RMs Future of Healthcare
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Examples of current and emerging technology being used for personal health, diagnosis, patient care, education and heath care providers.
Curated by Randy Matheson
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Collaborhythm: Empowering Patients to Become Active Participants in Their Care

CollaboRhythm has matured significantly as a result of Health and Wellness Innovation 2013. Here is a video which highlights the latest functionality and philosophy


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Lou Fetscher's curator insight, March 11, 2013 11:48 PM

Becoming a master in your health, that has a nice sound to it, in the "revolition in health".

 

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A croudsourced project for cancer research. This is the way forward!

A croudsourced  project for cancer research. This is the way forward! | RMs Future of Healthcare | Scoop.it

Cancer researchers often find themselves flooded by the amount of data they have to sift through in their projects. Often, this data is in a form that computers find hard to process and analyze, such as pathology slides from tumor biopsies.Cancer Research UK, finding itself loaded with a couple million slide images, decided to outsource the analysis to you, the anonymous online volunteer who always wanted to help with cancer research, but is instead an ophthalmologist. Partnering with Zooniverse, a project that allows anyone to help with looking at NASA’s data, the Cell Slider site, after a short prep, asks volunteers to count irregular cells and quantify how stained they are for every image presented. Each image is run through five unique volunteers to improve data confidence and each volunteer is rated in the background by the site based on the accuracy of previous image runs.

Each sample in the database has been stained to highlight the differences between ordinary cells, such as white blood cells, and irregular, cancerous cells. One slide has around 120 tumour samples, but these are broken down into 16 sections so the public is looking at a tiny subsection of the full dataset when they view each image on Cell Slider.

In the case of the breast cancer samples, the yellow colour represents the level of the oestrogen receptor (ER) protein present in the cell, a normal protein that in excess attracts too much oestrogen, which stimulates cancer cell division and tumour growth. Around 70 percent of breast cancers are classed as ER positive. Hormone therapies are helpful in treating this type of cancer — drugs such as tamoxifen effectively slot into the oestrogen receptors to block oestrogen, preventing it reaching and feeding the cancer. This is usually only effective if there are high ER levels, and that’s where Click to Cure comes in.


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Polymer Multilayer Tattoo for Safe, Effective Delivery of DNA Vaccines

Polymer Multilayer Tattoo for Safe, Effective Delivery of DNA Vaccines | RMs Future of Healthcare | Scoop.it

DNA vaccines hold promise of overcoming the downsides of traditional vaccinations, potentially allowing for effective defense against HIV and other viral infections. Delivering DNA snippets that code for viral proteins into the insides of cells is a bit tricky and currently requires using electroporation to open pores within cell walls. The technique is not terribly effective and can be painful on the patients. Now researchers from MIT are reporting in Nature Materials the development of a new skin patch, which they like to call a “multilayer tattoo,” capable of delivering DNA vaccines in a more civilized fashion.

The team embedded the vaccine within multiple layers of a polymer film which sits on top of a bed of microneedles that painlessly create a passageway into the body. The polymer film begins degrading once in contact with water and safely releases its cargo.

From the study abstract in Nature Materials:

Films transferred into the skin following brief microneedle application promoted local transfection and controlled the persistence of DNA and adjuvants in the skin from days to weeks, with kinetics determined by the film composition. These ‘multilayer tattoo’ DNA vaccines induced immune responses against a model HIV antigen comparable to electroporation in mice, enhanced memory T-cell generation, and elicited 140-fold higher gene expression in non-human primate skin than intradermal DNA injection, indicating the potential of this strategy for enhancing DNA vaccination.


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Yotam Levin's curator insight, July 29, 2015 4:22 AM

This is an exciting combination of innovations in skin immunity, the elegance of DNA vaccination and the cost-effectiveness of cheap and scalable polymer film technologies. Way to go!

Point of caution: it has still a long way to go.. I think this will launch in the next decade at best.

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4 Consumer-Focused Revolutions That Will Change Health Care

4 Consumer-Focused Revolutions That Will Change Health Care | RMs Future of Healthcare | Scoop.it
Health care is broken. Insurance is hard to access, and expensive. What you pay often has little to do with the care quality you receive. Physicians are pressed for time, when you can see them. And the relationships between patient and doctor, and employer, and health insurer often seem to have broken down completely. By 2000, 64% of Americans received health insurance through their employer. It wasn’t always this way. In 1943, the War Labor Board determined that health insurance benefits would be excluded from wage and price controls in key jobs like manufacturing. With much of the qualified labor off at war, and employers unable to raise wages, they resorted to offering non-wage perks (like health insurance) to attract and retain talent. The Kaiser Shipyards developed a system to care for their workforce. After the war, they opened their plan (today’s Kaiser Permanente) to other Northern California employers. By 1954, the tax exclusion was codified in law (PDF), solidifying the once-temporary link between employment status and health coverage.
Today, medical spending accounts for almost 18 cents of every dollar produced in our economy, the highest rate in the world. Americans pay 40% more than the country in second place on that list, and almost double what is spent in the U.K., but our outcomes are not substantially better. As more people confront the prospect of paying more for care out of pocket with reduced or non-existent benefit packages, it becomes increasingly important to understand, and to receive, what we pay for.Even if you have coverage, and you can afford the care, it’s likely that your doctor visit will only be about 20 minutes long. And while the shipbuilders at Kaiser probably developed a rapport with their doctor, the average college grad, staying in his or her first job less than 24 months, is unlikely to build a long-lasting relationship with one. Traditional relationships are breaking down between patients and their doctors.

But not all is lost. This very environment--fragmented, cost-pressured--is producing the innovative products and consumer-facing services which provide hope for the future.

The market is forcing insurers to design products for consumers, not employers

The shift away from employer-sponsored health coverage is already beginning. If and when the health reform bill is fully implemented, millions of people are expected to have access to health coverage for the first time. And, if you believe the rhetoric, 20 million Americans will lose their employer-sponsored care at that time. The employer-sponsored market is shrinking, and a growing percentage of people will be buying insurance directly. The major insurers have already anticipated this shift: They are gearing up for a world where they market their products directly to consumers, through health insurance exchanges. On a recent trip to PIttsburgh, where the headquarters of regional insurer UPMC dominates the corporate skyline, I was surprised to see billboards aimed not at benefits managers, but at soccer moms. The advertisements, directed at consumers, touted new individual health plans. And the CEO of Aetna gave a keynote at SXSW to tout his company’s commitment to people and products focused on consumers, in an area he calls “strategic diversification.”With the health plans preparing to sell their coverage directly to individuals, they’re starting to think like consumer marketers. Instead of focusing just on what happens when a member has an extraordinary diagnosis (and extraordinary cost), insurers are beginning to ask about what happens between billable moments, and between incidents of clinical care. When customer acquisition costs are high--as with a mobile carrier, or any subscription business--the key business success metric becomes customer retention rate. Unlike the mobile carriers, health insurers bear financial risk, so they’re even more motivated to keep around their healthy members, the ones who don’t anticipate using high-cost services and who are more likely to shop around based on features. The new plans clearly have incentive to optimize not just for cost, but for member experience.

Consumers are finding ways to access health care providers outside of traditional channels

With health reform bringing a new influx of people into the insurance system, pundits are projecting a shortage of as many as 150,000 physicians. Care seekers will be forced to rely more on alternative sources of care and guidance. Already, pharmacists can be reimbursed $2 a minute for counseling about diabetes. And any person can visit Sharecare and HealthTap to get a medical question answered by a qualified professional. You no longer need to make an appointment for the summer-camp physical or a flu shot; over 11 million people visited CVS-located MinuteClinic since it opened in 2000.

Cost sensitivity suggests consumers will opt for “right fit” rather than “best” solutions

Consumers do not always choose the most expensive product in a cost-value tradeoff. Consider cars, electronics, or even vacations. But historically, this didn’t hold true for health care. People shopped almost blindly for surgeries, deliveries, and medical imaging, with no information on cost or quality. As more more people bear more of the cost, and want to make decisions around quality, health care management companies like Castlight and CakeHealth, are poised to succeed by helping provide the right information, to the right people, at the right time.

Technology allows us, more than ever, to take health into our own hands

American habits have changed, and we’ve become more of a do-it-yourself culture. The average bank customer conducts less than 15% of his business with a live person in an actual branch, preferring instead to bank via ATM or computer. And in the hospitality industry, where the very name implies placing a premium on human interaction and the personalized touch, hotel chains now promote checking in at a kiosk without ever having to talk to a human.

