This month's eNewsletter (funded by the UK's Department of Health) focuses on proposed changes to the commissioning of NHS services with lots of links to related documents; presentation slides from the Whole System Demonstrator Event in Newcastle, and a new WSDAN briefing paper Sustaining Innovation in Telehealth and Telecare. Newsletter PDF download (760Kb)

In contrast to last Friday's 'hash' of an article, the New York Times has not one, but two worthy articles on monitoring technologies.  For your weekend reading: 

•  'Technologies Help Adult Children Monitor Aging Parents' profiles real families using (in order) GrandCare's behavioral/telehealth/connectedness system (Trillium; see HomeBase debut below), MedMinder, QuietCare (via Selfhelp) and a relative newcomer, BeClose's sensor-based monitoring system. 
• 'The Technology for Monitoring Elderly Relatives' is an overview of well-known and some not so well known services, products and pricing: Lotsa Helping Hands, Philips Lifeline and their new Auto-Alert fall detection option, GrandCare, Ideal Life (to go DTC in early 2011), Philips' medication dispenser and GPS monitors (MobileHelp, ActiveCare).

This week, the Oakland CA based Center for Technology and Aging awarded five $100,000 grants for home-based care and disease management using telehealth to the Sharp Healthcare Foundation (reducing readmissions via home care),  New England Healthcare Institute (ExpressMD Electronic House Call), AltaMed Health Service/Stamford Hospital (Honeywell HomMed), Centura Health at Home (video telehealth, inLife and American Telemed) and the California Association for Health Services at Home (Intel Health Guide).  They are also eligible for a total of more than $1.7 million in matching funds from other sources.  FierceMobileHealthcare.

A follow up to our article on doctors and their iPhone apps [TA 20 July].  Dr. Neil Paul of Cheshire has already developed several iPhone apps (iCalcRisk cardiac risk calculator, iMCQ for medical students, A2Z of Dermatology), is IT head (naturally) of a 15 person practice and a full time GP.  What is he looking at next?  Using the motion detection capabilities (accelerometer, compass, gyroscope) of the iPhone for exercise therapy.  Canadian Healthcare Technology  [A hat tip to Neil Versel of FierceMobileHealthcare]

This past week, at the beginning of a two day conference on wireless medical technology, FCC Chairman Julius Genachowski and FDA Commissioner Margaret Hamburg signed a memorandum of understanding and released a joint statement of principles.  This rather vague set of 'good intentions' states that the FDA and the FCC should encourage investment, ensure device safety and streamline regulatory processes...and of course clarifying the agencies’ jurisdiction over wireless devices.  When it comes to government agencies, promotion does carry a price.  The Hill's 'Hillicon Valley'. 

Whither telecare?  At the cutting edge, it's more and more comprehensive.  In GrandCare's new HomeBase system, we see converging telecare, telehealth and even 'social connectedness' for older people at home.  Like its high-end Trillium system (depicted in the New York Times article above), HomeBase incorporates an interactive touch screen system for messaging, two-way video, calendar reminders, pictures, music, weather and news.  With a new OS (based on the Asus eee Top), the monitor is thinner and lighter, is wirelessly connected to broadband and includes a video camera.  It also incorporates telehealth services and monitoring from new partner VRI.  This partnership was aided by AgeTek, which is a cooperative alliance of products and services mainly from smaller companies in the eHealth-for-older-adults field.  The pricing is also targeted to the home market; while not inexpensive, it's considerably less than the Trillium and in the range of a higher-end computer setup (which in a sense it is) at $1995 (plus installation and monthly fee).  Release (PDF)

As more information on Telefónica's recent 'global e-health' announcement [here and here] is coming to light, the extent of its ambition to become the dominant e-health player in the countries in which it has networks is starting to sink in. Let's hope that as it progresses its plans Telefonica does not get so wedded to the technology of the 'big name' equipment providers that the lighter-on-their-feet small technology companies get squeezed out, and millions of users become saddled with clunky kit. If I ran one of those small companies I'd be knocking on Telefónica's door right now.

