I love community anchors as a part of health and wellness. Community centers, churches, and even barber shops have great potential to improve health and wellness, especially in minority communities that have an increased burden of chronic disease. The key is to integrate them with existing health delivery, extending the reach and definition of care. I was excited to see this story about churches in Brooklyn helping to increase adoption of PHRs, specifically working with Dossia.
I’ve talked about ‘telemedicine abortions’ before on the site. It’s obviously an emotional and heated issue. Women get virtual consults with physicians who remotely prescribe RU-486 , more commonly called the morning-after pill. Last week, 48 House Republicans proposed a bill to cut public funding to organizations that offer telemedicine abortions (the only organization I know of is Planned Parenthood.) The problem really boils down to access, with parts of the country lacking access to providers that do abortions or prescribe the morning-after pill. Choice, if that’s still legal, is only really choice when you have access. If we’re going to outlaw telemedicine abortions because of the potential risk from virtual care, we need to critically assess all forms of telemedicine that have a risk associated with them (which includes basically everything.) Sometimes the games lawmakers play –and the time and energy they waste doing so — drives me nuts.
Aetna expands its ACO technology offering to Banner Health to include the iTriage mobile app, HIE technology from Medicity, and Active CareTeam clinical decision support.
A new study of the bant app for logging glucose readings evaluated if the app and incentives could encourage people to increase the frequency of testing blood sugar. The incentives were iTunes credit, which worked well because the app is only available on iOS devices. I love the mobile incentive concept and wonder why more apps aren’t doing it. You could also give airtime as an incentive if you had a large pay-as-you-go population (think Cricket users). bant also connects to LifeScan glucometers using Bluetooth. The study found a 50% increase in average daily frequency of glucose testing. It was a small study of adolescent patients with only 20 participants, so it’s really more preliminary than definitive.
Seattle startup EveryMove raises $2.6 million from angels and payers. The new company is creating a rewards program for healthy activities and has Premera Blue Cross as a first customer. The product has not been launched yet, but I hope we’ll see something like GetGlue for healthy activities, with badges and rewards linked to real savings. I also imagine the service will have a strong social component. Above is the pitch from the founder.
A new survey of ~3,000 physicians finds that tablet adoption doubled last year, up to 62%. More than 50% of physicians who own a tablet use it at the point of care. While I agree there has been considerable increase in tablet adoption with physicians (almost exclusively iPad), I think the survey results are likely a bit inflated, maybe because it was completed online by physicians.
A Nielsen report from March finds that 50.4% of people in the US use a smart phone, with 48.5% of those smart phones being Android. Apple is behind at 32%. Also of note from the data, minority groups were above average in terms of smart phone adoption. Nielsen didn’t report on usage by occupation, but obviously physicians are way above average, with numbers closer to 75-80%.
The 218-bed Orange Coast Memorial Medical Center (CA) selects PerfectServe as its clinical communication platform. It sounds like this is the first deployment of five hospitals within the same health system.
Mega-payer Aetna selects Kony as the platform for Aetna’s mobile app. I assume the app, which has been around since 2010, will be redeveloped using Kony’s platform, enabling it to pushed to an huge number of different mobile device types.
I enjoyed this article by an anesthesiologist (who now happens to be an MBA student at Sloan MIT), about his recent trip to Silicon Valley and his impressions of startups in health. My favorite quote: "Medical training, for all its excitement, is absolutely dreadful at teaching the importance of business and organizational process." The author isn’t quite as naive as the article makes it out — he’s the founder and CEO of a startup that has won several awards.
Global mHealth news: Johns Hopkins will offer two new courses next year on incorporating mobile health into fieldwork. The courses will be part of the Bloomberg School of Public Health, which is researching the impact of mobile technology on global health. I’d be excited about this if I was an MPH. I’m excited about it and I’m not an MPH.
