Michael's Mobile Musings

This site has been moved...

2011-05-03T10:19:00.000-07:00

For those of you that don't link to this blog from my site... you'll have to from now on.

Just go to MichaelScharf.us

Thanks.

Something that may kill NFC

2011-04-21T10:21:00.000-07:00

Came across a series of articles and events that have convinced me that NFC based payments are a long way off. If I were the guy at Apple, Google, RIM etc., in charge of NFC I would be afraid… very afraid.

I was asked to look at authentication systems by a prospective consulting client. They wanted to know of their idea (which is very neat) could be used for authenticating online transactions (replacing the username/password authentication). I was able to give him good news, but not what he expected...

But my research did produce some very interesting tidbits.
Here’s what I found…
1. $4B in credit card transactions were declined in the EU because American tourists only had credit cards with mag stripes. That’s about $40M in profits for US banks.
2. With the exception of the US, North Korea, Mongolia, and parts of Africa, credit card issuers are moving to EMV (contact based) chip cards and PINs. They are not issuing the RFID cards that have been issued in the US. The EU has a 65% penetration of EMV chip cards.
3. No terminal manufacturer (that I could find) makes a merchant terminal that handles both contact and contactless cards. OOPS
4. I could only find one vendor that made a combined chip card (contact and contactless).

Credit card issuers won’t make a change to combat fraud, but they will make a change if card acceptance becomes and issue. And, since both Canada and Mexico are in the process of converting to chip and PIN, I think were going to see some changes soon.

What does this mean for NFC? NFC is basically an upgrade to the PayPass and similar RFID card systems. If Visa/Mastercard/AMEX/Discover go to contact based cards (like the rest of the world seems to be doing), NFC terminals will disappear. No terminals, no NFC transactions.

Data Security and mHealth

2011-04-20T19:17:00.000-07:00

Good News/Bad News for us

The good news is that our government is investing (spending) a lot of money to support digitizing healthcare information. A good chunk of that money will be spent bringing healthcare into the field via mHealth. People will bring lots of ideas to the marketplace quickly, and the winners will make a different to the quality of healthcare, and to their bank balances.

The bad news is that we have to really think about securing that information. The HITECH Act increases the standards and the penalties for data lost. And, we're seeing more system break-ins then ever before. So we'll see more fines and lawsuits than ever before.

Companies who want to lead the transition to better healthcare, will need to balance these competing priorities. That's what leadership requires.

Diversinet, a producer of a "secure platform" for mobile heath applications just published a white paper on this topic, and it provides a real fright to anyone who wants to get into this business.

But there is a (relatively) easy alternative... Don't do apps! Don't store anything on the handset that can come back to bite you later. Okay, so most of you have now decided that I'm just a little crazy. Probably true...

There are alternatives that have several advantages to on phone apps:

1. No data stored on the phone
2. Can be used an almost any phone in circulation, you're not limited to smart phones
3. Can reach the populations that need us the most, that are the most underserved.

The alternatives I'm talking about are SMS, MMS, and HTML5.

Call me if you want to find out more.

Voxvia and Text4Baby - Epic Fail

2011-04-13T15:31:00.000-07:00

Late last week, Text4Baby announced plans to increase their subscriber base to 1 million moms to be in 2012. So far, they have reached 135,000. One hundred thirty-five thousand!! That's just a little more than 2% of the 6 million pregnancies in the US each year.

I figure that between all the companies, foundations and government grants, plus the value of all the free publicity they have received, Text4Baby has probably spent about $10 million.

$10 million/ 135,000 subscribers = $74 per subscriber
$10 million / 28,000 babies that die before their first birthday = $357 per baby

I don't believe that we're seeing anything close to the best use of these funds. The main problem is the $/subscriber cost is about 20x too high... There's no way that if this program was properly marketed through MDs and clinics that the cost per subscriber would be close to $74 each.

How will Text4Baby get to 1,000,000 subscribers? Will they have to get $75 million in new grants and unpaid advertising? Is that even reasonable? I think not.

BTW has anyone thought about studying if they are even reaching the right people?

After Episelon, NHIN - What could go wrong?

2011-04-06T10:21:00.000-07:00

It's only reasonable that the week after Episelon gets hacked and tens of millions of individual records are stolen that we have a new plan for a nationwide network to store and display your medical records.

In an article in the NY Times this morning, we have five leading medical groups (Kaiser, Mayo Clinic, Intermountain Healthcare, Geisinger and Group Health Coop) are planning to develop a system called the Care Connectivity Consortium. These five are probably the leaders in adopting EHRs internally, so they have experience with the benefits of an EHR...

Regardless of the potential benefits of a national system, this system will be the #1 target of hackers worldwide.

What could go wrong?

New rules for ACO's and healthcare IT

2011-04-05T12:45:00.000-07:00

On 3/31, the Feds released their new rules for Accountable Care Organizations. A number of articles have been written about these rules, how they will impact healthcare and IT shops, as well as every American.

An article on The Health Care Blog by Margalit Gur-Arie reviews the privacy rules for ACOs. The topic takes up about 5% of the entire package of rules, which is interesting in and of itself. Big news, ACOs ill be able to share personally identifiable health information from Medicare claims UNLESS patients opt out. Not a good thing.

A second article on the same blog by Vince Kuraitis is a more general review of the entire package... Here are his initial impressions:

1. The bar has been set high...very high. Tire kickers need not apply.
2. Don’t expect to see many or any small ACOs.
3. Patients will be confused by ACOs.
4. Concerns over maintaining competition and avoiding antitrust are being taken seriously.
5. CMS scores points for coordinating the ACO Rule across Federal agencies.
6. CMS loses points for micromanagement and a controlling mindset.
7. Possible losers — hospitals, ACO vendors.
8. Possible winners — physicians, health plans.

Okay, so patients will be confused at first, but will they be winners or losers?

April Fool's Joke becomes reality

2011-04-03T09:31:00.000-07:00

If any of you saw the April's Fool Day escapade from Google, Google Move, you probably had a good laugh, and then said, "but I want it."

So, some folks made a motion based communications system using an Xbox Kinnect.

Enjoy!

Half of Americans would access their health records online

2011-04-01T06:51:00.000-07:00

According to a survey by Capstrat and Public Policy Polling, 50% of Americans would access their health records online... IF their doctor offered that service. This does not bode well for either Google Health or Microsoft Healthvault. It might also be the reason behind some of the rumors that both companies are reducing their investment in the PHR market.

Other results from the survey:
Would use email to communicate with the doctor? Yes 60%
Would use social media (facebook, Twitter)? No 84%
Would use instant messaging? No 73%

People will use communication tools that they consider secure. Too bad they did not ask about SMS.

GreatCall - Seniors not ready to text?

2011-03-31T13:47:00.000-07:00

Over at MobiHealthNews, Brian Dolan talks with the VP of strategy over at GreatCall. If you don't know them, GreatCall is the company behind the Jitterbug cell phone MVNO aimed at seniors. They are also the folks that picked up "Pill Phone" and a number of other on-device applications aimed at this market.

Two things come out of this interview that need expansion. First, according to GreatCall 80% of seniors' activity on cell phones is voice. Given that the average subscriber is 68, is this truly surprising - No. But what does this tell us, almost nothing. Four or five years ago, I'll be that close to 80% of total activity on US cell phones was voice. All that this means is that text messages aimed at seniors need to be written more carefully, and creatively.

More importantly, 38% of Jitterbug users expressed a willingness to pay for health-related services. This is probably 3x or 4x the number for the general public. Again, this makes sense. Seniors use more health care services, they are more aware of the need to manage their own healthcare, and once retired have more time to manage their own care. But this is good news, and we can only hope it spreads to the rest of the population as more mHealth services become available.

Money quote, “We’re too early to get payer reimbursement on a lot of this,” Pantalone said. “If we wait around for the government to pay for all of this, we’re going to lose this generation of seniors.”

Trashing the competition is no way to grow a business

2011-03-30T08:53:00.000-07:00

Lots of articles today about how Dell and HP are trashing Apple and the iPad. Over at ComputerWorld Johnny Evans writes about how the iPhone is saving lives, one at a time.

A dozen reasons to implement and EHR

2011-03-29T07:11:00.000-07:00

A great article over at EMR and EHR outlining 12 reasons why EMRs will improve patient care.

The reasons range from less data loss than paper records and reduction in wait times, to reduction in risk of incorrect scripts.

Don't worry, be happy!

2011-03-28T13:19:00.000-07:00

Margalit Gur-Arie writing in The Health Care Blog, discusses the issues surrounding the - sometimes forced - adoption of electronic medical records.

It's too good to summarize here, go read the article.

Sometimes they just don't get it

2011-03-28T13:14:00.000-07:00

An article in the WSJ discusses "mHealth." Unfortunately, what Stephanie Simon calls mHealth, I just call making existing devices smaller and less expensive via better engineering. When Eric Topol, who should know better concedes that, “something will be lost when most face-to-face visits with physicians are replaced by wireless exchange of data,” he sets back the real changes that mHealth can have by months if not years.

Delivering healthcare via your mobile phone is not (only) about having teleconferences instead of face to face visits. It's about changing the paradigm of healthcare and driving more decisions via data instead of intuition. Sorry Eric and Stephanie, but I cannot make it any clearer.

Gaming tools used in the OR

2011-03-25T07:11:00.000-07:00

GamingExcelence.com has a great article on the use of an Xbox Kinect in the operating room. The doctors are using it to manipulate images without leaving the sterilized area.

Not mHealth, but too cool not to mention.

Great quotes:

Ironic considering a lot of hospital tech costs thousands upon thousands of dollars, and yet a $150 so-called gaming accessory is the one leading the charge.

It's interesting to think of video game technology saving lives while the political spectrum continues to bend itself over trying to legislate violent video games. Many claim that video games kill and incite violence, when they may be in fact saving more lives than are reported.

Dr. Patrick Soon-Shiong at CTIA

2011-03-25T06:36:00.000-07:00

Dr. Patrick Soon-Siong presented at CTIA yesterday on the potential of mHealth. Here's a portion of the speech. If I can find the entire presentation I'll post it.

Incentive perversion....

2011-03-24T07:56:00.001-07:00

Interesting Article over at The Healthcare Blog discussing who should care about you and your health...

Most disturbing paragraph:

Well, for goodness sake, what about your doctor? Your health professionals are there for you. But they too have perverse incentives. The most prevalent of these is that they are trained to and get paid well for taking care of sick individuals. The system does not reward them financially at all for improving health. They are also big believers in patient accountability and don’t usually buy that victim thing. So they quickly articulate a treatment plan so they can go on to the next sick person who needs their help. They expect you, the passive victim, to be proactive about learning everything you need to do to execute that plan and carry it out. They are not on the same page as society is regarding who is accountable for keeping you healthy. They’d say it’s you, with their help from time to time.

Mobile Health Apps Popular, but Efficacy in Question, Experts Say

2011-03-24T07:56:00.000-07:00

A number of articles discussing how today's mobile healthcare apps are nice, but not effective...

http://news.yahoo.com/s/ac/20110321/hl_ac/7982458_mobile_health_apps_arent_promoting_healthier_behavior
Leonardo De La Rocha writes in Yahoo News, that while there are over 8,000 mHealth apps in the various apps markets, many who download them, don't use them...According to a Pew Internet Research Study 26 percent of people who've downloaded them only use them once, and only two-thirds of people who have the apps use them as intended.

Loren Abroms, in the Journal of Preventative Medicine, reviewed smoking cessation apps "have low levels of adherence to key guidelines in the index. Few, if any, apps recommended or linked the user to proven treatments such as pharmacotherapy, counseling, and/or a quitline."

Margaret Morris, a senior researcher with Intel, speaking to a SXSW seminar said that to reliably change behaviors, health apps will have to account for variations in user motivations. "One of the landmines with developing and promoting health software is an assumption that people set health goals and follow them in a steadfast manner," adding, "But people have a lot of variation in motivation and we need to address the social and emotion[al] factors that affect motivation variation"

Who owns your medical data????