Most revealing item so far: an interview with Álvaro Fernández de Araoz of Telefónica in Global Telecoms Business. Read it carefully.

For a business analyst's take on Telefónica's interest in the market, read Charlie Davies of the Ovum consultancy. [Hat tip to MobiHealthNews]

• Claire Mitchell, Department of Health discussed The Fast Track Implementation Programme for Assistive Technologies
• Raffaella Somma, Lambeth Council who shared her Business Case Preparation for Telecare which outlined the steps involved in securing funding
• Carl Atkey, Head of CarelineUK and Technical lead for Cirrus, outlined the implications for telecare imposed by Next Generation Networks

There was also a discussion session run by Doug Miles, Chair of London Telecare, with questions and contributions from members. In  particular, the implications of BT having announced that it is abandoning its current plans for BT21CN [TA May 2010] were hotly debated...

We flagged up in February that changes were happening in the relationship between Age UK (ex Age Concern and Help the Aged - refresh your memory of the issues here) and Aid Call. Today's announcement that the telecare operation [not quite, see clarification below, Ed Steve] of Aid Call has been acquired by Tynetec is a welcome indication that more rationalisation of telecare services is, at last, on the way. With the new Government putting a tight squeeze on public service spending and operations, councils and other organisations that run small community alarm services will look at the case for outsourcing, but a healthy market for such services depends on having a number of independent suppliers that can achieve the required economies of scale. Tynetec press release with information on the acquisition (PDF)

CLARIFICATION UPDATE 29 July 2010: Tynetec has acquired Aid Call's Healthcare division, which includes its Nursecall systems. Age UK will continue to promote and operate its dispersed alarm monitoring business through its Personal Care Division. Tynetec will be integrating its range of telecare products the into the Nursecall systems.

Pointer to the future item alert:  We've had a backpack-sized brain scanner [TA 19 Jan], now here's where the sensors read your mind. At TEDGlobal 2010 earlier this month, a researcher named Tan Le developed for her company, Emotiv Systems, a headset costing only a few hundred dollars that can detect controllable brainwave changes to control the motion of virtual objects and electronics using visualization. According to the Emotiv website the use of this headset will be in gaming and EEG research. Droid Systems blog and video.

The latest battle for spectrum (the last in the US being non-digital TV) before the FCC (back in their other business) is now in the area of 'short range health devices' or BSN--body sensor networks to replace all those bedside cables.  According to GE Healthcare, the optimum spectrum for chip power management is the 2360 MHz to 2400 MHz frequency range.  However, Boeing uses that same range for flight testing; the two uses despite 2% overlap are not compatible.  Not helpful is that the GE spokesperson then in his comments includes home monitoring and the potential savings. Is this critical to the development of remote patient monitoring, or just some 'big boys' slugging it out?  You decide.  Bloomberg.com, 'GE Healthcare Path to Patient-Monitoring Boom Impeded by Boeing', a soberer backgrounder from Sep 2009's ComputerWorld.

In contrast to the thoughtful article by Dr. Miriam Stoppard that ran in the UK Daily Mirror a few days ago, this pastiche that appeared in the Newark (NJ) Star-Ledger/NJ.com is not only half-baked, but also furthers the poor reputation of healthcare technology as 'gadgets', 'bye and bye in the future' and (of course) violative of privacy.  By focusing on smart appliances

As many of our readers know, there are quite a few LinkedIn groups that have commentary and discussions on healthcare, mobile health, wireless health, connected health....with a liveliness unusual for any vertical.  This continues a discussion that started in the Health 2.0 group on the subject of healthcare apps--iPhone vs. Android.  Welcome Jeff Brandt to the Telecare Soapbox.