I thought this was an interesting story about Google launching search enhancements to help make meaning from searches. The first new feature helps clarify what the user is searching for, which is particularly valuable when searching for terms or titles with multiple meanings. The second new feature, to me at least, is potentially interesting for health. When users search for a topic that is "well defined by the Knowledge Graph," Google will present a topic summary of what it thinks are the most salient points about the topic, based on its own analytics. As more people go online to find health information, Google could present them with health summary information right on the search page. Unfortunately there is no mention of credibility of sources and I imagine Google will just show content and data that its users historically have clicked for a certain topic. No offense to the masses, but that doesn’t always translate to the most accurate health info. I know I’ve mentioned this before, but it would be awesome if Google presented credible summary topic data for health-related searches, and now it could do it right on the search page.
Welcome to National Nurses Week and thanks to nurses out there for all the hard work! In the spirit of the week, clinical communications company Voalte is celebrating with various activities, including a Facebook storytelling competition for nurses.
According to the lead author of a recent study assessing the effectiveness of telemonitoring at reducing readmissions and ED visits, "It didn’t help at all". The data found no difference in readmissions or ED visits between the telemonitored and normal care groups. The results certainly points out the need to better assess the technologies being touted as cost lowering and utilization reducing. TeleBLANK isn’t a panacea just be virtue of having "tele" in the name. The potential is definitely there but maybe more thought needs to go into the technology intervention itself, including how to integrate both tech and human care. Either way, it’s good to have more good data. What do you think?
More telehealth data, this time on the positive side. A new study of teledentistry finds it to be effective at improving treatment of childhood tooth decay. The intervention involved both virtual consultations and education.
I thought this was incredibly cool. Researchers at UCLA develop a game where players assess images of red blood cells to determine if the cells are infected with malaria. It sounds like something meant for pathologists, but is actually designed for untrained people, using the crowdsourced responses of gamers to determine which cells actually are infected. Apparently the crowdsourced responses are about as accurate as a trained pathologist looking at the slides, which is pretty amazing to me. I think the Gates Foundation should fund a project to use CellScope or one of the other cheap, phone-based microscopes to capture images of blood cells. Feed those images into a Facebook game based on the current game being researched at UCLA, and allow Facebook users to help with a real world problem in a fun way, getting some type of public health badge in the process. Health is improved, Facebook gets a warm fuzzy, and Facebook users improve their virtual credibility.
Physician use of social media seems to be the topic of discussion everywhere these days. Is it just the news that gets through my filters, or is this becoming an increasingly central component of the doctor-patient relationship discussion? I assume it’s an indication that more and more docs are online testing the waters, as this article lays out. What’s interesting is that only 10% of medical schools have social media policies, an astoundingly low percentage given recent concerns about students and residents sharing content they shouldn’t be sharing. I think this percentage is increasing rapidly, though, as every medical school I talk to is either in the process of creating a policy or has recently created one. Hopefully the behaviors developed in med school and training will stick, though with the evolving nature of social media, technology, public health, and doctor-patient relationships, it’s likely something that will need to be relearned and modified over time.
Congrats to our sponsor Kony for being named a Visionary in Gartner’s recent report on Mobile Application Development Platforms. The report predicts that 80% of mobile apps will be hybrid or mobile web by 2015.
The VA is distributing 1,000 iPads to family caregivers to help them care for veterans at home. Approved apps, which are still in development, will feed data from caregivers back into VA systems, and I presume will connect caregivers with VA personnel. This seems like a big pilot to me. I realize the VA is huge, but maybe a pilot of 500 or 250 or even 100 might be a better way to start.
I have to admit I like researching and publishing, though I think doing it as a central part of my job would be not terribly fun. Evidence is king these days when it comes to the practice of medicine. Doing your part to grow the evidence base is important, regardless of your academic setting. I’m not just talking about what med works best, but also what tech intervention improves outcomes or lowers costs or any number of other important outcome measures. Getting off the stump, this recent review article of the effectiveness of electronic reminders for adherence found that SMS was effective at improving short-term med adherence.
Kickstarter uber-success Pebble announces that RunKeeper will be the first app installed on its platform. For those of you that haven’t heard of Pebble, it’s a smart watch that connects to your smart phone (Android and iOS) using Bluetooth to bring alerts and other data from your phone to your wrist. Pebble is also launching an SDK for developers. Pebble has raised more than $10 million on Kickstarter. My big question with Pebble is how badly will it suck the life out of my iPhone battery if I’m running Bluetooth non-stop?
