As FCC’s next-gen rollout begins, NSF unveils 911 app prototype

By: Jonah Comstock | Jun 18, 2013        

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huamanwithphone3Speedy response is what emergency services are all about. But when it comes to responding to changes in technology, emergency response providers can be a little slow. The Federal Communications Commission announced last year that, with the penetration of smartphones and cellphones, the time had finally come for a next generation 911 service where people could use text messages, and even multimedia data, to contact police, fire, or medical services. Deployment of the service was meant to start as early as this month.

It turns out another government organization, the National Science Foundation, has been funding a team at the University of North Texas working on a similar project since 2008. The team has been working on taking advantage of the rich data networks the FCC has been setting up with smartphone apps that give new capabilities to 911 operators, potentially speeding up their response times.

“The protocol being used by [many] 911 operators right now is a deck of cards with different questions and answers. You call 911 and they pull out this deck of cards based on what you’re asking them,” lead researcher Ram Dantu told MobiHealthNews. “We have decided that based on what we are seeing, we can accelerate the number of questions and answers in a short time. Within 60 seconds, the operator can already decide who to dispatch to the scene. We looked at all the different protocols to see what are the common things that are happening here. The caller may be a family member or a friend. They may or may not be able to answer this question correctly. The easiest thing to do is to collect any vital signs and send them to the operator — respiration rate, breaths per minute, temperature. They might have a better idea of what’s going on.”

The apps developed by Dantu and his team demonstrate several different use cases for first responders. One app can be placed on the chest to monitor breathing, heart rate, and blood pressure and transmit that information directly to the call operator. This can be done by the victims themselves or by another person. The app also provides instructions for administering CPR, something that operators often have to do over the phone, which can cost precious time. What’s more the app allows the call operator to remotely take control of the phone’s camera, allowing them to see what’s happening onsite.

Two other features, text to speech and GPS refinements, make it easier for the call center to collect and store information about the scene of an emergency. The work Dantu’s team has done on the GPS makes it easier for the app to pinpoint a person’s location in a multi-story building or apartment complex.

Dantu presented the technology this week at a national conference of 911 first responders. The next step is for Dantu and his team to seek non-government funding to develop and deploy the technology, which he thinks will be completed by next August. NSF typically funds projects only in the research stage. The apps developed so far run on Android, but Dantu said they could be built for iOS as well in the future.

You can see a demo of one of the apps here.


Mobile health is touted as affordable, but costs still seen as barrier

By: Brian Dolan | Jun 18, 2013        

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GSMA mHealthThe mobile industry’s GSM Association recently funded a survey of 2,000 healthcare providers, patients and consumers in four different countries to better understand the perceptions they had about mobile health. Obviously, a prerequisite for participating in the survey was an understanding or familiarity with mobile health, so those surveyed were a very particular group of providers and consumers.

The survey’s top line metric is that 89 percent of providers, 75 percent of patients, and 73 percent of consumers believe that mobile health offerings can convey significant health benefits.

The group’s concerns about costs associated with mobile health offerings were perhaps the most interesting metrics collected by the pollsters.

“At a time of such current financial concerns and constraints, mHealth solutions will not be accepted if they add to the current costs of healthcare,” the GSMA writes. “…Many HCPs, patients and consumers surveyed by GSMA were concerned about the inaccessibility of mHealth solutions due to costs; 36% of patients believe that mHealth will be expensive, with Brazil and China driving this perception (45% and 41% respectively). Furthermore, almost three quarters of patients and consumers surveyed were concerned that mHealth solutions would not be covered by their insurance company. This is a particular concern in the US, where almost half of HCPs believe they will not be remunerated for mHealth.”

As the GSMA goes on to note, that stands in considerable contrast to one of mobile health’s overarching value propositions: That it is often fairly inexpensive and affordable.

“Of crucial value to regulators is the finding in this research that one third of patients surveyed struggle with affordability of care and half of them believe that mHealth is a solution to this,” the GSMA writes.

The full report is chock full of stats from people familiar with mobile health, read the whole thing here. (PDF)

Aetna Carepass is no longer just for developers

By: Jonah Comstock | Jun 18, 2013        

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CarePass City To City TabletAetna’s CarePass platform, which has been open to developers since early 2012 and to consumers in a limited beta, officially launched for consumers — not just Aetna members — this morning.

