Telecare Aware posts pointers to news items that have a broad range of interest. Authors of those items often use terms 'telecare' and telehealth' in inventive and ideosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:
• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently, and confidently, in their own home for longer.
• Telehealth: as in remote vital signs monitoring. This usually, but not exclusively, benefits patients with long term conditions.
Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.
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Editor Steve recently finished reading these two books and recommends them. The first, Klondike Playboy is an autobiography by John Boden, known in this industry as CEO of ElderIssues, Florida, and the second, Pitch Anything, by Oren Klaff is essential reading these days for anyone who has to sell new product ideas. Let's just say you won't want these techniques used against you!
And then, of course, there are the perpetual favourites that everyone in every equipment supplier company should read over and over again, by Geoffrey A Moore.
Spend 15 minutes with a cup of coffee and the video below to hear Dr Leslie Saxon sum up the present situation for remote monitoring of patients with heart implants and the case for, and current limitations on, mHealth generally. "It's a civil rights issue." Wow! It's better than many a two-day conference. Don't miss the anecdotes that start at 8mins 45secs. See this TEDMED page for biographical information on Dr Saxon.
Who invented the pendant alarm? When was the first telecare fridge monitor produced? Which company first sold a GPS tracker for people with dementia? Who first patented a system for asking health questions remotely?
Join in with our Telecare and Telehealth History Project and help us find and record the answers to these and many other questions! As the industry matures this list will become an invaluable resource.
Leave a suggestion for an addition or just ask a question in the comments and we will see if other readers can provide the answer - with proof!
In an interesting contribution to thoughts about the life of healthcare companies online, the introduction of an article by Farris Timimi of the Mayo Clinic says: "The biggest risk in health care social media is not participating in the conversation. Simply putting 'find me on Facebook' or 'follow me on Twitter' badges on your website does not equate with health care social media. Having noted this, among the most common concerns that seem to limit participation are those regarding professionalism. So let’s make this as easy as possible, with 12 words to light your way:
Don’t Lie, Don’t Pry
Don’t Cheat, Can’t Delete
Don’t Steal, Don’t Reveal"
The article, A 12-Word Social Media Policy, goes on to elaborate on those. Heads-up thanks to E-Patient Dave deBronkart, via a Facebook post.
The International Society for Telemedicine & eHealth (ISfTeH) is pleased to announce that the African Development Bank (AfDB) launched a competition for innovative and sustainable information and communication technology (ICT) solutions for the health sector in Africa. It aims to discover current work being done in the fields of eHealth and mHealth in Africa to provide added value through sharing of lessons learnt in eHealth and mHealth. The award is open to individuals, NGOs, development organizations, companies, academic institutions and research facilities. The deadline for submissions is 30 May 2012. Details in this PDF.
In an interesting move, the culmination of their somewhat under-the-radar development work in the past few years [TA May 2010 and March 2011], Bordeaux-based eDevice have now launched two versions of a 'fully configurable' device to sell to home health monitoring companies on a white label basis, it seems. "The HealthGO monitors are complete and customizable. They come with vital sign monitoring, USB and Bluetooth peripheral interfaces, embedded Blood Pressure monitor (optional on HealthGO+), touch-screen, embedded microphone and speaker, disease management possibilities, capability to display information, messages, weather or heath education tutorials. Both the firmware and the hardware of the HealthGO are customizable by the client. An API is available for in-house development of the client applications and graphical user interface and the casing can be modified to fit client requirements." Press release for more info.
BeatPanic is a small-time iPhone app to help people who have panic attacks to reduce their anxiety and it is getting rave reviews from its users. It's a pity the publishers do not yet have the resources to produce an Android version or even a decent website. Heads-up thanks to Gary Grainger.
A request for information from Tahir Idris, a consultant at TeleMagenta, which has been commissioned by the Housing LIN to write a viewpoint on how assistive technologies (AT) [definition has been deliberately left up to you] can play a greater part in supporting people to live well with dementia in extra care housing. He would be interested in hearing from you if you have experience of applying AT to aid people with dementia and carers. Have you established good practice and would you have any case studies you would be willing to share? What was discouraging? What would encourage you to use AT in future? Please email Tahir at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
.
