fastest-growing mobile Apps category, followed by retail and other e-commerce applications.

Conversely, other classical web applications like the web mail and weather services are seeing a lack of interest.

Access to news

The report lays stress on news consumption in markets where newspaper circulation is being challenged by online consumption. (In India, the scenario is different as of now.) It points to a change in the consumer pattern on the devices the readers used to access news through the course of the day. The use of smartphones and tablets peaked through the course of the day, whereas access to news through the traditional desktop computer seems to be on the wane. This could be one of the opportunities for publishers to look at this year.

New category of consumers

Defining a new category of consumers — “digital omnivores” who engage online through multiple touch points through the day — the report has predicted that 2012 could well be the year of a pitched battle among mobile operating systems (OS). Consumers in the U.S. and Europe reckon that network connectivity and strengths of the mobile operating system are key considerations before buying a smartphone.

The main contenders are Google's Android and Apple's iOS, but the report notes that Research In Motion's BlackBerry OS, which is making a comeback of sorts, and Microsoft's Windows Mobile, which is trying to reach out with the Metro interface that integrates the desktop and the mobile experience, could set things up this year.

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Medicine in 2012- You, the ipatient, and Your Doctor - Forbes

Medicine in 2012- You, the ipatient, and Your Doctor - Forbes | Mobile Health: How Mobile Phones Support Health Care |
  Image via Wikipedia As technology has infiltrated all aspects of our society, many patients have witnessed their doctors becoming more tech savvy.

This can be seen from the use of electronic tablets upon checking into the office for appointments, along with emergence of electronic filing of prescriptions, and finally with electronic medical records (EMRs) becoming more commonplace in medical offices, emergency departments, and hospitals in general.Originally designed to streamline patient care and produce legible records for other providers caring for patients, this technology also has the potential to alienate patients, feeling that they are in essence a placeholder for the real patient in our modern age- the “ipatient”.

Dr. Abraham Verghese, a well known physician practicing at Stanford, has become an authority regarding the excesses of computers and technology in medicine, noting how technology has significantly altered the “traditional” doctor-patient relationship. While technology has helped doctors access data and treat patients more efficiently, the computer has shifted our focus and attention from the real patient, and instead produced the “ipatient”.

In the past few years, I needed outpatient surgery at a modern computerized hospital. My nurse would come in infrequently to visit the computer workstation near my bedside with her back to me as she clicked away. As my nurse was focused on the computer, it created a sense of isolation or distance for me. Her focus was clearly on the computer record, as opposed to my needs as a patient when I required comforting and reassurance after a painful procedure. She was focused on charting, typing away feverishly, as though she had to finish an overdue project.

In many ways, the computer generated medical record after my surgery was nearly perfect- demonstrating close monitoring, excellent charting with precision detail, but lack of evidence of any human compassion. I certainly do not blame the nurse, because as an emergency medicine physician, I also spend a significant amount of time in front of the computer reviewing past medical records, lab and radiology results as I complete a patient’s chart.

The question, however, is this-how can we bring the real patient closer to the physician-so that the ipatient doesn’t threaten to erode the human bond you have with your doctor or other provider taking care of you.

That is the daunting challenge in practicing medicine in this modern computer age.

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ICD Software Predicts Earlier Device Failure

ICD Software Predicts Earlier Device Failure | Mobile Health: How Mobile Phones Support Health Care |
Researchers at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis, Minn. have reported that commercially available implantable cardioverter-defibrillator (ICD) monitoring software could identify problems with ICDs earlier than current monitoring practices.Modern ICD devices are capable of sophisticated sensing and data logging techniques which aim to both optimize therapies and monitor device performance. This logged data can easily be read by a clinician in an outpatient setting using existing ICD monitoring software. The study, which was published in Circulation: Cardiovascular Quality and Outcomes, aimed to identify whether this existing data could be used to predict device failures at an earlier stage.

From the announcement:

“Current monitoring approaches aimed at reducing harm from malfunctioning medical devices rely largely on voluntary reporting of adverse events by manufacturers, possibly leading to missed warning signs and delayed responses to the problems, such as late recalls,” said Robert G. Hauser, M.D., lead study author and senior consulting cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis, Minn. “We looked at whether using an automated software program to monitor large databases of ICD patients might help us detect potential device-related problems earlier.”

