 Your new post is loading...
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. .
In an effort to cut down on unnecessary doctor office visits, the UK’s Department of Health plans to ask general practitioners and physicians working at hospitals across the country to encourage their patients to use mobile health apps to track biometrics and symptoms. According to various reports in local newspapers, the Department of Health claims that some 15,000 NHS patients are already using mobile health apps that transmit such information to their physicians. The apps are used by pregnant women, and people with cancer, diabetes, heart problems, or chronic obstructive pulmonary disease. The information transmitted from patients using the apps will be monitored by healthcare providers who will urge patients to visit their doctor or nurses immediately if an abnormal reading comes in, according to a report in the DailyMail. The Department of Health hopes to save the NHS “millions of pounds” assuming the apps help cut down on unnecessary visits. Health ministers also contend that more frequent monitoring will help providers keep tabs on patients so that their condition, which will make it less likely that their condition’s will suddenly deteriorate and require a trip to the emergency room. According to a report in the Telegraph, the health minister claim that about 25 percent of the people who use the NHS Choices website and app visit their physicians less frequently as a result. In November the NHS Direct app announced more than 1 million downloads. “So many people use apps every day to keep up with their friends, with the news, find out when the next bus will turn up or which train to catch,” the UK Department of Health’s Secretary Andrew Lansley said in a statement. “I want to make using apps to track blood pressure, to find the nearest source of support when you need it and to get practical help in staying healthy the norm. With more information at their fingertips, patients can truly be in the driving seat.” Lansley assembled a list of 500 apps and tools that the NHS plans to recommend physicians prescribe to patients, but the NHS is looking to hear feedback from the UK public on which apps they think should be included. The government said the apps should be free or cheap to use, according to the Telegraph report. One of the apps helps people with food allergies avoid reactions by using their smartphone camera to scan food barcodes and receive alerts and warnings when an allergen is an ingredient. Another app on the list is from Diabetes UK and it provides people with reminders about checking blood glucose levels and taking their diabetes medications. The list includes apps for post-traumatic stress, breast cancer screenings, blood pressure trackers, and more. The Telegraph asked Phil O’Connell, an IT specialist at the Department of Health who developed some of the apps for the list. O’Connell told the publication these apps did not intend to “replace clinical judgment.” He also said the apps actually reduce anxiety among healthcare providers since they can better detect when a patient’s condition begins to worsen. Big (and obvious) questions remain: How will physicians and nurses sift through the information streaming in from all these mobile health apps? How accessible will these apps be for the elderly? Will the encouragement of physicians to use these apps be enough to change the health habits of patients in the UK? - See more at: http://mobihealthnews.com/16401/uk-to-encourage-doctors-to-prescribe-health-apps/#sthash.2J5ccl3H.dpuf
Summary Points Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth.We discuss what constitutes appropriate research evidence to inform scale up.Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base.We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth. Citation: Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC (2013) Scaling Up mHealth: Where Is the Evidence? PLoS Med 10(2): e1001382. doi:10.1371/journal.pmed.1001382 Published: February 12, 2013 Copyright: © 2013 Tomlinson et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: No specific funding was received for writing this article. MT acknowledges the support of the National Research Foundation (South Africa) and the Department for International Development (DfID-UK). ACT acknowledges salary support from U.S. National Institutes of Health K23 MH-096620. Competing interests: MT is a member of the PLOS Medicine Editorial Board. AT receives salary support from NIH K23 MH-096620. Abbreviations: EBI, evidence-based intervention; LAMIC, low- and middle-income country; mHealth, mobile health; MOST, Multiphase Optimization Strategy Provenance: Not commissioned; externally peer reviewed.
A few months ago I reviewed an app created by the American Red Cross to help educate users on first aid. One of the most captivating features of the app, outside of the tremendous useful information, was the integration of the Game Center on the iOS version of the app. After reviewing a section of the app on how to treat an emergency situation (e.g. bleeding), the user can then test their knowledge. Successful completion of the quiz yields a badge that can then be posted via Twitter, Facebook, and the Apple Game Center. This app is part of a growing trend to utilize gaming in medical education. While I have heard of using gamification to increase patients utilization of apps, I had never really appreciated it. As such, I tried to look into other potential places where gamification could be beneficial. A paper by McCallum explored the implication of games in health, while exploring challenges and possible future research [1] Expansion of gamification to patient education apps in specific disease fields could be potentially beneficial. Caffazzo et al explored the benefits of gamification incentives to increase recording SMBGs in teenagers with type 1 diabetes [2]. Rewarding patients with iTunes music and app gift cards demonstrated increased recordings of their measurements. However, this method really boiled down to applying a reward system to patients for increasing their measurements. In contrast, when I was at the Medicine 2.0 Conference in Boston last year, I happened to see an interesting poster being presented on pain management. The Hospital for Sick Kids in Toronto had created an app called ‘Pain Squad’ designed to help increase measurement of cancer patients pain levels for improved therapeutic management. Interestingly, the patient is thrust into the position as a detective who is investigating the pain they are experiencing. By being compliant, they are rewarded by increasing their rank up in the police department. Amazingly, they got a large cast of live actors from television to help encourage the patients to stay compliant! This is an amazing step and great deed. Areas of direct gamification being explored include actual games targeted at younger crowds to increase preferable activities or discourage unhealthy practices. One group that is exploring this aspect is Truth (the group behind the anti-tobacco company movement), who put together a game called ‘Flavor Monsters.’ The aim of this game is to help deter users from smoking by bringing together a tower defense/shooter game and information on smoking and tobacco manufacturers. Whether such a tactic will actually deter users from smoking will be interesting to see in the future The use of gamification, if used appropriately, can be a potential boon to the education of patients on medical related topics. One issue is that incentive based gaming will lose interest if maxed out by the user. However, with social media this could be refined through social rewards. A study by Lin et al explored the use of social media in gamification and how it may impact health [3]. This expansion of gamification for education could also be done by increasing utilization of social media such as with Facebook and Twitter. Zynga has made great strides in decreasing our daily productivity by encouraging people to pluck virtual apples on virtual farms. That alone is not what keeps users coming back. It’s the social factor that draws in others to see and participate. Can this mentality be expanded to education for both patients and professionals? If so how could this be done? I feel these areas will be explored further in the next few years and integration into practice may become more commonplace. One area that would be great is the incorporation of healthy lifestyles with gamification. One app that I think brings this together is Zombies, Run! I mean, what can be better than ‘running’ from zombies as you collect supplies and listen to a great story? Incorporation of an RPG (or role playing game) mechanics helps increase users desire to continue to participate. Could this be done with diet or other activities as well? Gamification as an incentive for health may be a great feature to be studied and prudently applied in the future. This may be beneficial for increasing medication adherence, or serve as an incentive for diet and exercise. Ideally, future research should center on what factors increase patient utilization of an app and analyze objective outcomes that would be pertinent for patient healthcare. I would love to hear others thoughts on where gamification can be expanded and what possible challenges we may encounter.
