OpenNotes study finds better outcomes, more engagement

By: Brian Dolan | Oct 4, 2012        

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Brian Dolan, Editor, MobiHealthNews[Reminder: Be sure to join us today at 2PM Eastern for the Inevitable, Imminent Rise of Remote Patient Monitoring webinar featuring presentations by MobiHealthNews, Preventice, and The Mayo Clinic. If you are not one of the 800 who has registered so far, don’t miss out and sign up right here — it’s free!]

The final results from a yearlong study of how patients and their primary care providers would fare if patients were given access to their physicians’ notes are in: Patients with access to the notes were more engaged and saw better outcomes. The final results are available in this week’s edition of Annals of Internal Medicine. What’s more the study’s authors note that physicians did not report any increase in their workload and some didn’t even realize the program was taking place.

The OpenNotes trial, which was funded by the Robert Wood Johnson Foundation, included participation from more than 13,500 primary care patients who were given access to their physicians’ notes via an online portal and electronic messaging. More than 100 physicians participated in the trial. Overall nearly 11,800 patients out of the 13,564 opened at least one note during the study, which took place at three healthcare facilities: Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Washington. About 84 percent of participating patients at BIDMC opened at least one note, while 92 percent of patients at GHS did, and some 47 percent of those patients participating at HMC did.

According to the study’s authors, a vast majority of the participating patients said that they could more easily understand their medical issues, better remember their treatment plans, better prepare for future visits, and that they felt an increased sense of control.

The study’s authors were also “excited to see that more than half of patients who received medications reported improved adherence, consistent with findings about general adherence from another open-records study”, but noted that self-reports fall short of objective data around adherence.

As we reported at the end of last year, many physicians expected that giving patients access to their notes about them would worry them — more than 50 percent of primary care providers who were set to participate in the OpenNotes study and a vast majority of nonparticipating PCPs expected that sharing visit notes would lead to greater worry among patients, while only about 14 percent of patients felt that way.

The overall positive outcomes from this study could help patients to work more closely with their own primary care providers — even those who practice at facilities that did not participate in the OpenNotes study. As e-Patient Dave concludes in his must-read analysis of the OpenNotes results:

“Many American hospital executives are greatly concerned about the new era of ‘accountable care,’ in which their reimbursement will increasingly depend on how well patients do, and that of course is affected by how much patients do. From the looks of things, this study – and my personal experience in it – strongly support the idea that best patient performance is supported by bringing the patient in – letting us see the medical record,” e-Patient Dave writes. “The evidence says it doesn’t ruin the doc’s life. In fact, it’ll be a business advantage: most patients said it’ll be a factor in which providers they’ll choose! That’s how much patients want it.”

Read the full study results here.


Qualcomm funds study of bloodstream sensors, app-enabled genetic tests

By: Brian Dolan | Oct 4, 2012        

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AirstripRPMThe Qualcomm Foundation announced this week that it had awarded the Scripps Translational Science Institute (STSI) $3.75 million to fund clinical trials focused on wireless biosensor systems, rapid pharmacogenomic diagnostic tests, and apps and embedded sensors for tracking and predicting heart attacks, Type 1 diabetes and some types of cancer. The monies will help fund three years of research focused on wireless health.

According to the companies, one of the first projects that the STSI will take on as a result of the grant will be a research study of AirStrip Technologies’ mobile-enabled remote patient monitoring offering. STSI Director Dr. Eric Topol will lead the study, which aims to determine how mobile monitoring of patients by physicians may improve clinical workflow, patient recovery rates and more.

In addition to the AirStrip study, the grant will enable STSI to focus on three projects:

Clinical trial validation of biosensor systems: Tiny sensors floating in the blood stream can serve as round-the-clock scouts for signs of health problems, such as heart disease, Type 1 diabetes and cancer. Clear evidence of the benefit and value of these technologies is critical for regulatory clearance, reimbursement approval and adoption by healthcare providers.

Development of mobile apps for embedded sensors: These devices look for particular gene expressions, gene mutations, proteins or antibodies that provide the molecular signatures of medical conditions. Once trouble is detected, the sensor can send the data wirelessly to an app on a patient’s smartphone, triggering a message to seek treatment. STSI is collaborating with Dr. Axel Scherer and his team at the California Institute of Technology Nanofabrication Group to build the embedded nanosensors.

Handheld genotyping for precisely prescribing medications: In collaboration with DNA Electronics and Dr. Chris Toumazou at the Imperial College London, STSI is testing a point-of-care chip genotyping platform that can determine within 20 minutes a patient’s DNA compatibility with certain drugs such as Plavix, Metformin and Interferon. The project could help lead to a radical change in the way prescriptions are filled at pharmacies and help to eliminate the costly use of ineffective drugs.

