The Journal of mHealth - Vol 2 Issue 5 (Oct 2015) by The Journal of mHealth

WHATâ&#x20AC;&#x2122;S INSIDE

NEWS, REVIEWS, CLINICAL DATA, mHEALTH APPLICATIONS

The

Journal of mHealth The Global Voice of mHealth

October 2015 | Volume 2 Issue 5

Integration Building Connected Health Ecosystems Also inside:

Delivering Effective Digital Health mHealth Summit Feature Publication

CYBERSECURITY Does Device Interoperability Sacrifice Security?

EXPERT INSIGHT Teletriage vs. Telediagnostics

INDUSTRY NEWS Latest Digital Health News

Some things just... ...stand out from the crowd

Global Digital Health 100 The most innovative companies in the field of digital health Nominations for 2015 now open, for more information please visit www.thejournalofmhealth.com

Editor's Comments

Welcome Integration and interoperability are two terms that are regularly up for discussion throughout the digital health community, and for good reason. With so many different disciplines within the healthcare industry, so many sources of data, users, and functions the only way that digital solutions can be truly effective is by working seamlessly alongside those systems already in use. Achieving this isn’t easy. Interoperability requires standardised ways of interacting and sharing data throughout provider networks, with patient Electronic Health Records (EHRs), and with all necessary stakeholders and users. Digital solutions need to be ready to communicate with other systems in a network as they are deployed, without major restructuring and with minimal effort. In this issue we feature a range of articles which discuss some of the elements required to begin delivering effective connected digital health ecosystems. We consider the role of security, standards and operational changes that need to be addressed in order to achieve these aims. Our regular readers will no doubt notice that this issue is publishing slightly later than our usual schedule. This is because we are pleased to be able to include, inside, a special feature publication - ‘Delivering Effective Digital Health’. Designed to coincide with the mHealth Summit in Washington D.C. this publication is a compilation of exemplar case studies and research papers, from around the world that discuss how digital solutions are producing real changes to the way healthcare is delivered.

Published by Simedics Limited www.simedics.org Editor: Matthew Driver Design: Jennifer Edwards For editorial, research and paper submissions, and advertising opportunities please contact: Matthew Driver matthew@simedics.org +44 (0) 1756 709605

Also, you may have already heard details of the launch of our new, online global research panel the Digital Health Crowd.

Subscribe at www.thejournalofmhealth.com

We believe strongly in open innovation and allowing people to come together in the creation of the solutions that are going to impact the way they work and their own health conditions. The Digital Health Crowd provides organisations with the tools necessary to leverage the passion from individuals worldwide by enabling participation and co-creation experiences that are both rewarding to users and at the same time enhance innovation, testing, evidence and market vigilance capabilities.

The editor welcomes contributions for The Journal of mHealth. Submissions can be sent to the editor by email, images and graphics should be submitted in high resolution format.

Equally importantly, it provides you – as someone with an interest in digital health to have your say!

The opinions expressed in this publication are not necessarily shared by the editors nor publishers. Although the highest level of care has been taken to ensure accuracy the publishers do not accept any liability for omissions or errors or claims made by contributors or advertisers, neither do we accept liability for damage or loss of unsolicited contributions. The publishers exercise the right to alter and edit any material supplied. This publication is protected by copyright and may not be reproduced in part or in full without specific written permission of the publishers.

The Digital Health Crowd allows us to collectively improve the way that digital health solutions are developed, deployed and delivered, by harnessing the shared knowledge, thoughts, ideas and skills of the health community. If you would like to become a member of the research panel and join the Digital Health Crowd or you are an organisation interested in gaining unparalleled access to a large global research panel of healthcare consumers, patients, caregivers and healthcare professionals to help support the design, testing and implementation of health technologies, apps and products then please get in touch at enquiries@simedics.org or find out more at thejournalofmhealth.com. This issue is published in memory of Harry Edwards, a true gentleman who will be sadly missed.

Matthew Driver Editor

The Journal of mHealth

Table of Contents

In This Issue 4

How to Build Clinically Effective Health Systems The adoption of digital healthcare systems is the most important but also the most difficult part of healthcare technology. In this article Dr Alex Graham discusses how the issues are usually people related rather than software or hardware related.

Interoperability and the Benefits of Connected Health Ecosystems In this interview Steve Rudland, Customer Advocacy & Consulting Lead for Hyland, creator of OnBase discusses digital health technologies and how technology standardisation and interoperability are fundamental enablers in delivering connected health services.

Does Device Interoperability Sacrifice Security? When medical devices work together, patients and healthcare providers benefit. But is there a downside to medical device interoperability? As our devices become more connected to each other and to hospital networks, they open up new cybersecurity risks. The same interoperability standards that make it easier for devices to communicate may also make medical devices more vulnerable.

October 2015

Table of Contents

Industry News

FEATURE

REPORT

Wearable Device Helps Medics Save Lives in Disasters and on the Battlefield

Doctors Develop New Trauma Training App

Code of Practice for Wellness Apps Published

UCSF Receives $5 million Grant to Create Online Database on all Types of Cancer

Next Generation Diabetes App Provides a Complete Integrated Care Environment

Innovations in Military Care are a True Testament to the Possibilities of Mobile Medical Technology

Real-time Clinical Information Platform Driving Improved Outcomes

The Secret Recipe of Meaningful Digital Health

Teletriage vs. Telediagnostics

Data Visualisation Empowers UK Healthcare Organisations to Modernise Services & Enhance Care

Is Your Digital Health Strategy Thriving, Surviving or NonExistent?

How Crowdsourced Insights can Drive the Future of Digital Health

VA Spinal Cord Injury Centre Demonstrates Clinical Improvement Using Contactless Bed Monitoring Sensors

Delivering Effective Digital Health

Qualcomm Acquires Capsule Technologie

UK Department of Health Team Tests Digital Prototypes

Smart Mirror Monitors Your Face for Telltale Signs of Disease

Google Pairs With Sanofi to Move Diabetes Patients to the Cloud

Diabetes Tools Acquires DiabetesGuru Child App

FBI Warns Healthcare Sector Vulnerable to Cyber Attacks

Building Connected Health Ecosystems

mHealth: Multidisciplinary Verticals

Report Finds UK has the Potential to Become a Global Leader in Digital Health

HIPAA Compliant Mobile Medical Camera App and Cloud Storage Service Launched

NHS Trust Cuts Norovirus Outbreaks by More Than 90%

Every Hospital Patient to be Given a Barcode as Part of Plan to Create a 'Paper Free' NHS

UK NHS Approved Apps Failing on Privacy Standards

Partnership Develops National Epilepsy App

Upcoming Events

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The Journal of mHealth

How to Build Clinically Effective Health Systems

By Dr Alexander Graham

Dr Alex Graham is a medical doctor by background, having trained in London before entering the business world. He is currently a founding partner at AbedGraham, a research and strategy consultancy which assists global IT corporates to navigate the clinical, organisational and commercial complexities of the UK’s National Health Service (NHS). He is also medical director of EMEA for Imprivata. The adoption of digital healthcare systems is the most important but also the most difficult part of healthcare technology. When we consider building technology into health systems, the issues are usually people related rather than software or hardware related. Everyone in the transaction process be they the board members or IT team at the hospital, the sales people from the IT vendor or the clinical frontline staff, will have their own agendas, markers of success and personal risk associated with the project. The risk is always that one stakeholder within the system misses out and the notional benefits for them soon become hindrances. I believe we are not learning the lessons of old when it comes to healthcare technology. There are too many projects which overrun in time and cost, don’t provide the appropriate clinical support and lead to further dissatisfaction with health IT. Below are a few markers I like to use when it comes to the clinical staff in the adoption process, although these tips could quite easily be used for other stakeholders as well.

