A Deloitte survey finds that 78% of surveyed mobile technology executives see health care as the biggest growth opportunity for 4G services.
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The Future of Health. Where are we headed? TEDxMaastricht 2012 will be held in the spirit of the current innovation and incredible change within the medical sector. With the growth of and ‘need’ for sharing information (for example by means of the internet) the gap between the mainstream individual and the professional is closing. This brings new perspectives and challenges for the healthcare professional of the future. TEDxMaastricht 2012 will be centered around five tracks, covering the fields of health and care, cure, prevention, research and lifestyle: medicine around the World, health is a data problem, E-health is Empowered-Health, to talk or not to… listen, the gamification of health.
Date: Monday April 2nd, 2012
Time: 9.00 AM – 6.15 PM
Location: Theater aan het Vrijthof, Maastricht
Check out the program below. There will be however speakers that we will not announce so although these “guys” and “girls” below are awesome enough, expect to be surprised! There will be a total of 32(!!) TEDxMaastricht talks this year.
Michael Snyder has taken “know thyself” to the next level — and helped heal thyself.
Over a 14-month period, the molecular geneticist at Stanford University in Palo Alto, California, analyzed his blood 20 different times to pluck out a wide variety of biochemical data depicting the status of his body’s immune system, metabolism, and gene activity. In today’s issue of Cell, Snyder and a team of 40 other researchers present the results of this extraordinarily detailed look at his body, which they call an integrative personal omics profile (iPOP) because it combines cutting-edge scientific fields such as genomics (study of one’s DNA), metabolomics (study of metabolism), and proteomics (study of proteins). Instead of seeing a snapshot of the body taken during the typical visit to a doctor’s office, iPOP effectively offers an IMAX movie, which in Snyder’s case had the added drama of charting his response to two viral infections and the emergence of type 2 diabetes.
Clinicians at the front of the movement to personalize medicine see Snyder’s self-analysis as a landmark. Cardiologist Eric Topol, who runs the Scripps Translational Science Institute in San Diego, California, calls the work a “tour de force ‘N of 1′ report with remarkably comprehensive state-of-the-art omics from one individual.” Topol recently published a book, The Creative Destruction of Medicine, that spells out how he believes the technologies Snyder tapped will create better healthcare. “The way the field is moving in such an accelerated fashion,” Topol writes in an e-mail, “this type of ‘pan-ar-omic’ study of individuals is now not only feasible but in select individuals with medical conditions, particularly useful clinically.”
Scientists in Snyder’s field similarly praise him and his team for collecting and attempting to find the links at different time points between the 3.2 billion nucleotides of DNA in his genome and more than 3 billion fluctuations in his blood molecules such as proteins, metabolites, microRNAs, cytokines, antibodies, glucose, and gene transcripts. “It’s a visionary kind of approach,” says Jan Korbel, a molecular virologist and cancer researcher at the European Molecular Biology Laboratory in Heidelberg, Germany. Daniel MacArthur, a genomics researcher at Massachusetts General Hospital in Boston, says the “fascinating study” is much more informative than simply looking at someone’s static genome sequence. (Snyder’s group decoded his at the beginning of the project.) “The nice feature of this study is that it profiles many of the dynamic molecular changes that our body experiences in response to environmental stresses.”
Snyder, now 56, says he began the study two years ago because of a slew of technological advances that make it feasible to view the working of the body more intimately than ever before.”The way we’re practicing medicine now seems woefully inadequate,” he says. “When you go to the doctor’s office and they do a blood test, they typically measure no more than 20 things. With the technology out there now, we feel you should be able to measure thousands, if not tens of thousands, if not ultimately millions of things. That would be a much clearer picture of what’s going on.”
Snyder selected himself as the subject of this study for the most practical of reasons. He says he wanted someone local who could frequently give blood samples, and he also needed to make sure the person would not turn on his research group if devastating information surfaced. “I wasn’t going to sue myself,” he says.