Hauser and colleagues used a commercially available software surveillance program to compare data from about 1,000 patients with recalled leads to about 1,600 patients implanted with ICD leads still on the market. Patients in both databases had their ICDs implanted between 2001 and 2008.

Using the surveillance software, researchers simulated what occurred years earlier. The software detected problems with the recalled leads at least a year before the company had recalled them.

This is quite a significant finding and another example of a growing need for data aggregation and mining techniques to help us keep on top of the ever-growing heap of medical sensor data.

Press release: Computer software monitoring detects ICD malfunctions sooner…

Abstract in Circulation: Cardiovascular Quality and Outcomes: Early Detection of an Underperforming Implantable Cardiovascular Device Using an Automated Safety Surveillance Tool CIRCOUTCOMES.111.962621
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E-way to health: Govt bets big on telemedicine - The Times of India

E-way to health: Govt bets big on telemedicine - The Times of India | Mobile Health: How Mobile Phones Support Health Care |

Skype, biometrics, M-health (use of mobile phones) and E-health are all set to make an entry into India’s primary health centres (PHCs) and sub-centres as the health ministry plans to go hi-tech. The steering committee on health said that in the 12th plan (2012-17), all district hospitals would be linked to leading tertiary care centres through telemedicine, Skype and similar audio visual media. M-health will be used to speed up transmission of data. The ministry plans to give a big push to support telemedicine services in primary, secondary and tertiary care. Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics would be an integral component of the system.

Via Dinesh Chindarkar, Lionel Reichardt / le Pharmageek
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5 must-haves for successful #telehealth initiatives

There’s no denying the impact telehealth initiatives have on patients in rural areas and those who are elderly and/or homebound. “Telehealth also addresses the critical shortage of medical specialists providing care to patients who previously didn’t have access,” said Fred Pennic, founder of HIT Consultant and senior advisor at Aspen Advisors.

“With the widespread adoption of EMRs, digital health records provide physicians/clinicians with the remote monitoring capabilities to communicate with their patients,” he added. But, according to Pennic, certain “must-have” endeavors still need to take place for the industry to fully feel the positive impacts of telehealth programs.

Pennic suggests five things that need to happen for telehealth initiatives to be successful.

1. Establishing an incentive-based program. According to Pennic, sustainable funding is vital to the successful, widespread adoption of telehealth. “Creating more incentive-based programs or grants will provide agencies and other organizations with the funding necessary to overcome the start-up costs associated with implementing such initiatives,” he said.

2. Infrastructure. “Having adequate infrastructures [in place] to support these initiatives are imperative,” said Pennic. Infrastructure is the “heart of telehealth,” he said, and includes equipment such as fiber optics, broadband/wireless coverage, video, computer, voice and imaging.

[See also: Telehealth helps cardiac patients improve conditions, study reveals.]

3. Improved telehealth reimbursements. As it stands legislatively, said Pennic, there’s no universal reimbursement policy among public and private sectors governing the reimbursement of telehealth services – something he believes is imperative to its widespread adoption and success. “Current payment for telemedicine services, such as offsite reading of medical images, includes Medicaid, Medicare, employers and private insurers,” he said. “However, payment is limited for interactive consultations and chronic-care patients.” According to him, CMS and AMA are working together to formalize a payment model for telehealth services, while studies have shown telehealth can not only significantly improve care, but also reduce costs.

4. Fostering user acceptance and confidence in telehealth. “Perhaps the greatest challenge in telehealth is increasing the user acceptance of technology, for both clinicians and patients who aren’t tech savvy,” said Pennic. Ideally, he said, successful telehealth programs must be able to easily integrate the telehealth process into healthcare and patient environments seamlessly.

[See also: Telehealth grant opportunities now available.]

5. Resources and time. In addition to meeting technology requirements, said Pennic, successful telehealth programs must have the proper allocated resources and time necessary to ensure its widespread adoption. “People and processes are the key components to effective telehealth utilization,” he said.