In 2012 there was estimated to be 308,000 patients remotely monitored by their healthcare provider for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension and mental health conditions worldwide. The majority of these were post-acute patients who have been hospitalised and discharged. As healthcare providers seek to reduce readmission rates and track disease progression, telehealth is projected to reach 1.8 million patients worldwide by 2017, according to The World Market for Telehealth – An Analysis of Demand Dynamics – 2012, a new report from InMedica, part of Wall street-quoted IHS. In addition to post-acute patients, telehealth is also used to monitor ambulatory patients – those who have been diagnosed with a disease at an ambulatory care facility but have not been hospitalised. However, telehealth has a much larger penetration in post-acute care as compared to ambulatory care patients as the majority of patients are only considered for home monitoring following hospital discharge to prevent readmission. In the US, for example, 140,000 post-acute patients were estimated to have been monitored by telehealth in 2012, as compared to 80,000 ambulatory patients. Theo Ahadome, senior analyst at InMedica, told Business Weekly: “A major challenge for telehealth is for it to reach the wider population of ambulatory care patients. However, the clinical and economic outcomes for telehealth are more established for post-acute care patients. Indeed, even for post-acute care patients, telehealth is usually prescribed only in the most severe cases, and where patients have been hospitalised more than once in a year.” CHF currently accounts for the majority of telehealth patients; in addition to being one of the largest cost-burdens for hospitalisation, the clinical outcomes of telehealth for CHF patients are most established. The number of telehealth patients with COPD is also projected to grow strongly as telehealth focus continues to expand to respiratory diseases. The successful results of the Whole System Demonstrator (WSD) program in the UK are serving as strong evidence-base for the benefits of telehealth for COPD patients. However, by 2017, diabetes is forecast to account for the second largest share of telehealth patients, overtaking COPD. Home monitoring of glucose levels for diabetes patients is more established through personal glucose monitors. There is an increasing drive to integrate these monitors with telehealth systems, allowing care givers access to patient glucose data. Over the next five years, InMedica identifies four main drivers of telehealth demand:- • Federal-driven demand: Readmission penalties introduced by the U.S. Centre for Medicare and Medicaid Services (CMS) are driving providers to adopt telehealth as a means of reducing readmission penalties. Faced with increasing healthcare expenditure, other governments, including the UK, France and China are also promoting telehealth as a long-term cost-saving measure. • Provider-driven demand: Healthcare providers want to use telehealth to increase ties to patients and improve quality of care. In many cases this is being done irrespective of the lack of a clear financial return on investment. • Payer-driven demand: Telehealth is also being increasingly used by insurance providers to increase their competitiveness and reduce in-patient pay-outs, by working directly with telehealth suppliers to monitor their patient base. • Patient-driven demand: There is currently very little demand from patients actively seeking out and requesting telehealth services from their payer or provider. Patient-driven demand is mostly limited to rural/non-metropolitan areas where there is a poor availability of clinics and physicians. As fitness awareness increases and consumers adopt personal devices to track their fitness, they will also increasingly seek professional devices to remotely track disease state
Technology has improved our lives in many ways but one area that we are only just starting to scratch the surface of and where there is perhaps the biggest potential in the coming years is healthcare.
Ageing populations in developed countries, rapid population growth in the developing world and issues such as rising obesity rates mean the burden on healthcare systems worldwide will continue to push them to breaking point if it is not addressed. Among the EU member states public health spend has risen from an average of 5.9% of GDP in 1990 to 7.2% in 2010 and that's expected to hit 8.5% in 2060. Especially in these times of economic austerity that kind of growth isn't sustainable.
The potential for technology to ease this burden and both improve healthcare for patients and boost the efficiency of doctors and nurses is huge. Anecdotal evidence shows IT adoption in healthcare lags a decade behind virtually every other sector so there is a lot of catching up to do.
But the market for these technologies is growing. Spend on global telemedicine has grown from $9.8 billion in 2010 to $11.6 billion in 2011 and is forecast to rise to $23 billion by 2015, according to a BCC Research study.
And, as seen by the gadgets at the CES trade show in Las Vegas earlier this month, there is rapid growth in health and fitness related mobile applications, devices and sensors - everything from wristbands that monitor activity levels and calories burned to heart and diabetes monitors that can report back to your doctor.
