Necklace sensor could be early warning system for heart failure

By: Jonah Comstock | Feb 26, 2014        

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Necklace-21-Fev-043-2-300x221A startup called Perminova is developing a necklace for clinical use that can track a number of vital signs including thoracic fluid levels, an early predictor of congestive heart failure that isn’t currently monitored by most connected sensors. Patients at risk for CHF could use the device in place of or along with a weight scale.

“You have weight gain four days before a heart failure event,” VP of Marketing Susan Pede told MobiHealthNews from the floor at HIMSS. “About seven days before that you can detect fluid build-up that’s trending upward. About 18 days before that you can see changes in stroke volume and cardiac output.”

The system, called the CoVa monitoring system, is a large decorative necklace, with adhesive on the back of it, which patients are instructed to wear for a few minutes once a day. It sends a Bluetooth signal to either an Android tablet or a Qualcomm Life 2net Hub, which then sends the data to the cloud via cellular or WiFi. Sensors in the device track fluid levels, heart rate, respiration rate, heart rate variability, stroke volume, cardiac output, single-lead ECG, and posture.

“The tagline is we’re trying to do for congestive heart failure what a glucometer [does] for diabetics,” Pede said. “We’ve talked a lot about congestive heart failure, but we have had some interest from other industries, in terms of a low acuity necklace for stroke monitoring.”

It might seem odd to have a wearable, fashion-forward device for a brief, daily check-up. But Pede says the necklace form factor both allows the company to be flexible in the development of future use cases and makes it easier to ensure consistent placement of the electrode.

The company isn’t ruling out consumer use cases for the $300 device, but they intend to start out going through hospitals, for whom preventing cardiac events and their associated hospital costs could be a major driver. Perminova will submit FDA 510(k) clearance in April, after which they can start to secure more hospital partners.

Perminova is currently funded by a single angel investor according to Pede. The company is also partnering with remote patient monitoring analytics company Jointly Health.

A few years ago, the FDA cleared a similar product, Corventis’s Piix sensor, for cardiac monitoring including fluid monitoring. Corventis, which was one of the first companies to be tested at the West Wireless Health Institute, has been quiet in recent years. Several other products, like the ZIO patch or Vital Connect’s Health Patch, are peel and stick sensors that monitor a number of vital signs, but not fluid or stroke volume.


Geisinger CIO: Patients like texting, portal better than apps

By: Jonah Comstock | Feb 26, 2014        

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GeisingerPatient engagement is about giving patients communication channels they want as well as the ones they need, according to Chanin Wendling, Director of eHealth at Geisinger Health System. And from her experience, patients are still more interested in useful web-based patient portals than they are in apps.

“We did a study this past summer on women’s health where we were trying to figure out if we could do a mobile app in that space, around lots of issues in women’s health and taking care of the family members,” she said in a presentation at HIMSS in Orlando, Florida. “And the feedback we got was ‘No, I’d really just like you to use the stuff in the portal, and text messaging would be great, but we’re not so interested in the mobile app space.’ We do have a mobile [version of the portal] for the iPhone and Android, but the adoption has been low.”

Wendling said the most important thing about engaging patients was giving them a voice and a chance to interact with their own care.

“Patient engagement is one of those catchphrases everyone’s talking about — patient engagement this, patient engagement that. In reality, though I think we’ve done a lot of cool stuff in this space, but I think we’ve barely scratched the surface. … We tend to think in a paternalistic way: this is what the patient needs, versus thinking ‘What will work best for the patient?’ and ‘How will the patient relate to whatever we’re prescribing?’. And that’s extremely important because at the end of the day, if you can’t get the patient to help, if they don’t take their meds, if they don’t lose the weight, if they don’t do their exercises, there’s nothing you as a clinician can do. You need the patient to help you.”

She shared a few examples of successes Geisinger has had with this approach. Using the portal and tablet applications in the waiting room, Geisinger was able to screen all adult primary care patients for depression, something that Wendling said would have been impossible without digital engagement tools. In another example, they used the patient portal to follow-up with patients and make sure the medication information on file for them was accurate.