We are seeing this transformation in the health care space. Over 80% of people have sought health information online (PDF), with over one-third of smartphone users tracking diet or exercise. Even Weight Watchers, built upon the strength of in-person meetings, is betting the future on DIY online and mobile experiences. In his critically acclaimed book, The Creative Destruction of Medicine, cardiologist Eric Topol details these transformations happening across the field. We are taking health into our own hands, supplementing fragmented physician interactions with data-driven personalized applications that really know us.

There will always be a need for deeply involved physician relationships. Especially with complex diagnoses and significant treatment plans. But the future seems bleak. Health care is broken. Coverage and care are harder to access, more expensive than ever, and lacking in quality and value.

But from where I sit, there’s hope. Market forces are pushing health insurers to develop products that consumers really want. And since retaining low-cost members is so important financially, the insurers are incentivized to look beyond traditional disease models and to design services for people to get healthy and stay healthy. New technologies and changing regulations allows consumers to access clinical resources where and when they want, outside of established channels. Shifting social norms mean that we’re often more accepting, even demanding of, a self-service model in health care. The companies poised to win in this space are the ones which build products not just for patients, but for people.

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Want A Diagnosis For Your Mysterious Medical Condition? Ask The Crowd

Want A Diagnosis For Your Mysterious Medical Condition? Ask The Crowd | RMs Future of Healthcare | Scoop.it
Crowdsourcing is quickly becoming a popular way to solve problems--even DARPA, home of the U.S. military’s most futuristic projects, is crowdsourcing new ideas. But until recently, certain things--like medical diagnoses--were generally left to professionals.

Take the case of Simon Turkalj and his wife (he requests that she remain anonymous). About two years ago, Turkalj’s wife was in her third trimester of her third pregnancy. After delivering the baby, Mrs. Turkalj began experiencing seizures. They would disappear periodically, only to return later. The seizures are still happening today. The Turkalj’s have sought help from a number of doctors, including a team at Stanford, to no avail. No one seems to know why Mrs. Turkalj, a physician herself, keeps getting seizures. "To have a seizure, it blunts your intellect. At this point, there is no way she can go back to being a physician," says Turkalj.

Instead of letting his wife languish while doctors ponder what to do, Turkalj is presenting the problem to the Internet at large. He recently created up a Facebook page, dubbed Mom’s Medical Mystery, with links to all the relevant facts: all of the relevant medical records; a Wiki with symptoms, confirmed and suspected conditions, and ruled out conditions; and progress updates. "I’m throwing down all my cards on this one," says Turkalj.

The Mom’s Medical Mystery page has picked up 362 likes since its launch on June 26. There are however, just 15 members on the wiki.

This isn’t the first attempt to crowdsource a medical diagnosis via the Internet. Patients do it all the time on medical message boards. A doctor made headlines two years ago when he crowdsourced a diagnosis on Twitter. And UCLA researchers have created a game to crowdsource malaria diagnoses.

We’ll be watching to see if anyone figures out


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Travel medical apps to aid chronic patients when travelling

Travel medical apps to aid chronic patients when travelling | RMs Future of Healthcare | Scoop.it

Travelers with chronic ailments like diabetes or high blood pressure have long struggled to remember when to take their pills as they cross time zones. Or they may have had a hard time finding emergency care in a foreign country or communicating about complicated health conditions.

But there are now a rapidly growing number of mobile health and medical apps that aim to deal with those types of situations.

¶ Travelers can tap into technology before the trip begins, by storing information that can help ensure the right care is delivered if health issues crop up. Some put their medical history, latest EKG, chest X-ray or list of allergies and medications on a flash drive marked with a red cross, and attach it to a necklace, bracelet or keychain. Those who have had cardiac or other surgery may create a simple image using the free app drawMD for iPad devices that shows the exact location of a stent, for example, or an implant or bypass. For travelers who prefer a traditional method of communicating, a laminated card lists important information and physician contacts.

¶ The Transportation Security Administration has a printable card available on its Web site for those who want to make their medical condition known discreetly to a security agent and discuss or undergo any screenings in private.

¶ Medical devices contained in their own bags do not count toward carry-on bag limitations, though not all airport employees know this. Mellanie True Hills, founder of StopAfib.org, a nonprofit group dedicated to helping those living with atrial fibrillation, says she is often stopped by check-in, security or gate agents and told that the machine that helps with her sleep apnea puts her over the carry-on bag limit and that she will have to check one of her pieces of luggage. The agents relent, Ms. Hills said, when she produces a laminated copy of the applicable T.S.A. regulation she has printed from the agency’s Web site.

¶ Dr. Robert Glatter, attending physician at Lenox Hill Hospital’s department of emergency medicine in Manhattan, suggested that travelers with chronic ailments look for specialists and hospitals at their destinations before they leave home. For those who have not planned ahead but need urgent care, phone apps can help locate nearby medical help. The Emergency Medical Center Locator, a free iPhone app, uses the phone’s GPS to find nearby centers. The app lists nearly 2,400 medical centers in 101 countries, and users can select from six specialty areas, including trauma, eye and cardiac care. While not every medical center is listed, the ones that are have been approved by credentialing societies like the American College of Cardiology.

¶ Time zone changes can be extra challenging for patients, like those with diabetes, with a 24-hour monitoring schedule. Phone apps like Glucose Buddy and GluCoMo remind users to track and record their blood sugar levels.

¶ WellDoc’s DiabetesManager, available on a variety of mobile and Web-based platforms, provides feedback based on glucose, medication, food and exercise information that patients enter, advising them on the actions they should take to adhere to their treatment plan. Anand K. Iyer, president of WellDoc, is a diabetes patient who travels frequently himself. He contrasts the feedback to a radio’s traffic report. “It’s nice to know if there’s a backup, but what I really want to know is the best route home,” he said. “If I’m told my glucose is too high or low, I want to know what actions I can take.”

¶ The app RxmindMe Prescription/Medicine Reminder and Pill Tracker for iPods and iPhones does what its name says and reminds travelers when to take their medicine. Users put in their medication names or search the database, and then specify when they want to be reminded to take them. The app can notify the user when medications need to be reordered, and the device’s camera can add a photograph of the pill.

¶ For travelers who put all their pills in a plastic bag instead of taking separate pill bottles (this is not recommended) the free app Epocrates can help identify them by taking the user through a list of questions about the pill’s color, shape and markings. The app can also be used to double-check the identification of any pills received on the road or review possible side effects or drug interactions.

¶ Dr. Myles Druckman, vice president of medical services for International SOS, which assists multinational organizations with customized health plans for their global travelers, said travelers needed to plan what they would do if their trip was extended. He suggested bringing an extra week’s supply of medicine. “No one knows when an overnight trip will turn into a multiday volcano ash delay,” he said.

¶ Because of language barriers or differences in equipment or supplies, travel to other countries, especially developing nations, can bring an extra set of challenges in a health crisis. Some companies contract with travel assistance providers like International SOS, which has offices in more than 70 countries, to help employees who fall ill or need medical advice. Local offices can deal with issues by phone, give health advice or refer the employee to the appropriate hospital, clinic or doctor. International SOS also offers a phone app that sends general health and security information pertinent to the traveler’s itinerary, noting, for instance, if there is an outbreak of a particular disease in the area.

¶ Apps are also available for doctors in case they are called upon to provide curbside or in-plane assistance. EyeChart can help evaluate patients who complain about their vision and uHear about their hearing. NeuroMind can take physicians through a series of questions to help diagnose a patient who has had a head trauma or is unresponsive.

¶ New apps are appearing every week, and they vary in quality. Paul Cerrato, who reviews medical apps as the editor of InformationWeek Healthcare, said, “Some apps have major research behind them and others don’t seem to have done their homework.” Mr. Cerrato recommended that patients consult with their health care provider to choose the best app for their situation.