This interview with Barry Chaiken, M.D., chief medical officer of Imprivata network security and former chair of HIMSS, is unsettling for several reasons.  The first is about halfway down (after the vineyard chat)--smartphones solve the problem of having a physician's desktop roam wherever needed--but are a major security problem for personal health information and should be replaced by secure mobile devices--but the workflows need tons of clinician input, and that will take a while.   The other is that in his opinion, how doctors practice is predictable based on their medical school and residency, and not necessarily based on 'best practices' which is rather simplified as 'move in the clinical space where physicians and nurses and others are doing their skill set around pattern recognition and treating the patients. IT is the source of that. pattern recognition.'  That left this editor [Donna] and one commenter fairly nonplussed on this simplistic view  HIStalk interview.  (Hat tip to Paul Sonnier over at Wireless Health/LinkedIn.)

Here in the US, as EHRs begin implementation in stages for the 2015 deadline as stipulated in the HITECH Act (iHealthBeat, 13 July and more), Verizon debuts its health information exchange (HIE) to consolidate patient clinical data over the web and translate it into a standardized format.  This will facilitate interoperability between EHR systems that are used by participating providers.  Building out aspects of the system for Verizon are Oracle, MedVirginia and MedFX.  Release and link to podcast.

There's no news for Telecare Aware readers in the blog item Pioneering new NHS scheme to allow you to live from your own living room.. but it is significant that someone has briefed Dr Miriam Stoppard of the Mirror, one of the UK's most widely read popular health journalists, on telehealth. Nice one, whoever it was!

If you're a physician who loves your smartphone, you may have thought about developing your own iPhone medical app. Here are stories of  five doctors who did and their apps.  iPregnancy, KidneyCalc, NeuroMind and SafeSurgery are all best sellers and primarily for professionals.  Healthagen's iTriage (for iPhone and Android) was developed by two emergency room physicians and blends information on symptoms, diseases and medical procedures with a nationwide directory of every hospital, urgent care, retail clinic, pharmacy and physician to provide a symptom-to-provider pathway for its users.  Meridian Health's five hospitals in central New Jersey are promoting this as a free download for both residents and the area's summer vacationers.  A tale of 3 app developers (American Medical News). [Excellent list of most popular medical apps by platform and a 'how to' follows]  iTriage/Meridian Health release.

And Google has now made it possible for anyone - yes, anyone, including people who have never written software - to develop their own app for smartphones using the Android operating system. Start here.

From the fairly 'gee whiz' Armed with Science: the Defense Center for Excellence in Psychological Health (DCoE) has developed an iPhone app called iBreathe to train young soldiers, including veterans, in proper diaphragmatic breathing.  'iBreathe will provide video-based instruction that explains the body’s reaction to stressors and how belly breathing can reduce stress.'  iBreathe: A Mobile App for Stress Reduction

The U.S. Department of Health and Human Services (HHS) earlier this week issued final guidelines which will determine how doctors, hospitals and other medical care facilities can qualify for reimbursements under ARRA (federal stimulus funding) by adopting EHRs over the next four years.  This is being done in stages--the one of most concern is due in 2011.  Primary care physicians and hospitals that deploy EHRs and prove compliance with "meaningful use" standards (23 for hospitals, 25 for physicians) can receive up to $44,000 per doctor in reimbursement funds through Medicare and $63,750 under Medicaid beginning next year.  For hospitals, this is potentially millions.  Whither eHealth?  Possibly here: 'providing patient-specific educational resources for eligible providers and hospitals.'  864 pages of guidelines leave a lot for Bloomberg Business Week (which could not resist getting it wrong--EHRs are not widely understood as eHealth) and iHealthBeat to write about.

Two new programs test the premise that smartphones with web access, coupled with reduced monthly rates as long as the patients are in the program, will be effective in helping urban, low-income people better manage their diabetes.  In Washington, D.C., George Washington and Howard Universities are using NoMoreClipboard to create a trackable record that's readable by the patient, then feeds into a PHR.  In nearby Baltimore, the University of Maryland Medical School is testing a mobile system from Welldoc.  Will it be effective now--and after the incentives are over?  Previous and ongoing text programs--sunscreen reminders from Center for Connected Health [TA 4 Dec 2009], Mount Sinai (NY) medication reminders to pediatric liver transplant patients, UC San Diego for eating reminders related to weight loss--results have been mixed.  AP story.  FierceMobileHealthcare summary.