Mobile and so-called 'm-health' has a huge role to play in delivering these often life-saving benefits. Here at EE a report we commissioned by Arthur D Little on the benefits of 4G found an example of a hospital in Germany using a 4G-enabled ambulance to send live high resolution CT scans of stroke patients to specialists on route to the hospital, resulting in a 54% reduction in alarm to therapy times during the trial.
The European Commission has just issued its eHealth Action Plan, outlining goals to support the adoption of better technology-enabled healthcare across the EU by 2020 and Neelie Kroes, Commission Vice President for the Digital Agenda, said: "Europe's healthcare systems aren't yet broken, but the cracks are beginning to show. It's time to give this 20th Century model a health check. The new European eHealth Action Plan sets out how we can bring digital benefits to healthcare, and lift the barriers to smarter, safer, patient-centred health services."
Much of the work outlined in that action plan will focus on reducing the interoperability and regulatory barriers to implementing ehealth services as well as addressing legal issues such as patient privacy around personal health data and records.
Technology will continue to augment our lives in many wonderful ways over the coming decades. It brings with it the potential for greater life expectancy and quality of life through better monitoring and earlier medical intervention, faster and more cost effective treatment and improved communications and management. If the right people make the right decisions, with the right direction and investment, the well-being of citizens in both the developed and developing world could be dramatically improved.
For one reason or another, as many as half the patients in the United States don’t take the medication that is prescribed to them at a cost to the US healthcare system of $290 billion a yearin waste. That’s according to NEHI, formerly known as the New England Healthcare Institute, which has been tracking the medication adherence problem for years. Mobile and digital health’s potential to help bring about healthy behavior changes has led a number of companies to target the problem with new connected devices, applications, and services. Some of these have claimed to be highly effective: MediSafe recently stated that their app raised users’ adherence rate to 81 percent over the course of its first eight weeks that it was made available, and Vitality GlowCaps once reported pushing adherence rates to as high as 98 percent, both well above the World Health Organization average of 50 percent. NEHI has stated that digital health offerings similar to these have considerably improved adherence, but the market penetration for these tools is still low. The challenge for these companies is not just to develop an effective product, but also to figure out who will pay for it. That means addressing the sticky question of whose problem med adherence really is. Patients don’t take their medication for a number of reasons. Forgetfulness is one, particularly in chronic disease patients who have a large regimen of pills to keep track of and in elderly patients who may have poor memories or become confused easily. But other patients don’t take their meds for psychological reasons: some patients “feel fine” and skip a drug, some are concerned about real side effects. Some, according to NEHI Senior Health Policy Associate Nick McNeill, are concerned about imagined side effects. Finally, many patients stop taking medications because they simply can’t afford the co-pay. This, of course, is not a complete list but it does include some of the more commonly referenced reasons. Digital health could play a role in resolving some of them. Apps, caps, and pillboxes Several startups working in this space originally launched as direct to consumer plays but many have since pivoted (or appear poised to pivot) and now market to providers, insurers, or pharmacies. The relevant digital health products for medication adherence typically fit into one of three categories: apps, smart pillboxes, and smart pill caps. Apps, like Janssen’s Care4Today and the Walgreens app, offer reminders and calendars to help keep track of meds, and even tools for communicating with the pharmacy to refill prescriptions. These are likely to remain patient-facing, and they primarily address the problems of forgetfulness and inconvenience. Vitality’s GlowCap is a smart pill cap that launched in 2009. Once a user enters a medication dose schedule into an online portal, the pill cap glows and plays a melody when it’s time to take a pill. Vitality started out offering the product directly to consumers via Amazon.com. The product, with its attractive display and branding, was marketed as a consumer electronic device. After the company was acquired by Nant Health, it pivoted on that strategy and currently only distributes GlowCaps through partnerships with employers and pharmaceutical companies. However, The Washington Post reported last week that the company plans to make Glowcaps commercially available once more in February through an undisclosed retailer. MedMinder, a company that makes large, smart pillboxes, also launched in 2009. MedMinder does target consumers, specifically elderly people who take a lot of medications. The pillbox connects via satellite so patients can use it even if they don’t have Internet or even a phone line at home. It has multiple trays for different medications and sends reminders if patients don’t open the trays when they should — first to the patient, and then to a family member. “We don’t see it only as ‘adherence’, we also see it as helping people stay independent at home,” MedMinder President Eran Shavelsky told MobiHealthNews. “Adherence has several aspects to it that we are trying to solve. Obviously one aspect is that people forget. They need to get nice, friendly reminders that help them take medication on time, and if they don’t then we inform the family. Another problem is overdosing.” Toward that end, MedMinder’s newest product is a locking version of their pillbox, to guard against patients becoming confused and trying to take a pill twice. MedMinder does sell directly to patients, but with its focus on elderly patients they’re also marketing to the patients’ caregivers and grown-up children. The company also partners with pharmacies and some health insurers. A newer company, MediSafe Project, also leverages family to improve medication adherence. MediSafe is a cloud-based app solution — the patient gets a reminder to take their meds on their smartphone app, and a prompt to tell the app when they do. If they don’t indicate that they’ve taken their dose, a graduated series of friends and family — the MediSafe Safety Net — is informed. “It pushes you a notification when its time to take your meds,” said MediSafe CEO Omri “Bob” Shor. “The first one is a quiet one, like a text message. The second one is a louder one. The third one you can’t ignore, and the fourth one goes to your wife.” MediSafe wants to use big data as an incentive to encourage pharmaceutical companies to partner with them by aggregating anonymous adherence data for various drugs. At the recent CES 2013 event, two companies showed off their digital health adherence solutions to drum up support for their crowdfunding campaigns on Indiegogo: uBox by Abiogenix and GeckoCap. GeckoCap is an adherence offering for kids who have asthma. The system consists of a smart inhaler cap and an app that helps parents track their kids’ inhaler use and uses gamified features to encourage kids to keep up with their medication as well. The uBox, on the other hand, is a general purpose smart pillbox. A locking, spinning carousel, the uBox is also connected to an app that includes schedules, a calendar, and the ability to notify family members about missed doses. “Adherence is a very complex and very human problem,” said Abiogenix co-founder Sara Cinnamon. “Medication, the way it’s delivered today, is an open system. Maybe the patient fills it at the pharmacy, maybe they don’t. The doctor has no idea, and at a followup if the treatment’s not going well they don’t have any objective information.” That highlights another feature of several of these solutions — self-tracking. Not only does a mobile app or smart pillbox remind you to take your pills, it gives you a record you can give to your doctor that shows your adherence. Cinnamon said the company is starting out by marketing directly to consumers, but it plans to partner with pharmacies, possibly so patients can get their pills pre-filled. The company has also run some pilots with the uBox at addiction treatment centers. “I don’t see them as direct competitors,” she said of the other companies in the space. “We’re all trying to solve the same problem and there are different ways of solving it. We’re trying to focus on younger patients who have a more active lifestyle, who want to be proactive in taking care of themselves.