¶ While most of the medical apps today record, remind and refer, the future holds more diagnostic uses like the iBGStar Blood Glucose Monitoring System, which features a small meter that plugs directly into the iPhone or iPod Touch. Patients insert a test strip into the meter to take a blood sugar reading, and the information is automatically synced with the app. Another is a blood pressure cuff that can attach to a smartphone. Both can send results to a home physician from a hotel room or business meeting across the world. “These apps are really game changers,” Mr. Cerrato said, “for everyone.”

 ahp as Health Aide


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Sunny Huang's curator insight, January 13, 2014 12:44 AM

Many people have smart phones or tablets these days. Medical apps that can be installed into a device will make things easier and quicker. So doctors can have more time to look at different cases. I look forward to more medical or science related apps.

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How the FDA regulates pharmaceutical apps

How the FDA regulates pharmaceutical apps | RMs Future of Healthcare | Scoop.it

Mobile apps seem all the rage in the pharmaceutical industry. According to the website InPharm, there are presently over 100 of them publicly available. Based on what I’m hearing from pharmaceutical companies directly, that’s only a small number compared to the apps in development.

Recently there’s been a debate going on in the UK about whether pharmaceutical apps are medical devices under EU law. Consulting firms Bluelight & d4 suggested in a January report that many health-related apps are indeed medical devices in the UK. Specific to pharmaceutical apps, the report suggests that at least in the UK “if your app will be associated with, contributes to or makes a clinical decision, assume that it will be classified as a medical device….” The report stirred quite a controversy among champions of innovation and free speech.

In the US, there’ve been a couple of events recently that have caused pharmaceutical companies to focus on these issues. First, FDA held a public hearing in March to take testimony on whether greater reliance on patient decision support software could allow certain drugs to be switched from prescription status to over-the-counter. That prompted companies to wonder how such software would be regulated. Further, on May 18, in an issue briefing for congressional staff, Dr. Jeff Shuren, the director of the center at FDA that regulates devices, spoke plainly about the agency’s intention to deregulate certain apps used for low-risk pharmaceutical management.

In my series of posts on this website 2 years ago, I laid out the basics of FDA regulation of mHealth. Now I’d like to expand that to address FDA regulation of pharmaceutical apps. Regulatory CategoriesThe starting point is to understand the four different possible regulatory categories into which pharmaceutical apps might fit. Those four categories are:

1. Heaven on Earth, a.k.a. Apps not Actively Regulated by FDA. Just about everyone wants their app to be unregulated. And Utopia it nearly is. But, not to be a Debbie Downer, I need to be clear this just means unregulated by FDA (and even that status may change in the future). Most apps would still be regulated by the Federal Trade Commission, and indeed it was FTC that brought one of the first enforcement actions against a mobile app developer. Further, nearly all apps would be subject to state regulators, Lanham Act challenges by competitors, and tort law if they hurt somebody. So it’s probably still a good idea if app developers exempt from FDA regulation nonetheless test their apps to make sure they work.

2. Drug labeling. FDA law makes it clear that information provided by a pharmaceutical company in support of its drugs qualifies as a regulated drug labeling even if it is not physically near the drug itself. Generally there are two kinds of labeling:

Prescribing information—also sometimes referred to as product labeling or a package insert—provides carefully crafted information regarding instructions for use. This information is highly regulated and, for new prescription drugs, is the subject of much negotiation between the manufacturer and the agency.Promotional labeling—is used to help sell the drug. This kind of labeling comes in all different shapes and sizes from brochures and booklets, videotapes, refrigerator magnets, cups and other giveaways to virtually anything else where a pharmaceutical company tries to convey a message about its drugs. There are different levels of promotional labeling; for example, a reminder advertisement is intended merely to convey the brand name.

A full discussion of the contours and scope of promotional labeling is well beyond this post, but suffice it to say that apps and other software used to convey information about a prescription drug will typically be regulated at least as drug labeling. As such, the labeling must include (at a minimum) full prescribing information, and perhaps need to be filed with FDA at time of first use.

3. Medical device. Yes, I said a medical device. In my previous posts, I explained the medical device definition ad nauseum, and I don’t want to bore you with the details of that again. Basically software, if intended for a medical purpose in the treatment or diagnosis of disease, can be a medical device. In the guidance document FDA published last summer on mobile medical apps (MMA), FDA outlined its thinking on when mobile medical apps would constitute a medical device. A specific category mentioned in that guidance is standalone clinical decision support (CDS) software, or software that is not connected to any medical device but provides information used in the treatment or diagnosis of disease. The agency explained that it was beginning a process to refine its definition of the scope of regulated CDS, and then they held a public workshop on the topic in September of 2011. At that workshop, FDA suggested that there were three primary elements to CDS, including:

Data taken from any source, for example, a medical device, environmental data or demographic data;A conversion, by which the FDA seemed to be referring to the use of algorithms, formulas, database lookups or other analytic steps to produce;An actionable result, which I understood to have two key defining characteristics: (i) a specific patient and (ii) a specific recommendation, not a list of possibilities.

The agency then gave some examples of what they would consider CDS, and offered up BMI calculators, trending algorithms, medication reminders and drug/drug interaction software to be examples of low-risk CDS. On the high-risk side, the agency mentioned radiation dose calculators, medical imaging analyzers, cancer treatment software and complex analyzers for untrained users.

The agency is working on a CDS guidance, but in the MMA guidance the agency made it clear that it does not plan to regulate:

Electronic copies of medical textbooks;Apps that are simply used to provide clinicians with training;Apps that are used for general health and wellness, and not disease; orThe traditional electronic health record apps used as an electronic health record.

FDA also indicated that they would use enforcement discretion to hold back on regulating certain apps they consider to be medical devices, but that are low-risk. The draft guidance wasn’t very specific, and hopefully the final guidance will elaborate more, but in a footnote (#13) FDA mentioned apps “that may meet the definition of a medical device [and] have functionality either to automate common medical knowledge available in the medical literature or to allow individuals to self-manage their disease or condition.” Remember, always read the footnotes!

As I mentioned above, on May 18, 2012 Dr. Shuren spoke at a Capitol Hill briefing where he revealed a little bit of the agency’s thinking. He explained that the items listed above are low-risk CDS and would likely not be actively regulated. Putting the pieces together, it would seem that although FDA might say that they qualify as medical devices, they plan to exercise enforcement discretion and not regulate them presently. Dr. Shuren specifically mentioned not regulating:

Educational tools (e.g., apps that provide a list of questions to ask physicians);Medication reminders for therapy adherence;Simple, common calculators (e.g., for tabulating an apgar score);BMI calculators;Drug-drug interaction formulae;Diabetes management guides (e.g., nutritional guides or pre-diabetes risk assessments); andSubstance abuse behavior guides.

Because it was part of an informal panel discussion, we don’t have much detail on specifically the scope of each of those categories.

4. Combination products. This category only applies if the app first is a medical device. If that’s true and the app cross-references a drug to be used with the app, and if likewise the drug cross-references the app to be used together, that creates what is called a combination product. Below I’ll give some examples of combination products, but for the moment it’s simply important to understand that if an app and a drug together constitute a combination product, it means the FDA regulatory process gets a bit more complex. Literally it means that two different centers at FDA—the drug people and the device people—get actively involved in regulating the product. FDA has put in place some procedures for improving the coordination of the reviews between those two centers, but it is not without its challenges.


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CVS Caremark research finds link between medication adherence, employee productivity | Drug Store News

CVS Caremark research finds link between medication adherence, employee productivity | Drug Store News | RMs Future of Healthcare | Scoop.it

WOONSOCKET, R.I. — Employees with such chronic diseases as asthma, diabetes and high blood pressure spend fewer days out of the office when they are adherent to their medications, according to new research conducted by CVS Caremark and Truven Health Analytics (previously the healthcare business of Thomson Reuters).

Such chronic diseases as asthma, diabetes, high blood pressure and elevated cholesterol impact nearly 70% of working-age adults in the United States. While research has demonstrated the impact of medication adherence on reducing overall healthcare costs, there has been less evidence available to date on whether adherence improves employee productivity. However, the new research, published on Monday in the Journal of Occupational and Environmental Medicine, found that employees with chronic conditions who were adherent to their prescribed medications had up to seven fewer days away from work annually (including absenteeism and short-term disability days) than those who were not adherent. This translated into estimated annual savings of up to nearly $1,700 per adherent employee.

"These research findings clearly show that employees who receive appropriate medical care and follow their doctor's directions about taking their medication are healthier and more productive," stated Troyen Brennan, EVP and chief medical officer of CVS Caremark. "These results are one more piece of the puzzle illustrating the impact of medication adherence in improving health outcomes while managing overall healthcare costs."