Castlight Health raises an astonishing $100 million in Series D funding. I must admit I’m baffled by the numbers here, as this $100 million brings the total to $181 million raised by Castlight over the last several years. Castlight provides employers with a platform to help employees assess the cost and quality of care, giving them insight and presumably improving decision making. The press release mentions "dozens" of organizations using Castlight, but only four are listed. With this type of investment, Castlight is pushing to be the healthcare marketplace, which I imagine will probably include a goal of being a part in the health insurance exchanges supposedly coming in the next few years. This is the sort of investment that scares off competitors, especially in a category that has not been won yet.
The screen sizes of smart phones are getting bigger. I remember when five inches was a small tablet, not a smart phone. Supposedly the new iPhone is going to have a slightly larger screen, and I’m sure developers of existing apps will love the change in aspect ratio. I personally think a slightly longer screen would work well as long as the menu and screen options are well place so I don’t have to stretch to reach them.
Welcome to May! I can’t believe it’s already this close to summer. I hope everybody else is enjoying the warming weather.
Facebook launches features to encourage people to register as organ donors. It’s nice to leverage the 900 million-user-strong network to do good things. I read some other stories about Facebook having an impact on healthcare and wondered if readers agreed.
The VA is rolling out its mobile EMR starting this summer. Initially limited to 1,000 devices – apparently all VA-issued iPhones and iPads — the program will be expanded once the VA has implemented a more advanced and scalable mobile device management (MDM) platform. It sounds like the mobile app will enable reading, but not writing. That’s probably a good choice to start with because it’s easier and has value as read-only.
"One of the greatest risks of social media is ignoring social media", according to Don Sinko, chief integrity officer at Cleveland Clinic. This was my favorite quote from an article about patients wanting social media tools for healthcare. The main use cases for social media are benign – appointment requests, reminders, and referrals.
A new survey of employers finds that 9% of them plan to implement games as part of their wellness programs by the end of the year. That’s good news for companies like Keas that are creating gamified wellness programs.
Back in February I wrote a couple of posts arguing in favor of building health apps for mobile devices before the desktop. I read an interesting story (not specific to health) that takes it one step further and argues the Web 2.0 Age is over and the Age of Mobile has begun. The author discusses the reasons why entrenched Web 2.0 players like Google and Facebook should be scared of this shift. I think you could use the same argument in health, and find the entrenched players — many of which haven’t even hit Web 2.0 — should fear the growth of mobile. It’s not as easy in health as the consumer space because of the enterprise nature of sales, lack of data portability, restrictive nature of security and privacy rules, and misaligned incentives, but it’s still nice to imagine a world where mobile apps can be used to preempt entrenched companies, improve care for patients, and make the daily lives of providers a little better. If you look at a recent Medscape survey — which found that only 41% of doctors would choose the same specialty again and only 54% would choose medicine as a career again — you see why improving the daily lives of docs is something they’d probably like a lot.
A new app store is launching specifically for genetics. The app store concept is being driven by Illumina, which will provide an API to its genetics platform. The app store will enable developers to create tools for researchers that use Illumina’s platform. It’s certainly a good way to speed up and reduce the cost of innovation.
There’s a new health incubator in town, the New York Digital Health Accelerator. The program has a strong set of partners including 18 New York-area healthcare organizations. The story is projecting that the incubator / accelerator will bring $150-$200 million in VC investment and create 1,500 jobs. That would certainly be impressive and would provide a good return on the $4.2 million used to launch it.
A new survey by medical publisher Lippincott finds that 71% of nurses use a smart phone on the job. Surprisingly, a slightly lower percentage (66%) of nursing students use a smart phone for school. Not surprisingly, 85% of those surveyed would want a mobile drug reference app, of which there are a few to choose from.