A group at the University of Arkansas has come up with their own nanotextile/sensor e-bra (and e-undershirt for men). Similar to the Nuubo [TA 23 Sept], it has sensors smaller than a dime, the fabric has gold nano-electrodes fabricated on to a flexible base ('bendy' sensors!) They communicate with system software via a wireless module that snaps on to the bra and connects to a smartphone, including a GPS. Data monitored includes blood pressure, body temperature, full ECG, respiratory rate, oxygen consumption and some neural activity. Results from the sensor system have been published in the Journal of Nanotechnology in Engineering and Medicine. The sports bra that can tell your doctor if you're having a heart attack (and where to send the ambulance) (Daily Mail/UK)
The National Center for Telehealth and Technology, the primary Department of Defense area which applies technology to psychological health, has developed an intriguing Android app, Positive Activity Jackpot. To help returning combat veterans adjust to unstructured time and the civilian world, it uses a behavioral therapy called 'pleasant event scheduling.' From an extensive list of pre-programmed activities, the user selects activities and friends to accompany them from their contacts, or lets the phone randomly choose them by "pulling the lever" from the application's slot-machine screen. Mobile App Helps Troops Adjust to Life After Combat (Armed with Science)
For veterans who are recovering at home from injuries which make them dependent on caregivers, the VA will be piloting an iPad-based program called 'Clinic-In-Hand' starting in 2013. The apps will provide access to VA systems to allow the exchange of health-related data between the department, veterans and caregivers. 1,000 primary caregivers enrolled in VA's Comprehensive Assistance for Family Caregivers program will be randomly selected. VA to provide 1,000 iPads to family caregivers (NextGov)
Here in the US, hospitals (along with pharmacists, nurses and doctors) come out on top in terms of people's trust in healthcare. Health plans are way down at the bottom (along with lawyers and Congress in other surveys.) Vince Kuraitis flips the script in noting:
Hospitals are dragging their feet in connecting you with electronic health information (American Health Association in their 68 page objection to 'meaningful use'
Health plans are highly motivated to connect you with your health information (in surveys of plan executives, and moves towards a more retail model, patient experience programs)
So who is really leading in accountable care? Or have health plans found a way up and out of the 10-20% approval ditch? e-Care Management
Did you know that implanted medical devices generally do not have identification once used? What is more, once the FDA has approved devices, there is a lack of rigor in documenting and reviewing incidents in what's generally called 'adverse event reports'. While manufacturers are legally obligated to investigate death or injury related to their device, this can take months and often is fobbed off on the surgeon, hospital or patient. So if we in telehealth are seriously looking at implants, here is another situation not only to consider, but to be better than. How does the FDA monitor your medical implants? It doesn't, really (MSNBC.com)
One of the less featured uses of medical alert pendants--because it has a fear factor--is for personal security. This report from Marion, Ohio describes how a 93 year old woman, using her PERS pendant, and an alert dispatcher signaled police to an assault and home burglary. The assault was on her (she managed to press the pendant and announce an accident before being tied up), the dispatcher stayed on the line, quickly notified the police and could hear with excellent sound quality the two armed (with a BB gun) teens threatening to kill her and steal her car. Kudos to this gutsy lady (reportedly uninjured) and the savvy VRI dispatcher! Medical alert helps Marion police catch intruders
[The only PERS company Editor Donna is aware of, which has promoted PERS for personal security for some time to a younger older adult group and even to younger women living alone, is Life Alert. Could this, with a cool design and at the right price point, be a wholly new market?]
On the other side of the coin, our story of three months ago [Medical alert summoned police--with tragic consequences],where an agitated older US Marine veteran attacked police summoned by his PERS, has resolved with a Westchester County, NY grand jury saying the police were justified in tasering and killing Mr. Chamberlain. The audio recording taken by the monitoring company was a large part of the (perhaps equivocal) evidence.NY Daily News.
The 3ML organisers will find that seeking publicity is a two-edged sword. See the following article by the UK's populist newspaper the Daily Mail as it responds to 3ML publicity from Bosch and Tunstall with a good description of telehealth monitoring...but look how their readers respond in their comments! Apart from the two errors* in the item, it indicates what the 3ML campaign will be up against. Some readers might want to post a more balanced reaction. Would you trust this machine to act as your GP?
* The Bosch part of the item implies that 3ML is all about 3 million telehealth users and ignores telecare users, and Tunstall's UK & Ireland Managing Director Simon Arnold says "Telehealth staff are not medically trained..." That may be true of Tunstall Healthcare, but it is not true of all telehealth companies.
NHS Somerset has begun rolling out telehealth equipment to thousands of its patients as part of a scheme that will allow them to monitor long-term health conditions from home. As part of a three-year, £1.2m contract, 4,000 NHS patients with chronic obstructive pulmonary disease (COPD), heart disease and diabetes will be able to monitor their health and vital signs remotely. The scheme uses the system from Safe Patient Systems with touchscreen mobile phones programmed with personalised care plans. Each day the phones will prompt patients to answer key questions about their health and will automatically capture their vital physical signs. [Let's hope Safe Patient Systems has its Bosch patents portfolio base covered.] Telehealth has been used in Somerset for some time, but this is the first time mobile devices have been involved. Some patients have said they prefer using mobile phones instead of the previous Tunstall system which used a 'box' located in the living room, GP Dr Sarah Pearce told Guardian Government Computing: Telehealth on mobiles rolling out to thousands of patients in Somerset for more information.