Qualcomm Life’s VP of Global Strategy and Market Development, Don Jones will also join the Scripps Digital Medicine program in an unpaid position as chief digital officer.

More on the grant and the projects it enables here.

Text4Baby developer launches Care4Life for diabetes support

By: Brian Dolan | Oct 4, 2012        

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Care4Life1This week Voxiva, which powers the technology behind the federal government’s Text4Baby program, announced the official launch of Care4Life, a mobile-based diabetes education and support program that leverages text messaging, a mobile app and a web portal. HealthInsight, a multi-specialty care delivery network in the Utah Beacon community is currently evaluating Care4Life.

“Since 99 percent of text messages are read and over 90% are read within three minutes, we know that this channel is effective in its ability to pace the delivery of education and reinforce desired behaviors on an ongoing basis,” Voxiva CEO Justin Sims stated, “numerous studies have demonstrated the efficacy of mobile communications in improving diabetes self-management. We know this works and will make people healthier.”

Theresa Garnero, APRN, BC-ADM, MSN, CDE, author of “Your First Year With Diabetes” developed the content used by Care4Life, which focuses on helping patients with Type 2 diabetes to better control their condition and adhere to their prescribed treatment plan. The offering helps users to create an electronic record of blood glucose readings, blood pressure, weight and exercise that they can view themselves and share with providers. Like Text4Baby, Care4Life is available in both English and Spanish.

Care4Life2“It is the daily reinforcement that is so unique about Care4Life,” Garnero said in a statement. “Interactive text messaging, combined with an online log that is built one text message at a time, will reinforce the guidance provided by the patient’s educator and care team.”

As a promotion Voxiva is currently offering the program to health plans and providers at no charge until the end of the year.

In June 2011 Voxiva announced the launch of Text2Quit, a smoking cessation program similar to Text4Baby. Just a few months later Alere signed on as the exclusive distributor of Text2Quit.

For more on Care4Life, check out this presentation from HealthInsight about the program. (PDF)

Chopra defends Obama’s approach to healthcare innovation

By: Neil Versel | Oct 4, 2012        

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Neil_Versel_LargeA lot of people out there believe “meaningful use” regulations has stymied innovation in health IT by effectively standardizing functionality in electronic health records. Backers of President Obama might argue the point. In fact, one did this week.

“There has never been a better time to be an innovator in healthcare,” former federal CTO Aneesh Chopra, said Wednesday at the 2012 American Health Information Management Association (AHIMA) convention in Chicago. Though he curiously followed comedian and “The View” co-host Joy Behar in the closing plenary session, Chopra was not joking.

And in many ways, he was right. We have a ton of innovation going on right now, as long as you look past traditional EHR functions. And, as Chopra pointed out, a lot of it is in the realm of mobile and wireless health.

Chopra rejoined the Advisory Board Co. as a senior advisor after leaving the Obama administration, and subsequently announced his intention to run for lieutenant governor of Virginia in 2013, was particularly enthusiastic about one program he and his successor Todd Park – who was CTO of HHS before taking Chopra’s White House job – championed: the Health Data Initiative.

In three years, this program, which Park calls “data liberación,” already has produced a number of successful apps. How successful? iTriage, which Dr. Peter Hudson created by downloading an otherwise dry list of Federally Qualified Health Centers maintained by HHS, was bought by Aetna. “Dr. Hudson found a way to make it meaningful,” Chopra said.

iTriage may be the exception to the rule – there wouldn’t be innovation without a few failures along the way – in terms of its sale to a major corporation, but Asthmapolis, which Chopra noted pulls from a little federal database known as the Global Positioning System, has partnered with Qualcomm Life. He also pointed out that symptom-checking and triage app Symcat, which won the backing of accelerator Blueprint Health, queries National Library of Medicine databases in search of medical and scientific knowledge.

“This is starting to have a profound effect on the way you and I access the healthcare system,” Chopra said of mobile apps in general and “liberated” government data in particular.

Some things very much remain works in progress, however.

Castlight Health, which Park helped establish in 2008 before entering government service, went mobile in March. As Chopra noted Wednesday, that system draws on a mix of public and private databases to help consumers understand the costs of health services and compare the quality of certain providers. But we are a long way from having anything close to full price transparency in healthcare.

“We are probably in the first or maybe second inning of empowering patients with this information to make better choices,” Chopra said, using a baseball analogy on the final day of the 2012 major-league regular season.

Chopra also hyped the Blue Button initiative, a push to include a single blue button in EHR patient portals offering patients one-click downloads of their health information to print out, import into personal health records or share with other healthcare providers. Blue Button has its roots, and some success, at the Department of Veterans Affairs; the VA said in August that 1 million patients had clicked to download records in the first two years since Obama announced Blue Button in a speech marking the end of U.S. combat operations in Iraq.

