iHealth smartphone-enabled devices to integrate with EHR

By: Jonah Comstock | Dec 7, 2012        

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iHealth BP CuffiHealth Labs, a subsidiary of China-based Andon Health that produces wireless health monitoring devices, announced partnerships with EHR-maker Practice Fusion and with popular memory-aid app Evernote.

Practice Fusion is the first EHR-maker to partner with iHealth, Adam Lin, general manager of iHealth Labs, told MobiHealthNews. The first phase of the partnership will allow physicians who use Practice Fusion to give their patients special offers on and access to iHealth products. But in a few months, Lin said, Practice Fusion’s patient health record will integrate with data from iHealth devices.

“It’s imperative to us that our devices will actually integrate with the EMRs and the EHRs,” he said. “There has to be a way our information can flow into the system.”

iHealth’s blood pressure monitor and weight scale are Bluetooth-enabled, and currently sync with iHealth MyVitals, iHealth’s free app announced last month. But the company wants to make the data from their app available to consumers in more ways, Lin said.

“We’ve been a little bit slower to the game of integrating with third party apps. Evernote is part of that even though they’re a little bit unique,” he said. “Our strategy has always been to allow our users to see and manage our data elsewhere. Not all users will utilize our application as a dashboard.”

Evernote isn’t a health app, per se. It bills itself as an app to help people remember everything, and it integrates a camera, a voice recorder, and  a “web clipper,” for taking online screenshots. iHealth device data will integrate with Evernote in the form of a Results Card that will be generated when someone takes a reading. The system will also generate a summary card at the end of each week.

Lin said a lot of iHealth users have requested integration with other apps, such as RunKeeper, and the company wants to keep pace with those requests. Towards that end, the company recently made it’s API publicly available.

Although Practice Fusion and Evernote share Morgenthaler Ventures as a major investor, Lin said that relationship is just a coincidence.

The simultaneous move into both consumer-facing and physician-facing health integration shows that  iHealth is positioning its devices for a variety of use cases. But Lin said they’re really just two different vectors for connecting people with data about their body.

“This is just the beginning for us,” he said. “At the end of the day the person with the device considers themselves a consumer, a patient or both. Whether you buy or product from Apple or get it from your doctor, the person is the same. We’re targeted at that person, with the goal of true mobility, allowing your information to move with you.”

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Content, partnerships now trump technology in global mHealth

By: Jonah Comstock | Dec 7, 2012        

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Mark Blatt and Ebenezer Appiah-Denkyira

Mark Blatt and Ebenezer Appiah-Denkyira

Texting programs for health education in developing countries have been around for over a decade, but several factors are bringing global health efforts to a new scale in 2012, including increasing mobile adoption in developing countries and an increased spirit of collaboration.

Nafis Sadik, a United Nations Foundation board member, has worked with the UN on women’s health since 1987. At the mHealth Summit this week Sadik delivered a keynote presentation about the opportunities provided by the wide adoption of mobile phones by women in the developing world.

“When I started work if you had access to mobile technology, it meant that you had a car,” she said. “In the villages people had never seen a telephone and few had ever heard of one. Today mobile phones are everywhere.”

“For me, 2013 is the year for scale for mHealth,” said Patricia Mechael, Executive Director of the mHealth Alliance, in her opening remarks. She said in the nearly 10 years since she began working on mobile health programs in developing countries, “mHealth has transitioned from a novel idea to a strategy for global health. We are seeing great progress in the growth and rigor of mHealth evaluations and greater attention to evidence.”

Mechael spoke about the Mobile Alliance for Maternal Action, or MAMA, a partnership between the mHealth Alliance, USAID, Johnson & Johnson, the United Nations Foundation, and BabyCenter. MAMA was founded to educate and support new mothers in Bangladesh, India, and South Africa through mobile messages, similar to Text4Baby in the US. Today the program’s adaptive messaging system is used in 40 countries and reaches 20 million moms, Mechael said.

She also announced a new mHealth Alliance partnership with the Nigerian Federal Ministry of Health and with Intel, to leverage mobile technology in Nigeria’s Saving One Million Lives initiative. The initiative, launched in October, seeks to eliminate the one million deaths a year in Nigeria to preventable causes.

Hajo van Beijma, CEO of Text to Change, a company that works with organizations to develop text messaging interventions in developing countries, said that when Text to Change started in 2007, it worked with companies that weren’t very ambitious and launched a lot of pilot programs with no plans for follow-ups. He told MobiHealthNews the industry has learned that scale depends more on ambition than anything else.

blog post over at the Center for Health Market Innovations site Content, partnerships now trump technology in global mHealthrecapped van Beijma’s panel at the Summit. In it, researcher Lily Wei mentions three dimensions of scaling: project, with refers to the content of specific programs, platform, which refers to the technology used, and strategy, the effectiveness of the intervention in bringing behavior change to end users. Van Beijma says there’s been a shift in prioritizing those dimensions.