2011-03-23T07:00:00.000-07:00

Walgreens is being sued over the sale of "de-identified" prescription data, the class action suit claims that Walgreen's customers should share in the revenue from these sales.

An interesting twist on the more common cases where an individual will make a privacy claim over the sale of data.

So what do you think? Do you own data that you generate? Do your healthcare providers own the information and can sell it, as long as your name has been removed?

Interesting questions in the world of online data exchanges.

Coordination of Care & On line transfer of records

2011-03-22T06:49:00.000-07:00

e-Patients.net has a great article on how we're at the beginning of online transfer of records enabling coordination of care. He cites the following stat, "that's been around for years...."

The typical primary care physician has 229 other physicians working in 117 practices with which care must be coordinated.

For more information and a webinar, go to http://www.nationalehealth.org/NHIN301.aspx

Spring Fling - Health 2.0 comes to San Diego

2011-03-21T07:01:00.001-07:00

The two-day Health 2.0 Spring Fling conference that begins today in San Diego will focus on three themes: making health care cheaper; the evolution of healthcare research; and prevention, wellness, exercise, and food. Officials from the West Wireless Health Institute in San Diego are set to make presentations on new models for care delivery, new technologies that cut costs, and alternate funding models tailored for a faster and lower cost approach to health technology innovation.

http://www.health2con.com/conferences/san-diego-2011/

Genetics and Health 2.0 versus "The Old Guard"

2011-03-17T07:18:00.001-07:00

Jon Entine at the American Enterprise Institute (http://www.american.com/archive/2011/march/health-2-0-vs-the-old-guard) wrote an article on how an "overaggressive FDA could strangle a revolutionary technology still in its infancy."

Jon's talking about personal genetic testing that's sold DTC (direct to consumer). In recommending the article, the author of The Health Care Blog wrote about a meeting he attended two years ago with a regulator from NY. At that time the state was going after two of the personal genomics companies. When asked why, her answer was, "doctors have the power in my state." Not exactly a good reason.

Heritage Health Prize

2011-03-17T07:18:00.000-07:00

Starting on April 4, the Heritage Health Prize (@HPNHealthPrize) competition, funded by the Heritage Provider Network (HPN), will ask the world's scientists to submit an algorithm that will help them to identify patients at risk of hospitalization before they need to go to the emergency room.

"This competition is to literally predict the probability that someone will go to the hospital in the next year," said Anthony Goldbloom at the Strata Conference. Goldbloom is the founder and CEO of Kaggle, the Australian data mining company that is running the competition for HPN. "The idea is to rank how at risk people are, go through the list and figure out which of the people on the list can be helped," he said.

If successful, HPN estimates that the algorithm produced by this competition could save the country billions in healthcare costs. In the process, the development and deployment of the algorithm could provide the rest of the healthcare industry with a successful model for reducing costs.

"Finally, we've got a data competition that has real world benefits," said Pete Warden, author of the "Data Source Handbook" and founder of OpenHeatMap.

One significant challenge with this competition is that the data set isn't just about what movies people are watching. It's about healthcare, and that introduces a host of complexities around privacy and compliance with regulations. The data has to be de-identified, which naturally impairs what can be done. Jonathan Gluck, senior executive at HPN, emphasized that the competition is HIPAA- compliant. Avoiding a data breach has been prioritized ahead of a successful outcome in the competition. Not doing so, given the sanctions that exist for such a breach, might well have made the competition a non-starter.

Key Drivers for mHealth App Growth

2011-03-17T07:17:00.000-07:00

Karen Warth, writing in the Broadband for American blog reviewed the key drivers for apps.

Just over two months ago Research2Guidance provided research that suggested mobile health or mHealth applications would be distributed in the future by physicians and hospitals and as opposed to app stores like iTunes and Android Marketplace. (As a bit of disclosure, we participated in the research). While the release of this information was widely published and discussed in social media mhealth circles, people outside of the mhealth space seemed much more surprised by the findings. The reason? Those of us in the mHealth arena are close observers of trends and drivers affecting the industry.

The key drivers leading to app distribution by healthcare providers are:

- Numerous physicians and health practitioners embracing existing mobile apps that patients can use to manage their condition and share information
- Healthcare provider organizations including hospitals, healthcare groups and even insurance companies are promoting mobile health applications to their patients and members
- New mobile web technologies and app designs will create universal apps, which can run on any Smartphone, regardless of its operating system (iOS, Android or Blackberry)
- Expansion of high speed wireless access, like 4G and the adoption of electronic health records (EHR)

Physicians and healthcare professionals are recommending apps to their patients. For instance, we have seen forum posts regarding various heath management tools like, Glucose Buddy, which suggest that the healthcare provider is recommending these tools to their patients. In many cases, the patients had not been familiar with them. In fact, we have even had physician groups tell us they are recommending our iPhone Pain MonitorTM app to their patients. Healthcare practitioners like tools that enable their patients to email them regular results or questions with the results.
Healthcare systems are now launching their own apps or private labeling existing apps with a variety of uses and functionalities. In many cases, providers are launching condition-related apps for managing and tracking their healthcare. In other instances, providers are offering patients mobile access to their own health information. For instance Sutter Health First Health System in California is offering patients access to MyChart, a mobile app patients can use to view their health information and send secure messages to their doctor, check lab results, view appointments and receive health reminders.

Wait until 2012?

2011-03-16T05:24:00.000-07:00

Protima Advanti over at The Healthcare Blog has an interesting article on reasons to wait before attempting to demonstrate meaningful use.

Reason #1: Compressed, unreasonable timeline for achieving Stage 2: The final rule states hospitals that first demonstrate meaningful use in FY 2011 will need to achieve Stage 2 by FY 2013 (i.e. Oct. 1, 2012). Furthermore, hospitals must demonstrate meaningful use requirements for the entire year in Stage 2 as opposed to the 90-day reporting period for the first year that a hospital is a meaningful user. Unfortunately, the final rule defining Stage 2 requirements will not be finalized until mid-2012, leaving hospitals that first demonstrate meaningful use in 2011 with less than six months to meet Stage 2 by Oct. 1, 2012.

Reason #2: No incentives lost for starting in FY 2012: In order to maximize the incentive collection across all four payment years (Medicare incentives for hospitals end in 2016), hospitals must demonstrate Stage 1 of meaningful use no later than July 2013 and continue to successfully demonstrate subsequent meaningful use stages. This means that hospitals have no early mover financial advantage for achieving meaningful use in FY 2011 (other than the net present value of the incentives). However, while there is no financial upside for achieving meaningful use in FY 2011, hospitals run the risk of forfeiting their Medicare incentives in FY 2013 and beyond if they fail to successfully demonstrate future stages.

Reason #3: Building with a more complete information set: CMS and the Office of the National Coordinator for Health IT already have released several FAQs and clarifications on demonstrating various meaningful use requirements. Undoubtedly, more are on the way based on the challenges and pitfalls faced by health care providers who attempt to achieve meaningful use in FY 2011. Some of these clarifications could significantly impact hospitals’ meaningful use plans and strategies.

EMR Incentives.... Are they for real?

2011-03-15T07:44:00.000-07:00

One of the best resources around for information on the physician's EMR incentives is the EMR and HIPPA blog. Lynn Scheps (VP government affairs at SRSsoft) has done a great job of trying to unravel the incentives puzzle.

Some of the articles include:
How will you actually get your meaningful use money?
Follow up on ePrescribing
Meaningful use? Not yet
Registering for EHR incentive money

If you are a physician, medical group manager or hospital IT executive, get over there now and you'll learn a lot.

FDA to being regulating medical apps on smartphones

2011-03-14T06:11:00.000-07:00

From QARA.info...

At a US Food and Drug Administration town hall meeting held March 10 in Irving, TX, Center for Devices and Radiological Health director Dr. Jeffrey Shuren disclosed to Emergo Group officials in attendance that the regulator plans to issue guidance on mobile medical applications later this year.

Manufacturers have thus far received little official guidance from the FDA regarding how the CDRH would handle mobile medical applications. Although some medical devices incorporating mobile applications have already been cleared by the FDA—GE’s Pocket Viewer, Airstrip Technologies’ Airstrip, Mobisante’s MobiUs and MIM Software’s Mobile MIM, for example—no high-level evaluation criteria have yet been issued by the regulator regarding these products.

According to information provided by FDA officers at the town hall, software validation will be required for mobile medical applications. Whether such devices would have to go through 510(k) or pre-market approval processes, or be ruled 510(k)-exempt—has not yet been determined, they said.

As mobile application and medical device technologies will only converge at a steadier rate going forward, the FDA’s pending guidance on this industry-changing trend should prove highly influential in both how manufacturers devise mobile capabilities and how other regulators develop their own approaches to such devices.

Health 2.0 comes to SXSW

2011-03-14T06:10:00.000-07:00

Looks like the Health 2.0 sessions at SXSW are a big hit.

Indu Subaiya, co-founder of Health 2.0, moderated a panel on the issue at SXSW, which included people from various projects using open information to improve healthcare:
Jamie Heywood (http://www.twitter.com/jamie_heywood) PatientsLikeMe
Giles Frydman (http://www.twitter.com/gfy) ACOR
Aman Bhandari (http://www.twitter.com/GHideas) Health and Human Services

PatientsLikeMe
"I'm just interested in figuring out what's wrong with people and helping make them better," said Heywood. He started PatientsLikeMe (http://PatientsLikeMe.com) when his brother was faced with ALS and found that the experience as a patient was like walking a path that thousands of people had been down without the ability to see their footprints.

PatientsLikeMe believes in full openness. If you agree to share all of your information, you get the benefit of seeing those footprints. You can find out exactly what other people like you have been through, and in aggregate, the trends with symptoms and drugs other people like you have experienced.

The average study in the health system would involve a small slice of data over a small slice of time over a specific question. PatientsLikeMe broadens every aspect of that and creates greater power for patients with more access through sharing information openly.

ACOR
The Association of Online Cancer Resources (ACOR) has a similar mission to PatientsLikeMe, but it's sixteen years old, and because of that is based in older technology. It also has a similar root. Frydman created it after his experiences on a listserv for cancer patients after his wife was diagnosed with cancer. The advantage is not only is getting information from someone like you, but that you get that nformation more quickly than it can be processed through an organization like the FDA or any other system. Frydman told a story from 2003, when a new drug was approved by the FDA, saying that njection had to be done in 15 minutes. Within three months, patients who were using that drug and heir families were reporting death or near-death because of it. The group figured out before anyone else that the drug should actually be injected in 30 minutes. Since the change, no one has died.

HHS
On President Obama's first day in office, he signed the Open Government Directive to increase collaboration, ransparency, and participation. Now there's HealthData.gov. The philosophy was to become the NOAA of health data," releasing as much information as possible.

Video Consulting for Diabetes Patients

2011-03-13T08:02:00.000-07:00

A test of remote conferencing via video provided substantial benefits to diabetes patients and the NHS...

There are currently 150 home based patients being telemonitored. Set against registry data service is saving ~0.1 all cause admissions, per patient, per month

Between July 2009 and December 2010 it has saved 202 all-cause admissions > Based on these reduced admissions alone it’s saved £93k in 18 months

"And the visual dimension gives you a lot more confidence in your decision making. So you’ve got a data stream coming in oxygen saturations are low and you’re going to admit somebody because thye’ve dipped but you can actually see them in their own house and they’re not breathless and you just make decisions that you make day in day out and I also think there is an ability to engage in a different way with the family so i’ll give you an example, I was doing a call to a guy with diabetes at home and he’s telling me how he’s sticking rigidly to his diet and then i hear a shout from the kitchen “oh no you’re not you lying bugger!” and his wife comes around the corner joins in the call and we have a much more engaging conversation. So obviously he’s given permission to have his wife in the room so confidentiality isn’t an issue in this case but there are lots of examples like that were another patient who was hospital phobic and wouldn’t come to clinic, and her (blood sugar) control was awful and she felt really bad about herself."

