Study: Smartphone-enabled dermatology is comparable, less comprehensive

By: Jonah Comstock | May 20, 2013        

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handyscopeA small validation study in Sweden suggests that teledermatology, conducted using an iPhone, a dedicated app, and a connected dermascope, can be roughly as effective as a face-to-face dermatology consultation.

The study of 69 lesions (the number of patients is not specified) was conducted at Sahlgrenska University Hospital in Sweden and published in the journal Dermatology Practical and Conceptual. The lead researcher, Dr. Alexander Borve, is also the founder of iDoc24, the app used in the study. Borve is an orthopedic surgeon, not a dermatologist, and was not involved in any of the diagnoses.

In the study, patients who came in for face to face dermatology consults first had their lesions photographed with the iPhone and connected dermoscope, a German-made device called a Handyscope by FotoFinder. (This device is not FDA-cleared but the company said it may register as Class I in the future.) The images were sent to two separate teledermatologists, whose diagnoses were compared with the face-to-face diagnosis.

The teledermatologists were comparable to the face-to-face dermatologist, but over all not as accurate. The in-person dermatologist diagnosed 46 of the 69 lesions accurately, a rate of 66.7 percent, while the teledermatologists accurately diagnosed 42 (60.9 percent) and 35 (50.7 percent), respectively. However, when researchers looked only at the classification of benign vs. malignant, accuracy went up considerably, with the in-person dermatologist at 87 percent accuracy and the teledermatologists at 75 and 79 percent respectively.

The study authors conclude that teledermatology could be useful as a screening device or a triage tool, with a clear implication that it is not sufficiently accurate to replace face-to-face dermatology. Borve told MobiHealthNews in an interview that the study also found that 10 to 15 percent of the time, the face-to-face doctor found an additional lesion that turned out to be dangerous in the course of a full body screening.

“It’s a good way to screen one mole, but it’s not a good way to screen a whole patient,” he said. “One thing you have to understand is, just taking a picture with your iPhone, we cannot diagnose from that, but we can screen it, give a probable diagnosis and treatment information and education.”

The study as conducted, with a $600 dermascope, doesn’t have clear indications for direct to patient, “store and forward” teledermatology. However, there are relevant consumer applications: In addition to iDoc24’s direct to consumer application, where users can pay $39.99 to anonymously submit pictures of skin lesions or moles and receive suggestions from dermatologists, the company offers iDoc24Pro to general practicioners who can use it for in-office consultations. And the startup is conducting a pilot where dermascopes are placed in pharmacies and patients can send off for their consultation in-store.

Borve said he’s working on a follow-up study with a much larger sample: around 900 patients. The study will include four dermatologists and 122 general practitioners. Preliminary results in the second study suggests that teledermatology triage can reduce the average time for diagnosis of a malignant melanoma from 46 days (the average with traditional paper referrals) to 14 days.

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Utah healthcare system inks deal for wristworn vital signs monitors

By: Jonah Comstock | May 20, 2013        

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visi-productsSotera Wireless, the San Diego-based in-hospital mobile wireless monitoring company that’s raised nearly $60 million from investors like Qualcomm and Intel, announced a deal with Utah-based healthcare system Intermountain Healthcare.

Back in March at HIMSS, Sotera announced it was piloting its ViSi Mobile wireless patient monitoring platform with two Intermountain hospitals, its flagship Intermountain Medical Center and LDS Hospital in Salt Lake City. This week’s announcement elevates that pilot to an official customer deal, and Intermountain’s executive vice president and chief financial officer Bert Zimmerli will join Sotera’s board of directors. Intermountain Healthcare is a nonprofit healthcare system with 22 hospitals and 185 clinics in Utah and Idaho.

As a clinical partner of Sotera, Intermountain will join Scripps Health, Palomar Pomerado Health, and NASA. According to Pomerado News, Palomar Pomerado became the first hospital to incorporate the ViSi Mobile system in February of this year. The system interfaces with Palomar Pomerado’s EHR system, as it will at Intermountain Hospitals, according to Sotera.

The ViSi Mobile system monitors blood pressure, heart rate or pulse rate, electrocardiogram (ECG) or heart rhythm, blood oxygenation level, respiration rate and skin temperature from a wearable sensor system with a wristworn screen. ViSi received FDA clearance for it’s full system in August 2012, after getting the monitoring device cleared in April 2012.

The company claims the system is as accurate as standard ICU devices, and it includes an alarm system that alerts physicians to sudden changes. Scripps Health cardiologist and unofficial digital health ambassador Dr. Eric Topol frequently uses the ViSi in his technology demonstrations, including his appearance on Comedy Central’s Colbert Report earlier this year.

Sotera Wireless raised $14.8 million this past February, bringing the company’s total funding to a little under $60 million. Among the company’s investors are Qualcomm Ventures, Intel Capital, and the West Health Investment Fund.