Snyder had a cold at the first blood draw, which allowed the researchers to track how a rhinovirus infection alters the human body in perhaps more detail than ever before. The initial sequencing of his genome had also showed that he had an increased risk for type 2 diabetes, but he initially paid that little heed because he did not know anyone in his family who had had the disease and he himself was not overweight. Still, he and his team decided to closely monitor biomarkers associated with the diabetes, including insulin and glucose pathways. The scientist later became infected with respiratory syncytial virus, and his group saw that a sharp rise in glucose levels followed almost immediately. “We weren’t expecting that,” Snyder says. “I went to get a very fancy glucose metabolism test at Stanford and the woman looked at me and said, ‘There’s no way you have diabetes.’ I said, ‘I know that’s true, but my genome says something funny here.’ ”
A physician later diagnosed Snyder with type 2 diabetes, leading him to change his diet and increase his exercise. It took 6 months for his glucose levels to return to normal. “My interpretation of this, which is not unreasonable, is that my genome has me predisposed to diabetes and the viral infection triggered it,” says Snyder, who acknowledges that no known link currently exists between type 2 diabetes and infection. He has become so convinced that this type of analysis is the future of medicine that last summer he co-founded a company in Palo Alto, Personalis, which aims to help clinicians make sense of genomic information.
George Church, who has pioneered DNA sequencing technology and runs the Personal Genome Project* at Harvard Medical School in Boston that enrolls people willing to share genomic and medical information similar to what’s presented in the Cell report, says some might critique Snyder’s self-exam as merely anecdotal. “But one response is that it is the perfect counterpoint to correlative studies which lump together thousands of cases versus controls with relatively much less attention to individual idiosyncrasies,” Church says. “I think that N=1 causal analyses will be increasingly important.
The mobile industry is at an exciting stage: There are enough smartphone customers that there’s a huge field of opportunity for device makers, carriers, and app makers, but the market is still fragmented enough that no one company dominates. In this kind of frothy market, the risks are high, but the potential payoffs are huge, too.
The kind of people who thrive in this world are disruptive individuals. Troublemakers. Shakers-up of the status quo. Yes, we’re accustomed to writing about companies and their products, but true innovation always originates with human beings.
That’s why VentureBeat is naming the 10 individuals below as the Top Mobile Movers for 2012.
We asked for your nominations a week ago, sifted through the suggestions, added a few of our own, and vigorously debated the entrants. The finalists, here, are our admittedly idiosyncratic and (we hope) provocative choices. These 10 people are unusually effective at disrupting business as usual.
In two weeks, at our Mobile Summit, April 2-3, we’ll announce which of these 10 finalists we’re naming as the Top Mobile Mover. So stay tuned.
Want to be part of the debate? Use the form at the bottom of this post to vote on who you think is the most disruptive, innovative person on the list. Let us know what you think in the comments section. Or apply to take part in the conversation in real time at the Mobile Summit. It’s an exclusive conference of just 180 executives and investors, and while the room is filling up fast, we’re still accepting last-minute applications to participate. I hope to see you there.
Without further ado, here’s the list (in alphabetical order).
This week the US Food and Drug Administration (FDA) is holding a hearing about using innovative technologies and other mechanisms to expand the number of medications that can administered over the counter. A report in the San Diego Union Tribune recognizes that some of the innovations that the FDA has in mind are mobile health apps and devices.“FDA is aware that industry is developing new technologies that consumers could use to self-screen for a particular disease or condition and determine whether a particular medication is appropriate for them,” the agency wrote in the Federal Register last month. “For example, kiosks or other technological aids in pharmacies or on the Internet could lead consumers through an algorithm for a particular drug product. Such an algorithm could consist of a series of questions that help consumers properly self-diagnose certain medical conditions, or determine whether specific medication warnings contraindicate their use of a drug product.”
Last year the FDA listed a number of example mobile medical apps that were diagnostic in intent, for example:
> Apps that connect to a home use diagnostic medical device such as a blood pressure meter, body composition analyzer, or blood glucose meter to collect historical data or to receive, transmit, store, analyze, and display measurements from connected devices.
> Apps that use the built-in accelerometer or other similar sensors in a mobile platform to monitor the user’s movement to determine conditions such as sleep apnea, sleep phase, fall detection, or detect motion related to other conditions or diseases or to measure heart rate.
> Apps that use a mobile platform to record response time and accuracy of patients completing a cognitive task and/or automatically score or interpret cognitive testing results.
> Apps that use a mobile platform to upload electroencephalograph (EEG) recordings and automatically detect seizures.
These are just a few of the mobile medical apps that the FDA outlined in its proposed guidelines for medical app regulation last year. There are many more examples of new diagnostic apps and devices.
According to the Federal Register posting, the FDA is considering OTC status under certain conditions for drugs that treat: asthma, diabetes, high blood pressure, high cholesterol, and migraines. Which apps might be used by pharmacists to make these OTC recommendations? Which mobile health screening apps might be safe for patients to use at home to determine a need for OTC meds or other treatments?