Follow Michelle McNickle on Twitter, @Michelle_writes


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Why doctors aren't prescribing health apps to patients

Why doctors aren't prescribing health apps to patients | Mobile Health: How Mobile Phones Support Health Care |
The BBC had a story recently about general practitioners (GPs) in the UK prescribing health apps to patients. The idea is that prescribed apps would be free to patients, even if they had a cost associated with them, so I’m assuming that the NHS would pick of the tab for such apps.

The story has gotten a lot of attention, and I think with good reason. I’ve written before and believe that physicians need to prescribe health apps, whether they be mobile or web, in order for patients to signup and use them on an ongoing basis.

There are several huge benefits that exist from this approach:

Enhancing, not replacing, the doctor-patient relationship. As eroded as it has become, the doctor-patient relationship is a powerful thing capable of very positive things for our health system. In my utopia, health apps are used to enhance that relationship, providing constant touch points between provider and patient, even if some of the content from the provider is somewhat generic and/or canned. I think that constant contact and accountability for the patient, whether real or perceived, will be a huge driver of ongoing usage. Also, collecting additional data and summarizing it for the provider, potentially with clinical decision support built in, makes the time spent face-to-face that much more valuable.

Minimizing disruption. If the provider can have select apps for each condition or cohort of patients then it makes disruption of clinical flow less for them as they only have to learn to view and act on results from a small subset of apps. Also, if these targeted apps are then integrated into the EMR, even as attached reports, that is less disruption. Or maybe more app developers start making physician apps for viewing patient data. Again, the number of apps has to be limited. If all app makers agree to push data to one platform, such as MS HealthVault or Dossia or whatever, then this problem is solved, but I don’t see the convergence of one storage platform to be very realistic in the near future.

Reducing silos. This relates to disruption above. Reducing the number of apps used by patients reduces the number of silos of data from different app makers. It also filters the huge number of potential apps out there.

Virtually linking patients and providers. If a doc prescribes an app, ideally they could do it with an invite code or QR code or someway for the patient to choose them as part of the app registration process. I realize very few apps do this today but we’re going to be seeing more and more of this coming. Instead of walking out with directions memorized or on printed documents, prescribed apps can pull data into the app and present it a more meaningful way, or maybe automatically add events to a calendar, or create a specific health calendar. This is definitely future-state but has a ton of potential. Linking the two makes access to data easier and also enables messaging between parties, once both patients and providers are ready to message.

Lowering the cost of care. Regardless of provider involvement, I think engaged patients that use health apps on an ongoing basis will be healthier. I think patients feel more accountable if something is prescribed to them and can be tracked. Accountability leads to more active engagement which then leads to better outcomes and lower costs.

With so many benefits, why aren’t physicians prescribing apps? Unfortunately, I believe we are a long ways off from seeing most docs prescribe health apps to patients. The UK has a bit of an advantage because it is a more centralized health system. Systems that are similar in the US, like Mayo, Kaiser, Intermountain, and Geisinger, I could see being some of the first to start having providers prescribe institutionally approved apps.

But, for the vast majority of providers and, by extension, patients, several very large obstacles remain:

The vast majority of providers don’t know anything about health apps. If you’re a provider reading this post, I’m not talking about you. Most practicing physicians don’t have any idea what apps are out there for their patients. Heck, most providers don’t have much of an idea of what apps are out there for themselves (Epocrates and UpToDate excluded, although my wife only knows UpToDate has a mobile app because I installed it on her phone).

Assuming providers knew about apps, they need guidance on what apps are safe. I believe docs are never going to prescribe an app unless a trusted organization confirms its value and accuracy or a trusted colleague tells them about how great it is. Maybe that is where the FDA comes in? But, even with FDA approval, apps don’t fit into nice categories like drugs do (it’s easier to compare two statins than it is to compare two diabetes apps). I’m not sure how this will work exactly but I know there needs to be some higher authority validating, and in essence taking some of the responsibility, from providers. This is what Happtique is trying to do; we’ll just have to see how well it works from a clinical buy-in perspective.

