Interoperability holds the key to EHR, mobile health success

By: Neil Versel | Jan 24, 2013        

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Neil_Versel_LargeHave you seen all the pushback of late against the direction of the “meaningful use” EHR incentive program and EHRs in general?

The year started with the publication of a RAND Corp. study in Health Affairs cautioning that health IT had fallen far short of its potential so far. Notably, EHR design and implementation problems, a lack of interoperability and continued reluctance among providers to redesign care processes and spend time trying to “master difficult-to-use technology” has stood in the way of expected cost savings, efficiency gains and better care.

Meanwhile, interest groups all over the country have been publicizing their comments to the Department of Health and Human Services in response to the Health IT Policy Committee’s preliminary recommendations for Stage 3 of meaningful use, and quite a few have been critical of the whole direction of the program.

Not surprisingly, the American Medical Association (AMA) and the American Hospital Association (AHA) both said it was premature to develop rules for Stage 3 before Stage 2 starts in 2014 and while many providers have not yet achieved Stage 1. But even some EHR vendors have expressed reservations.

“The pace is too damn high,” John Glaser, Siemens Healthcare’s CEO of health services, told Forbes, suggesting that there hasn’t been enough time to focus on interoperability of health information. “We need the time to do it right,” Glaser said.

I don’t think anyone would argue at this point that there aren’t gaps in meaningful use and in health IT, particularly when it comes to interoperability. And that’s where mobile and personal health devices need to come in.

Last week, the Association for Advancement of Medical Instrumentation (AAMI) and the Food and Drug Administration (FDA) issued a report based on a summit they convened in October suggesting that policy-makers were ignoring all the data coming from connected medical devices by focusing so much on EHRs.

“Healthcare organizations are focused on getting electronic health records (EHRs) up and running. Very few are stepping into the even more complex space of device interoperability,” the report said. But they eventually will need to pay attention to the latter, which includes everything from home health monitors to fitness counters to inpatient telemetry equipment.

“Getting it right protects patients, contributes to clinical decisions and positive patient outcomes, and improves efficiency. Getting it wrong introduces significant risk and the likelihood of adverse patient events. Worse, getting it wrong doesn’t mean returning to the baseline risks of an unconnected world — it will lead to more serious situations than exist now. Safe interoperability is central, not peripheral, to the core mission of healthcare,” the AAMI and FDA said.

At least one person believes device interoperability is coming as soon as Stage 3, which is scheduled to start in 2016, or two years after a provider first achieves Stage 2, whichever is later. That person is Chuck Parker, executive director of the Continua Health Alliance.

Writing on the HIMSS blog this week, Parker said the current recommendations for Stage 3 promise to get everyone connected by encouraging patient engagement. “If [the HIT Policy Committee’s] recommendations come to pass, Stage 3 will encourage medical practices and hospitals to enlist their patients to use health devices and apps, and to accept patient-generated data into EHRs,” Parker said.

“Studies of connected health show that when patients incorporate mHealth into their lives — at home, work, and on the go — they recognize the relationship between their health behaviors and experience of health and are consequently better able to self-manage. My prediction is that practices and hospitals embracing Stage 3 will discover a new capacity to bring about positive outcomes through timely, targeted interventions, both at the individual and population levels,” Parker continued, but then he added one caveat: devices and IT systems need to be connected.

“The fact is, unless personal health devices work together with minimal effort, patients are unlikely to stick with mHealth tools, and the momentous opportunity for connected health will be lost,” Parker said.

Yes, interoperability remains elusive and difficult. But we have to get it right. Billions of public and private dollars are on the line here, and more importantly, so are millions of lives.


FDA clears Welch Allyn’s iPhone-enabled opthalmoscope

By: Jonah Comstock | Jan 24, 2013        

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An iPhone app and peripheral device that allows doctors to use the iPhone camera to take photographs of the interior surface of the eye has received 510(K) FDA clearance.

iExaminerThe iExaminer System from Welch Allyn will build on the company’s existing PanOptic Opthalmoscope, a device that lets a physician see into the back of a patient’s eye. The FDA clearance is for an adapter that connects the opthalmoscope to an iPhone 4 or 4s and an app that will allow the iPhone to take about 85 images in five seconds.

“It really is more of an enhancement or supplement,” said product manager Rick Farchione. “It provides the ability to store and analyze the image, send for consultation, and save for future comparison. That’s what it does better than a traditional opthalmoscope.”

