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Does automation sacrifice patient empowerment?
 Wireless biometric sensors, connected health devices, mobile phones and online portals hold the promise of automating the management of chronic diseases. Some service providers, however, aim to do no such thing.
If you truly automate the process of measuring a patient’s blood pressure, for example, do you miss the key opportunity to engage that patient in their care regimen? If a chronic condition is automatically monitored wirelessly from a smart bandaid, will the patient have a convenient way to review that information or does the automation itself remove the ideal window for the patient’s review?
Zume Life founder Rajiv Mehta thinks automation does just that. We cannot remove the patient from this process, Mehta told mobihealthnews during a reception at the Wireless Life-Sciences Alliance here in La Jolla, California. If a patient is experiencing abnormal biometrics, like a higher A1c, then the service should give them a chance to explain why they think that may be, Mehta explained.
Others disagree that automation sacrifices patient empowerment and discourage having patients manually entering biometric data at all costs.
Scripps Health’s Dr. Eric Topol, who is also Chief Medical Officer of the West Wireless Health Institute, agrees that wireless health services need to get the biometric data in front of the patient to encourage patient empowerment, but “we don’t want to rely on individuals to manually enter anything,” Topol told mobihealthnews in a recent interview, “because it just doesn’t get done efficiently.”
That said, sometimes automation is really the best and only choice — a person monitoring sleep apnea can’t very well manually enter apnea episodes, because they are sleeping, Topol noted.
DiabetesMine’s Amy Tenderich pointed the audience at the Health 2.0 event in Boston last month to another benefit of automation — a wireless health service that is completely automated does not remind a person (all throughout the day, in some cases) that they have a chronic disease. Automation may allows them to focus on other aspects of their daily lives while ensuring that the data is still being captured for review later.
Clearly the balance between automation of data collection and ensuring patient engagement is a tension that the wireless health industry will continue to prod and tweak. What do you think — is automation always key? Is the point of data capture really the best time to engage users?
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Dr. Topol: EMRs remind me of the Tower of Babel
mobihealthnews had a chance to sit down with Scripps Health’s Dr. Eric Topol, who is also Chief Medical Officer of the recently founded West Wireless Health Institute, on the sidelines of the Wireless Life-Sciences Alliance meeting here in La Jolla, California. Topol explained why he disagrees with Gartner analyst Wes Rishel, why EMRs are like the story of the Tower of Babel, how PHRs aren’t much better and why the Obama Administration needs to learn about the revolutionary potential of wireless sensors today.
mobihealthnews recently wrote a commentary on a story that quotes Gartner analyst Wes Rishel as saying that technologies like the heart sensor patch that you demonstrated at the CTIA conference are “incremental advances” and that the the real revolution in health care IT will likely come from increased deployments of electronic medical records systems and the resulting improvements in data-sharing among organizations. Any response to that?
I certainly respect his opinion — and I don’t know him — but I couldn’t disagree more. On the one hand, electronic medical records and getting health IT systems to share medical record information is the most formidable challenge of all. But on the other hand, all of these exciting wireless healthcare technologies can be siloed in their development — they don’t depend on EMRs to be successful. In fact, most of these wireless sensors work perfectly well without any electronic medical record at all. (Read on…)
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Google Health: Future of healthcare is mobile
In the past few months we have given Google Health a hard time for not bringing more functionality from their PHR onto the mobile platform, indeed, there was a time we noted Google Health’s mobile strategy was allowing users to print out a copy of their health information and keep it in their wallet. (Seriously.) After a short interview with Google Health Product Manager Roni Zeiger, however, it’s clear that mobile phones, connected devices and mHealth applications will become a crucial part of Google’s health plans moving forward. Zeiger hinted at undisclosed mHealth partnerships and better mobile accessibility for Google Health users, and while Zeiger was short on details, we look forward to Google Health’s arrival in the mHealth space.
mobihealthnews: In general, what’s your take on connected personal health devices — like wireless-enabled blood glucose monitors — or mobile health devices. Are these solutions looking for a problem or do they really have value?
Zeiger: I think that mobile devices in the world of healthcare, including consumer healthcare, will actually play a central role. So to answer your question directly, they will absolutely play an important part in the future of this space.
mobihealthnews: Many of these connected devices or mobile applications have their own online portals. My first question for them is why not partner with HealthVault or Google Health — users aren’t going to want to have to log into a number of different portals. That gets to the PHR as “platform”. Microsoft has said outright that HealthVault is not a PHR, it’s a platform. What about Google Health?