Clinical agendas Every single clinician will have a different set of success markers with any IT project. But these are not limited to doctors vs. nurses vs. physios etc. The workflow, patient contact points and IT usage varies hugely between individual departments and even grade. A first year A&E doctor will use IT far differently from either an A&E consultant or a first year ward doctor. The issue with building large ecosystems or transformation projects is that you must appreciate the variation in agendas in the clinical workforce. You have to spend time getting to know what people actually do on a day-to-day basis

October 2015

before you start implementing something that is going to alter the way they work.

of a huge number of them before they tell you. Never assume, always ask.

Language One key issue when you bring together disparate group is that aside from agendas, everyone has different competencies which manifest themselves in the language they use. Medicine is a world within itself, and being involved in the medical sphere involves the accumulation of essentially a new language, and the same will be true, to a degree, for IT staff, vendor employees and so on. As a result of this, communication and understanding of each other becomes a real challenge, especially as it takes up to 6 years to become a doctor. The only real way to get around this is to have clinical support and interaction at every level, including the vendor, such that a common idea of the clinical issues and solutions can be generated.

Use them during The initial launch stage is the best time for system failure and disenchantment. This is the stage that is most likely to generate patient safety and data issues and negative brand connotations. When building anything complex or multifactorial in health IT, it’s essential to have a rigorous handholding process from both the technical and clinical side. Extensive testing and training prior to this can help alleviate some of these issues but there will always be unexpected teething problems. The question is, are you going to let these issues turn into something larger? Reacting to clinical feedback is the key to stopping the generation of systemic breakdown.

Use them before The next points could easily be combined as ‘clinical engagement’ but given some of the issues with previous IT projects, breaking this down into three sections is actually integral to success. When you build anything complex in health IT, you must plan the clinical landscape before even discussing procurement never mind installation. A simple health app on a ward for nurses may only have a small footprint, but something like an EHR or a new A&E system will have far reaching knock-on effects, which if not planned for can easily lead to project collapse and issues with patient safety. Mapping and conversing with all the potential end-users and analysing their workflow is critical here. Also, how about a seemingly unique method – ask them what they want! Frontline staff will tell you their issues, bottlenecks and inefficiencies, and believe me if you’re a manager, you will have no idea

Use them after Hopefully the initial launch will have been a success, but the key to realising the true potential of anything digital is its reliability and continuity. Remember that the majority of frontline staff change roles or locations every 4-6 months, and very quickly you can have problems. Furthermore, how do you know if the installation has been a success? Anecdotal feedback is welcome, but a structured, consistent feedback mechanism is necessary along with quantitative measurement of the pre and post installation metrics, both clinical and financial. By constantly refining the technology and the process, you will consistently satisfy the end-users. A combination of the steps above will hopefully assist in the creation of ecosystems, in whichever form they take, that can improve healthcare provision and patient outcomes. Unfortunately they are too often overlooked. n

Interoperability and the Benefits of Connected Health Ecosystems

Interoperability and the Benefits of Connected Health Ecosystems Interoperability remains one of the biggest digital challenges in healthcare. In this interview Steve Rudland, Customer Advocacy & Consulting Lead for Hyland, creator of OnBase discusses digital health technologies and how technology standardisation and interoperability are fundamental enablers in delivering connected health services. 1) What would you say are the key considerations when it comes to trying to effectively integrate new digital and connected health solutions with existing health technologies? "There should be a shared understanding among stakeholders to what the process involves and what a successful outcome should look like. Each stakeholder – whether an end user or a vendor, should be aware of the consequences of their specific needs and uses of the system on other parties. Most importantly, they must all be prepared to work together for the benefit of the patient. The management of stakeholder expectations is one of the major considerations but is easily overlooked when everyone is focused on the technology." 2) In your opinion, what are the main challenges when it comes to dealing with interoperability in digital and connected health technologies? "It is essential to create willingness within the vendor community to work together and share information. Cross-enterprise interoperability and collaboration may also be stymied by a lack of funding during an austerity regime, especially where no strategic budget is available." 3) Do you believe that these challenges are principally driven by technical issues or implementation problems within organisations and health systems? "The technology itself is not the major challenge. The technology, standards and protocols exist today. Implementation can be a problem, particularly if it is under-resourced. "Customers need to understand that 'go-live' on any issue is really the beginning of their journey, not the end of the project." 4) What are the common roadblocks in systems that prevent interoperability? "It is usually human and increasingly budget issues. Interoperability projects cost money and the fragmented nature of health

systems, actively conspires against collaborative working and interoperability across providers.” 5) Do you believe that a universal standard is possible for the health tech industry? If so, what are the main changes that would need to be adopted? "Is an interoperability standard purely for the healthcare sector either desirable of sustainable? Interoperability must go beyond the health sector. We are dealing with larger, older populations with a significant increase in chronic conditions. The health of an individual involves multiple agencies including health, social care, housing, planning and education. The patient as a citizen has the right to expect that in socialised healthcare systems the various agencies will be able to collaborate around consistent, timely, accurate information. "A change in emphasis is required across the healthcare sector, to ensure individuals are treated as citizens, not patients." 6) Where are we in terms of achieving a universal standard for health tech? "A universal standard may not be the ultimate objective. We should be working towards standards for interoperability and data exchange, which will serve not just the health sector but other government and social sectors as well." 7) What steps do you think that healthcare organisations and the wider health technology industry need to take in order to address the lack of standardisation in digital solutions? "The technology providers need to accept the need to work together and actively participate in ensuring interoperability between their systems. Healthcare organisations can encourage this through their procurement process by writing interoperability requirements into their contracts. Continued on page 19

The Journal of mHealth

INDUSTRY NEWS News and Information for Digital Health Professionals

Wearable Device Helps Medics Save Lives in Disasters and on the Battlefield Wearable device designed to measure and monitor the vital signs of multiple trauma patients for emergency response in disasters and battlefield situations The First Response Monitor has been designed to help medics monitor both heart rate and respiratory rate. Respiratory rate is often neglected by automated monitoring systems and has been described as the ‘forgotten bio-sign’, as many existing wearable monitors focus on heart rate alone and those that do measure respiratory rate have low accuracy or are difficult to use in an emergency situation. However, the benefits of accurately monitoring respiratory rate are clear, and when combined with other parameters – such as heart rate and body temperature – can indicate life-threatening conditions such as sepsis. In developing the new device design agency Cambridge Design Partnership interviewed a range of army medics about their needs and challenges in multiple casualty emergency situations. An unmet need was identified for a low-cost device to bridge the gap between manual methods of vital signs measurement – which can be laborious and challenging amidst the noise and stress of a disaster or on the front line - and more expensive patient monitoring systems.