Providers don’t know how it fits into practice. Providers are going to want to know how the apps fit into their practice. Right now I think that’s still unclear. Obviously more data on mood trends as somebody is starting new meds for depression is great, as long as it is presented to the provider in a digestible way. But, what if the patient is suicidal according to the app and there is no feedback mechanism to trigger an alert. If providers are now prescribing patients to enter this additional information, are providers on the hook to assure they know when an immediate response is warranted and then to respond to it?

Lack of payment. Unfortunately this might be the biggest obstacle. In the NHS story references above, the apps were going to be free to patients. In the US, that is not the case, at least it isn’t today. Prescribing patients to spend additional money is likely going to prevent widespread uptake. Or maybe different payers will have different “app formularies” so providers will have to wade through lists to see what approved apps are free based on payer. That would be great. Also, if providers aren’t paid for responding to app messages or alerts it’s likely not going to happen.

I’m curious to see where this goes in the UK and also within some larger health systems in the US. I think prescribing apps is crucial so we’re going to see organizations start to address some of the obstacles I listed above. I’m sure I’m missing some benefits and obstacles. What others can you think of?

Travis Good is a physician involved in health IT startups. He blogs at HIStalk Mobile.

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This Week in Electronics: iPad 3 Arrives; mHealth Startup Gets Funding | Medical Electronics Design

This Week in Electronics: iPad 3 Arrives; mHealth Startup Gets Funding | Medical Electronics Design | Mobile Health: How Mobile Phones Support Health Care |
iPad 3 Hits Stores

The third iteration of the iPad went on sale Friday morning in the US, greeted by the usual throngs of early the company’s flagship 5th Ave. store — ground zero in New York — hundreds lined up for the new iPad, which reviewers have said introduces some powerful new processor and graphics features but lacks the “wow” factor of the two previous versions.

Mobile Health Startup Completes Funding Round

Palo Alto, California-based Jiff announced this week that it had raised $7.5 million in its first round of funding...The startup also announced that it had appointed former president and CEO of Robert Bosch Healthcare, Derek Newell, as its first CEO.

Researchers to Evaluate Effectiveness of Health Apps

One of the broadest efforts to assess "mHealth" strategies is being made by dozens of faculty, staff and students in multiple departments at the Johns Hopkins University...The center aims to evaluate which strategies can aid doctors, community health workers and consumers in ways equal to other more traditional methods, such clinic visits or in-person coaching.
Baltimore Sun

For mHealth Applications to Catch on, They Must Be Easy to Use

It’s been said that physicians will only adopt health IT – namely, electronic medical records – if their workload isn’t disrupted. The same can be said for those suffering from a chronic condition.
Government Health IT

Publication Takes Aim at Medical Device Approval Process

Consumer Reports, the 76-year-old publication best known for its reviews of automobiles and refrigerators, is trying to galvanize the American public into protesting the way medical devices are approved by the U.S. Food and Drug Administration.

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Should patients access data of medical devices or softwares?

Should patients access data of medical devices or softwares? | Mobile Health: How Mobile Phones Support Health Care |
This is an absolutely timely topic and I’ve just recently come across pretty relevant news and articles focusing on whether patients should get access to source codes and data provided by their implantable devices. A few examples:

“I have a right to my damn data”: Hugo Campos in the Mercury News

Hugo Campos has a small computer buried in his chest to help keep him alive. But he has no idea what it says about his faulty heart.

All the raw data it collects, especially any erratic rhythms it controls with shocks, goes directly to the manufacturer. And some of it later gets sent to his doctor.

Should Patients Have Access to Implant Data? Medtronic, Boston Sci Weigh In

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Calculate is an essential free download for all Android users

Calculate is an essential free download for all Android users | Mobile Health: How Mobile Phones Support Health Care |
When it comes to medical apps and mobile technology, one of the most well used resources is the medical calculator. These apps take user input information and apply defined formulae to calculate a range of useful information.

These apps allow physicians to save time and effort but more importantly reduce the chance of making a mistake. QxMD have developed a highly successful medical calculator called Calculate for iPhone which has recently been ported to Android.

