Cigna, BodyMedia partner to study diabetes prevention

By: Jonah Comstock | Jan 24, 2013        

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BodyMedia Fit ArmbandOne thread MobiHealthNews has been following since 2010 is the changing role of the payer in digital health. The buzz at the mHealth Summit suggested that 2013 could be a big year for payers taking on more proactive, preventative measures to reduce their own costs and improve the health of their clients.

Health insurer and self-styled “global health services company” Cigna has announced a partnership with BodyMedia to use the latter company’s popular armband tracker as a diabetes prevention and management tool. Cigna is launching a pilot program with four of its US employer health plan clients, serving 16,000 employees total.

Through the program, employees will be given a BodyMedia device to wear constantly, which will monitor their calories burned, physical activity, and other physiological data. That data will be transmitted to coaches who will work with the employees to modify their behavior and motivate them to healthy actions.

BodyMedia’s CEO Christine Robins has long maintained that her product is for people dealing with serious health problems, and the company has a history of advancing through high-profile partnerships: 24-Hour Fitness and NBC’s The Biggest Loser are two examples. But in partnering with Cigna, Robins is pushing the device into a new use case, focusing on diabetes specifically rather than weight gain or fitness more generally.

“Fitness trackers have proven their value in weight control, but this study illustrates their potential usefulness for other health purposes,” Robins said in a statement. “If being able to see your food and exercise choices will change your behavior – and we believe it can, based on our experience with consumers who use our armbands to support their weight loss efforts – healthcare practitioners may have a whole new way to deal with a variety of lifestyle-related health conditions.”

Cigna made headlines recently when they partnered with Audax Health, a company developing a health-focused, HIPAA-compliant social network. Audax is apparently developing an in-house version of its network for Cigna’s clients. In the past, the company has partnered with behavior change app Daily Feats.

Between this deal with BodyMedia and the recent Audax partnership, Cigna is putting itself on the digital health map in a big way. The pilot will also produce RCT-quality data according to Cigna, so other payers will certainly be watching closely.

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Misfit’s Shine raised $846K on Indiegogo; new product expected this fall

By: Brian Dolan | Jan 24, 2013        

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Misfit Shine syncing on phoneLast year Misfit Wearables’ activity monitoring device Shine met its goal of raising $100,000 on Indiegogo in less than 10 hours after launching on the crowdfunding site. Last week Misfit’s two month campaign came to close with about $846,000 raised from almost 8,000 people from 64 countries and all 50 states.

All told, the company now has pre-orders for about 10,000 Shine devices, which it aims to ship “as soon as humanly possible” some time this spring, Misfit Co-founder Sonny Vu told MobiHealthNews. A new product from the Misfit team will also launch in this fall, Vu said.

The Shine activity tracker device is about the size of a couple of quarters stacked together. While it is waterproof, the all-aluminum device also has thousands of micro laser drilled holes on its surface that let LED lights to shine through. These act as the device’s interface by illustrating the activity mode the device is currently tracking in with various LED configurations that represent running, swimming, or biking. Shine also uses a new form of wireless data transfer, because its solid aluminum build makes it nearly impossible to leverage common wireless transfer technologies like Bluetooth.

At an Indiegogo-hosted media breakfast held at CES in Las Vegas earlier this month, Vu and other startup co-founders who had successful campaigns through the crowdfunding site shared their experiences:

Vu said crowdfunding was completely contrary to Misfit’s original plans for how to launch, which was to remain stealthy. Misfit was not going to bother announcing its first product until it was ready to buy within three days. Then, Vu said, his team read the book The Lean Startup (which he said made them the last company in Silicon Valley to read it) and they changed course. They chose to crowdfund the Shine because they wanted feedback as soon as possible.

“Will people actually pay for this device? Yes they are paying for other pedometers out there but we took some pretty bold design decisions…” Vu said. “We wanted to get validation before we spent ‘x’ number of dollars on marketing and manufacturing.”