Hello Health launches patient-facing iPhone app

By: Jonah Comstock | May 20, 2013        

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hello health appMyca Health subsidiary and “patient platform management” company Hello Health has taken its emphasis on patient engagement mobile, with the company’s first iPhone app.

The app, called PortalConnect, enables patients whose physicians use the Hello Health EHR to update and access their own personal health record (PHR). Using the app, they can enter and review their medical information, send and receive secure messages from their doctors, revisit appointment notes, review and print lab results, and schedule appointments. Currently the app is available in both English and Spanish.

The Hello Health PortalConnect app was quietly added to the AppStore in January, but the company is only now publicizing the launch. Most of the features of the app were already available previously on Hello Health’s online patient portal. Some features of the online patient portal are free, but most require an annual subscription of around $17, with additional per-use fees for features like video visits. The app is free to download, but can’t be used without a Hello Health subscription.

Hello Health markets its patient portal to providers as a way to meet Meaningful Use guidelines for patient engagement with its’ EHRs. The company has raised $21.5 million, with $11.5 million coming in last November from First Generation Capital since its founding. Hello Health powers the employer clinic practices at Qualcomm and Apple among other large, self-insured employers.

Despite its ties to Apple, Hello Health says it will be releasing its app for Android as well in the future. The company also plans to release a provider-facing version of the app.

Mobile epilepsy sensors: student-led, stopped, or stalled

By: Jonah Comstock | May 17, 2013        

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The SMART belt (Photo by: Jeff Fitlow/Rice University)

Epilepsy is one medical condition where the constant monitoring capability of a wearable sensor could save lives, providing an early warning when a person with epilepsy has a seizure or even predicting seizures before they happen. Surprisingly, though, it hasn’t been an overly popular target for mobile health entrepreneurs. For developers working on this technology, getting to market has proved challenging for various reasons.

Affectiva’s Q-Sensor

Rosalind Picard, a professor at the MIT Media Lab, developed a wristworn sensor to provide an early warning system for children with epilepsy. The discovery was made by accident, when Picard and her team were using the wristbands to study emotional responses in children on the autism spectrum. They discovered that changes in galvanic skin response could predict the onset of seizures.

Picard co-founded sensor company Affectiva to commercialize some of her work with emotion sensing. The device Picard and her student Ming-Zher Poh developed was the basis for Affectiva’s Q-Sensor, a commercial device used in a number of epilepsy studies, including one at Boston Children’s Hospital.

As of last month, however, Affectiva stopped production of the Q-Sensor, saying they were now focusing on their Affdex facial expression analysis software “in response to strong and growing market demand.” Affdex is not a healthcare product, but instead targets its offering at advertisers, who could use expression analysis as part of next generation focus groups.

“Affectiva will discontinue the Q Sensor, as of April 30, 2013,” the company said in a press release. “The company will stop taking new device orders after this time, but is committed to supporting all existing customers until April 30, 2014.”

Picard is on a sabbatical from MIT and couldn’t be reached for comment, but based on her absence from the company’s team page, she appears to have split with the company she co-founded.

Rice University’s SMART Belt

A team of undergraduate students at Rice University in Texas has created a prototype belt that could potentially detect seizures in children with epilepsy. The belt detects changes in electrical conductivity in skin and respiration, both signs of an oncoming epileptic seizure, using electrodes that rest against the skin. A module on the belt can send a signal to a computer or smartphone via Bluetooth if it detects signs of a seizure.

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Affectiva's discontinued Q-sensor

The team, made up of Ethan Leng, Mihir Mongia, Charles Park, Tiffany Varughese and Andrew Wu, calls the system the SMART belt, for Seizure Monitoring and Response Transducer. The project was sponsored by Houston-based Cyberonics, which developed and markets an FDA-cleared therapy for refractory epilepsy.

The developers claim the device works better than a motion sensor, because they say it’s less likely to return false positives. It also works best at night, when there aren’t many external stimuli that can interfere with the sensor.

“Some of the existing things on the market are vibration monitors, microphones in beds that detect motion and sounds coming from people with epilepsy when they’re sleeping. But one flaw with this approach is that they weren’t able to detect non-convulsive seizures,” Wu told MobiHealthNews. “Using EEG, which is the clinical standard, is also very costly. We want to make ours slightly more affordable, so more people could have access to this sort of technology.”

Wu said the team has tested the prototype on healthy people mimicking seizure symptoms by being startled or hyperventilating, but the device still needs to be tested on people with epilepsy. Although the students who took on the project, all seniors, have just graduated, Cyberonics maintains the intellectual property for the belt and it’s likely that the recent graduates will continue to develop it with an eye toward commercialization. You can check out a video about the project here.