Calculate by QxMD is an incredibly useful free app for Android. It contains over 150 medical calculators and clinical support tools which are all easily accessible from the home menu.

The home menu is divided into specialties which allow appropriate calculators to be easily found. The user interface is clear and it was easy to find the appropriate calculator.

Once a calculator was found, the interface to input information was clear, straightforward, and informative – which meant data input was easy. The app made good use of the large screen size with large buttons and clear instructions. One feature which would be useful to implement in the future would be a memory function that makes it possible to save the results of the last calculation. There were occasionally times when I would accidentally move off the screen showing the result and be faced with the task of running through all the questions again.

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[GRAPHIC] Don't Call The Mobile Healthcare Revolution A Revolution - Yet

[GRAPHIC] Don't Call The Mobile Healthcare Revolution A Revolution - Yet | Mobile Health: How Mobile Phones Support Health Care |
Earlier this week, Float Mobile Learning released an info graphic making a promise that we've heard before: that the market for mobile health care is about to "explode." And why shouldn't it?
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The Only 5 Things That Matter at Mobile World Congress

The Only 5 Things That Matter at Mobile World Congress | Mobile Health: How Mobile Phones Support Health Care |
It's easy to get distracted at Mobile World Congress: There are some 60,000 people here in Barcelona, hundreds of booths, some product announcements, and - oh, right - an entire conference of panels and keynotes going on in the background.
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UHC announces RxLINK mobile app for pharmaceutical supply chain management

UHC announces RxLINK mobile app for pharmaceutical supply chain management | Mobile Health: How Mobile Phones Support Health Care |
UHC announced the launch of a mobile app for RxLINK, UHC's online analytic tool that gives hospitals insight into their pharmacy price performance.
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Cell phone as wallet, human battery, fuzzy Glomper stand out in SXSW marketing blitz

Cell phone as wallet, human battery, fuzzy Glomper stand out in SXSW marketing blitz | Mobile Health: How Mobile Phones Support Health Care |
This annual Internet conference is a visual extravaganza. These are the companies and the marketing efforts that rose above the noise.The most memorable brands were the ones that provided a critical service. Catch a Chevy cars picked up and dropped off festival folks all over town. People who had waited an hour or more for a shuttle ride to the convention center were thrilled to get a fast, free ride downtown. Also, Samsung charging towers were ubiquitous in the session halls.

Customers will remember those experiences long after the made-up name of a fuzzy mascot has faded.

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O2 Health launches Help at Hand mobile telecare service | Mobile News Online

O2 Health launches Help at Hand mobile telecare service | Mobile News Online | Mobile Health: How Mobile Phones Support Health Care |
GPS device aimed at people with long-term conditions runs with O2 mobile coverage and connects to alarm receiving centre in an emergency

O2 Health has launched ‘Help at Hand’, which it claims is the UK’s first telecare service built around mobile technology.

It sees the user carry a mobile-enabled pendant or wristwatch that is connected to a UK-based alarm receiving centre, with specially trained staff supervising it around the clock. The device runs with O2 mobile network coverage.

Features of the device include a fall down detector and GPS so the user’s location can be identified.

Safe zones can also be defined, so if the individual moves out of this zone, the receiving centre is alerted and staff can take the appropriate action.

The Help at Hand website allows users, carers or social care organisations to manage the user’s profile, setting up bespoke guidelines based on their care requirements and detailing how to react to any issues should they arise.

O2 said that according to a review conducted by Medipex, which provides technology services to the NHS, £5.8 million has been saved in care services across 1,722 service users in England.

It added one per cent of telecare solutions in the UK are mobile-based, leaving many people with long-term conditions with little choice when it comes to accessing support beyond their homes.

O2 said the use of telecare helps delay or avoid unnecessary admission to care homes, reduce emergency call outs, days in hospital and reduce the risk to the user.

O2 Health managing director Keith Nurcombe said: “For many groups of patients now being considered for telecare services, being confined to their homes is no longer acceptable. They want to be able to go about their daily lives with the reassurance that help is quickly available should they need it.

