GE’s Centricity Radiology Mobile Access, a mobile radiology image viewer for Centricity PACS, receives FDA approval. The FDA clearance is specific in that it only applies to iPhone and iPad diagnostics when not in proximity to a PACS workstation. Is that the way that the FDA clearances for these mobile image viewers are always worded, such as with AirStrip’s FDA clearances?
The future of mobile for clinicians is bright based on a recent survey of medical residents in ACGME-approved programs. 85% of residents have smart phones and 56% of those are iPhones. Both numbers seem low, but it reminded of my shock and horror just this past weekend when I was speaking to a resident who didn’t have a smart phone. She had an Android, but lost it and is punishing herself (her words) by not replacing it immediately. Of those residents with a smart phone in the survey, the majority used them in clinical practice, with far and away the most common app used being were drug references (likely Epocrates.) Apps not in use but most requested were reference and clinical algorithms. I bet you could do this survey each year and find that these percentages uniformly increase.
Five reasons for the love between clinician and mobile, from a clinician’s perspective. I’d also add feeling like you’re not using 1970s technology to the list.
The potential to increase patient engagement
More data points for the patient
Mobility=convenience – access in the car, on wards, etc.
4) It makes face-to-face appointments more meaningful
5) Improved doctor-patient relationship.
This is a good story about Ottawa Hospital’s experience with iPads in the enterprise. We reported on the initial order of 1,000 iPads by the hospital back in 2010 and that number has increased to over 3,000. I was unaware that the hospital has a team of 70 software developers churning out an app a month, based on clinician recommendations. The hospital is using MobileIron for mobile device management. I didn’t see it anywhere in the article, but I’d read before that the main clinical application in use was Adaptiv Clinical Viewer (video above).
Kony launches Member Mobile, an out-of-the box app for health plans. The app can be branded by health plans and delivers pretty impressive features by default. Features include browsing and purchasing plans, displaying and sending cards (I need this), provider locator, appointment requests, benefit status, prescription life cycle management (refills, pricing, reminders), wellness program integration, and PHR.
Equitable Life of Canada introducesEZClaim, a mobile app that allows plan members to submit health and dental claims. This seems like a pretty cool feature. The app is available on BlackBerry now and will soon be available on iOS. It’s an interesting strategic move, based on the most recent data about smart phone platform uptake, to release first on BlackBerry over both Android and iOS. Maybe Canadians are brand-loyal to RIM and the Pew data doesn’t translate north of the border.
I love this story. An ICU in NY deploys a video-based hand washing monitoring system and sees improvements in hand washing compliance from 6.5% three years ago to over 80% today. The system monitors when somebody enters the room and records a 10-second video clip of the hand sanitizing station. The clips are randomly reviewed by contracted employees in India to assess compliance. The real-time results are displayed on a screen in the ICU for all to see. The ICU pays $1,000/month to maintain the system. What a smart use of tech and non-tech resources with little to no implementation cost.
Speaking of hand sanitizing, Proventix Systems announces that its nGage hand hygiene monitor is the most widely used system in the US. Proventix is much higher tech than the above story in that it uses RFID to monitor compliance and personal alerts to remind workers.
Mobile risk management (MRM) firm Fixmo raises $23 million in a Series C round. In case you’re wondering what exactly MRM is and how it differs from mobile device management (MDM), you’re not alone. According to the story, MRM "empowers organizations to identify, mitigate and manage the risks associated with mobile devices". This goes beyond MDM, which is more about risk avoidance, and supposedly allows organizations to realize more of the potential benefit of mobile technology. Does Fixmo have any healthcare clients?
The Australian government is launching an $8 million trial to test home monitoring for 300 veterans connected to the Australian National Broadband Network. The grant amount is in Australian dollars, which is actually pretty close in value to US dollars. In either currency, it seems like a lot of money for a 300-patient trial.
