What the Air Force’s PHR efforts reveal about patient adoption

By: Jonah Comstock | Feb 27, 2013        

Tags: | | | | | | | |  |
The study looked at the Air Force's MiCare PHR.

The study looked at the Air Force's MiCare PHR.

The failure of Google Health in 2011 pointed to a critical question about patient health records (PHRs): do people want them? If a giant like Google couldn’t get enough people interested in their own health records to continue offering the service, what hope was there for mass market penetration. With Meaningful Use Stage 2 requiring hospitals to not only offer patient access to their records, but that at least 5 percent of patients actually access them, the question has never been more salient.

A recent study in the Journal of Medical Internet Research aimed to look at the question of PHR adoption in the context of an employer program. The University of Maryland’s Dr. Ritu Agarwhal and her research team conducted an observational study at Elmendorf Air Force Base in Alaska in December 2010, as the base was launching its MiCare opt-in PHR and secure messaging system. Only about 7 percent of the patients at the base invited to register for the PHR system actually did so: 1,801 out of some 26,000. Of those, 283 completed surveys about how they intended to use the records.

“The survey sample was significantly older, higher paid, more sick, and more likely to be female than the [overall] Elmendorf population,” the study reports. “The survey sample was also older, higher paid, more sick, and more likely to be active duty than early adopters who chose not to complete the survey. These differences were consistent with findings from other studies which examined usage patterns of secure messaging and found usage to be higher for women, individuals with higher levels of education, and increased morbidities. Education information was not available from the Air Force databases, but income was often correlated with education.” They also found that most of the survey group rated their computer skills as “quite extensive” or “very extensive.”

In addition to these broad demographic trends, Agarwhal and her team found a link between patients’ current satisfaction with their health provider and adoption of the PHR, suggesting that one thing providers can do to increase adoption is to build strong relationships with patients. They also found that communication about the PHR tool needed to be specific and personalized. In the study, they found that respondents who considered record keeping the most important function of the PHR were less likely to use it, possibly because the marketing materials downplayed the record-keeping functionality compared to the patient-provider engagement functions.

In general, the study found that effective communication from the employer was a bigger factor in adoption intention than whether a patient thought the system would be useful.

“The health care process management support function of the PHR represents a two-way street between the patient and provider (eg, scheduling appointments, exchanging messages),” the study says. “It is not surprising that the patient needs to perceive that the other party in the exchange believes in the benefits of the system as well. Communication tactics help reinforce this message. Organizations planning a PHR implementation should carefully craft a communication strategy suited to their organization’s needs to improve the likelihood of a high adoption rate, resulting in the highest return on their investment in the technology.”


New sensors aim to make surgery smarter

By: Jonah Comstock | Feb 27, 2013        

Tags: | | | | | | | | | | |  |
The smart handle from Fraunhofer.

The smart handle from Fraunhofer.

Surgeons learn to conduct all sorts of mind-bogglingly complex procedures within our bodies, whether it’s installing and adjusting medical devices, removing or ablating tumors, or conducting precise surgery on organs as small as our eyes. Surgeons do incredible work with their hands and manual tools, but a new generation of smart surgical tools, incorporating microsensors and instant feedback, could make these difficult jobs safer and easier.

The latest such tool, from Fraunhofer Institute for Manufacturing Engineering and Automation IPA and Weber Instrumente GmbH in Stuttgart, Germany, which, as MedGadget noted, is similar to the digital torque wrench a mechanic might use to fix your car. It’s actually a smart handle that can be attached to surgical screwdrivers or surgical spreaders. Sensors in the handle measure the force being applied and tell the surgeon whether they can safely tighten a screw more or insert a tool more deeply — specifically, the handle lights up when it reaches optimal torsion.

It’s more complicated to make a smart surgical device than, for instance, a mechanic’s wrench, because surgical tools need to be sterile. There can’t be any seam or hole where germs can fester, and the whole device needs to be able to be sterilized. Fraunhofer’s handle charges wirelessly with no plug and the electronics can be switched off so the device can be safely heated up to 134 degrees Celsius. The handle also records the force data and can transmit it to a computer, allowing the surgical process to be documented for research or training.

Another technology, developed this past summer at Johns Hopkins, was designed to aid surgeons in operations involving very small movements – like eye surgery.

“The retina is about 250 microns thick and very fragile,” Kristi Birch writes in the Johns Hopkins Engineering Magazine. “Some scar tissue is no more than 3 microns thick and transparent to boot. And when even a good eye surgeon can have 40 microns of hand tremor that must be compensated for, removing the scar tissue is very difficult and not always successful. Surgeons sometimes have had to accept small areas of injury in order to recover larger or more vision-critical areas of the retina.”

Like the smart handle, the tool developed by Jin Kang is a module that can be attached to different surgical tool tips. Using a laser probe and a motor, the tool compensates for a surgeons involuntary hand movements, holding the tool steady even during extremely precise surgery.

