AMIA studies show iPad remains popular with docs but imperfect

By: Neil Versel | Nov 8, 2012        

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Allscripts Wand iPad EHRThe iPad continues to be a hugely popular but imperfect tool for physicians, as suggested by two papers presented Monday at the American Medical Informatics Association (AMIA) annual symposium in Chicago.

In two Fairview Health Services emergency departments in the Minneapolis-St. Paul area, physicians actually told IT leadership prior to the December 2010 go-live of an electronic medical record that they would not use the EMR unless they could access the new system on iPads. This “unique and interesting phenomenon,” as one of the newly published papers put it, prompted University of Minnesota researchers to explore why.

“Any physician will swear by the fact that EMRs slow them down,” said lead author Akhil Rao, a former Minnesota graduate student who now is a clinical analyst at HealthEast Care System in St. Paul. The doctors put a premium on workflow efficiency, and were convinced that iPads would make their jobs easier, he explained. In fact, 85 percent of the 14 emergency physicians Rao and his research partners interviewed – out of 22 total in the two EDs – already owned an iPad. Keep reading>>


Pew: 19 percent of smartphone users have health apps

By: Jonah Comstock | Nov 8, 2012        

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Pew Mobile Health 2012

Source: Pew Internet/CHCF Health Surveys: August 9 ‐ September 13, 2010 , N=3,001 adults; August 7 ‐ September 6, 2012, N=3,014 adults ages 18+. Margin of error for both surveys is +/‐ 3 percentage points for results based on cell phone owners.

About 11 percent of all mobile phone users and 19 percent of smartphone users have at least one health app on their device, according to Pew Internet & American Life Project’s Mobile Health 2012 survey, which the group published this morning. The percentage of mobile phone users who have downloaded a health app has remained unchanged since 2010.

Forty-five percent of the 3,014 adults surveyed said they used a smartphone. Pew’s Associate Director Susannah Fox, who wrote the report, likened this smartphone tipping point to the adoption of broadband Internet back in 2003. In both cases, adoption happened quickly and fundamentally changed the way users engaged with the online world.

“Mobile seems to increase people’s likelihood to participate,” Fox told MobiHealthNews. “It’s the smartphone owners that I ended up really focusing on in the analysis, because they’re so much more likely to use [their devices] to access health information.”

This is the first year that Pew has identified smartphone users with a single question, rather than a complicated series. The term “smartphone” has only recently become widely understood enough for that approach to return meaningful results, Fox said.

The study looked at who was most likely to use health apps within the group of smartphone users. While 19 percent of smartphone users have health apps, that number changes to 22 percent for caregivers, 21 percent for those with chronic conditions, and 22 percent for those who had faced significant medical crises in the last 12 months.

Pew also asked about positive health events. Specifically, one question referred to “significant change … such as gaining or losing a lot of weight, becoming pregnant, or quitting smoking.” A full 29 percent of respondents who reported that kind of change were health app adopters.

Of the 254 health app-users in the survey, fitness and wellness apps dominated among respondents. Thirty-eight percent used apps to track exercise, fitness, or heart rate, 31 percent tracked diet or food and 12 percent tracked weight. The next largest categories were menstrual cycle trackers at 7 percent and blood pressure trackers at 5 percent. Fox said it was no surprise that the top three categories were wellness-related.

“But that’s where the fun really starts,” she said. “After the obvious findings.”

The report lists a number of other health app categories cited by less than 1 percent of respondents, including “Hypnosis” and “First Aid.” Fox said the “Long Tail” of the app market likely contains niche markets that could be successful for app-makers, but she did not specifically point to any of these niche categories as winning ones.

Predictably, app adoption broke down along age lines, with 24 percent of health app users between ages 18 and 29 and another 19 percent between 30 and 49. Fox said the middle age group’s interest in health is typical – that’s the group that has their own personal health issues, as well as often caring for their children and parents. By 65 most people are seeing a doctor regularly and are happy with their offline care.

Fox says that data shows the youngest group, digital natives, are more intimate with their smartphones, and therefore they might be more comfortable casually corresponding with them on health-related questions. Because these young adopters see the smartphone as a go-to for all information, that includes health information also.

Outside of apps specifically, the survey showed that 31 percent of mobile phone owners have used their phones to look up health information, up from 17 percent in a comparable 2010 survey. When you look at just smartphone owners, that number goes up to 52 percent. The report showed that Latinos, African Americans, those between the ages of 18 to 49, and those with college degrees are more likely than others to use their phones to look for health information.

The increased health engagement of Latino and African American users can be partly explained by the diversification of the country, Fox said. Younger people are statistically more likely to be minorities than older people are. Additionally, though, there is a perception that Latinos and African Americans are more likely to be mobile-only and early smartphone adopters.