The New York Times has jumped into the robotic fray with a fairly sympathetic (and touching) look at the PARO 'harp seal' robot, along with a 'emotion' sensor based text messaging program for drug addicts, Autom (the 15" high diet coach robot)--and people who dress up their Roomba robotic vacuum cleaners.   Discovering a Soft Spot for Circuitry.

Now that Supra UK's series of launch events are complete, Telecare Aware can bring you the first picture of the new, police approved key safe: The Supra GE C500 KeySafe:

New features include a fold down front; more code combinations; more room for keys; more intuitive opening mechanism. Supra UK website.

The newspaper, Herald Scotland has a positive, all-round look at telecare and likes what it sees. So far so good, but this editor [Steve] has a problem with the leading example - a lady with epilepsy who has clearly been 'sold' on the benefits of her main telecare devices, a fall detector in a pendant and a bed sensor. Both are items that are notorious amongst services for generating false positive and false negative alerts. In the article she says she has lost count of the number of times they have been activated. This, it seems to me raises a real ethical issue: it is right that services should offer unreliable equipment to someone who relies on it so completely? Guardian angel gadgets.

Cypak, a technology developer based in Stockholm, and Meridian Health, a Neptune NJ-based non-profit healthcare provider, have announced what this editor [Donna] believes is the first-ever type of joint venture between two such organizations for healthcare.  iMPak Health’s first product is Health Journal for Pain:  a portable, lightweight wireless diary for recording pain levels before and after their prescribed medication regimen.  It uses Cypak’s Touch and Post technology, an implementation of Near Field Communication (NFC), a two-way technology based on RFID (see Cypak's release at Continua Summit.)  The recorded information downloads via cellphone or 'Smart Cable' reader (developed by Cypak and A&D Medical) to a back end monitoring system accessible by the physician or clinician.   Based on the release, Cypak's technology can also incorporate sensors; other product offerings will be targeted to diabetes, depression, weight management and asthma. Meridian Health release.

Robert N. Butler, M.D. died this week at 83. Beginning in the 1970s, his work was dedicated to rethinking aging and how we think of aging....not the technology, but our understanding of the process and most importantly, our attitudes. The many tributes and obituaries tell the story of his life and work far better than possible here.  What is surprising to this editor [Donna] is that Dr. Butler is not being acknowledged--even by his International Longevity Center--for his role in kickstarting the use of technology to support healthier aging and a better quality of life for older adults. It's only mildly speculative on my part that being a scientist, Dr. Butler saw a role for technology in helping to maintain health. The proof: he joined the medical advisory board of a New York-based startup, a pioneer in telecare. Certainly not for the money--it was unpaid.  But his name mattered a great deal in lending credibility to a then-fledgling Living Independently Group (QuietCare) [disclosure: my former company]. Farewell and thank you, Dr. Butler.  New York Times obituary, 'A last conversation' (NY Times), International Longevity Center tribute.

[Update 15 July:  Neil Versel's article in FierceMobileHealthcare confirms this last thought.  Dr. Butler's conversations with Eric Dishman and his visit to an Intel lab.]

The 2010 mHealth Summit will take place 8-10 November 2010 in Washington, D.C.  The conference is a partnership of the Foundation for the National Institutes of Health, the National Institutes of Health and the mHealth Alliance.  It will connect leaders in health, government, the private sector, academia and not-for-profit organizations to advance discussion and decision-making related to the intersection of mobile technology, health practice and research, and policy in the United States and abroad. 

• Only one week left on the Call for Presentations & Research Technology Demonstrations--the deadline is Friday 16 July.
• Early bird discount registration is available until 24 September, and further discounts are available for government and military registrants.