Chopra highlighted a mobile version of Blue Button, namely the iBlueButton suite of iPhone and iPad apps for consumers, veterans and physicians that can “push” data between patient and doctor when two iBlueButton users are within Wi-Fi or Bluetooth range of each other. “Apps like the iBlueButton allows people to literally fistbump their medical records [onto their phones],” Chopra said. Keep reading>>

Mayo telestroke study affirms accuracy of ResolutionMD smartphone app

By: Neil Versel | Oct 3, 2012        

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resolution-mdThe evidence is building that smartphones are suitable for remote viewing of medical images by consulting specialists. The latest comes from the Mayo Clinic Telestroke Network in Arizona, which found that the ResolutionMD Mobile smartphone app, from Calgary Scientific, was adequate for evaluating remotely located stroke patients.

“CT head interpretations of telestroke network patients by vascular neurologists using ResolutionMD on smartphones were in excellent agreement with interpretations by spoke radiologists using a picture archiving and communications system and those of independent telestroke adjudicators using a desktop viewer,” concludes a study published in the October issue of the American Heart Association journal Stroke.

“Essentially what this means is that telemedicine can fit in our pockets,” Mayo Clinic Telestroke Medical Director Dr. Bart Demaerschalk says in a Mayo press release. “For patients this means access to expertise in a timely fashion when they need it most, no matter what emergency room they may find themselves.”

Mayo Clinic neurologists in Phoenix can remotely consult with emergency departments at 12 rural hospitals, mostly in Arizona, that have fixed telemedicine platforms or telemedicine robots. Typically, the stroke specialists have face-to-face video chats with remote ED physicians and view brain scans on a standard desktop or laptop PC to look for signs of hemorrhage or blocked arteries.

For this study, the Mayo neurologists and radiologists at Yuma (Ariz.) Regional Medical Center compared brain scans for 53 patients on traditional PACS displays and with the FDA-cleared ResolutionMD app. The reviewers were in agreement on 92 to 100 percent of what are considered the most important radiological features, according to the report.

Quick diagnosis of stroke and administration of clot-busting drugs can save lives and the remote nature of the telestroke interventions help prevent costly, dangerous patient transfers by ambulance or airlift from rural facilities to urban trauma centers. Being able to make accurate diagnoses from mobile devices can save even more precious time when on-call neurologists are not in front of a PACS station.

“If we can transmit health information securely and simultaneously use the video conferencing capabilities for clinical assessments, we can have telemedicine anywhere, which is essential in a state like Arizona where more than 40 percent of the population doesn’t have access to immediate neurologic care,” Demaerschalk says.

For more, watch this video of Demaerschalk explaining the study.

Medical device tax could hurt medical app developers

By: Brian Dolan | Oct 2, 2012        

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iBGStar Diabetes Manager App iPhoneIn an editorial published in The Wall Street Journal last week, former Senator Evan Bayh, a Democrat from Indiana, argued that at least one provision in the Affordable Care Act “threatens thousands of American jobs and our global competitiveness”. Bayh was pointing to the 2.3 percent tax that the law requires medical device companies to tack on to each sale starting in January.

For the first half of his editorial Bayh extols the medical device industry before making his most provocative point:

“All of this is now threatened by the only law that is guaranteed to pass in Washington: the law of unintended consequences. A 2.3 percent tax on medical-device sales, not profits, was imposed under the theory that sales to medical device companies would surge after patients newly insured by the Affordable Care Act poured into the system. What the industry lost in margins, it was supposed to make up in greater volume. That calculation ignored the fact that the vast majority of medical-device consumers already are covered by Medicare, Medicaid or private insurance,” Bayh writes.

Bayh also glancingly referenced FDA regulated medical apps, which, of course, are also medical devices:

“Especially hard hit could be the hundreds of small companies developing medical software applications. These apps promise to revolutionize the practice of medicine—for instance, by delivering blood-sugar test results for diabetics. The IRS is deciding now whether to treat apps as medical devices subject to the tax,” he writes.

Bayh, who now works at a law firm that represents a number of medical device companies, points out that the House has already voted to repeal the medical device tax, but the Senate appears less likely to do so.

Quick Plug: The medical device discussion here on MobiHealthNews is largely centered on remote patient monitoring — using converged medical devices and sometimes companion medical apps on mobile devices to provide care any place and any time. MobiHealthNews is excited to discuss this trend with the Mayo Clinic and their partner Preventice during a free webinar this Thursday at 2PM ET. Don’t miss it! Register here for The Inevitable, Imminent Rise of Remote Patient Monitoring to join the discussion.