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Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study

Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study | Mobile Healthcare |
Background: The use of mHealth apps has shown improved health outcomes in adult populations with type 2 diabetes mellitus. However, this has not been shown in the adolescent type 1 population, despite their predisposition to the use of technology. We hypothesized that a more tailored approach and a strong adherence mechanism is needed for this group.
Objective: To design, develop, and pilot an mHealth intervention for the management of type 1 diabetes in adolescents.
Methods: We interviewed adolescents with type 1 diabetes and their family caregivers. Design principles were derived from a thematic analysis of the interviews. User-centered design was then used to develop the mobile app bant. In the 12-week evaluation phase, a pilot group of 20 adolescents aged 12–16 years, with a glycated hemoglobin (HbA1c) of between 8% and 10% was sampled. Each participant was supplied with the bant app running on an iPhone or iPod Touch and a LifeScan glucometer with a Bluetooth adapter for automated transfers to the app. The outcome measure was the average daily frequency of blood glucose measurement during the pilot compared with the preceding 12 weeks.
Results: Thematic analysis findings were the role of data collecting rather than decision making; the need for fast, discrete transactions; overcoming decision inertia; and the need for ad hoc information sharing. Design aspects of the resultant app emerged through the user-centered design process, including simple, automated transfer of glucometer readings; the use of a social community; and the concept of gamification, whereby routine behaviors and actions are rewarded in the form of iTunes music and apps. Blood glucose trend analysis was provided with immediate prompting of the participant to suggest both the cause and remedy of the adverse trend. The pilot evaluation showed that the daily average frequency of blood glucose measurement increased 50% (from 2.4 to 3.6 per day, P = .006, n = 12). A total of 161 rewards (average of 8 rewards each) were distributed to participants. Satisfaction was high, with 88% (14/16 participants) stating that they would continue to use the system. Demonstrating improvements in HbA1c will require a properly powered study of sufficient duration.
Conclusions: This mHealth diabetes app with the use of gamification incentives showed an improvement in the frequency of blood glucose monitoring in adolescents with type 1 diabetes. Extending this to improved health outcomes will require the incentives to be tied not only to frequency of blood glucose monitoring but also to patient actions and decision making based on those readings such that glycemic control can be improved.
(J Med Internet Res 2012;14(3):e70)
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Mobile Healthcare
A collection of latest innovations in healthcare, in the space of mobile health, telemedicine and remote patient monitoring
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E-Health Tracking Increasingly Common; 21% of people who track their health use some form of technology

E-Health Tracking Increasingly Common;  21% of people who track their health use some form of technology | Mobile Healthcare |

Whether they have chronic ailments like diabetes or just want to watch their weight, Americans are increasingly tracking their health using smartphone applications and other devices that collect personal data automatically, according to health industry researchers.

“The explosion of mobile devices means that more Americans have an opportunity to start tracking health data in an organized way,” said Susannah Fox, an associate director of the Pew Research Center’s Internet and American Life Project, which was to release the national study on Monday. Many of the people surveyed said the experience had changed their overall approach to health.

More than 500 companies were making or developing self-management tools by last fall, up 35 percent from January 2012, said Matthew Holt, co-chairman of Health 2.0, a market intelligence project that keeps a database of health technology companies. Nearly 13,000 health and fitness apps are now available, he said.

The Pew study said 21 percent of people who track their health use some form of technology.

They are people like Steven Jonas of Portland, Ore., who uses an electronic monitor to check his heart rate when he feels stressed. Then he breathes deeply for a few minutes and watches the monitor on his laptop as his heart slows down.

“It’s incredibly effective in a weird way,” he said.

Mr. Jonas said he also used electronic means to track his mood, weight, mental sharpness, sleep and memory.

Dr. Peter A. Margolis is a principal investigator at the Collaborative Chronic Care Network Project, which tests new ways to diagnose and treat diseases. He has connected 20 young patients who have Crohn’s disease with tracking software developed by a team led by Ian Eslick, a doctoral candidate at the Media Lab at the Massachusetts Institute of Technology.

Data from their phones is reported to a Web site that charts the patients’ behavior patterns, said Dr. Margolis, a professor of pediatrics at Cincinnati Children’s Hospital. Some phones have software that automatically reports the data.

Patients and their parents and doctors watch the charts for early warning signs of flare-up symptoms, like abdominal pain, nausea and vomiting, before the flare-ups occur. The physicians then adjust the children’s treatment to minimize the symptoms.

“One of the main findings was that many patients were unaware of the amount of variation in their symptoms that they were having every day,” Dr. Margolis said.

The Pew survey found most people with several chronic conditions said that tracking had led them to ask a doctor new questions, led them to seek a second opinion or influenced their treatment decisions.

Mr. Holt said self-tracking products and services companies formed the fastest growing category among the 2,100 health technology companies in his database. He said venture capital financing in the sector rose 20 percent from January through September 2012, with $539 million allotted to new products and services for consumers by Sept. 30.

He attributed the rise to a “perceived increase in consumer interest in wellness and tracking in general, and the expectation that at-home monitoring of all types of patients will be a bigger deal under the new accountable care organizations,” as President Obama’s health care law takes effect.

But even an enthusiast like Mr. Jonas said he saw “a dark side to tracking.”

“People who are feeling down may not want a tracking device to keep reminding them of their mood,” he said.

Laurent FLOURET's curator insight, October 31, 2014 9:24 AM

"The Pew survey found most people with several chronic conditions said that tracking had led them to ask a doctor new questions, led them to seek a second opinion or influenced their treatment decisions."