The free mobile and online platform integrates a number of different digital health devices and free apps. Newly announced partners Bodymedia, Jawbone, LoseIt, Withings and Fitbug will join the list of partner apps and devices Aetna has previously announced, as well as Aetna-owned iTriage.

The full list of partners at launch is MapMyFitness, LoseIt, RunKeeper, Fooducate, Jawbone, Fitbit, fatsecret, Withings, breathresearch (makers of MyBreath), Zipongo, BodyMedia, Active, Goodchime!, MoxieFit, Passage, FitSync, FitBug, BettrLife, Thryve, SparkPeople, HealthSpark, NetPulse, Earndit, FoodEssentials,, Healthline, and GoodRx. Previously announced partners that Aetna no longer lists include GymPact, Pilljogger, and mHealthCoach. Martha Wofford, head of CarePass at Aetna, told MobiHealthNews that the partner apps have been downloaded a combined 100 million times.

Additionally, for Aetna members, the platform can make use of personal health information that the user chooses to make available.

“Basically what we’re trying to do is connect core medical data in the form of PHR information with information more in the wellness space of mobile apps,” Wofford told MobiHealthNews. “What we’re trying to do is create this whole picture of one’s health and pull the different pieces from the silos where they sit today to create really personalized insights into one’s health.”

When Aetna was courting developers, the company presented the platform as being about the data. But the insurer has prepared for the consumer launch by putting more effort into creating a consumer wellness experience that wraps around the existing user interfaces of the partner apps.

“When we launched the developer portal I think we had a hypothesis that the data we were opening up — things like aggregated claims data that had not been opened up before or aggregated cost of claims information — would catch on in the developer community like wildfire,” said Jesse Givens, head of CarePass product at Aetna. “When we put that out there, we found that people were interested in it, but conversations we had were far more focused around how do they get their app in front of our members and in front of a large user community.”

The new CarePass platform, which has been “100 percent redesigned” since the beta according to Givens, will have three entry points. One option takes the user directly to iTriage and provides a brief introduction to the app. A second option allows users to connect their partner apps and devices directly to use CarePass as a sort of health data dashboard.

But it’s the third entry point that the company is primarily promoting, which presents users with a choice of goals to work towards. For instance, “run from city to city” is a goal that will allow users to track their running with any app or device on the platform — Runkeeper, the Jawbone UP, a Fitbit, etc. The data from the app or device will be fed into CarePass, which will express the user’s runs as distance traveled between, for instance, New York and Boston. This is a similar approach to engagement to a number of fitness apps including Aetna’s free Passage app, which turns a run into a virtual visit to a foreign city.

Other goals include “kickstart my weight loss” and “fit into my favorite jeans.” Wofford described the jeans goal by evoking Pew researcher Susannah Fox’s idea of a “skinny jeans tracker,” someone tracking their health data in a very rudimentary way based on how they fit into their jeans. But Wofford said the jeans metric is a good example of how CarePass aims to reduce the divide between wellness and health.

“[Fitting into your jeans] is one of the goals we have, and we recommend apps to help [users] acheive that goal,” Wofford said. “But when we think about it, we are actually thinking about metabolic syndrome, because the leading indicator of going from prediabetic to diabetic is actually wasteline. So it actually has a real clinical basis – its not as frivolous as it might sound. … The very same things we’re recommending here in terms of exercise and nutrition are the same things you need if you’re right at that juncture between pre-diabetic and diabetic.”

Once a user selects a goal, CarePass presents them with a curated list of apps and devices they can use to track progress on that goal — not unlike the recently announced app curation engine from Jiff Healthcare. Users can only connect one app or device to a goal at a time, but they can switch at any time. From then on, users can track their progress on CarePass. They can also access the data from the app or device on CarePass, alongside relevant PHI (if they are Aetna users). Finally, users can link out to a relevant SparkPeople community to get support in meeting their goals.

In the future, the company plans to add additional goals focused on sleep, stress management, and possibly even smoking cessation. The company is also considering incorporating PHI from other sources into CarePass. Wofford said this could possibly happen via HHS’s Blue Button initiative if it sees wide adoption.

Quick takes on mobile health efficacy, regulation, and funding

By: Brian Dolan | Jun 18, 2013        

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Brian Dolan, Editor, MobiHealthNewsLast month the medical journal of Diabetes Science and Technology published the results of a small efficacy study conducted at George Washington University Medical Center that used Vocel’s PillPhone application. MobiHealthNews covered the results of the study in-depth back in early 2011 when they were first made public, but last month’s medical journal was the first to officially publish the results.