More studies on SMS reminder programs

2011-03-12T07:06:00.000-08:00

Two studies on SMS and smoking
#1

"Researchers at George Washington University and published in the American Journal of Preventive Medicine's March issue, indicates they shouldn't. The study compared a series of 47 apps against the U.S. Public Health Service's 2008 Clinical Practice Guideline for Treating Tobacco Use and Dependence, to see how closely they adhered to the guidelines.

The results: Abysmal. On a scale of zero to 60 points (60 being the best), the highest score any of the apps received was a 30. And most scored well below 10, the study reports. Researchers concluded that quit-smoking apps were simply ineffective. Interestingly, however, there was no clinical work to show whether they actually are effective or not."

"A study at the University of Oregon indicates that text messaging should work. The study is published in Health Psychology, the journal of the American Psychological Association. It found that a series of eight anti-smoking text messages per day over a three week period was highly effective in stimulating the segments of the brain that work to fight cravings.

That study's conclusion: "Text messaging may be an ideal delivery mechanism for tailored interventions because it is low-cost, most people already possess the existing hardware and the messages can be delivered near-instantaneously into real world situations," researchers say."

SMS for epilepsy patients

"Statistics from a UK program show that regular text messaging can help patients control their epilepsy better and reduce seizures. The service numbers are small--only about 50 patients participate--but it has been ongoing for more than a year. Preliminary stats find that patients are adhering better to their medication regimens, take better care of their health generally, and have greater satisfaction with hospital services.

"We are continuing to collect feedback from people using this service and it is beginning to become clear that improvements in adherence are resulting in better seizure control and less use of emergency medical services for some. We hope to get a clearer idea of the scale of these benefits later in the year," said Anthony Linklater, one of the hospital's epilepsy specialist nurses."

Our thoughts and prayers...

2011-03-11T06:57:00.000-08:00

Our thoughts and prayers for those in Japan this morning. We're now about 8 hours after one of the largest earthquakes in recorded history. Beyond the quake itself, a tsunami seems to have done more damage, sending a 3 or 4 meter high wall of water into a small town north of Tokyo. That same tsunami has just hit Hawaii (of course with a much smaller swell) and will hit Southern California in about 4 hours.

Why mention this in a mobile health blog... The first communications system back up in Japan is the SMS system. SMS has become the most used and most consistant method of getting the word out.

Something to keep in mind...

Big Step: ATA and AADA request payments for services delivered via mobile

2011-03-10T06:57:00.000-08:00

ON February 25, the American Telemedicine Association and the American Academy of Dermatology submitted a formal request to CMS to provide payment for services delivered via telemedicine.

The two organizations are asking CMS to “clearly identify the visualization of photographs as a covered service, thereby allowing the broader application of this cost-effective and access-enabling technology.” The letter documents numerous studies showing that the use of store-and-forward teledermatology is a cost-effective strategy for providing broader access to dermatological care. In use since the 1970s, teledermatology can improve access to specialist care for geographically underserved, rural, disabled, or institutionalized patients with skin diseases.
The letter represents a milestone in cooperation between ATA and a leading medical society in promoting telemedicine. “The support by medical societies has been seen as a critical goal in deploying telemedicine and allowing patients and consumers with better access to healthcare beyond the walls of hospitals and doctor’s offices,” said Jonathan Linkous, CEO of the American Telemedicine Association.
“The practice of dermatology heavily relies on patient history and visual examination to make a diagnosis, both facilitated by advancements in technology that allow for high quality care through telemedicine,” said Ronald L. Moy, MD, FAAD, President of the American Academy of Dermatology Association. “With comprehensive patient information and clear images, the dermatologist can often make a diagnosis at a distance and advise the local doctor how to care for the patient, keeping patients out of high-cost care sites and allowing patients access to care that may have otherwise seemed unattainable.”

Growth of patient monitoring

2011-03-09T06:54:00.000-08:00

From Berg Insights:

The market for home health monitoring of [chronic] diseases was worth approximately € 7.6 billion in 2010 and is growing about 9 percent annually. The diabetes monitoring segment is by far the largest segment, worth about € 6.3 billion. The market includes revenues from monitoring equipment, disposable materials and services. Wireless technologies have only just begun to penetrate the market.

The end of the pager is near

2011-03-08T07:56:00.000-08:00

Dr. Satish Misra over at iMedicalApps.com says that the day of the pager is over, and boy is he happy....

When I started medical school, I always envied the attending physicians who would get paged a lecture. The intrigue of what was in that message and what life-or-
death decision was about to made – it seemed so exciting and just reinforced my decision to enter medicine. Well, now I’m a bit older, perhaps a bit wiser, and I’ve learned two things. First, at least half of those pages weren’t worth the fraction of a millivolt it took the pager to display them. Second, pagers are a horribly inefficient way to communicate.

Frankly, just not ever having to hear that awful pager beeping sound again was enough of a reason for me to want to buy in to one of these new systems. But in addition to sparing me that pain, implementation of these kinds of mobile communications platforms will soon change how healthcare providers work together and improve the care we deliver to our patients.

Answering the tech support challenge

2011-03-07T06:16:00.000-08:00

Laurie Orlov @ the Aging In Place Blog has a great post on managing tech change, from the user point of view. Some thoughts...

Watching people watch their phones. Over the past several months my consciousness has been raised about the pace of tech change -- and how far behind most of us are from understanding the new phone, computer or software we confront -- by choice! -- at too frequent intervals. Cell phones are kept an average of 20 months at an average monthly bill of $78. Oh well - Pew Research observes that 35% of adults have cell phones with apps, but only two-thirds of those who have apps actually use them, and Pew's theory as to why? They don't know how.

Maybe we need a multi-tech 'genius bar' inside Walgreens or CVS. The Apple Genius Bar idea makes a lot of sense -- and works if you a) have an Apple product and b) can easily get to the store. But a state with 18 million people like Florida has only 16 stores with Genius Bars -- all in urban locales. What if CVS or Walgreens upgraded their photo counter staff with some tech support skills, where you could come in with your prescription refill and sign up for a time slot with a tech person who knows your device, can explain what anti-virus software you might need, give you a personalized bit of advice -- based on a displayed menu of tech products the staffer understands? Rather than force folks into a tech store, bring tech skills into places where older adults already go. Don't sell them a device -- sell them service and knowledge about devices they already own. Let's slow down the pace of adoption long enough to figure out the tech products we already own.

http://www.ageinplacetech.com/blog/tech-change-challenging-add-support-where-people-are?

Walgreens gets consumers to use text alerts

2011-03-04T06:42:00.000-08:00

After just four months of launching “Refill by Scan,” Walgreens have found that users of its smartphone application have embraced the feature which enables them to use the camera on their phone to scan the barcode printed on a prescription label to order a refill. Walgreens said half of all refill orders originating from a mobile device are now from Refill by Scan. The feature has been available to users of Walgreens’ iPhone and Android apps since November 2010.

Walgreens also announced that more than 1 million people have subscribed to its prescription text alert service, which informs customers when a prescription is ready for pickup. That service was launched in March 2010.

“Our customers have enthusiastically adopted our mobile applications and we’re continuing to bring innovative technology to our online and mobile platforms to enhance the customer experience,” Sona Chawla, Walgreens President of E-commerce, stated in the company release. “With refill by scan, prescription text alerts, unique photo features and the ability to shop or browse products all available on a mobile device, we’re adding new levels of choice, control and convenience for our rapidly-growing numbers of mobile customers.”

Walgreens plans to launch a new advertising campaign this week to promote Refill by Scan and its other mobile services.

Changing Health Behaviors

2011-03-04T06:36:00.000-08:00

Margaret Morris, PhD, clinical psychologist and researcher in Intel’s Digital Health Group shares her research into how technology might be used to facilitate positive change toward healthy behaviors. Margaret covers 3 theories and research into how to apply them to helping people make healthy choices:

Emotional Awareness: Facilitating awareness of behaviors through mobile therapy - can your phone be your psychologist?
Social Psychology: People are very affected by what they think other people are doing - how can we tailor messages that will motivate people to make the right choices?
Loss Aversion: Loss affects us twice as much in a negative way as gain affects us in a positive way - how can we use this “stick” to help people change?

Here's the video

http://www.youtube.com/watch?v=RXDmmxJsAdk

HIMSS Conference Overview

2011-03-04T06:00:00.000-08:00

Read a blog post by John over at Chimark Research. FUD at HIMSS... Not exactly surprising since there is little clarity and lots of experiments going on. But one of John's points is worth repeating. The big players have been purchasing smaller companies and that's who is participating at HIMSS.

Examples:
IBM acquired Initiate
Ingenix acquired Axolotl
Aetna acquired Medicity
GE is partnering with ICW
Surescripts is partnering with Kryptiq
Thomson Reuters is partnered with Care Evolution
Microsoft with Amalga/Emdeon
Harris Corp announcing they will acquire Carefx

How is this playing out? Will payer ownership of Healthcare Info Exchange companies help or hinder sales?

Brought to you by the law of untended consequences…

2011-03-03T06:00:00.000-08:00

From last week's Global Post:

As authorities in China seek to combat a growing aging problem, legislators have proposed an amendment to the 1996 law protecting elderly rights that would make it mandatory for children to visit their aging parents “often" — though just how "often" that is has yet to be determined.

The legislation, proposed by legislator Liu Qing Ning and sponsored by 31 other legislators, states that "supporters" of seniors — including sons, daughters and those legally obligated — will be made to “pay medical expenses for the elderly suffering from illnesses and provide them with nursing care.” As such, this proposed legislation is seen as an effort to alleviate pressure on the already over burdened health care system.

Many children born under the "One Child" policy have migrated to far-flung cities, placing the burden of caring for the elderly on the health-care system. In Chinese culture, it is a childʼs duty to care for his or her parents, but the pressures of the modern world are changing views of traditional practices.

Around 155 million of China's 1.3 billion people are over 65, and the number is expected to swell rapidly to about 260 million by 2020, according to reports. Amy Sommers, a lawyer who has been practicing China-related law for the last 17 years, sees the amendment as "a reflection of pressures that economic opportunity and social changes are wreaking on China's already frayed social safety net."

"So many more people now seem to be mobile,” she said, “it is perhaps not surprising that there is a perceived need to specify that 'supporters' have a duty to be in contact in with their elderly parents."

The option of rebalancing Chinaʼs lopsided society by amending the draconian laws which engendered it in the first place has kindled a debate across online forums in China and abroad.

It isnʼt that there is a lack of filial piety in todayʼs society, said professor Wang Ping of the Zhejiang University of Technology, itʼs that “the change of social values has placed views of economic situations over that of traditional practices.”

EMRs incentives off to a fast start

2011-03-02T06:17:00.000-08:00

From The Hill's website:

The Centers for Medicare and Medicaid Services is touting early interest in new programs offering bonuses to healthcare providers for using electronic health records (EHR). More than 21,000 providers have already signaled their intent to apply for Medicare and Medicaid incentives, and 11 states have launched Medicaid EHR programs, CMS announced Wednesday. Four Medicaid programs have already paid out $20 million in incentives.

The programs, which opened for registration Jan. 3, are funded by nearly $30 billion included in the 2009 stimulus for the adoption and implementation of EHR technology. To receive the funding, doctors and hospitals must meet certain clinical and administration benchmarks intended to boost patient safety and quality of care.

Doctors can receive up to $44,000 or $63,000 in the Medicare and Medicaid programs, respectively, for the “meaningful use” of EHR technology, and hospitals stand to earn millions for either program. The bonuses will eventually turn into penalties for providers who don’t adopt.

