Epocrates for patients may be coming soon

By: Brian Dolan | Nov 20, 2012        

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Brian Dolan, Editor, MobiHealthNewsWhen Epocrates officially filed its plans for a $75 million IPO in mid-2010, the point of care medical reference company said it had more than 1 million users across the globe. At the time it said about 40 percent of the physicians in the US used its applications. Two years later Epocrates still has about 1 million total users but about 50 percent of US doctors now use its apps. Epocrates’ user base could change dramatically soon.

During the most recent Epocrates investor call, President and CEO Andrew Hurd mentioned a potentially “transformative” move for the company: Develop an Epocrates app for patients.

“We are looking at this,” Hurd told MobiHealthNews during a recent interview, “but we want to be thoughtful about it. We do have some initiatives underway. This is a path that I think the market is going [down] and it is an opportunity that we are really well-positioned to take advantage of.”

Hurd, of course, is right to be “thoughtful” about any potentially transformative initiatives. Earlier this year Epocrates announced that it finally shuttered its ill-timed EHR offering, which the company has not sold. Hurd said a piece of the EHR functionality has been licensed out to someone, but the company has not and “probably will not sell the whole EHR functionality.” When Epocrates announced that it was pulling the plug on the EHR in February, then-interim CEO Peter Brandt said the project had proven to be a distraction that hindered the company’s ability to pursue opportunities closer to its core capabilities.

Hurd thinks the patient opportunity makes more sense.

“The uniqueness of Epocrates is that this platform does not just have half the docs in the US, but half the docs in the US are using Epocrates while they are interacting with their patients and typically it’s being used during the treatment path,” Hurd said. “That is pretty unique and pretty powerful. That position — both our scale and the fact that Epocrates is being use during that treatment path — is unlike any other medical application in the market today. We believe there is an opportunity for us to be able to extend that encounter.”

Hurd believes Epocrates can become a better “swivel app”, where a doctor turns their mobile’s screen around to share some information with a patient about a drug interaction, for example. The next step would be for that physician to tell that they can download an Epocrates patient application to manage the medications that they are on, check symptoms, or look at drug interactions themselves.

“The value for the physician here is that this patient would now be using the same IP and the same knowledge database that they are instead of [medical reference sources with] conflicting information,” Hurd said. “Also, when the patient leaves the office it is likely they will forget half of what was said — or maybe the patient forgot to ask a question that they wanted to ask their physician. With a shared application that is running on the same IP and has the same database of information, they can refer to that rather than having to call back or return to visit the physician.”

“The continuity of the knowledge base is unlike anything that is out there today,” Hurd said.

Given the overall increased focus on patient engagement in healthcare today and Epocrates positioning at the point of care, a pivot toward making the patient a better informed partner in their own care seems to be the right one for this company. If Epocrates’ physician users become willing channels for an Epocrates patient app — should one ever become available — Epocrates could see substantial gains to its 1 million strong user base, too.

WEBINAR: For more on mobile health at the point of care, be sure to tune into our upcoming webinar next Thursday, November 29th. Free registration here!


CardioNet diversifies with new event monitor

By: Jonah Comstock | Nov 20, 2012        

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The MCOTos, released earlier this year.

The MCOTos, released earlier this year.

CardioNet, one of the oldest companies in the mobile cardiac arrhythmia monitoring space, announced the launch of a new product last week, the wEvent wireless event monitor.

“This new wireless device provides physicians a much improved replacement to their traditional event monitor,” CEO Joseph Capper said in a statement. “The wEvent, unlike existing event monitors, offers wireless transmission of symptom and activity reporting, providing a higher level of patient convenience and better quality of information.”

Capper said in a recent investor call that the new device would share a monitoring platform with CardioNet’s flagship product, the Mobile Cardiac Outpatient Telemetry, or MCOT. CardioNet rolled out the MCOTos, the newest update of the MCOT system, earlier this year.

“The integration of multiple products into a highly scalable common processing platform will contribute to an enhanced customer experience and improved back office efficiencies,” Capper said in the call.

Over the past few years, CardioNet has seen many more companies enter the heart monitoring space, and dealt with management changes and lawsuits on the corporate side. After several years of losses, the company has focused on diversification, acquiring cardioCORE lab for $23.5 million earlier this year, and ECG Scanning prior to that. According to Capper, the wEvent marks the start of an expanding suite of heart-monitoring products, not just the MCOT system that has been CardioNet’s primary focus up until now.

“To illustrate, two years ago 90 percent plus of our revenue came from MCOT, in the third quarter of 2012, 65 percent of our revenue came from MCOT, and in the fourth quarter we expect it to be 60 percent,” Capper said in the investor call. “To be overly reliant on a single product and a single CPT code in today’s environment does not make good business sense.”

