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.

Travis Good is an MD/MBA involved with health IT startups. More about me.

Thanks for the clarifications and comments on my last post about telemedicine and evidence. As I said in the post, the more data we collect, the more we’re learning what questions we really need to ask and answer. Hopefully we’ll see more good data being published to address these new questions.

One issue that was highlighted by reader C. Gresham Bayne in his comment pertains to house call patients, an area that fascinates me. I need to write a post about physicians delivering care in the home and the associated technology that enables it. This comment motivated me to do the research and get it done. It’s not for today, but it’s coming.

For today I was motivated by the picture above. I had the unfortunate experience of being in the hospital last week with one of my kids. It was only day surgery and all went well, thankfully. The experience wasn’t unfortunate because of the treatment we received but, let’s be honest, being in a hospital as a patient or family member is not pleasant. The center was an academic center, if that matters to anybody.

In the recovery room, I glanced next to the bed and found the tape deck in the picture above chained to the wall. I can’t really imagine what it is used for today, but maybe there are still tapes on the recovery floor that patients can rent out, sort of like borrowing a DVD to play in your room. I love that it was chained to the wall, either to prevent it from being stolen or from being thrown across the room out of anger, frustration, or maybe psychosis.

[As a side note related to physical media, doesn't it make sense to eliminate all of it – including DVDs -- from hospitals ASAP? Bringing them from room to room probably brings unneeded contamination. I know they are cleaned with wipes, but still. The technology to replace the media certainly exists today, although I realize it is not at the top of the priority list or fires-to-be-put-out list for hospitals.]

Back to the original reason for the post. My initial thought in seeing the radio was that a lot of the stuff I write about and read about in health IT is not standard operating procedure. We have an extremely long way to go. All the companies with cool ideas and services that people like me report on have a lot of executing to do to become a part of our health system. It was a good reminder to me how far certain aspects of medicine — on both the patient and doctor side — are from today’s technology. It’s also good news for investors and innovators, because opportunities abound.

My next thought was how poorly we engage patient when we actually have them sitting in front of us or lying in beds in our facilities. iPads and smart phones are a long way from tape decks, but as we push to give people ownership over their own health and wellness, doesn’t it make sense to start that ownership in the hospital or office?

What would giving somebody ownership and engaging them at the point of care really look like? I think it can take many forms and I think we’re starting to see people trying it.

From a totally low-tech point of view and in the inpatient setting, why don’t we give patients printed daily information about what the medical team is doing for them and how there care is progressing? The information could be high level and not specific, and it could also include targeted educational material.

The paper forms could also include daily medication lists, with nurses helping patients check off each med as they are given or taken. This gets them used to monitoring adherence and practicing what they should be doing at home. Also, include a way for patient to document questions they have, and even encourage it. I’m sure you could gamify this if you wanted to encourage the behavior.

Smart TVs or tablet devices could make that paper process high tech. I’m not sure if GetWellNetwork or LodgeNet are doing this, but it certainly makes sense. GetWellNetwork is extending services to post-acute care and that is a step in the right direction.

In the case of the VA pilot, in which iPads are issued to family caregivers, why not build apps and tools to make appointments and hospital stays more meaningful and care seemingly continuous, not episodic? Or why not start patients using the mCare platform for health communications when they are still at the VA?

You could do the same thing with office appointments. Require patients to document — along with MAs and nurses — their weight, blood pressure, and any other biometric data. Obviously both paper and apps could do this. The idea is to get patients used to having some responsibilities and ownership of their own health and health data.

I’m interested to learn who is doing these things. Maybe this is something that has been tried and doesn’t work, or something that is working swimmingly. 

In my next post, I’ll discuss similar concepts that are more socially enabled.

Travis Good is an MD/MBA involved with health IT startups. More about me.

When I wrote the title for the post, I realized that it sounds like it would be about the screen size of mobile devices, both smart phones and iPads. Alas, the post is not about screen sizes, but about telehealth and connected health applications. I may still write a post about screen size, which is a very important consideration in app design and functionality, just not today.

For today, I wanted to write about a telemonitoring study I referenced in my last post. The attention-getting Mayo study found no differences in rates of readmission or ED visits between patients who received telemonitoring and those wgi received standard care with no telemonitoring. From this data, the authors concluded that telemonitoring did not help in any way. This is not exactly in line with much of the promise many see in telemonitoring.

