The number of total wireless connected devices is expected to more than double from 9 billion today to more than 24 billion in 2020, according to the GSMA.
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John Sculley has had a diverse career by any measure--he has served as president of PepsiCo, CEO of Apple (where he famously championed the tablet computer in the 1980s), and more recently, chairman of Watermark Medical, a medical products company that has developed an in-home sleep apnea diagnostic device). Sculley is also working with Audax Health Solutions, a startup that has developed a personal health management platform with a gamification layer that allows users to compete with friends and collect points and badges.
We caught up with Sculley at this year's Body Computing Conference--an event that brings together doctors, designers, programmers, entrepreneurs, journalists, and members of the entertainment industry to preview the future of high-tech health care--to learn more about his thoughts on the future of health care technology.
Why are you interested in the high-tech health sector now?
I've been in high-tech now almost 30 years and I watched the health care industry miss the personal computer revolution and miss the Internet revolution. It's quite clear that the government and special interests aren't going to solve our health care costs to the economy and that [the sector] is ripe for innovation and disruptive approaches to shift the accountability more towards the patient, and to shift over time from reimbursements to outcomes. It's not going to happen by any one company, but I think there's enough opportunity to change the world of health care that it's attracting a lot of talent.
Why do you think health care missed out on the technology revolutions of the past and what are the factors coming together now to help it catch up?
I think first of all that it missed out on the PC and commercialized Internet revolutions because doctors are notorious for being late adopters to any kind of technology. The medical health care system is so complex and so institutionalized and there so many special interests that we now have the combination of a really aggregated problem that is touching the entire economy.
I think that a lot of credit has to be given to Apple, because previously when technologists were trying to address the health care industry with technology, they had to start from scratch and try to build unique devices. Well, Apple in less than two years with the iPad has revolutionized many industries, from media to music to games to all kinds of things and we're finding that doctors as well as patients feel very comfortable with the iPad as a platform technology. So the intimidation of technology is no longer the issue now that it was just a few years ago. The size of the problem is an order of magnitude larger than it was a decade ago. You combine those conditions and it creates an opportunity for entrepreneurs to come in and find disruptive solutions.
With the majority of the discussion over the last couple of weeks focussed on the launch of Google+ I will once again demonstrate my fingers lack of proximity to the pulse by talking about an offering launched to great publicity in 2008, Google Health. More specifically though a number of conversations held with the #hcsmUK & #hcsmeu community confronted the questions; is the true revolution at the heart of social media not necessarily communication but the capacity to generate and utilise ‘big’ data? Secondly, will issues of privacy kill at birth any attempt to bring personal health information and support together for patients online?
Via Alex Butler
Yesterday, one of the greatest and most inventive technological pioneers in history passed away when Steve Jobs lost his fight with pancreatic cancer and died at the age of 56. Apple’s most famous CEO had an impact on health care that is helping to revolutionize the way in which medical practitioners conduct their procedures and work with their patients. Through his innovations, the medical world has undoubtedly changed for the better.
Camden — The streets of Camden often host visitors from around the world. What distinguishes those who arrive on the third week of October, each year, is their interest in bringing projects, ideas and events from their lives and work together at the annual Pop Tech conference.
Speaking in her office on Elm Street, Pop Tech President Leetha Filderman said Oct. 3 that what has changed since Pop Tech began its thought leadership conference 16 years ago is the movement, away from a single event that takes place once a year, toward a focus on global innovation.
"The world's gotten smaller," said Filderman. She said the organization is working to address challenges that surface all over the globe and have impacts everywhere.
One way Pop Tech has changed to meet this mission is by forming what Filderman called incubators for social and scientific innovators who are at the forefront of creating systems and mechanism that address issues of vital concern. This has been done through the creation of social innovation and science and public leadership fellowships that, according to Filderman, "support some of the world's most promising innovators, entrepreneurs and scientists by providing training, mentoring and a vibrant peer group of like-minded individuals."
These people are often relatively unknown outside of their disciplines or geographic regions. The connections they make through Pop Tech can serve to spark important growth in their creative processes and connect them to others who share their interests. Those connections often provide a catalyst for significant growth in the development of solutions to issues that are common throughout the globe.
"What we're looking for in fellows is work that has a potential to replicate," said Filderman. "Solutions should be able to address more than one challenge and should be able to replicate geographically."