“We found out that 50 percent of our patients aren’t taking a medication we think they are taking. Twenty-one percent are taking a med differently than we think they are, and 25 percent are taking a medication we didn’t even know about. This is a way, again, that doing something interactive with the patient can help you get information you’re struggling to get and help you get a better clinical outcome.”

Geisinger has also found success with text messages. They found that using motivational text messaging for patients trying to lose weight reduced BMI about half a pound on average, and they have 73,000 patients signed up for text message appointment reminders.

Wendling also shared some stories of mobile initiatives tried and failed by her department in the last year. One project, a game designed to increase engagement in under-40 men, failed because of internal logistics — making a game was more complicated than she anticipated and she missed her pilot deadline. Another project was a mobile app meant to supplement cardiac rehab. Though promising, this one failed because Wendling couldn’t get a physician to sponsor it.

“For them, they couldn’t figure out how to introduce this change,” she said. “They had a very set program, they were used to the program, and it was very hard for them to fathom how to set this up with their patients. And they put up a lot of resistance and barriers. I tried to get an executive sponsor to help and I couldn’t get one, so ultimately I pulled the plug. … I don’t treat patients. I need the people who treat patients to work with me.”

Tension between clinicians and the innovation department is not uncommon, according to Wendling. She also said she meets resistance when she tries to make additional patient data viewable in the patient portal.

“If I want to make my clinical teams crazy, I try to add additional data into the portal,” she said. “I usually get ‘Chanin, the patient won’t understand that’ or ‘The patient’s just going to call us, it’s going to create more work.’ That’s all bunk. … This past May, we made a decision to display Open Notes, the provider’s process notes. … We have about 1400 providers displaying their notes to patients now. In our March 10th release I’ll have over 85 percent of the outpatient providers on board. I have not gotten a single complaint. Not a single comment from a patient or provider that says ‘You’ve ruined my life’.”

Wendling shared a lot of general advice for innovators. She said to be selective in dealing with vendors, and to be aware of your own health system’s size, strengths, and limitations. She extolled the virtues of having a dedicated innovation staff, saying she doubted the efficacy of putting innovation responsibilities on the shoulders of people with full time operations jobs. Finally, she re-iterated that not every project will succeed.

“When you innovate, you mess up sometimes,” she said. “You’ve just got to learn, discard what didn’t work, move on.”

KP discharge app is early step in future care vision

By: Jonah Comstock | Feb 25, 2014        

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journey home board Kaiser PermanenteThree new Kaiser Permanente hospitals will be opening soon in California and will roll out the Journey Home Board, a tablet application that serves as an outpatient education and engagement app. The Journey Home Board is the latest technology to come out of Kaiser’s Imagine Care Anywhere program, an innovation center based out of Kaiser’s Garfield Innovation Center in San Leandro, California.

“For those of you who have never been hospitalized, when you’re a patient at the hospital you don’t really feel like you’re in control,” Danielle Cass, Innovation Evangelist at Kaiser Permanente said in a presentation at HIMSS in Orlando, Florida. “You don’t really know what’s going on, when do I get to go home, what tests are happening, who’s my care team. The Journey Home Board puts the member at the center.”

While the patient is in the hospital, the Journey Home Board is similar to Mayo Clinic’s MyCare app that was piloted last year. It shows a list of appointments or recovery milestones that have to be met before they can go home. It allows them to track progress in a patient diary.

But the app goes further than the Mayo Clinic app. The application will be tailored for different kinds of patients, but Cass used the example of a new mother. For her, the app might contain videos of breastfeeding techniques, information on post-partum depression, and even an instructional video about setting up a car seat. It also would connect the mother to other KP members who are new mothers.

In the Imagine Care Anywhere vision of future care, however, the Journey Home Board is just the first step. Cass and Kaiser CIO and senior VP Wendy Lee talked about a number of technologies that combined to enhance the care experience with mobile, either at home, at a mall-based clinic, at the hospital, or out and about in the world. An online demo is now available as well.