Vu said they ended up learning a lot including about price elasticity and a new business model.

“Almost all the companies in the Valley are praying for software [revenues], so they hope people will buy a device and then pay for a coach or some other kind of software. We learned [through our Indiegogo campaign] that people will buy hardware accessories. People will buy a leather strap or a necklace accessory.”

Prior to the Indiegogo launch last year, Hadi El Heneidi, Misfit Wearables’ Commercial Lead told MobiHealthNews that Misfit decided to soft launch Shine through a crowdfunding platform because the company wanted the community’s blessing before committing to a full launch. Keep reading>>

Interoperability holds the key to EHR, mobile health success

By: Neil Versel | Jan 24, 2013        

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Neil_Versel_LargeHave you seen all the pushback of late against the direction of the “meaningful use” EHR incentive program and EHRs in general?

The year started with the publication of a RAND Corp. study in Health Affairs cautioning that health IT had fallen far short of its potential so far. Notably, EHR design and implementation problems, a lack of interoperability and continued reluctance among providers to redesign care processes and spend time trying to “master difficult-to-use technology” has stood in the way of expected cost savings, efficiency gains and better care.

Meanwhile, interest groups all over the country have been publicizing their comments to the Department of Health and Human Services in response to the Health IT Policy Committee’s preliminary recommendations for Stage 3 of meaningful use, and quite a few have been critical of the whole direction of the program.

Not surprisingly, the American Medical Association (AMA) and the American Hospital Association (AHA) both said it was premature to develop rules for Stage 3 before Stage 2 starts in 2014 and while many providers have not yet achieved Stage 1. But even some EHR vendors have expressed reservations.

“The pace is too damn high,” John Glaser, Siemens Healthcare’s CEO of health services, told Forbes, suggesting that there hasn’t been enough time to focus on interoperability of health information. “We need the time to do it right,” Glaser said.

I don’t think anyone would argue at this point that there aren’t gaps in meaningful use and in health IT, particularly when it comes to interoperability. And that’s where mobile and personal health devices need to come in.

Last week, the Association for Advancement of Medical Instrumentation (AAMI) and the Food and Drug Administration (FDA) issued a report based on a summit they convened in October suggesting that policy-makers were ignoring all the data coming from connected medical devices by focusing so much on EHRs.

“Healthcare organizations are focused on getting electronic health records (EHRs) up and running. Very few are stepping into the even more complex space of device interoperability,” the report said. But they eventually will need to pay attention to the latter, which includes everything from home health monitors to fitness counters to inpatient telemetry equipment.

“Getting it right protects patients, contributes to clinical decisions and positive patient outcomes, and improves efficiency. Getting it wrong introduces significant risk and the likelihood of adverse patient events. Worse, getting it wrong doesn’t mean returning to the baseline risks of an unconnected world — it will lead to more serious situations than exist now. Safe interoperability is central, not peripheral, to the core mission of healthcare,” the AAMI and FDA said.

At least one person believes device interoperability is coming as soon as Stage 3, which is scheduled to start in 2016, or two years after a provider first achieves Stage 2, whichever is later. That person is Chuck Parker, executive director of the Continua Health Alliance.

Writing on the HIMSS blog this week, Parker said the current recommendations for Stage 3 promise to get everyone connected by encouraging patient engagement. “If [the HIT Policy Committee’s] recommendations come to pass, Stage 3 will encourage medical practices and hospitals to enlist their patients to use health devices and apps, and to accept patient-generated data into EHRs,” Parker said.

“Studies of connected health show that when patients incorporate mHealth into their lives — at home, work, and on the go — they recognize the relationship between their health behaviors and experience of health and are consequently better able to self-manage. My prediction is that practices and hospitals embracing Stage 3 will discover a new capacity to bring about positive outcomes through timely, targeted interventions, both at the individual and population levels,” Parker continued, but then he added one caveat: devices and IT systems need to be connected.