During the high profile product launch of the iPhone 4S Apple CEO Tim Cook sung the praises of other Apple products including the iPad’s penetration of the US healthcare industry. “They (iPads) are also showing up in hospitals where medical professionals are using them to access patient records, to review medical images and to administer bedside care. Over 80 percent of the top hospitals in the US are now testing or piloting the iPad,” he said. High usage of Apple’s iPad is often attributed to US doctors in particular but Cook’s figure really emphasises how successful the company has been in the healthcare industry. However Cook did not breakout what proportion of hospitals are in trial stage as opposed to a pilot as a precursor to a full launch. Also, it is unclear what is meant by "top" hospitals.
Elsewhere during the event, Apple also announced enhancements to the iPod nano that included “improved built-in fitness features”. Users can now have the iPod nano track their run or walk without the need for an additional accessory. The idea is to make a fitness programme easier to start, says Apple. “iPad nano can track the time, pace and distance of your run, the calories you burn, and the number of steps you walk”. Workout data can be uploaded to the Nike + website to share with friends.
Apple's claim that FaceTime video chat can be made HIPAA-compliant could be a game-changer for telemedicine specifically and healthcare generally.
Apple officials just announced that with the right security configuration, FaceTime video chat sessions can be secured end-to-end, and at a level that will satisfy HIPAA requirements.
That configuration does require a bit of advanced networking. To run the video chat sessions securely, you'll need a WPA2 Enterprise-enabled network that provides authenticated access. Existing WEP, WPA1, and WPA2 won't cut it.
WPA2 Enterprise, however, uses 128-bit AES encryption, and Apple encrypts FaceTime sessions with unique session keys and a unique ID for each user. The upshot: This security configuration will qualify as HIPAA-compliant, Apple officials indicate.
I particularly agree with bloggers at mHealthWatch who put it this way: "With Apple putting these security and regulatory systems in place, the iOS platform in general could become a hotbed of advanced mHealth innovation--well beyond the basic health and fitness apps we're seeing today."
So even with Apple's curated development process, we expect to see telehealth developers migrating quickly to the iPad, iPhone, and other iOS platforms. And given the recent alerts about malware and viruses on Androids, this security announcement may put Apple in the mHealth lead for some time to come.
The security assurances also may widen the use of FaceTime beyond the traditional clinician-to-patient model, to include provider-to-provider consults, nurse-to-physician powwows, combined treatment video sessions with multiple clinicians, and other scenarios that right now require a special, secured telemedicine connection.
And given the ubiquity of iPhones and iPads in healthcare--more than 75 percent of U.S. doctors own them, according to a recent study by Manhattan Research--those uses will undoubtedly become even more creative with time.
One cautionary note: If Apple specifically markets its FaceTime software for healthcare purposes, it could fall under FDA's emerging "intended use" regulations. We'll be watching to see how this part of the debate unfolds. -
Can you play your way to better health? What does it take to get people moving? That was the question kicked around (har!) at the gaming-health session at Health 2.0.
Chris Hewett’s demo of MindBloom had the room packed. He began by talking about being motivated by fear, or, instead, being motivated by purpose. You’re either running away from something, or toward something. Mindbloom is about spending two minutes every day looking at images that mean something to you, and that motivate you. One step every day is the key to enduring change. The key is sustained engagement. Many of the tools that exist today are not engaging. The core goal is to make life change fun, and engaging. As a gamer, Hewett wants to make behavior change appealling. And it needs to be authentic. I think that he is trying to make Mindbloom into the Farmville of health – a pervasive and widely appealing game, but one that happens to have a positive effect on people’s health and life. People use Mindbloom to discover what’s most important to them. A key differentiator is to take a view of the entire life. The key reason why most people want to be healthy is to spend more time with their relationships. Mindbloom just finished their public beta with 15,000 users.
The central visual image to Mindbloom is a tree, with each of the leaves representing an area of life that means something to you (such as spirituality). The sun represents inspiration, and rain represents the steps that you are going to take today to nourish what is important to you. Users in communities can upload their favorite images (in addition to the ones provided by MindBloom), and sayings and songs that inspire them. You earn points by setting it up, and as you apply it, there is a visual response (the tree grows a bit and the sun glows). The rain is simple steps that you can take to improve your life. You again get positive feedback to improve your life. If you keep your tree green, you produce ore “seeds” and the seeds can then unlock features and content, as well as action-packs for different areas of your life. Game items include the ability to purchase sun and rain for your friends’ trees. The social element is a crucial part of personal growth. It is supported here by the ability to add friends, as well as the ability to encourage people who may not be doing so well. The worst that happens to the tree is that the leaves turn brown-ish (they don’t fall off). Coaches are also able to invite in their clients, and can see how they are doing. Mindbloom’s beta showed that people were, on average visiting three times a week and spending 15 minutes at the site.
