Bosch Healthcare chief is bullish on telehealth-enabled care management

By: Neil Versel | Sep 15, 2011        

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Jasper zu Putlitz BoschAn article in the September issue of policy journal Health Affairs looked at a CMS demonstration project involving care coordination with Robert Bosch Healthcare’s Health Buddy telehealth appliance. Researchers from Stanford University and economic consulting firm Analysis Group found that the Health Buddy system helped trim spending by 7.7 percent to 13.3 percent, or $312-$542 per person each quarter, on Medicare patients with various chronic diseases at two multispecialty clinics in the Pacific Northwest.

“These results suggest that carefully designed and implemented care management and telehealth programs can help reduce healthcare spending and that such programs merit continued attention by Medicare,” they write.

Not surprisingly, Dr. Jasper zu Putlitz, president of Palo Alto, Calif.-based Robert Bosch Healthcare, the global telehealth business of German industrial conglomerate Bosch, is thrilled. “This study is a real breakthrough,” he tells MobiHealthNews. “It’s one of the few CMS demonstration projects that actually showed impact.”

The researchers, led by Laurence C. Baker, chief of health services research at Stanford, also found evidence of better outcomes in the form of lower mortality rates, but suggested that more study is needed. Their analysis relied on claims data and did not account for the cost of the technology, but they are optimistic that they were on to something big.

So is zu Putlitz, who took the top job at Bosch Healthcare at the beginning of 2011. “The very idea that Health Buddy can save lives is very intriguing to me,” he says.

With this study now out there, the next step, according to zu Putlitz, is convincing healthcare payers, purchasers and providers that this kind of telehealth technology is worthy of the investment, particularly for Medicare enrollees.

Zu Putlitz says it’s somewhat unrealistic to expect commercial insurers to cover the up-front cost of monitoring technology such as Health Buddy since members switch plans so often. The same goes for employers, because companies downsize and people do change jobs. “That’s less of an issue for Medicare,” the Bosch Healthcare boss notes. He also says a similar opportunity exists in European markets, where healthcare is largely government-funded.

He is particularly excited about the new Center for Medicare and Medicaid Innovation, created by the 2010 Patient Protection and Affordable Care Act. The same health reform law gives CMS the power and some money to expand successful pilot programs without waiting for further congressional authorization. “We give them a little bit of what I call a luxury problem,” zu Putlitz says of the results of the study, which involved Medicare patients at Wenatchee Valley Medical Center in Wenatchee, Wash., and the Bend Memorial Clinic in Bend, Ore.

He adds that Bosch is prepared to ramp up telehealth programs in a hurry, should the demand arise. “Bosch has a lot of experience with large telehealth deployments,” zu Putlitz says. The company has done larger-scale rollouts with CMS in the Bronx, N.Y., and with the Department of Veterans Affairs. “We can do it. We are ready,” according to zu Putlitz.

Health Buddy, which Bosch acquired when it purchased entrepreneur Steve Brown’s Health Hero Network in 2007, is one of two telehealth systems Bosch currently markets. The other is ViTelCare T400, a home monitor for more acute and intensive cases, that Bosch picked up in a 2009 acquisition. The company is marketing the latter more to hospitals as a way to monitor recently discharged patients, particularly since Medicare next month will stop paying for certain preventable readmissions within 30 days of hospital discharge. Keep reading>>

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How to get health devices on Apple store shelves

By: Chris Gullo | Sep 14, 2011        

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December 2010: Dr David Albert and the iPhoneECG case

December 2010: Dr David Albert and the iPhoneECG case

As part of its ongoing mHealth feature, MIT Technology Review has a new article on obtaining a major achievement for iOS health device manufacturers: Getting Apple to carry a device at its brick-and-mortar retail stores.

Apple’s retail locations already sell iPhone-compatible health and wellness devices, including the Withings Body Scale and the iHealth BP3 Blood Pressure Cuff. Connected medical devices for the iPhone first gained notice in early 2009 at an iPhone 3.0 launch event, when Apple demonstrated how a LifeScan blood glucose meter could connect to the iPhone. (LifeScan has been relatively quiet about mobile devices since but recently emerged as a partner to mobile health startup Cellnovo.)

Two years later, securing FDA clearance and also finding a spot inside Apple’s retail locations is far from easy. TR polled companies that have managed to do so about the process.