“The fact is, unless personal health devices work together with minimal effort, patients are unlikely to stick with mHealth tools, and the momentous opportunity for connected health will be lost,” Parker said.

Yes, interoperability remains elusive and difficult. But we have to get it right. Billions of public and private dollars are on the line here, and more importantly, so are millions of lives.

FDA clears Welch Allyn’s iPhone-enabled opthalmoscope

By: Jonah Comstock | Jan 24, 2013        

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An iPhone app and peripheral device that allows doctors to use the iPhone camera to take photographs of the interior surface of the eye has received 510(K) FDA clearance.

iExaminerThe iExaminer System from Welch Allyn will build on the company’s existing PanOptic Opthalmoscope, a device that lets a physician see into the back of a patient’s eye. The FDA clearance is for an adapter that connects the opthalmoscope to an iPhone 4 or 4s and an app that will allow the iPhone to take about 85 images in five seconds.

“It really is more of an enhancement or supplement,” said product manager Rick Farchione. “It provides the ability to store and analyze the image, send for consultation, and save for future comparison. That’s what it does better than a traditional opthalmoscope.”

Farchione said the primary market for the device, which is cleared for medical professional (prescription) use only, is not eye specialists. The goal is, instead, to give primary care physicians and multi-specialist clinicians the means to do an eye exam without more expensive equipment (the whole system costs about $600). Images of the interior of the eye, or the fundus, can help doctors diagnose glaucoma, hypertension, and papilledema. Perhaps the most common case, Farchione said, is diabetes. He said about half of diabetes patients don’t get an eye exam when they should.

With the pictures instantly available on the iPhone screen, doctors can easily show the patient a picture of their eye, which can be helpful in motivating a patient to seek treatment.

The MIT Media Lab has developed technology that uses an iPhone to detect cataracts and a consumer-facing eye diagnostic peripheral, but neither tool fills the same role as a fundus camera. Farchione said it’s unlikely the company will adapt this technology for consumer use.

Currently the FDA clearance is only for the iPhone 4 and 4s, and Farchione said the device is not currently designed to work with the iPhone 5.

“Not to say we will not do it,” he said, “but we don’t have definitive plans at this time.”

100Plus beta launch pairs little actions with big data

By: Jonah Comstock | Jan 23, 2013        

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100plusAfter a year of development and “app experiments,” 100Plus, a startup backed by, among others, PayPal cofounder Peter Thiel’s Founder Fund and LinkedIn cofounder Reid Hoffman, is debuting in public beta. The app combines little actions with big data to motivate users to lead generally healthier, more active lifestyles.

“There’s quite a lot of literature that just being more active in your daily life is as good or even better than exercising a lot,” CEO Chris Hogg told MobiHealthNews, citing this 1999 JAMA study and recent coverage in the New York Times Well blog.

In addition, Hogg said, getting people to be active in little ways — like taking the stairs rather than an elevator — is easier than getting them to make a big life change, like adding the gym into their weekly routine.

“Everybody wants to be healthier, but most people don’t know what to do,” he said. “They know in the abstract, but giving people very concrete suggestions is very motivating for them. They want this little nudge.”

The 100Plus app presents users with a series of health opportunities or “Hopps”, which are tailored specifically to their neighborhood. Initially these will be created by the developer, but as people adopt the app they’ll be able to create their own Hopps, which can then be served to others. The app will launch with nearly 18,000 Hopps in 7,000 different locations.

“So not just ‘eat a salad,’ but ‘eat a salad at this restaurant that’s close to you,’ ” Hogg said.

Users check in as having completed their Hopp by taking a picture, and the app rewards them with a fact about that activity and why it’s good for you, and with an update to their “LifeScore.” The LifeScore is the other big component of 100plus: Using data from the CDC and EHR provider Practice Fusion, the app adds and subtracts years, months, weeks or days to the user’s life expectancy. It mostly adds.

“We plan to get more and more data from people over time,” Hogg said. “Without data, we assume you’re average. And then [based on] everything we learn about you, your score changes.”