The lightweight, robust and low-cost wearable biometric device not only monitors patients but collects and

October 2015

time. The data can then be transmitted using Bluetooth low energy to a smartphone app or tablet, enabling other data analyses such as multiple patient triage or situational awareness across the group.

transmits data in real-time, enabling the medic to care for a greater number of casualties, providing more effective casualty triage to deliver improved patient outcomes. The small device clips onto a patient’s nose and monitors breathing rate and heart rate, giving ‘at a glance’ indication of both parameters, and this data is added to a trends graph showing how these measurements have changed over time. This enables the medic to focus their efforts on providing care rather than taking measurements but also enables the care giver to understand how the patient’s condition has changed over

Although the device has been primarily designed with first response medics in mass casualty incidents in mind, it has applications in many other fields – such as civilian medicine where additional monitoring of conditions has demonstrable benefit in patient outcomes, wellness monitoring and within sports for training and performance monitoring. The technology can also be developed to provide a low-cost solution for low resource healthcare settings. Speaking about the new development James Baker, Partner, Cambridge Design Partnership said: “At Cambridge Design Partnership we’re always looking for ways to find a solution to a clear, unmet need. With the First Response Monitor we’ve combined our expertise in wearable connected devices with our extensive medical experience to develop a technology for effectively measuring breathing and heart rate. The monitor can help save lives in a variety of environments and we’re really keen to speak to partners about developing the potential applications further.” n

Industry News

Doctors Develop New Trauma Training App Doctors and medical students at South Devon Healthcare NHS Foundation Trust have released a new app they claim could curb the number of deaths from trauma injuries. The team had become concerned at how trauma is an increasingly significant cause of death and disability throughout the world, with developing countries having the highest number of such fatalities, often connected with road accidents, violent crime, civil and military conflicts and landmine injuries. In response, their new Primary Trauma Care (PTC) app has been built for both Android and Apple (iOS) devices to help – offering a resource for clinicians to quickly reference information from the standard manual in the field on their best options for managing all aspects of treating a severely injured patient, including pediatric trauma and trauma in pregnancy. Primary Trauma Care is a system of training for front-line staff in trauma management, aimed at preventing death and disability in seriously injured patients. It is aimed at the needs and logistics of health practitioners in the developing world, by providing straightforward clinical practice that doesn’t require access to high-tech facilities. This training App has been designed to be used by people who have attended Primary Care Trauma courses which are run free of charge around the world by the organisation. The PTC course is widely regarded as a worldwide standard for doctors, nurses, paramedics and other health professionals working in

resource-poor contexts. The app is costed at £2.29, with a plan for money from all sales to go to the maintenance and ongoing development of the app, in addition to the provision of future trauma care courses globally. “A PTC app seemed the logical next step given the success of other educational Apps, and taps into the widespread use of smartphones which we have observed even in remote environments,” commented app project leader Dr Kerri Jones, Associate Medical Director for Innovation and Improvement at Torbay Hospital’s Horizon Institute. The App is available for download on the App Store and Google Play. For more information visit www.primarytraumacare.org. n

Code of Practice for Wellness Apps Published BSI, the business standards company has launched a new code of practice, in conjunction with Innovate UK, specifically designed for Health & Wellness Apps. The new guidance - PAS 277 Health and Wellness Apps: Quality Criteria Across the Life Cycle - stems from the research and strategy report ‘A Framework for standards to support innovation in Long Term Care’, which was published by BSI in September 2014. As populations age, those within communities who are living with debilitating conditions (and their carers) face new challenges in their everyday lives. To

meet this need and be at the forefront of innovation, work is being championed to revolutionise long term care. PAS 277 will allow app developers to come up with innovative ways of providing solutions that can be adopted by healthcare professionals and the public. More specifically, it identifies where standards can support the revolution of radical new ways of delivering solutions to long term care. As part of this, PAS 277 was developed for the governance and life cycle of healthcare apps, so that developers can ensure their products are of a high quality and fit for purpose.

The purpose of the PAS is to develop a set of principles that health app developers should follow, in order to ensure that their products and services can be trusted by healthcare professionals and the public. By developing health apps that are of a high quality, and are fit-forpurpose, health care professionals will develop a growing confidence in their benefit, which will increase usage. The public will be able to use health and wellness apps to proactively manage their healthcare needs, and use their own data Continued on page 8

The Journal of mHealth

Industry News Continued from page 7

and personal information to access the products, services and interventions they need. This assurance and increased usage should allow app developers to be properly reimbursed so that they can continuously monitor and improve their apps to ensure that they remain current. What PAS 277 does: »» Gives recommendations for quality criteria of health and wellness apps, intended to meet the needs of healthcare professionals, patients, carers and the wider public. »» Covers the full app project life cycle, including development, testing, releasing and updating of an app, including clinical, native, hybrid and web-based apps. It addresses fitness for purpose

and the monitoring of usage. »» Informs the development of health and wellness apps intended for internal use, within organisations, as well as those that are placed in the market. PAS 277 does not cover the process or criteria used to establish whether a health and wellness app is subject to regulatory control (e.g. such as a medical device, or related to information governance). Anne Hayes Head of Market Development for Governance at BSI said: “There is huge scope for advancement in the area of wellness innovation, and we are thrilled to be pioneering work in the healthcare arena. It is therefore also our responsibility to safeguard the consumer and healthcare professional by governing the apps that are developed

in the future. We can only do that by arming app developers with guidance such as PAS 277.” PAS 277 will be of use to app developers and publishers, health care professionals and general users of mobile apps; and was developed using a consensusbased approach involving experts from across the industry. Some of the organisations involved include: Association of British Healthcare Industries (ABHI), BT, BUPA, Caton Bell Limited, Digital Health & Care Alliance, Health & Social Care Information Centre (HSCIC), INPUT Patient Advocacy, INPS, NHS England, NIHR Mindtech Healthcare Technology Cooperative, Omron Healthcare, Royal College of Physicians and South West Academic Health Science Network (SWAHSN). n

UCSF Receives $5 million Grant to Create Online Database on all Types of Cancer UC San Francisco has received a National Cancer Institute grant of $5 million over the next five years to lead a massive effort to integrate the data from all experimental models across all types of cancer. The web-based repository is an important step in moving the fight against cancer toward precision medicine. The goal is to accelerate cancer research to improve the way we diagnose, treat and conduct further research on the disease. The resulting database, called the Oncology Models Forum (OMF), will be accessible to researchers through the National Institutes of Health, to encourage scientists to use existing validated cancer models, rather than creating new ones. "There are incredible new discoveries happening in cancer research today, such as detecting cancer cells and DNA in the blood stream, and even harnessing the immune system to fight cancers," said Atul Butte, MD, PhD, director of the Institute for Computational Health Sciences at UCSF and principal investigator for the grant. "These research methodologies generate enormous amounts of data that can and should be harnessed by researchers and engineers to yield new drugs and diagnostics."