“At the beginning, the assumption was that if you had good technology and a good platform, you would scale,” he said. “Now the general assumption is if you have good content and good partnerships you’ll scale.”

Van Beijma’s Text to Change has been exploring bigger partnerships, he said, teaming up with companies he once would have considered competitors. Last year they made their proprietary software freely available to better facilitate partnerships. Wei concludes that one of the big goals of the global heath track of the Summit was to better facilitate these partnerships.

Van Beijma also said that it’s often more productive to integrate mobile health with other mobile initiatives like mobile banking and mobile agriculture than to promote it in isolation.

Dr. Ariel Pablo-Mendez, Assistant Administrator for Global Health with USAID, made similar points in his keynote address. He said mobile money has the potential to reduce corruption in healthcare systems in emerging economies, and mobile-enabled human resource management systems like IRIS can help manage clinic and aid workers.

Mark Blatt, Worldwide Medical Director at Intel shared keynote session with Ebenezer Appiah-Denkyira, Director General of the Ghana Health Service. They spoke about taking the scope of global mobile health beyond texting programs.

As developing countries build their healthcare system, Blatt said, they can integrate mobile health and electronic data management from the beginning.

“How can we use these tools to empower citizens to better care for themselves so we diminish the pressure on the healthcare system?” he said. “Mobile tools offer emerging economies an opportunity not to make the same mistakes we made in our western healthcare system.”

Van Beijma agreed. “Africa is famous for leapfrogging with regards to technology,” he said. “The fact that they were lagging behind technologically is actually helping them because they can skip all kinds of technology we don’t like anymore, like landlines.”

Healthcare cathedrals and the consumer health bazaar

By: Brian Dolan | Dec 6, 2012        

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Brian Dolan, Editor, MobiHealthNewsOne out of every three adults in the US will buy a digital health product of some kind in the next year, Gary Shapiro, the CEO of the Consumer Electronics Association (CEA), said — citing data from an upcoming CEA survey — during his luncheon keynote at HIMSS’ mHealth Summit this week. With the exception of that prediction, Shapiro largely steered clear of the consumer health conversation and instead discussed how lowered healthcare costs could save the country from the so-called “fiscal cliff”, how perverse reimbursement policies for physician visits need to be removed, and how our lawsuit-happy legal system needs to adopt a “loser pays” policy.

With the head of the largest consumer electronics association tackling systems issues, at times it seemed like the consumer health conversation at the mHealth Summit was buried.

Over the course of this past year the consumer/patient-facing digital health conversation shifted from a predominantly direct-to-consumer market to one that might leverage traditional healthcare channels. Among the drivers that steered the industry back toward the patient-provider relationship: the prospect of physicians prescribing apps, the importance of integrating data from mobile health programs with EHRs and other systems, and the push for patient engagement from forthcoming meaningful use requirements.

Still, many speakers at the mHealth Summit championed direct-to-consumer.

Martha Wofford, Head of Aetna’s Consumer Platform, praised iTriage, which Aetna bought last year, for ramping up to 8 million downloads. Wofford described that as “a tremendous number of people” and as having “far outpaced any adoption” for other direct to consumer products that Aetna had tried launching on its own. Wofford said in some instances startups understand direct-to-consumer distribution better than large companies like Aetna do.

“Large companies understand [business-to-business channels] better,” Wofford said. Now that iTriage is a part of Aetna, “the marriage of the two is very exciting.”

Scott Peterson, the VP of Sales for Verizon’s Healthcare Practice, poked a hole in the hype surrounding health app certification and touting consumer savviness.

“Code will be written. Apps will be deployed that change the way both patients and providers get access to information. The market will sort the ones that don’t work.” Peterson said that “ultimately the consumer and patient want the same thing as providers and payers: better outcomes and better care” and that “savvy consumers know which apps work; savvy payers and providers know which apps appeal to consumers.”

While it may be somewhat expected that nontraditional companies, telecoms like Verizon, take a different stance than the healthcare establishment, some healthcare providers touted consumer-driven disruption, too.

Dr. Joe Kvedar, Founder and Director of Partners HealthCare’s Center for Connected Health, said that he’s “a fan of retail clinics because they are a glimmer of what [the future of healthcare] will look like.” Kvedar said that retail clinics “took 5 percent of primary care and no one really noticed.” The healthcare system is so occupied by incumbents, he said, “that have so much to lose by changing” that things won’t change there first.