The researchers examined data on prescription drug usage, absenteeism and short-term disability for more than 100,000 employees at more than 16 medium- to large-sized employers. Employees included in the study were diagnosed with diabetes, high blood pressure, congestive heart failure, high cholesterol or asthma/chronic obstructive pulmonary disease. The research found significant differences between adherent and nonadherent employees in the number of short-term disability days taken for all conditions studied, and between adherent and nonadherent employees in the number of absenteeism days for those with diabetes, high blood pressure, high cholesterol and asthma/COPD.

"This is one of the first studies to be able to quantify the impact of medication adherence on worker absenteeism," stated Ginger Carls, senior research leader of Truven Health Analytics and co-author of the study. "The results provide a clear message that employees with common chronic conditions who take their medications as directed miss fewer days at work, resulting in potential cost savings for employers."

This study is a product of ongoing CVS Caremark-sponsored research that is focused on understanding why many consumers do not take their prescriptions as directed, and developing solutions to assist patients in using their medications effectively. Annual excess healthcare costs because of medication nonadherence in the United States are estimated to be as much as $300 billion annually.


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there are now hundreds of apps that focus on various chronic conditions, and many of them enable users to track symptoms or observations of daily living

there are now hundreds of apps that focus on various chronic conditions, and many of them enable users to track symptoms or observations of daily living | RMs Future of Healthcare | Scoop.it

Four years after the launch of the AppStore, growth in the number of available consumer health apps for iPhone users is still accelerating. It’s growing more quickly now than ever. There were more consumer health apps in April 2012 than we expected there to be: In July 2011 we predicted that the number of consumer health apps would top 13,000 in July of this year, but that happened at least three months ahead of schedule.

In April of this year there were already more than 13,600 relevant consumer health apps, and that number does not include the thousands of miscategorized and foreign language apps found in the Health & Fitness and Medical categories of of Apple’s AppStore. As we have done for almost three years now, the MobiHealthNews team sifted through Apple’s health-related categories and placed each consumer health app, one-by-one, into more than 80 subcategories of our own for our 2012 definitive, quantitative analysis of consumer health apps for Apple’s iPhone.

  This unexpected acceleration in the number of consumer health apps does bring more meaningful app choices for patients, but it also exacerbates the discoverability issue. With so many health and fitness apps available, can the best ones really break out? Certification platforms like Happtique are tackling the issue and an increasing number of medical professional blogs, publications, and journals are popping up to serve up reviews from the provider perspective.Over the long term we expect these top-down approaches to help drive provider awareness, and while “prescribing” apps will become more common, consumer health app adoption will be driven by patient communities and social networks. The best will bubble up because they work and because these app users will share their stories.

It’s clear from the still rudimentary – though increasingly creative – selection of consumer health tools that health apps still have to amp up their feature set before mass adoption occurs beyond novelty heart rate monitor apps and exercise trackers. As other have noted – including Chris Wasden from PwC – the regulatory environment is pushing some health app developers to pare back some features in an effort to remain unregulated or less regulated. Precious few consumer health apps offer coaching elements – similar to what Wasden calls “intelligence”. Additional regulatory guidance from the FDA may help more developers take their apps beyond reference and tracking and into the realm of coaching and personalized feedback.

Encouragingly, there are now hundreds of apps that focus on various chronic conditions, and many of them enable users to track symptoms or observations of daily living. Diabetes and heart disease-focused management apps are among the largest contingencies of chronic condition management apps, but cardio fitness, dieting, and stress relief apps continue to be the three biggest consumer health categories overall.

Another interesting trend: The price of consumer health apps continues to drop. As we reported in our August 2010 health apps report, the average price of all consumer health apps (including both paid and free apps) was $2.34 at the time. By July 2011 the price fell to $2.20, or by about 14 cents. Since July 2011 the price has dropped an additional 15 cents, making the average price for all consumer-facing health apps as of April 2012: $2.05.

While the price is falling for health-related apps, that still puts the category at the higher end of Apple’s AppStore for average pricepoints.

To learn more about the current state of consumer-facing health apps, join the thousands of others who have purchased MobiHealthNews’ apps reports or subscribe to all of our 2012 paid content reports. For more on MobiHealthNews’ latest research report: An Analysis of Consumer Health Apps for Apple’s iPhone, visit our online research store here.


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Too Much Hype in the Mobile Health App World?

Too Much Hype in the Mobile Health App World? | RMs Future of Healthcare | Scoop.it
The Wild West of mobile health (mHealth) is taking the health care industry by storm, but "there are no rules to the game," said Joseph C. Kvedar, M.D., founder and director at the Center for Connected Health in a recent interview. Mobile health is a "game changer," he added, but there is a lot of hype because there are a lot of people developing health apps just to "get rich quick."

According to the U.S. Department of Health and Human Services, mHealth is "the use of mobile and wireless devices to improve health outcomes, healthcare services, and health research." mHealth includes gamification, text messaging, telemedicine/telehealth (remote patient monitoring), electronic health records, and health apps, to name a few.

There's a lot of enthusiasm surrounding mHealth -- from mainstream media tapping into the mHealth rage to social networking sites exploding with discussions about mobility in health care. Take a look at the conversations happening on Twitter and you'll observe how popular mHealth really is. Follow the hashtags #mHealth, #HealthIT, #HIT100, #apps, #healthapps, #digitalhealth, #hitsm, and #hcsm; and observe the 140 characters of tweets that soar at an accelerated rate through cyberspace offer fiery information. Paul Sonnier's Linkedin group Digital Health has over 11,000 members to date.

Not only is mHealth soaring through the social networking sites, U.S. revenue in the mHealth market earned $230 million is 2010 and it's estimated to reach $392 million in 2015, according to a news release by Frost and Sullivan. Globally, Reseach2Guidance reports that the mHealth market will reach $ 1.3 billion this year. Despite mHealth being in its infancy, the revenue projections are significant.

According to a 2011 press release statement from Juniper Research, the number of mobile healthcare and medical app downloads will reach 44 million this year and will reach 142 million globally by 2016.

Consumers are downloading apps to help them stay fit, track their pregnancies, monitor their moods, eat healthier, and sleep better. They are also downloading apps for chronic disease management. They can manage their prescriptions, have medication reminders, and monitor blood pressure and sugar levels. Consumers can be empowered to take charge of their health, but right now navigating the array of health apps can be confusing. Consumers lack guidance on choosing a safe, secure, medically sound health app. Trying to navigate the health app craze without direction can be painstakingly difficult.

Cleveland Clinic, Nike Fuel Band, American Red Cross, and Walgreens are known in the space, and consumers may find it easy to trust them and download apps associated with them. However, consumers may find it confusing to navigate the mHealth app world from companies that are off the radar. How do consumers know if the apps are safe and reliable?

Consumer Safety Is a Priority

The FDA is prudent on drafting guidelines for developers, but will it stifle innovation? "It may slow innovation, but I don't know that it stifles it. Regulations do create barriers to entry as they set a high bar. But in so doing, they also create significant economic opportunities for those who follow the appropriate processes and win regulatory approval," said Bill Crounse, M.D., Senior Director of Worldwide Health at Microsoft Corporation, in an email. "I do think thoughtful regulation is required in the health industry to protect consumers. This is certainly true related to pharmaceuticals and medical devices to protect consumers from harm."

"The primary role of the FDA is to insure consumer safety," notes Kvedar. "Mobile health has the potential to get out of hand if not regulated. For example, there is an app that based on self input of one's carbohydrate count; it will generate insulin dosing suggestions. Clearly this could be dangerous," he added. "While I don't think the FDA process will ever eventuate in a 'consumer report-like' or 'D Powers-like' rating, it will be a filter. If apps get through the filter, we should at least be comfortable that they are safe."

Aside from safety concerns, there are "two problems with health apps," said Kvedar. First, after downloading the app, it may be used once or twice and then it's forgotten, he said. "There's no engagement." Secondly, health apps can be prone to error because the data that is self-entered by consumers may not be true. It's a "social diversity bias problem," he said, because the data entered isn't honest and there is no meaningful engagement to help change consumers behavior. After downloading health apps with enthusiasm, the "shiny new toy isn't so shiny anymore," because there's "lack of interest and lack of engagement," said Kvedar.

Health apps need to be engaging and motivating and offer a coaching component.