Farchione said the primary market for the device, which is cleared for medical professional (prescription) use only, is not eye specialists. The goal is, instead, to give primary care physicians and multi-specialist clinicians the means to do an eye exam without more expensive equipment (the whole system costs about $600). Images of the interior of the eye, or the fundus, can help doctors diagnose glaucoma, hypertension, and papilledema. Perhaps the most common case, Farchione said, is diabetes. He said about half of diabetes patients don’t get an eye exam when they should.

With the pictures instantly available on the iPhone screen, doctors can easily show the patient a picture of their eye, which can be helpful in motivating a patient to seek treatment.

The MIT Media Lab has developed technology that uses an iPhone to detect cataracts and a consumer-facing eye diagnostic peripheral, but neither tool fills the same role as a fundus camera. Farchione said it’s unlikely the company will adapt this technology for consumer use.

Currently the FDA clearance is only for the iPhone 4 and 4s, and Farchione said the device is not currently designed to work with the iPhone 5.

“Not to say we will not do it,” he said, “but we don’t have definitive plans at this time.”

100Plus beta launch pairs little actions with big data

By: Jonah Comstock | Jan 23, 2013        

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100plusAfter a year of development and “app experiments,” 100Plus, a startup backed by, among others, PayPal cofounder Peter Thiel’s Founder Fund and LinkedIn cofounder Reid Hoffman, is debuting in public beta. The app combines little actions with big data to motivate users to lead generally healthier, more active lifestyles.

“There’s quite a lot of literature that just being more active in your daily life is as good or even better than exercising a lot,” CEO Chris Hogg told MobiHealthNews, citing this 1999 JAMA study and recent coverage in the New York Times Well blog.

In addition, Hogg said, getting people to be active in little ways — like taking the stairs rather than an elevator — is easier than getting them to make a big life change, like adding the gym into their weekly routine.

“Everybody wants to be healthier, but most people don’t know what to do,” he said. “They know in the abstract, but giving people very concrete suggestions is very motivating for them. They want this little nudge.”

The 100Plus app presents users with a series of health opportunities or “Hopps”, which are tailored specifically to their neighborhood. Initially these will be created by the developer, but as people adopt the app they’ll be able to create their own Hopps, which can then be served to others. The app will launch with nearly 18,000 Hopps in 7,000 different locations.

“So not just ‘eat a salad,’ but ‘eat a salad at this restaurant that’s close to you,’ ” Hogg said.

Users check in as having completed their Hopp by taking a picture, and the app rewards them with a fact about that activity and why it’s good for you, and with an update to their “LifeScore.” The LifeScore is the other big component of 100plus: Using data from the CDC and EHR provider Practice Fusion, the app adds and subtracts years, months, weeks or days to the user’s life expectancy. It mostly adds.

“We plan to get more and more data from people over time,” Hogg said. “Without data, we assume you’re average. And then [based on] everything we learn about you, your score changes.”

The app will calculate a basic score based on age, gender, city of residence, and whatever other information the user chooses to provide during an introductory survey. Each Hopp completed will adjust the score a little bit in an upward direction. Hogg said that people instantly understand adding weeks or months to one’s life, as opposed to using an abstract or artificial scale.

Rather than launching a lengthy private beta, Hogg and his team tested the waters with two smaller “app experiments” over the course of the year. The first, 100proof, was localized to film and music festival South by Southwest. Seven thousand attendees downloaded the app and took an interactive survey about their drinking habits at the festival. In turn, the app displayed data about how they compared to others at the festival and to national averages and told them how the habit would affect their lifespan.

“There’s a myth that people don’t want to give you information,” said Hogg. “From 100Proof, we learned that people are very interested in giving you this type of data, especially when they get something cool in return. It kind of proved that data can be used to engage people, to make a fun experience.”

More recently, the company developed an app called Outside, which is how the team derived the idea of using photographs to help engage people in their achievements, Hogg said.

The company plans to submit the app to the iOS App Store within a month or so, Hogg said, and the Android version is expected by the end of February. In the meantime, customers can sign up for the public beta at

In addition to going direct to consumer, the company has signed a deal with a major employer to include 100plus as part of their health plan, with some others in the works.

The company also signed a new deal with Practice Fusion to get access to another 1 million de-identified health records from the company, information Hogg said will be invaluable in refining their LifeScore algorithm.

In the future, 100Plus is looking to integrate with self-tracking apps and gadgets. Hogg said that integrating with RunKeeper, so that users’ LifeScores go up when they run, is at the top of his list. He said they’re also in conversation with Jawbone UP and Sonny Vu of Misfit Wearables.