Zeiger: Absolutely, so Google Health is a platform without a doubt. We have a well-documented and easy to use API. We also have a user facing application that sits on top of that platform. A key part of the value of Google Health is that users can not only use the application, but also connect the application to a variety of other sources, whether importing data from a hospital, pharmacy, lab company or sharing with a family member or even connecting with a service like the Heart Attack Risk Calculator from the American Heart Association. All of those iterations are possible because Google Health is, indeed, a platform.
mobihealthnews: Right, so the portability of the data seems to be the key theme for Google Health — but if it’s portable, then why not make it mobile? Why hasn’t there been a push on Google’s part to really mobilize this data and make it easily accessible from mobile phones. I know one partner, Anvita Health, has made Google Health viewable from Android phones, and there is at least one independent iPhone developer who made a Google Health reader for that phone, but again, that’s just a reader. Why hasn’t Google Health stepped in yet to make a mobile application? (Read More)
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“Meaningful use” to include connected devices?
As is well known by now, part of the federal stimulus package included $19 billion for electronic medical records (EMR) implementation — and part of those billions include incentives for physicians and hospital groups that implement EMRs by various deadlines. Of course, the implementation also has to meet a criteria referred to as “meaningful use,” however, the legislation purposefully left out just what “meaningful use” meant.
In the past few weeks, health IT thought leaders have sketched out their own takes on what meaningful use should mean, but only the most recent opinion piece includes an analysis that suggests connected devices and smartphones may have a place in that definition.
Dave deBronkart, also known as ePatientDave, has written an eloquent post on the ongoing debate as to what “meaningful use” should mean for EMR implementation. One of deBronkart’s central points is: “The systems we design today will be in use a long time from now, so I suggest we look at the world as it will be in 2020, and how we’ll be using these systems then.”
deBronkart goes on to emphasize that everything and everyone will be ten years older — you, your parents, your children — and even the Internet will have ten more years of innovation behind it. Our oldest doctors today will be retired or deceased by then, and doctors like Fast Company’s “Doctor of the Future” Jay Parkinson (of Hello Health) will be middle-aged, he writes.
“Handheld computers (smartphones) will be ten years more advanced,” deBronkart writes. “(More advanced? Heck, the iPhone was only introduced 28 months ago.) Connected e-health devices will be out of their infancy: WiFi blood pressure monitors, bathroom scales, glucose monitors, you name it. It’s fairly certain that by then we’ll be able to use cheap devices that send routine data to some central storage place, where smart software (your choice of smart software) can send out alarms or reminders, your care team can view it … and you should be able to view it, too. And make notes on it.”
Predicting the future is no easy task, and deBronkart does a nice job of only hinting at the vision of a more connected health environment in 2020, but decisions makers at ARRA need to decide now whether and (then how) technologies like connected devices should be included as part of the definition for meaningful use.
Read more of deBrankart’s excellent article over at ePatients.net
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CTIA: All wireless carriers want mHealth
“We took a run at this five years ago and it fizzled out pretty quick,” explained Rob Mesirow, Vice President of CTIA, the international association for the wireless industry. “Quite frankly, it just wasn’t the time, the stars weren’t aligned, wireless data networks weren’t robust enough and medical data wasn’t there.”
“Now, the next generation of doctors, who are more comfortable with health IT technology along with stronger mandates from the federal level and robust carrier networks are coming together,” Mesirow explained during an interview at the Wireless Life-Sciences Alliance meeting in La Jolla, California. “Everyone agrees that healthcare industry is inefficient — and that’s putting it lightly.”
CTIA’s wireless health initiative really kicked off at its most recent event in Las Vegas last month, but the association plans on hosting events in Washington D.C. and bringing Gary West and Dr. Eric Topol from the West Wireless Health Institute to discuss wireless healthcare with policy makers on the Hill.
Mesirow said that wireless health services are of great interest to wireless carriers: “When I specifically asked the carriers which verticals should [CTIA] be focusing on, carriers have unanimously said that healthcare is one we should go for.” This is “exactly the kind of deployment carriers are looking for,” Mesirow said, since it includes heavy data usage and subsequent data revenues.