Cell lines and mice have been placeholders for studying human cancer for decades, resulting in thousands of mouse models for all cancer types. While results from those studies are chronicled in scientific papers and journals, it is difficult to know how relevant the data from these experimental systems are to the actual research and development of drugs and diagnostics in

October 2015

actual human cancers. This is particularly important, Butte said, because there can be a gap of up to 10 years between the early basic science discoveries from experimental systems and the actual clinical trial of the drug candidates that are developed from that science, with many drug candidates failing in those clinical trials. As a result, it is critically important to ensure that early scientific discoveries are in fact relevant to human cancers, to provide every possible hope that the eventual drugs developed from those discoveries will work in clinical trials and be available to cancer patients.

Industry News The project aims to create an online cache of molecular data that oncologists and cancer researchers could use to validate the current models that best translate to humans, make predictions about the disease and move toward a collaborative, precision medicine approach to cancer. Ultimately, Butte said, the effort also has the potential to create computer-based cancer models that greatly reduce the need for using animals in research.

Health Sciences, will collaborate with Alejandro Sweet-Cordero, MD, Julien Sage, PhD, and Nigam Shah, PhD, at Stanford University, who will provide support with the latest genetically-engineered cancer models, as well as standardized nomenclatures. It also will include bioinformatics specialists from the Northrop Grumman Corp., who will help build and maintain the online database.

The project, led by the UCSF Institute for Computational

Source: www.news-medical.net n

Innovations in Military Care are a True Testament to the Possibilities of Mobile Medical Technology As health technology becomes increasingly central to providing improved patient experiences and outcomes across healthcare innovations in military care continue to provide news ways of supporting military personnel both in and out of combat. Philips recently revealed a full range of solutions for military care and treatment at the Defence and Security Equipment International 2015 event in London. Medical solutions across the military care continuum, from helping to educate and train medical teams before deployment, to providing lightweight, rugged medical solutions to help triage and diagnose at the point of injury, as well as providing rapidly deployable solutions for diagnosis and treatment were demonstrated. A highlight of the event was the official opening of the world’s first 128 slice CT scanner housed in a rapidly deployable, expandable container. Fitted inside an expandable Marshall shelter, the latest Philips Healthcare Ingenuity Elite 128-slice CT Scanner provides ultra-high resolution imagery in less than a minute enabling diagnosis or essential surgery to take place quickly. The Marshall CT Scanner is designed to be transported by land, sea or air using both civil and military logistics chains. On arrival at its tasking location the team is able to have the scanner providing its first patient imagery within four hours. This is possible because of the

layout of the equipment in the shelter which negates the need to re-calibrate it each time it is deployed. The main scanner unit, or gantry, does not move during transit and so does not need to be certified each time it is moved, unless required by local regulations. It was this design that led to the company being awarded a Queen’s Award for Enterprise in the Innovation category in 2013. “We are continuously looking for new solutions to provide better care and treatment to those who serve and protect us. This solution enables faster diagnosis and treatment which we believe leads to better patient outcomes and more lives saved. The expandable Marshall shelter with the latest Philips Ingenuity 128-slice CT Scanner provides

ultra-high resolution imagery in less than a minute, enabling fast diagnosis and essential surgery to take place quickly” said Paul Cropper, Global Head Military and Disaster Relief, Philips Healthcare. Also on display were a range of solutions and innovations from Philips showcasing its growing range of military technologies and solutions for enabling early, confident diagnosis and rapid, effective treatment. Among these were vital signs monitoring devices to help diagnose and assess injury and treatment requirement, for faster, more efficient care; rugged, certified professional-grade AED for medevac; and, portable, lightweight, ventilation solutions for transporting patients from the point of injury to field or static hospitals. n

The Journal of mHealth

Industry News

VA Spinal Cord Injury Centre Demonstrates Clinical Improvement Using Contactless Bed Monitoring Sensors A VA Spinal Cord Injury (SCI) Centre has reported significant positive clinical results achieved using a contactless bed monitoring system from EarlySense. The Scientific Poster was presented at the Academy of Spinal Cord Injury Professionals (ASCIP) 2015 Educational Conference.

by 50%. Furthermore, ICU Transfers decreased by 40% and Mortality following MRT/Code Activations decreased by 83%. These results were derived from the monitoring of 1,150 patients monitored on the EarlySense System during a one year period of time.

Patient safety for chronically ill Spinal Cord Injury patients in the hospital is an ongoing challenge. Early detection of patient deterioration has helped drive significant clinical improvements in the Veterans Spinal Cord unit. Post implementation results showed a decrease of more than 60% in Medical Response Team (MRT) Activations; Code Blue Activations decreased

“These are at-risk patients and it is vital to protect their clinical progress. To have such a meaningful impact on outcomes for our Veterans is very rewarding. A reduction of 80% in mortality following major deteriorations, is a breakthrough in quality of care which the professional team at the SCI Centre should be applauded for.” said Tim O’Malley,

President of EarlySense Inc. “In adding the EarlySense System to existing clinical support efforts, the Veterans Spinal Cord Injury Centre staff elevate their level of response and, therefore, improve outcomes for these Veterans.” The EarlySense Monitoring System - a solution designed for proactive and personalised patient care for general care non-ICU patients - monitors patients’ Heart Rate, Respiratory Rate and Motion on a continuous basis, through a contactfree sensor under the mattress, or within the cushion of a chair. The system has allowed the Veterans Spinal Cord Injury centre to facilitate proactive interventions for SCI Veterans by adding a layer of care with continuous monitoring and drawing attention to those who show early signs of deterioration and who may require timely clinical intervention. The technology assists clinicians in early detection of patient deterioration and in identifying and preventing potential adverse events such as patient falls and pressure ulcers. The system was designed to address safety challenges as well as failure to rescue of those patients who are usually monitored by nursing staff approximately once every four to eight hours in general care floors and alternate care facilities. n

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Industry News

Qualcomm Acquires Capsule Technologie Qualcomm Incorporated has announced that its subsidiary, Qualcomm Life, Inc., has acquired Capsule Technologie, a leading global provider of medical device integration and clinical data management solutions with more than 1,930 hospital clients in 38 countries. Capsule will become a wholly owned subsidiary of Qualcomm Life. The acquisition of Capsule extends Qualcomm Life’s connected health offerings into the hospital, ultimately creating a more seamless care continuum from hospital to home and all points in between. By combining Qualcomm Life’s wireless expertise and ecosystem of connected medical devices outside of the hospital with Capsule’s leadership for connecting medical devices, EMR’s and IT systems across the hospital enterprise, Qualcomm Life is creating one of the world’s largest open connected health ecosystems to deliver intelligent care everywhere. Capsule’s leading medical device integration and clinical data management platform enables data collection, EMR and health IT system integration and monitoring in one of the largest ecosystems of connected devices inside the hospital. Capsule’s smart networking goes beyond device integration by delivering timely clinical data to various in-hospital decision support

systems, alarm and notification systems and asset management tools, which help reduce latency and transcription errors to ensure timely, informed care. “Qualcomm is focused on strengthening its position in specific Internet of Everything verticals, like healthcare,” said Derek Aberle, president, Qualcomm Incorporated. “The acquisition of Capsule expands the breadth of our healthcare platform, enabling us to provide connectivity solutions for the entire care continuum and create one of the world’s largest connected health ecosystems. This will be an important step in advancing the Internet of Medical Things.” “As health care continues to move into the home and ambulatory settings and outside of traditional care areas such as the hospital, the convergence of medical device data from wherever the patient is located is critically important,” explained Gene Cattarina, CEO, Capsule. “Together, Qualcomm Life and Capsule will power this convergence by making data more accessible and interoperable among care teams to provide true continuity of care at the hospital, in the home and at all points in between.” n