Steve Wozniak, co-founder of Apple, keynoted last week's ATA with some surprising statements:
Artificial intelligence will make smartphones smarter than humans
Siri-Watson-type combinations will reduce doctors to technicians when it comes to diagnostics; artificial intelligence-fueled computer systems will run decision-support systems and "listen" to patients via voicerecognition
ClickCare, a 'virtual doctors' lounge' which lets doctors, specialists and patients collaborate via messaging and image sending online and on mobile (iClickCare), was singled out for praise by the self-admitted 'gadget guy.' However, the online version of ClickCare has been around since 1995! [TA 1 April]
In what is the first review of studies concerning text reminders on medications, a Netherlands research team found that SMS, audio/visual reminder devices and even pager reminders significantly improved medication adherence, at least in the short run (under 6 months.) According to the researchers, text messages seem to be easily integrated into daily life, and resolved the forgetfulness of patients. Unresolved was optimum frequency of messages. Abstract (Journal of the American Informatics Association). iHealthBeat article. FierceHealthIT article.
Implanted user interfaces, which is what chips in your arm or chest are formally called, can be used for alerting, recharging and reprogramming of existing implanted devices such as pacemakers without wireless transmissions, which can be hacked. On the other hand, Bluetooth transmissions from the chips could prompt a smartphone or other wireless hub to message a care manager or physician. Early research seems promising. Autodesk Research in Toronto and the University of Toronto will present a paper on their findings at the upcoming Association of Computing Machinery conference in Austin, Texas. Perhaps it's just Ed. Donna, but implanted chips are way beyond Proteus Biomedical's microchipped pills on the creepy scale. And another thing that will send airport security into a tizzy. Information Week.
The iPhone has proven itself to be wonderfully adaptable for apps that aid blind and vision impaired people in such necessities of life as identifying currency bills (LookTel Money Reader), Sendero (audible GPS locator), speech texting (HeyTell), HopStop (transit point to point directions), VizWiz (clothing color) and books (Audible). Built in is accessibility that audibly guides navigation of the touch screen. And those who are blind and visually impaired are designing even more apps. It's not much of a leap to imagine these in wider distribution for older people with vision or cognitive impairments, and for younger adults with TBI or post-stroke. How the blind are reinventing the iPhone (The Atlantic).
Those innovative people at The Carephone [previous TA items] look like they are about to do it again with a shoe with a GPS tracking device embedded in the heel and with conductive charging so that it never needs to be charged by plugging it in.
This prototype was demonstrated earlier this week at the Naidex exhibition and apparently met with an enthusiastic reception from visitors.
They would also appreciate comments and observations from Telecare Aware readers, since you are among the first in the industry to hear about it.
It's tough out there, and despite the push to reduce readmissions and for healthier patients, likely to get tougher. What is not sorted out is the old 4BQ* and the new 4BCQ**. Two panels at ATA dissected financing for telehealth and telemedicine. 'Paying for Telemedicine' came to the unsurprising conclusion that the US can't wait for the government to reimburse (ahem); it has to add value that customers (patients) will pay for. ACOs will spur this because underlying the model is sharing of risk. The second discussion concerned what VCs look for in health technologies (see 4BCQ) along with markets which exceed $500 million (seeking a big payoff, niche market products need not apply) and already successful entrepreneurs. Telemedicine financing takes center stage at ATA (Healthcare Finance News)
* 4BQ--Ed. Donna's Four Big Questions: who pays, how much, who looks at the data, who takes action on the data
**4BCQ--Citing Jack Young of Qualcomm Ventures at 'Financing Telemedicine' ATA 2012. From here on in, we will credit Mr. Young and call them the Four Big Cost (and Care) Questions or 4BCQ. From the article, "When seeking investment dollars, healthcare entrepreneurs should be able to explain how their product or service will benefit payers, patients, doctors and device makers." He goes on to specify the key benefits for each: "how will it reduce costs (payers), improve care (doctors), create convenience (patients) and drive revenue (device makers)."
The difference: 4BQ is operational and revenue stream--fairly basic stuff, but if this box isn't ticked with assurance, you don't have a product that can go to market. 4BCQ is broader and more complex; it needs to be answered by any eHealth enterprise in their business model to go for financing beyond the FFF level. The benefits do cross--payers do care about care improvement (because of NCQA published quality standards), and costs are controlled in care models such as PCMH and ACO--but here is a start.