Vinod Khosla, founder of the investment firm Khosla Ventures, agreed:

“The right way to look at it is to say ‘How does innovation happen and how do very large systems like the healthcare system change?’ Most of the time change comes from the outside. Not the inside where there are too many vested interests, too many people with very good intentions who have too much experience to be unbiased,” Khosla said. “They are not naive enough to ask naive questions. The answers have changed because of the circumstances — because of technology. Healthcare innovation will be consumer-driven not doctor-driven. It will be driven by devices that power the consumer to have better data about themselves.” Khosla was quick to point out that technology is an important component but not the only one: “It is necessary but not sufficient.”

Health apps and smartphone-enabled medical devices today, which Khosla described as “clumsy point solutions”, are just version 1.0 of digital health, he said. This is just the beginning and some of the consumer-driven services today will quickly make their way into the healthcare system. Aetna’s iTriage acquisition is one key example. Khosla clearly believes there will be others soon.

Consumer health and provider-driven digital health initiatives, of course, will grow up together in parallel. Each can help drive the other in their own way.

“There are really two models for how the world works: the cathedral and the bazaar model,” Khosla explained. “Bazaars evolve much faster than cathedrals do — often because people leave cathedrals to join the bazaar. You can also be in a cathedral and help the bazaar evolve faster than any cathedral could on its own.”

Mobile tools help public, private payers be more proactive

By: Jonah Comstock | Dec 6, 2012        

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(Left to Right) Mark Wynn, William Shrank, and CMMI Innovation Award winners Kevin Volpp, Deborah Stewart, and David Goodman

(Left to Right) Mark Wynn, William Shrank, and CMMI Innovation Award winners Kevin Volpp, Deborah Stewart, and David Goodman

Aetna CEO Mark Bertolini’s opening keynote set the tone for an mHealth Summit with a notable, but not unexpected, payer presence. In 2010 MobiHealthNews wrote about the changing role of the payer in health care, predicting that payers would soon help drive the mobile health agenda. The 2012 summit confirmed that prediction may soon be proven true.

“We as payers cannot go forward as [the] traditional payers as you know today, but rather we have to interact with the patients to give them the right information, when they need it,” said Pat Keran, Senior Director if Innovation and Research and Development for the UnitedHealth Group. “We need to provide upfront care management.”

Keran spoke about several UHG initiatives that use mobile health to engage patients directly. In addition to their OptumizeMe app, he said they were looking into other ways to leverage social media, such as creating a rating system for care providers and using big data to track public opinion about health care reform to inform company decisions.

Marty Webb of AT&T spoke at the same panel, likening his company to the large payers because of the scope of its employee healthcare program.

“We currently sponsor one of the largest private sector health plans in the country,” he said. “What happens at AT&T in many senses mimics what happens in the United States.” Keep reading>>

BYOD, HIPAA are rock and hard place for CIOs

By: Jonah Comstock | Dec 6, 2012        

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(Left to Right) Penelope Hughes, Andrew Litt, Rohit Nayak, and Omar Hussein

(Left to Right) Penelope Hughes, Andrew Litt, Rohit Nayak, and Omar Hussein

When Meaningful Use Stage 2 roles out in 2013, one guideline hospital’s EHRs will have to meet is increased protection of patient health information. That means the HHS Office of Civil Rights (OCR) will be doing audits for HIPAA-compliance.

The OCR fined Massachusetts Eye and Ear associates $1.5 million in September when a laptop with patient data was stolen. In June, the Alaska Department of Health and Human Services was fined $1.7 million for one stolen USB drive.

Those audits are particularly daunting in an environment where Bring Your Own Device (BYOD) policies are becoming so prevalent that hospital information officers don’t even see them as a choice.

“When I first created this presentation, it was the question of whether you want to implement BYOD,” said Brian Balow, a member of the law firm Dickinson Wright. “The cows have kind of left the barn on that one.”

A recent KLAS survey of 105 CIOs , IT specialists, and physicians in the US, found that 70 percent used mobile devices to access their electronic health records, including customers of nearly every major EHR (Epic, Cerner, GE, Allscripts, Siemens, MEDITECH, and McKesson). The vast majority of organizations, 94 percent, were supporting Apple, with 49 percent and 44 percent supporting Android and Microsoft, respectively.

As physicians and health administrators adopt mobile devices in hospitals, it’s up to hospital IT departments to keep up with them and make sure the patient data on those devices is secure.

“This is part of a broader macro-trend in security,” said David Houlding, Healthcare Privacy and Security Lead Architect at Intel. “It was very topdown, where IT departments made decisions about security. It’s going to much more of a detect, respond, and govern security model.”