“We encourage early adoption, and we’re seeing the registration numbers continue on an upward trajectory,” CMS Administrator Don Berwick said in a statement.

States that have launched Medicaid programs include: Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

About four-fifths of the nation’s hospitals and 41 percent of physicians said they intend to qualify for EHR incentives, according to January polls from the Office of the National Coordinator for Health Information Technology.

Interview: Paul Kusserow, Humana Venture Capital

2011-03-01T06:15:00.000-08:00

Perhaps it's because there are so many mHealth conferences that the CTIA will be sparsely attended by mHealth companies (see previous post). But I did see this interview that Brian Dolan of MobiHealthNews.com did the other day.

I'm impressed by his honesty and willingness to learn...

“We have this integrated wellness program now but we know we need to figure out how to put it through mobile apps to drive engagement,” Paul Kusserow, Chief Strategy Officer, Humana Venture Capital told MobiHealthNews in an interview at the HIMSS event in Orlando, Fla. this week. “We are talking to a lot of people to get ideas there.”

Kusserow said that he is most interested in data standardization and analytics currently: “If mobile is the last mile and that’s the face of the consumer, then you better make sure the data is out of the silos and personalized. Otherwise people aren’t going to use it.”

Diabetes management, aging in place and social networking and media trends have been top of mind for Kusserow recently. “Health IT valuations are stratospheric,” Kusserow said. “It will be interesting to see what happens there... On the apps side I haven’t seen such high valuation, though. In the post reform market, the individual market tends to be young and independent. We want to make sure they get their information and staying engaged. We want to make sure we are getting information to these folks.”

Kusserow also sees opportunities on the other end of the age spectrum.

“I’ve looking into a lot of aging in place technologies recently.” Kusserow said. “A friend of mine told me at breakfast [here at HIMSS] that [aging in place] technologies won’t find adoption because they change the whole business model for home care. My response was: The business model needs to change.”

Kusserow said it is still unclear to him how these technologies should be implemented and who should implement them.

“Sensor technology is getting cheaper, commoditized, and standardized, but there are still lots of questions around putting in protocols. What does it all mean? When you open the fridge less, sit on the sofa more, etc,” Kusserow said. “Those kinds of protocols can quickly begin to predict behavior. When someone breaks from their norms, what sort of protocols kick in? We serve a lot of older people since we are a Medicare shop so home care and aging in place tech is key for us. There is interesting work being done in these retirement communities — the pre- nursing home environments — so it’s going to be interesting to see where that goes.”

Whether it’s aging in place or wellness programs for the employed and younger individual markets, Kusserow sees the opportunity for data analytics across all of our health choices.

CTIA pre show report

2011-02-28T06:13:00.000-08:00

I received the first package from CTIA for the show next month. I'm curious as to how little mHealth displays and exhibitors will be there. Here's what's in the brochure....

One afternoon there will be sessions on mHealth, called "Moving Wireless Health Forward." There will be one from the folks at Lake Nona Medical City. I've not heard of these folks before, and I'll be looking them up. The other two are from Continua Health Alliance and the Wireless Life Sciences Alliance. Both of these are non-profits that promote mHealth.

Over at the wireless health pavilion, as of the brochure's print date, there are only three or four exhibitors. Diversinet, Doro from Europe and Optum Health. I have a feeling that the ATA will be there along with Continua and the Wireless Life Sciences Alliance. No one else???

Why don't doctors use SMS for appointment reminders....?

2011-02-25T05:44:00.000-08:00

Someone's asking the right question over at 3G Doctor Blog:

Robert Flynn, a Consultant Urologist at the Adelaide Meath Hospital in Tallaght, Dublin has written an excellent letter to the Editor in this months Irish Medical Journal that I think deserves a lot more awareness: “The Use of Text Messaging to Reduce Non-Attendance at Outpatients Clinic – a Departmental Experience” P Ellanti, RP Manecksha, R Flynn

Summary:
Non-attendance at outpatient clinics is a common occurrence and impacts significantly on the efficiency of clinical departments. High rates of non-attendance result in under utilisation of medical, nursing and administrative resources. It also has a negative impact on already overstretched clinic waiting lists. More than half of patients who miss their appointment cite forgetting their appointment or confusion about dates or times as the reason for non-attendance. Several methods have been reported to reduce non-attendance rates, including reminder letters, personalised or automated phone calls, all with varying degrees of success. In an effort to reduce the outpatient clinics non-attendance rate, the Urology department in conjunction with the Information and Communication Technology department commenced the use of a text message reminder, sent to patients three days prior to each patient’s appointment. We audited non-attendance rates at Urology clinics before and after introduction of this service.

Between 2007-2009 there were 25,820 appointments made and there was a DNA of 17.6%. The Hospital then introduced SMS appointment reminders over the next 2 years at a total cost of €1,807 (for 25,820 SMS). Between 2009-2011 there were 27,604 appointments made and there was a DNA of only 12.4%, an overall reduction of 29.5% in no-shows. Somewhat unsurprisingly the initiative was very positive with patients aged 16-30 years with the reduction in DNA’s by patients from this age group falling by 63%.

In absolute figures a service that cost just €900 per year resulted in 500 patients per year attending appointments that they otherwise would have missed.

While this is one of a number of studies that say the same thing, one still struggles with the answer to the question.

Medicine and Privacy

2011-02-24T07:32:00.001-08:00

The two do go hand in hand. Over the years, we've seen a number of initiatives that involve doctors looking at or being asked to look at non-medically related behavior inside the exam room. Mostly this has to do with issues that I would consider more politically motivated than medically motivated, in an effort to shame people into changing their behavior. In the US, this comes up every once in a while around gun ownership.

But in Britain, they are going a lot further. From the UK Guardian… "The benefits that NHS Direct and patients can receive from our use of Twitter include an increased level of feedback that improves the ongoing development of our services," says Roger Donald, head of digital delivery at the online and phone advice service."

But there's more to this than service, NHS openly stating that they are “making appropriate searches” into patients personal twitter streams to gleam information that they then can then “raise” during consultations.

Now the NHS is streaming closed circuit TV images of waiting rooms onto the Internet. The British Medical Association is now concerned about a new law, "As currently drafted, there is very little in the Bill relating to confidentiality and information governance controls, which are so fundamental to medical practice and the trust-based relationship between doctors and patients," it says. "Fears that their data may be shared with others may result in patients withholding important information; this may not only affect their own health but has implications to the wider health service.

"By failing to put in place proper safeguards, the government is potentially removing the control doctors and, most importantly, patients have over their confidential data. This conflicts with government promises that patients will be given greater control over their medical records."

Less than 0.6% of Britain's use the NHS health care portal, could this be why?

Device Review Slowdown Across FDA Impacting Medical Device Jobs

2011-02-23T07:32:00.000-08:00

Pharma Jobs website discussed a report by BCG and the California Healthcare Institute that highlights the role of the FDA in the research and innovation process for health care.

"The report, , titled “Competitiveness and Regulation: The FDA and the Future of America’s Biomedical Industry”, has underlined that an increasingly unpredictable approval process at the FDA has negatively impacted public health, the economy, job creation, American competitiveness and innovation.

This report represents the first study to quantify approval timelines and trends over the past decade across both pharmaceuticals and medical devices using FDA and other data.

According to the study’s findings, when comparing the most recent year with the average for 2003-2007, review times for drugs and biologics have increased by 28%; while for medical devices, 510(k) clearances have slowed by 43% and PMA approval times have lengthened by 75%.

“Patients here in the United States ultimately suffer when there are delays in bringing new medical discoveries to the market,” said David Gollaher, Ph.D., president and CEO of CHI, an entity that represents more than 275 leading biotechnology, medical device, diagnostics, and pharmaceutical companies, and public and private academic biomedical research organisations."

The FDA’s expanded data requirements, changing clinical trials protocol, and lack of consistency all lead to high levels of regulatory uncertainty.

“While this may have been uncomfortable in good economic times, it has become intolerable after the crash,” said Simon Goodall, a partner in BCG’s Health Care Practice. “The business risk posed by regulatory uncertainty has increased sharply since 2007. With less capital available, the risk of FDA unpredictability and delays is only compounded, especially when European approval often offers a faster and more predictable pathway to commercialisation.”

MWC Round UP

2011-02-23T07:31:00.000-08:00

From Research2Guidance: Broad awareness for mHealth and home monitoring: mHealth was clearly the biggest cross industry topic on the conference. Most of the OEM and operators as well as big fishes like Qualcomm and IBM showed some of their solutions which make use of a mobile device to support the treatment of a patient. Interesting that most of the mHealth solutions where not smartphone centered but made use of a specific device. Only smaller players which showed their solutions in the health care pavilion where mainly smartphone focused. Home monitoring has been another interesting cross industry area which caught a lot of attention during the week. Telco companies used an entire pavilion, the “Embedded House”, to showcase their offerings. It became clear that the Telco industry will compete against the energy industry in that promising market.

Will your doctor share information?

2011-02-22T06:35:00.000-08:00

We've all talked about EMRs and meaningful use... But what about the patients access to the info? How can the patient be more active in the diagnosis and treatment decisions if they cannot get access to the relevant information?

Good questions raised by Jane over at the Health Populi blog.... "Researchers from the AMA, University of Chicago and the Markle Foundation wondered how willing physicians would be to use patients’ PHRs. The results of their survey are published in the February 2011 issue of Health Affairs. The bottom line is that physicians’ willingness to connect with patients’ PHRs varies by the doctor’s gender, clinical specialty, race, geographic location, size of the practice, and whether they are already using an EHR.

The physicians who would least likely embrace patients’ would most likely practice in suburban geographies, in solo or duo practices, be female, and be in primary care or pediatrics. And those who don’t use an EHR currently are much less likely to be unwilling to use a patient PHR.

Health Populi’s Hot Points: Physicians most willing to use PHRs tend to see PHRs as tools that empower patients “to participate in care.” At the same time, a majority of physicians most willing to use PHRs are also concerned that patients might omit important information in their PHR, that the PHRs might contain incorrect information, that they might be held liable for knowing all information in that PHR, and that the PHRs might lack sufficient privacy protections.

Which Tablets Do Developers Like

2011-02-21T05:35:00.000-08:00

More and more applications are transitioning from paper and single purpose technology to more general purpose tablets. IDC asked developers which tablets they are planning to develop their applications on.

NYT: Preventing Falls

2011-02-19T05:34:00.000-08:00

Prevention calls for unconventional actions sometimes, and the New York Times had a great article on new recommendations to help seniors avoid falls...

The American Geriatrics Society and the British Geriatrics Society have updated their guidelines for preventing falls in older people. The update includes two notable changes: One recommends tai chi — the meditative, slow-motion Chinese exercise — as an effective way to prevent falls, while another suggests that doctors review medication use by all elderly patients, with an eye toward reducing use of those drugs that increase the risk of falling.

Tai chi gets the nod because several trials have suggested that it seems to help reduce the risk of falling, she said, although it is possible that other forms of balance training work just as well.

The geriatrics groups also have long recommended that the medication regimens of older patients be reviewed and, if possible, scaled back. Earlier guidelines called for reviewing medications only if a patient takes more than four. This time around, researchers say that all older patients ought to have their doctors review their prescriptions for any that might
increase the risk of falling.

“The evidence is strongest that medications that affect the brain — these include antidepressants, sleep medications and medications for anxiety — increase the risk of falling,” said Dr. Mary Tinetti, Yale University School of Medicine. “There is also a suggestion, not yet proven, that narcotics and some blood pressure medications may increase the risk of falls, as well.”

Healthcare Out Loud

2011-02-18T19:59:00.000-08:00

From Kru Research, Susannah Fox on social networks and chronic illness:

mHealth not ready for primetime???