Here, roughly, are the steps a company needs to follow: First check-in with the FDA and spend the time and money to get medical device clearance if need be. Apple isn’t interested until this step is complete, according to TR. Next, device makers need to submit the app that corresponds with their peripheral device to Apple’s AppStore. Next, device makers need to apply to be a part of Apple’s “Made for iPhone” or MFI program and be ready for a good amount of feedback. A few tips for gaining approval: Keep a tight connection with the iPhone either through a case or cordless plug-in. Keep the peripheral device form factor small since shelf space is precious. Then, you submit your device and include as much info as you can muster along with some prototypes. The next step, according to TR, is to keep quiet about all this. Here are the last three steps according to TR:

Secret sauce: Now you’re ready for the secret stuff. Developers who get this far will obtain the “iPod Accessory protocol,” the secret technical specs needed to communicate with the iPod, iPhone, and iPad. Connect! The iPhone is famously locked down. Apple provides special hardware and other components needed to connect through Apple’s 30-pin dock connector. Get approved: All that’s left is final approval by Apple. Developers say that’s harder than getting a green light from the FDA. Unlike the government, Apple can reject you without telling you why.

One company that is interested in a spot on Apple’s store shelves is AliveCor, whose founder Dr. David Albert told TR that he has met with Apple executives about carrying his iPhoneECG device.

Read the Apple Store article over at Technology Review here and an article about AliveCor’s iPhoneECG here.

Usability, finances, lack of scientific evidence holds back home health tech

By: Neil Versel | Sep 14, 2011        

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As any reader of MobiHealthNews should know, the market for home care is gradually shifting from durable medical equipment to Internet-enabled, connected technologies. But acceleration of that change is hamstrung by finances, accessibility of the technology and lack of scientific evidence showing that wireless monitors and the like can save money and improve outcomes.

“We see substantial growth potential in technology-enabled home health care. An aging population and an increasing chronic-disease burden point to a large and growing market,” researchers from consulting firm McKinsey & Co. write in the fall edition of the McKinsey Quarterly. “But home care stakeholders must get the reimbursement models right and ensure that the technologies coming to market truly make a difference for patients and the bottom line alike.”

Home care today is a $68 billion industry, representing about 3 percent of U.S. healthcare spending, and it’s growing at an annual rate of 9 percent, according to McKinsey. The researchers, Basel Kayyali, Dr. Zeb Kimmel and Steve van Kuiken, note that home-monitoring technology is a tiny part of that, especially considering that two-thirds of cost of home health is related to labor.

“What’s holding the market back? We observe a daunting array of financial and operational barriers, including the misalignment of incentives between payers and providers, the need to demonstrate a strong clinical value proposition and the problem of designing attractive, easy-to-use products that facilitate adoption by patients,” the article says.

Kimmel, a former visiting fellow in the Office of the National Coordinator for Health Information Technology, and his McKinsey colleagues say that any sustainable business model for home healthcare technology must meet eight “key success factors”: Keep reading>>

Mechael takes the helm at mHealth Alliance

By: Chris Gullo | Sep 14, 2011        

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gI_105680_PattyMechaelThe mHealth Alliance (mHA) appointed Patricia Mechael (PhD, MHS) as its executive director. Mechael has been active in the mHealth field for over a decade, using mobile technology to improve healthcare in Africa and other low- and middle-income areas. She was previously the director of strategic application of mobile technology for public health and development at the center for global health and economic development at the Earth Institute.

Last year Mechael had one of the more memorable presentations at the mHealth Summit, where she shared 10 lessons learned from global mobile health deployments.

The mHealth Alliance is a consortium created in 2009 by the Vodafone Foundation, Rockefeller Foundation and the UN Foundation that aims to further policy research, advocacy, and support for mHealth globally, especially in developing nations. Its founding members now include PEPFAR, HP, and the GSM Association.

“Mobile health offers innovative solutions to some of global health’s most pressing issues,” stated Tom Wheeler, Chairman of the mHA Partnership Board, in a press release. “Under Dr. Mechael’s leadership, the mHealth Alliance will continue to mobilize this innovation in order to deliver quality health to the furthest reaches of wireless networks and mobile devices.”

“We’re at a tipping point in the mHealth field,” stated Mechael in a press release. “There is an unanticipated demand for mHealth and we cannot afford the fragmentation the field is experiencing. The mHealth Alliance is in a strong position to provide leadership in the direction, standards, tools, support mechanisms and fora needed to move mHealth forward.”

The alliance’s executive director position has been vacant since its first leader, David Aylward, decided to step down from the position to focus “his talents and commitment to mHealth… on delivery of mHealth rather than running the multi-faceted Alliance.” That’s how UN Foundation Chief Executive Officer Kathy Calvin explained Aylward’s departure in an email to mHA partners in March of this year. Aylward had held the position since the fall of 2009 — shortly after the founding of the mHA. MobiHealthNews interviewed Aylward about his position at the mHealth Alliance shortly after he joined as its leader in September 2009.