With the inescapable reality of BYOD pushing them from behind and the threat of massive fines for HIPAA violations looming ahead, hospital CIOs are finding themselves in need of security solutions fast.

Houlding says physicians are sensitive to security concerns, but their primary worry is treating patients.

“From the healthcare worker’s standpoint, security is impeding the quality of care,” he said. “We’ve got to provide security that’s usable. So if we put encryption on a device, it cannot slow that device down, or providers will seek an alternative, which can be risky.”

Most of the security solutions hospitals are adopting have potential negative effects on the effectiveness of the tools. For instance, if the hospital sets up a thin client so patient information is stored on a server and merely display on doctors’ devices, that means the doctor’s charts will fail if the network connection is compromised.

Of course, it’s not just the threat of fines that will drive hospitals to adopt security solutions, it’s also maintaining a trust relationship with patients, who data shows are increasingly concerned about security.

Andrew Litt, Dell’s chief medical officer, said that a recent study showed that if patients lacked confidence in the security of their data, 50 percent would withhold their data, 38 percent would forgo care, 38 percent would seek care elsewhere, and 70 percent said it would reflect poorly on the institution. Finally, 87 percent thought someone should lose their job over a breach.

Litt also said that hospitals are one of the biggest targets for hackers, who can sell health records for about $50 on the information black market.

Omar Hussein, CEO of Imprivata, said the questions of security in health are fundamentally different from in other industries.

“[In] every other industry, security is a single issue: keeping the bad guy out. In healthcare, it’s not just about that. It’s actually keeping patient information in,” he said. “When someone steals your credit card, the bank will make you whole, you’ll get the 1,000 bucks back. But if information about your STD or that you’re taking medicine for depression gets out, how do you get that back?”

Panic buttons for seniors must go

By: Neil Versel | Dec 6, 2012        

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Neil_Versel_LargeNursing homes, assisted-living facilities and other senior residences, it is time to join the 21st Century. Those panic buttons you routinely give your residents have got to go. Now.

If you grew up in the 1980s like I did, you know that “I’ve fallen and I can’t get up” became as much a part of the lexicon as “Where’s the beef?” or “I pity the fool.” That was the tagline for an early personal emergency response system (PERS) called LifeAlert that first hit the market in 1987.

LifeAlert went away for a while, but it’s back. The ads still feature a variation of the catchphrase, and the saying is right there at the top of the company’s home page. The thing is, the technology isn’t much better than it was 25 years ago. While LifeAlert and others in the PERS business have added such things as smartphone apps and connectivity to home fire alarms, users still have to push the button to summon help. That’s a fatal flaw. Literally.

I’ve been on personal leave for most of the last two weeks because my elderly grandmother was on death watch after a fall. She finally succumbed last Friday to a combination of a subdural hematoma, dementia and simply the ravages of living more than 93 years, but not before the whole family went home when she stabilized and even started drinking coffee again, showing that she wouldn’t go down without a fight.

While it probably was her time to go, I’m convinced she suffered unnecessarily despite the fact the senior apartment complex we moved her into just a few months ago issues a Lifeline PERS pendant or watch to every resident. It’s just a panic button, wirelessly connected to a very early 1990s-style landline phone in each apartment and receivers in some of the common areas.

Panic Button PERSShe was wearing the pendant when caregivers found her passed out on the sofa about three weeks ago, where she was for perhaps as long as eight hours. The panic button was useless for someone who had already been suffering from dementia and who had sustained a head injury. Absolutely useless.

I don’t know if she would have survived with any quality of life, but a PERS with automatic fall detection and perhaps wall-mounted motion detectors would have immediately known something was wrong and summoned paramedics hours earlier. Instead, my dear grandmother lay motionless on the couch overnight as she bled on her brain.

Ironically, Lifeline is now owned by Royal Philips Electronics, one of the growing number of companies offering “passive” PERS that automatically detects falls and other serious health risks that affect the elderly. And Wednesday, the U.S. division of Netherlands-based Philips introduced CarePartners Mobile, a free iPhone and Android app that allows caregivers to coordinate the care of elderly and sick relatives. While Philips does not give any indication that the app connects with PERS devices, I imagine that is coming.

I have heard from another older relative who tried the Lifeline with AutoAlert passive PERS that the Philips product returned several false positives and called for help when none is needed, but isn’t a false alarm better than no alarm at all? The technology isn’t perfect, but it is a major improvement on something that hasn’t changed much in decades.

Today, I call upon anyone caring for the elderly to make passive PERS a standard of care. Panic buttons are no longer good enough.