2011-02-18T06:05:00.000-08:00

Ted Driscoll, PhD, is a Technology Partner at Claremont Creek Ventures. He is also an active angel investor in the Life Science Angels and a founding director of the Sand Hill Angels. He wrote an article stating that mHealth is not ready for prime time.

Ted states, correctly, that doctors and the conventional healthcare system is not ready for it. I have bad news for you Ted... It may not be ready to make angel investments or VC investments, but it's in use RIGHT NOW and successful. I have a list of over 40 trials where SMS has been used to improve outcomes all over the world (michaelscharf.us then go to the download page). Is the US behind the curve, yes, as it has been on everything mobile. Can we catch up quickly, absolutely.

Information and integration will be just as important to improving healthcare outcomes as innovation has been. It's just a matter of finding the right people to take the lead.... And you can reach me through the blog.

Pharma companies invest in apps

2011-02-17T08:22:00.000-08:00

From Bloomberg...

Drugmakers led by Merck & Co. and Novartis AG boosted investments in mobile phone applications and educational websites by 78 percent to get patients to take their drugs, eat right and exercise, an Ernst & Young report found.

Pharmaceutical companies initiated 97 projects last year aimed at using information technologies to improve patient health, according to the report by the New York-based consulting firm, which relied on analyst reports and press releases to reach its tally. That compares with 124 projects started in the four prior years combined. About 41 percent of the projects were smartphone applications, an increase from 11 percent since 2006.

“Pharma can’t exist the way they have existed; what is surprising is the pace of change,” said Carolyn Buck Luce, Ernst & Young’s global pharmaceutical leader, in a telephone interview. “The next big change in health outcomes is behavioral change, where medicines play an important part but not the only part.”

Two take aways. First, health care outcome improvements will be driven as much by information as by innovation. Second, adherence is THE issue for mHealth today.

More from MWC

2011-02-16T13:26:00.000-08:00

This week in Barcelona, Samsung has announced that they are modifying Google Android's mobile operating system to include 91 custom APIs to enhance mobile app security. The additional APIs will enable health care providers to use products like ResolutionMD's radiology viewing app as well as SAP's Mobile EMR product.

The goal is to go after both enterprise users as well as hospital CIOs, and the new services will be available on the forthcoming version of Android (version 3.0 or "Honeycomb").

Second announcement, although I have not been able to confirm this yet. The Cancer Institute at George Washington University is partnering with AVON Foundation For Women on a new, text based, information program aimed at breast cancer patients. Modeled on the Text4Baby program, you can text "BSE" to 64274 to get information on breast self exams. Like Text4Baby, there is no clue as to how this new program will raise the tens of millions of dollars required to reach their audience.

Global Opportunity in mHealth

2011-02-15T21:57:00.000-08:00

There is no doubt that mobile health services can have a positive impact. One interesting argument is where the impact will be felt more directly, in emerging markets where existing infrastructure is limited and regulations are more lax. Or in the developed nations, where rapidly escalating costs are forcing a rethink in how healthcare is delivered.

Brian Dolan and company put together a montage from last year's mHealth summit.

Enjoy...

MobileHealthisGlobal from ListenIn Pictures on Vimeo.

SMS versus Apps

2011-02-15T11:18:00.000-08:00

If you wanted to understand why SMS still works better than apps for mHealth today, look no further than New York City. The NYC Health Department has unveiled a new app yesterday. The Valentine's Day launch of Condom App enables Android or iPhone users to locate where the department is providing free condoms.

To get the free condom, someone has to have one of these two types of smart phones (probably less than 15% of all mobile phone users in the US), have their data plan paid up to date, not have exceeded their data plan allotments, went to the respective app store, found the app, etc. etc. etc.

Using SMS, it would be as simple as telling people to text "Condom" to 12345. The response would include the address of the distribution point.

If all you have is a hammer, everything looks like a nail...

MWC meta coverage - day one

2011-02-14T08:35:00.000-08:00

I was not able to get to Barcelona this week for the Mobile World Congress, but there are enough people covering the event that we can discuss the event via those reports...

Today was day one, and mHealth was on the minds of a number of people.....

GoMoNews.com provides the first couple of articles. Dr. K Ganapathy from India discussed how true communications needs to be the heart of healthcare, and compares mHealth to mBanking. In India, 45 million urban Indians already use mBanking. How come mHealth has not grown as quickly, he asks. Unfortunately, he sees this as a chicken and egg problem. "If 50 million people are on the system, then it can make profit." Wow, 50 million people. We need more creativity, we need to find those "low hanging fruit" that can enable profitability at much lower volumes.

A second article from GoMo News follows the session with Telefonica's Head of Global Healthcare, Jose Padermo. Mr. Padermo looks at our current situation, costs of chronic disease taking about 70% of all healthcare expenditures, healthcare information services becoming more integrated (HIMSS is this week as well). However, his answer is that we need huge scale. I have to disagree, we need solid examples of mHealth improving healthcare outcomes, while reducing costs on a small scale. And, with lots of these examples, we will get the scale we all expect to see in 5 to 10 years.

Final article of the day, from Laurie Orlov's great blog, Aging In Place. Laurie starts out discussing how so many studies have been published in just the first six weeks of the new year. Add to that the number of healthcare apps on the iOS (Apple) and Android apps stores and one would believe that we're in the beginning of an mHealth renaissance. But given the lack of adoption by older americans (less than half of age 75+ even have mobile phones), barriers are in place impeding the success of mHealth. However, it's more fundamental than just adoption issues. Phone makers, especially smart phone manufacturers are not building products for older people.

One example. My wife and I purchased a mobile for her mother in 2007. She and her husband were in a minor traffic accident and did not have any way to call a tow truck, or us for that matter. We got a simple phone and put them on our plan. What we noticed was that my mother in law never carried her phone with her. When asked, she complained that the phones never worked. Well she was right, the connector between the phone and the charger was broken. So, out we went an purchased another phone. And another, and another about every six months. I don't believe that anyone considered the ability of a older person to connect a micro-usb connector without breaking it. Between changes in eyesight and dexterity, it's almost impossible. I'm in my mid-50's and I cannot see which way is up on the micro-usb, no way my 88 year old mother in law can. We finally found one (there's an opportunity here) phone that included a cradle. Drop the phone in and it charges... no connectors to worry about. She's had that for about a year and loves it. The phone now goes everywhere with her.

More from MWC tomorrow.

Taking the weekend off

2011-02-11T22:15:00.000-08:00

It's my birthday tomorrow, so I'm taking the weekend off. Have a great weekend and Happy Valentine's Day!

Best Microkia analysis

2011-02-11T08:00:00.000-08:00

From Ryan Paul over at Ars Technica...

"Adoption of Windows Phone 7 is fundamentally an act of capitulation by Nokia—an acknowledgement that the company is incapable of building its own ecosystem or innovating above the hardware layer."

That's going to hurt.

Microkia?

2011-02-11T07:43:00.000-08:00

I hate to say this, but it's the beginning of the end for Nokia, the world's largest handset maker. If you follow the mobile hardware business, then you have read that Nokia has decided to jump from their "burning platform," and into Microsoft's arms. They have adopted the Windows Phone 7 OS as the core of their new smart phone strategy.

What does this mean for Microsoft-Nokia:
- Microsoft now has the support of the largest (and some think best) hardware designer/manufacturer in the world. A big win for them.
- Unfortunately, Nokia estimates that it will take two years to fully convert their product lines to the WinPhone7 OS. That's two years of "support" for Symbian and MeeGo (their new platform co-developed with Intel).
- Both companies will merge their IP/software products... Bing for search, Nokia Maps, Nokia optics, etc.
- Nokia has effectively split into two companies, a smartphone organization and a feature phone company.

The feature phone business will compete against low-cost Asian companies. Their short term success will depend on whether they can continue to build good products at ever lower costs. The long term success is dependent on how much latitude they will have to drive innovation in this area. IF they have to get approval from the smart phone group - like the WinPhone developers have to get approval from the Windows desktop group, they will lose share and respect within a few quarters.

The smart phone group now competes against Apple, RIM, and Google + (the plus is for all the OEMs that manufacturer Android phones). In addition, they may soon be competing against HP with WebOS and Samsung with Bada. Survival will depend on innovation and amazing execution. No room for error here at all.

What does this mean for Nokia's ecosystem of developers and operators:
- Run, there's nothing good for you here.
- While Nokia will continue to build phones based on Symbian and launch at least one MeeGo phone, support and innovation on these platforms will probably come to a screeching halt within a couple of months.
- Now that Nokia's app store will be merged into Microsoft's product, current developers have a whole new set of relationships to build.

What does this mean for US carriers:
- It depends on what existing WinPhone 7 OEMs decided to do. If they continue to manufacture WinPhone models, you might as well give Nokia a chance in two years. Also, you have to decide how many smartphone OS's you want to support.

What does this mean for the others in the marketplace.
- Feature phone companies now have the time to take Nokia's share by producing low cost phones with both high quality and more features than Nokia phones.
- Smart phone companies need to continue to do what they have done over the past several years to Nokia and Microsoft, out innovate, out manufacture, and out market these two lumbering giants.
- Intel has an opportunity to market MeeGo to another manufacturer, perhaps
- HP has a small window to promote WebOS

If I were at HTC, LG, Samsung, et al, I would be thinking long and hard about whether to stick with Microsoft or not. Given the history that Mr Softie brings to table - abandoning partners (and suing them) at every turn... I would be heading to the exits as fast as I could run. Apple and RIM are not options (they are vertically integrated competitors), but Google loves me and there are some other choices out there. Perhaps I should be thinking of Bada for low-end smart phones, or Intel's MeeGo. Perhaps I want to think about going vertical myself and buy/build my own OS.

The bottom line, no consumer is going to spend $500+ (including subsidy) for a phone that will not be supported 100%. Symbian and MeeGo are dead and buried. The market can handle, at best, three strong OS ecosystems. Apple, Google + and RIM have a huge head start on Microkia, and have well deserved reputations for faster product refresh cycles than either Microsoft or Nokia. With enough money and time, Microkia can produce great devices and even replace RIM as the third ecosystem. But that will take perfect execution by Microkia coupled with many mistakes by RIM. Of course, Samsung will have something to say about that.

Notification services providing mixed results

2011-02-10T06:18:00.000-08:00

Two different reports discussion mobile notification services. Different modes of communication and different messaging strategies.

First, Text4Baby, not doing well despite government money and support. Datadyne reports that one year after starting up with lots of White House fanfare, Text4Baby has not reached their goal and signups are actually slowing down.

In November, the organization reported that they had signed up 100,000 subscribers for its 3x per week messages to pregnant women and new mothers. In the US, there are approximately 4.5 million pregnancies per year, so they have reached about 1% of their target audience. But to reach that number, they have spent almost $2 million in cash grants plus a substantial amount of free promotion (PSAs, web spots, White House awards, etc.). If we value this additional promotion at another $2 million, their cost per acquisition is nearly $40 per subscriber. That number is unsustainable. Their recent results seem to bear that out, per Joel Selanikio at Datadyne, their recent acquisition pace has slowed 30%.

Next on the block, Vocel's Pill Phone. Mobihealthnews.com reports on a study (funded by Qualcomm) on 50 DC Medicaid patients served by GWU clinics. These were high-risk patients. Median age of 53, all had hypertension, half had diabetes, and 42% smoked. As far as demographics... All but two of the participants were African American and only 21% were employed full time. Just 17% of the subjects had college degrees and 44% had a literacy rate at or below 8th grade.

On average they had a drug regime of 8 different medications. During the study 1/3 of the respondents were seen in an ER.

All the participants were given phones and service through Wireless Reach and Cricket Communications. The feature phones were loaded with the Pill Phone app.

Over the course of the seven month study, consisting of 15,000 scheduled dosages, less than 100 were reported skipped via the Pill Phone app. Not one of the subjects initiated a change in the Pill Phone app.

