Embrace, don’t fear SMS for patient convenience

By: Neil Versel | Apr 12, 2012        

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Neil_Versel_LargeThere’s a lot of talk out there about text messaging not being appropriate for many healthcare uses. The usual excuses are that SMS is not secure to healthcare standards, that you can’t really prioritize delivery of text messages and that there is no way to “escalate” texts if earlier messages aren’t acted upon.

Those are all valid points. In particular, anything involving personally identifiable, protected health information (as defined by HIPAA) certainly is not appropriate for an unencrypted text message. But let’s not completely dismiss texting in healthcare settings.

As the Montreal Gazette reported last week, several walk-in clinics in that city have started sparing patients endless waits by sending a text or an automated voice message when it’s almost their turn to see the doctor.

“The patients gain back their freedom. They don’t have to wait for four or five hours in a waiting room full of sick people,” Sara Michaels, the manager of one clinic, told the newspaper. “Instead, they can take a number, and then they can go out and do their groceries or whatever, and the system will alert them to come back,” she added.

“In a sense, it’s like coming in and asking for an appointment later in the day, something we couldn’t do before.”

The problem of long waiting times is particularly acute in the Montreal area, where, according to the Gazette, 300,000 people do not have a regular family physician. Say what you want about the government-run Canadian healthcare system that is plagued with provider shortages, but we have quite an access problem in this country, too. Keep reading>>


PositiveID’s cellular-enabled iGlucose hub now on sale

By: Brian Dolan | Apr 12, 2012        

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iglucosePositiveID announced this week that its cellular-enabled iGlucose mobile health system, which adds cellular connectivity to a handful of commercially available glucose meters, is now available for pre-order. It expects to commercially launch the device sometime during this quarter. The company also claimed to be in the process of rolling out pilot programs with health insurers and home-healthcare providers, but did not provide specifics.

In November 2011 PositiveID announced that the FDA had cleared iGlucose, which only worked with two glucose meters at the time: the LifeScan OneTouch and Nipro Diagnostic True. Now the device also works with Abbott FreeStyle and Bayer Contour devices too, according to the company. The iGlucose device transmits the data to a secure database via a cellular connection supported by AT&T in the US and Rogers in Canada.

“iGlucose eliminates the burden of keeping manual logbooks and empowers individuals with diabetes to be more engaged in the self-management of their condition,” according to a company press release. “iGlucose uses mobile technology to seamlessly communicate blood glucose readings from an individual’s data-capable glucometer to the iglucose diabetes management portal, where, with the user’s consent, glucose readings can be shared automatically with family members, caregivers and healthcare professionals via text message, email or fax.”

Last year Glooko started selling a cord that connects already available glucose meters to a user’s iPhone to transmit data to an app on the device — another way to solve the manual logbook issue. Telcare, the first cellular-enabled and integrated glucose meter, also recently became commercially available after securing an FDA clearance in August 2011. Sanofi and AgaMatrix’s iBGStar iPhone peripheral glucose meter is currently available in Europe but has yet to commercially launch in the US after securing FDA clearance late last year.

More on the imminent iGlucose launch in the press release below: Keep reading>>

Ethiopia: A “learning lab” for national mHealth strategy

By: Neil Versel | Apr 11, 2012        

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mHealth EthiopiaIf Ethiopia is to achieve two of the United Nations’ Millennium Development Goals, mobile technologies will need to play a central role, according to a proposed strategic plan now being circulated in global development spheres. The document is intended to serve as a model for other countries considering national mobile health strategies.

The UN wants developing countries such as Ethiopia to reduce child mortality by two-thirds and deaths of new mothers by three-quarters between 1990 and 2015. Greater availability of community-based health services are key to achieving these goals, and mobile technologies can make community health workers more efficient and effective, suggests a detailed report from Vital Wave Consulting, a Mountain View, Calif.-based firm that specializes in finding ways technology can help accelerate growth in emerging markets.

“If managed successfully, mHealth can be an effective tool for advancing the government’s key health initiatives, particularly community-based interventions that have women at their center,” the report says.

But that will not be an easy task.

Ethiopia has nearly 85 million people, but only 8 percent have mobile phones, according to the report. A state-owned telecommunications company has a monopoly on mobile phone service, and service tends to be spotty. Plus, many rural outposts lack reliable electricity, so it’s difficult to recharge phones. Keep reading>>

VA hopes to scrap copay for home video consults

By: Brian Dolan | Apr 11, 2012        

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American Well iPhone app

Video consultation provider American Well's iPhone app

As expected, the Department of Veterans Affairs plans to do away with copays for in-home telehealth services in an effort to increase access to the services for veterans with health conditions, who are frail or have difficulty traveling to healthcare facilities. According to the VA’s notice in the Federal Register, unless the department received compelling negative comments about the plans, the copayments will be eliminated starting May 7th.

The VA lists a number of benefits that the technology provides: increased access to specialist consultations, improved access to primary and ambulatory care, reduced waiting times, and decreased veteran travel.

“Specifically, the regulation is amended to exempt in-home video telehealth care from having any required copayment,” the VA writes. “This removes a barrier that may have previously discouraged veterans from choosing to use in-home video telehealth as a viable medical care option.”