Blue Cross and Blue Shield Association affiliate's acquisition of Intelimedix is latest attempt to offer actionable clinical information for quality improvement.
Breathe in, breathe out. Dial and repeat.
A health IT startup claims since its mobile health app to improve patient adherence hit the market in November, patient adherence has exceeded 81 percent.
Pharmaceutical companies lose an estimated $188 billion annually in revenues in the U.S. because patients fail to take their prescribed medications, according to a study by consulting firm Capgemini. That’s a massive waste of money for an industry experiencing patent expirations and few breakthrough drugs. Drug companies have limited direct contact with patients, compared to payers and pharmacists, and have struggled with how and when to intervene to make sure patients take their medications. “In terms of crunching patient data, and from a behavioral standpoint, they’re not advanced,” says Thomas Forissier, an author of the Capgemini study. Interventions have mostly centered on free drugs, reminders, or lower co-pays. But in Western European countries, such as the Netherlands, where medications are fully covered, adherence is a still a major issue. Research sponsored by Aetna shows that waving drug co-pays for heart attack patients after hospital discharge improved adherence overall from 39% to 44%. The New England Journal of Medicine called the findings sobering “given the low baseline adherence and the small improvement in adherence in what should have been a highly motivated group of patients after myocardial infarction.” Drugs such as statins can keep those patients out of the hospital. “We need serious rethinking about what happens when medication is dispensed,” says Kevin Volpp, who heads the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics, and has written extensively on motivation and medical adherence. Volpp and behavioral scientists are experimenting with approaches that incorporate incentives which might prod patients to take their medications before they stop. Digital health start-up HealthPrize, which co-authored the Capgemini study, has borrowed some of these approaches that reward patients frequently and in small increments, and is testing them with two pharmaceutical companies. Co-founder and neurosurgeon Katrina Firlik won’t disclose who they are or details, but they focus on acne and hypertension drugs. HealthPrize recruited patients by tapping pharmaceutical companies’ databases, and linked its site to co-pay cards offered by drug companies through doctors. Patients who respond to reminders receive a variable number of points; they score additionally for engaging in educational quizzes pertaining to their disease. Patients receive the bulk of their points at refill, and rewards are determined by the pharmaceutical company. They can range from an Amazon to an iTunes gift card. Firlik expects results early next year from those pilot programs, as well as return on investment numbers for its customers. HealthPrize has raised $4 million to date from angel investors. Another start-up RxAnte uses predictive algorithms to help its clients–pharmacy benefit managers and Medicare plans, hone in on patients most likely to stop taking their prescriptions. “Seventy percent of the time reminders are wasted,” says Joshua Benner, chief executive of RxAnte. “Most interventions don’t work well because of wrong targeting.” RxAnte has drilled so far through two years of claims data, such as age, sex, race, and clinical history, and assigned individual patients a score which predicts their likelihood of adherence. It is up to the customer to decide whether or how to intervene. Medicare, for example, doesn’t allow rewards in the form of payments. Monitoring patients might be more effective, but being selective keeps costs down. This past September, RxAnte raised $4.5 million from Aberdare Ventures, with West Health Investment Fund. With Medicare payment reforms and an emphasis on preventive health measures affecting other sectors in health care, pharmaceutical companies are no longer alone in facing poor medication adherence. “The good news for pharmaceutical companies is they’re not the only ones with a stake,” says Benner.
InteraXon, one of a few companies working on making consumer EEG brain monitoring practical and useful, has announced the development of a new device that is light, non-intrusive, and that can interface over Bluetooth with other gadgets. The Muse headband features a four electrode EEG that is low energy. Interaxon is now raising crowdsourced money on IndieGoGo to help fund the first production run for the Muse. They hope to be able to make it available for purchase in the spring of 2013 and we really hope someone will develop apps for it that people can actually get a real benefit from. So far consumer EEG, though it has great potential for amazing things, has been essentially limited to basic gaming. There’s endless room left for developers to better interpret brain wave signals and take this technology to the next level. From InteraXon’s IndieGoGo campaign: We wanted to build an EEG device that would comfortably introduce people to brainwave-enabled technology. Something designed with comfort, style, and everyday use in mind. Something that would open new pathways for people to both shape and be shaped by the world around them. Introducing Muse, our brainwave-sensing headband. The Muses were ancient Greek goddesses of Art and Science who inspired genius and creativity in mortals. We chose Muse as the name for our headband because our vision from the beginning has been to distill the science of brainwave-enabled technologies into a striking and artful physical form.