“This pilot program had high acceptance, sustained use, patient satisfaction and retention rates in this high-risk population,” Dr. Samir Patel, an internist in the GWU Division of Renal Diseases and Hypertension, said Wednesday at an event on the GWU campus in the nation’s capital.

“The importance of the Pill Phone research study is that it offers a model for disease self-management that can be applied to at-risk communities,” said Dr. Richard Katz, director of cardiology at The George Washington University Hospital.

However, Patel noted the limited nature of the research. “This is a small study. We really can’t make a lot of inferences,” he said. “Longer studies will be needed.”

My take on both studies:
Text4Baby - right media (SMS) wrong distribution method (public service announcements and Internet ads).

Vocel's Pill Phone - very expensive to develop feature phone app only available on specific phones. More complex to use than SMS for a high-risk population with limited literacy. No return path to doctors / providers to support the patient on a more active basis.

Editors Please Note

2011-02-09T06:30:00.000-08:00

Editors: Please don't whipsaw your reporters like this....

Poor Sara Jackson over at Fierce Mobile Healthcare... At 10:30 on Tuesday, 2/8, Sara wrote an article asking the question is mHealth investment hype or hope. Her example was the Minneapolis based obesity med device company Gruve. Four years, and a name change after launch the company is holding on, but not able to pay any employees. I wonder more about the business plan that Gruve put together, perhaps about the initial management team. One failed company does not make a trend.

An hour later, she covered the Parks Associates report estimating the digital health market at $5.7 billion by 2010. In her words, mHealth will "skyrocket" from $1.7 billion in 2010.

Best line from the two articles: Harry Wang from Parks Associates said, "To move forward, this industry needs smart entrepreneurs and visionary industry leaders and a regulatory and reimbursement system amenable to innovative, effective and cost-saving technology advances."

Harry, way to state the obvious. Editors, pay more attention.

Factory Medicine

2011-02-08T00:00:00.002-08:00

This is as much a messaging problem as anything else. The term "factory medicine" brings up all the wrong images. But we are entering a time of "data-driven healthcare" (see you feel better already).

Listen to the podcast at ReachMD (http://reachmd.com/xmsegment.aspx?sid=5845), where Patrick Hagan, COO at Seattle Children's Hospital discusses how efficiency can drive better outcomes and even profits.

Healthcare coming home... now what

2011-02-08T00:00:00.001-08:00

With the increase in older Americans (as the Baby Boomers age) as well as longer lifespans, more and more healthcare services will be delivered at home. That's one of the reasons that mobile (as well as portable) healthcare is so important. But as these services are delivered by para-professionals as well as self-administered, how do we keep patients safe?

The FDA has launched the Medical Device Home Use Initiative, a pilot program in which manufacturers of home-use devices may voluntarily submit their labeling for posting on a website repository. The repository will provide a central location for home care patients and caregivers to access important information about the safe use of their devices.

But we need more, the FDA, FCC, and CMS must take a new look at the entire delivery system (as well as reimbursement issues) for home care.

Check out an article on this @ http://www.thehealthcareblog.com/the_health_care_blog/2011/02/when-patients-go-home-safety-must-follow.html

Clinical trials get smartphone update

2011-02-08T00:00:00.000-08:00

Source FierceBioTechIT: http://www.fiercebiotechit.com/special-reports/smartphone-apps-clinical-trials

Great round up of smart phone apps geared towards all phases of clinical trials - from recruitment to data reporting to output.

ICD 10 conversion at the half way point

2011-02-07T07:31:00.000-08:00

US health care providers have reached the half way point in their four year conversion from ICD 9 to the newer and more numerous ICD 10 codes. One more expensive IT change....

Branding and control

2011-02-07T07:27:00.000-08:00

One of the things you will learn as a marketer is that your brand is very important. For you to build a good brand, you must have control over the customer's experience - how you treat the customer, how your product meets his/her needs, etc. Obviously, when that experience is out of your organization's control, so is your brand.

Stephen Wilkins, is a principal at Health Messaging, a communications company focused on health care companies. This morning, he describes the struggle he's had with his insurance company to save his wife's life by having her cancer treated at MD Anderson.

Take a quick look at the article over at http://healthecommunications.wordpress.com/2011/02/07/when-a-major-healthcare-brand-fails-to-deliver-on-its-promise-%E2%80%93-the-case-of-md-anderson-cancer-center/

Now back to my thought...

First, I'm happy to hear that his wife continues to receive good care and that she appears to be cancer free after five years. But look at the title of the article, "... A Major Healthcare Brand Fails to Deliver..." Note who is getting the bad press. MD Anderson is named, not the insurance companies that fought with Mr. Wilkins.

Bottom line, healthcare providers are going to have to take more control of payor - patient interactions, else they will be blamed for poor outcomes.

Sue Siegel on 2011

2011-02-06T08:30:00.000-08:00

Sue Siegel is a partner at Mohr Davidow Ventures. She identifies five trends that are sure to impact health care in 2011...

1. Data-driven healthcare
2. Patient engagement increases "healthspan" more than just lifespan
3. Technology enables better remote care
4. Mental health is ripe for "sweeping advances"
5. Changing landscape - everything changes again

Check out the entire article, it's well worth the read.

source: http://www.xconomy.com/san-francisco/2011/01/05/five-things-to-look-for-in-the-coming-year-in-healthcarelife-sciences/

FDA approving smartphone-based devices

2011-02-05T09:01:00.000-08:00

Late last week, two companies announced approval of smartphone based medical products.

First, Mobilesante announced approval of their portable ultrasound. At $10K per unit (1/2 to 1/10 of more traditional ultrasound equipment) this should speed deployment of this technology. The device is based on a TG01 WinMo phone coupled to an ultrasound probe. Note that WiMo phones are not made anymore. Hmmm.
Source: http://www.xconomy.com/seattle/2011/02/03/mobisante-wins-fda-approval-for-ultrasound-on-a-smartphone-technology/

Next is Mobile MIM, a radiological assessment software package for the iPhone. It was originally launched in 2008 but pulled off the AppStore due to regulatory concernes. Now that the 510(k) has been approved, it's back.
Source: http://www.xconomy.com/seattle/2011/02/03/mobisante-wins-fda-approval-for-ultrasound-on-a-smartphone-technology/

While this is a great advance in portable health care products, neither of these are really mHealth products. We will have to see what happens when the FDA begins reviewing services/devices/software that changes the way medicine is delivered.

mHealth Investments start 2011 strong

2011-02-04T06:48:00.000-08:00

Yesterday we took a quick look at Q4/2010's investments in mHealth. So far, 2011 looks like investments as well as M&A activity will be even stronger.

First, is the stealth mode start up Massive Health. Interestingly, Massive Health appears to be focused more on design than science. Little has been disclosed about the company, but it appears to be focused on designing apps that will help manage chronic illnesses. They received $2.25 million in first round investment from a variety of "A" list VCs and angels.

Next is Epocrates. Originally filed in 2007, the company sold their first shares the other day, raising almost $90 million. So, when it comes to providing information to MDs, the market is ready for the mHealth revolution.

On the other end of the spectrum is Vitality. The maker of Glowcaps was acquired by Dr. Patrick Soon Shiong. Now you have to understand that Dr. Soon Shiong is okay by me, no matter what else he does, because he recently purchased a small interest in the LA Lakers - and I love the Lakers. However, Vitality has focused on the consumer (therefore no FDA clearance required) and done a great job of tying into existing channels (AT&T Health consulting, Amazon and more).

I have to believe that while the IPO market may be open for some, most mHealth companies will need to focus on acquisitions as their ultimate funding / exit strategy.

2010 mHealth Investments

2011-02-03T06:37:00.000-08:00

Brian Dolan over at Mobihealthnews.com does a great job of tracking investments in the mHealth space. In an article published on Monday (http://mobihealthnews.com/10087/investors-pumped-233-million-into-mobile-health-in-2010/) he lists the 14 deals that accounted for Q4's $233 million in VC investments.

While there are a number of applications focused on this area, the adoption rate appears to be much slower than what would be expected - given the investment. Perhaps this new team can discover the "secret sauce" that will move this genre of apps forward.

Can EMRs improve healthcare outcomes?

2011-02-02T06:53:00.000-08:00

Interesting article from eWeek:http://www.eweek.com/c/a/Health-Care-IT/Stanford-Study-Questions-Benefits-of-EHR-Applications-861902/?kc=rss

Brian Horowitz reviews a Stanford University study that "concluded" that EMRs may not improve health care outcomes, even if the system provides decision support functions.

To quote Homer Simpson, "Duh!"

Electronic Medical Records cannot, in an of themselves, improve health care. BUT they can improve care when part of a medical infrastructure:

- By improving communications between providers and patients and providers
- By extending the point of care beyond the doctors office
- By allow for data collection and display over long periods of time
- By allowing care to be provided by other professionals under a doctor's instruction

EMRs are a part of the new infrastructure, but to look at them separate from the rest of the health care system is foolish.

The Health Information Divide

2011-02-01T07:48:00.000-08:00

From e-Patients.net:

The most likely groups to look online for health information include:
- Adults who, in the past 12 months, have provided unpaid care to a parent, child, friend, or other loved one
- Women
- Whites
- Adults between the ages of 18-49
- Adults with at least some college education Adults living in higher-income households

By contrast, fewer than half of adults in the following groups in the U.S. look online for health information:
- African Americans
- Latinos
- Adults living with a disability
- Adults age 65 and older
- Adults with a high school education or less
- Adults living in low-income households ($30,000 or less annual income)

Only 29% of adults age 65+ look online for health information (mostly because only 40% have access to the internet), compared with 58% of 50-64 year-olds, 66% of 30-49 year-olds, and 71% of 18-29 year-olds who look online for health information. Yes, the internet is an amazing resource, but for whom? And whose voices are we not hearing from online? The wisdom of our elders is not well represented.

Caregivers are a potential bridge to older adults: fully 70% gather health information online. And young people, Latinos, and African Americans are increasingly likely to use mobile devices to gather information, which could potentially shift the patterns among those groups when it comes to using health information resources.

HCR and economics

2011-01-31T08:09:00.001-08:00

It's not known as the dismal science for nothing:

http://www.thehealthcareblog.com/the_health_care_blog/2011/01/victims-of-health-care-reform.html

Still think that every one in the US has a smartphone? Part 2

2011-01-31T08:07:00.000-08:00

From the iMedicalApps Blog:

According to marketing research conducted by independent research firms and technology companies, smartphone use among physicians is wholly on the rise. Manhattan Research, a pharmaceutical and healthcare market research firm, conducted a study last year and showed72% of physicians are using smartphones. Their research also showed this will reach 82% in 2012. Another marketing research company, Spyglass Consulting Group, showed 94% of physicians using some sort of smartphone.

Epocrates, an app maker, released a study last year showing 96% of surveyed medical students are using some sort of smartphone (although this is not explicitly stated in their presentation of the results; they focused more on what kind of smartphone med students are using).

Although these studies show a high degree of smartphone adoption among physicians, these results should be interpreted cautiously. These firms provide few details on how they actually conducted these studies. A major hurdle to conducting such research is sampling bias. This can occur in survey research when researchers get a low response rate (i.e.—researchers approach a large number of individuals to fill out a survey but few actually fill it out).

Formal, peer-reviewed studies generally work very hard to avoid such biases and could provide a much clearer picture of actual smartphone use among a representative sample of physicians. Unfortunately, I could not find any such articles. Searches in PubMed and Google Scholar yielded no studies that specifically examined the prevalence of smartphone use among physicians. I found several studies examining the use of older PDAs in clinical medicine, but no recent work on smartphone use. Smartphones represent a very recent technological evolution. Given that peer-reviewed literature generally lags at least one year behind current trends, it is very possible such studies are in the works and have yet to appear in the journals.