For instance, KP is working on software that would allow the user to check various health indicators by breathing into his or her smartphone. Other technology would speed up check-in, allowing a patient to check in and even pay a co-pay automatically just by scanning his or her smartphone at the clinic. Or, a patient could do his or her grocery shopping from a KP app that would only display the groceries that fit in with their nutritionist care plan. In return for using KP’s app, the user would get a discount on their groceries, which would then be delivered to their home. Several of the clinical concepts KP presented involved a huge touchscreen table from which a doctor can access records or initiate video messaging with other members of a patient’s care team.

The center also offers tours, and brings a smaller version of its prototype to events like HIMSS. Those efforts, and the new online version, exist to seek out feedback from a wide range of doctors and patients and to better refine the ideas.

Cass and Lee admitted that not every concept technology makes it into the real world. But that’s a feature, not a bug. Cass said that after testing an ultimately abandoning a concept where nurses would use mobile medication carts for medication administration, Kaiser discovered that another hospital had gone ahead and implemented the same thing — and the hospital system wasted $12 million before concluding it didn’t work.

“It’s great to have a place where you can test things out and sometimes succeed and sometimes fail,” she said.

Galaxy S5 will have built-in heart rate sensor

By: Aditi Pai | Feb 25, 2014        

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GalaxyS5Samsung launched a line of mobile products at Barcelona’s Mobile World Congress (MWC) this year, and every single device had one built-in digital health component — a heart rate sensor.

The most significant addition of the heart rate sensor was to Samsung’s Galaxy S5 smartphone. This new iteration has many health features on top of its built-in heart rate sensor, such as the next version of Samsung’s S Health app and a pedometer.

To use the heart rate sensor, located on the back of the phone under the camera, users must launch their S Health app, select the heart rate option, and then place their finger on the heart rate sensor on the back of their phone to get a reading, according to Phone Arena. It’s unclear how exactly the heart rate sensor works, but an optical sensor like Basis uses seems most likely.

In the past, other apps, such as Azumio’s Instant Heart Rate app, used the smartphone’s camera and flash to track color changes in the light that passes through the index finger as new blood is delivered with each heartbeat.

Samsung also launched a new wristworn fitness tracking wearable at MWC, Gear Fit, which offers users a curved screen for comfortable wearing, is also waterproof, includes a heart rate sensor, and allows users to get text and call notifications while exercising.

The announcement for Gear Fit came just a few days after Samsung launched its two new smartwatches, Gear 2 and Gear 2 Neo. While these two smartwatches are not specifically meant for health, they also have built-in heart rate sensors, unlike their predecessor, Galaxy Gear.

According to the company, both devices offer personal fitness coaching, “allowing users to develop a customizable fitness routine and monitor their heart rate in order to improve their overall well-being”. The specs indicate the device will track running and walking, cycling and hiking on a preloaded app. The user can also download a Samsung app for sleep and stress tracking.

Gear 2 will also offer MapMyRun in its app gallery. On Samsung’s original smartwatch, the company added three native fitness apps that launched with the device — Azumio, RunKeeper and MyFitnessPal.

Hearst Health Ventures invests in patient engagement company Tonic Health

By: Aditi Pai | Feb 25, 2014        

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TonicHealthHearst Corporation subsidiary Hearst Health Ventures, a corporate venture fund, announced an undisclosed investment in Tonic Health, a company that develops medical data collection platforms, yesterday. As part of the investment, Hearst Health Ventures Managing Director Ellen Koskinas will join the Tonic Health Board of Directors.

“With Hearst Health Ventures, we are looking for innovative investments that deepen our insight into information-driven solutions that have the potential to improve healthcare quality and efficiency,” Hearst Corporation CEO Steven Swartz said in a statement. “We are pleased with the opportunity to work with Tonic Health and learn more about effective patient engagement.”