Philosys, a company based in New York City, received European CE Mark approval for its Gmate SMART glucose meter, an iPhone/iPad attachment that is the world’s smallest glucometer. The meter uses the iOS device via the headset jack as the interface to display results and track readings. It would seem that the same glucometer should also be compatible with other smartphones as long as an appropriate app is developed. Philosys is currently looking to partner with cell phone firms to help distribute the Gmate SMART and hopes to have it’s device available to European customers by the end of the year.
|
This year IBM dedicated its Five in Five series (an annual list of five technologies that are likely to advance dramatically) solely to sensors. Digital sensors of the touch, sight,hearing, taste and smell kind along with their potential are all profiled by IBM Sensor technology is going through a renaissance as companies develop smart and innovative new ways to track data using them. Sensor innovation is in-part driving the Digital Health Revolution as digital health companies find ingenius ways to integrate them in to apps, devices and other peripherals. The smartphone will play an increasing important role in all of this as they go from having six built-in sensors currently to having sixteen in the next five years. If these predictions are correct then the next five years will be half-a-decade of sensor proliferation meaning the Digital Health Ecosystem will grow exponentially. In the meantime though there are already a plethora of digital health sensors in use or in the pipeline that are helping people improve and, in some instances, save lives.
Via Andrew Spong
Today's smartphones are much more than phones -- they are powerful, networked multimedia computers, and over the next 10 years they'll get far more advanced.
How could medicine be transformed by smart devices? Dr. Anthony Jones, who works for Philips Healthcare, a company that designs machines and software for hospitals around the world, says a nurse could check on you four times a day, or there could be networked machines that send data on your vitals in a constant stream to a master control. "If I now have a continuous monitor, and I have that data going up into a central repository, I can write algorithms and put some intelligence into that repository that allows me to look for trends," says Jones. "So part of what the Internet of things will allow is much more sophisticated, much more continuous monitoring." Done right, this new era of monitoring could also help keep you from going into the hospital in the first place. Advances in wireless and medical tech will go even further still, according to Ed Price at Georgia Tech's Institute for People and Technology. "If you've got chronic blood pressure issues, maybe there is blood pressure sensor in your seatbelt in your car," says Price. "Obviously there is no time for a human to analyze all that data, but an algorithm in a computer can look at all your data for your blood pressure and trigger when there is an event that needs to be noticed by care providers." And the health care reform law plays a role here, as doctors and health care companies get new incentives to make people well and keep them that way. "Electronic devices [and] tele-medicine will be a key part of that," says Price.
Via Andrew Spong
At the end of the year, two things tend to happen: You look back over the past year to evaluate its lessons, and you try to predict the future. You can combine these two processes by taking the lessons and patterns of the past and applying them to the future, if you can extrapolate the patterns. That’s how trends are predicted. And 2012 has been an eventful year, for both search optimization and social media marketing. In this article, we’ll take a look at some of the most important developments of the past year, and how they should continue to play a vital role in social media campaigns in 2013. 1. Humanize Many people are active in social media these days. Brands that want to engage customers, websites that hope to gain traction through social media, and marketers who need to create viable social media campaigns have all recognized one important trend: To achieve success, you have to humanize your brand and website. The social space is more like a personalized space. Users choose what they like, what they want to see, and what they interact with. In other words, users connect with social media on a personal level. As a result, users aren’t likely to respond warmly to a distant, cool media campaign approach on social media channels. If you use social media just to post links to your blog or website, you aren’t going to gain much. It’s essential to provide a name, a persona, a human being in all your social media marketing and campaign efforts. Don’t go out there with just your website or brand; be there as a person. Share links, post videos and photos, interact with communities, comment on other people’s statuses. Do what a person does naturally on social media. The level of interaction between individuals is enormous on social media websites like Twitter and Google+. People will more readily interact with profiles that feature people on them than the ones that are only brands. And people trust other people much more than brand names, even when both operate the same way. 2. Engage While it’s important to personalize your entire approach to social media marketing, it’s also important to engage. Without engagement, you leave your audience out of the equation. If you do that, you are nullifying the effect of your social media campaign. If your marketing efforts on social media amount to no more than just posting links, you’re doing it wrong. You need to engage users, customers, and curious visitors so you can change them into potential customers. Engaging users involves: reaching out to them by commenting on relevant activitiesproviding valuable input in discussions on Twitter, Google+, Facebook, etc.giving more: sharing links from websites other than your ownhaving answers (or if not, finding them) for people’s queries, even when they are not addressed to youasking for feedback and acting on it3. Be Transparent It is becoming clear that people value honesty and transparency online amidst so much noise. Brands have made mistakes and continue to do so. But a brand that is transparent, apologizes, and moves on is the one people will remember positively. The social space is littered with fake profiles, misinformation, and quite obviously not-so-useful information, too. People expect honesty from brands and if one responds to this expectation seriously, that brand will stand out from the crowd. Building trust is very important in marketing your brand/website/blog. And trust comes through transparency. 