Bosch taps Doro for mobile telecare in Europe

By: Jonah Comstock | Nov 19, 2012        

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Doro 740

The Doro Secure 740, Doro's new 3G smartphone

Doro, the Swedish company that makes mobile phones specifically designed for seniors, has announced a partnership with Bosch Healthcare to expand Bosch’s European telehealth network to include a mobile phone-based component.

Up until now, Bosch’s telehealth offering in Europe has been in the home, Doro CEO Jerome Arnaud told MobiHealthNews. Integration with Doro’s phones will allow seniors to be in touch with the system even outside their homes. The mobile phones will have an alarm button built in, which would contact Bosch’s call centers in one of two ways — either using an IP messaging platform or sending an SMS message. The alarm call will contain GPS information, allowing Bosch to dispatch emergency response teams to the user’s location, even if they’re not able to speak or don’t know where they are. The message will also include pre-entered information about the user and information about the phone’s battery life.

Doro has had an alarm system on its phones for some time, acquiring tele-assistance company Birdy Technology in 2011. But Bosch’s telehealth infrastructure will allow them to sell those phones in many more of their European markets, starting in Switzerland and Germany. The Bosch alarm system will be included on one of Doro’s standard feature phones, the Doro Secure 680.  But it will also role out on Doro’s first smartphone, which the company has just begun to offer in Sweden.

The Doro Secure 740 is a sliding Android smartphone, which is debuting with its own app store, featuring a limited number of apps from the Google Play store. Arnaud says the company plans to offer more apps as customers request them, but is starting with a limited number to keep the device simpler. Doro bought Prylo SAS, a France-based Android developer, last year.

Arnaud says it’s too soon to gauge the seniors’ reaction to the smartphone offering, but said the decision was motivated by requests from Doro’s consumer base. The features Doro touts on its website are the abilities to access email, read the news, and take and share photos with the built-in 5MP camera. It also integrates Doro Experience, a software product designed to make tablet, PC, or smartphone user interfaces clearer and easier for seniors, and provides an option for remote assistance from family or more tech-savvy friends.

Although Doro’s US phones are equipped with single-button emergency dialing, Doro’s partnership with Bosch hasn’t been brought to the United States yet. Meanwhile, competitor GreatCall, which makes the Jitterbug line of phones for seniors, announced the expansion of its 5star mPERS system this summer.

Evidence builds for SMS smoking cessation

By: Jonah Comstock | Nov 16, 2012        

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nosmokingThis week, the Cochrane Library published a review of mobile messaging-based smoking cessation interventions. The report found that, based on five studies, with a total of more than 9,000 participants, smokers who used mobile messaging interventions were twice as likely to make it six months without smoking than those who didn’t.

“We can’t say from the result that this means all text messaging cessation programs work, but we can say these studies have shown that they can work,” said Robyn Whittaker, the lead author of the review from the University of Auckland in New Zealand. She told MobiHealthNews that of the five studies looked at, three were pure text messaging interventions, one incorporated text messaging and use of a website, and one used both text and video messaging. In the mixed studies, the Cochrane review looked at the texting intervention specifically. Although not all of the five studies were conclusive, the meta-analysis of the five showed significant results, according to Whittaker.

The participants in the text message interventions all received similar support: automated motivational messages at regular intervals, strategies for avoiding temptations, and quick responses to texts about cravings. Overall, 444 out of 4,730, or about 9 percent, of the participants in the five treatment groups reported being clean after six months, with some self-reports confirmed by analysis of saliva samples. Only 240 out of 4,370 in the various control groups reported the same results (about 5 percent).

Whittaker says this level of success is roughly comparable to other, proven methods of smoking cessation such as telephone quit lines and nicotine substitution therapy. Although this study only looked at effectiveness, Whittaker thinks mobile messaging interventions might have some advantages over those other methods.

“We think that it’s probably cost effective, because it’s cheaper than, for example, a free phone quit line where you’re paying for a phone line to be available to people all the time,” she said. She also mentioned the potential value of text message interventions in developing countries where mobile phone use is widespread.

This study was an update of a 2009 Cochrane Library study by the same team. At the time, Whittaker said, there hadn’t been enough studies completed to make conclusions about the six-month mark, which she called the gold standard in smoking cessation.

“People find the first weeks are the most difficult, and then it evens out but we still get people dropping out,” said Whittaker. “Mostly the six month quit rate will be a longterm quit rate.”

Just the increase in available data from 2009 to today makes a statement about the rising prominence of texting-based health interventions. MobiHealthNews wrote about a smaller study last year, and has been following efforts like the Department of Health and Human Service’s SmokeFreeTXT and Text2Quit, the paid service developed by Voxiva and offered by Alere.

Whittaker said smartphone app-based cessation strategies are one area where there’s still not enough data to do a review, although she did point to an American Journal of Preventative Medicine study from last year. That study showed that most smoking cessation apps didn’t follow Public Health Service Guidelines for smoking cessation.