HIMSS is getting into the infographic spirit with this one from HIMSS12. The graphic details the number of visitors and associated social media stats. The most interesting stat to me was that 70% of mobile users at the conference were using Apple devices vs 14% Android and 2% BlackBerry. My bet is Apple is both iPhone and iPad so that’s a little skewed, but that’s still a dominantly Apple mobile crowd.
Since that infographic from HIMSS isn’t exactly scientific or representative, I thought I’d include some of the other recent data showing the growth of Apple mobile market share at the expense of Android. The story paints a very bad picture for Android. The arguments are well laid out. I think the most relevant reason for Android to worry is the interest in developers and investors in iOS vs Android (graphic above.) Instagram showed everybody they need to build iOS first. I also start to think about the iPad and the battle of the e-book readers. I wonder if Apple is going to be able to continue to drop the prices on older model iPads like it does with iPhones, bringing them closer to the price point of a souped-up e-reader like the Amazon Fire (which I have and don’t like.)
Here’s an interesting but incredibly long story about the convergence of big data and biology, showing the immense potential of the quantified self movement. The article is based on a meeting with lots of people in the field, Eric Topol among them. It’s a good overview if you want the highlights on why big data could be a huge force. Still some kinks to work out in getting and connecting all that data, but the potential is there.
More Facebook and mobile trend news. As Facebook prepares for its IPO, people are writing about it a lot. This story outlines facts and figures related to Facebook. I found it interesting that Facebook has 488 million mobile users each month and 83 million users who only access the network over mobile devices.
Thanks Terry Edwards of PerfectServe for his guest post on clinical communications.
I’m leading again with another poll, this one relating to how providers should be using social media.
Continua Health Alliance (did they add the word "Health" or was that always there?), the industry group that develops standards for device interoperability, releases its newest set of Design Guidelines to the public. This is good news for those not lucky enough to have the deep pockets necessary to become a Continua member since access to the Design Guidelines was previously restricted to members. The Design Guidelines help developers create devices and services that can be connected to other devices and services that follow Continua standards.
Warm Health, a provider services for health plans and their members, releases a new iPhone app. It enables members of plans that use Warm Health to enroll in educational programs and to securely chat with care managers. This is another service that I’d like to see more concierge practices offer. I think people who pay to participate in a practice would pay a subscription fee for tools like this.
Aging at home platform company Independa announces it has completed a convertible note round of financing worth $2.35 million. This seems like a significant round of financing for convertible debt. Am I wrong on this, I thought the high-end of the range for a convertible note was typically $1.5 million, with up to $2 million being extremely rare? The story goes on to say that Independa is now seeking to raise an equity round of financing. I assume the money will go to scaling sales and adding some additional partnerships. Independa offers a platform on dedicated tablets and the web, as well as implemented on 3rd party devices like LG TVs, to help seniors accomplish tasks of daily living and stay connected with loved ones. If Independa can become widely adopted, the opportunities for additional revenue from its platform seem huge.
Mobile health startup Massive Health, which released its first app in November, has unveiled data and created some pretty cool visualizations. The Eatery alllows user to take photos of meals, rate them, and have friends rate them. The app has logged more than 7.68 million food ratings, though that is ratings and not logged meals. I think anecdotally we know most of the findings that Massive data showed, but the numbers are a nice, data-driven touch. Most impressive to me is how much worse we eat as the day goes on.
Walgreens unveils a "Find Your Pharmacist" feature on its website. Results can be filtered by years in practice, areas of expertise (med management, immunizations, etc), and location. The site also includes pictures, which alone made me feel a little more connected to my pharmacist. Walgreens is on a serious mission to change the image the public has of pharmacists and pharmacies in general. It’s going to be interesting to see how effective it can be at making itself part of the care team and not just a drug dispensary.
Boston Children’s Hospital launches a mobile app called MyWay. It does the usual phone numbers lists, physician lookups, and other hospital services. Boston Children’s also partnered with Meridian to provide users with turn-by-turn directions within a building. Meridian converts paper maps to interactive mobile maps for places like museums and now apparently hospitals. Considering that hospitals, especially large and academic ones, can be a bit confusing to get around, this is a nice touch.