4. Go Mobile More people are logged into Facebook, Twitter, and other social profiles through smartphones and tablets these days than through PCs. Supporting mobile devices is no longer just an option; it’s mandatory. If you want to leverage the power of social media completely and profitably, you should: optimize your landing pages for mobile screensplace ads that appear on mobile appsinvest time in observing the user patterns in mobile advertising in your industryunderstand the dynamics of the mobile user: what drives him to click your ad?optimize your social profiles so they look good on mobile platforms5. Mitigate Information Overload The problem of information overload is persistent, and that’s not likely to change anytime soon. When people look for information, they have to sift through tons of garbage to get to the real deal. Search engines aren’t very helpful in this respect, and that’s one of the main reasons the social space is becoming enormously important. How can you sort through this information overload and provide useful content to your target audience? Value, quality, and context. Apply these three litmus tests to what you share, what you write, what you post, and what you comment on and you will have the best shot at achieving a balance between being active and generating valuable material for your prospects. 6. Content, Content, Content Naturally, success boils down to the quality of your content. Links, posts, videos, images, comments, retweets, mentions … the list goes on. Content has always been the pillar of all marketing efforts. There are clear indications that content is going to be even more important in the social media context. The success of websites like Quora proves that people value those that produce genuine, useful, and high-quality content. But you’ll have to combine that with exceptional social media positioning. This means you must: publish on multiple channels, probably several times for reachprovide material that is uniqueoffer vital information directly on social media; people are less likely to click a link through to a website if the information is not very usefulemploy a variety of media to circulate content7. Become a Social Media Superstar There’s stiff competition in social media for marketers. It’s the hottest place, brimming with people from almost all walks of life, so naturally there’s a ton of competition already. By doing many things at once, you can make your presence felt and become a social media superstar. To do this, you’ll have to: engage in many social media channels consistentlybe very active (but not at the cost of being noisy)also be interactive, much more than being active (comment, reply, mention more than just posting things)engage audiencesbe insanely useful before trying to market anythingbecome a leader, a troubleshooter, a helper, and a friend 2013 is going to be a critical year for social media campaigns. The influence of social signals in search results will only grow. Create a master plan for your social media efforts in 2013, and stick to the successful policies you implement. .
Aside from the rise of sensors, expanded broadband access and the ubiquity of connected and mobile devices among patients and doctors, several health-specific trends are making remote care more of a reality. More patients are coming online, meaning that fewer doctors will be needed to serve more patients; payment models are shifting from fee-for-service to managed care approaches that emphasize patient outcomes; and hospitals are under more pressure to keep re-admission rates down. Remote monitoring and communication technology could play a critical role in addressing each of those issues. Some telehealth innovations, like the iRobot that lets doctors visit a patient’s bedside via an electronic avatar and 15-inch screen, seem like the stuff of science fiction. San Francisco-based Scanadu is developing handheld tools that have been likened to the StarTrek “Tricorder.” A recent product lets you check your temperature, blood oxygen levels, pulse and other vitals by holding the device close to your body. Then it sends the information to your smartphone, where it can be sent on to your doctor. To encourage more innovation in sensor-based mobile technology, the X Prize Foundation even developed the Qualcomm Tricorder X Prize competition (in which Scanadu is a participant). A “Magic Carpet”developed by researchers at GE and Intel, uses sensors in home carpets to monitor seniors’ activity and then predict and detect falls.
Via Andrew Spong
This last week – the widely read Dr. Rob Lamberts lamented the usability of his Electronic Medical Record (EMR) software for his new primary care practice. It's worth reading (here) as it highlights the larger systemic problem of EMR software...
Glooko, Inc. of Palo Alto, CA was given clearance for its line of over-the-counter glucose management products that aim to simplify tracking of glucometer
ABSTRACT Background: Mobile phone based remote monitoring of medication adherence and physiological parameters has the potential of improving long-term graft outcomes in the recipients of kidney transplants. This technology is promising as it is relatively inexpensive, can include intuitive software and may offer the ability to conduct close patient monitoring in a non-intrusive manner. This includes the optimal management of comorbidities such as hypertension and diabetes. There is, however, a lack of data assessing the attitudes of renal transplant recipients toward this technology, especially among ethnic minorities.
Objective: To assess the attitudes of renal transplant recipients toward mobile phone based remote monitoring and management of their medical regimen; and to identify demographic or clinical characteristics that impact on this attitude.
Methods: After a 10 minute demonstration of a prototype mobile phone based monitoring system, a 10 item questionnaire regarding attitude toward remote monitoring and the technology was administered to the participants, along with the 10 item Perceived Stress Scale and the 7 item Morisky Medication Adherence Scale.
Results: Between February and April 2012, a total of 99 renal transplant recipients were identified and agreed to participate in the survey. The results of the survey indicate that while 90% (87/97) of respondents own a mobile phone, only 7% (7/98) had any prior knowledge of mobile phone based remote monitoring. Despite this, the majority of respondents, 79% (78/99), reported a positive attitude toward the use of a prototype system if it came at no cost to themselves. Blacks were more likely than whites to own smartphones (43.1%, 28/65 vs 20.6%, 7/34; P=.03) and held a more positive attitude toward free use of the prototype system than whites (4.25±0.88 vs 3.76±1.07; P=.02).