A US News & World Reportarticle covers how physicians are using social media. Use of Twitter and Facebook is mostly for sharing links and generic education for patients. Using Twitter to let patients know that a provider is running late for appointments seems sensible as long as they’re promoting the Twitter account so people can follow it.
Travis Good is an MD/MBA who works with health IT startups.
Everybody wants to have a mobile presence these days. With smart phone usage on the rise and close to 40% of US residents owning a smart phone today or likely to buy one in the next year, providing access to services over mobile is crucial. Developers and organizations have choices in mobile app development. They can go native or use a mobile web app built on HTML5, which is getting tons of press for being the future of mobile development.
A native app is simply that — an app written exclusively for a specific mobile platform. If the device is iOS, it’s written in Objective-C and if it’s Android, Java. Web apps are developed using HTML5, JavaScript, and CSS. Web apps are not listed in the app stores or app marketplaces, but users can add icons for them to mobile screens fairly easily.
Native apps provide full access to the features of the phone (GPS, camera, etc.), offer the best performance and experience, and provide a presence in the app store. However, in the case of native iOS development, technical resources are harder to find and the cost is greater. The other major problem with native apps is that they need to be written specifically for individual platforms.
Web apps have limited access to the features of the phone and have relatively worse performance than native apps. One major performance issue is that web apps are dependent on network speed, so the experience can be frustrating if network performance is bad. A recently published story on HTML5 presents some of the hard truths of HTML5 web apps, several of which are applicable to mobile health.
Since web apps run in a browser, their major benefit is the ability to deploy the same web app across different types of devices without rewriting any code. Web apps are also dynamic, so new content and features can easily be deployed without approval from an app store or user-driven upgrades. The other big benefit of web apps is that the skill set required to build them is in greater supply, so the cost is less and the timeline is usually shorter.
For mHealth development decisions, it comes down to the purpose of the app and intended audience. In my view, if building anything for clinicians (EMRs, DSS, charge capture, PM, etc.), it had better be snappy, with minimal lag between touch and response. For this audience, where adoption has always been an issue (though Apple devices seem to garner more forgiveness), building native apps is the way to go. Another major limiting factor of web apps for clinicians — at least for those that require data collection — is synchronization (Hard Truth #4 from the above story).
In building apps for consumer end users, native apps are still superior, in my view. Unless you’ve got a name like WebMD, a presence in the app store is a requirement to acquire users. Additionally, as everyone seems to be pointing out, user experience is extremely important, especially in consumer health where the level of motivation is not as high. Slightly slower data entry or access to health-related information might not be forgiven.
For hospitals creating a facility app, the user experience isn’t as important and the goal isn’t necessarily repeated use. Building one app that can be accessed today by ~40% of phone users, as opposed to an iPhone app that can be used by 10% of phone users makes a lot of sense.
Hybrid models between web app and native app exist. Kony enables the reuse of a single code base for distribution as native apps to an incredibly large number of mobile platforms. Open source PhoneGap allows you to wrap a web app as a native app to be distributed in the app store to iOS, Android, RIM, WebOS, Symbian, Windows Phone 7, and Bada.
Travis Good is an MD/MBA involved with health IT startups.
A new report from ABI Research predicts the mobile app market for health and fitness will grow from $120 million last year to over $400 million in 2016. This rapid growth will be mainly fitness, not health apps, according to the report. Much of the growth is due to the the ease of tracking with smart phones and connecting smart phones to existing sensors.
The above projection is exactly what RunKeeper and its new investors, are betting on. RunKeeper recently closed a round of financing of over $10 million from Spark Capital and Revolution Ventures. RunKeeper plans to grow its staff from 14 to 40. With the recent news and talk about the RunKeeper HealthGraph and associated API, RunKeeper will be pushing to become the central source of data from various devices and applications. I’m not sure it can succeed in the broader health market, but I think it’s got a great shot at taking a big chunk of the fitness market, which seems more than big enough. Also, if I was investing in tracking services and apps, I’d prefer the “fitness conscious” to the “unhealthy” as a customer base.