These questions should lead to an interesting discussion this Thursday and Friday at the FDA.
Importantly, here’s the core reason for this discussion, based on the FDA’s notice in the Federal Register: “Eliminating or reducing the number of routine visits could free up prescribers to spend time with more seriously ill patients, reduce the burdens on the already overburdened health care system, and reduce health care costs.”
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.
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..
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 gmail.com.
Here are links to the 2 blog posts I wrote about my experience w/this timeline:
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.
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.”
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.
Smartphones show promise in disease surveillance in the developing world because it is faster, cheaper and more accurate than traditional paper survey methods to gather disease information after the initial set–up cost.
Smartphone data was more reliable than paper, according to the findings of the Kenya Ministry of Health and researchers in Kenya for the U.S. Centers for Disease Control and Prevention (CDC).
[See also: Pair of pop health app contest winners named at HIMSS12.]
Survey data collected with smartphones in the study had fewer errors and were more quickly available for analyses than data collected on paper. For example, smartphone data were uploaded into the database within eight hours of collection compared with an average of 24 days for paper-based data to be uploaded, in a study released March 12 by CDC.
"Collecting data using smartphones has improved the quality of our data and given us a faster turnaround time to work with it," said Dr. Henry Njuguna, sentinel surveillance coordinator at CDC Kenya, adding that it also helped save on paper and other limited resources.
Researchers compared survey data collection methods at four influenza surveillance sites in Kenya. At each site, surveillance officers identified patients with respiratory illness and administered a brief questionnaire that included demographic and clinical information.
Some of the questionnaires were collected using traditional paper methods, and others were collected using HTC Touch Pro2 smartphones using a proprietary software program called the Field Adapted Survey Toolkit (FAST).
[Feature: A new age of CDC biosurveillance is upon us.]
Of the 1,019 questionnaires each by smartphone and paper, only 3 percent of the surveys collected with smartphones were incomplete compared with 5 percent of the paper–based questionnaires. Of the questions that required mandatory responses in the smartphone questionnaire, 4 percent were left unanswered in paper–based questionnaires compared with none of the smartphone questionnaires. Seven paper–based questionnaires had duplicated patient identification numbers, while no duplication was seen in smartphone data.
While the upfront costs to set up the systems were higher for the smartphones, the cost of collecting data by smartphones was lower in the long run than paper–based methods.
Needham, Mass. USA and Ann Arbor, Mich., USA and CHICAGO USA – (March 15, 2012) –“Interconnected Health 2012: Enabling Health through High-Impact IT;” presented by OMG®, Health Level Seven® International (HL7), and HIMSS, features a full program of top-notch presenters and topics of interest to the healthcare IT community. The event will be held at the Hyatt Regency O’Hare in Chicago, Ill., on April 2-4, 2012. Registration information and the full program may be found online at http://www.interconnected-health.org.
Interconnected Health 2012 focuses on approaches, challenges, and solutions affecting the ability to connect health organizations and systems, and the role of IT as an enabler in achieving this connectivity. Geared toward the CxO suite and senior leaders within healthcare organizations, Interconnected Health provides a venue to hear what peer organizations are doing (both within the US and abroad), to exchange ideas, and to interact with peers who are leaders in this space. The theme of the conference is “Enabling Health through High-Impact IT.” Sub-tracks focus on Clinical Decision Support, Clinical Vocabulary and Terminology, Service-Oriented Architecture, Mobile Health, Enterprise Architecture, the Role of Open Source in Health IT, Devices, and Health Information Exchange. Some session highlights include:
Experiences with NHIN Direct, by Kevin Puscas, Principal Consultant, Nitor Group;A Service Based Approach to Patient Identification at The New York Presbyterian Hospital, by Virginia Lorenzi, Manager, HIT Standards and Collaborations, The New York Presbyterian Hospital, Associate - Columbia University Department of Biomedical Informatics;A Converging Approach from Enterprise Architecture to SOA – Singapore’s Experience in National eHealth Initiatives, by Victor Chai, Senior Enterprise Architect, MOH Holdings Pte Ltd.;Implementation of OpenCDS, an Open-Source, Standards-Based SOA Framework for Clinical Decision Support, with Kensaku Kawamoto, MD, PhD, Project Founder and Principal Investigator, OpenCDS, Director, Knowledge Management and Mobilization, University of Utah Health Care; Daryl Chertcoff, Senior Project Manager, HLN Consulting, LLC; and Angel Aponte, Computer Specialist, Software, New York City Department of Health and Mental Hygiene, Bureau of Immunization; andUsing NIEM for Health Information Exchange, by Tony Mallia, Practice Director, Edmond Scientific Company.