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Greater use of digital health can be a 'game-changer' for asthma care

Greater use of digital health can be a 'game-changer' for asthma care | Mobile Healthcare |
In a report published today the charity said that technology delivered via smartphones, including ‘smart inhalers’, apps that help individuals avoid triggers and remote monitoring, would revoluntionise asthma care and ease pressure on the NHS.The report, Connected asthma: how technology will transform care, said immediate action should be taken to ensure every person with asthma has an action plan available to them digitally. These action plans should eventually be incorporated into shared patient records.
Via Alex Butler
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A connected home robot that could take care of your health - Design Week | mHealth- Advances, Knowledge and Patient Engagement

A connected home robot that could take care of your health - Design Week | mHealth- Advances, Knowledge and Patient Engagement | Mobile Healthcare |
Pillo is a robot which uses artificial intelligence to dispense medication and respond to people's health queries through voice activation. | mHealth- Advances, Knowledge and Patient Engagement
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The Mobile Health Paradox: Why Data Isn’t Nearly Enough

The Mobile Health Paradox: Why Data Isn’t Nearly Enough | Mobile Healthcare |

Across most developed economies, healthcare costs are rising faster than inflation. In the U.K., the National Health Service (NHS) faces an estimated funding gap of £30 billion by 2020. In the U.S., the situation looks more bleak, with total annual healthcare spending surpassing $3.8 trillion, representing an astonishing 17.4 percent of the country’s total GDP.

A key cause of the rise in healthcare spending lies in the spiraling costs of treating preventable chronic diseases (such as obesity, heart disease, stroke and cancer), which account for 88 percent of total healthcare spending. This figure isn’t surprising when you consider that approximately half of all adults in the U.S. have one or more chronic conditions. More worryingly, seven of the top 10 causes of deaths occur as a result of preventable chronic diseases, with cigarette smoking alone accounting for 480,000 deaths in the U.S. every year.

These facts suggest that many of the key healthcare challenges of the twenty-first century lie in how we tackle chronic disease. This article will explore the role of mobile technologies in meeting these challenges, why they have failed to do so until now and what a solution might look like in the future.

The paradox of mobile health

With almost five billion mobile phone users in the world, of which two billion are smartphones, mobile health (also known as m-health or connected health) has been lauded as an attractive solution to address the challenges of the rising costs of chronic morbidities.

Moreover, the ubiquity of smartphones has led to a burgeoning market for m-health apps and wearable devices, resulting in more health data being collected than ever before. This has given rise to a phenomenon known as “the quantified self,” the process of tracking everyday activities to learn more about yourself.

For example, it is now possible for individuals to know their average time spent in REM sleep over three months and whether their sleep quality correlates with bad weather. One can now check their blood pressure, oxygen saturations and ECG in a single device, receive a full genetic analysis for less than $100 and soon be able to keep track of real-time glucose levels thanks to Bluetooth enabled contact lenses.

Simply knowing more won’t necessarily help us live healthier lives.

A simple look at Apple’s Health app yields no less than 79 different health records, spanning Vitamins A through E, variations in body temperature and caffeine levels.

A new mobile app takes the obsession to quantify into the bedroom, by helping individuals track their sexual encounters on their smartphones. The app collects information on the sexual duration and noise levels in order to quantitatively assess the user’s performance, presenting the data in a series of attractive graphs.

Proponents of “the quantified self” phenomenon argue that the data we collect is for self-knowledge and self-empowerment. Whilst there is certainly nothing inherently wrong with the notion, insights from behavioral economics teach us that simply knowing more won’t necessarily help us live healthier lives.

Numerous experiments have shown that we human beings are not “rational individuals who engage in maximising behaviour,” but instead place little emphasis on long-term rewards, tend to prefer avoiding losses to acquiring gains and, in general, are motivated by cognitive biases of which we are largely unaware.

Failing to appreciate this, most health and wellness m-health apps have historically suffered from very short life spans, with engagement disintegrating soon after the novelty wears off — users are then free to return to risky health behaviors, negating any intended long-term health benefits.

It’s all about health behavior

As a senior medical student at Imperial College London, I find myself exposed to a range of medical and surgical specialties during my clinical rotations — each of them presenting different problems, but managed in the same three stages: conservative, medical and surgical management.

Despite the rapid pace of medical innovations over the past century, the first line treatment for almost any insidious chronic disease involves taking a conservative approach comprising “lifestyle and risk-factor modification.” This typically involves the doctor reciting their well-rehearsed spiel; for example, instructing arthritic patients on the mobility exercises which, if completed regularly, could extend the life of their joints by 5-10 years, or young diabetic patients on the importance of good glucose control.

Yet research shows that patient recall of the medical information delivered in doctor consultations tends to be poor and inaccurate, with most patients focusing on diagnosis-related information and therefore failing to register advice, ultimately affecting their ability to later act on it.


Mobile devices offer a promising solution as a conduit for behavioral intervention programs. By combining the “big data” generated by health apps and devices with digital behavioral interventions, there is potential to pave the way for a new generation of m-health apps.

The success of such an approach requires a radical transformation — from simply collecting, storing and relaying information back to users to intelligently processing the data collected to help recommend highly personalized, evidence-based techniques, designed to nudge behaviors in the right direction.

The future of healthcare lies in how we tackle chronic disease and avoid health-risky behaviors.

For example, research shows that not all smokers confer the same benefits from smoking, nor have the same motivations for wanting to quit.

A simple illustration would be that person A might smoke to help manage their stress and want to quit as a result of social pressures, whilst person B might enjoy the social aspect of smoking but may be looking to quit due to health concerns.