UK Department of Health Team Tests Digital Prototypes Lead official outlines transformation project that includes investigation for the potential development of ‘health as a platform’ A Department of Health (DoH) team in the UK has begun to test and prototype approaches to supporting digital healthcare as part of its recently launched NHS.UK Alpha project. It includes work on the possibility of extending the ‘government as a platform’ approach into healthcare through the development of ‘health as a platform’ in the creation of new digital services. The team, which is working under the National Information Board, includes members from healthcare website NHS Choices and the Government Digital Service. Dan Sheldon, Digital Strategy Lead at the

DoH, says in an NHS.UK Alpha blogpost that it is “setting a vision for NHS. UK”, and dealing with two major challenges: supporting digital transformation in the large, federated environment of the health service; and helping the public to navigate the system. It is looking at the way that information is published by health and care organisations on the nhs.uk and gov.uk domains, and at the processes involved for the public in obtaining care. Platform Approach Sheldon says one of its approaches is to look at health as a platform as a way of fixing common problems such as establishing patient identities and booking appointments once, rather than expecting each service to develop its own solutions. “Over the past few weeks we have been exploring and prototyping opportunities

to make things better across all three – information, services and platforms,” he says, adding that the team will provide updates on progress. Another priority is to meet the needs of people with particular health conditions, although Sheldon says there should not be an over-emphasis on specific conditions as this could undermine the effort to look at the total care of an individual. The team is also looking at the protection of personal data, how to get different systems to speak the same language, and the impact of online referrals and appointments on NHS working practices. The project, which began in September, will run for 12 weeks and is aimed at producing plans for the further development of prototypes, standards and guidance for NHS teams building digital services. n

The Journal of mHealth

Industry News

Smart Mirror Monitors Your Face for Telltale Signs of Disease Wize Mirror looks like a mirror, but incorporates 3D scanners, multispectral cameras and gas sensors to assess the health of someone looking into it. It does this by examining the person’s face, looking at fatty tissue, facial expressions and how flushed or pale they are. Facial recognition software looks for telltale markers of stress or anxiety, while the gas sensors take samples of the user’s breath looking for compounds that give an indication of how much they drink or smoke. The 3D scanners analyse face shape to spot weight gain or loss, while the multispectral cameras can estimate heart rate or haemoglobin levels. After the software has analysed the face – which only takes about a minute – the mirror produces a score that tells the user how healthy they seem. It also displays personalised advice on how to improve their health. Wize Mirror is being developed by a consortium of researchers and industry

partners from seven European Union countries, with EU funding. Sara Colantonio and colleagues from the National Research Council of Italy, which coordinates the project, want to use Wize Mirror to address common long-term health issues that are difficult to treat once something has already gone wrong, like heart disease or diabetes. Need for prevention “Prevention is the most viable approach to reduce the socio-economic burden of chronic and widespread diseases, such as cardiovascular and metabolic diseases,” they write. Clinical trials of the device will begin next year at three sites in France and Italy, aiming to compare its readings with those from traditional medical devices. Consumer technology that can read signals from the body to interpret underlying physical and mental health is on the cusp of becoming part of everyday life. For example, Cardiio, originally devel-

oped at the Massachusetts Institute of Technology, is an app that uses a smartphone’s camera to monitor blood levels in the face and tell you your heart rate. At MIT’s Media Lab, Javier Hernandez has looked at using mirrors for health monitoring. He also developed a program called SenseGlass, which uses Google Glass and other wearables to measure someone’s mood and help them manage emotions. Hernandez says that although mirrors are great for health monitoring because we use them every day, putting them to use in this way is trickier than it sounds. “Accurate health assessments in natural settings are quite challenging due to many factors such as illumination changes, occlusions and excessive motion,” he says. Journal reference: Biosystems Engineering, DOI: 10.1016/j.biosystemseng.2015.06.008 n

Google Pairs With Sanofi to Move Diabetes Patients to the Cloud Google Inc.’s life science unit is still seeking a name but it already has a foe: Diabetes! The U.S. Internet giant has agreed to work with French drugmaker Sanofi to devise new ways of managing a disease that afflicts 382 million people worldwide, adding to recent deals with Novartis AG and DexCom Inc. Andy Conrad, the head of Google’s life science team, said diabetes is precisely the kind of disease in which technology can help patients, whose bodies can’t manage sugar, by keeping track of their blood and insulin measurements -- and avoiding discomforts that range from daily finger pricks to more gruesome limb amputations.

“Diabetics are far more likely to have heart attacks, they’re far more likely to have cancer, and they’re 15 times more likely to have their foot cut off because of vascular issues,” Conrad said in an interview. “If we could prevent strong and profound fluc-

October 2015

Industry News tuations in the levels of blood sugar, we could prevent most of the problems associated with diabetes.”

avoid long-term complications associated with poor management of the disease, which include heart attacks and cancer.

Google last year agreed to work with Novartis to develop contact lenses that use tiny sensors to read blood-sugar levels from tears. Tests on that product will begin next year, according to Conrad. This August, Google also said it would work with DexCom on a bandagesized sensor connected to the cloud. Sanofi, the maker of Lantus, the world’s best-selling insulin, will work on new ways of delivering the hormone, such as Bluetooth-enabled pens that let a physician monitor how much insulin their patient is using, and when.

“The cost of diabetes is the cost of complications of diabetes, which is often not treated well enough and early enough,” said Pascale Witz, the head of Sanofi’s newly-created diabetes and cardiovascular-care unit.

“That’s the system that we’re endeavouring to build: smart insulin delivery devices, smart measurement devices, with an interface and integrated platform that helps physicians and patients see how they’re doing,” said Conrad, whose division will be renamed in the coming months as a unit of Google’s new holding company, Alphabet Inc. Diabetes, which will affect an estimated 600 million people by 2035, costs about $245 billion a year in the U.S. alone in healthcare resources and lost productivity, according to the American Diabetes Association. Google and Sanofi will develop ways to store and analyse glucose levels in real time, enabling patients and their doctors to respond more quickly to peaks and troughs in blood sugar and

Sanofi last year signed a memorandum of understanding to work with Medtronic Inc. on developing devices for diabetes, but Witz said the Paris-based company will no longer pursue that partnership because "we did not feel that it was going far enough." Patients monitor their blood sugar several times a day by pricking a finger with a needle and dabbing a drop of blood onto a strip that’s inserted into a meter that computes the level of glucose -- or sugar. Patients also need to monitor their diet and exercise regimes and calculate how much insulin they need, a combination of tasks that means more than half of patients miss their target levels, according to a 2013 study. Devices that continuously monitor glucose, and upload that data to the cloud, will enable physicians and patients “to move away from the reactive and episodic towards the proactive and preventative,” Conrad said. “An ounce of prevention is worth a pound of cure.” Source: Bloomberg n