Conclusions: The data demonstrates that kidney transplant recipients have a positive overall attitude toward mobile phone based health technology (mHealth). Additionally, the data demonstrates that most kidney transplant recipients own and are comfortable using mobile phones and that many of these patients already own and use smart mobile phones. The respondents felt that mHealth offers an opportunity for improved self-efficacy and improved provider driven medical management. Respondents were comfortable with the idea of being monitored using mobile technology and are confident that their privacy can be protected. The small subset of kidney transplant recipients who are less interested in mHealth may be less technologically adept as reflected by their lower mobile phone ownership rates. As a whole, kidney transplant recipients are receptive to the technology and believe in its utility. (J Med Internet Res 2013;15(1):e6)
doi:10.2196/jmir.2284
The landmark Diabetes Prevention Program (DPP) study was published in the New England Journal of Medicine on February 7, 2002, a bit more than a decade ago. It demonstrated conclusively that progression from prediabetes to diabetes could be prevented by weight loss and increased physical activity (oh no, not that again!). The results of this study were impressive. Individuals randomized to receive “intensive lifestyle modification” had a mean weight loss of 7%, reduced the prevalence of diabetes by 58% in the overall group and by 71% in the group over age 60. The now popular diabetes medication, metformin, also reduced the risk of developing diabetes, but not nearly as much as the healthy behavior changes. So here we are, once again, facing the cold hard truth that when it comes to diabetes and obesity (aka “diabesity”), changing bad behavior is the essential work that needs to be done – by patients, their families, clinicians, and, I would add society as a whole, if we are going to make a dent in the epidemic. It is not going to be easy and it is going to be expensive – but not, my dear readers, as expensive as continuing the status quo. A September 2011 paper in Health Affairs (30:9, 1673-1678), authored by Kenneth Thorpe and Zhou Yang, estimates that Medicare alone could save $1.8-2.3 billion over the next 10 years if prediabetics, aged 60-64, were enrolled in a community-based program similar to the National Diabetes Prevention Program. Depending on how broadly program eligibility is defined, savings could be as high as $7 to $15 billion. Failure to enact such a program means that we would spend that money. So what exactly is “Intensive Lifestyle Modification?” The original DPP intervention was a sixteen-lesson curriculum that covered diet, exercise, and behavior modification. It was taught one-on-one over the course of 24 weeks by registered dietitians or trained case managers with master’s degrees (hmmmm, seems a bit of overkill to me – even my mama told me to eat my fruits and veggies.) In addition to the personal trainers, participants received ~$100 per year to spend on exercise classes and videos, healthy cookbooks and the like. I remember colleagues at the time the original DPP study was published saying, “interesting, but way too expensive to work in the ‘real world.’” In an effort to make the DPP more affordable, the YMCA of the USA created community based programs that retain the principles of the original program, but reduce the cost by enrolling people in groups of ten to twelve in a 16 week program that cover the same material. They also eliminated the subsidy for classes, videos and books. A randomized trial (the DEPLOY pilot study) found the (pardon the pun) skinnier version of the DPP delivered almost the same results as the original, but it cost more than $1100 less per person per year (Am J Prev Med 2008, p 357-63). But we are still talking about a relatively expensive brick and mortar program. What if the DPP could be moved out of a building and onto the web? Enter Omada Health Today, December 11, 2012, is launch day for this Silicon Valley startup founded by CEO Sean Duffy and friends. I first met Sean at FutureMed and later reconnected via activities at Rock Health – the San Francisco based startup accelerator where the company was incubating. What he told me in our first conversation shocked me. He was, he said, on a leave of absence from Harvard – one of the most prestigious Medical Schools in the country. Not only that, he had been in the combined MD-MBA program. In my medical school days, we would have considered voluntarily leaving such a program the act of a mad man. Medical School was THE educational prize of my generation – you would have given your eyetooth to get in and you never, ever, ever would have dropped out (sorry, Sean, taken a leave of absence.) But I soon learned that this guy was not and is not a mad man – he is a brilliant, hard-working entrepreneur who has taken on one of the most important health issues of our day and created a great digital solution. It is aptly called Prevent. Prevent combines the evidence-based approach of the original DPP with the convenience and efficiency of internet. The Omada team worked with an interdisciplinary group of technologists, entrepreneurs and clinicians from Google, Amazon, IDEO, Harvard, Stanford, and Columbia to create an accessible technology with the potential to prevent disease and promote health. They also attracted an outstanding group of Advisors, including endocrinologist Dr. Anne Peters, from USC and Dennis Boyle, Co-Founder of IDEO. Like the original program, Prevent has a 16 lesson curriculum that, according to their fact sheet, is “scientifically-supported, and uses cutting-edge principles of behavior change in a way that’s fun and engaging. Participants are divided up into small online groups based on age, BMI and location. Each participant is mailed a “no-setup” wireless scale that automatically transmits daily weigh-ins to private personal profiles. A pedometer tracks daily activity. Each participant receives one-on-one telemedicine support from a professional health coach. Sean told me, “this is not a static replication of the on-the-ground experience.