The support required to address their reasons for smoking and motivations for quitting will vary drastically from person A to person B. To tackle this, we are developing our flagship product, Quit Genius, a behavioral intervention for smokers looking to quit, capable of intelligently identifying and adapting to all aspects of the user’s thoughts and feelings about smoking.

There are also cross-specialty implications for digital behavioral programs. A new coin-sized device developed at Imperial College now makes it possible for patients to accurately monitor their breathing and cardiac activity overnight at home to detect sleep apnea, a devastating sleep disorder estimated to cost the U.S. economy as much as $165 billion annually.

A promising application of this data could involve a targeted digital behavioral program specific to the individual, matching their weight loss to measurable improvement in their quality of sleep. Linking these lifestyle modifications to the individual’s chronic condition and consequently providing a personalized and highly structured digital behavioral intervention could have a transformational effect on the individual’s life, improving their quality of sleep and, as a result, their ability to function.

Maintaining the evidence threshold

There are currently some 165,000 health-related apps available on the market. Although that’s a highly impressive number, research has revealed many mental health apps, as well as existing digital behavior interventions, are plagued by a lack of underlying evidence and scientific credibility and, most worryingly, confer limited clinical effectiveness.

Theranos’ recent misadventures clearly illustrate what can go wrong when healthtech startups believe their own hype and refuse to engage the scientific community. As a result, there is an ongoing debate within academic circles regarding the level of clinical validation required for m-health apps. To tackle this, the Department of Health in the U.K. is looking to create a new endorsement model for evidence-based health apps.

Embracing an evidence-first approach by building up a solid evidence-base through published clinical trials will confer additional benefits. It will give healthcare practitioners much needed reassurance when recommending m-health apps to their patients, laying down the foundations for clinicians to “prescribe” digital behavioral interventions to help tackle specific “lifestyle and risk-factor changes” in the future (similar to how a clinician might currently prescribe drugs).


However, for this to occur, more work is required to help establish a framework for conducting rigorous clinical trials. A fine balance must be struck to ensure these apps can be clinically validated within a reasonable time frame, whilst maintaining validity in the scientific approach and the evidence-base that is generated.


Toward a better future?

It is widely accepted that individuals can drastically reduce their risk of premature morbidity and mortality by avoiding risky health behavior, of which lack of exercise, poor nutrition, tobacco use and drinking too much alcohol are the four main culprits.

To truly make a dent on a global scale, digital health startups must recognize the importance of creating highly structured and personalized evidence-based behavioral therapies to tackle specific risky health behaviors. To achieve this, one approach is to create a close cross-collaboration between clinicians, behavioral psychologists, designers and developers to conceptualize, build and clinically test behavioral interventions programs.

The future of healthcare lies in how we tackle chronic disease and avoid health-risky behaviors. The opportunity is clear; the part m-health interventions will play in tackling this challenge has yet to be decided.

Via JP DOUMENG, Lionel Reichardt / le Pharmageek
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Apple Watch used to study epileptic seizures

Apple Watch used to study epileptic seizures | Mobile Healthcare |
For the 2.5 million people living with epilepsy in the United States, medications can help control their seizures — most of the time. But some suffer unpleasant side effects from the drugs. And a few remain at risk of death.Researchers at the Johns Hopkins University hope to help those with the neurological condition by collecting information about their seizures through their watches, specifically their Apple Watches.
Via Alex Butler
ChemaCepeda's curator insight, November 23, 2015 6:27 AM

Interesante aplicación del Apple Watch como medio para cuantificar las crisis en personas con epilepsia

Paul Epping's curator insight, November 24, 2015 3:25 AM

interesting new posssibilities are rapidly come available by a variety of devices. Smaller, faster, cheaper.

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Tablet app reduces CHF patient readmissions by 53 percent

Tablet app reduces CHF patient readmissions by 53 percent | Mobile Healthcare |

New York City-based Health Recovery Solutions announced that its tablet-based program reduced the 30-day readmission rate for 130 congestive heart failure (CHF) patients at Penn Medicine’s Penn Care at Home program by 53 percent.


Health Recovery Solutions looked at Penn Care at Home’s data between July 2014 and February 2015. During this time, the readmission rate fell from 8 percent to 3.8 percent.


Via Alex Butler
Havas Lynx Medical's curator insight, May 28, 2015 6:58 AM

Used correctly, digital can aid patients to achieve goals

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FDA makes official its hands-off approach to regulating health apps and medical software

FDA makes official its hands-off approach to regulating health apps and medical software | Mobile Healthcare |

The Food and Drug Administration today issued its final guidance on the regulation of health apps and other software, and health tech developers should be breathing a sigh of relief.

The FDA confirmed that it’ll take a hands-off approach to most medical device data systems (MDDS), or software that conveys data to and from a medical device (like a glucose meter, for example).

“This guidance confirms our intention to not enforce regulations for technologies that receive, transmit, store, or display data from medical devices,” the FDA statement reads. “We hope that finalization of this policy will create an impetus for the development of new technologies to better use and display this data.”

The agency updated its Mobile Medical Apps guidance to be consistent with the MDDS final guidance. In general, the FDA will not regulate apps that don’t pose a real health threat to the user if they malfunction. And most of the apps that fit that bill are ones that turn a mobile device into a serious diagnostic or treatment platform. That is, they “transform a mobile platform into a regulated medical device by using attachments, display screens, sensors, or other such methods,” in the FDA’s words.

