Surveys look at digital health adoption, reasons for hesitance

By: Jonah Comstock | Mar 8, 2013        

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Source: Ruder Finn mHealth Report

Source: Ruder Finn mHealth Report

Several surveys were released this past week at — or coinciding with — HIMSS, focusing on different areas of consumer engagement in digital health. The Atlantic surveyed 1,000 US residents, finding that only 12 percent had emailed or texted their doctors. A Ruder Finn survey of more than 1,000 US adults found that 16 percent of smartphone and tablet users access health apps regularly. Finally, an online study by IEEE of 1,200 Facebook members (mostly engineers and technologists) explored attitudes about connected health devices, finding that only 9 percent listed health as a way in which they’re most interested in using connected devices.

The Atlantic study, conducted in conjunction with GlaxoSmithKline, found 64 percent of people taking health into their own hands, looking up some kind of health information online. Of those, 59 percent used WebMD, 22 percent used Google, 17 percent used the Mayo Clinic website, and 12 percent used their health insurance website. The top reason for using these sites (64 percent) was seeking general health information, but 40 percent cited self-diagnosis and 38 percent said they were evaluating whether to see a doctor.

On the subject of emailing with doctors, the study found that hypothetical attitudes about online physician engagement dwarfed actual practice — 31 percent of those surveyed said they would be willing to pay for online consultations with their doctor, and 20 percent said they would be willing to communicate with their doctor online.

Similarly, the IEEE respondents‘ hypothetical interest in using connected medical devices was high, despite being more excited about the internet of things in the context of work. The survey found that 68 percent of respondents would be comfortable using a connected device that monitors health information, and 72 percent believe such a device would improve their wellness.

Ruder Finn’s study of mobile engagement found that by far the most popular health apps were fitness and wellness apps, not an unexpected finding. Forty-nine percent of respondents who used health apps said they used healthy eating apps, and 48 percent named similar categories: fitness training apps and calorie counter apps. For nutrition apps, the figure was 46 percent. Similar to the Atlantic study, only 12 percent said they would use an app to videoconference with their doctor.

Patients were also asked which mobile capabilities they most wanted to see their doctors use. Forty-two percent said they wanted their doctor to have an app to see their test results, 33 percent cited remote monitoring devices, and 30 percent wanted doctors to have access to patient health records via a mobile device. A surprising 13 percent said they didn’t think apps would help improve patient care at all.

While Ruder Finn asked patients about physician mobile health tools, a survey from Accenture, conducted by Harris Interactive, asked physicians about patient engagement. The survey of 3,700 doctors across eight countries found that 82 percent of doctors believe patients should actively participate in their health by updating their own electronic health record. Only 31 percent believed patients should have full access to their record, though, with 65 percent saying they should have only limited access and 4 percent saying they should have no access at all.

Most interestingly, although the three studies that looked at adoption found relatively low adoption of mobile health engagement, two of them also looked at the reasons consumers don’t engage. Ruder Finn asked those who did not use health apps why they didn’t. Twenty-seven percent said they didn’t have any need to access health-related apps, 26 percent said they preferred to talk to a doctor in person about health issues, 11 percent were concerned about sharing information with an app, 9 percent didn’t find apps helpful, and 7 percent didn’t know they were available.

The IEEE study asked respondents to name the biggest challenge to the adoption of connected health devices, in their opinion. Of those surveyed, 39 percent were concerned about the security of data and 46 percent cited privacy concerns. It’s clear that regulators and developers will have to continue to emphasize privacy and security to get to a point where consumers are widely comfortable with mobile health services.

MobiHealthNews coverage of the HIMSS13 event in New Orleans is sponsored by AirStrip Technologies.


Slideshow: 8 healthcare tablets for physicians, nurses, clinicians

By: Jonah Comstock | Mar 7, 2013        

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HIMSS13’s showfloor had no small number of dedicated medical tablets, some from big tech companies like Panasonic and Fujitsu and others from dedicated tablet companies like Motion Computing. Here’s seven devices that were on display at the show, and one that was being shown off in Austin this week at SXSW. Some devices are enterprise tablets designed for a wide range of uses in manufacturing and retail, while others are truly dedicated medical devices.