Diabetes Tools Acquires DiabetesGuru Child App Swedish digital health company Diabetes Tools, the maker of the TriabetesClinic online service, has announced the acquisition of DiabetesGuru a smartphone app for children developed by Shore Innovation AB. This agreement transfers the rights to Diabetes Tools while still allowing the developer behind DiabetesGuru, Henrik Sjöstrand, to support the project. “The deal with DiabetesGuru adds a new dimension to our digital health product portfolio,” said Diabetes Tools’ Chief Executive Officer Anders Weilandt. “Whereas TriabetesGo, our app for keeping insulin-dependent children connected with their families and doctors, is exclusively available from treatment clinics using the TriabetesClinic service, DiabetesGuru is a standalone app and can therefore be used by children and families when a TriabetesClinic affiliation is not offered in their local area.” “I created DiabetesGuru out of neces-

sity to help my young son with his diabetes,” said DiabetesGuru’s developer and Shore Innovation’s CEO Henrik Sjöstrand. “Now the app helps hundreds of insulin-dependent children across Sweden. Since I do this in my spare time, now is the right time to move the app to a more professional setting. I am delighted that Diabetes Tools has agreed to take it over. It's a move that will allow many more families to benefit from the hard work I have put into it.” According to the deal, Diabetes Tools will own the rights to the DiabetesGuru app in addition to other marketing and brand assets. The software assets will be formally transferred during the next few months so DiabetesGuru can become part of the Diabetes Tools quality management framework and product portfolio. Then, the company expects to offer DiabetesGuru as a free-of-charge, standalone app available from online app stores as it is today. n

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Industry News

HIPAA Compliant Mobile Medical Camera App and Cloud Storage Service Launched Clearwater Clinical has announced the formation of MODICA, its new mobile endoscopy and mobile medical photography division. The company also announced the availability of the MODICA mobile medical camera phone app and HIPAAcompliant cloud storage service. Most physicians today use their personal mobile devices to record photos and video of patients. These images provide an excellent visual medical record that makes collaborating over cases with colleagues, consultants, and residents easier. However, most default camera and messaging apps offer no security protection. In fact most phones are designed to automatically move images to non-compliant storage services and have settings that could result in the inadvertent sharing of medical images on social media networks.

“Every doctor I know uses their personal mobile phone to take medical pictures and videos. We do it because it is easy and convenient and we carry around these HD cameras in our pockets every day. We also like how simple it is to share the photos with colleagues and residents. It’s a tremendous productivity tool for collaborating with other doctors, teaching residents, and even sharing with patients. But before today, every one of us were doing it in an insecure, non-compliant way”, Dr. Matthew Bromwich, ENT Surgeon at the Children’s Hospital of Eastern Ontario (CHEO) and Co-founder of Clearwater Clinical. “Now with MODICA, I use my mobile phone to record, manage, and share images of my patient cases with complete confidence that medical data is kept private and secure.”

The MODICA medical camera app and cloud solution lets physicians leverage the convenience of using their smartphone for capturing images while remaining in compliance with privacy and regulatory requirements. The solution can be used to record photos and video and secure them in a segregated, password-protected camera roll. All medical images are automatically moved off the device to a HIPAA-compliant, encrypted cloud storage service adding further protection in the event of a lost or stolen device. For regulatory control over how images can be used, MODICA

“Within the MODICA division, our goal is to develop medical software that harnesses the power of mobile technology for capturing medical photos and videos. The challenge has been how to do that securely, and in keeping with regulatory requirements,” said Michael Weider, CEO of Clearwater Clinical. “With the formation of this division, we are able to align our resources – which includes vast expertise in both privacy regulations and software security – to focus on developing solutions that solve real problems, and removes great risk, for physicians and medical institutions.” n

enables physicians to capture and store patient consent directly within the app. The application also helps physicians speed up patient care by facilitating secure in-app sharing of images with colleagues, consultants, and residents. Physicians can easily collaborate on patient cases with the benefit of a visual record to facilitate discussions.

NHS Trust Cuts Norovirus Outbreaks by More Than 90% An NHS Trust has cut outbreaks of the norovirus winter vomiting bug by more than 90% over a five-year period, according to research published in the journal BMJ Quality and Safety.

simple clinical measures and computer-based surveillance to identify and manage promptly patients who had been infected with the virus.

Portsmouth Hospitals NHS Trust used a combination of

The initiative meant that norovirus outbreaks at the Trust

October 2015

Industry News dropped by 91% between 2009-10 and 2010-14. The drop was much larger than the reduction in outbreaks reported by other hospitals in the Wessex region and across England. The paper in BMJ Quality and Safety concluded: “A multi-year quality improvement programme, including use of real-time electronic identification of patients with norovirus-like symptoms, and an early robust response to suspected infection, resulted in virtual elimination of outbreaks.” Norovirus is the most common cause of epidemic gastroenteritis and outbreaks in hospitals are frequent, particularly during winter. The virus causes diarrhoea and vomiting, and can cause fatal complications. When a norovirus outbreak is identified, affected wards may be closed to admissions resulting in a loss of bed capacity, often during the winter months when bed pressures are at their highest. Outbreaks also result in a loss of productivity, as many staff may be affected. Portsmouth Hospitals NHS Trust worked with The Learning Clinic to develop computer software called VitalPAC Infection Prevention Manager. It uses an existing hospital–wide electronic vital signs system (VitalPAC), which uses Apple iPods to record patient observations such as nausea and vomiting, to create a series of alerts that highlight potential cases of norovirus infection. It speeds up notification of the infection prevention and control team, who can then respond faster by instituting simple bedside measures. Where appropriate, patients were moved into isolation, hand hygiene measures were enhanced and bed areas, crockery and utensils were intensively cleaned to prevent infection spread. The study found that between 2009-10, when the initiative began, and 2013-2014, the number of norovirus outbreaks fell by 91%, from 21 to just one. The number of patients affected by norovirus-like symptoms fell by 92%, the number of affected staff fell by 81% and the days of disruption in the hospital as a result of the virus fell by 88%.

The number of reported outbreaks also fell across the Wessex region and across England as a whole, but by a far lower percentage (15% in Wessex and 28% across England). Public Health England has reported that, nationally, norovirus outbreaks are associated with 13,000 patients and 3,400 staff becoming ill every year, plus 8,900 days of ward closure and the loss of more than 15,500 bed-days. Dr Caroline Mitchell, Associate Director for Infection and Patient Safety at Portsmouth Hospitals NHS Trust, and one of the study’s authors, said: “By application of simple measures we have significantly reduced the number of cases of Norovirus and other gastrointestinal viruses which can cause serious and unpleasant symptoms in patients and massively disrupt the operational capacity of the hospital. “The combination of new technology and better training and organisation of our staff has contributed hugely to our successful results in this field.” Dr Peter Greengross, Medical Director of The Learning Clinic, which developed the VitalPAC system, said: “We believe norovirus outbreaks cost the NHS £41.5 million a year. If every hospital achieved the same result as Portsmouth the savings could be £38 million a year. That would have a massive impact.” The paper is available online at http://qualitysafety.bmj.com/content/ early/2015/09/08/bmjqs-2015-004134.abstract n