It’s tempting to make a connection between the many years between this study’s completion and its publication — especially since Vocel went out of business in the meantime — but one of the study’s authors noted that the publication of the study’s results was more happenstance than hard fought:

“Dr. [Samir] Patel and I did not have any special reason for the publication to finally be submitted,” Dr, Richard Katz told me in an email. “We recognized the limitations of the design (which was limited by the grant amount and the time availability of the Pill Phone product) and the fact that the Pill Phone was a first generation ‘unidirectional’ reminder system which would only have mild impact on med adherence behavior change. It has been our experience that mHealth as a simple reminder, without additional human interaction from the healthcare team, will have low and short term success. When this special edition of the J Diabetes and Technology became available we dusted off our data and improved the data analysis for submission.”

Notably, Vocel was the first mobile health company with a patient-facing application to get a greenlight from the FDA.

Speaking of the FDA, Rep. Mike Honda (D-Calif.), whose district covers much of Silicon Valley, just re-introduced a near carbon copy of his 2012 Healthcare Innovation and Marketplace Technologies Act (HIMTA), which he first offered up in December of last year. The 2013 version of the bill is the same word-for-word save for its dates and deadlines — now pushed up a year. The bill calls for the creation of an Office of Wireless Health at the Food and Drug Administration (FDA); a HIPAA-focused developer support program at HHS; an X Prize-like prize program in addition to small “innovator challenges” to “stimulate new approaches”; a low interest loan program for small physician practices and clinics that want to purchase “non-EHR” health care technology; and two year grants that assist medical care providers in retraining employees on how to use health IT.

The bill’s prospects are low, but some of its ideas may find traction.

In other news, we’ve seen it published elsewhere that Boston-based Healthrageous had raised $6 million in its first round of financing this month, but that is, of course, a mis-reading of the company’s June 2010 funding announcement, which for some reason has no date listed. Since then the company has raised a total of at least $15 million. A quick scan of the company’s site shows Healthrageous CTO and Co-founder Doug McClure, formerly of Partners HealthCare, is now just listed as the company’s co-founder. McClure did not respond to a request for comment before deadline. The title change appears to have occurred some time in the past few weeks.

Sensors are great, but they’re still no safeguard against head injuries

By: Neil Versel | Jun 18, 2013        

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Neil_Versel_LargeA story in Sunday’s New York Times about wireless devices that can help detect blows to the head in athletes is bringing fresh attention to the issue of sports-related concussions and how digital health technology can help better monitor and treat head injuries. It also is reaffirming the fact that body-worn sensors are not meant to be substitutes for expert medical care.

As Cambridge, Mass.-based sensor maker MC10 explained to MobiHealthNews a few months ago, its product is not designed to diagnose concussions, but rather to detect signs of head trauma. That’s exactly what Dr. Robert C. Cantu, medical director of the Sports Legacy Institute at Boston University School of Medicine, told the Times.

“[Sensors] give you a rough estimate of total number of hits to the head the person has taken,” Cantu is quoted as saying. “You don’t want to get a high number of hits,” Cantu explained, “because there is no hit that is good for your head.”

However, he added this caveat: “There’s no magic number you can read on a device that means you have a concussion. … Many more factors besides forces are involved.”

Stefan Duma, who runs the Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, told the Times that devices such as the CheckLight, a sensor-equipped beanie from MC10 and Reebok said to be hitting the market this month – a year later than previously planned – for the price of $150, and the forthcoming xPatch from Seattle-based X2 Biosystems, are probably helpful. “They may help us understand more about the risks that come with head impacts,” he said in the article.

However, he came up with several scenarios in which a wearable sensor like the xPatch could backfire. You don’t even have to be a coach to appreciate this tactic: “Players might target people and get their lights blinking to get them removed from the game,” Duma suggested.

Duma has been measuring head impacts on Virginia Tech football players with sensors embedded in their helmets for 11 years, according to the Times. But only recently has the issue of concussions in athletes come to the fore. One might call it epidemic.

The National Football League has 32 teams, each with 53-man active rosters, for a total of 1,696 players – not counting those on practice squads and others listed as inactive due to injury. The PBS show “Frontline” and the ESPN show “Outside the Lines” have teamed up to track concussions in the NFL, based on official team injury reports. By their count, there were 170 reported concussions during the 2012 season. That works out to about one concussion for every 10 players. By any measure, that’s a lot.