Panasonic’s Toughbook and Toughpad series

Panasonic Toughpad FZ-G1

Some of Panasonic’s devices — like the 20-inch tablet the company announced at CES this year — strain the definition of “mobile.” Their products range from Toughbooks, which are convertible and weigh up to 8.2 pounds, to Toughpads which are more like traditional tablets. Both lines are fully rugged devices, according to the company. Panasonic also gives their customers operating system options of Windows 8 or Android devices. Keep reading>>

At HIMSS13 tablet makers angle to edge out the iPad

By: Jonah Comstock | Mar 7, 2013        

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Panasonic's ToughPad was subjected to a shower of water at HIMSS 2013.

One of the media narratives that came out of CES this year, was that despite not attending the show, as is its custom, Apple managed to have a significant effect on the proceedings. The same thing could be said of HIMSS, especially when it comes to tablets, where Apple’s absence was keenly felt in the midst of so many competitors. And while Microsoft was staunchly promoting their new Surface Pro tablet, most devices on display were not competing consumer devices, but rugged, dedicated “medical-grade” enterprise tablets.

With the overwhelming popularity of iPads and iPad Minis among tablet-using physicians, it’s easy to forget that the history of the medical tablet long predates Apple’s entry into the field. Companies like Motion Computing were making medical tablets in 2001, but for a number of reasons, adoption has been slow.

“Half of the sales cycle was convincing them they needed a tablet,” Kyle Sale, Director of Product Marketing at Motion Computing told MobiHealthNews during an interview at HIMSS13. “And the iPad came along and broke down that barrier for us, but it began to present a challenge. People use their iPads at home and think, this is really cool. I’d like to use this at work.”

But according to the medical tablet makers, a good consumer device is not always a good enterprise device, and for all the panache of the iPad, they argue that it is inadequate for clinical workflows. Sale said that more than once the company has lost out to Apple on a sale, only to have the CIOs come back with a changed tune.

“Ninety days later they call us back and say we just deployed 30 as a pilot, it’s not working,” he said. Keep reading>>

AMC Health guarantees lower readmissions, prepares wireless monitor for inhaler use

By: Neil Versel | Mar 7, 2013        

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Graci Bluetooth Weight Scale

Graci Bluetooth weight scale used in Geisinger case study.

Telehealth systems provider AMC Health is offering a money-back guarantee that its customers will see at least a 10 percent decline in hospital readmissions within 90 days of implementing AMC’s interactive voice response (IVR) technology and case management services.

“We feel confident enough that this will reduce readmissions enough that we won’t have to give anybody their money back,” AMC Health senior vice president for research & business development John Holland said at the 2013 Healthcare Information and Management Systems Society (HIMSS) conference in New Orleans. Customers include hospitals, health insurers, accountable care organizations (ACOs) and home health agencies.

AMC Health reported last year that Geisinger Health Plan, the payer side of integrated delivery netork Geisinger Health System, reduced the risk of 30-day readmissions by 44 percent among Medicare patients actual 30-day readmissions by 19.5 percent over a two-year period using AMC’s technology.

Telephone case management can be labor-intensive, as nurse managers have to call to check up on patients after hospital discharge. But, according to Holland, the Geisinger experience indicated that it takes an average of 2.9 attempts to get a patient on the phone, and three-fifths of calls were unnecessary because they found no gaps in care. That means that as few as 15 percent of calls required a medical intervention.

With IVR, nurse case managers only have to pick up the phone when automated calls find a problem, such as a patient missing a doctor’s appointment or being unable to find transportation to a pharmacy, Holland said.