Wave Technology Group

Back in 2010, MobiHealthNews spoke with Wave Technology Group, a startup working on constant EEG monitoring via a smartphone for patients with epilepsy. In an interview this week, founder and CEO Sam Cinquegrani said the group has continued to work on the technology in the meantime, and the advancement of mobile devices has been very promising. Wave now has a working prototype, and he believes the technology could even be developed to the point where it could predict seizures before they happen.

Cinquegrani said the delay in getting to market is due to a lack of funding, which is in turn a consequence of regulatory and reimbursement uncertainty.

“Our biggest problem right now, and the reason things have slowed down tremendously, is the investment community is very scared of anything that looks like a medical device and anything that’s reliant on the current payment model,” he told MobiHealthNews. “Investors are saying ‘How are you going to get anyone to pay for it?’”

The company’s solution may be to move to a different regulatory and reimbursement environment entirely. They’re in discussions to take their monitoring product to New Zealand for pilot testing.

Tigerlabs Health launches first class of six startups

By: Jonah Comstock | May 16, 2013        

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CLUENine months after its launch announcement, Tigerlabs Health accelerator in Princeton, NJ has finally debuted its first class at a demo day event on Wednesday. The accelerator launched with a strong focus on it’s ties to the pharmaceutical industry, but the six startups it has assembled don’t seem overwhelmingly pharma-centric. The companies, from around the country and the world, received $20,000 in seed funding, mentorship, software, professional seminars and access to a co-working space.

None of the companies showcased at the demo day are participants in Tigerlabs’ recently announced Innovation Track, a partnership with Merck and New York Presbyterian Hospital. Those applications are still being accepted through July 2nd.

Here are the six companies in Tigerlabs Health’s first class.

CareTree

CareTree is creating an online portal for record keeping in senior and home care. The software helps caregivers keep track of medication adherence and reconciliation, and centralizes and stores documents and calendars. CareTree’s offering is HIPAA-compliant and secure. On their website, the company also pitches its software as a way for hospitals to help achieve Meaningful Use Stage 2, because the software can interface with EHR patient portals.

Clue

Clue is building an app for women to track fertility. The interface allows women to log factors like mood, pain, and menstruation on a calendar. The app from the Berlin-based company is currently in beta.

The DentBoard

The mission of DentBoard is to build an improved cloud-based software for managing dental practices. The business-intelligence software automatically pulls data from existing dental office software.

LifeVest

A portmanteau of “life” and “invest,” LifeVest is a consumer and employee health plan that incentivizes people to get and stay healthy by collecting money from them and sponsors from their friends and families. The money works like a stock — if a person meets their health goal, their investment appreciates; if they don’t, it goes down. WelTok CEO Jeff Margolis is an investor in the company.

New York City Technology in Medicine

The team at NYCTM saw an opportunity in the rise of needlessly high megapixel cameras in each successive generation of smartphones. According to a video on their website, they saw that increasing resolution as an opportunity to use the smartphone camera along with an algorithm to minutely track eye movement and pupil behavior, data which could lead to diagnosis and monitoring of multiple medical conditions.

PLoM.io

Paris-based PLoM stands for “Public Library of Models.” The company aims to leverage crowdsourcing to help with scientific research, including health-related studies.

Report: 56M sports, fitness monitors to ship in 2017

By: Jonah Comstock | May 16, 2013        

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Fitbit Flex__ColorsSports and fitness monitors, including wearable sensors and running and cycling computers, will hit 56.2 million global shipments in 2017, up from 43.8 million this year, according to IMS Research. Over the five years, the research firm predicts 252 million units will ship.

IMS Research’s sports and fitness monitor category includes “fitness and heart-rate monitors, sports and running computers, outdoor pursuit computers, cycle computers, activity monitors and pedometers,” according to a release from the firm.

The largest single segment of the market in 2012 was fitness and heart rate monitors that include a chest strap, accounting for 23 percent of the market, IMS said. As more easily wearable activity monitors like the Fitbit or Nike+ FuelBand eclipse chest straps, IMS predicts that will drop to 19 percent by 2017. Meanwhile, wrist and finger-based heart monitors will grow at a 9.5 percent compound annual growth rate through 2017.

IMS researchThe firm said that pedometers are currently the largest segment of the market on a per unit, rather than monetary basis. However as pedometers evolve into more sophisticated activity monitors, and smartphones evolve into pedometers, the firm expects pedometers to decline. Meanwhile, activity trackers will increase threefold over the next five years.

Last summer, IMS conducted a survey of 400 UK and US consumers that found 63 percent of smartphone owners who exercise at least once a week and are interested in sports and fitness apps were also prepared to buy a sports or fitness sensor.

A report from ABI Research that came out last January predicted 160 million shipments of wireless, wearable health sensors. They predicted that 60 percent of those sensors — or 96 million devices — would be fitness trackers.