On a similar topic of health apps vs apps for "self-tracking zealots", Joseph Kvedar, director of the Center for Connected Health at Partners Healthcare, presents the challenge of ubiquitous sensing, namely that only about 10% of the population is interested in sensing and tracking themselves. He even mentions RunKeeper. Much like the challenge of PHRs, which are really a form health tracking, Kvedar writes that strategies need to employed to engage and sustain behavior change, not just collect and present data. The strategies he predicts will win out are "social networking, incentives, games/contests, and automated coaching".
Continua announces it will make its 2011 Public Design Guidelines available to students participating in the GSMA Mobile Health University Challenge. The challenge is looking for teams of students with app ideas. The Continua guidelines will help participants by easing integration with medical devices. If you want a chance to win a free trip to South Africa — along with $5,000 and advice from VCs — find a couple of college students and submit an idea.
Calgary Scientific and its FDA-cleared mobile medical image viewer ResolutionMD becomes the most recent addition to the AT&T ForHealth family of products. AT&T will offer ResolutionMD to its Medical Imaging and Information Management customers through the new partnership.
The NHS Direct app (Android and iPhone), which contains health and symptom checking, has been used over 1 million times in the six months since its release. That seems impressive and I have to say I’m a bit surprised that the National Library of Medicine hasn’t created a native iPhone or Android app for MedlinePlus. I’ve been told that smart phone users are more likely to download a mobile app than browse a mobile website, but I’ve never seen that confirmed with data.
CompTIA’s new report, Third Annual Healthcare IT Insights and Opportunities, highlights the increasing use of mobile for medical practice. According to the release, 25% of providers are using tablets in practices and the majority are using smart phones. Most surprising to me is that one-third of providers questioned said they used mobile devices to access EMRs. Can that actually be true? It may be in part because the survey had more data from IT firms than providers themselves. The report also found very low numbers in terms of provider use or knowledge of cloud computing and telemedicine.
Ford’s partnership with WellDoc and Medtronic to offer in-car health apps and services was showcased recently. I’m not sure that offering diabetes or asthma services in a connected car is more convenient than on a smart phone, and I’m betting most people with a newer model car already have a smart phone. Maybe it’s a good additional reminder to test your blood sugar.
Freescale Semiconductor debuts a home heath hub (HHH) platform to assist device makers in building remote access platforms. The reference platform is meant to help engineers as they design data collection and aggregation services.
I stumbled on this story about the relationship between pharma and patient groups and ways that pharma can improve its image. I know pharma gets a lot of bad press about the ways that it targets consumers, but I think we’ll likely see more apps for patients put out by pharma. What really surprised me is that over 75% of US patients said their experience working with the drug industry was good or very good.
Travis Good is an MD/MBA involved with health IT startups.
Reader Todd Edwards pointed me to a Joint Commission link that addresses texting in healthcare, specifically for providers and order. This is their stance: "No, it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting." That’s pretty clear.
Reader Chris Wasden commented, "You should check out Atlantic Healthcare. They have done some very sophisticated texting that is very tailored to change beliefs and behaviors around drug adherence." I looked and was unable to find anything specific. Can somebody please send me a link or some data? Thanks.
I wrote two posts recently on texting for health (Part 1 and Part 2). In both posts I mentioned text4baby. The reason for using text4baby is that it is national program with support from HHS as well as several other organizations concerned with maternal and fetal health. I’ve always assumed this makes it the largest texting program for health in the US with about 250,000 registrations from recent data.
In both posts, I questioned the efficacy of text4baby in influencing pregnancy outcomes and providing HHS with a return on investment. The main funder of the program, Johnson & Johnson, doesn’t need better outcomes for a return on what is likely a marketing investment, but I imagine HHS is trying to solve a specific problem in healthcare, and hopefully that is outcomes.