Honeywell HomMed’s Genesis Touch: More item on Honeywell's latest product which "offers enhanced mobility so users can manage their healthcare wherever they are and thanks to tamper-proof interfaces, it provides a smooth, safe and secure experience for the user. With the tablet based on an open development platform, it also allows third-parties to continue to expand the application and service offering." Press release.
American Well Online Care Suite 6.0: 'Telehealth' as in defined more broadly than, but including, remote monitoring. Doesn't it sound like they are using the Genesis Touch? Press release.
Numera Introduces New Personal Health Home Hub: "No computer required, HealthPort offers a low cost personal health gateway supporting a broad range of wireless and "direct to cloud" telehealth. HealthPort will provide telehealth connectivity for virtually any patient, transmitting personal health information through cellular networks, home broadband, digital or analog phone lines." Press release.
Microsoft tests 'smart home' waters with HomeOS: "HomeOS is designed to provide a central hub through which various household devices can be controlled...Microsoft is seeking to overcome the problem of getting various, currently incompatible devices to communicate with each other." GizMag item.
At ATA, AT&T and VRI announced that they would jointly develop a home health platform over the AT&T wireless network. Alerts based on VRI's proprietary software will be monitored by their nurse case managers and marketed by AT&T's ForHealth unit starting 3Q 2012. According to the eWeek article, AT&T will sell VRI's services and hardware (e.g. blood pressure cuffs, weight scales, pulse oximeters) and manage enterprise billing and customer support. Earlier reports have ForHealth systems being sold in AT&T wireless stores. According to Eleanor Chye, AT&T is developing middleware so that population reporting can be generated from VRI and other AT&T mobile-health data platforms. The express purpose is to reduce readmissions and better manage chronic conditions. Article.
Following Dr Lance Forbat's Soapbox item yesterday I (editor Steve) had a look at his Facebook Page, only to discover an excellent testimonial from a patient to the benefits of using telehealth - in this case the Doc@Home system - to be able to be monitored from abroad. "The heart monitor fitted around our lives rather than having to fit around the monitor." To read the full testimonial, follow the Facebook link above, scroll down and click on the scanned image to enlarge it.I thought it was good enough to 'like' and 'share'. Perhaps you will too.
Independent consultant cardiologist Dr Lance Forbat, whose work using telehealth monitoring Telecare Aware has reported a number of times, responds to the recent headline on the Mayo Clinic study that telehealth monitoring appeared to treble death rates and points out that in comparing monitoring people at home with and without telehealth monitoring they were not comparing like-for-like.
If I do a twice daily ward round on my patients and look at the physiological signs recorded by the nurse and take a history, possibly pick up on unnoticed issues that my years of experience detect, I would like to think I make an impact on the outcome of patients' illnesses as well as their sense of well being...
Neil Versel, in mobihealthnews, picks up on the 'trebles death rate' story. Study raises questions about home health monitoring. Neil is always worth reading (although his admission that he is unaware of falls detectors having a high rate of false positives is rather surprising) but his item has also attracted some thoughtful discussion in the form of comments from people with a high profile in the field in the US. Telecare Aware readers might want to join in.
Guy Dewsbury, in his blog, sounds an alarm bell on what he sees as an increasing (and worrying) trend: the idea that ticking boxes as part of an assessment for social care needs can lead to appropriate 'prescriptions' for telecare devices and services. Tick Box Telecare - its coming to you...
The UK's Design Council has announced five ideas ('solutions') for helping people with dementia that it has chosen to feature in one of its 'innovation stimulating design challenges'. They include:
Trading Times, an online service for carers.
Grouple, a secure, private online social network.
buddi wristband personal alarm that will be familiar to many TA readers.
ode, a fragrance-release system designed to stimulate appetit.
Dementia Dog, a service providing assistance dogs.
They have recieved wide coverage in the media focusing on different aspects that caught the journalists' attention. ode seems to have been particularly popular, e.g. this item in The Telegraph. And here's the Design Council's original announcement (currently throwing up an error) and Community Care's take which includes a couple of videos.
In February we reported that Waldo Networks was one of three companies being sued by Bosch Healthcare in order to protect its portfolio of patents in the telehealth (remote monitoring) arena. It looks as if, like a number of other companies, Waldo has realised that they are on difficult ground and it is more cost effective to reach an agreement with Bosch. This enables both to put a positive spin on the development in the press release Waldo Health Licenses Bosch Telehealth Patent Portfolio.
A reminder that telehealth remote monitoring has a longer history than many people now jumping on the bandwaggon suppose: Frasier's father Martin is having his blood pressure monitored at random over 48 hours and the data is being transferred to, and monitored at, his doctor's office. From the 201st episode, Sharing Kirby, first broadcast over 10 years ago: November 20th, 2001. (2 minuite extract: Click to play.)