(Read more…)
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MedApps connects to Microsoft HealthVault
MedApps has inked a deal with Microsoft to connect its wireless remote monitoring HealthPAL device with Microsoft’s HealthVault personal health record. The deal reinforces HealthVault as a platform for connected device makers and remote monitoring applications to connect to and deposit patients’ health information. MedApps will officially connect to HealthVault tomorrow.
MedApps describes HealthPAL as a solution “that eliminates the need for expensive specialized equipment, smart phones, hard-wired monitoring systems or even computer access in order for individuals to upload medical device readings to their Microsoft HealthVault account.”
The HealthPAL device is “about the size of a cell-phone” and “its low cost enables remote monitoring to be available to large patient populations.” MedApps explains that while it has some buttons for special features and set-up, the reading and data transmissions are automated: “The patient does not push any buttons, navigate any screen commands or touch the HealthPAL in any fashion.”
According to the company site, HealthPAL is approved for use with glucose meters, but the company is working toward approval for the recording and transmitting of data from weight scales, blood pressure monitors, INR monitors, ECG, Pulse Ox, CPAP, spirometers and O2 concentrators.
“Microsoft views wireless monitoring as an important tool for individuals managing their health,” Bert Van Hoof, director of partner development, Microsoft’s Health Solutions Group, said in a press release. ”We see MedApps HealthPAL as a valuable and synergistic extension to the vibrant HealthVault ecosystem of over 50 health and fitness devices already connected through Windows and HealthVault Connection Center.” (Read More…)
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Kaiser: Where’s the doctor-patient in mHealth?
“I think what’s missing from a lot of these mobile [health] demos is the patient-doctor interaction,” Kaiser Permanente’s Ted Eytan said during an interview on the sidelines of the Health 2.0 conference earlier this month. “If my doctor recommended a mobile service and said, ‘Hey, I’ve looked at this and I think it would be useful,’ then I’d be more likely to use it.”
As we have noted in the past, Kaiser Permanente recently announced plans to roll out a nationwide text messaging appointment reminder option for its patients and has also surpassed 3 million users of its online personal health record. Of course, the mobile platform offers much more than convenient appointment reminders, but Eytan said Kaiser has no plans to push tech for tech’s sake.
The most successful mHealth services will be the ones that leverage text messaging technology, Eytan explained, but developers of these services still need to work hard to make them easy to use. Just because SMS is a straightforward service, doesn’t mean applications built on top of it will be. Eytan gave up on using Google’s SMS query service because he found it too difficult to use.
“The thing about SMS, though, is that it’s common to everyone,” Eytan said. “A lot of these iPhone services are too complicated, maybe there are some easier to use apps out there, but, overall, the key will be using SMS to push and pull health data and information.”
During a panel session at Health 2.0 that Eytan was a part of, DiabetesMine founder Amy Tenderich noted that mobile phone based applications are a lot easier to use than desktop ones if the app requires users to keep a log or take frequent notes throughout the day. One important caveat that Tenderich made was that few people with chronic conditions want to be reminded that they have the condition all throughout the day — these services need to be more seamless.
“I agree that mobile is perfect for when you are out and about,” Eytan told me during the interview following the panel session. “It comes back to getting that information in a useful way — right when you need it. What Kaiser Permanente is very good at is taking really large systems and making them very accessible and flexible, which is something a lot of Health 2.0 companies can’t do as well. We watch some of the mobile [health] demos going on and try to take what we can learn from them and apply it to our own system,” Eytan continued, “but our goal, of course, is always to improve the interaction between patient and doctor in order to improve medical care.”
For more of Eytan’s thoughts on healthcare innovation, check out his personal blog here.
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Citrix: Cerner, McKesson now on iPhone
Big news for hospitals and other care facilities that are currently using Citrix XenApp infrastructure to deliver Windows applications, but whose staff wants to use iPhones at work too — Citrix just unveiled the Citrix Receiver for iPhone. Now iPhone and iTouch users can download the Citrix app and access any of their facility’s Windows applications, so users can open documents, update reports, approve expenses, join a webinar and more.
Citrix announced the launch of the Receiver app earlier last week at its Citrix Synergy conference in Las Vegas on May 5. The app is available for free from Apple’s iTunes store.