"There's a short shelf life, don't expect it to change your life," he said.

Happtique, a mobile health application store and total app management solution released a draft of the standards that it will be using to certify medical, health, and fitness apps under Happtique's App Certification Program. The purpose of the program is to help users identify apps that meet high operability, privacy, and security standards and are based on reliable content.

David Lee Scher, M.D., a former cardiac electrophysiologist who is presently director at DLS Healthcare Consultants and senior medical advisor to Happtique, said in an email interview:

Happtique App Certification Program represents a major step in setting standards for safe and reliable health, fitness, and medical apps. Certification will assure users that the app meets security, usability, privacy, and content standards. Happtique has curated and categorized over 12,000 apps to date in over 300 categories.
Mobile technology has allowed consumers to receive information at lightning speed and gives consumers health and wellness apps that can help improve their health care. Mobile technology may help to transform the lives of patients and provide a stronger partnership with health care providers.

Bottom Line

Consumers need safe, reliable, trustworthy apps to help guide their health and wellness and help them manage their chronic diseases.

The health app world needs guidance. The vast assortment of apps to choose from makes it difficult for consumers to navigate. Which apps are reliable, trustworthy, and medically sound?

Joseph Kvedar, M.D., Justin Major and Carol Colman are actively involved in writing a series of books for consumers titled Wellocracy; it's the first in a series of books to help consumers navigate the ever-growing and dizzying array of health apps.

So, how do consumers navigate the crowded world of health apps? "Common sense rules," he said. If consumers think it's a "magic app," it probably isn't.

In this exciting world of health care where technology rules, one thing is for sure, technology will never replace the doctor/patient relationship (or health provider/patient relationship). Face-to-face communication with health care providers will always be paramount.

It doesn't seem as if there is too much hype -- just little guidance. The push to move the mHealth app world forward may be in the power of consumers to clamor for health and wellness apps that are safe, reliable and trustworthy, developed by companies who are not just those looking to "get rich quick," as Kvedar said.

Your Turn

We would love for you to share your thoughts in the comment section below. Do you download health apps? Do you feel guidance is needed to help navigate the enormous amount of health apps? What health apps do you use? As always, thank you for sharing your thoughts and for your valuable time.


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The Age of 'Wearatronics': Advances for remote patient monitoring

The Age of 'Wearatronics': Advances for remote patient monitoring | RMs Future of Healthcare | Scoop.it
In the beginning there was the triode, a vacuum-tube that heralded the early age of electronics. However, this age was limited because the triode was relatively bulky, required a lot of energy and, since it was made of glass, extremely fragile. Its replacement, the solid state field-effect transistor, was perhaps the greatest technological leap of the 20th century. The transistor reduced the size & power load of electronics while simultaneously improving their durability.We are now entering a new age of electronics, one in which new materials and interconnects have made circuit assemblies flexible (‘Flextronics‘) and, as a result, embeddable. We at Medgadget have been closely following flextronics as well as its subfield of wearable electronics, or “wearatronics,” over the last few years. The fundamental concept is that flexible electronic arrays may be embedded into textiles in order to, for example, measure the wearer’s vital signs or even generate and store power. In this post we would like to provide one timely example and two resources that you may use to learn more about wearatronics and stay ahead of the curve:

MC10, a leading company developing flexible electronics, informed Medgadget that it has signed an R&D contract with the US Army Natick Soldier Research, Development, & Engineering Center (NSRDEC) to “develop solar cells that are directly integrated into the fabric cover of combat helmets and rucksacks.” We have covered MC10 before because of their work on adding conformal electronics to medical devices, such as catheters and stents, and are interested by this new partnership that more directly relates to embedding electronics into textiles. Their CEO, David Icke, explains the recent move:

Soldiers today carry a lot of high-tech gear, but often go long periods of time without access to power. MC10 is providing a renewable power source that doesn’t add to the heavy load our soldiers already carry.

Given MC10′s existing partnerships with Reebok, Mass General Hospital, and others, we can expect to hear more about their work in the field of wearatronics.

In terms of the resource to learn more about wearatronics, our colleagues at GigaOm just released a research briefing earlier this week entitled “The wearable-computing market: a global analysis.” One highlight from the report is that the wearatronics market for just health and fitness products is estimated to reach 170 million devices within the next five years. We’ve quoted the report summary below:

What do Google’s Project Glass, Zephyr Technology and the Hug Shirt have in common? All are examples of wearables: computing devices that are always on, always accessible and easily worn on the body. With the growth of sensors and microelectronics, the potential uses of wearable-computing technologies now reach to health and fitness, gaming, fashion, disabilities and augmented reality. Most importantly, the widespread adoption of wearables will drive the form function and market for mobiles in vital ways. This report provides a historical background, an overview of the technologies in the wearables market and possible future trends as the market expands.

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Approved: The First Swallowable Electronic Devices

Approved: The First Swallowable Electronic Devices | RMs Future of Healthcare | Scoop.it
No matter how fast pharmaceutical companies can churn out drugs to prevent or cure illnesses, health insurance doesn't cover the cost of hiring a person to follow you around and remind you to take your meds. So the FDA has approved a pill that can do it on its own by monitoring your insides and relaying the information back to a healthcare provider.

The pills, made by Proteus Digital Health, have sand-particle-sized silicon chips with small amounts of magnesium and copper on them. After they're swallowed, they generate voltage as they make contact with digestive juices. That signals a patch on the person's skin, which then relays a message to a mobile phone given to a healthcare provider. It's only been approved for use with placebos right now, but the company is hoping to get it approved for use with other drugs (which would be where it would get the most use).

Even if there's a slight whiff of dystopia about a pill that tracks your actions, it does help with a major problem. Patients aren't the best at taking their pills, especially those suffering from chronic illnesses, so it's one step of many toward a future where they don't have to.


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a new technology offering that provides the ability for all sorts of medical sensors to easily use smartphones and tablets as their interface.

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.


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Aetna and PatientsLikeMe Help Empower Members Through Collaborative Program | Aetna News Hub

Aetna and PatientsLikeMe Help Empower Members Through Collaborative Program | Aetna News Hub | RMs Future of Healthcare | Scoop.it

Aetna (NYSE: AET) and PatientsLikeMe today announced a new program to help Aetna members improve the way they live with various health conditions. Through a one-year pilot program, Aetna is directing its members to PatientsLikeMe so they can connect with others who have the same condition, and access real-world symptom, treatment and outcome reports


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Mapping future health: patient, provider, pharma perspectives

Mapping future health: patient, provider, pharma perspectives | RMs Future of Healthcare | Scoop.it

The future patient will be:

Committed to self management. The future patient is aware of the fact their personal health future is most likely to be conditioned by preventative strategies rather than treatment after the fact. The future patient is self-aware, and whilst they may not always abstain from actions that have health impacts, or engage in risky behaviours, they do so as a personal microchoice that they account for to themselves rather than expecting their decision to be ameliorated by external agencies. The future patient appreciates that informed choice trumps informed consent. The future patient will become who they are.

Health privileged. The future patient appreciates that whilst access to good healthcare should be a right, good health itself is a privilege and should be treated as such. The future health consumer aspires to maintain or attain good health in the same way that the historical retail consumer has aspired to the acquisition of commodities on the basis of their appreciation that health is the most precious possession of all.

Quantified. The future patient practices and advocates the collection and redistribution of the data that streams from their body among their healthcare team (and perhaps further, if they see a collective/personal benefit) not just to manage their day-to-day health or to optimise the management of chronic disease, but to inform the advancement of future health research through the processing of data on a planetary scale.

The future provider will be:

Fully participatory. The future provider’s default assumption is that the patient will participate fully in all decisions that are made about their health. The future provider will see it as a duty of care on their part to encourage the patient to self-identify as a shared decision maker, and a co-creator of their own care.

A committed innovator. The future provider will facilitate those expectations that the future patient brings to the point of care. They will provide access to health records. They will expect and encourage patients to research their own conditions. They will be looking to deploy proven innovations within the point of care as soon as their benefits have been proven. The future provider talks constantly about the ways in which facial recognition technologies could welcome patients to their practice, how non-invasive sensor technologies will revolutionise health, how artificial intelligence in the consulting room is an adjunct to their practice rather than an insult to their professionalism, how healthcare information should be prescribable, and dream along with their patients of the time when the personalised, genomic EHR is a reality.

