News 5/9/12

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.

  • Chris Wasden

    Travis,

    Here is the Continua Health Alliance response to the Mayo study which we found very flawed

    Mayo RPM and Continua Response

    Continua Health Alliance Members:

    Rigorous clinical research is an important step in validating the effectiveness of connected health programs to deliver high quality care, improve outcomes and better manage healthcare resources. Continua supports ongoing research efforts to study telehealth programs to determine the most effective model of care delivery in specific patient populations. Providers, payers, patients, policy makers, and technology developers are all encouraged by the positive results achieved in numerous clinical studies showing improved engagement, adherence, and outcomes.

    As you may be aware, the telemonitoring study conducted by researchers from the Mayo Clinic and Purdue University, published in Archives of Internal Medicine last week, has caused some controversy. The study found no difference in hospitalization rates, emergency department visits and hospital day rates between older adults at high risk for re-hospitalization participating in telemonitoring, compared to a group of similar adults not enrolled in a telemonitoring program (n=205 patients; median age 80.3 years). This study further reported an increase in mortality in the telemonitoring group (14.7%) over the usual care group (3.9%). For the purpose of this study, telemonitoring included daily biometric measures of blood pressure and weight, symptom reporting and videoconferencing. “High risk” was defined as a score above 15 on the Elder Risk Assessment Index, which evaluates risk based on age, sex, previous hospitalizations, and co-morbid conditions (stroke, dementia, heart disease, diabetes mellitus and chronic obstructive pulmonary disease).

    When considering the study results, it is also important to keep in mind that the authors of this study noted that “the lack of efficacy of telemonitoring may reflect the number of patients in the trial or may indicate a lack of effective infrastructure needed to fully optimize case management.” We believe it is important to offer some additional perspective on these study results and provide a summary of several other research programs that have demonstrated the effectiveness of telemonitoring and other approaches to connected health.

    The results of this study are in stark contrast to dozens of well-designed studies that included thousands of patients with a variety of conditions, many of them at high risk:

    * Analysis of data from the Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) program, from a cohort of 17,025 CCHT patients (65+ years old; predominantly male) demonstrated the following results:
    * 25% reduction in numbers of bed days of care
    * 19% reduction in the number of hospital admissions
    * 86% mean satisfaction score

    CCHT is now a routine service for VHA patients with chronic conditions as they age, to help avoid unnecessary admission to long-term institutional care.

    * For the last six years, the Center for Connected Health (CCH) at Partners HealthCare has been offering the Connected Cardiac Care Program (CCCP) to non-homebound patients with heart failure. To date, more than 1,000 patients have been enrolled in this program resulting in close to a 50% reduction in hospital readmission rates overall. Patients use remote monitoring equipment in their home to submit weight, blood pressure, heart rate, and symptoms on a daily basis. Telemonitoring nurses monitor these vitals, respond to out-of-parameter alerts, and guide patients through structured biweekly heart failure education. 84.7% of patients reported they were able to gain control over their heart failure while in the program.

    * In February, Geisinger Health Plan announced that its interactive voice response post-hospital discharge telemonitoring solution demonstrated a 44% reduction in 30-day hospital readmissions. Approximately 1,000 heart failure patients are in the remote monitoring program at any given time; patient compliance has been greater than 85%. Because of the success of the telemonitoring heart failure program, Geisinger has expanded the program to include patients with hypertension and diabetes.

    * In Germany, numerous remote monitoring studies have demonstrated positive outcomes, including:
    * Telemedicine for the Heart project, which showed 21.5% fewer hospitalizations and a 51.7% reduction in mortality within the first year in patients with chronic heart failure
    * A randomized, controlled study of 214 heart failure patients (NYHA stages I-IV) demonstrated a 48% reduction in the number of days in the hospital and a 14.7% mortality rate, compared with 27.1% in the control group (observed during the 6-18 month observation period)

    * The Ontario Telemedicine Network, part of the Canadian Ministry of Health and Long-Term Care, recently completed a successful remote monitoring program involving more than 800 patients with congestive heart failure or COPD, demonstrating significant results:
    * 65% reduction in hospital admissions
    * 72% reduction in Emergency Room visits
    * 95% reduction in the walk-in clinic visits

    * Healthcare Unwired, a 2010 report published by PricewaterhouseCoopers Health Research Institute, cites data from several remote monitoring studies, including:
    * Congestive heart failure patients receiving care via a trans-European home care management system saw a 35% decrease in inpatient length of stay, a 10% reduction in office visits, and a 65% drop in home health visits
    * In Canada, COPD patients participating in a remote monitoring program reduced hospital readmissions by 50% and acute home exacerbations by 55%

    * A three year study conducted by the UK Department of Health, including nearly 6,200 patients with heart failure, diabetes or COPD, demonstrated that remote monitoring reduced mortality rates by 45%. Additional results included:
    * 15% reduction in emergency visits
    * 20% reduction in emergency admissions
    * 14% reduction in elective admissions
    * 14% reduction in number of bed days of care

    * Earlier this month, researchers from the Stanford Prevention Research Center reported that Smartphone applications can raise awareness and motivate older adults to improve their health. Smartphones were loaned to 31 adults (45 to 77 years old) who had never owned or regularly used this type of phone. Each phone included an app targeting at least one health behavior (increased walking, decreased sitting time, improved diet). After eight weeks, 80% of participants reported increased awareness regarding the targeted health behavior and three-quarters said the apps helped track the behavior; two-thirds indicated the apps increased their motivation to make improvements.

    We encourage you to review the Mayo Clinic study as well as those referenced above, and to share these data with your colleagues. We look forward to a continued dialogue about the value of personal connected health.

    Continua Health Alliance is working to provide accurate, unbiased information and resources to our members, the healthcare and health IT communities, and the media to support the advancement of personal connected health. Our goal remains, to move health and wellness into the day-to-day lives of consumers and improve health management, quality of life, and clinical outcomes, while reducing costs.

    We are currently developing a library of business case studies and clinical abstracts to demonstrate the effectiveness of personal connected health, and will continue to share this information with our members. If you have data or case studies you would like to share with us in support of this effort, please contact Continua’s public relations representative: Gina Cella, Cella Communications, ginacella@comcast.net.

  • re: screen sizes.

    TPD hopes that the new increased size for the next iPad is 12 inches, so that it can expand the possibilities of use with numerous legacy software programs currently installed worldwide. Yes, it will be a little heavier, and not fit in some pockets, but the gain in efficiency it will bring is worth the effort if Apple wants a bigger slice of the healthcare market.

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