Other apps will be left alone, such as ones that just help users document or track basic health metrics, or self-manage a disease or condition without providing specific treatment advice.

“FDA is certainly sticking to its word, working to down-classify or altogether exempt low-risk software-based technologies,” said our go-to FDA regulation specialist, attorney Brad Thompson, who works with medical devices makers to navigate the sometimes tricky FDA regulatory waters.

Thompson said today’s news is big for the health tech industry. “The implications are profound, both for MDDS-type software, but also for what it suggests about the future for health information technology generally,” he said. “FDA is quite earnestly working to ensure that it uses the lightest regulatory touch appropriate for software.”

He continues:

“It’s exciting, because it means that innovation in this space can truly flourish. This is a very natural extension from the recent FDA guidance on accessories where FDA acknowledges that the risk associated with an accessory is not necessarily the same as the risk of the parent medical device.”

The news comes just weeks after the FDA issued two draft guidances that explain how it intends to regulate low-risk hardware and software products focused on general wellness and medical device accessories. It’ll take a similar light regulatory approach to these product classes

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An Epilepsy Tracker So Beautiful, It Could Be Sold In An Apple Store

An Epilepsy Tracker So Beautiful, It Could Be Sold In An Apple Store | Mobile Healthcare |
Wearables are getting smarter. Once considered little more than glorified pedometers, the wearables coming out of 2015 are going to be considerably more powerful. So powerful, in fact, that they might save lives. That's what the Embrace aims to do. A wearable created by the computing company Empatica, the Embrace isn't just an attractive looking smartwatch that can do all the usual fitness-tracker tricks. It's designed to help epileptics track and manage their seizures without feeling stigmatized. "With the Embrace, we didn't want to design a medical device someone living with epilepsy would be ashamed of," explains Mladen Barbaric, a designer at Pearl Studios, which helped make the Embrace a reality. According to Barbaric, the Embrace was the result of a question: can you make a device that everyone would want to wear, even if you literally have to? In appearance, the Embrace is about as minimalist as you can get. A thin square of metal held on your wrist with an understated magnetically clasped band, the Embrace can be used as an understated watch, telling time according to the position of two small LEDs in the central ring. Like other wearables, it connects to a smartphone app, giving you metrics on your fitness, your sleep patterns, and more. WHY DO PEOPLE WHO ARE SICK, HAVE TO HAVE UGLY DEVICES, WHILE THE PEOPLE WHO ARE HEALTHY GET BEAUTIFUL DEVICES THAT AREN’T VERY USEFUL? But where the Embrace differentiates itself from the competition is as an epilepsy tracker. According to statistics released in 2012 by the Institute of Medicine, one out of every 26 people in the United States will suffer an epileptic seizure in his or her lifetime. And seizures are dangerous: more people die from epileptic seizures every year than in a house fire. Yet even though there's no shame to owning a smoke detector, many epileptics feel stigmatized by wearing epilepsy trackers. "I became really obsessed with this question: Why do people who are sick have to have ugly devices, while the people who are healthy get beautiful devices that aren’t very useful?" Empatica founder Matteo Lai tells me. "Are people living with a chronic condition not worthy of the same design, quality and sophistication that we’re all used to? We wanted to have a device that could be sold at the Apple Store, but that was designed to save lives." o measure epilepsy, the Embrace uses clinical-grade sensors to detect a user's electrodermal activity, or the way electrical signals spike through their skin. These signals can be used to determine a number of factors, like whether we are stressed or scared, but can also be used to detect unexpected events, like convulsive seizures. When the Embrace detects such a seizure, it automatically sends an alert to a friend, partner, or caretaker, along with the wearer's location. The Embrace is the result of more than seven years of research and development from medical designers who originally came out of MIT. The Embrace, which costs $189, recently concluded a successful Indiegogo campaign., but you can still preorder one. You can do so here.
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Glow raises $17 to develop digital health tools for women | mobihealthnews

Glow raises $17 to develop digital health tools for women | mobihealthnews | Mobile Healthcare |

San Francisco-based Glow raised $17 million in a round led by Formation 8 with participation from existing investors Founder’s Fund and Andreessen Horowitz. This brings Glow’s total funding to $23 million.

“If you look at the evolution of our products — of what we’ve done — we have gone from fertile health and started evolving and moving towards general women’s health,” Glow CEO Mike Huang told MobiHealthNews. “A lot of the investment will definitely go into, not only product development, but also opportunities for research that can further help us expand in that direction. The ultimate vision is that we are able to provide the best and most engaging experience for users out there [and] hopefully through our experience they can stay engaged and improve their health.”

Glow also plans to use the funds to continue expanding its data science, product, and design teams. When the company raised its first round of funding last year, Glow had 10 employees. Now it has closer to 20.

Additionally, Glow wants to hire operations staff to continue to scale one of its newer products, Glow Enterprise.

“We are in discussion with a lot of companies in terms of rolling [Glow Enterprise] out,” Huang said. “The problem is it’s a really progressive benefits program, if you will. For those people who truly value women’s health in a company… [well,] we saw the diversity studies.”

Given that there are still comparatively few women in senior positions at companies as compared to men, Huang said this is an area Glow believes to be “truly underserved”.

“The awareness is not at the level we’d like to see,” he said. “We want to change that.”

Glow released the program in February 2014 for employers as an extension of its not for profit offering, called Glow First, which helps women who are having trouble conceiving. Women pay into a fund — $50 per month for 10 months and if at any point during those 10 months a woman gets pregnant, she stops contributing to the fund. And when the 10 months are over, women who did not get pregnant receive funds to pay for services at an infertility clinic.