Despite a lack of peer-reviewed research on the subject, the available evidence does suggest most physicians are using some sort of smartphone. My own experience in hospitals and clinics points towards rapid adoption by clinicians. Although I do see most physicians using a smartphone, they also have a pager clipped to their white coat. Comprehensive communications systems with smartphones as their backbone seem to be scarce. Hospitals and clinics are currently unwilling to foot the bill for fully integrating smartphones into their communications systems and phasing out pagers. Texas Children’s Hospital recently announced a new initiativeto install Voalté, a comprehensive, smartphone-based system.

Still think that every one in the US has a smartphone?

2011-01-31T07:28:00.000-08:00

While I know that most mobile phones in the US are still feature phones, this story surprised even me:

SAN FRANCISCO, MACWORLD 2011 — Here’s a surprising statistic from Macworld 2011: about 40% of show goers don’t have a smartphone.

That was the number given to me at a meetup on the show’s last night. It was from someone who ran a competition all week in one of the booths. To win a prize, entrants had to download an app to their smartphone — and about 40% didn’t have a device that could download apps.

“I was really surprised,” said the source, who asked that neither she nor her company be identified. “Especially in a city like San Francisco and at a show like Macworld.”

Why is mHealth like the iPod and the Zune?

2011-01-30T13:42:00.000-08:00

Okay, sounds like a silly question, right? But it's not.

Let me explain...
The Apple iPod has 80% market share for music players world wide. Sony has stopped making the "Walkman" series of products. On the other hand, Microsoft's Zune player has a tiny market share, and I believe that it's dropping. What is the difference between the iPod and the Zune? They are both very sophisticated, very capable, high quality music players.

Apple rolled out iTunes and the iTunes Store 10 years ago. They provide a full eco-system, purchase music, manage playlists, manage DRM, and sync with the device.

Microsoft has put forth 3, 4, 5 different systems in the same time. All except the Zune product have been taken off line - which means that if you purchased music on "Plays for sure" you're out of luck and have to repurchase the music.

In the smart phone arena, we see much the same...
- RIM Blackberry phones had the first consistent, well designed eco-system (with BIS, BES and Blackberry Messinger). They fell behind when the App Store concept was launched a couple of years ago.
- Nokia has made a couple of half-hearted attempts with Ovi and their music program. Now, they provide - Symbian on their current phones, while telling the world that their new devices will be based on a joint Nokia/Intel OS.
- Google has launched Android, and has been very successful with it. BUT they are now confusing the market with their promotion of the Chrome OS. Both Android and Chrome seem to be aimed at the tablet market, but no one is really sure what's up.
- Microsoft, well they keep killing off smart phone OS'es. Danger (T-Mobile's Sidekick), the KIN phones, which were on sale for about a week, and WinMo 6 have all given way to WinPhone 7. No one knows how long Microsoft will support this new OS.

How does this relate to mobile health product and services? Simple, can you give me the name of a full ecosystem for medical treatment. A system that manages patient history, tests, diagnoses, treatment, COMPLIANCE, billing and reimbursement. And this system has to coordinate data exchanges between various providers (pharmacies, therapists, etc.).

I'd like to refer you to one of the best books on corporate strategy I've ever read. Value Migration by Adrian Slywotzky. Although the book is 15 years old, and filled with stories about early PC software successes and failures, it is still very applicable today. Dr. Slywotzky shows a number of well known products that simply fell off the face of the planet when the public moved on.

Look at my previous post on how EMR installations are running into a wall. Without a full ecosystem, these efforts will turn out to be (at best) of limited value. At worst, billions of dollars in systems and business methods that will have to be ripped out and replaced.

When is federal involvement "meaningful?"

2011-01-29T20:43:00.000-08:00

Great article from Anthony Guerra @ Information week; (http://www.informationweek.com/story/showArticle.jhtml? articleID=229000851)

Trying to keep politics out of this, Guerra states, and I agree, that the concept of EMR meaningful use is a "breakless train heading for a solid mountain." Billions of dollars invested into EMR systems that won't help improve outcomes or costs.

Hopefully, smarter heads will prevail and pull together a better approach to moving providers into online record systems.

Looking at the "Digital Divide"

2011-01-28T22:13:00.000-08:00

Thanks Tomi Ahonen...

Are we forgetting about nurses

2011-01-28T06:30:00.000-08:00

I certainly hope not...

A Manhattan Research study, Taking the Pulse Nurses, surveyed 800 RNs and advanced practice nurses (RN who has completed graduate training as a clinical nurse specialist, nurse anesthetist, nurse-midwife or nurse practitioner.) They learned 50% of nurses feel that they influence the treatments that patients end up following. With physicians spending less and less time with patients, nurses play an increasingly key role.

A MedTera survey of 7,028 respondents found that:
- 95% indicated that they are looking for more comprehensive information about disease management
- 77% said they hadn’t received any written information about their illness or medications directly from the physician
- High percentiles of the patients surveyed said specific types of information are “very much” or “extremely” valuable, including:
Online resources to help manage a condition (84%)
Information on medications and potential side effects (78%)

Remember to keep nurses in mind when designing health care systems.

Crowdsourcing policy

2011-01-27T11:31:00.000-08:00

The Center for Democracy and Technology has launched a website that asks everyone to come up with questions on HIPAA, mHealth, and health care privacy.

These questions will be forwarded to the Office of Civil Rights within HHS, which is charged with enforcing the privacy aspects of HIPAA. Questions will be accepted until February 11, so go to www. CDT.org and ask away.

Crowdsourcing emergency services

2011-01-27T07:03:00.000-08:00

Couple this app with a strong Good Smaritian law and we have a great thing going…

From MobiHealthNews.com

An iPhone application created by interns at Northern Kentucky University’s Center for Applied Informatics has turned into something much bigger, according to a report over at TechCrunch this week. In San Ramon, California a press conference featuring Fire Chief Richard Price, International Association of Fire Chiefs President Jack Parow, Workday CEO Dave Duffield, and Tim O’Reilly of O’Reilly Media announced an initiative to use the app, called Fire Department to enable users to help strangers in need of emergency CPR.

The app allows users who have been trained in CPR and who are willing to help strangers in need, to receive an alert if someone is located in their general area. When a 911 dispatch center receives a call for an emergency occurring near the user, a push notification is sent to the user with the victim’s location along with an alert about whether an automated external defibillator is located on the way or nearby.

We have reported before on augmented reality applications for locating AEDs, but this app takes that idea much further. The idea that a mobile health app could tie into the 911 dispatch system, alert CPR-trained citizens to others in need and provide the users with locations of AEDs is an inspiring concept.

It’s also fraught with potential issues — liability being top of mind. Still the Fire Department app is a sign that mobile health is maturing and securing real attention from the healthcare industry’s frontline care providers."

Vince Kuraitis: "PCAST HIT report becomes a political pinata"

2011-01-26T10:51:00.000-08:00

Great article on "The Health Care Blog" regarding the PCAST report that was released in early December. Vince has reviewed the public comments on the report and finds that his own attitude about it has changed dramatically in just six weeks.

From, "it was a good start," to "oh man, what a problem." For me, I believe that any time the government selects technology we're in for a problem. I'll agree with the Center for Democracy in Technology, set the policies, don't select the technology.

mHealth on the Federal "fast track"

2011-01-26T10:40:00.001-08:00

In press events leading up to and in the SOTU address, the President has attempted to make clear that the federal government wants to move quickly to approve mobile health devices and ideas.

See http://mobihealthnews.com/10008/former-fda-director-mhealth-shouldnt-wait/

for some of the specifics.

But, what we haven't seen is much progress on the part of the FDA or FCC on how to approve mHealth products and services. Those of us that are leading this industry must be cognizant that if we are too far in front, we risk feeling the arrows of regulators in our backs. But if we don't lead, who will.

It's a quandary we need to resolve, each in our own way.

Consumers looking for health info online, but not careful about the source

2011-01-05T16:55:00.000-08:00

Researchers at the London School of Economics released a survey to day that documents consumers use of the Internet to get healthcare info. According to the survey:

68% of respondents went online to obtain information about specific medications
About 40% researched how others handled specific medical conditions
58% used the information for self-diagnosis
BUT only a quarter said they checked where the advise came from
The survey covered over 12,000 people in 12 countries.

The good news is that information is out there and people are accessing it. The bad news, people can be mislead by bad information.

WSJ article: Sensitive Data Being Released, It's all my software's fault

2011-01-05T16:51:00.000-08:00

Okay, this study is just crap, and shame on the Wall Street Journal for taking the study and author seriously. A Dartmouth employee, M. Eric Johnson studies "data leaks," defined as sensitive data files leaked onto the internet. His results, "software that is difficult to use."

What's this difficult to use software, BitTorrent and other Peer to Peer programs designed to share music and videos installed on computers with sensitive data. These P2P programs find common files, word processing files and spreadsheets, as well as MP3 music files and movies, and then make them available to anyone on the 'net with a browser.

This is simple data security folks. Like the story a couple of weeks ago that talked about how most personal data losses come from people losing laptops with the data on the drive. Sensitive stuff should not be allowed to walk out the door... similarly desktop computers that contain sensitive information should not be used to download music and movies.

If it were my company's data being handled like this, I would be firing the person... Remember, WikiLeaks got it's info from some Army private that walked in with a recordable CD disguised as a Lady Gaga album.

Kalorama Research - new numbers on the mHealth app market

2011-01-05T12:14:00.000-08:00

Summary - the mobile health apps market is growing at 100% per year. In 2009, there were $41 million in healthcare app sales and this last year, $84.1 million. At year end, there were about 2,000 medical and healthcare related apps in the Apple App Store. Average price of an app was $15, far higher than the average app.

"Not only is the medical community using smartphones and their applications for basic tasks, but they report using them to complete some of the work that would have previously been done on a desktop or laptop computer," says Melissa Elder, an analyst with Kalorama Information and author of the report. "With one of the main focuses in healthcare today centered on the reduction of costs, any tool that can help medical personnel become more efficient is a boon to the industry."

Most popular apps included...
Epocrates
Medscape Mobile
iRadiology
Nursing Central
Care360 Mobile
STAT ICD-9 LITE
Netter’s Atlas of Human Anatomy as well as various EMR apps

The report can be purchased at Kalorama.com.

Happy New Year and Welcome to 2011

2011-01-05T12:02:00.000-08:00

All I can guarantee is that 2011 will be an interesting year.

An early present from Tomi

2010-12-20T08:39:00.000-08:00

I don't know how many of my readers know Tomi Ahonen, but you should. And I can think of no better way to get to know Tomi than by getting and reading his new book, The Insider's Guide to Mobile. I've gotten about 50 pages into his 10th book (hey, give me a break, the book's almost 500 pages - He's got a lot to say), and it's his usual compendium of insight, stats and humor.

Thanks to Tomi's generosity, the book is available now for free!
Just go to this site and you can download a pre-press version of the book.

To all my readers, have a great and safe holiday. See you in 2011.

Microsoft HealthVault – Things to come for personal health records?

2010-11-29T10:50:00.001-08:00

Short and Mid-term, I’m not sure if there is any business model that makes personal health records (PHR) profitable. I just don’t believe that physicians and other health care providers are willing to participate in a system where the data is OWNED by the patient. Here in the US, where we’re move towards larger providers controlling health care data, it would appear that the opposite is true.

Looks as if Microsoft has reached the same conclusion. According to a report last week from the Financial Times, Mr. Softie has pulled a U-turn and has abandoned its efforts to make a profit on the package. The Financial Times, Microsoft is giving up due to the “complexity of the country’s health system.”

Peter Newpert, VP for health at Microsoft is quoted as saying that the company will use HealthVault to “increase the brand relationship.” In otherwords, it’s something that they will give away to others in an attempt to sell more copies of Windows and Office.

Earlier this year, Microsoft dropped their EMR system and advised that they will focus on analytics products.

Isn’t a home the right place to grow old?

