Group led by Daschle, Frist sizes up mHealth opportunity

By: Jonah Comstock | Dec 10, 2012        

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Tom Daschle (D - S.D.)

Tom Daschle (D - S.D.)

A report from the Bipartisan Policy Center’s Health Project, led by former Senate majority leaders Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.), says that mobile health is a promising avenue for increasing patient engagement, which should be one of the major goals of health care reform. But barriers to mobile adoption and increased engagement include lack of awareness, lack of innovation, and privacy concerns. The BPC was founded by Daschle and other former Senate Majority Leaders Bob Dole (R- Kansas), Howard Baker (R-Tenn.), and George Mitchell (D-Maine) in 2007, and its mission is to “drive principled solutions through rigorous analysis, reasoned negotiation, and respectful dialogue.”

The BPC Health Project highlighted patient engagement as a key goal in their January report “Transforming Healthcare: The Role of Health IT.” By reviewing a wide range of available literature, they found that patients who are more directly involved in their health have less pain and faster recovery, are more adherent to doctors’ treatment plans, and are less likely to choose elective surgeries.

In the latest report, entitled “Improving Quality and Reducing Costs in Health Care: Engaging Consumers Using Electronic Tools,” the BPC looked at two categories of electronic tools, those that promote education and self-care, and those that enhance patient-physician communication. The first category includes online and app-based educational materials, trackers and health management apps, online support communities, and personal health records. The center noted that for many patient it’s currently not easy to download data to a personal health record from a doctor’s electronic health record system. In many cases, patients must instead input their health data manually, which is time consuming and introduces a lot of room for error into the system.

Among the tools in the second category — those that help patients interact with the health care system — the report listed patient access to EHRs, secure email, remote monitoring, and online tools for scheduling appointments and renewing prescriptions. The report says some physicians are slow on adopting these tools because patient interaction outside of office visits isn’t covered under fee-for-service payment models, leaving providers uncompensated for electronic interactions. However, privacy concerns continue to be one of the largest barriers to adoption on both the physician and patient sides, according to the report.

At the end of the report, the center outlined some suggestions to the government for overcoming the barriers to adoption. Increasing awareness of electronic tools among both consumers and providers was one suggestion. The report also emphasized the need to develop and disseminate standards and best practices for adoption, especially in small clinics where the cost could be prohibitive.

“The federal government and the private sector should accelerate the development of principles, standards, policies, and strategies that guide the development, selection, dissemination, implementation, and use of electronic tools that promote engagement of patients and their families by providers,” the report reads. “Approaches should be tailored toward intended populations—particularly those that are historically underserved.”

Finally, the authors suggest increasing federal and private sector incentives for adopting electronic health tools, including continued support of mobile health by the Center for Medicare and Medicaid Innovation, public and private reimbursement for telemedicine services, and employer and private payer incentives for using electronic tools to manage wellness or chronic disease. A bill recently proposed by Congressman Mike Honda in the House also calls for a loan program to help smaller practices adopt patient-engagement technologies, not including EHRs.


AT&T develops sensor to warn asthma patients of triggers

By: Neil Versel | Dec 10, 2012        

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AT&T ForHealthRather than partner with an existing sensor maker, AT&T has created its own device to measure pollutants that could set off asthma attacks and warn people with asthma that it may not be safe to spend a lot of time outside.

The telecommunications giant, through its AT&T ForHealth initiative, previewed the sensor, called Asthma Triggers, at last week’s mHealth Summit in National Harbor, Md. Asthma Triggers measures volatile organic compounds (VOCs)—a class of chemicals that asthmatics are particularly sensitive to—in the air.

The sensor connects via ZigBee to a smartphone, tablet or PC to send data to AT&T’s health information exchange platform, known as Healthcare Community Online, to measure the true risk for people in a given geographic area. AT&T says 27,000 adults miss work and 36,000 children miss school every day in the US due to asthma symptoms, citing data from the Asthma and Allergy Foundation of America.

“AT&T Labs researchers first decided to create an asthma sensor when they became aware of the rising trend in asthma sufferers, which is currently at its highest level on record,” AT&T Labs researcher Bob Miller explains in an extensive interview with Medgadget.

“For the Asthma Triggers project, we worked with a manufacturer to create the miniature VOC sensor, however, there is much more to making a new healthcare measurement solution work productively,” Miller says.

“There have to be software, connectivity and a network to get the sensor data into a form that can be interpreted by physicians, caregivers and patients. That’s where AT&T’s research comes in. The sensor itself is part of an end-to-end measurement, wireless transmission, data storage and analysis system to get such a concept ready for ‘meaningful use,'” Miller adds.