The first cohort of users enrolled in the Glow First program finished the 10-month program this month. Huang said 50 users who were enrolled in Glow First received 4 times the amount they put in — $2,000.

Huang also said he’s interested in conducting research on new products including a pregnancy test device and a basal body thermometer. He added that if the company pursues pregnancy tests, they would have to get FDA approval, which would take a long time.

In July, Glow announced a new app for pregnant women, called Glow Nurture. The new app offers users a very similar experience to Glow. The main screen shows women a picture of a baby and the picture changes as weeks and month pass to represent the baby’s growth. Women can also run through a list of survey questions about how they feel physically and emotionally, if they’ve exercised, how much weight they’ve gained, how much water they’ve had, and if they’ve done their kegel exercises. The app is only available on iOS, but Huang said that an Android version will be out sometime this year.

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How Google Fit and Apple Healthkit integrate patient data from health apps

How Google Fit and Apple Healthkit integrate patient data from health apps | Mobile Healthcare |

Google launched a preview software developers kit (SDK) for the Google Fit fitness app platform at Google I/O earlier this year. Similarly, Apple launched their new Healthkit API at Apple’s WWDC 14 — and clearly healthcare will be a big focus for Apple with their Apple Watch. Developers are now able to create and test health and fitness apps for Android and iOS 8.

Via Alex Butler
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Report: Healthcare analytics market is still “finding its way” |

Report: Healthcare analytics market is still “finding its way” | | Mobile Healthcare |
The healthcare industry might finally be waking up to the possibilities of big data and clinical analytics, but the marketplace for analytics solutions is still finding its feet, says a new report from Chillmark Research.  While the shift to pay-for-performance reimbursement models is driving interest and investment in population health management tools and tighter management of the revenue cycle, a fragmented market and provider confusion over the most effective analytics strategies may be keeping the vendor community treading water. While EHRs are firmly entrenched in the provider consciousness, and most healthcare organizations have figured out how to leverage the technology to improve care, they are less certain about the right path to take when it comes to supplemental software such as clinical decision support, analytics dashboards, and patient management suites.  While the report found more than a hundred vendors offering solutions for these problems – a dizzying array of choice for cost-sensitive customers – few of those vendors are successfully addressing the long-term needs of healthcare providers.“Vendors can be roughly divided into two categories: best-of-breed and platform-play vendors depending on their particular products and marketing strategies,” writes analyst Cora Sharma in the report. “It is currently a best-of-breed market, with providers adapting vendor solutions to meet a particular need created by a specific payment contract. Vendors aspiring to be become enterprise-wide platforms find ‘enterprise-thinking’ healthcare organizations in short supply.”Some EHR vendors are finding opportunities to sell more technology to existing customers by developing integrated population health management and patient engagement products that are already interoperable with the existing EHR, the report adds.  Other surveys and studies have found that providers are generally eager to embrace these fully integrated offerings that allow for clinical documentation, risk identification, and patient management all in one place.But EHR vendors with viable analytics packages form only a small piece of the healthcare analytics marketplace, Sharma points out.  Best-of-breed vendors are taking the lead, but healthcare organizations don’t have to fall into the trap of spending exorbitant amounts of money cobbling together specialized solutions.  By examining the scope and quality of their data before investing in technology, healthcare organizations can devise far-seeing strategies that encourage accountable care while choosing health IT that meets long-term goals across the continuum of care.
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An interesting perspective of how Sweden care for the elderly population.

An interesting perspective of how Sweden care for the elderly population. | Mobile Healthcare |
The system for looking after older people in England is "horribly fragmented", Care Minister Norman Lamb has said during a visit Sweden to see how the elderly are cared for there.
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A Great example which demostrate the value of flexible holistic care that integrates primary secondary and social care.

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#Telehealth only lead to modest improvement of #Diabetes management in this trial over 12 months.

#Telehealth only lead to modest improvement of #Diabetes management in this trial over 12 months. | Mobile Healthcare |

The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients with long-term conditions in three areas of England. Telehealth involved the regular transmission of physiological information such as blood glucose to health professionals working remotely. We examined whether telehealth led to changes in glycosylated haemoglobin (HbA1c) among the subset of patients with type 2 diabetes.

Kel Mohror's comment, August 7, 2014 2:51 PM
The technology is new and patients need more than 12 months to make life-style behavior changes that lead to better, more effective management of the condition and reducing its effects.
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New sensor system can predict when senior citizens are heading for a fall

New sensor system can predict when senior citizens are heading for a fall | Mobile Healthcare |

Falling is awful. It causes irreparable harm to senior citizens and the fear of falling reduces senior citizen mobility drastically, creating a feedback loop that can be catastrophic. Now, thanks to a team at the Sinclair School of Nursing and the College of Engineering at the University of Missouri, caregivers can predict falls up to three weeks out, allowing for care and assistance before its needed. The system is non-wearable and uses cameras to assess gait speed and stride length. The researchers found that a “gait speed decline of 5 centimeters per second was associated with an 86.3 percent probability of falling within the following three weeks.” Further, a shortened stride length “was associated with a 50.6 percent probability of falling within the next three weeks.” With these two pieces of data caregivers can intervene before things get out of hand. 122721_web “Aging should not mean that an adult suddenly loses his or her independence,” said Marilyn Rantz, Professor Emerita of Nursing. “However, for many older adults the risk of falling impacts how long seniors can remain independent. Being able to predict that a person is at risk of falling will allow caretakers to intervene with the necessary care to help seniors remain independent as long as possible.” The team based their system at TigerPlace, a retirement residence in Columbia, Missouri. They installed sensors around the location and set up an email alert system “when irregular motion was detected.” It’s a great use of some intelligent technology and, what’s more, it requires no wearables and is completely passive.