Digitally integrated. The future provider continually seeks to refine and improve the reach of their professional digital presences to the communities they serve at a local level, and perhaps beyond. They endeavour to find ways of using digital technologies that improve the frequency and quality of professional connections with patients with a view to supporting health behaviours, improving compliance and working cooperatively towards better patient outcomes.

Two out of three future pharma requirements are primarily internal rather than external objectives. Future pharma will be:

Visible expertise. Future pharma will be the most open, available and discoverable source of gold standard information about their own products and the disease areas they work in. Future pharma works tirelessly to make all data about their medicines available in a balanced, approvable way in online environments and platforms that the communities of interest which they serve are most likely to find and use it. Future pharma’s default expectation is that it has an ethical responsibility to proactively and openly disseminate all information about its products from clinical trials onwards.

Socially evolved. Future pharma drives the precepts of social business through its enterprise and uses social technologies and the attitudinal dispositions that underpin them to the fullest. Future pharma fully appreciates that its future financial success is contingent upon rather than threatened by observing policies of openness wherever possible, and has reoriented its business away from the traditional conceptual frameworks within which its activities had formerly been configured.

Postmarketers. Future pharma has reconfigured the means whereby it talks about and shares information concerning its products and services to the point that they no longer resemble ‘marketing’ activity as it was formerly understood. Future pharma’s former dominant marketing behaviours and the contexts within which they were practiced have become residual. Future pharma now listens actively to patient and professional needs and responds quickly and openly. Future pharma’s goal state is to anticipate needs, not to directly influence behaviours. Future pharma appreciates that its further success will reside in sublimating everything other than its irrepressible desire to innovate and promote the science it practices.


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With sensors, apps & data, my smartphone is (almost) my doctor

With sensors, apps & data, my smartphone is (almost) my doctor | RMs Future of Healthcare | Scoop.it

Walking and running centric personalized health devices like Nike FuelBand and Jawbone Up will soon have company in the market place, thanks to Scanadu, which is making a vital health signs monitor, Scanadu Scout. Soon to follow, Scanadu Flu and other gadgets, FDA willing, of course.


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"Printing" pharmaceuticals with a 3D printer

"Printing" pharmaceuticals with a 3D printer | RMs Future of Healthcare | Scoop.it

A Nature Chemistry paper by researchers from the University of Glasgow describes a process for "printing" pharmaceutical compounds from various feedstocks, and supposes a future in which we have diagnosis/medication manufacturies at home. The process uses an off-the-shelf 3D printer technology to assemble pre-filled "vessels" in ways that create the desired chemical reaction in order to produce medicines. It's a scaled-down version of the industrial process used to manufacture drugs in bulk, and the paper's principal, Prof Lee Cronin, calls it "reactionware." From the BBC: "We can fabricate these reactionware vessels using a 3D printer in a relatively short time. Even the most complicated vessels we've built have only take a few hours.

"By making the vessel itself part of the reaction process, the distinction between the reactor and the reaction becomes very hazy. It's a new way for chemists to think, and it gives us very specific control over reactions because we can continually refine the design of our vessels as required.

"For example, our initial reactionware designs allowed us to synthesize three previously unreported compounds and dictate the outcome of a fourth reaction solely by altering the chemical composition of the reactor."

...Prof Cronin added: "3D printers are becoming increasingly common and affordable. It's entirely possible that, in the future, we could see chemical engineering technology which is prohibitively expensive today filter down to laboratories and small commercial enterprises.

"Even more importantly, we could use 3D printers to revolutionise access to health care in the developing world, allowing diagnosis and treatment to happen in a much more efficient and economical way than is possible now.

"We could even see 3D printers reach into homes and become fabricators of domestic items, including medications. Perhaps with the introduction of carefully-controlled software 'apps', similar to the ones available from Apple, we could see consumers have access to a personal drug designer they could use at home to create the medication they need."


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A croudsourced project for cancer research. This is the way forward!

A croudsourced  project for cancer research. This is the way forward! | RMs Future of Healthcare | Scoop.it

Cancer researchers often find themselves flooded by the amount of data they have to sift through in their projects. Often, this data is in a form that computers find hard to process and analyze, such as pathology slides from tumor biopsies.Cancer Research UK, finding itself loaded with a couple million slide images, decided to outsource the analysis to you, the anonymous online volunteer who always wanted to help with cancer research, but is instead an ophthalmologist. Partnering with Zooniverse, a project that allows anyone to help with looking at NASA’s data, the Cell Slider site, after a short prep, asks volunteers to count irregular cells and quantify how stained they are for every image presented. Each image is run through five unique volunteers to improve data confidence and each volunteer is rated in the background by the site based on the accuracy of previous image runs.

Each sample in the database has been stained to highlight the differences between ordinary cells, such as white blood cells, and irregular, cancerous cells. One slide has around 120 tumour samples, but these are broken down into 16 sections so the public is looking at a tiny subsection of the full dataset when they view each image on Cell Slider.

In the case of the breast cancer samples, the yellow colour represents the level of the oestrogen receptor (ER) protein present in the cell, a normal protein that in excess attracts too much oestrogen, which stimulates cancer cell division and tumour growth. Around 70 percent of breast cancers are classed as ER positive. Hormone therapies are helpful in treating this type of cancer — drugs such as tamoxifen effectively slot into the oestrogen receptors to block oestrogen, preventing it reaching and feeding the cancer. This is usually only effective if there are high ER levels, and that’s where Click to Cure comes in.


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New Wireless Sensors Tackle Old Problems Like Pneumonia -- InformationWeek

New Wireless Sensors Tackle Old Problems Like Pneumonia -- InformationWeek | RMs Future of Healthcare | Scoop.it
For the past seven years, wireless sensor technology developed at the University of Missouri (MU) has helped detect disease in its early stages among residents living at the TigerPlace assisted care facility in Columbia, Mo. Now, thanks to a grant from the National Science Foundation, that technology soon will be expanded to remotely monitor the elderly in another facility in Cedar Falls, Iowa. Marilyn Rantz, RN, professor of nursing at the Sinclair School of Nursing at the University of Missouri, said that staffers and MU researchers will remotely monitor residents in Cedar Falls from the TigerPlace facility, which is about three miles from MU. High-speed video conferencing capabilities will allow communication between staff and residents at the two locations. "Using what we're already doing at TigerPlace and deploying it at the facility in Cedar Falls will allow us to further test the concept of remote health care," Rantz told InformationWeek Healthcare. "Monitoring individuals with in-home sensors allows us to unobtrusively monitor their health changes based on their individual activity patterns and baseline health conditions."

[ There's almost no end to the amount of useful medical information available online. Read 7 Health Education Tools For Patients. ]

Rantz said that environmentally embedded sensors that monitor pulse, respiration, and bed restlessness have been a key to the success of early detection.

"What we have been able to discover are new pieces of information from the environmentally embedded sensors that can indicate when people are having functional decline and particularly when they are getting sick," Rantz said. She added that the sensors are able to pick up when people are developing an illness between 10 and 26 days before the older adult or someone else detects the illness.

"We've automated this process, we send out alerts to the staff and take a closer examination and look at the changes in the sensor patterns. We look at those changes and do an assessment to see what's going on."

For example, pneumonia caught in its early stages can deter an emergency room visit or hospitalization. "You have less health care costs and it's easier on the person because you can recover from that acute illness faster because you caught it early," said Rantz.

Alerts are set up on an email system and are accessible via a smartphone, said Rantz. The alerts are currently sent to the healthcare staff at TigerPlace and the healthcare research team at MU. The alerts from the sensors at the Iowa facility go to the Iowa staff, the TigerPlace staff, and the research team, she said.

An environmentally embedded sensor is a motion sensor that is unobtrusive and environmentally pleasing. For example, a sensor that that can be mounted on a wall or one that sits in a box that looks like an end table.

These sensors wirelessly transmit data to small computers that in turn transmit data via a secure network server located at TigerPlace and in the telecom building at MU. "We do real-time data analysis and feedback to the user and the healthcare provider," Rantz said.

Rantz said that the combination of sensor technology with care coordination represents the future. "Much of what I see with older adults are the same problems that I saw 40 years ago and this is a new solution to those same old problems."