Citrix offers up Cerner and McKesson as two companies whose applications will now be available to iPhone users thanks to the Citrix Receiver app:
“Simply install, login, and work,” the Citrix product page explains, “Citrix Receiver gives you instant, real-time access to Windows apps and docs hosted in your corporate XenApp environment. Work with apps from companies like Cerner, McKesson, Microsoft, Oracle and SAP whether you’re in an airport, at the doctor’s office or in a meeting.”
Of course, the first concern for many hospital CIOs will be this solution’s security. According to Citrix, “with Citrix Receiver, only keyboard input, screen gestures and screen updates traverse the network. This means that data, like e-mail and intellectual property, remains safe and secure on your company network and never gets sent to or stored on your iPhone.”
For more, visit the Citrix Receiver product page here.
Be sure to read eWeek’s product review of the Citrix Receiver here.
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FDA’s budget increase and mHealth regulation
The U.S. Food and Drug Administration (FDA) announced today that it is requesting a budget of $3.2 billion, which represents a 19 percent increase over the current FDA fiscal year budget. Given the recent buzz over the FDA’s intent to take a closer look at health and medical applications for the iPhone, we wonder if any of fraction of these billions will go toward sharpening the FDA’s ability to regulate the exploding app market.
In early February, Don Witters from the FDA’s Center for Devices and Radiological Health announced that he wanted to begin a dialog with the mHealth industry to establish clear pathways and regulations that ensure wireless quality of service, coexistence with other medical systems, data integrity, security and electromagnetic compatibility. Witters said his goal was safe, secure and reliable deployments of wireless technology in healthcare. During a Q&A period Witters asserted that in some cases where an iPhone was part of an mHealth service, it should be regulated as part of that system.
Here are two areas of the FDA’s proposed budget that may have some bearing on mHealth services:
The increases include $166.4 million for a “Safer Medical Products” initiative that will provide targeted resources to improve the safety of human and animal drugs, medical devices, vaccines, blood and other medical products. The initiative “will allow the FDA to strengthen safety and security of the supply chain for medical products.” So, they’re gearing up on resources to better understand new advances in the categories listed above — mobile apps could be “other medical products”.
Another $74.4 million will come from “Current Law User Fees,” which will lead to increases for fees that support FDA review of applications for new human drugs, animal drugs and medical devices. So, it’ll cost more to get approval.
For more, check out the FDA’s press release on the budget increase request.
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WebMD to launch CME iPhone app soon
WebMD plans on launching a Medscape iPhone application during the last week of May or in early June, according to a report over at Medical Marketing & Media that cites a WebMD spokesperson. WebMD already has a free iPhone app for symptom navigation.
The Medscape app will feature a drug reference database and drug interaction checker along with Medscape’s specialty-focused professional news. As expected, Medscape continuing medical education (CME) resources will be available as well and these mobile CME credits will be tracked by the app.
On the CME front, WebMD will be facing competition from XM radio station ReachMD, which launched its own CME iPhone app last fall. We caught up with ReachMD earlier this year to discuss their application and other plans for the iPhone.
“The popularity of our iPhone app was astonishing to us,” ReachMD’s CEO Gary Epstein told us last month. “50,000 people registered for ReachMD after downloading the application on their iPhone to begin using this CME. We have been listed in the top ranks of free iPhone applications in the medical category. In fact, of the 400 or 500 ratings from users in the App Store, the only real complaint so far is that certain doctors want more content that’s relevant to their specialty. The approval process to get content on the air the problem, but we already have 35 new shows in the pipeline and every week 12 more hours of new programming goes up to the satellite,” Epstein explained.
This month, ReachMD expects to have another iPhone app on the market that enables access to all of its XM Satellite Radio station’s content, not just the CME content. During the week ReachMD broadcasts talk radio style conversations about news and trends of interest to the medical industry. This content typically takes the format of doctors discussing issues with doctors, which the company describes as easy listening for physicians.
For more on WebMD’s Medscape app, check out this post over at MM&M.
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Connected inhaler for compliance reminders
Cambridge Consultants’ wireless medical device interoperability system, Vena is gearing up to unveil a connected asthma inhaler prototype at the Respiratory Drug Delivery Europe event in Portugal this month, according to a report over at MedGadget.