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Are Fitbits Fitting into Hospitals’ Care Coordination Plans?

Are Fitbits Fitting into Hospitals’ Care Coordination Plans? | Mobile Healthcare |
One of the nation’s top cancer hospitals is turning to consumer-facing wearables to help patients with their care management. New York’s Memorial
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Four Ways to Connect Older People to Digital Health

Four Ways to Connect Older People to Digital Health | Mobile Healthcare |
Understanding the user experience and audience is key when developing any digital health technology. It is important to create a product that satisfies the customer through ease of use and simple interactions. When considering user experience for a digital healthcare product, there are three important questions a developer must answer: 1) Is the tool presented with the appropriate literacy (including both language and health literacy) for the user? 2) Is it visually appealing, with logical and easy navigation? 3) Is its design minimalistic? These questions are relevant for all audiences, but become critical for new adopters of technology.
Via Alex Butler
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People with epilepsy invited to share seizure data via app for research| Epilepsy Society

People with epilepsy invited to share seizure data via app for research| Epilepsy Society | Mobile Healthcare |

The app helps users manage their epilepsy by tracking their seizures and possible triggers, medications and side effects. Although the app is not an alarmed seizure detection device, it does allow users to send a message to caregivers to let them know when the user is tracking a seizure.The EpiWatch allows users to contribute their to epilepsy research by sharing their personal health and seizure data with Johns Hopkins researchers. The researchers conducting the study are exploring whether a future app could potentially detect seizures, estimate their duration and contact caregivers, all using Apple Watch.

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Beyond the pill trend marks milestone with Proteus-Otsuka digital medicine-NDA application - MedCity News

Beyond the pill trend marks milestone with Proteus-Otsuka digital medicine-NDA application - MedCity News | Mobile Healthcare |
The “Beyond the Pill” movement marked a major milestone with the FDA’s acceptance of the first digital medicine-New Drug Application. It will pair Proteus Digital Health’s ingestible sensor platform with Otsuka Pharmaceuticals’ FDA-approved Abilify drug to treat people with schizophrenia, bipolar disorder and in some cases for major depressive disorder to monitor adherence.

The Abilify tablet contains an ingestible sensor that communicates with a wearable sensor patch and medical software application. The idea is to measure adherence.

Otsuka CEO for development and commercialization Dr. William Carson said in a statement that patients suffering from severe mental illnesses struggle with adhering to or communicating with their healthcare teams about their medication regimen, which can greatly impact outcomes and disease progression.

The technology behind the embedded sensor is pretty cool. Stomach juices activate an energy source — similar to a potato starch battery. The embedded sensor sends signals to a skin patch electrode, which wirelessly transmits information such as vital signs, body position and verification of medication ingestion.

The sensor would be embedded during the drug manufacturing process as a combination drug-device, communicating with the Proteus patch and relevant medical software.  If approved, the combination drug-device could be used to tailor medicines more closely to reflect each of our medication-taking patterns and lifestyle choices, Andrew Thompson, Proteus Digital Health CEO said in a statement.

The complexities behind poor adherence loom large in the face of attempts to improve it. But with schizophrenia the consequences of non adherence include relapse, hospitalization and attempted suicide, depending on the severity of the condition.

Last year Proteus Digital Health raised $120 million to commercialize its digital medicines.

The FDA’s move follows its clearance of Propeller Health’s remote monitoring platforms for GSK and Boehringer Ingelheim to better track how people with asthma and COPD use their inhalers between appointments. The idea is that by tracking how patients use the devices Propeller’s platform can provide useful information to physicians to help alert them to potential problems with patients’ medication or the inhaler, before the problems worsen.

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Elite Concierge Healthcare Practices: Making Telemedicine Work For Everyone

Elite Concierge Healthcare Practices: Making Telemedicine Work For Everyone | Mobile Healthcare |

There are individuals, family offices, and private equity funds that are heavily investing in telemedicine devices – hardware and software – that will enable physicians to diagnose, monitor, and even treat patients in distant locations. For a multitude of excellent reasons, they see the future of telemedicine to be foundational to the future of healthcare delivery.

A major complication to the effectiveness of telemedicine is weaknesses in the human side of the process. It’s the functioning systems and processes – the “peopleware” – that will enable physicians to use the technology to expertly meet the needs of their patients.

There are two components to “peopleware.” On one side is motivating patients to diligently use the mobile technology to monitor themselves and take corrective actions when directed by their physicians. Many physicians will attest that getting patients to listen and be responsive – to follow directions – can periodically be a very trying exercise in futility. The evolution of the technology will make some – but not all – of this conundrum vanish.

The other “peopleware” component is the physicians’ learning curve in how to provide their expertise as a core part of a telemedicine ecosystem. This includes detailing the workflows essential for a smooth running, long distance physician/patient relationship.

With a tremendous amount of attention being paid to developing amazing devices, “peopleware” in this environment is being addressed by a growing number of concierge healthcare practices as well as various medical institutions. According to Daniel Carlin, M.D., president of WorldClinic and a leader in the industry, “The point of failure for most device based solutions is usually over reliance on technology. The key to success is to lead with the doctor/patient relationship; it must be enduring, caring and based in trust and compassion. The devices, when tied to a physician, provide ongoing, useful data for diagnosis and treatment, resulting in better care.”