Holland also told MobiHealthNews that AMC Health also is developing a form of the smart pill bottle, but for inhalers. He said the New York-based company just wrapped up a beta test of a wireless device that clips over inhalers for treating respiratory ailments such as asthma and chronic obstructive pulmonary disease that can alert caregivers if a patient misses a dose or even if they are taking too much of a “rescue” medication instead of “control” drugs.

Patients who increase usage of the rescue drug to aid in breathing might need to see a doctor or even require emergency care, Holland explained. “We can measure excess use of the rescue med as an indicator that lung function is diminishing,” he said. “It’s an overadherence monitor instead of an underadherence indicator.”

Asthma medication ratio is a Healthcare Effectiveness Data and Information Set (HEDIS) quality measure that payers refer to in assessing patient outcomes.

MobiHealthNews coverage of the HIMSS13 event in New Orleans is sponsored by AirStrip Technologies.

Kaiser Permanente tapped 100Plus for health app for employees

By: Brian Dolan | Mar 7, 2013        

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Kaiser Permanente 100Plus Hopp2ITAt HIMSS13 this week, Kaiser Permanente had its suite of smartphone apps on display at its booth on the exhibit hall show floor. In the mix was an app called Hopp2IT, which turned out to be a white labeled version of an app developed by 100Plus. 100Plus, of course, was just acquired by its partner Practice Fusion. The app is not publicly available — it is being used in an internal pilot by Kaiser Permanente IT’s thousands of employees.

Jason Cheng, a Director in Technology Strategy & Planning at Kaiser Permanente, told MobiHealthNews in an email that KP came to work with 100Plus through a “combination of strategy, good luck, and a good deal of hard work,” Cheng wrote. “As we build out our own digital health ecosystem, one of our strategies is to support and work with startups in the digital health space. There are so many great ideas and innovations coming out of this space.”

Cheng said that while KP is supporting digital health startups through Rock Health, it also wants to work with them directly. Cheng said he sought out 100Plus co-founder Chris Hogg after reading about his startup’s launch.

“What I really liked about their app is that it is in line with Kaiser Permanente’s focus on Total Health, encouraging little, repeatable healthy activities — not just exercising — enabled through mobile and social,” Cheng wrote. “I would also mention that I would not have pushed this forward without having a lot of trust in our startup partner.”

KP worked with 100Plus to develop a white-labeled version of the 100Plus app to serve as the foundation of the 2013 CIO Health Challenge that Kaiser Permanente’s CIO Philip Fasano spearheads for employees of KP each year.

Hopp2IT 1“We branded the app ‘Hopp2IT’ [which is a nod to 100Plus’ concept of healthy opportunities or ‘hopps’] and made an entire internal marketing campaign around it,” Cheng said. “This has enabled us to bring a cool, innovative app to our employees more quickly than developing one on our own.”

Brian Gardner, Kaiser Permanente’s Executive Director of its Mobility Center of Excellence, told MobiHealthNews during an interview at HIMSS that, like the original 100Plus app, Hopp2IT includes pre-loaded ideas for simple, healthy things to do as well as the option to create your own. KP employees get points for eating healthier lunches, doing pushups, taking a walk around the lake that’s nearby the office, and pretty much whatever else they can come up with. Gardner said the app assigns custom “Hopps” a point score via an algorithm. Custom Hopps are visible to other users who can choose to adopt them as their own and Hopps can be voted up by the community of users, too.

One of the key features of Hopp2IT are images of the Hopps that users take to “capture the essence” of the activity. Gardner was really impressed by one of the app’s main screens that displays a gallery of these photos to help inspire people to discover a new Hopp. He said the app also helps him and his colleagues better understand what is important to their team members.

Gardner said he currently has about 265 points. If the total number of points accumulated by Kaiser Permanente employees tops 250,000 in a few months time, Gardner said KP will make a donation to (an as yet undecided) charity.

In addition to the Hopp2IT app, Kaiser Permanente was showing off a newly redesigned version of its Every Body Walk! app for Android and iOS. KP also noted that its main app, KP Mobile — which helps KP members locate facilities, make appointments, access records, refill prescriptions and more — now has more than 390,000 downloads. KP Locator was the company’s first iPhone app — it launched in mid-2011.