Meaningful use, of course, is the $27 billion federal incentive program for electronic health records (EHRs).

“The opportunity to innovate in this field is vast and a collaboration between AT&T’s Labs and the AT&T ForHealth HIE platform was natural considering the brilliant minds, technology and expertise in both groups – and ultimately the power of the AT&T network which powers the device,” Miller says.

The sensor, which currently is a prototype, is intended to be part of a wider personal telehealth ecosystem. It is “an example of what the future of healthcare will enable for patients as sensors and computer-assisted analytics become more commonplace,” according to Miller.

ABI: 30M wearable sensors shipped in 2012

By: Jonah Comstock | Dec 10, 2012        

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The Nike+ Fuel Band

The Nike+ Fuel Band

According to ABI research, nearly 30 million “wireless wearable health devices” were shipped in 2012, a 37 percent growth from 2011. Jonathan Collins, lead analyst on the study, told MobiHealthNews that the report only looked at devices worn on the body (nothing subdermal), with some form of wireless connectivity, and related in some way to monitoring health.

The 30 million figure, up from 20.77 million in 2011, is just a little behind ABI’s February predictions, when the firm predicted that between 2011 and 2017, the market would grow at an average rate of 41 percent per year, leading to 169.5 million devices shipped in 2017.

Currently, ABI predicts an annual average growth rate of just under 40 percent, which will lead to 160 million devices shipped in 2017. Collins said that the slight adjustment is not a reflection on the fitness side of the wearables market, which is continuing apace, but rather because of smaller-than-anticipated adoption of medical wearables.

In 2017, according to ABI, 60 percent of the devices sold will be fitness trackers and 23 percent will be home monitoring technology for aging in place seniors. Seven percent will be devices for remote patient monitoring, with another 7 percent for point of care healthcare use.

Collins said that consumer-oriented sports and fitness trackers were the main driver of the continued growth, particularly those made by incumbent device companies like Polar, Garmin, Nike and Adidas.

“The established players are still shipping the most devices,” he said. “We haven’t seen the startups get anywhere near those numbers.”

The big trend driving wireless wearable trackers this year is the ubiquity of Bluetooth connectivity, according to Collins. He said ABI has been tracking a slow build in the market over the last four years, but the rise of low-power, wireless communication, as well as the market working through some regulatory ambiguities, has led to a big boom in 2011 and 2012, which he predicts will continue.

Earlier this year, Juniper Research predicted the wearables market would be worth $1.5 billion in 2014 and IMS put the market’s value at $6 billion in 2016.

“There is an incredible flow of ideas coming into this market,” said Collins. He predicts that as the market develops, there will be more tracker integration with social media, more corporations will invest in trackers for employee health and that the professional medical markets will continue to grow.

iHealth smartphone-enabled devices to integrate with EHR

By: Jonah Comstock | Dec 7, 2012        

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iHealth BP CuffiHealth Labs, a subsidiary of China-based Andon Health that produces wireless health monitoring devices, announced partnerships with EHR-maker Practice Fusion and with popular memory-aid app Evernote.

Practice Fusion is the first EHR-maker to partner with iHealth, Adam Lin, general manager of iHealth Labs, told MobiHealthNews. The first phase of the partnership will allow physicians who use Practice Fusion to give their patients special offers on and access to iHealth products. But in a few months, Lin said, Practice Fusion’s patient health record will integrate with data from iHealth devices.

“It’s imperative to us that our devices will actually integrate with the EMRs and the EHRs,” he said. “There has to be a way our information can flow into the system.”

iHealth’s blood pressure monitor and weight scale are Bluetooth-enabled, and currently sync with iHealth MyVitals, iHealth’s free app announced last month. But the company wants to make the data from their app available to consumers in more ways, Lin said.

“We’ve been a little bit slower to the game of integrating with third party apps. Evernote is part of that even though they’re a little bit unique,” he said. “Our strategy has always been to allow our users to see and manage our data elsewhere. Not all users will utilize our application as a dashboard.”

Evernote isn’t a health app, per se. It bills itself as an app to help people remember everything, and it integrates a camera, a voice recorder, and  a “web clipper,” for taking online screenshots. iHealth device data will integrate with Evernote in the form of a Results Card that will be generated when someone takes a reading. The system will also generate a summary card at the end of each week.