Wellframe CEO Jacob Sattelmair spoke at the Digital Healthcare Summit in Boston and said, “When we think about digital medicine, it’s not about replacing human care, it’s about amplifying and extending human care and helping patients feel more connected and more cared for especially during periods of need.”

The world of elite concierge medicine is an excellent environment for the refinement of devices but, more critically, to the development of the “peopleware.” The lessons learned here would be able to be leveraged as the benefits of telemedicine are rolled out to everyone.

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14 Major U.S. Hospitals Now Using HealthKit as Apple Adds Health Industry Advisors

14 Major U.S. Hospitals Now Using HealthKit as Apple Adds Health Industry Advisors | Mobile Healthcare |

Fourteen major U.S. hospitals have rolled out their own trials of Apple's HealthKit tool, with the pilot program earning praise among doctors for its ease of use and advanced tracking of various health metrics, reports Reuters. 

According to the news agency, eight hospitals trying out HealthKit are on the U.S. News & World Report's Honor Roll which ranks the best hospitals, with the program seeing more of a positive reaction versus health tracking programs by Google and Samsung.

Ochsner Medical Center in New Orleans has been working with Apple and Epic Systems, Ochsner's medical records vendor, to roll out a pilot program for high-risk patients. The team is already tracking several hundred patients who are struggling to control their blood pressure. The devices measure blood pressure and other statistics and send it to Apple phones and tablets. 

"If we had more data, like daily weights, we could give the patient a call before they need to be hospitalized," said Chief Clinical Transformation Officer Dr. Richard Milani.

Via Alex Butler
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Analytics in the era of value-based care

Analytics in the era of value-based care | Mobile Healthcare |

The power of revenue cycle and population health analytics multiplies when you manage them together


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Apple's HealthKit Now Sends Medical Data Right to Your Health Record

Apple's HealthKit Now Sends Medical Data Right to Your Health Record | Mobile Healthcare |
iHealth was the first company to sell a medical device through Apple, so it's only natural it's also the first to fully integrate its products with Apple's HealthKit. That means all the data iHealth's connected monitors and trackers collect not only gets sent straight to the app, it's also automagically logged in your electronic health record.

Via Alex Butler
Sandy Spencer's curator insight, September 30, 2014 10:53 AM

This could be so important during a medical event.

Olivia Klenda's curator insight, September 30, 2014 6:50 PM

The new HealthKit is a great way to keep track of your personal health records, exercise, and eating habits. 

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How wearable tech will change your life—like it or not

The Silicon Valley giant has redrawn the line that separates our technology and ourselves. That may not be a good thing

With the unveiling of the Apple Watch Tuesday in Cupertino, California, Apple is attempting to put technology somewhere where it’s never been particularly welcome. Like a pushy date, the Apple Watch wants to get intimate with us in a way we’re not entirely used to or prepared for. This isn’t just a new product, this is technology attempting to colonize our bodies.

The Apple Watch is very personal—“personal” and “intimate” were words that Apple CEO Tim Cook and his colleagues used over and over again when presenting it to the public for the first time. That’s where the watch is likely to change things, because it does something computers aren’t generally supposed to: it lives on your body. It perches on your wrist, like one of Cinderella’s helpful bluebirds. It gets closer than we’re used technology getting. It gets inside your personal bubble. We’re used to technology being safely Other, but the Apple Watch wants to snuggle up and become part of your Self.

This is new, and slightly unnerving. When technologies get adopted as fast as we tend to adopt Apple’s products, there are always unintended consequences. When the iPhone came out it was praised to the skies as a design and engineering marvel, because it is one, but no one really understood what it would be like to have it in our lives. Nobody anticipated the way iPhones exert a constant gravitational tug on our attention. Do I have e-mail? What’s happening on Twitter? Could I get away with playing Tiny Wings at this meeting? When you’re carrying a smartphone, your attention is never entirely undivided.

The reality of living with an iPhone, or any smart, connected device, is that it makes reality feel just that little bit less real. One gets over-connected, to the point where the thoughts and opinions of distant anonymous strangers start to feel more urgent than those of your loved ones who are in the same room as you. One forgets how to be alone and undistracted. Ironically enough experiences don’t feel fully real till you’ve used your phone to make them virtual—tweeted them or tumbled them or Instagrammed them or YouTubed them, and the world has congratulated you for doing so. Smartphones create needs we never had before, and were probably better off without.

The great thing about the Apple Watch is that it’s always there—you don’t even have to take it out of your bag to look at it, the way you would with an iPhone. But unlike an iPhone you can’t put the Apple Watch away either. It’s always with you. During the company’s press event the artist Banksy posted a drawing to his Twitter feed of an iPhone growing roots that strangle and sink into the wrist of the hand holding it. You can see where he was coming from. This is technology establishing a new beachhead. To wear a device as powerful as the Apple Watch makes you ever so slightly post-human.

What might post-humanity be like? The paradox of a wearable device is that it both gives you control and takes it away at the same time. Consider the watch’s fitness applications. They capture all data that your body generates, your heart and activity and so on, gathers it up and stores and returns it to you in a form you can use. Once the development community gets through apping it, there’s no telling what else it might gather. This will change your experience of your body. The wristwatch made the idea of not knowing what time it was seem bizarre; in five years it might seem bizarre not to know how many calories you’ve eaten today, or what your resting heart rate is.