Only 9 percent of the 2,581 mobile phone users surveyed used text messaging to receive health or medical information, with women, African Americans, and those between the ages of 30 and 49 the most likely to receive health information by text.

California hospital tests disposable, vital signs monitoring patch

By: Neil Versel | Nov 7, 2012        

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Toumaz Sensium Digital Plaster

Toumaz Sensium Digital Plaster

Toumaz Ltd., a British maker of wearable medical sensors, has begun the first U.S. pilot of its SensiumVitals disposable “digital plaster” at St. John’s Health Center in Santa Monica, Calif., in conjunction with Dr. Patrick Soon-Shiong’s California Capital Equity.

Working through Toumaz US, a joint venture backed by UCLA surgeon and billionaire investor Soon-Shiong, Toumaz is testing the continuous monitoring capabilities of SensiumVitals for capturing heart rate, respiratory rate and body temperature of patients in general hospital wards. Without the disposable plaster sensors, St. John’s clinicians have to record vitals manually every six to eight hours.

SensiumVitals, which gained FDA 510(k) clearance in July 2011, picks up changes in the patient’s condition as they happen, allowing physicians and nurses to respond more quickly. This, according to the company, helps reduce costly hospital admissions, readmissions and transfers to intensive care.

This, of course, has become more important to hospitals now that Medicare is no longer reimbursing for preventable readmissions within 30 days of discharge from inpatient treatment of heart attacks, congestive heart failure and pneumonia. Hospitals and health systems also are increasingly financially responsible for keeping patients out of high-acuity units as private and public payers demand more accountable care.

“Early feedback from patients and hospital staff at St John’s has been very positive, with the device detecting deterioration in patients’ conditions instantaneously, enabling intervention much sooner than normal,” Toumaz CEO Anthony Sethill says in a company statement. “SensiumVitals represents a breakthrough in how patient care is delivered, setting a new, cost effective standard for hospitals and also benefiting patients’ recovery.”

Through California Capital Equity, Soon-Shiong purchased an 80 percent stake in the Toumaz US joint venture last year and pledged to infuse $25 million over two years. Los Angeles-based Soon-Shiong has since moved all of his healthcare investments under the NantHealth and NantWorks umbrella.

“At NantWorks, we believe continuous patient monitoring in the hospital will one day be standard practice and this will be enabled by foundational technology like SensiumVitals, delivered by Toumaz US. Continuously streamed patient data automatically flowing into hospital information systems will drive the right care at the right time and in the right place,” NantHealth CTO Michael Trevino said.

Denver Health patients like text reminders, but clinical gains uncertain

By: Neil Versel | Nov 7, 2012        

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DoctorDyerText messaging for disease management once again is proving popular among patients with chronic conditions and their doctors, though the clinical gains are not always easy to determine.

In a just-concluded test at Denver Health, about 80 percent of mostly older, low-income people expressed interest in participating in a text-based communication plan beforehand. After the trial, all 135 participants — two-thirds of whom were Hispanic and 70 percent of whom were older than 50 —said they wanted to continue in the program, according to Dr. Andrew Steele, director of medical informatics at Denver’s public health system.

The texting trial, funded by the federal Agency for Healthcare Research and Quality, wrapped up Thursday. Steele presented preliminary findings Monday in Chicago at the American Medical Informatics Association’s annual symposium — and said Denver Health recently got a Centers for Medicare and Medicaid Services innovation grant and will be rolling a similar program out to 150,000 patients.

As Steele explained, patients have about 5,800 waking hours per year, time when they can do something about their health, but might only interact with a physician for a single hour each year. Electronic communications like SMS can help make more of those hours productive, he said.

Denver Health has dubbed this a “patient relationship management” system much like businesses engage in customer relationship management. The messaging helps patients recall physician instructions and adhere to self-management behaviors. Or, as one participant described it, “It’s like an accountability partner,” according to Steele.

For the trial population of people with Type 2 diabetes and hypertension, Denver Health sent out text reminders for medication refills, laboratory tests and upcoming medical appointments. Messages also asked patients to report blood sugar, blood pressure, their step count from a pedometer and any barriers they might have had to staying on their meds. Any data returned was sent into the patient’s electronic health record.

Denver Health sent out a total of 6,850 texts during the trial. Patients responded to blood sugar-related messages 54 percent of the time, which was about as high as Steele could have hoped for. “For blood sugar, if we sent something out, we got something back,” he said. The response rate was 49 percent on requests for step counts but 32 percent when asking for blood pressure.

About 95 percent of texts back from patients had accurate data, Steele said. While this sounds high, clinicians expressed concern about the 5 percent of responses that were inaccurate, according to Steele, himself an internist. However, they were not discouraged by the small clinical gains from the texting intervention, and Steele believes there is potential for sustained improvement over time.