“ Rather it paints a post digital post card for the patient of how they will look and feel after completing the program. “Imagine yourself in 16 weeks, he said, “new friends, new clothes, more energy…and we show you a structured timeline to get there.” Getting the DPP to Scale Although some people may prefer to have this intervention delivered in person, others may not. Community-based, in person programs require centers to administer them, a population of potential clients located near those centers, and, of course all the overhead that goes with brick and mortor anything. The future of the DPP at scale, Sean said, is using the web. This seems like a no brainer to me…think Amazon, Zappos, Kahn Academy, etc. etc. etc. Part of getting to scale is finding the right reimbursement model. Although Omada will be offering Prevent direct to consumer for $480 for the 4 months program (comparable to other leading weight loss programs), their biggest market will be insured people, particularly now that the Accountable Care Act is not as endangered as it was pre-election. On this front, Omada has what appears to be almost perfect timing. Senate bill 3463 was introduced on July 31, 2012. This bill proposes that “a qualified diabetes prevention program” be offered as a Medicare covered benefit (100% coverage – no co-pay or deductible) if I am reading it correctly. And, we all know that Medicare Advantage plans and commercial insurers are likely to follow Medicare’s lead on this. According to Sean, United Health Care is already paying for on-the-ground DPP programs. From a business perspective, THIS IS BIG. Someone besides the consumer is going to pay for the program – this is the big jackpot all healthcare care entrepreneurs hope for (eat your hearts out, guys). Also good timing for this young company is the emergence of new models of care and reimbursement, such as Accountable Care Organizations, that will be rewarded for improved outcomes and lowered cost of care. If Omada can meet the criteria to be a qualified program, they will have achieved the dream of every health care startup entrepreneur I have talk to – being a coveted “covered benefit.” So, Does it Work? It is one thing to say you are going to build an online health program that mimics an in person program known to work. But, if you build it, will they use it? And if they use it, will it deliver the same results? Omada smartly designed a study to test Prevent’s efficacy early on. Although only a pilot – and not a “gold standard” randomized controlled design, the results of its recent 230 person trial resulted in an average weight loss of 13.7 pounds (or 6.5%) – almost the same as the original DPP study results. Pretty good. Of course, an important question is whether the weight loss is sustainable overtime – the company is in the process of evaluating their 6 months results. mHealth – the Real Health Care Reform? Ok, so I really like what Omada Health is doing. It is not just a technology solution, as Sean told me, “it is really a human social connection solution – it brings together all of the elements that exist in our current siloed health care world.” The Omada platform has the potential to be applied to other chronic conditions. And, it isn’t just Omada that I am crazy about – it is the entire mHealth world of young (and not so young) entrepreneurs – physicians, nurses, physical therapists, pharmacists joining hands with software engineers and experts in design and user experience to create a new, more accessible, more consumer friendly and hopefully more effective health care delivery system. Now that is real reform
LionsGate Technologies of Vancouver, Canada has announced a new technology offering that provides the ability for all sorts of medical sensors to easily use smartphones and tablets as their interface. By using the audio jack as the cheap and universal way to transfer data, LionsGate can make their technology compatible with just about any programmable consumer device out there. They’ve already demonstrated their Vital Signs DSP technology by building a pulse oximeter that works straight off an iPhone’s audio jack and displays readings on its screen. This technology gives companies the ability to focus on the core technology they’re working on, either during development or for actual production of a cheap medical device that doesn’t need its own display.
SAN FRANCISCO — Dr. Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level. As a third-year resident in internal medicine, Dr. Rajkomar was the senior member of the team, and the others looked to him for guidance. An infusion of saline was the answer, but the tricky part lay in the details. Concentration? Volume? Improper treatment could lead to brain swelling, seizures or even death. Dr. Rajkomar had been on call for 24 hours and was exhausted, but the clinical uncertainty was “like a shot of adrenaline,” he said. He reached into a deep pocket of his white coat and produced not a well-thumbed handbook but his iPhone. With a tap on an app called MedCalc, he had enough answers within a minute to start the saline at precisely the right rate. The history of medicine is defined by advances born of bioscience. But never before has it been driven to this degree by digital technology. The proliferation of gadgets, apps and Web-based information has given clinicians — especially young ones like Dr. Rajkomar, who is 28 — a black bag of new tools: new ways to diagnose symptoms and treat patients, to obtain and share information, to think about what it means to be both a doctor and a patient. And it has created something of a generational divide. Older doctors admire, even envy, their young colleagues’ ease with new technology. But they worry that the human connections that lie at the core of medical practice are at risk of being lost. “Just adding an app won’t necessarily make people better doctors or more caring clinicians,” said Dr. Paul C. Tang, chief innovation and technology officer at Palo Alto Medical Foundation in Palo Alto, Calif. “What we need to learn is how to use technology to be better, more humane professionals.” Dr. Paul A. Heineken, 66, a primary care physician, is a revered figure at the San Francisco V.A. Medical Center. He is part of a generation that shared longstanding assumptions about the way medicine is practiced: Physicians are the unambiguous source of medical knowledge; notes and orders are written in paper records while standing at the nurses’ station; and X-rays are film placed on light boxes and viewed over a radiologist’s shoulder. One recent morning, while leading trainees through the hospital’s wards, Dr. Heineken faced the delicate task of every teacher of medicine — using the gravely ill to impart knowledge. The team arrived at the room of a 90-year-old World War II veteran who was dying — a ghost of a man, his face etched with pain, the veins in his neck protruding from the pressure of his failing heart. Dr. Heineken apologized for the intrusion, and the patient forced a smile. The doctor knelt at the bedside to perform the time-honored tradition of percussing the heart. “Do it like this,” he said, placing his left hand over the man’s heart, and tapping its middle finger with the middle finger of his right. One by one, each trainee took a turn. An X-ray or echocardiogram would do the job more accurately. But Dr. Heineken wanted the students to experience discovering an enlarged heart in a physical exam. Dr. Heineken fills his teaching days with similar lessons, which can mean struggling upstream against a current of technology. Through his career, he has seen the advent of CT scans, ultrasounds, M.R.I.’s and countless new lab tests. He has watched peers turn their backs on patients while struggling with a new computer system, or rush patients through their appointments while forgetting the most fundamental tools — their eyes and ears. For these reasons, he makes a point of requiring something old-fashioned of his trainees. “I tell them that their first reflex should be to look at the patient, not the computer,” Dr. Heineken said. And he tells the team to return to each patient’s bedside at day’s end. “I say, ‘Don’t go to a computer; go back to the room, sit down and listen to them. And don’t look like you’re in a hurry.’ ”
|