Lin said a lot of iHealth users have requested integration with other apps, such as RunKeeper, and the company wants to keep pace with those requests. Towards that end, the company recently made it’s API publicly available.

Although Practice Fusion and Evernote share Morgenthaler Ventures as a major investor, Lin said that relationship is just a coincidence.

The simultaneous move into both consumer-facing and physician-facing health integration shows that  iHealth is positioning its devices for a variety of use cases. But Lin said they’re really just two different vectors for connecting people with data about their body.

“This is just the beginning for us,” he said. “At the end of the day the person with the device considers themselves a consumer, a patient or both. Whether you buy or product from Apple or get it from your doctor, the person is the same. We’re targeted at that person, with the goal of true mobility, allowing your information to move with you.”

Content, partnerships now trump technology in global mHealth

By: Jonah Comstock | Dec 7, 2012        

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Mark Blatt and Ebenezer Appiah-Denkyira

Mark Blatt and Ebenezer Appiah-Denkyira

Texting programs for health education in developing countries have been around for over a decade, but several factors are bringing global health efforts to a new scale in 2012, including increasing mobile adoption in developing countries and an increased spirit of collaboration.

Nafis Sadik, a United Nations Foundation board member, has worked with the UN on women’s health since 1987. At the mHealth Summit this week Sadik delivered a keynote presentation about the opportunities provided by the wide adoption of mobile phones by women in the developing world.

“When I started work if you had access to mobile technology, it meant that you had a car,” she said. “In the villages people had never seen a telephone and few had ever heard of one. Today mobile phones are everywhere.”

“For me, 2013 is the year for scale for mHealth,” said Patricia Mechael, Executive Director of the mHealth Alliance, in her opening remarks. She said in the nearly 10 years since she began working on mobile health programs in developing countries, “mHealth has transitioned from a novel idea to a strategy for global health. We are seeing great progress in the growth and rigor of mHealth evaluations and greater attention to evidence.”

Mechael spoke about the Mobile Alliance for Maternal Action, or MAMA, a partnership between the mHealth Alliance, USAID, Johnson & Johnson, the United Nations Foundation, and BabyCenter. MAMA was founded to educate and support new mothers in Bangladesh, India, and South Africa through mobile messages, similar to Text4Baby in the US. Today the program’s adaptive messaging system is used in 40 countries and reaches 20 million moms, Mechael said.

She also announced a new mHealth Alliance partnership with the Nigerian Federal Ministry of Health and with Intel, to leverage mobile technology in Nigeria’s Saving One Million Lives initiative. The initiative, launched in October, seeks to eliminate the one million deaths a year in Nigeria to preventable causes.

Hajo van Beijma, CEO of Text to Change, a company that works with organizations to develop text messaging interventions in developing countries, said that when Text to Change started in 2007, it worked with companies that weren’t very ambitious and launched a lot of pilot programs with no plans for follow-ups. He told MobiHealthNews the industry has learned that scale depends more on ambition than anything else.

blog post over at the Center for Health Market Innovations site Content, partnerships now trump technology in global mHealthrecapped van Beijma’s panel at the Summit. In it, researcher Lily Wei mentions three dimensions of scaling: project, with refers to the content of specific programs, platform, which refers to the technology used, and strategy, the effectiveness of the intervention in bringing behavior change to end users. Van Beijma says there’s been a shift in prioritizing those dimensions.

“At the beginning, the assumption was that if you had good technology and a good platform, you would scale,” he said. “Now the general assumption is if you have good content and good partnerships you’ll scale.”

Van Beijma’s Text to Change has been exploring bigger partnerships, he said, teaming up with companies he once would have considered competitors. Last year they made their proprietary software freely available to better facilitate partnerships. Wei concludes that one of the big goals of the global heath track of the Summit was to better facilitate these partnerships.

Van Beijma also said that it’s often more productive to integrate mobile health with other mobile initiatives like mobile banking and mobile agriculture than to promote it in isolation.

Dr. Ariel Pablo-Mendez, Assistant Administrator for Global Health with USAID, made similar points in his keynote address. He said mobile money has the potential to reduce corruption in healthcare systems in emerging economies, and mobile-enabled human resource management systems like IRIS can help manage clinic and aid workers.

Mark Blatt, Worldwide Medical Director at Intel shared keynote session with Ebenezer Appiah-Denkyira, Director General of the Ghana Health Service. They spoke about taking the scope of global mobile health beyond texting programs.

As developing countries build their healthcare system, Blatt said, they can integrate mobile health and electronic data management from the beginning.