Microsoft sees pen, computing power as differentiators for Surface Pro tablet

By: Neil Versel | Jan 23, 2013        

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Microsoft Windows 8 Surface Pro tabletMicrosoft is upping the ante in the tablet game.

The Redmond Empire announced Tuesday that Microsoft Surface Windows 8 Pro, a business-class line of its Surface tablets, will hit stores in the U.S. and Canada on Feb. 9. The Pro models will have third-generation Intel Core i5 processors, touch screens with 1080p (1,920 by 1,080) HD resolution, plus an included digital pen and “Palm Block” technology that prevents extraneous marks and commands when users rest their palms on the on the screen while writing with the pen. Each one also has a full-size USB 3.0 port and a Mini DisplayPort interface that can output to external displays with up to 2,560-by-1,400 resolution.

Unlike basic Surface models that start at $499, Surface Windows 8 Pro tablets will run any Windows 8 application or Windows 7 desktop software, so they are just as powerful as a laptop. However, the 10.6-inch Pro tablets are not cheap: $899 for a 64-gigabyte version or $999 for 128 GB, with an add-on keyboard available for $100-$120 – more than the most expensive iPad. Apple’s 64 GB tablet with built-in 3G or 4G cellular connectivity tops out at $829; the entry-level 16 GB iPad mini with just WiFi costs $329.

In healthcare, Microsoft is pushing the computing power, the pen, and Palm Block features as a differentiator.

“For years I have been writing about the challenges of data input in clinical medicine. Doctors and other clinicians need all of the data input options possible including keyboard, mouse, touch, pen and voice,” Dr. Bill Crounse, Microsoft’s worldwide senior director for health, writes on the Microsoft HealthBlog.

“With Surface Pro, you’ll have it all. With EMR solutions and apps that have been optimized for Windows 8, you’ll be able to tap into discrete data fields and enter information (with handwriting to text conversion) using the pen. The pen can also serve as a navigation, tap and dictate tool if you are using voice recognition software,” Crounse continues.

Microsoft will sell the Surface Pro tablets through its own bricks-and-mortar and online retail stores in the U.S. and Canada, as well as at Best Buy and Staples locations in the U.S., the company says.

Healthbox London holds demo day; Irish accelerator HealthXL launches

By: Jonah Comstock | Jan 22, 2013        

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Healthbox CEO Nina Nashif speaks at the Innovation Day in London.

Healthbox CEO Nina Nashif speaks at the Innovation Day in London.

Just a year after launching its first class in Chicago, Healthbox held a demo day in London to showcase its first European class. The seven startups, representing four countries, which were announced in October 2012, have now completed Healthbox’s three-month accelerator course. They were chosen out of an initial pool of about 200 applicants. Each company received some seed capital, access to a collaborative workspace in central London, and mentorship from Healthbox’s European partners: global innovation company Bayer, international healthcare group Bupa, Guys’ and St. Thomas’ charity, and Serco Health.

“In Europe we have 27 different systems which restrain innovation, which keep investors out of the country. Nobody knows the exact environments and it’s harder to investigate the risks,” said Ben Heubl, the chapter founder of Health 2.0 Copenhagen, who was involved in facilitating Healthbox’s Innovation Day. Heubl said accelerator programs in Europe are key to building the kind of multinational communities that encourage angel investors to look beyond their own countries and support the whole European health IT ecosystem.

Another European accelerator, HealthXL just had the first in a series of selection days in Dublin. HealthXL is a health-specific division of Startup Bootcamp, which Heubl described as the European equivalent of TechStars. The Irish accelerator will be focusing on later stage companies than Healthbox, he said, and will include partners like GlaxoSmithKline and IBM and mentors like O’Reilly Media founder Tim O’Reilly and Global Diagnostics founder Johnny Walker.

Here are the seven companies that featured at the Healthbox event in London:


HealthClinicPlus creates prescription software to guide patients through exercises and physical therapy at home. The Irish company is currently piloting their software at a London Hospital with post- and pre-operative patients. Their first consumer product, SportsClinicPlus for the sports industry market, is under development.

MIRA Rehab

Similarly, Romanian company MIRA Rehab converts existing physical therapy exercises into videogames, currently for the Microsoft Kinect system, which sports a sensor the software can use to determine whether patients are really following through with exercises. MIRA won the Innovation Award at the event, which came with a £10,000 prize.