MobiHealthNews coverage of the HIMSS13 event in New Orleans is sponsored by AirStrip Technologies.

Congress asks FDA if “actual use” is factor in medical app regulation

By: Brian Dolan | Mar 6, 2013        

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mHealth Regulatory Coalition FDA Report

Source: mHealth Regulatory Coalition FDA Report

Last week six members of the US House of Representatives Committee on Energy and Commerce wrote a letter to FDA Commissioner Margaret Hamburg MD to ask her when the agency expects to publish its final guidelines for how and when it regulates mobile medical apps as medical devices. The FDA draft guidance document on mobile medical apps was published for public comment in July 2011. The letter also asks whether the FDA will consider the “actual use” of a mobile medical app in addition to the “intended use” when making its determination about whether an app needs to go through the 510(K) process. Finally, the letter closes with a series of questions related to the final guidance document and the committee wants answers by March 15th.

The letter is signed by Rep. Fred Upton (R-MI), Rep. Tim Murphy (R-PA), Rep. Marsha Blackburn (R-TN), Rep. Michael Burgess (R-TX), Rep. Joe Barton (R-TX), and Rep. Greg Walden (R-OR).

Almost a year ago a similar group of legislators — also six Republicans — sent a somewhat similar letter to the FDA about the mobile medical apps guidance document. In April 2012 ix Republicans in the US House of Representatives sent a letter to the FDA and FCC that explained the importance of wireless health devices and medical apps, cautioned against slow and inconsistent regulations, and asked for a progress report on how the two regulatory bodies were working together to co-regulate these technologies. That letter — like the latest one — was signed by Blackburn, Walden and Burgess, and a few others.

While the questions posed in the newest congressional missive to the FDA might be the most interesting, the section about how the FDA may treat “actual” vs. “intended” use in its decision-making was a new thread. Here’s the relevant passage from the letter:

“Since the July 2011 guidance, the FDA has held a public workshop on mobile medical apps and received many public comments but has not yet issues final guidance. Although FDA’s announcement on medical applications focused on the ‘intended use’ of the application when determining whether it should be regulated as a medical device, we are concerned about the potential of ‘actual use’ becoming a factor in the future. Last year Members on this Committee wrote to you because draft guidance issued by the FDA on Commercially Distributed in Vitro Diagnostic Products indicated that ‘actual use’ would be a factor in your analysis of ‘intended use’. If FDA decides to take a similar approach in its final guidance with medical applications, this could affect the growth and innovation in this market.”

The letter also points out that if medical apps are regulated as FDA cleared medical devices, then “it raises the possibility that they would also be subject to new taxes” under the health reform legislation. It’s curious that the legislators don’t know this for certain, they believe it’s still just a possibility.

The legislators asked the FDA to answer these four questions by March 15th. MobiHealthNews has answered a few of these already:

1. When will the FDA issue final or updated guidance with respect to the July 19, 2011, request for input on its oversight approach for mobile medical applications designed for use on smartphone or other mobile computing devices?

2. Has the FDA discussed, prepared, or analyzed the effect of the medical device tax on smartphones (as well as tablets or similar devices) or the creators or distributors of applications for those products? If so, please provide all documents analyzing or relating this issue.

3. Will the actual use of a smartphone, tablet, or app be a factor in whether the FDA chooses to regulate the device or app as a medical device? Has it been a factor in any analysis by FDA already completed?

4. How many mobile medical apps have sought approval from the FDA before entering the market? What was the processing time for each of these apps? How many mobile medical apps have been subject to oversight by the FDA after introduction to the market? How many apps have either been changed or removed from the market by FDA oversight, and why?

MobiHealthNews’ recent report on FDA cleared apps answers some of the questions posed in the fourth question. For example, there are at least 76 510(k) cleared medical devices that would qualify as mobile medical apps based on the FDA’s definition of “mobile platform” and “app”.