“Mobile technology is a natural fit – this is where we have identified a need and developed Help at Hand to meet it.”

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E-diagnosis tool at HealthPartners has treated 22,000 patients since launch

E-diagnosis tool at HealthPartners has treated 22,000 patients since launch | Mobile Health: How Mobile Phones Support Health Care |
Health system HealthPartners has treated 22,000 patients using the online diagnosis since September.

Telemedicine and mobile health’s popularity and efficacy have spurred a plethora of innovations, not the least of which is the online diagnosis of common ailments.

One integrated health system in Minnesota, which functions both as a healthcare provider and insurer, has witnessed growing popularity of its e-diagnosis system. Called Virtuwell, the online service of HealthPartners has treated around 22,00o patients since its launch in October 2010, said Kevin Palattao, the service’s vice president.

Patients log on to the Virtuwell website, select the symptoms they are having and enter information about their medical history, including allergies and any medications they are on. A nurse practitioner reviews the information and texts or emails back a treatment plan, which may include filling a prescription, in 30 minutes. The patient can also request to speak with a nurse practitioner, and the service is available 24 hours, all year round.

“We are trying to leverage our know-how about clinical protocols with online and modern communication tools to deliver these more affordable and convenient healthcare experiences for patients,” Palattao said in a phone interview.

The premise for Virtuwell is simple: to treat common ailments — like bladder infections, acne, cold, cough and allergy as well as sunburn and ear pain — safely, quickly and in an affordable manner, Palattao said.

In fact, the service costs $40 or less, depending on insurance co-pay, and a nurse practitioner texts or emails the diagnosis and treatment plan in half an hour. Patients don’t have to take time off from work and wait at the clinic or an urgent care center. Nor do they have to shell out a lot of money to see the doctor in person.

“At Virtuwell’s price point on average we are saving $70 per visit over all other venues,” Palattao said. “We have saved probably over $1.5 million for Minnesota and Wisconsin residents who have used our service.”

And in terms of time, patients can save between two to four hours, he said.

However, not all patients can be treated through telemedicine. If during the course of the e-visit, the nurse practitioner determines that lab work or imaging or detailed analysis needs to be done, the patient is directed to go to a clinic or other in-person center, Palattao said. In fact, since Virtuwell launched, 40,000 patients were told that they needed to come to get checked out instead of getting a diagnosis online.

“In essence these patients received free triage,” Palattao said.

While HealthPartners introduced Virtuwell in October 2010, earlier in the spring Park Nicollet Health Services began to offer a similar service powered by a Minnesota software company named Zipnosisfor $25. A year later, Park Nicollet did not renew its contract with Zipnosis. A spokesman for Park Nicollet wasn’t immediately able to say whether the health system plans to offer such a service again.

Meanwhile Zipnosis has found a taker in Fairview Health Services. Since January, Fairview is offering Minnesota residents the option of online diagnosis. Fairview alsooffers a virtual diagnosis through a video platform where patients can use the Internet to schedule a remote, video appointment that enables a conversation between them and their doctor.

Another Twin Cities provider — Allina Health — has been offering ane-diagnosis toolthrough its MyChart service since September. The service costs $35 and is submitted to patients’ insurance providers. Unlike Virtuwell, the service is not 24 hours (it is only available between 7 a.m. and 9 p.m., seven days a week) and takes slightly longer for a diagnosis — one hour.

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Apple launches remote configurator to remove even more complexity – a big advance for mHealth care providers

Apple launches remote configurator to remove even more complexity – a big advance for mHealth care providers | Mobile Health: How Mobile Phones Support Health Care |
“Apple Configurator makes it easy for anyone to mass configure and deploy iPhone, iPad, and iPod touch in a school, business, or institution”

I’m a massive fan of the remote device management services that Doro have implemented with their easy to use mobiles (a few clicks and I can add/change a number/shortcut on a patients mobile) so it’s great to see this functionality arriving on much more complicated devices. A big plus for care providers who are trying to use Apple devices with patients.