The full program is available online.
Registration & Information
About Health Level Seven (HL7) International
Where social, mobile, big data and the Internet of Things come together will shape the future. CEO and tech analyst Ray Wang of Constellation Research Group says, “The convergence of the trends is when it becomes interesting.”
I think the Quantified Self movement is where all these trends converge, and I believe the future will be quantified.
What is Quantified Self?
Quantified Self is personal self-tracking of daily habits and behaviors through quantitative tools and apps in order to effect positive life change. Some people also opt to share their data socially on social media platforms, or anonymously on data-collecting sites like CureTogether.com. Quantified Self started as a blog by Wired journalists Gary Wolf and Kevin Kelly. It has grown into a movement and community that includes a resource site including 400 apps, a forum, a conference, and an upcoming book.
According to a recent Deloitte survey, 78 percent of senior mobile industry executives view healthcare as the most promising new growth channel for 4G services. Deloitte conducted about 250 interviews with senior executives from mobile network operators, mobile device manufacturers, software applications developers and infrastructure component manufacturers and finished analyzing the results last August. After healthcare and the life sciences, those interviewed picked the retail industry and the financial industry as the second and third most promising industry verticals for mobile growth potential.
Deloitte’s report, which is freely available here, includes a discussion of the trends driving mHealth as well as a summary of the barriers holding it back:
“Before the real breakthroughs occur on a scale required to address escalating healthcare costs, mHealth adoption needs to build momentum by overcoming some important hurdles. To begin with, more trials are required to broaden the disease and population samples and align them with FDA recommendations. To date, trials have been carried out on a selective basis but need to broaden to end the uncertainty about the true extent of health benefits to the patient, and the subsequent effect of reducing hospital readmissions and caregiver visits. This should also help broaden commitment from the healthcare industry’s insurance sector, which so far has been reluctant to provide coverage for patients using these technologies. In parallel, pricing on RPM devices needs to align with current consumer electronics price points to stimulate consumer demand and ensure widespread adoption,” Deloitte wrote in the report.
The report includes one head scratcher: “Analysts tracking the flow of activity in this area predict a threefold spike in apps available in 2012 from a baseline of 200 million available in 2010.” The reference is to a Pyramid Research report from December 2010 that proved confusing to many at the time, too. Pyramid’s 200 million figure treated downloaded apps as units referred to the number of apps in use at the time not the number of different kinds of health apps available. It was more of a figure for total number of downloads than total number of health app options available.
The number of consumer health apps available is still between 10,000 and 20,000. Available professional medical apps are even fewer in number. There are far fewer than the hundreds of millions the Deloitte report seems to indicate.
Overall the Deloitte report is a worthwhile read for a refresher on overall drivers and barriers of mHealth as long as a collection of data points about the wider mobile data services market. Read it here (PDF)
Des chercheurs Néo-Zélandais ont mis au point un prototype permettant de surveiller sa santé en utilisant la technologie Bluetooth, combiné à un dispositif de localisation.
Vous êtes entre de "bons capteurs". Et oui disait une célèbre publicité pour smartphone, parce qu'il y a une application pour tout, il y a aussi celles pour gérer son état de santé. Muni de capteurs, le dernier dispositif repéré par L'Atelier permettra au patient d'envoyer directement ses données physiologiques à son médecin. Connecté à un smartphone, ce micro-appareil transfère rythme cardiaque, pression artérielle et température...
A l'origine de ce projet, les Néo-Zélandais Helen Zhou et Tim Roberts, de la School of Electrical Engineering du Manukau Institute of Technology, ont également intégré un procédé permettant de localiser le patient en cas de réception d'indicateurs inquiétants. Le prototype a vocation à étendre son champ d'action à des maladies nécessitant une surveillance quotidienne, par exemple le diabète. D'autres capteurs pourraient ainsi complétés le système et donner le taux de glucose dans le sang ou d'autres...
Le partage d'information est à double sens. Si le médecin reçoit des informations de son patient, il peut également envoyer un diagnostic et des conseils sur le traitement, et tout cela en accélérant considérablement le processus médical.
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.
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 adopters...at 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.
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.
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.
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
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.