Every Hospital Patient to be Given a Barcode as Part of Plan to Create a 'Paper Free' NHS Every patient in a UK hospital will be given an individual barcode to ensure they are given the correct drugs and treatment, as part of plans to make the NHS “paper free” by the end of the decade. Under proposals outlined in September, patients will also be able to book appointments, order repeat prescriptions

and access their GP records using NHS smartphone apps. The UK Government is also going to examine the feasibility of installing free wi-fi in every hospital and GP surgery in England. By 2020, NHS England says, it will have digitalised every patient and care record in the country – meaning that whenever patients come into contact with

the health service, medics will have all of their clinical notes and test results available immediately. The changes will not apply in Scotland and Wales, but similar plans are being developed in the devolved regions. In addition, patients, pieces of medical equipment and drugs will be identified Continued on page 17

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Industry News

Partnership Develops National Epilepsy App

A mulit-disciplinary partnership of health and technology providers have announced the introduction of a self-help app designed to support anyone with epilepsy to take better care of themselves. The app, called EpSMon (Epilepsy Self Monitor), is a self-help tool aimed at anyone who experiences seizures. It provides lifesaving knowledge to people with the condition by allowing them to assess their risk every three months, say the team behind it. It has already been included as part of an epilepsy toolkit to be used by NHS Clinical Commissioning Groups across the United Kingdom. Created by a team of partners based at Plymouth University; Cornwall Foundation NHS Trust; Royal Cornwall Hospital and SUDEP Action, the solution provides a digital version of the SUDEP and Seizure Safety Check List. EpSMon is designed to prompt users to see their doctor when their risks increase and suggests simple ways they can lower this risk, say its creators. The app asks users for information about their epilepsy, including their last appointment, information about seizures and their general well-being, analysing answers to generate advice ranging from 'all clear, no further action required' to 'make an appointment with your doctor now.' That analysis can be shown to a GP to help them decide the best treatment regime for their patient as well as helping to facilitate meaningful person-centred communication of key risk issues. Fatalities including Sudden Unexpected Death in Epilepsy (SUDEP) do happen in some people with epilepsy. EpSMon shows users which risks are getting better, which have worsened and which have stayed the same. This data can then be

October 2015

shared and used to help plan care options. "People with epilepsy are often not accurately informed about the risks, in particular Sudden Unexpected Death in Epilepsy. This device not only informs people about those risks but also gives information about how to modify them, so empowering patients and carers. Moreover, it provides an invaluable summary for GPs and hospital specialists involved in their care." Comments Professor Matthew Walker of University College, London. Since its official launch in July the app has received significant acclaim, from both healthcare professionals and people with epilepsy, and has now been included within an Epilepsy Commissioning Toolkit for Clinical Commissioning Groups (CCGs) across England. The toolkit is a web-based hub of information, advice and evidence needed to improve or commission epilepsy services for children and adults across their local area. It aims to help inform the decision making process of service design and/ or improvements, guiding CCGs through the process with a mix of case studies, resources and tools they can use. "We are very pleased that our work here in Cornwall has been recognised at a national level,” commented Dr Brendan McLean, Consultant Neurologist at the Royal Cornwall Hospitals NHS Trust. “We hope that this initiative will go a long way to helping patients in self-managing their epilepsy and identifying risks to their seizure control early so avoiding harm and improving confidence." For more information visit: v Source: British Journal of Healthcare Computing n

Industry News Continued from page 15

using barcodes for the first time. This, it is claimed, will help to ensure that the right patient will be given the right drug, at the right dose and at the right time. While the NHS has a troubled record with large-scale IT projects, NHS England’s national director for patients and information, Tim Kelsey, has said that this time the organisation is in a position to deliver on its pledge. A new set of “digital standards” that healthcare providers must provide will be integrated into NHS contracts while organisations will be inspected by the Care Quality Commission to ensure that they are being implemented. The Government estimates that annual cost of paper storage is between £500,000 to £1m for each healthcare trust – money which, it says, will be invested in more doctors and nurses. “Every day, care is held up and patients are kept waiting while an army of people transport and store huge quantities of paper round our healthcare system,” Mr Kelsey will say. “This approach is past its sell-by date. We need to consign to the dustbin of history the industry in referral letters, the outdated use of fax machines and the trol-

leys groaning with patients’ notes.” Innovations such as electronic prescribing systems, which help doctors ensure the right medicine is provided to the right person in the right quantity can halve medication errors, yet only 14 per cent of NHS hospital trusts currently use such systems. In addition, a study published in the British Medical Journal found that death rates at two major hospitals fell by more than 15 per cent when nurses were given handheld computers to monitor patients’ vital signs. The drop in mortality represented more than 750 lives saved in a single year across

Some things just...

the two sites, which could equate to tens of thousands of lives across the NHS. “As well as saving precious resources, technology can dramatically reduce errors,” Mr Kelsey says. “Urgent action is a moral imperative where paper is the currency of clinical practice.” “The NHS needs to get over the idea that we’ve had too many false starts and we can’t do technology. While bringing our own systems into the digital age, we must do more to help the public and clinicians take advantage of the game-changing opportunities on offer to improve outcomes for patients.” Source: The Independent n

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Does Device Interoperability Sacrifice Security?

Does Device Interoperability Sacrifice Security? By Stephanie Preston, Cyber Embedded Systems Engineer, Battelle and Melissa Masters, Director of Electrical, Software and Systems Engineering, Battelle When medical devices work together, patients and healthcare providers benefit. But is there a downside to medical device interoperability? As our devices become more connected to each other and to hospital networks, they open up new cybersecurity risks. The same interoperability standards that make it easier for devices to communicate may also make medical devices more vulnerable. The Promise of Device Interoperability The Institute for Electrical and Electronics Engineering (IEEE) defines interoperability as “the ability of a system or a product to work with other systems and products without special effort on the part of the customer.” Interoperable devices use standardized ways of interacting and sharing data with each other, with hospital networks, and with patient Electronic Health Records (EHRs). Devices designed to be interoperable are essentially intended to be “plug and play”: when you add them to your network, they should be ready to communicate with other parts of the healthcare system. The desire for connected, interoperable devices is already driving significant improvements in healthcare quality and patient outcomes. For example, a hospitalized patient may be connected to six or more medical devices, including infusion pumps, ventilators, and various vital signs monitors. When these become integrated and communicate directly with the EHR, doctors and nurses have real-time access to complete, accurate information on a patient in one place rather than consulting each device individually. This reduces clinician burden and healthcare errors. Interoperability also enables sophisticated healthcare data analytics and device automation – for example, a drug delivery device that