It might be a little harder to count concussions in other arenas. Teams in the National Hockey League, for example, play injuries close to the vest, since they aren’t required to be any more specific than “upper body” or “lower body.” However, Sports Illustrated counts 18 NHL players whose careers were ended by concussions, including at least three hall-of-famers.

Major League Baseball player Ryan Freel, who reportedly committed suicide at age 36 last December, claimed in a 2009 interview to have had “nine or 10″ concussions, and also had problems with alcoholism.

Those are just the pros. We really have no idea how many amateur and youth athletes suffer head injuries, but I’m sure it’s a lot. I know I’ve had a couple over the years as a weekend warrior. The 11-year-old son of a friend of mine recently was out of school for nearly three weeks because he sustained a concussion from playing ice hockey.

Fortunately, awareness of the problem of traumatic head injuries is growing. No longer are athletes of any age or skill level being forced back into the game prematurely at the risk of having their toughness or commitment challenged.

I’m not ready to give up playing sports for fun, but I’m certainly being more careful than I used to be. Equipment may be better, but it’s not perfect. A recent feature in Bicycling magazine described how US standards for bike helmets haven’t changed since 1999, and that those standards are based on a test that dates to the 1950s. “Bicycle helmets do an outstanding job of keeping our skulls intact in a major crash. But they do almost nothing to prevent concussions and other significant brain injuries,” the story says.

Researchers have developed a new class of helmets that do help safeguard against concussions, but they aren’t legal for sale in the US because product safety regulations are so difficult to change. The best we can hope for now is continued heightened awareness of head injuries and, yes, better detection of symptoms from innovations such as wearable sensors.

Mayo Clinic to use connected devices in new employee wellness offering

By: Jonah Comstock | Jun 18, 2013        

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Screen Shot 2013-06-17 at 6.02.19 PMMayo Clinic announced last week a new online platform called Mayo Clinic Healthy Living that will leverage mobile health tools to provide preventative care to employees of Mayo’s B2B employer clients. The company plans to launch the product in October.

“The clinic is a great setting, it’s really great for complex medical problems, but for the majority of the population that has no significant chronic problems, it’s not the best place to take care of health,” Dr. Philip Hagen, medical director of the Mayo Clinic’s Healthy Living online program told MobiHealthNews in an interview. “I think that the tools and the techniques of the mobile health world are the ones that have brought us to the point where we can do something like an onsite visit, but through digital tools.”

Mayo Clinic has partnered with a number of digital health companies recently, including backing recently-launched startup Better. The company is also running a number of mobile health pilots including Preventice’s BodyGuardian system, Mayo Clinic helped develop, and the Sessions coaching platform. The organization is also providing patient education content for iPad EHR maker DrChrono.

The new program will combine content from the Mayo Clinic with engagement tools from Everyday Health. The product will use mobile health tools like connected sensors to improve on the traditional health risk assessment. Users will be able to upload data from an as-yet-unnamed connected activity tracker as part of the process of filling out the assessment. The plan is also for employees to be able to track their sleep with another not-yet-revealed device. Hagen said the company is not naming device brands at the moment, but hopes to be able to work with a range of devices.

As part of the offering, Mayo will provide the option of bringing employees in to their Rochester, Minnesota site for an immersive wellness assessment. But whether they come in or not, Hagen said, the assessment and follow-up, using mobile tools, will be the same.

“We’ll offer a similar analog for the people who never set foot in the place,” he said. “The advantage to face to face is the hands-on skill building. But we think the digital tools are good enough now that we can capture a lot of that at a distance.”

The online platform will include a challenge platform for team-based and peer-to-peer competitions data as well as programs for weight management, physical activity, nutrition, resiliency, stress, sleep, tobacco use and preventive services. Employers will be able to tailor the offerings to their particular employee populations. Mayo Clinic Healthy Living will follow up with employees to track their progress.

“Our intent is to work with a number of these different technologies,” said Hagen. “We’re looking to include blood pressure cuffs, connected scales, and glucometers. The more a person has to enter in by hand, the less likely they are to stick with it. So the extent that the device can download that, the better off we are.”

Hagen, a specialist in preventive medicine, stressed the impact wellness programs can have for employers.

“For the past 15 years we have been working hard on developing tools to help companies, including our own, keep their employees healthy,” he said. “And we know from the research that’s being done that, while healthcare costs are high, the costs are at least as high in lost productivity and absenteeism as the actual direct medical costs. So it’s a double whammy.”