The VA describes in-home video telehealth care as a service that connects a veteran to a VA health care professional using real-time videoconferencing and (sometimes) other peripheral equipment. The service aims to:

“Replicate aspects of face-to-face assessment and care delivery that do not require the health care professional to make an examination requiring physical contact. However, in-home video telehealth care is provided in a veteran’s home, eliminating the need for the veteran to travel to a clinical setting. Using telehealth capabilities, a VA clinician can assess elements of a patient’s care, such as wound management, psychiatric or psychotherapeutic care, exercise plans, and medication management. The clinician may also monitor patient self-care by reviewing vital signs and evaluating the patient’s appearance on video.”

The VA hopes the move helps “to make the home a preferred place of care, whenever medically appropriate and possible.” The VA also argues that eliminating the copays should be applauded since these services are not used to provide “complex care” and it is significantly less expensive and resource-constraining than in-person, outpatient visits.

Encouraging the adoption of in-home video consultations is an important first step. Perhaps asynchronous telehealth services — that do not replicate in-office visits — are next?

Mount Sinai’s new ER has bedside “geriPads”

By: Brian Dolan | Apr 11, 2012        

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iPad2FaceTimeTwo months ago New York City’s Mount Sinai Hospital opened the doors on its new geriatric emergency room, which is specifically designed to cater to the needs and particular medical issues of patients aged 65 and older, according to a report in The New York Times this week. A part of the Affordable Care Act of 2010 calls for hospitals’ Medicare payments to be tied to patient satisfaction surveys and readmission rates. The geriatric ER is designed to improve scores and reduce readmits.

Mount Sinai’s patient satisfaction scores for those in the new ER are “off the scoreboard,” Dr. Andy Jagoda, Mount Sinai’s chairman of emergency medicine told the Times. The facility, which has just eight beds, also offers quieter rooms (no metal curtain rings), non-slip floors, an artificial skylight that turns dark at night, and an iPad at every bed. Dr. Jagoda told the newspaper that the stripped down iPad, which he calls the geriPad, is one of his favorite innovations. The device enables patients to have two-way video conversations with nurses and also offers touch screen buttons to ask for lunch, pain medication, or music.

Typically about 27 percent of older patients treated in the ER are readmitted within three months of being sent home. While the new geriatric ER only admits patients with relatively less severe conditions — broken hips but not heart attacks — they have reduced readmissions to 1 percent in some cases, according to the report.

The team at St. Joseph’s Regional Medical Center in New Jersey, which has served as a model for other geriatric ER initiatives, has reduced unscheduled return visits to the ER to 1 percent of cases, down from 20 percent. One reason is they have increased scheduled return visits by checking in on patients after discharge and bringing them back in if conditions appear to be worsening.

Much more in this must-read New York Times report (reg. req.)

Republicans put pressure on wireless health regulators

By: Brian Dolan | Apr 10, 2012        

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Congress LetterLast week six Republicans in the US House of Representatives sent a letter to the FDA and FCC that explains the importance of wireless health devices and medical apps, cautions against slow and inconsistent regulations, and asks for a progress report on how the two regulatory bodies are working together to co-regulate these technologies. The six House members that signed the letter were: Rep. Marsha Blackburn (R-TN), Rep. Joseph Pitts (R-PA), Rep. Greg Walden (R-OR), Rep. Brian Bilbray (R-CA), Rep. Michael Burgess MD (R-TX), and Rep. Phil Gingrey MD (R-GA).

The letter includes a nod to MobiHealthNews’ apps reports series: “Between 2010 and 2011 the number of medical applications (apps) available in the iTunes App Store subject to FDA evaluation under the draft guidance increased by 250 percent. The technology is changing rapidly. We are concerned that applying a complex regulatory framework could inhibit future growth and innovation in this promising market and could preclude tools that help patients better manage their care and allow the health system, as a whole, reduce costs and improve quality.”

“Innovative wireless medical devices play a vital role in addressing our nation’s unsustainable health care costs. These technologies enable physicians to know that a patient’s condition is worsening before the patient feels any symptoms, and provide treatment to keep the patient from having a health crisis that results in a trip to the emergency department,” the letter reads. “Additionally, the popularity of mobile medical applications reflects the desire of many Americans to use technology to actively engage in their own health. The abilities of smartphones and wireless devices to perform complex health and medical functions are increasing and the use of mobile medical applications is becoming more common. As policy makers, we must ensure a regulatory framework that encourages innovation while increasing access to care, protecting patient safety and lowering costs.”

The Congress members note that the FCC and FDA recognized the necessity of working together more closely to regulate wireless health back in July 2010 when it signed a Memorandum of Understanding (MOU): “We hope that the momentum generated by those actions continues and that collaboration between the agencies remains a priority,” the representatives write.

The representatives have asked the FDA and FCC to respond in writing to a series of questions about their co-regulation efforts by April 17, 2012 “so that [they] can better understand the progress FDA and FCC have made to date, future steps planned by the agencies, and how [they] may best assist the agencies’ efforts.”

Read the entire letter, including the questions, below: Keep reading>>