But wearables also ask you to give up control. Your phone will start telling you what you should and shouldn’t eat and how far you should run. It’s going to get in between you and your body and mediate that relationship. Wearables will make your physical self visible to the virtual world in the form of information, an indelible digital body-print, and that information is going to behave like any other information behaves these days. It will be copied and circulated. It will go places you don’t expect. People will use that information to track you and market to you. It will be bought and sold and leaked—imagine a data-spill comparable to the recent iCloud leak, only with Apple Watch data instead of naked selfies.

The Apple Watch represents a redrawing of the map that locates technology in one place and our bodies in another. The line between the two will never be as easy to find again. Once you’re OK with wearing technology, the only way forward is inward: the next product launch after the Apple Watch would logically be the iMplant. If Apple succeeds in legitimizing wearables as a category, it will have successfully established the founding node in a network that could spread throughout our bodies, with Apple setting the standards. Then we’ll really have to decide how much control we want—and what we’re prepared to give up for it.

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Apple's iWatch & iPhone 6 event from physician perspective

Apple's iWatch & iPhone 6 event from physician perspective | Mobile Healthcare |
Apple's iPhone 6 and iWatch event could have a significant impact on health tracking depending on the integration of the iWatch with Apple's Health app.

Via Alex Butler
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Which telemedicine model will triumph?

Which telemedicine model will triumph? | Mobile Healthcare |

With news that Richard  Branson sees telemedicine as a decent investment opportunity, it raises the  question of whether a dominant telemedicine model will emerge. That was one of  the observations shared by Katerina Fialkovskaya, co-founder and managing partner at  Boston-based OKM Capital.

She welcomed Branson’s entrance into the market last week and noted:

“The flow of investment into the space will certainly accelerate the process  and help to figure out the winning model. Whoever is the winner, the benefits  for the society, that mobile technology is to bring by disrupting the health  care, are incomparable to the social network revolution.”

It’s too early to say which model will win, since familiarity with  telemedicine will take some time before it works its way into the mainstream  awareness. But here’s a sense of how some companies are approaching telemedicine  models.


Web-based and mobile companies like Doctor on Demand, in  which Branson invested, provide feedback to patients based on the symptoms they  give. They tend to generate revenue from employers interested in whittling down  healthcare expenses and whose employees tend to have high out-of-pocket costs.  Users tend to get whoever is qualified to provide medical advice in their  community. Some also offer the services to consumers for a flat fee, such as  $50-$60.

What’s interesting is the scope for specialty medicine in this area such as  dermatology. Dermatologist on  Call is a direct to consumer mobile platform that lets users take a  picture of a rash or mole and send it to the company and receive a response from  a dermatologist in three business days. Second opinions are also another part of  the model. MDLive  recently partnered with Children’s Hospital of Pittsburgh to offer second  opinions in pediatric cases. For $3,000 2ndMD  customers can speak with two to five specialists, depending on their condition,  after providing lab, test results and a physician’s assessment or recommendation  for treatment a few days before.

The healthcare kiosk has the feel of stepping into some  futuristic pod. HealthSpot and SoloHealth  are the dominant companies in this space. HealthSpot users connect with a  physician online and tend to play an active role in the exam by using one of a  handful of electronic medical devices such as a thermometer, stethoscope, an  otoscope to get a better view of an ear and a dermascope to get a better view of  a rash or skin problem. Non emergency medicine tends to dominate in telemedicine  and kiosks are no exception. Each of the devices transmits an image or reading  to the physician on the other side of the screen. It’s formed a joint venture  with Cleveland Clinic after doing a pilot of the service for one year which  raises some interesting questions about which directions it could go in. It’s  also providing it kiosk service through an employer wellness plan by Kaiser  Permanente to one of its company clients.

With healthcare kiosks and many of the online models, the physician tends to  be someone the patient hasn’t previously met. But the founders of these  businesses take the view that access triumphs familiarity. SoloHealth has kiosks  in retail sites and lets consumers in high-traffic retail locations monitor  their blood pressure, central vision and weight, as well as get a health-risk  assessment. Users can identify and contact local physicians. WellPoint  and Coinstar are among its investors.

The highest profile national drugstores are still experimenting with how they  approach telemedicine through in-store clinics. The furthest  along appears to be Rite Aid. It embraces  both telemedicine through the in-store clinic and the online experience. Its NowClinic is available at 58 of  its stores through  a collaboration with UnitedHealthcare’s Optum Health Solutions. It started  with nine stores in Detroit in 2011, but now has a presence in stores around  Baltimore, Philadelphia and Pittsburgh. In some states providers — doctors or  nurse practitioners can prescribe medication based on their diagnosis. But it  also offers 24/7 access to providers online. Users log in and complete their  contact details and health history. They can also get a copy of the physician’s  summary sent to their primary care provider and integrated into their health  record.

CVS uses nurse practitioners to provide telemedicine services to patients in  the presence of a nurse. Although its initial focus has been rural communities  where Medicare tends to reimburse for telehealth care, an increasing number of  states require private insurers to cover telemedicine, including California.  That’s where CVS is piloting telehealth in 28 states. Walmart  is collaborating with Humana to provide telemedicine access in a handful of  stores at Humana Health and Well Being Centers.

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Sensors And Sensitivity

Sensors And Sensitivity | Mobile Healthcare |

This is the sensible trajectory of connected sensor technology. The world around us gains the ability to perceive us, rather than wearable sensors trying to figure out what’s going on in our environment by taking a continuous measure of us.

Via Alex Butler
Rowan Norrie's curator insight, August 5, 2014 9:13 AM

A useful lesson - wearables should not just be about harvesting data for the sake of it. By incorporating into objects we are in contact with, e.g. seat belts, we can make it a seamless part of our everyday life to gather information when it really matters.