One more technology moves beyond tools as we know them entirely, making the surgeon’s hand itself into a smart device. As reported in the Daily Mail, electronic fingertip sensors developed by researchers from University of Illinois at Urbana-Champaign, Northwestern University and Dalian University of Technology can be built into surgical gloves, allowing surgeons to detect data like temperature and connectivity. The gloves could allow surgeons to perform heat-based ablation from their fingertips or even obtain ultrasound imagery of the tissue. The gloves were written up in the journal Nanotechnology last August.

Practice Fusion acquires wellness startup 100Plus

By: Brian Dolan | Feb 27, 2013        

Tags: | | | | | |  |

100plusPractice Fusion, developer of a free, web-based EHR system, has acquired consumer health app startup 100Plus for an undisclosed sum. 100Plus was co-founded by data analytics pro Chris Hogg and Practice Fusion CEO Ryan Howard in late 2011. Hogg told MobiHealthNews that Howard was not directly involved with the day-to-day running of 100Plus and served as more of a mentor to him. 100Plus was the first company to leverage Practice Fusion’s data set, and it was also based out of the Practice Fusion offices in downtown San Francisco. Financial terms of the deal were not disclosed.

100Plus raised $1.25 million in seed funding, with $500,000 of that coming from Peter Thiel’s Founders Fund.

The entire 100Plus team has joined Practice Fusion, Hogg said, and he will become Vice President of Data Sciences at the company. While 100Plus will continue working on consumer-facing apps, they will also begin focusing on apps that help patients and providers better work together. It appears that 100Plus has become an integral part of Practice Fusion’s patient engagement strategy, which, partly because of meaningful use requirements, has become increasingly important to EHR developers and healthcare providers alike.

“[100Plus] had a couple offers come in and we started talking to Practice Fusion, too,” Hogg told MobiHealthNews. “The idea of doing what we were already doing but on such a larger scale and with Practice Fusion’s distribution just made a lot sense. Our goals are so synergistic with their future goals. Strategically this move made a lot of sense. We get to keep doing what we were doing in a slightly different way.”

Hogg said Practice Fusion is looking ahead and they know how important patient engagement is and how challenging it is. Hogg said the company wants to focus on health that happens between doctor visits.

100Plus was a consumer wellness app developer. It wasn’t interested in activity at the gym but rather in alerting people to health opportunities or “hopps” like walking hills with views in your neighborhood and “healthifying” your commute by taking stairs instead of the escalator. At Health 2.0 in Boston last year Hogg told MobiHealthNews that these small things have become undervalued and people have been trained to think that the only way to be healthy is to go for a run or head to the gym. 100Plus never fully launched a product, but rather a series of beta testing apps. One of its most interesting concepts was Lifescore, which gave users a sense of how these small actions can affect their longterm health. Healthy actions added small increments of additional time to the user’s life expectancy, which starts at 78.1 years for everyone since that is the general life expectancy. It then got tweaked based on demographic information — women live longer, for example — and then by real-time actions.

“It is hard to get people to an app that is focused on health and wellness,” Hogg told MobiHealthNews this week. “I have thought about that so much over the last year. The way I see it, at least in the near term — the next one, two or three years — there are a couple of defined ways that people come to a health or wellness app. One of them is that people find an app to help them tracking something that they already do — running, biking, and so on. Apps like RunKeeper. Then there are apps that are tied to a device of some kind and really extracting the value out of the device — that’s Jawbone, Misfit, Fitbit and the rest. The third way people come to a health app is that companies tell [their employees] to use them. The fourth way is going to be that doctors are going to tell them to use these apps.”

Outside of those channels Hogg said it becomes very hard to break through the noise and gain mass adoption. Hogg has long been a believer that this fourth way — that doctors will prescribe apps — will be key for mobile health. Just before founding 100Plus in 2011 he gave a TEDx talk in Silicon Valley that mentioned it.

“This will be a major trend,” Hogg told MobiHealthNews. “It’s also why Practice Fusion was the ideal choice for us.”

Hogg agrees that there has existed a fairly wide gap between healthcare and wellness. He said it was a “bifurcation” that he has often pointed to in his presentations at industry events over the years. While the founding of a consumer wellness startup like 100Plus as a partner company of an EHR vendor like Practice Fusion was already a sign that the gap was narrowing, the acquisition of 100Plus by Practice Fusion could help close it altogether for providers that use Practice Fusion’s EHR.

Aetna offers international members mobile app to file claims from anywhere

By: Brian Dolan | Feb 26, 2013        

Tags: | | | | | | |  |

Aetna Mobile Assistant AppThis week Aetna announced the launch of its Mobile Assistant App for non-US-based members that aims to make it easier for them submit health claims and receipts by snapping a photo of them with their smartphones. The free app is now available in Apple’s AppStore and for Android users through Google Play.