According to a 2010 position paper released by the Center for Technology and Aging entitled "Technologies for Remote Patient Monitoring (RPM) for Older Adults," the U.S. healthcare system could reduce its costs by nearly $200 billion during the next 25 years if remote monitoring tools were used routinely in cases of congestive heart failure, diabetes, and chronic obstructive pulmonary disease (COPD). The position paper stated that RPM technologies could help older adults slow the progression of chronic disease and alert caregivers and prompt intervention when a vulnerable older adult is injured or in harm's way.

Get the new, all-digital Healthcare CIO 25 issue of InformationWeek Healthcare. It's our second annual honor roll of the health IT leaders driving healthcare's transformation. (Free registration required.)

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Patients want technology to manage their health -- but with a personal touch - amednews.com

Patients want technology to manage their health -- but with a personal touch - amednews.com | RMs Future of Healthcare | Scoop.it
The majority of patients are interested in using online tools to help self-manage their health care, but not if it means sacrificing face time with their physicians to do so.

A survey of 1,100 U.S. patients by Accenture, a management consulting and technology services company, found that 90% of patients want tools such as online medical record access and appointments to self-manage their health care. But nearly the same percentage (85%) say they want to preserve their in-person interactions with their physicians when needed.

What this means is that patients want choices, said Kaveh Safavi, MD, managing director of Accenture’s North America health industry group.

“They want the option to do some things on their own, but also the option to see a clinician when they want to see a clinician,” he said.

“When we say self-manage, we are talking about a much broader notion than clinical visits,” Dr. Safavi continued. Patients identify things they can do on their own schedules, when it’s convenient to them, and things physicians do on their schedules. There are ways technology can allow those tasks to be accomplished without a coordination of both patient and physician schedules, he said.

There are also ways patients’ online activities can supplement what happens in the office, said Julia Hallisy, DDS, founder of the Empowered Patient Coalition, a consumer advocacy organization. But physicians have to do their part to make sure their patients are engaged, she said.

The Accenture survey, conducted online from March 30 to April 4 and released June 20, found that while the majority of patients want online access to self-management tools, nearly half don’t know whether their health records are available online.

Hallisy said this lack of awareness is due to patients not yet thinking about their empowerment in those terms. They view it as more of a concept at this point, she said.

When asked about technology and transparency, “patients know there is value and safety in those things. But the disconnect comes when we ask if they know what their role is,” Hallisy said.

She said physicians can guide patients to take on tasks that will empower them and make their clinical visits more efficient. One example is having physicians tell patients that their medical records are online and asking them to review them before their next visit so they can discuss any concerns or questions. Or physicians can tell patients to look up their lab results so an informed discussion can take place. Setting specific challenges, such as asking patients to come up with a list of three things they want to talk about and following up on those challenges, will result in patients becoming more engaged.

“Technology means more than making appointments online,” Hallisy said. “The ultimate value is when the patient is using the medical record as a tool.”


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UMSkinCheck Keeps a Temporal Record of Users Skin for Surveillance of Dermatologic Cancers

UMSkinCheck Keeps a Temporal Record of Users Skin for Surveillance of Dermatologic Cancers | RMs Future of Healthcare | Scoop.it
Skin cancer is an unusual cancer in that it often hides in plain sight, looking like pimples, warts, and other benign growths. A regular full body photo-exam professionally done at a clinic can be useful as a screening tool for early cancer detection, but it’s time consuming, can be expensive, and may not appeal to people who don’t like to undress in front of strangers.A team of researchers at the University of Michigan Health System, including practicing physicians, developed an iPhone/iPad app called UMSkinCheck for performing self exams and for visual surveillance of suspicious moles and legions over time. The app stores 23 shots from each of the previous self exams, comprising the skin surface of the entire body, and permits tracking of objects on the skin from one photo exam to the next.

More from the app’s iTunes page:

A skin cancer self exam is used to identify suspicious moles or lesions that may be cancer or growths that may develop into skin cancer (precancers). Individuals who are at a high risk of skin cancer are encouraged to perform frequent skin self exams and to have full body photographic surveys taken by professional photographers. Using UMSkinCheck, patients will be able to complete a full skin cancer self exam and photo survey, track and create a history of moles and lesions and receive regular reminders to perform follow up self exams and check on lesions that are being tracked.

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Too Much Hype in the Mobile Health App World?

Too Much Hype in the Mobile Health App World? | RMs Future of Healthcare | Scoop.it
The Wild West of mobile health (mHealth) is taking the health care industry by storm, but "there are no rules to the game," said Joseph C. Kvedar, M.D., founder and director at the Center for Connected Health in a recent interview. Mobile health is a "game changer," he added, but there is a lot of hype because there are a lot of people developing health apps just to "get rich quick."

According to the U.S. Department of Health and Human Services, mHealth is "the use of mobile and wireless devices to improve health outcomes, healthcare services, and health research." mHealth includes gamification, text messaging, telemedicine/telehealth (remote patient monitoring), electronic health records, and health apps, to name a few.

There's a lot of enthusiasm surrounding mHealth -- from mainstream media tapping into the mHealth rage to social networking sites exploding with discussions about mobility in health care. Take a look at the conversations happening on Twitter and you'll observe how popular mHealth really is. Follow the hashtags #mHealth, #HealthIT, #HIT100, #apps, #healthapps, #digitalhealth, #hitsm, and #hcsm; and observe the 140 characters of tweets that soar at an accelerated rate through cyberspace offer fiery information. Paul Sonnier's Linkedin group Digital Health has over 11,000 members to date.

Not only is mHealth soaring through the social networking sites, U.S. revenue in the mHealth market earned $230 million is 2010 and it's estimated to reach $392 million in 2015, according to a news release by Frost and Sullivan. Globally, Reseach2Guidance reports that the mHealth market will reach $ 1.3 billion this year. Despite mHealth being in its infancy, the revenue projections are significant.

According to a 2011 press release statement from Juniper Research, the number of mobile healthcare and medical app downloads will reach 44 million this year and will reach 142 million globally by 2016.

Consumers are downloading apps to help them stay fit, track their pregnancies, monitor their moods, eat healthier, and sleep better. They are also downloading apps for chronic disease management. They can manage their prescriptions, have medication reminders, and monitor blood pressure and sugar levels. Consumers can be empowered to take charge of their health, but right now navigating the array of health apps can be confusing. Consumers lack guidance on choosing a safe, secure, medically sound health app. Trying to navigate the health app craze without direction can be painstakingly difficult.

Cleveland Clinic, Nike Fuel Band, American Red Cross, and Walgreens are known in the space, and consumers may find it easy to trust them and download apps associated with them. However, consumers may find it confusing to navigate the mHealth app world from companies that are off the radar. How do consumers know if the apps are safe and reliable?

Consumer Safety Is a Priority

The FDA is prudent on drafting guidelines for developers, but will it stifle innovation? "It may slow innovation, but I don't know that it stifles it. Regulations do create barriers to entry as they set a high bar. But in so doing, they also create significant economic opportunities for those who follow the appropriate processes and win regulatory approval," said Bill Crounse, M.D., Senior Director of Worldwide Health at Microsoft Corporation, in an email. "I do think thoughtful regulation is required in the health industry to protect consumers. This is certainly true related to pharmaceuticals and medical devices to protect consumers from harm."

"The primary role of the FDA is to insure consumer safety," notes Kvedar. "Mobile health has the potential to get out of hand if not regulated. For example, there is an app that based on self input of one's carbohydrate count; it will generate insulin dosing suggestions. Clearly this could be dangerous," he added. "While I don't think the FDA process will ever eventuate in a 'consumer report-like' or 'D Powers-like' rating, it will be a filter. If apps get through the filter, we should at least be comfortable that they are safe."

Aside from safety concerns, there are "two problems with health apps," said Kvedar. First, after downloading the app, it may be used once or twice and then it's forgotten, he said. "There's no engagement." Secondly, health apps can be prone to error because the data that is self-entered by consumers may not be true. It's a "social diversity bias problem," he said, because the data entered isn't honest and there is no meaningful engagement to help change consumers behavior. After downloading health apps with enthusiasm, the "shiny new toy isn't so shiny anymore," because there's "lack of interest and lack of engagement," said Kvedar.

Health apps need to be engaging and motivating and offer a coaching component.

"There's a short shelf life, don't expect it to change your life," he said.