“I think we need more studies so we can say that for sure, but none of these programs are based on really well-proven therapies,” she said. “We know that some of them don’t work very well, like acupuncture or hypnosis for smoking cessation. Motivation and support seems to work for people for quitting smoking, and those are the sorts of things that you can provide through mobile phones. So we need to ensure that these things are using what we know.”

Whittaker pointed out that many apps are downloaded and never used. Text messaging, on the other hand, proactively engages the user.

“We can more actively deliver messages to people wherever they are at the right time and those messages can be relevant to an individual even though we’re sending them out on a mass basis,” she said.

FDA clears iPhone-enabled body thermometer

By: Jonah Comstock | Nov 16, 2012        

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raiingA Beijing-based medical device company called Raiing has been granted 510(k) FDA clearance for the Raiing Wireless Thermometer, a peel-and-stick contact thermometer sensor that continuously transmits body temperature readings to a companion iPhone app, which is already available in the iOS AppStore. The app is called Vitals Monitor and is currently available for a free download, but the device itself does not appear to be commercially available yet.

The device, which is worn under the armpit, uses Bluetooth to transmit data in real time to the iPhone, according to Raiing’s website. The thermometer can also store up to 72 hours worth of readings According to the FDA filing, the device is battery-operated, reusable, and intended for use by ages 2 and up.

The 510(k) document doesn’t give any specific indication of the use case the device is cleared for, except for the age restriction noted above. However, the app can alert users when the thermometer hits a preset temperature, which could be useful for parents monitoring sick children, the use case Raiing promotes on their website.

Of course, thermometer apps for non-medical use have been around for a while. For instance, the iGrill cooking thermometer was an early iPhone accessory, and more recently the iCelsius was released for detecting ambient temperature.

Lately, a couple of companies have been pursuing infrared body temperature thermometers, which detect the intensity of infrared light that naturally emits from objects. Medisana’s Thermodock and CellScope both intend to leverage that technology, but neither has been cleared by the FDA. Just this week, Forbes reported on a patent filing for another infrared thermometer app, from the Fraden corporation.

Raiing’s contact thermometer appears to be the first smartphone-enabled body temperature thermometer to secure FDA clearance.

As a wireless patch that monitors continuously, the device is more similar to Cambridge Temperature Concept’s Duofertility device, than anything else on the market. Duofertility, which is 510(k) cleared for use as a conception aid, tracks women’s ovulation cycles by constantly monitoring body temperature.

The thermometer will be Raiing’s first product, but the app’s description in the AppStore mentions “Raiing wireless health monitors,” suggesting the company has other devices in the works.

Clinton turns to remote monitoring, Verizon to address health gaps

By: Neil Versel | Nov 16, 2012        

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Photo Credit: Adam Schultz / Clinton Foundation

Photo Credit: Adam Schultz / Clinton Foundation

Remote and home patient monitoring technologies will be a key component of former President Bill Clinton’s new push, through his William J. Clinton Foundation, to eliminate health disparities between communities of different socioeconomic and racial strata.

Clinton this week introduced the Clinton Health Matters Initiative, in partnership with General Electric, Tenet Healthcare and Verizon Communications. Those companies and the Clinton Foundation will work with individuals, communities, corporations and not-for-profit organizations to promote healthy lifestyles, with a focus on underserved areas in the U.S.

“Our nation’s rising tide of preventable health problems is alarming because it is ruining the quality and length of life for millions, and driving up healthcare costs in a way that can’t be sustained,” the former president said in a statement. “The Clinton Health Matters Initiative builds on my Foundation’s work to address global health crises and the childhood obesity epidemic in the United States by engaging not only with individuals but also with the systems and places that affect individual health,” Clinton added.

Of note, Verizon will support technologies such as wireless networks for patients to take vital signs at home and send readings to their physicians, as well as systems to alert doctors when patients with chronic diseases need medical interventions, Verizon Chief Medical Officer Dr. Peter Tippett told Reuters. The telecommunications company also is providing connectivity for telemedicine networks that will bring much-needed specialty care and image interpretation services to rural areas.

“We are proud to partner with the Clinton Foundation on this innovative and potentially life-changing initiative,” Tippett said in the Clinton Foundation’s statement. “As the foundation’s technology provider, we believe we can empower individuals to take better care of their health. We have barely scratched the surface on using technology to improve health and well-being and reduce medical costs.”

Health disparities and preventable illness “are robbing people of a lot of good years. We can’t let that continue,” Clinton told Reuters.

The Clinton Health Matters Initiative is starting its work in California’s Coachella Valley, where poor desert communities often get forgotten amidst the glitz and wealth of Palm Springs and Indian Wells, and in greater Little Rock, Ark. The capital city of Clinton’s home state has major income and health disparities, too. The project will expand to other areas, according to the foundation.

At the very end of his presidency in 2001, Clinton called health disparities “unacceptable in a country that values equality and equal opportunity for all,” and called on the nation to close major gaps by 2010. As with other goals in healthcare, that never happened, and state of crisis in this $2.7 trillion industry lingers.