In response to the publication and attention it generated, The Continua Health Alliance issued a statement to its members that Chris Wasden was kind enough to share in the comments of my last post. The Continua statement presents some of the limitations of the Mayo study from the authors of the study themselves. It then lists a smattering of other studies that support the use of telehealth and other connected health technologies to improve outcomes.

It is important to have a balanced perspective when it comes to evidence. The Continua cites only evidence that supports telehealth, and a recent Cochrane Review of 25 studies found telemonitoring to be effective both in terms of cost and outcomes. The new study, which was designed as a randomized controlled trial (RCT), is not the only RCT to find no difference in outcomes between telemonitoring and standard care (NEJM study).

To add some power to that, RCTs are the gold standard in study design and are considered the highest level of evidence. Also, the two RCTs I’m referencing above were published in Archives of Internal Medicine and the New England Journal of Medicine, both well-respected journals. At least one of the Continua-cited studies was also an RCT, but I’m not sure about the others because they are not linked back to the primary sources in the Continua statement.

The debate over evidence is a good one. It’s a healthy process as we learn about the efficacy of new treatment modalities, technology included. As the body of evidence surrounding telehealth — and really health technology generally — continues to grow, more answers emerge. However,  you don’t know what you don’t know, and as we collect more data, we are also coming up with more questions. In the case of this specific study, questions arise about the infrastructure needed to develop an effective connected health intervention and the population that should be targeted.

These are increasingly important considerations, but there are many, many others. When it comes to providing either sick or well care, there is no magic bullet. Also, I was under the impression that the trend in medicine and healthcare was not one-size-fits-all, but solutions tailored and personalized to the specifics of the patient and situation. Connected health technology and telehealth are great tools for improving access to care and quality of care and increasing our focus on preventative care, but they are not standalone solutions and not a standardizable healthcare delivery system.

I don’t think the studies that find no difference in outcomes and cost with telemonitoring care are edge cases that can be ignored or pushed off. If you look at the demographics and length of study for the linked studies above, the patients represent a significant portion of those who need improved care.

Let’s continue our dialogue and critical assessment of the ways that we design and implement remote care interventions. I have no doubt that telemonitoring has a significant role to play in reducing cost and improving outcomes, but I also have no doubt it doesn’t fit for every patient or every type of healthcare encounter. As long as I still get stuck behind people at the grocery store that write checks and don’t use check cards, we need another way to reach certain people. The really hard part is going to be building the flexibility and upfront identification of those people.

Travis Good is an MD/MBA involved with health IT startups. More about me.

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.

Travis Good is an MD/MBA involved with health IT startups. More about me.

I’m a big fan of simplicity, especially when it comes to tasks that I do often. I’m also a big fan of companies that are extremely focused, have messaging I understand, and make tools that I just get. One such company that I’ve recently discovered and come to love is MobileDay.

If you’re like me and you use your smart phone as your primary phone, either because you travel a lot or just decided to unify you communication on one device, then you should check out MobileDay. It solves the ever-present problem of joining conferences from a mobile phone and having to bounce back and forth between the calendar and phone to enter conference access codes.

Basically, the app (Android and iOS) takes the call-in information and dumps it into the location field of the calendar invite. You can do this yourself for meeting invites, and I have some colleagues that do. Just add the phone number, then a comma, then the access code for the conference, then the pound key. In iOS at least, you can then click that long string in the location field and it will call the number, pause for a second after the line picks up, and enter the access code and pound key.

Even though you can do this all manually in the iOS calendar, MobileDay makes it so simple and comes with added bonuses, like a better day view than the default iOS calendar, a free conference call service, and the ability to store and use multiple outside conference call credentials if you have paid services for conference calls. You can also add conference calls, with invites, from the app.

Because the day view is better than the default iOS calendar and creating events is just as easy, I’ve taken to using it instead of the iOS calendar. Funny, but I’m gradually replacing the built-in iOS apps on my main screen with third-party apps that I’ve found to be better. Apple is probably not terribly concerned with this, as great apps and experience are exactly what will drive up Apple device sales.

MobileDay is one of those apps that I started using and thought, “Why did it take so long for somebody to do this?” I think MobileDay has big plans considering the size and makeup of the team and the investors behind it. They’ve done something I think is one of the most challenging aspects of launching a new business — focusing like a laser on one thing that pains users and getting the solution right.

Travis Good is an MD/MBA involved with health IT startups. More about me.