What would our week be without a forecast?  A new research report from Kalorama Information projects a 7% global growth from 2009 in handheld healthcare devices to $8.8 billion in 2010. The report looks at all handheld devices and makes forecasts for specific categories within healthcare. For example, patient monitoring products account for the largest share of sales and generated about $5.3 billion for 2009 with a market share of 64%.  Information Week

For those of us who were trying to keep up with the flying posts about the World Economic Forum's (WEF) recent mHealth 2010 Summit in San Diego over at LinkedIn's Wireless Health group, Neil Versel's commentary on FierceMobileHealthcare, and 'is it is or is it ain't transparent' debate (no press, limited public statements, Chatham House Rules, anyone?), here are most of the 'bits' in one place... 

In testimony before the House Subcommittee on Veterans' Affairs [TA 2 July], Col. Ronald Poropatich, M.D. of TATRC and US Army Medical Research gave a comprehensive report on their extensive eHealth initiatives:  mCare which delivers to the cell phones of over 300 wounded, recovering soldiers a minimum of six messages weekly comprising health tips, appointment reminders, and general announcements; Text4Baby [TA 4 Feb]; testing a cell phone video reminder system for soldiers with diabetes to improve compliance; and reviews of commercial systems such as the iPad, iPhone and iPod.  The US armed services and the VA remain the largest to-date users of eHealth and mHealth technologies. Information Week.

Shanghai, China September 8-10, 2010

This event may appeal to people (high-level executives only need apply) who want to do business in China and visit the World Expo. Three-day delegate fee US$1,700 ($1,500 until 20 July) Restricted refunds policy. Website for info.

London, 15–17 November 2010

The UK's premier annual event for networking and exhibiting to key people in the telecare and telehealth industry, organised by the Telecare Services Association (TSA). This is the one they attend, even if others are missed. Chaired by writer and broadcaster on health, Roy Lilley, this year's highlights will include:

When I [Editor Steve] began looking at the role of equity capital in companies, I started out feeling sympathy for company directors, like those of Tunstall, which run businesses saddled with large debts. However, I have learned a few things along the way and my sympathy has evaporated somewhat.

I've also concluded that I understand very little about the magical world of company finance, but I'll do my best to explain how I came to this conclusion after looking through two sets of Tunstall accounts for October 2008-September 2009 which recently become publicly available. [Note for US readers - although Tunstall is privately owned, its accounts are in the public domain.]

The first set of accounts, for Tunstall UK, gives a rosy picture. Profits of £28.7million before tax on turnover of £86.4million. However, Tunstall UK is just one part of the UK-based Tunstall Group, which made the astonishing — to me — loss of £84.1million on a worldwide turnover of £141.7million.

How was this loss achieved? And — this is where my accountancy friends tell me my lack of company finance understanding kicks in — how come a company in this position can still be a going concern? …

London, 2-3 March 2011

Heads-up for the International Congress on Telehealth and Telecare, 2 and 3 March 2011, organised by The King's Fund, London in partnership with the University of Utrecht Medical Centre. Themes include:

• Exclusive results from the UK's Whole System Demonstrator pilots
• Managing long-term chronic illness
• Improving independence, health and well-being
• Sustaining innovations in a cold financial climate
  

Baltimore, 26-28 September

This event combines the two-day American Telemedicine Association (ATA) Summit 2010, the 5th Annual Pediatric Telehealth Colloquium and an exhibition. Webpage for details here.

Camden is a council in North London with a population of 236,000. I hear that Camden has done good things on the telecare front...so why does their new one-minute advert for the telecare service concentrate on pendant alarms? Ah, the mysteries of councils' marketing and communications departments!

Not telecare, but this will interest a lot of Telecare Aware readers. RSLSteeper, a well-respected UK company in the assistive technology arena has started to show off its new, sensitive 'bionic' hand. BeBionic website. [It's a pity the site does not render well in Firefox browser.]

In the video below, see the visitor to an exhibition last month use the hand for the first time... and tie his shoelace. (About 3 mins in.)