Imagine being able to send a message like this to your patients:

“Dear David, Dr Jones has sent you out a new health monitoring device in the post (click here and you can watch a video all about it). When it arrives simply send a reply to this message at a convenient time and I’ll give you a video call and we’ll set it all up so that you can get started using it. Glad to see your keeping so active! Nurse Jane“
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Digital Records May Not Cut Health Costs, Study Cautions - The New York Times

Computerized patient records are unlikely to cut health care costs and may actually encourage doctors to order expensive tests more often, a study published on Monday concludes.

Industry experts have said that electronic health records could generate huge savings — as much as $80 billion a year, according to a RAND Corporation estimate. The promise of cost savings has been a major justification for billions of dollars in federal spending to encourage doctors to embrace digital health records.

But research published Monday in the journal Health Affairs found that doctors using computers to track tests, like X-rays and magnetic resonance imaging, ordered far more tests than doctors relying on paper records.

The use of costly image-taking tests has increased sharply in recent years. Many experts contend that electronic health records will help reduce unnecessary and duplicative tests by giving doctors more comprehensive and up-to-date information when making diagnoses.

The study showed, however, that doctors with computerized access to a patient’s previous image results ordered tests on 18 percent of the visits, while those without the tracking technology ordered tests on 12.9 percent of visits. That is a 40 percent higher rate of image testing by doctors using electronic technology instead of paper records.

The gap, according to the study, was even greater — a 70 percent higher rate — for more advanced and expensive image tests, including M.R.I. tests and CT, or computerized tomography, scans.

“Our research raises real concerns about whether health information technology is going to be the answer to reducing costs,” said Dr. Danny McCormick, the lead author of the study, who is an assistant professor at the Harvard Medical School and a member of the department of medicine at the Cambridge Health Alliance, a health system north of Boston.

Dr. McCormick had three co-authors: Dr. David H. Bor, chief of medicine at the Cambridge Health Alliance; and Dr. Stephanie Woolhandler and Dr. David U. Himmelstein, both professors at the City University of New York School of Public Health at Hunter College.

The research was based on a survey conducted by the National Center for Health Statistics, which collected data from more than 28,000 patient visits to more than 1,100 doctors in 2008.

Health policy experts who have championed the adoption of electronic health records were critical of the study. They noted that the data came from the National Ambulatory Medical Care Survey, which is intended mainly for another purpose — to assess how medical care is practiced.

The study, they noted, included any kind of computer access to tracking images, no matter how old or isolated the function.

By contrast, modern electronic health records are meant to give doctors an integrated view of a patient’s care, including medical history, treatments, medications and past tests. The 2008 data predates federal incentive payments for doctors and standards for the “meaningful use” of electronic health records that began last year.

The new study, they said, was also at odds with previous research. It is “one of a small minority of studies” that have doubted the value of health information technology, said Dr. David Blumenthal, a professor at the Harvard Medical School.

Dr. Blumenthal, the former national coordinator for health information technology in the Obama administration, was co-author of a study, published last year in Health Affairs, that surveyed articles in professional journals in recent years on electronic health records.

It found that 92 percent of those articles were “positive over all” about the prospect that technology would improve the efficiency and quality of care.

But Dr. McCormick said the previous research had been primarily statistical models of expected savings, like the RAND study, or research that looked at the use of electronic health records at a relatively small number of flagship health systems.

“We looked at not just a few cutting-edge institutions, but a nationally representative sample,” Dr. McCormick said.

Dr. David J. Brailer, who was the national coordinator for health information technology in the administration of George W. Bush, said he was unconvinced by the study’s conclusions because they were based on a correlation in the data and were not the result of a controlled test.

The study did not explore why physicians in computerized offices ordered more tests. Dr. McCormick speculated that digital technology might simply make ordering tests easier.

Dr. McCormick said he hoped the study would damp any inflated expectations about electronic records. But he added that the technology can improve the actual practice of medicine.

The Cambridge Health Alliance, where he practices, made the switch to electronic records in 2005.

“I’m a primary care doctor,” Dr. McCormick said, “and I would never go back.”

A version of this article appeared in print on March 6, 2012, on page B1 of the New York edition with the headline: Digital Records May Not Cut Health Costs, Study Cautions.

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