The app will calculate a basic score based on age, gender, city of residence, and whatever other information the user chooses to provide during an introductory survey. Each Hopp completed will adjust the score a little bit in an upward direction. Hogg said that people instantly understand adding weeks or months to one’s life, as opposed to using an abstract or artificial scale.

Rather than launching a lengthy private beta, Hogg and his team tested the waters with two smaller “app experiments” over the course of the year. The first, 100proof, was localized to film and music festival South by Southwest. Seven thousand attendees downloaded the app and took an interactive survey about their drinking habits at the festival. In turn, the app displayed data about how they compared to others at the festival and to national averages and told them how the habit would affect their lifespan.

“There’s a myth that people don’t want to give you information,” said Hogg. “From 100Proof, we learned that people are very interested in giving you this type of data, especially when they get something cool in return. It kind of proved that data can be used to engage people, to make a fun experience.”

More recently, the company developed an app called Outside, which is how the team derived the idea of using photographs to help engage people in their achievements, Hogg said.

The company plans to submit the app to the iOS App Store within a month or so, Hogg said, and the Android version is expected by the end of February. In the meantime, customers can sign up for the public beta at 100plus.com.

In addition to going direct to consumer, the company has signed a deal with a major employer to include 100plus as part of their health plan, with some others in the works.

The company also signed a new deal with Practice Fusion to get access to another 1 million de-identified health records from the company, information Hogg said will be invaluable in refining their LifeScore algorithm.

In the future, 100Plus is looking to integrate with self-tracking apps and gadgets. Hogg said that integrating with RunKeeper, so that users’ LifeScores go up when they run, is at the top of his list. He said they’re also in conversation with Jawbone UP and Sonny Vu of Misfit Wearables.

Microsoft sees pen, computing power as differentiators for Surface Pro tablet

By: Neil Versel | Jan 23, 2013        

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Microsoft Windows 8 Surface Pro tabletMicrosoft is upping the ante in the tablet game.

The Redmond Empire announced Tuesday that Microsoft Surface Windows 8 Pro, a business-class line of its Surface tablets, will hit stores in the U.S. and Canada on Feb. 9. The Pro models will have third-generation Intel Core i5 processors, touch screens with 1080p (1,920 by 1,080) HD resolution, plus an included digital pen and “Palm Block” technology that prevents extraneous marks and commands when users rest their palms on the on the screen while writing with the pen. Each one also has a full-size USB 3.0 port and a Mini DisplayPort interface that can output to external displays with up to 2,560-by-1,400 resolution.

Unlike basic Surface models that start at $499, Surface Windows 8 Pro tablets will run any Windows 8 application or Windows 7 desktop software, so they are just as powerful as a laptop. However, the 10.6-inch Pro tablets are not cheap: $899 for a 64-gigabyte version or $999 for 128 GB, with an add-on keyboard available for $100-$120 – more than the most expensive iPad. Apple’s 64 GB tablet with built-in 3G or 4G cellular connectivity tops out at $829; the entry-level 16 GB iPad mini with just WiFi costs $329.

In healthcare, Microsoft is pushing the computing power, the pen, and Palm Block features as a differentiator.

“For years I have been writing about the challenges of data input in clinical medicine. Doctors and other clinicians need all of the data input options possible including keyboard, mouse, touch, pen and voice,” Dr. Bill Crounse, Microsoft’s worldwide senior director for health, writes on the Microsoft HealthBlog.

“With Surface Pro, you’ll have it all. With EMR solutions and apps that have been optimized for Windows 8, you’ll be able to tap into discrete data fields and enter information (with handwriting to text conversion) using the pen. The pen can also serve as a navigation, tap and dictate tool if you are using voice recognition software,” Crounse continues.

Microsoft will sell the Surface Pro tablets through its own bricks-and-mortar and online retail stores in the U.S. and Canada, as well as at Best Buy and Staples locations in the U.S., the company says.