Read the full press release about Mechael’s appointment below.

Keep reading>>

Good iPad EMR apps still six months out

By: Chris Gullo | Sep 14, 2011        

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Cerner's Physician Express for iPad

Over the past few years, more and more hospitals have upgraded their wireless networks to support the increasing number of connected medical devices and droves of smartphone and tablet-equipped providers, patients, and visitors. Michael Catrini, Director of Information Systems and Infrastructure at Rutland Medical, a 188-bed hospital located in Vermont, recently spoke with MobiHealthNews to discuss his facility’s recent wireless network overhaul, which Aruba Networks helmed.

Prior to the Aruba installation, the hospital used Cisco networks. “Cisco handles the quality service from a ‘data is data’, ‘voice is voice’ [perspective],” Catrini told MobiHealthNews, and that distinction became a potential issue. As an example, he presented a typical scenario: A wireless monitor is tracking a patient on a ventilator in transit from their room to an x-ray machine. According to Catrini, Cisco’s installation wouldn’t prioritize the data being sent from their monitor — it would have the same importance on the network as “an Excel spreadsheet being emailed on a computer.”

In contrast, “One of the key drivers for us was Aruba’s ability to profile the application traffic and apply quality of service at a particular application, rather than just blindly saying that… voice always gets the highest priority.”

Rutland also uses its wireless network to support handheld Dolphin barcode scanners for medication administration: Barcodes are scanned on patients’ bracelets as well as the medication container.

Catrini said his facility equips its providers with smartphones but Rutland is device agnostic.  iPhone and Android smartphones: “The industry changes so rapidly, we’ve gotten away from trying to standardize any particular phone,” Catrini said. He’s also already seen the impact Android has made: “Android really blew up the market,” he said.

When asked about tablet adoption, Catrini said that the “topic is a hot [one]. Physicians are coming in and saying, ‘We want iPads!’ The real challenge with an iPad isn’t a physical challenge; it’s the applications,” he said. “If an application isn’t designed to interact with that screen size or [multitouch] technology, then it raises all kinds of issues.”

In March, the hospital started using Cerner’s EMR. Although Cerner does have one native application already available for both iPhone and iPad users, called Physician Express, Catrini believes that mobile EMR apps still have a ways to go: “I think we’re six months or a year from a really good native [iPad EMR app].”

While other CIO types have also predicted better native EMR apps are in the works at the big name EMR vendors like Cerner and Epic, smaller design-focused shops that have concentrated on the tablet form factor, including DrChrono and Clear Practice’s Nimble, have received a number of lauds over the past year.

Read the press release about Rutland’s Aruba overhaul below. Keep reading>>

Investment and design among mHealth’s challenges

By: Chris Gullo | Sep 13, 2011        

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sep08_vc_x616_textInvestment trends, design challenges, top apps, and tablets for clinicians are often discussed in mobile health circles. This month Technology Review has put together a series on e-medicine, which included a focus on mobile health this week. Here’s a quick round-up of their coverage so far:

First up is TR‘s trend piece on investment challenges facing healthcare startups. “The usual reason HIT doesn’t get funded is because the opportunities aren’t large enough,” Barbara Lubash, a managing director at Versant Ventures, told TR. Large hospitals are hesitant to adopt new technology after spending hundreds of millions of dollars on legacy IT systems developed by large companies such as Siemens, Epic, and Cerner. This hesitation forces entrepreneurs to focus on niches in HIT, including mobile apps, which many investors don’t believe are sufficiently large.

Despite these hurdles, Dow Jones VentureSource estimates that VC investments in HIT rose about 20 percent in 2010, to $460 million (about a fifth of the $2.3 billion that venture capitalists invested in all health companies), according to the report. Jessica Canning, research director for VentureSource, told TR that half the deals counted in 2010 were seed-stage or first-round financings. Canning said that the numbers are “very promising at a time when VCs are struggling to keep their existing portfolios alive. It means a pipeline is being built in HIT.”

TR also has a profile piece on Massive Health’s Aza Raskin, a well-known Silicon Valley-based designer, whose company is currently developing consumer-facing apps for chronic conditions. Massive Health has yet to discuss its specific plans or strategy.

“Health really happens in between doctor’s visits,” Raskin told TR in an interview. “We now have these always-on connections, rich interfaces, mobile devices, and people who are willing to share,” he said. Keep reading>>