Fitbit, of pedometer fame, announces the official release of its Aria Wi-Fi scale. You can order one today for $129 (2-4 weeks to ship). Aria was introduced in January at CES. The scale tracks weight for up to eight users (similar to other wireless scales) and automatically sends and tracks via the Fitbit website and mobile app. If you’ve got the Fitbit pedometer and want to add to your data points, this is good addition.
Speaking of wireless scales and quantified selves, Withings partners with BodyMedia to automatically send weights records from the Withings Wi-Fi scale to BodyMedia. BodyMedia makes an armband that tracks tons of different biometric parameters. Of course you have to wear it around on your arm, not slip it in your pocket or on your belt.
This is a good commentary and summary of games for health. It walks through a lot of initiatives and the science behind health games to create behavior change. I was surprised that 4-5% of all games are health related games.
The above infographic highlights mobile usage trends. It’s a good view of how, when, and why people use mobile. Specific highlights I found interesting were that mobile web is expected to overtake desktop web by 2015, main uses of mobile are search and browse, and 90% of mobile searches result in an action (going somewhere, buying something, etc). This last statistics, coupled with health related searching (doc finding, med price lookups, self diagnosis support), is powerful.
A new smart phone camera attachment, called OScan, is being tested for oral cancer screening in the developing world. The attachment captures and sends images for remote reads. The article says oral cancer makes up 40% of all cancer cases in India, which is astounding to me. Pretty soon the untrained health workers who are using these new tools (cameras, microscopes, data collectors, etc), are going to have an impressive kit of phone attachments and apps.
Rock Health is moving to Boston this summer to host an incubator class. Rock is really spreading the brand these days. If you’ve got an idea and would like to spend the summer in Boston, give it a shot.
Travis, thank you for igniting such a lively discussion!
Going back to your original post of the growing list of companies focused on growing a network of physician users to enable secure doc-to-doc communication, and the expansion of the discussion around pagers and smart phones, here’s how I look at it.
Health systems don’t need a secure doc-to-doc messaging solution, which just adds to the fragmented communications clinicians put up with today. The industry needs a comprehensive clinical communications solution that includes secure messaging as a feature or component.
While physician-to-physician communication is important, a far greater frequency of communication occurs between nurses and physicians in the course of providing care. Therefore, any truly effective communications solution must incorporate nursing and all of the other clinicians responsible for care coordination.
Physicians are unique because they need greater flexibility in reliable mobile device technologies. For example, nurses in a hospital environment are mobile within the four walls of the hospital where they provide care during a given shift. Physicians, on the other hand, may be in Hospital A at certain times, and at other times they may be in Hospital B, their office, or in-between care settings, or at home.
For a physician, fewer devices means more convenience. In addition to convenience, physicians need reliability. Reliability has more to do with the communications process than it does with devices. All wireless devices will fail to receive a signal at some point.
For clinicians — physicians in particular — the solution requires technology-enabled processes that distinguish critical and time-sensitive communication from that which is non-critical and less time-sensitive. And for those critical, time-sensitive communications, those processes must anticipate and accommodate device failure.
If I’m carrying a pager and a smart phone, another clinician can contact me in at least one of five ways. They can (a) send me a page; (b) call me on my phone; (c) send me an SMS text message; (d) send me an e-mail, or (e) send me a text via one of myriad secure messaging apps.
The question is: which one of those modalities should I choose now ? And if the communication is critical and time sensitive, what is the process if there is no acknowledgement or response?
The realities are that cellular and Wi-Fi innovation and user adoption are growing and will continue to grow. Paging is dying and is becoming less reliable. The latter point is evidenced by continued decline in USA Mobility’s annual paging revenue (2011 down 14% vs. 2010); continued decline in its pager disconnects; and continued decommissioning of the company’s paging transmitters (13% fewer in 2011 vs. 2010).
I’d like to say something provocative like. “Paging will be dead in three years.” However, in all likelihood, it will still be around in some limited, niche capacity.
The question is, how do we best use and apply these different technologies and devices to enable reliable communication processes that truly help clinicians better coordinate care?
Terrell “Terry” Edwards is president and CEO of PerfectServe.