“How can we use these tools to empower citizens to better care for themselves so we diminish the pressure on the healthcare system?” he said. “Mobile tools offer emerging economies an opportunity not to make the same mistakes we made in our western healthcare system.”

Van Beijma agreed. “Africa is famous for leapfrogging with regards to technology,” he said. “The fact that they were lagging behind technologically is actually helping them because they can skip all kinds of technology we don’t like anymore, like landlines.”

Healthcare cathedrals and the consumer health bazaar

By: Brian Dolan | Dec 6, 2012        

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Brian Dolan, Editor, MobiHealthNewsOne out of every three adults in the US will buy a digital health product of some kind in the next year, Gary Shapiro, the CEO of the Consumer Electronics Association (CEA), said — citing data from an upcoming CEA survey — during his luncheon keynote at HIMSS’ mHealth Summit this week. With the exception of that prediction, Shapiro largely steered clear of the consumer health conversation and instead discussed how lowered healthcare costs could save the country from the so-called “fiscal cliff”, how perverse reimbursement policies for physician visits need to be removed, and how our lawsuit-happy legal system needs to adopt a “loser pays” policy.

With the head of the largest consumer electronics association tackling systems issues, at times it seemed like the consumer health conversation at the mHealth Summit was buried.

Over the course of this past year the consumer/patient-facing digital health conversation shifted from a predominantly direct-to-consumer market to one that might leverage traditional healthcare channels. Among the drivers that steered the industry back toward the patient-provider relationship: the prospect of physicians prescribing apps, the importance of integrating data from mobile health programs with EHRs and other systems, and the push for patient engagement from forthcoming meaningful use requirements.

Still, many speakers at the mHealth Summit championed direct-to-consumer.

Martha Wofford, Head of Aetna’s Consumer Platform, praised iTriage, which Aetna bought last year, for ramping up to 8 million downloads. Wofford described that as “a tremendous number of people” and as having “far outpaced any adoption” for other direct to consumer products that Aetna had tried launching on its own. Wofford said in some instances startups understand direct-to-consumer distribution better than large companies like Aetna do.

“Large companies understand [business-to-business channels] better,” Wofford said. Now that iTriage is a part of Aetna, “the marriage of the two is very exciting.”

Scott Peterson, the VP of Sales for Verizon’s Healthcare Practice, poked a hole in the hype surrounding health app certification and touting consumer savviness.

“Code will be written. Apps will be deployed that change the way both patients and providers get access to information. The market will sort the ones that don’t work.” Peterson said that “ultimately the consumer and patient want the same thing as providers and payers: better outcomes and better care” and that “savvy consumers know which apps work; savvy payers and providers know which apps appeal to consumers.”

While it may be somewhat expected that nontraditional companies, telecoms like Verizon, take a different stance than the healthcare establishment, some healthcare providers touted consumer-driven disruption, too.

Dr. Joe Kvedar, Founder and Director of Partners HealthCare’s Center for Connected Health, said that he’s “a fan of retail clinics because they are a glimmer of what [the future of healthcare] will look like.” Kvedar said that retail clinics “took 5 percent of primary care and no one really noticed.” The healthcare system is so occupied by incumbents, he said, “that have so much to lose by changing” that things won’t change there first.

Vinod Khosla, founder of the investment firm Khosla Ventures, agreed:

“The right way to look at it is to say ‘How does innovation happen and how do very large systems like the healthcare system change?’ Most of the time change comes from the outside. Not the inside where there are too many vested interests, too many people with very good intentions who have too much experience to be unbiased,” Khosla said. “They are not naive enough to ask naive questions. The answers have changed because of the circumstances — because of technology. Healthcare innovation will be consumer-driven not doctor-driven. It will be driven by devices that power the consumer to have better data about themselves.” Khosla was quick to point out that technology is an important component but not the only one: “It is necessary but not sufficient.”

Health apps and smartphone-enabled medical devices today, which Khosla described as “clumsy point solutions”, are just version 1.0 of digital health, he said. This is just the beginning and some of the consumer-driven services today will quickly make their way into the healthcare system. Aetna’s iTriage acquisition is one key example. Khosla clearly believes there will be others soon.

Consumer health and provider-driven digital health initiatives, of course, will grow up together in parallel. Each can help drive the other in their own way.

“There are really two models for how the world works: the cathedral and the bazaar model,” Khosla explained. “Bazaars evolve much faster than cathedrals do — often because people leave cathedrals to join the bazaar. You can also be in a cathedral and help the bazaar evolve faster than any cathedral could on its own.”