The device aims to offer patients a direct link to doctors and online applications to help them improve compliance and improve treatment. As you would expect, the inhaler can be programmed to remind users when to take their treatment and can then automatically record its use so caregivers can remotely monitor the patient’s compliance through an online portal or alerts.The connected inhaler can connect via Bluetooth to a nearby personal computer or smart phone to an online personal healthcare application, and can remind the patient to take their treatment and send compliance information to the relevant personal healthcare portal.
Interestingly, the company also suggests that “non-patient-specific data from a population of users can also be aggregated to provide medical researchers, insurance providers and even policy makers with information to better evaluate a therapy’s efficacy… Pharmaceutical companies with new therapies in Phase IV trials can directly access usage data to demonstrate and document compliance, correlating ongoing use with improved outcomes,” the company’s press release states.
For more, check out Cambridge Consultants’ press release.
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Wound care via Windows Mobile phones
Microsoft’s Senior Director of Worldwide Health Bill Crounse posted an article this week on his HealthBlog about the Wound Technology Network, which is a nationwide physician network that uses Windows Mobile-based phones for remote wound care.
“Every clinician understands the challenges associated with wound care,” Crounse writes. “The process is slow, time-consuming, complex, and expensive. Non-healing, ulcerations and wounds are associated with a variety of chronic conditions including diabetes, peripheral vascular disease and stasis. Non-healing wounds are also associated with immobility due to aging, injury, paralysis, or other co-morbid conditions. Many of these patients end up being hospitalized to treat secondary infections, or to provide the intensive regime needed to heal chronic ulcerations or wounds. Hospitalization itself is risky as it exposes these susceptible patients to dangers they might not otherwise Windows Mobile-powered WTNencounter in their home environment such as MRSA.”
WTN’s Windows Mobile phones help the caregivers capture information via the phone’s camera at the point of care. The data can then be transmitted and incorporated into the medical record for continuity of care. WTN can then support caregiver collaboration with two-way audio and video streaming at the bedside.
Check out Crounse’s post to download Microsoft’s video on WTN.
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May 13-16, Boston, MA:
The Heart Rhythm Society’s 30th Annual Scientific Session
Science, discovery and innovation represent the driving forces behind this year’s Scientific Sessions. Collectively, they embody the accomplishments and aspirations of the field of cardiac arrhythmias. Attend and gain first-hand knowledge and perspectives you can put to work immediately in your own practice and learn more about the emerging and enabling technology of the future.
Register
June 16-17, Ft. Lauderdale:
8th CCS Summit
Transforming Healthcare through Health Information Technology
Designed to help top-level executives, legislators, physicians, regulators and technologists come to grips with the swirling forces of health information technology change, policy development and changing business models, the CCS HIT provides an intimate, high-level forum that facilitates open avenues of communication amongst executives and stakeholders in healthcare.
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June 22-23, Seattle, WA:
Sixth Annual Healthcare Unbound Conference & Exhibition
Healthcare Unbound will have a strong focus on use of remote monitoring / home telehealth technologies for wellness promotion and disease management, with a special emphasis on Baby Boomers and the elderly population. The agenda will also cover topics such as the emerging role of mobile/wireless technologies, legal/regulatory developments and reimbursement issues, strategies for success for Healthcare Unbound vendors and much more.
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July 27-28, Boston, MA:
The World Health Care Congress Leadership Summit on Wireless Health
This two-day Summit convenes policy-makers, payers, providers and medical group practices from across the nation to discuss business and clinical opportunities for integrating mHealth, Remote Monitoring and Telehealth solutions into existing care systems. Real-life, case studies and the results to-date from pilots at several leading provider organizations will be shared..
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October 6-9, San Diego, CA:
CTIA WIRELESS I.T. & Entertainment
No matter what your business is – healthcare, entertainment, fleet management or financial planning – wireless can transform how you do business. International CTIA WIRELESS I.T. & Entertainment brings this possibility to life. With a focus on applications, network architecture and technologies such as LBS, machine-to-machine and WiMAX (just to name a few), this international event brings a community of users, carriers, developers and manufacturers together to generate dialogue, share ideas and debate the economics of MOBILE BUSINESS.
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October 27-30, San Diego:
TEDMED 2009
The fifth in a series created by Marc Hodosh and Richard Saul Wurman, TEDMED celebrates conversations that demonstrate the intersection and connections between all things medical and healthcare related: from personal health to public health, devices to design and Hollywood to the hospital. Together, this encompasses more than twenty percent of our GNP in America while touching everyone’s life around the globe.
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