Happtique, a mobile health application store and total app management solution released a draft of the standards that it will be using to certify medical, health, and fitness apps under Happtique's App Certification Program. The purpose of the program is to help users identify apps that meet high operability, privacy, and security standards and are based on reliable content.

David Lee Scher, M.D., a former cardiac electrophysiologist who is presently director at DLS Healthcare Consultants and senior medical advisor to Happtique, said in an email interview:

Happtique App Certification Program represents a major step in setting standards for safe and reliable health, fitness, and medical apps. Certification will assure users that the app meets security, usability, privacy, and content standards. Happtique has curated and categorized over 12,000 apps to date in over 300 categories.
Mobile technology has allowed consumers to receive information at lightning speed and gives consumers health and wellness apps that can help improve their health care. Mobile technology may help to transform the lives of patients and provide a stronger partnership with health care providers.

Bottom Line

Consumers need safe, reliable, trustworthy apps to help guide their health and wellness and help them manage their chronic diseases.

The health app world needs guidance. The vast assortment of apps to choose from makes it difficult for consumers to navigate. Which apps are reliable, trustworthy, and medically sound?

Joseph Kvedar, M.D., Justin Major and Carol Colman are actively involved in writing a series of books for consumers titled Wellocracy; it's the first in a series of books to help consumers navigate the ever-growing and dizzying array of health apps.

So, how do consumers navigate the crowded world of health apps? "Common sense rules," he said. If consumers think it's a "magic app," it probably isn't.

In this exciting world of health care where technology rules, one thing is for sure, technology will never replace the doctor/patient relationship (or health provider/patient relationship). Face-to-face communication with health care providers will always be paramount.

It doesn't seem as if there is too much hype -- just little guidance. The push to move the mHealth app world forward may be in the power of consumers to clamor for health and wellness apps that are safe, reliable and trustworthy, developed by companies who are not just those looking to "get rich quick," as Kvedar said.

Your Turn

We would love for you to share your thoughts in the comment section below. Do you download health apps? Do you feel guidance is needed to help navigate the enormous amount of health apps? What health apps do you use? As always, thank you for sharing your thoughts and for your valuable time.


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Healthcare Mobile Apps - It's not the Consumer but the Healthcare Providers That Need Them

Healthcare Mobile Apps - It's not the Consumer but the Healthcare Providers That Need Them | RMs Future of Healthcare | Scoop.it
A recent article at Healthcare Collective takes the position – in asking the question, “What’s the Matter with Mobile Health Apps Today?” - that most mobile healthcare apps aren’t used, at least not beyond an initial download and trial, after which the apps are discarded as quickly as they were downloaded. The article also noted that healthcare apps have appeared in record numbers of late – from just under 3,000 to just over 13,600 of them. Most of these apps focus on personal healthcare, and most of them are redundant in terms of what they do – some do certain things better than others, but most are destined for the delete bin.

At the 2012 Consumer Electronics Show (CES) held in January 2012 there was an entire exhibiter space dedicated to mobile healthcare. We noted a potentially useful collection of applications, especially some that appeared to us to do a rather good job of checking vitals and keeping track of them. As we roamed the aisles, it turned out that there was one exhibiter – UnitedHealth Group, a rather major name in the health insurance industry – that had a significant booth there. Why?

Nick Martin, vice president of innovation, research and development at UnitedHealth Group says, “At UnitedHealth we believe that we need to use mobility to create a tight bond with our policyholders. Users know how to put their mobile devices to work, and this provides us with a means to communicate closely with them. We engage our users through experiences and interactions that are typically fun for the user, but that ultimately lead us to teach our clients how they can achieve savings on medical costs. Our mobile apps are accessible anytime and anywhere, but more specifically, they give our users the freedom to engage with us when they want to.”

“In our case it isn’t simply about providing some sort of health app that substitute for such things as tracking blood pressure,” Martin continued. “In our case we are looking to specifically provide real financial and medical benefits. It becomes a differentiator for us – and as long as we provide real value, the users keep coming back and using the apps.”

For Martin, the apps aren’t simply a means to earn a few pennies on an app download. The use of mobile apps is a specific healthcare driver that aids in direct user engagement, and one that will continue to grow significantly, not just for UnitedHealth, but for its competitors as well. From this perspective mobile health apps are doing extremely well.

Doctors and Mobile Apps

The Ottawa Hospital in Ottawa, Ontario, Canada is an example of a healthcare provider that has deployed an iPad mobile app - not for consumers but for doctors. The app, a computerized physician order entry (CPOE) system, was deployed to more than 1,000 doctors. The goal Ottawa specifically had was to change the process that had evolved for doctors to gain information about patients – a process that involved keeping doctors glued to computers rather than keeping them out in the field, so to speak, where they could visit in meaningful ways in face to face conversations with their patients.

Once the doctors became mobile through the iPad and the CPOE app, there was an immediate, measureable and very positive impact in the doctor-patient relationship. Doctors were able to gain substantial valuable time back, time that was then devoted entirely to face-to-face patient visits on a daily basis. Patients were able to sense a difference in terms of the quality of engagement, and doctors were able to specifically hone in on what patients needed right at the point of their interactions.

Having iPads in hand, providing immediate patient information, vitals, and other valuable insights literally at their fingertips changed the doctor-patient relationship from a reactive to a proactive one. Proactive engagement, in turn, allowed patients – as well as other family members – to collaborate on medications, treatment alternatives and medical reviews. Ottawa Hospital officials say that engaged patients take a much stronger interest in their own treatments, a perhaps subtle but significant change that increases overall treatment benefits.

These are but two of numerous examples of where the real value in mobility is to be found in the healthcare industry. Whether engaging with an insurance company, a pharmacy or a doctor (or a nurse or an intern…you get the picture), mobility drives immediate engagement with caregivers. It is the immediate engagement between the caregiver and patient that makes the difference.

Other mobile app examples include those that provide secure, real time patient data – an extremely valuable service in the emergency room, those that monitor patients through their mobile devices, and those that communicate real time information – whether between doctor and patient, or doctor and doctor in consultative situations.

The bottom line is that consumer apps that do very simple things are of likely very little value – and simply not worth talking about. Those that aid doctors, emergency rooms, nurses, and so on, and those that drive better patient-health provider/doctor engagement or that monitor health from the perspectives described here, are the real mobile applications that matter in any discussion of mobile healthcare.

Tony Rizzo has spent over 25 years in high tech publishing and joins HealthTechZone after a stint as Editor in Chief of Mobile Enterprise Magazine, which followed a two year stretch on the mobile vendor side of the world. Tony also spent five years as the Director of Mobile Research for 451 Research. Before his jump into mobility Tony spent a year as a publishing consultant for CMP Media, and served as the Editor in Chief of Internet World, NetGuide and Network Computing. He was the founding Technical Editor of Microsoft Systems Journal.

Edited by Rachel Ramsey

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Approved: The First Swallowable Electronic Devices

Approved: The First Swallowable Electronic Devices | RMs Future of Healthcare | Scoop.it
No matter how fast pharmaceutical companies can churn out drugs to prevent or cure illnesses, health insurance doesn't cover the cost of hiring a person to follow you around and remind you to take your meds. So the FDA has approved a pill that can do it on its own by monitoring your insides and relaying the information back to a healthcare provider.

The pills, made by Proteus Digital Health, have sand-particle-sized silicon chips with small amounts of magnesium and copper on them. After they're swallowed, they generate voltage as they make contact with digestive juices. That signals a patch on the person's skin, which then relays a message to a mobile phone given to a healthcare provider. It's only been approved for use with placebos right now, but the company is hoping to get it approved for use with other drugs (which would be where it would get the most use).

Even if there's a slight whiff of dystopia about a pill that tracks your actions, it does help with a major problem. Patients aren't the best at taking their pills, especially those suffering from chronic illnesses, so it's one step of many toward a future where they don't have to.


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NeuroMetrix Sensus Diabetic Pain Management System

NeuroMetrix Sensus Diabetic Pain Management System | RMs Future of Healthcare | Scoop.it
NeuroMetrix out of Waltham, MA was cleared by the FDA to bring to the U.S. market its SENSUS transcutaneous electrical nerve stimulator that’s intended for use by diabetics to help manage chronic intractable pain. The SENSUS is attached to the patient’s upper calf and uses proprietary algorithms to generate an electric current that disrupts/modulates nerve pain signals from reaching the brain.

The company is expecting to launch the device later in the year.


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