2010-11-29T10:31:00.001-08:00

Having gone through this process with my parents, as well as my mother-in-law… and looking towards a future where we might need some of these services, I’ve been forced to become more involved in this issue. And with a Baby Boomer turning 65 every second, more and more people will have to deal with this as well.

So why are so few ideas being launched, tested, and rolled out? No idea, but at least there are some ideas and tests being promoted.

First, the best place to follow this area is Laurie Orlov’s Aging in Place Technology Watch. She pulls together all the threads. One of her posts linked me to last week’s, “Aging Means Business Forum” in New Orleans. Laurie was one of the speakers, but there were other organizations represented as well.

Microsoft is getting into the act as part of their Accessibility efforts. Unfortunately, they’re focused on basic computing, not residential technology.

But the MIT AgeLab is moving in interesting ways. Treating aging as a system, the AgeLab is addressing three specific areas:

· * Infrastructure, or how to empower “places and things,” to adapt to the needs of residents/users.

· * Information, comprises how adults decide, and plan.

· * Institutional Innovation, looking at both business strategy and government policies.

Most interesting of their work is the research into the adoption of new tech and services among older people. I’ll be very interested in the results in this area.

One area where results are being published right now is in Britain’s Newcastle Science City. We’ll see what comes of their work.

CMS takes a step forward on the reimbursement issue

2010-11-03T19:36:00.000-07:00

CardioNet, one of the pioneers in M2M based cardio monitoring announced today that CMS has set a national reimbursement rate for their services (and those of competing providers).

From the press release, "Joseph Capper, President and Chief Executive Officer of CardioNet, commented: 'We are pleased that our ongoing dialogue with CMS over the last two years culminated in a national price. We believe that this sends a clear message that MCOT(TM) is an established, accepted technology that is critical to providing better patient care to Medicare beneficiaries nationwide.'"

Why is this important? It's important as it provides mHealth companies with some assurance that CMS - and private insurance companies - will begin looking at reimbursement for sensor based, mHealth products. Earlier in the year, when the CPT code was withdrawn, CardioNet and others lost a huge percentage of their market value.

Small steps...

What the future of healthcare infrastructure must look like

2010-11-03T10:17:00.000-07:00

I saw this post on EMRandHIPAA this morning and appreciate the post. Unfortunately, John was unable to cite the idea's author, so I cannot give him or her proper attribution. But the concept deserves repeating...

The infrastructure that we must strive for has the following attributes:
*High touch
*Right treatment
*When they need it
*Where they are
*Lower cost

Don't know who said it, but the were right on the money.

mHealth killer app to live on the smartphone?

2010-10-27T10:49:00.000-07:00

Research2Gudiance, which bills itself as “the mobile research specialists,” has published a new study on the use of smart phone apps in healthcare. They discuss the 10-year history of medical apps on mobile phones, and why they have not succeeded until recently. Their conclusion, the “new smartphone application model,” specifically the iPhone/iOS app store changes everything.

The impact of the new app model is summarized in the graphic below

You can look at their press release and purchase the study at: http://www.research2guidance.com/will-smartphone-apps-become-the-killer-application-of-the-mhealth-market/

When you absolutely, positively have to get the word out...

2010-10-25T07:08:00.000-07:00

According to the Red Cross Blog, to help fight against the Cholera outbreak in Haiti, the Red Cross has sent vital medical supplies to the main hospital in Saint Marc, and information about treatment of the disease to the population via SMS...

"For such a formidable disease, treatment is simple. Rehydration with clean water, salt and sugar should be enough to save someone’s life. Red Cross teams have also been reaching people with hygiene information, including through mass SMS messaging."

EPIC Lowers White House's Grade for Health Data Privacy

2010-10-24T19:12:00.000-07:00

Yes, I’m really concerned about data privacy. Comes from my background in the credit card industry as well as working for a credit bureau designing products.

EPIC, the Electronic Privacy Information Center, has lowered the grades given to the US government on the management and protection of data privacy. The full report is over at http://bit.ly/aKL4tM.

The biggest concern to me is that the grades go lower the more the feds are responsible for data privacy. They get a "B" for health care data privacy, but this is a new area, and mostly theoretical at the moment. But when it comes to consumer data, an issue going back to the 1970's, they get a "C" and when we talk about civil liberties, which goes back to the 1950's, the grade is a "D."

Not good news for us. EPIC says they gave the administration credit in 2009 for the safeguards within the "HI-TECH Act." In 2010, the record is muddied as they have backed off. HHS Secretary Sibelius has expressed stronger patient controls, but implementation of existing laws is moving slowly.

Dr. David Blumenthal on EHRs

2010-10-22T08:46:00.001-07:00

The Texas Tribune was able to get an interview with Dr. David Blumenthal, the national coordinator for health IT within HHS. His group is responsible for assisting, and incenting the conversion of all health records from paper to electronic by 2014.

The interview focused on patient privacy, and in light of my previous blog post on the use of Google and other private companies for EHRs, I thought it interesting to get another point of view.

Q: How important is it for patients to have their records in electronic form?

Blumenthal: I think most patients will see that there are a lot of advantages to getting their records into digital forms. For example, having information present in an emergency room if their doctors’ offices are closed, or if they can’t get a hold of them or don’t remember where they were seen.

Comment: This is not an advantage of electronic records; this is an advantage of anywhere, anytime access to records. Hence the focus of most discussions seems to be on records access, not how EHRs will improve care.

Q: The issue of privacy has been a hotbed of concern. There have been reports, even here in Texas, of patient electronic records being sold to research companies. How do you respond to concerns that electronic records will only increase the risk of violating patient privacy?

Blumenthal: Well, they shouldn’t be sold if people don’t give consent. We’re committed to having patients control the uses of their health data. Their consent is going to be vital.

Q: Whose responsibility is it to ensure that patient privacy is protected?

Blumenthal: It’s a collective responsibility.

Comment: Here’s the problem. When it’s everyone’s responsibility, no one is accountable. The feds set up guidelines “protecting” records, but then a Congressman holds a hearing berating health care executives for not making records available for research. We’ve seen what happens when our government speaks out of both sides of its’ many mouths (Google “The 25 people responsible for the housing crisis”).

EMR interoperability – time to get serious

2010-10-18T12:48:00.001-07:00

Jean-Louis Gassee wrote a great piece on his blog (MondayNote.com) entitled, “What if Google Stored All Our Medical Records?” Jean-Louis deals with the current state of affairs when it comes to getting and moving your medical records and postulating Google’s potential as the storehouse of medical records.

The objections that he faced were fairly typical… “They’ll exploit our medical records,” “Google will have too much power.” But let’s be honest. The goal of electronic medical records is to make data collection, interchange and display easier than we have today with a combination of paper and electronic records.

Let’s take a look at the issues with today’s medical record management system:

• Lots of people have access to our records, some who should and some who should not. Pieces of our records are ping pong’ed around the world for a number of reasons, payment of insurance claims (more often processed offshore), pharmacy records, and insurance applications, eligibility for government benefits, etc. etc. etc. Who knows who has access your records as they sit in file folders in a dozen different places? I have some idea as Kaiser handles both the payer side and the provider side. And, if something goes wrong, I know who to go after.
• Have you tried to move records from one provider to another? You fax in a request, but who in the office can verify the signature as yours? Then they start making photocopies of records (20 cents per page or so), but that’s only of the work that they do. Not included are records from pharmacies, specialists, and so on.
• Then your employer may have copies of your records as well, as they might be self-insured. I’m not sure I want the HR department to have copies of my kids’ medical history and plot that against my attendance info.

Okay, so what does Google bring to the table? First, their systems have the scale to handle the tens of petabytes of data our medical records generate. Few other companies have that ability.

More importantly, Google can do what few others can do, make sense of the data. How many drugs have been taken off the market after FDA approval? By looking at morbidity and mortality information based on drug use, we would have a much better system for early and accurate warnings about the meds we use.

One last comment, there are a few other organizations that have the capability to manage our nation’s healthcare information. Equifax, Experian, and TransUnion have the scale and analytic knowhow to do this. One criterion that would put these three ahead of Google is the ability to apply the incoming updates to the right person.

If we are going to trust our physicians to make good recommendations on our care, we must insure they have good information. It’s time to get serious about EMR interoperability.

Medical Reminder Apps

2010-10-11T11:03:00.000-07:00

From the NYTimes, a listing of the "best" medication reminder apps:

MedsLog ($4): Most features, but user interface can be difficult to use. Connects to your iPhone’s calendar, this can be a good thing if your iPhone’s calendar automatically syncs with your Google Calendar – allowing you to get medication updates on your computer. [iPhone]

Medsy ($2): Great user interface and has the best notifications. Not as full featured as other medication reminder applications and medication regime is not as customizable. [iPhone]
Dosecast ($4): Possibly the favorite of the authors due to the extremely customizable nature of how you can set your medication reminders. [iPhone]

Of note, the author mentions how Blackberry users have limited options, focusing on an app called MediReminder ($3) – available for the Blackberry and Android. It’s the highest rated app, but the rating is based on just a few reviews.

From the apps mentioned in the review, it appears Android users have limited options as well. The author does mention MotionPHR Health Record Manager ($10), available for the Android as well as the iPhone – saying it had a positive history but recently started receiving poor reviews due to flaws in the reminder system.

Side Bar: The “end” of coins and cash?

2010-10-11T10:57:00.001-07:00

My background includes about 15 years in the financial services industry and throughout that time, I have heard lots of talk about the elimination of checks and cash. While we have not come close to a checkless society, we are certainly a “less check” society than we were in the 80’s and 90’s.

Tomi Ahonen, one of the most knowledgeable people in the mobile industry today and was asked to present to the association of national mints – the folks that mint coins and print cash. For some, still unknown reason, Tomi’s presentation was cancelled at the last second. Literally, instead of introducing him to his audience, the audience and Tomi were told that Tomi was not going to be speaking. Crappy surprise indeed! But Tomi has begun to publish the information from his presentation in a series of blog posts. They will be on his blog, Communities Dominate Brands, and the first post is located here: http://communities-dominate.blogs.com/brands/2010/10/end-of-cash-first-blog-in-a-series-examining-the-pending-doom-of-minted-coins-and-printed-banknotes.html

So how does this apply to mobile health?

Tomi’s history of money is very similar to how we handle medical records. From the patient presenting their symptoms, no records, the equivalent of barter, to paper based systems, to today’s electronic medical records to the future of medical records – mobile. If cash and plastic money moves from the wallet to your mobile phone, then where will you carry your medical insurance ID?

As for me, I cannot wait. The less I have to carry, the happier I am.

Mobile Healthcare Apps, A $60 Billion market?

2010-10-11T10:56:00.003-07:00

Jody Ranck, over at GigaOm has produced an interesting report on the guide to healthcare apps for mobile devices. McKinsey has predicted that mobile health apps will become a $60B market within a couple of years.

With 6,000 health and medicine related apps in the various app stores, we’re seeing the beginning of a very different healthcare environment.

Jody’s key points:
- Much of the innovation is coming from Africa and other developing areas of the world where the need for low cost solutions has generated a lot of experimentation
- The iPad is making waves in the medical world, from school to hospital, as the high quality screen enables imaging applications anywhere
- Consumer apps are pushing real time health information to consumers
- Challenges include how to approve medical apps as well as how to pay providers for services delivered via the mobile

Building compliant SMS programs

2010-10-11T10:56:00.001-07:00

A mobile advertising firm up the street from me put out a white paper on the risks of “non-compliant” SMS program. What, you ask, is a non-compliant SMS program?

Unfortunately, it’s almost any non-marketing SMS program. Have I got your attention yet? Because the telcos (in America) basically adopted the Mobile Marketing Association’s best practices as their rules for SMS programs, the carrier’s rules don’t work for healthcare programs.

Work with someone that specializes in mobile messaging programs when you are trying to build your SMS or mobile program.