Mindbloom’s goal is to create the most fun, simple interface, with sophisticated gaming mechanics. The gaming elements are a positive feedback element to help people feel effective. Their mobile application with be released in about a month. Aetna is a major sponsor, with plans to integrate it into their employee space. The demographic split of users is approximately 55% women and 45% men, but their goal is build a tool for everyone. In other words, the Farmville of health.
Game On: Massively Multiplayer Approaches To Behavior Change was the first panel. So why do behavior change games work, how they keep people on track, and how they are changing the approach to behavior change? Those were all questions discussed by the panel.
The panel included people from Zamzee, Shapeup and Livn.it. ShapeUp’s CEO talked about how successful patients will often leverage their existing successful social networks to create enduring change. Their products began as a 12 week shapeup challenge in Rhode Island, funded by a non-profit. People could form teams and compete to either lose weight, increase their exercise or increase walking (based on a pedometer). In the state of Rhode Island, the game went viral — studies showed that 10% of the population has participated in this game.
Read more here…
What startup health ideas would you like to see? Let us know. You can follow Doc Gurley on Facebook. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.
The Mayo Clinic and a local IT company have joined forces to develop a mobile app for people who suffer from skin allergies.
Called CARD (Contact Allergen Replacement Database), it’s the first publicly available application based on technology licensed between the Rochester, Minn.-based Mayo Clinic and Preventice, Inc., which announced a collaboration this past July. The app gives users instant access to information about chemicals, preservatives and fragrances in skin care products that cause allergic reactions.
“The occurrence of contact dermatitis is increasing and product labeling remains an issue, despite the growth of all-natural products,” said Jon Otterstatter, Preventice’s co-founder, president and CEO, in a press release. “Physician and patient response to the CARD application has been extremely positive, and patient stories reinforce the real-life value that CARD offers.”
“The Preventice CARD System represents an essential clinical tool for discovering and avoiding skin-care products that cause allergic reactions,” added James Yiannias, MD, of the Mayo Clinic. “Dermatologists at
Company officials say CARD, which can be downloaded onto iPhones, smartphones and tablets, offers access to data on more than 8,000 known ingredients found in more than 5,500 commercial skin care products. It can be used to create, check and print safe-shopping lists, create personal journals of any reactions, compare products while shopping, receive notification of product formula changes, and save photos to share with physicians and improve diagnosis and treatment.
In 1995, a National Ambulatory Medical Care survey indicated 8.4 million people visited a doctor because of contact dermatitis, with allergic reactions to skin care or cosmetic products the second most frequent cause of those allergic reactions.
Preventice was launched in 2007 in Rochester, Minn., and began rolling out mobile health apps last year. The company is now working with the Mayo Clinic on several new products, including apps focused on cardiac care, sleep disorders and other health and wellness issues.
The truism "Culture eats technology for lunch" surfaced during a recent InformationWeek Healthcare Webcast. Jared Quoyeser, director of healthcare marketing at Intel, one of the Webcast's sponsors, mentioned it during his presentation on mobile devices, and it reminded me of a similar maxim: "Policy changes from funeral to funeral."
The point here is no matter how useful a new healthcare technology is, whether it be a mobile device or an electronic health record (EHR), it's not going to take hold unless it fits in with the mindset of clinicians. And that mindset can sometimes be inflexible.
So how do you overcome the roadblocks set up by an entrenched medical culture? If you've been working in health IT for a while, you already know how important it is to find a clinical champion to encourage colleagues to start using a new IT tool. But Casey Helfrich, chief architect at the University of Pittsburgh Medical Center's technology development center and one of the presenters at our Webcast, emphasized the importance of getting a clinical champion during the design phase of your project as well.
When Helfrich's team was designing a mobile app for emergency medical technicians, for instance, it enlisted the help of EMTs to shepherd the project to fruition--and doing that made all the difference. During every step in the process, those clinicians were deeply involved, and the result was a mobile app that was well received by UPMC's EMT community.
[Legally, EHRs are double-edged swords: They protect clinicians from malpractice litigation but also put them at greater risk. See Will Your EHR Land You In Court?]