Tonic Health helps patients complete surveys that physicians can build and customize on the platform. The company’s product has been deployed at health systems such as Partners HealthCare and UCLA Health. The company said they have redesigned the data collection process so that it is interactive, intuitive and simple. Tonic Health’s surveys have been tested with different audiences including lower income and lower education audiences who many not have used an iPad before. The system is also capable of tying into a hospital’s existing backend.

A month ago, Tonic Health partnered with Welltok as part of a program, called CafeWell Connect, to link technology with disease management and wellness programs.

Hearst Corporation created Hearst Health just one month ago to give the company a “consolidated presence” across the clinical, pharmacy, home and hospice care, and health insurance markets. This new brand consists of Hearst Health Ventures and the Hearst Health Innovation Lab. The company’s first investment since its conception was in CareInSync, which raised its last round in August from Samsung Venture Investment Corporation.

UCSF, Samsung to validate and commercialize digital health tools

By: Aditi Pai | Feb 25, 2014        

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Samsung Gear FitSamsung Electronics announced a partnership with the University of California San Francisco (UCSF) last week to “accelerate validation and commercialization of promising new sensors, algorithms, and digital health technologies” that will be used in preventive health offerings. The new lab will be called the UCSF-Samsung Digital Health Innovation Lab.

Technologies that will be brought to the lab will include Samsung products along with products developed by UCSF students and faculty.

“When we say validate, it can be a variety of things,” Dr. Michael Blum, UCSF School of Medicine’s associate vice chancellor, told MobiHealthNews. “If it’s a brand new sensor we would be doing clinical validation of ‘Does it measure and sense what it was intended to?’, and ‘Does it do it with sufficient accuracy and reliability?’ at a very basic level. But then [testing] more sophisticated [features] and saying ‘OK so this thing technically works. How does it work in healthcare? Does it bring value to the patient by doing something more quickly, more easily, and more accurately than the way we did it before?'”

Some technologies that UCSF will help to validate include those Samsung launched at Mobile World Congress this week. One device that might be included is Samsung’s wristworn fitness tracking wearable, Gear Fit, which offers users a curved screen for comfortable wearing, is waterproof, includes a heart rate sensor like Samsung’s other just launched wristworn offerings, and allows users to get text and call notifications while exercising.

“The other direction is that we will bring devices and concepts and technologies that come out of UCSF investigators, UCSF medical students, and other professional students as well as staff,” Blum said. “We’ll build that through proof of concept and through a prototype and then we’ll work with Samsung to build that out to production scale and distribution.”

Samsung will pay UCSF licensing fees for some of the intellectual property that comes out of the partnership.

Many products from UCSF’s Center for Digital Health Innovation (CDHI) will be sent to the UCSF-Samsung Digital Health Innovation Lab to be reviewed and further developed with Samsung’s help. CDHI aims to combine technology, science and medical records to better understand the roots of disease and develop targeted therapies for patients.

“We have several other applications and products that we’re working on right now,” Blum said. “One that is moving through the pipeline is a collaborative care platform that’s called CareWeb, which is a team based communication [tool], that takes elements of the best of concurrent social communication such as Facebook and Twitter, but use them in a healthcare environment so we can improve the team based and collaborative communication that go on in those environments. That has been piloted and is getting ready to be scaled and distributed out to the rest of the country.”

Another product out of CDHI, Health eHeart, is a cardiac web-based data collection platform, powered by Azumio, AliveCor and iHealth, that Blum said is scaling around the country in collaboration with the American Heart Assocation.

While Blum could not disclose specific projects that will enter the UCSF-Samsung Digital Health Innovation Lab, they will likely be along the same lines as those that have been developed in CDHI in the past.

“Digital health has been moving along slowly and getting some momentum,” Blum said. “We think this [partnership] is going to speed up the pace of delivery of really high quality, impactful digital health innovations to the public. And then, as a next step, to help with wellness and disease management — to help people get better, live longer, and live happier.”