One issue Denver Health is going to have to contend with as it ramps up its texting is whether to invest in a secure messaging system that meets HIPAA requirements. “Who is going to pay for this?” Steele wondered. “It’s not super cheap.”

iHealth launches new health peripherals, including BP wrist cuff

By: Jonah Comstock | Nov 6, 2012        

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view 2Mountain View, California-based iHealth Labs announced today the launch of a suite of smartphone-enabled health monitors, which are mostly updates of devices that were already available from the company, a subsidiary of China-based medical device company Andon Health.

Best Buy has already begun stocking the Bluetooth-enabled devices, which include the iHealth Wireless Body Analysis Scale, the iHealth Wireless Blood Pressure Wrist Monitor, and the iHealth Wireless Blood Pressure Monitor, all of which connect to the iPhones, the iPad or the iPod touch. Apple’s online store is also offering the product, and brick and mortar Apple stores will roll them out later this month. In addition, the company announced iHealth MyVitals, a new, free app designed to integrate and display the data from all three devices.

MobiHealthNews reported on iHealth’s FDA filing for the blood pressure wrist monitor this summer. Unlike other blood pressure monitors on the market, the wrist device is wireless and Bluetooth-enabled, so it doesn’t require a dock to communicate with mobile devices. It weighs only about a fifth of a pound and is automatically inflating, making it easier to use. iHealth officials told MobiHealthNews that taking blood pressure at the wrist rather than the upper arm is a popular method in Europe. MobiHealthNews has learned that the original iHealth blood pressure monitor will be discontinued.

“Heart disease is the leading cause of death in the United States. Lifestyle changes such as utilizing an iHealth Blood Pressure Monitor or Body Analysis Scale can help equip users to make informed health decisions to significantly reduce their risk,” Adam Lin, general manager of iHealth Labs, said in a statement. “By employing these simple to use products which connect with iOS devices to easily show progress, people can vastly improve their health and quality of life.”

Lin recently told MobiHealthNews that iHealth is working with at least two electronic health record vendors to integrate its blood pressure data with their systems.

For the moment, the wrist cuff gives iHealth an edge over perennial competitor Withings, which doesn’t yet have a comparable device. Withings also manufactures a wireless upper arm cuff and both Withings and Fitbit offer a mobile-integrated smart scale. iHealth’s new scale tracks a wider range of metrics than its competitors, including weight, body mass, lean mass, muscle mass, bone mass, body water, and visceral fat rating and can display them either on it’s native screen or on an Apple device, through the MyVitals application. MobiHealthNews has also learned that an Android app for these devices is in the works.

The Wrist Monitor will retail for $79.95 and the Blood Pressure Monitor will sell for $99.95. At $109.95, the Body Analysis Scale will undersell both Withings’ ($159.95) and Fitbit’s ($129.95) offerings.

Digital health and redefining the point of care

By: Brian Dolan | Nov 6, 2012        

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Brian Dolan, Editor, MobiHealthNewsOne of the shifts that occurred in telecommunications once most people began to carry mobile phones was that we no longer only called places, we called people. Location no longer mattered us much, we can now make calls — for better or worse — from virtually anywhere.

A popular phrase in healthcare — “point of care” — has historically been a phrase that is very much tied to a particular geography. The doctor’s office. The emergency room. The clinic. Because of digital health technologies, however, the “point of care” increasingly means wherever the patient is.

That is the longterm opportunity that a number of mobile and digital health services promise — that for many health-related services, location will no longer matter. Already, however, the point of care — where patients and care providers meet face-to-face — is undergoing some changes because of new digital health offerings. Patients and physicians alike have new and improved tools that augment their relationship. The in-person point of care is changing, too, as the remote point of care is under development.

Later this month and early in December I’ll be discussing mobile health at the point of care with two different groups of healthcare industry thoughtleaders.

On November 29th at 2PM ET I’ll be joining AirStrip Technologies CEO Alan Portela and HCA’s Clinical Transformation Officer Dr. Divya Shroff to discuss this very topic in a complimentary MobiHealthNews webinar, Mobile Health At The Point of Care. HCA, of course, is one of the largest private operators of healthcare facilities in the world. I am excited to hear from both Portela and Shroff, who will share HCA’s perspective on what is practical today as well as possible in the future when it comes to digital health technologies that support physician workflow and enhance the patient experience. Don’t miss this webinar — be sure to register today.

Next month, coincidentally, I’ll be moderating a panel on a similar topic at HIMSS’ mHealth Summit in Washington D.C. The mHealth Summit organizers assembled an interesting mix of panelists for the discussion, which is called Point of Care Delivery Transformed. The group includes Pierce Graham Jones, Innovator-in-Residence HHS, West Health; Hon Pak, CEO & Director, Diversinet; Chanin Wendling, Manager, Geisinger Health Systems;  and Michael Yuan, CEO, Ringful Health. The session will kick off at 2:45PM ET on Monday, December 3rd.