SOMA Analytics

SOMA Analytics is a German company developing passive monitoring software for smartphones. Targeted at employee stress management, the software will measure voice affect and typing speed and errors to provide a realtime assessment of stress and wellbeing.


HomeTouch employs a software-as-a-service model for helping aging-in-place elders with busy families. The company’s platform consists of two connected applications: a tablet app for older people which gives them easy access to services like messaging, video calling, calendars, and photo albums and a cross-platform app for families that lets them manage and help with that platform remotely. The software is currently in beta, with a full release planned for later in the year.

Portable Medical Technology, Ltd.

Irish company Portable Medical Technology, Ltd. makes ONCOassist, a smartphone app to help oncologists get fast and easy access to the latest research and clinical decision support tools. ONCOassist is one of the first European smartphone apps to get CE Mark clearance, according to the company.


Medopad is a tablet interface for hospital servers, allowing doctors to access a patient information without needing to consult a fixed terminal.

Desktop Genetics

Desktop Genetics is developing the SynthBot, a gene printer that aims to make it easier and more affordable to create synthetic genes in the lab. The British company is currently beta testing the software and expects to be able to launch the SynthBot for construction by 2015.

About that meta-analysis of mHealth efficacy studies

By: Brian Dolan | Jan 22, 2013        

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Brian Dolan, Editor, MobiHealthNewsTechnology moves too quickly for the world of academic publishing. That’s a long held belief by many but also a common topic of conversation among those working in digital health today. How to best study efficacy can be a tricky subject for digital health, however, the argument that efficacy data is unimportant rarely enters the debate — it is, especially for those companies that hope to convince payers that their services are worthy of reimbursement. Of course, the benefits of rigorous study go well beyond that in many cases, too.

There are some digital health studies, however, that are best published elsewhere. Any sensible person would agree that a scientific journal is no place for them. Take meta-analyses of mHealth efficacy data. Are you looking to determine whether the scientific evidence supporting clinical efficacy of mobile health was robust back in mid-2010? Well, you just had to wait until January 2013 to find out — in fact, you probably did last week.

The fact that the scientific body of efficacy data was lacking as of September 2010 should come as a surprise to no one. A quick poll of those mobile health companies with published efficacy studies informed me that the time it takes from when an mHealth service is ready to begin an RCT to the actual publish date of the study in a medical journal is at least two years. That might be appropriate for some intervention studies, but what good is a meta-analysis report on the state of current affairs if it arrives two years later?

As my colleague Neil Versel wrote last week: “British researchers examined 20 years’ worth of published studies on mobile interventions delivered to healthcare consumers and mHealth technologies intended to improve care delivery processes. In both cases, they were underwhelmed with what they found.”

The 20 years, of course, stretched from January 1990 to September 2010. Given the typical two years (minimum) it takes to get to the publish date, that means the study was only looking at mHealth interventions developed by mid-2008. That pre-dates MobiHealthNews by a few months. Apple launched its AppStore around the same time these studies were just beginning. At that time, Matthew Holt and Indu Subaiya had hosted just one Health 2.0 event and a single Spring Fling!

So, yes, scientific mobile health research was found to be severely lacking as of September 2010. Since then, much has happened, including the publication of WellDoc’s landmark efficacy study in 2011. In a comment on our post last week, Wireless Life-Sciences Alliance strategic advisor Jack Florio noted: “This field has been evolving with lightning speed. It is likely that studies which were started in 2009 and 2010 have not reached the literature. This means there is an additional 5 years of past and ongoing work which is not accounted for in this research.”

He’s right, of course, and on that note, a much more current meta-analysis found that the future of mHealth efficacy data is bright.

Alain Labrique, Ph.D., the founding director of the Johns Hopkins University Global mHealth Initiative, and his team recently conducted a survey of the mHealth studies that were registered in the government’s database as of November 2012. Labrique writes: “We identified 215 unique mHealth studies that were registered in the database, of which 8.4 percent (n=18) were observational in nature while the remaining 91.6 percent (n=197) were interventional. Of the 215 studies, 81.8% (n=176) studies used a classical randomized trial design and 40 new studies were added to the database between May and November 2012 alone. Based on these results, we posit that the field is entering a new ‘era’ where a body of rigorous evaluation of mHealth strategies is rapidly accumulating.”

Labrique concludes: “The transition into an era of evidence-based mHealth supports our position that innovation in this domain can be evaluated with the same rigor as other public health strategies, attenuating some of the hype previously associated with mHealth.”

We’ll continue to cover that transition in near real-time here at MobiHealthNews.