Text4baby is currently being assessed. I think the outcomes will influence other texting programs, especially those from HHS. I’m anxious to see the kinds of results that text4baby is getting and apparently I missed the recent news about preliminary text4baby data from University of California, San Diego (UCSD). Thank you to Voxiva for contacting me to point me to the data and press.
Below are the high level findings from the White House press release (based on interviews with 150 text4baby participants, mostly by phone):
81% have an annual household income under $40,000
65% are either uninsured or enrolled in California’s Medicaid program
63% said the service helped them remember an appointment or immunization that they or their child needed
75% said they learned a medical warning sign they didn’t know previously
71% talked to their doctor about a topic they read on a text4baby message
39% called a service or phone number they received from a text4baby message (this rose to 53% among individuals without health insurance)
At first glance, I was a bit skeptical and put off by the interpretation of the results, but that’s because I was reading this press release instead, which I think reads a little too much into the results as proving this type of texting model not only for the population intended (underserved pregnant women) but also more generally to other populations.
As I looked at the high-level stats a second time, I started to realize that they represent very positive findings and potential long term improvements in care, though the clear ROI in terms of clinical outcomes is likely to remain hard to quantify. I’ll try to explain what I mean.
In my interpretation of the stats, text4baby is overwhelmingly hitting its target population of underserved women based on income and insurance status. This might be skewed a bit by the overall population of UCSD, but text4baby is targeting community health centers, so this is probably consistent nationally.
Second, the majority of users said that the service helped them remember an appointment or immunization. This doesn’t exactly translate to improvements in adherence as some press releases are stating, but it’s still a good thing that text4baby is helping people stay connected and it’s tailored enough to be relevant.
Third, almost three out of four users talked to their doctors about a topic from a text4baby message. The content behind text4baby is backed by large partners, including HHS, so my assumption is that it is clinically accurate. That means that most text4baby users are coming to doctors with valid discussion points, not random things they learned on crazypregnancysite.com (I actually tested that link and it doesn’t go anywhere), and engaging in discussions about them. This is a very good thing for both patients and providers.
Fourth, and I think the most important stat, is that 39% of all text4baby users — and 53% of text4baby users without insurance — contacted a service that was listed in a text4baby message. This is pretty amazing to me. About half of users were engaged and trusted text4baby enough to follow-up on a lead in a text message. The trust is likely due to the fact that community health centers — and by extension, providers — are endorsing this service and patients ultimately trust providers.
HHS is trying to find ways to engage citizens, especially underserved populations, and link them with appropriate services. If text4baby is helping in this process, that’s a very big positive for the program and for HHS.
All of these results are linked to increased engagement in health — a big part of the future of health, but also one of the most challenging aspects. In this sense, text4baby is a huge success according to this data, albeit from a very small sample.
But I wouldn’t say this proves that similar texting services will work well for other areas of health, mostly because pregnant women are already some of the most engaged patients in the health system. It does help show that targeting interested patients with ongoing education can produce positive results in terms of patient education. Maybe similar messaging services for cancer patients and parents of kids with special needs would bring similar benefits? Again, underserved groups are likely to benefit the most across all these different conditions.
I was on vacation and unable to speak with a representative from Voxiva about the data, but I hope to this week and provide an update when I do. In terms of quantifying results, I was informed that text4baby is adding in messaging specifically to increase rates of flu vaccination, something that is discretely quantifiable. Until then, or some other results come out from the national research on text4baby, Voxiva has to feel very good about the results of its first national SMS program.
Travis Good is an MD/MBA involved with HIT startups.
The AMA made some mobile app news this week with the announcement of its 2011 App Challenge winners and the launch of the AMA’s first patient facing app, called My Medications. The 2011 App Challenge invited entries from docs, residents, and students for apps that the AMA would build. The winning apps were Rounder, an app that allows docs to easily collect data at the bedside for tracking patient progress, and JAMA Clinical Challenges, a learning tool that I think will take the content from Clinical Challenges (images, vignettes) published in JAMA and offer it on mobile. The AMA will officially launch both winning apps at its conference. The My Medications app allows patients to store and e-mail health information including medications, providers, immunizations, and allergies. One of the features is the ability to "store information on your device, not on the Internet". I’d rather my data get backed up automatically in case something happened to my device or it wasn’t with me.