The app is currently available to Aetna’s international customers who live outside of the US, but a version for US expats will also launch later this year. Aetna noted that the app is not available to members who live in China, because regulations in that country require that original documents be submitted.

Using the smartphone’s camera to scan and submit health insurance claims has been available from various insurance companies for years. In 2011 we reported on the rise of camera phones’ role in the automation of healthcare-related paperwork.

Curiously, Aetna’s main mobile app, called Aetna Mobile, does offer its members the ability to view the past five claims they submitted, but it does not include a camera-enabled claims submission feature.

Aetna also announced this week that it was reviving the Healthagen brand, which used to be the parent company name of iTriage, the mobile health company that Aetna acquired in 2011. The new Healthagen division at Aetna will include Aetna’s population health management solutions and health information technologies from ActiveHealth Management, iTriage, and Medicity. Sharp eyes trolling the list of exhibitors at HIMSS would have noticed that Healthagen has been on there for weeks alongside subsidiaries like iTriage.

More on the Healthagen division formation in the Aetna announcement here.

Misfit Shine appears on Jeopardy! expects to ship in June now

By: Brian Dolan | Feb 26, 2013        

Tags: | | | | | | | |  |

1zZce.jpg.gifLast Friday mobile health startup Misfit Wearables received some free publicity from television gameshow Jeopardy! when its soon-to-launch Shine device was featured as part of one of the last clues in the semi-finals edition.

The clue was: “The Misfit Shine is a high tech one of these that tracks how much you not only walk but bike or swim.” The correct question was “What is a pedometer?” which one of the contestants guessed immediately.

“I wish I had a cooler story but to be completely honest, I think a staff writer probably just heard about us,” Misfit co-founder Sonny Vu told MobiHealthNews. “Perhaps they were one of the 8,000 people who ordered [a Shine device] on [crowdfunding site] Indiegogo or one of the [650,000] views on YouTube… and thought it’d be cool to include us rather than any one of the dozens of other activity trackers.”

Vu said his company hasn’t hired a PR firm or anything like that, but he was happy to see a digital health company get some mainstream action on TV like this.

“It was just a $200 hint,” Vu pointed out, “so I guess it was a pretty easy clue. [Does that mean] everyone knows what a pedometer is?”

This week Misfit Wearables also notified those who bought the device via Indiegogo that the company expects to begin shipping in June. Its customers have pre-ordered about 10,000 devices. The first 5,000 units will go out on or before June 1st and the remainder will be out by June 15th, the company wrote. When it first launched on Indiegogo last November, Misfit expected to get the devices out by March. In late January Vu told MobiHealthNews they would get them out “as soon as humanly possible”.

In its most recent email to Shine buyers, the company wrote: “We’re really sorry we can’t get Shine out sooner to you. If you’d like a refund for any reason, we’d be more than happy to give back 100% of the money that you gave us – even if your order was later in the campaign.”

In recent weeks Misfit has also made two updates to the Shine. Most recently, the device has been revamped with a new wireless firmware update feature, so the device can receive fixes and improvements when it syncs to the user’s phone, if needed. The device is also sporting brighter lights than were previously demo’d. Misfit also expects to announce its next product this fall.

Watch the Shine’s appearance on Jeopardy! in the clip below (starts at 8:59):


Rumor: Samsung Galaxy S IV to launch with mobile health peripheral

By: Jonah Comstock | Feb 26, 2013        

Tags: | | |  |
Samsung Galaxy SIII

Samsung Galaxy SIII

There has been a fair amount of speculation this week based on a report in a Korean publication, first picked up by Android technology blog The Droid Guy, that Samsung’s upcoming Galaxy S IV smartphone launch will include the launch of a mobile health peripheral. According to the Korean report, the peripheral device is described in part as a “pad” similar in form factor to a weight scale. The report also claims the device can track and transmit pulse rate and measure blood glucose.

Based on translations by two native Korean speakers, MobiHealthNews has learned that the original Korean report claims that Samsung will provide this health peripheral device without additional charges to those who buy the S IV. Samsung already has a healthcare division and it expects synergy effects between these two parts of its company following this launch.

If true, the rumored device will likely build on Samsung’s S Health app launch, which coincided with the device company’s Galaxy S III launch last year. S Health connects with a handful of health monitoring devices to track blood pressure, blood sugar, and weight and allows manual entry to track diet, exercise medication adherence. It was launched in several countries including the UK last July, but it didn’t find its way to US phones as planned. According to a Samsung spokesperson, S Health is currently only available on the “global” version of the S III device. Mobile operators in the US often strip out some preloaded apps and software and add their own apps, too.

Although Samsung wouldn’t confirm it, the lack of a US release might be because the app might require FDA clearance, which it does not appear to have currently. The same reason could certainly keep the new rumored health peripheral from launching here as well.

We won’t have to wait too long to see whether the rumored connected health tablet is coming to the United States. The Galaxy S IV is scheduled to launch on March 14, at Radio City Music Hall in New York City.