Debra Wolf, PhD, associate professor of nursing at Slippery Rock University in Pennsylvania, would certainly agree with that approach. She told me in a recent email: "Unless point-of-care clinicians are leading the design and integration, then a disconnect occurs ..." So is it possible your doctors and nurses complain about the IT tools they're asked to work with because they weren't enough involved in their initial design?
Karen Bell, MD, chair of the Certification Commission for Health Information Technology, strikes a similar chord in a recent article in iHealthConnections: "[The] recipe for failure includes: no one individual in a leadership role; staff who feel marginalized from the process; staff who are not well prepared, trained, and comfortable with new job descriptions ..."
Bell suggests a few novel incentives to help clinicians come around, like folding EHR training into continuing medical education or requirements for re-licensure.
Since most states require doctors and nurses to take a certain number of continuing education courses to maintain their license, this approach can kill two birds with one stone. And if the IT instruction has the seal of approval from their state medical or nursing associations, it may help remove deeply held cultural beliefs.
G. Daniel Martich, MD, the chief medical information officer at UPMC, has his own insights on why doctors resist IT innovations. Their training has taught them "a fair degree of self-regulation and trusting oneself to make the 'right' decision for the patient," he said in an email.
Taking that observation a step further, he pointed out that "evidence-based medicine is a relatively new phenomenon and the art of medicine is still practiced by many--maybe even most--physicians. When you put in place a system--computerized or on paper--that challenges that autonomy and suggests that it knows more than the time-tested model of education, training, and care, you will see doubt, pushback, rebellion, and maybe one day acceptance."
UPMC has found effective ways to deal with this cultural resistance. It makes a concerted effort to understand the skeptics' workflow and look for ways that the IT tools can improve their workflow--or ways that the workflow can fit into the IT process.
It also provides clinicians with what Martich likes to call "academic detailing," which is similar to drug detailing, but in this case, it involves telling doctors about the features and benefits of their IT products.
Rebecca Armato, executive director of physician and interoperability services at Huntington Hospital in California, has a different perspective. In a recent email to me, she said one reason clinicians aren't enthusiastic about EHRs is because the programs are not intuitive enough. She said, "What we need is an 'Angry Birds' EHR that can connect and exchange with other EHRs and that's easy and intuitive to use."
She rightly pointed out that physicians have adopted technology "when it excites and interests them," a fact that's borne out by the number of iPad/iPhone/Android apps they download.
That point of view dovetails with what Stephanie Reel, CIO at Johns Hopkins Hospital, told me. "Some of our best EHR solutions still seem to insert a barrier between the physician and the patient at a time when both would prefer to work together seamlessly ... Not until our solutions are intuitive, our information is integrated, and our systems are easy to use will our physicians (and nurses) enthusiastically embrace the suites of applications we provide to them."
In the final analysis, a good IT/MD relationship is like a good marriage. It requires a lot of give and take, compromise and patience.
The potential of mobile healthcare has been well documented, but the growth may be coming from some unexpected quarters.It’s not only highly industrialized countries that are feeling the effects of aging populations and chronic diseases and it’s not just sick people who are looking to mobility to improve health conditions, according to a newly published GigaOM Pro report, “Future of Mobile Health 2011-2016.”
McKinsey & Co. said in 2010 that the global market for mobile health was worth about $50 billion, with $20 billion of that in the U.S. alone. ABI Research estimated that sales of wearable wireless devices would top 100 million units per year by 2016. GigaOM cites those findings, but attempts to explain why.
As a recent United Nations meeting on non-communicable diseases demonstrated, diabetes, heart disease and cancer are cropping up all over the world. “The fastest-growing middle class in the world is in Africa,” the GigaOM Pro report’s author, Jody Ranck, tells MobiHealthNews. Similarly, upward mobility is leading to unhealthy lifestyle changes in India, the Middle East and Latin America, Ranck says, and that is putting strain on limited health resources.
Mobile and wireless technology can help, particularly as the cost of wearable and implantable sensors declines. “The creative use of sensors, mapping and mobiles could change the way we think about the very nature of health itself,” according to the report.
“Telemedicine and mobile health hold the promise of providing more affordable ways to manage treatment of chronic conditions, facilitate business models for the medical home and offer substantial cost savings from improving drug adherence and monitoring vital signs. This can reduce rehospitalizations—a major source of expenditures in the health system,” the report states.