Catholic Health West (CHW) signs a three-year deal worth $4.3 million to implement AirStrip OB in the health system’s 32 birthing centers. The rollout will take place over the next 12-18 months. I wonder how long it will before the hospitalists and cardiologists get AirStrip Cardiology at CHW?
iPad testing at Seattle Children’s hospital finds that it doesn’t work well in the clinical environment. The reason is that the applications that clinicians use, namely the Cerner EMR, are desktop applications that do not provide a good user experience on the smaller touch screens. Clinicians were using the iPad to connect to virtual desktops, so I’m not really surprised at the outcome. Eventually enterprise EMR vendors will release decent native mobile apps and then I think iPads — and hopefully other tablets — will get a better test.
In contrast to the poor experience of running desktop EMRs over mobile, this article highlights five ways that hospitals are using mobile: 1) educate, 2) inform, 3) make money, 4) impart history, and 5) heal. It’s not very flashy, but I really like the Survey on the Spot app (video above). So much is done poorly in terms of customer service that getting feedback might go a long way. The mobile app (tablet and smart phone) gives patients the ability to provide feedback about their experience before they leave the hospital or ED. I think this is much more useful than sending somebody an HCAHPS survey two weeks after discharge.
A recent article in Forbes looked at text messaging for health. The researchers interviewed were all very positive on its prospects, especially for chronic disease. I tend to be a little less positive, but that’s mostly because I think SMS campaigns need to be planned and executed in a strategic way to avoid message fatigue, especially when trying to change the behavior of chronic disease patients. Incorporating personalized SMS with more in real-world (real-person) interaction is also a good approach.
CareStream Health receives FDA clearance for its Vue Motion medical image viewer. The viewer interfaces with different PACS and image archiving systems. It is Web-based, so it can be accessed on a PC or mobile browser (video above). Vue Motion joins Mobile MIM as an FDA-approved mobile image viewer. Are there other mobile-enabled viewers with FDA approval?
Several apparently unrelated stories on smell-related mobile health were published this week. Grand Challenges Canada and the Gates Foundation are funding a collaborative project between groups in California and India to test technology called the Electronic Nose to diagnose tuberculosis. I assume this non-invasive diagnostic tool would be very fast. Now if we can get people to complete TB treatment, we’re making progress.
In related news, a Belgium-based org, Interuniversity Microelectronics Center (IMEC), is trying to incorporate the smell technology into mobile phones "to check out freshness of food, test air quality or measure alcohol level in your body after a party." Between TB testing and checking blood alcohol at a party, you’ve got most of the globe covered in terms of demand. Really though, combining the sensor technology being funded by Gates for TB with inexpensive mobile technology would be great for global health.
Buffalo County (NE) is using telehealth to deliver remote behavioral health visits to county inmates. The program is a partnership between the sheriff’s office and three groups of providers. Do people do studies and publish on telehealth with inmates?
Kaiser Health News ran a good story last week on the investment trends in healthcare, with a focus on health technology. After funding expensive biotech ventures, now much of investment is going towards companies that are trying to curb the costs of healthcare.
The VA in West Virginia is getting some good press about its home telehealth program for vets. Are vets using the Health Buddy device from Robert Bosch? Also, according to the article, all VA primary care managed vets are being considered for home telehealth.
"In order for any M-Health initiative to be sustainable, it has to be commercially sustainable," according to an article on global mHealth. The article outlines the need for entrepreneurship in mobile health to take it beyond NGO pilots to scale. It’s internationally focused, but obviously the sentiment translates well to the US, where more and more companies with very cool mobile health services are searching for sustainable models.
Travis Good is an MD/MBA involved with health IT startups.