“Similarly, Body Area Networks (BAN) enable remote monitoring of patients. The hope here is to reduce the costs of care associated with rehospitalizations, enhance access to care and improve drug adherence by monitoring patient behaviors.”
Remote monitoring isn’t just confined to rich countries. Ranck notes that the Carlos Slim Health Institute is supporting use of the technology in Mexico.
In the West, the market for mobile health goes well beyond the sick to include people interested in health, wellness and fitness. But don’t write off the rest of the world, either, in looking at the potential of fitness and gaming-related apps, Ranck says.
So far, though, there hasn’t been much widespread success with attempts to alter unhealthy behaviors, as evidenced by the difficulty health plans have had with disease management programs. “The way the health system looks at behavioral change is epistemologically stuck in the 1950s,” Ranck says. And those who pay for disease management, typically employers, have become “jaded” because of the limited results.
Gaming apps might—might change the paradigm. “While there is a great deal of interest and certainly hype in the gamification of the health genre, the game changer, so to speak, will have to come from the rigorous evaluation of outcomes,” Ranck cautioned.
The potential of regulation of mobile apps is on a lot of people’s minds, too. Ranck believes more and more apps will fall under Food and Drug Administration jurisdiction in the U.S. as functionality improves, based on a draft guidance document circulated in July. There won’t be much need for regulation in global health in the near term, since, according to the report, most applications in the developing world are SMS-based.
Health 2.0 ostensibly is about interactive technologies and user-generated content for health and healthcare (yes, they are two different things). The Internet is the primary enabler for these types of innovations, but as the Internet has become more mobile, so has the idea of health 2.0.
Many of the sessions featured demos and even introductions of mobile apps, some more interesting than others. A look at the tweetstream is instructive; Microsoft’s Sean Nolan offered this: “At odds with myself after a long day at #health2con. So much great stuff, but so much shiny hyped iVapor too. Let’s make it REAL folks!”
Plenty of 1,500 people in attendance at the just-concluded Health 2.0 Conference in San Francisco were happy to drink the Kool-Aid and act like the event was a pep rally for their cause. In many cases, people seemed to confuse “health 2.0″ with “fitness 2.0.” But there certainly were a whole lot of intriguing technologies and ideas on display that the healthcare industry could get behind.
Happtique, featured elsewhere in MobiHealthNews this week, seemed to win some plaudits for curated app store for healthcare professionals. “You can deploy the apps the way you want, when you want. Apple doesn’t have to see it,” Paul Nerger, Happtique’s Chief Technology Officer, said. Nerger added that the company is looking at how to include apps for non-Apple mobile platforms like Android, Windows Phone and BlackBerry.
Ringful Health, a producer of mobile clinical decision support and communications technologies, demonstrated an iPad app that delivers educational content and videos to walk patients through the hospital discharge process. CEO Dr. Michael Yuan said the app also includes a self-guided process for post-discharge assessments, an important consideration as Medicare gets ready to cut reimbursements for some preventable readmissions.
Nephosity, a company with the motto, “mobilize your cloud,” showed consumer and professional versions of an iPad app that lets people in different locations manipulate radiologic images. It’s not yet FDA-approved for diagnostic purposes, but Nephosity founder and CEO Michael Pan, a former DreamWorks Animation image-rendering pro, said the image quality is suitable for consultations.
Aetna Chairman, CEO and President Mark Bertolini announced that the health insurer would introduce an app next spring to allow members to make physician appointments on their smartphones. He was part of a high-powered session on health 2.0 for employers and payers that included Louis Burns of GE-Intel Care Innovations (interviewed in MobiHealthNews this week) and Kaiser Permanente CEO George Halvorson.
Numera, the telehealth firm formerly called iMetrikus, launched Numera Social, a white-labeled platform for care coordination that is embedded within Facebook or delivered as an iPhone app. “Our philosophy is, go where the people are,” CEO Tim Smokoff said. The system can pull data from various wireless devices and health databases and deliver alerts as necessary. Users can create challenges among their friends, too. “We think there’s an opportunity through this interface to drive clinical recruitment, too,” Smokoff added.
Other highlights included GE Healthcare’s Richard Peters showing off the new Centricity EHR iPad interface, as well as a demo by Adam Odessky, a U.S.-based product manager for France Telecom subsidiary Orange, of a prototype triage device that combines voice recognition, avatars and Microsoft’s Kinect motion-capture technology.