October 2015

could automate dosages based on feedback from various monitoring devices. As healthcare moves towards greater reliance on electronic records and connected devices, hospitals and regulators are pushing towards standardized systems for interoperability. The Office of the National Coordinator for Health Information Technology is advocating a ten-year plan for achieving universal interoperability, including the development of device interoperability standards. This is also an increased area of focus for the FDA; this September, the FDA, Center for Disease Control (CDC) and National Library of Medicine (NLM) of the National Institutes of Health are conducting a workshop to promote semantic interoperability of laboratory data. A Tempting Target for Hackers Device interoperability standards would make life easier for both clinicians and medical device manufacturers. A universal interoperability standard would give device manufacturers a simple roadmap to follow to ensure that their devices will meet purchaser expectations and potential future regulations. Unfortunately, universal interoperability standards would also make life a lot easier for hackers. Currently, most medical devices are fairly low-value targets for hackers. Because each device has its own software and there are varied methods for sending and receiving data, each device has to be hacked individually. Unless a device is widely used or has a known cybersecurity vulnerability, most devices won’t be worth the trouble of figuring out. However, universal interoperability standards would give hackers a much tastier target to aim for. Because all devices would share the same communication formats, they would all share similar points of vulnerability. Hackers can use these vulnerabilities to pivot into hospital networks. Finding a vulnerability shared across many kinds of devices would open up dozens or hundreds of potential entry

points into a hospital network. Once inside the network, cybercriminals have the opportunity to engage in several kinds of attacks. Some hackers may simply want to disrupt hospital operations, whether for terrorist aims or simple amusement. But most hackers are after the money. Hospitals store tens or hundreds of thousands of records containing sensitive financial, medical and identity information, which are valuable on the black market. Hospitals are also increasingly vulnerable to ransom attacks; in which hackers lock electronic data on the network—including critical patient information—until a specified ransom has been paid. In most cases, hackers will not be trying to harm patients directly. However, patient harm can result indirectly if care providers don’t have access to records or if a medical device is compromised during the hacking attempt. For example, a patient record may give a false status that results in a patient not receiving needed medication, or a respirator may malfunction due to changes made to its code. Hospitals have significantly tightened network security in response to these threats. However, connected devices can act as “weak links” in the network, providing easy access to hackers. Shared standards increase the potential payoff for finding vulnerability. They also make the hacker’s job easier by publicizing the communications protocols that all devices will use. Balancing the Risks and Benefits This is not to say that the industry should halt the movement towards greater interoperability. The benefits of connected, interoperable devices far outweigh the potential risks. The benefits not only include advancements in patient care, but also significant efficiencies and potential reductions in human error as well. However, it becomes even more critical that cybersecurity risks at both the network and the device level are considered when developing interoperability standards.

Does Device Interoperability Sacrifice Security? At the device level, medical device manufacturers must address three critical aspects of cybersecurity during design: »» Create a security plan (similar to a safety risk management plan) early in the process. Make sure the plan addresses launch and post-market security protocols. »» Conduct a device-specific threat assessment and revisit it throughout the design process. Threat assessment should include characterizing, modeling and measuring existing threats. Thinking about the ways that devices send and receive data gives us important clues to the ways they may be vulnerable to either intentional attacks or software glitches. »» Design with security in mind by baking cybersecurity into hardware and software development from the start. Once the device is on the market, medical device manufacturers of connected devices need to continue to be diligent and more proactive: »» Schedule periodic reviews of the threat assessment once the device is deployed. »» Be ready to act fast when an issue is identified, as time is critical to containment. Make sure your CAPA process has swift time tables for a response. »» Define a responsible disclosure policy and link it to your CAPA process. »» Be open and work with your customers right away when a security issue is identified.

Lastly, don’t be afraid to connect! The more data, the better the data, and the better correlated the data, the more insights we gain into individual health and healthcare quality. As medicine evolves towards more connection in the future, there is the potential for exponential improvement in our overall wellbeing. To learn more about DeviceSecure from Battelle, visit battelle.org/our-work/pharmaceutical-medical-devices/medical-devices/ battelle-devicesecure-services About the authors Melissa Masters, RAC, (B.S., Electrical & Computer Engineering) Ms. Masters is Director of Electrical, Software and Systems Engineering at Battelle and heads Battelle’s DeviceSecure Services. Ms. Masters has more than 14 years of experience in product development as a project manager, systems engineer and design engineer, serving as the project manager and lead systems engineer on medical device development and sustaining engineering programs. Ms. Masters is a voting member of the Association for the Advancement of Medical Instrumentation (AAMI) working group on cybersecurity for medical devices and contributed to the vulnerability model

Continued from page 5

"While standards are in place, individual country standards need to be subject to international standards." 8) Who should be leading the drive to mandate these changes (e.g. industry alliances/initiatives, regulatory bodies, government policy)? "It is in everyone's interest for this to work and healthcare organisations can play a key role through the procurement process. There may well also be a role for government at some level to encourage or even mandate those standards in procurement when it relates to public money – not just for healthcare but also other sectors which would benefit from wider interoperability. "In the UK we are seeing healthcare community of vendors and providers engaging to create the interoperability charter. "In economies where health and social care is not primarily gov-

for AAMI’s TIR 57. She has been published and widely quoted on a variety of medical cybersecurity topics in AAMI Horizons, Mass Device, ExecutiveGov. com, and Fierce Medical Devices. In addition, Ms. Masters holds a Regulatory Affairs Certification (RAC) and has a working knowledge of domestic and international regulatory requirements for medical devices. Stephanie Preston, EIT, GIAC, CEH, (B.S., Computer and Electrical Engineering) Ms. Preston is on Battelle’s Cyber Innovations team, where she focuses on firmware reverse engineering (x86, x86_64, MIPS, 8051), as well as application development (C/C++). She also serves as the team’s intellectual property steward. Ms. Preston contributed to the IEEE guidelines for security in medical device software development and production, a step toward industry standards that will systematically secure medical devices. Ms. Preston is a registered engineer in training (EIT) in the state of Ohio, holds a (GSEC) Global Information Assurance Certification (GIAC) Security Essentials certification, and a Certified Ethical Hacker (CEH) certification. She also serves as an adjunct faculty member at the Ohio State University College of Computer Engineering. n

ernment controlled, such as the US, it can still be incentivised, although in developing markets it is more difficult." 9) What would be your top tips for managing digital deployments in healthcare, in terms of ensuring effective integration? "Concentrate on stakeholder engagement. When users, vendors, and executives co-operate and collaborate to build a shared understanding of a successful project, they’ll have a great chance of achieving that success." Steve Rudland is Customer Advocacy & Consulting Lead for Hyland, creator of OnBase in EMEA. He has more than 20 years' enterprise content management experience, gained in some of the world's leading technology companies. With particular expertise in systems integration, collaboration and multi-agency information sharing across the healthcare, social housing and local government sectors, Steve is currently advising clients on strategic healthcare business transformation projects in the UK and Denmark. n

The Journal of mHealth

FBI Warns Healthcare Sector Vulnerable to Cyber Attacks

FBI Warns Healthcare Sector Vulnerable to Cyber Attacks The FBI has warned healthcare providers their cybersecurity systems are lax compared to other sectors, making them vulnerable to attacks by hackers searching for personal medical records and health insurance data. Health data is far more valuable to hackers on the black market than credit card numbers because it tends to contain details that can be used to access bank accounts or obtain prescriptions for controlled substances. "The healthcare industry is not as resilient to cyber intrusions compared to the financial and retail sectors, therefore the possibility of increased cyber intrusions is likely," the Federal Bureau of Investigation said in a private notice it has been distributing to healthcare providers, obtained by Reuters. The notice, dated April 8, did not mention the Obamacare website, Healthcare.gov, which has been criticised by opponents of the Obama administration for security flaws. It urged recipients to report suspicious or criminal activity to local FBI bureaus or the agency's 24/7 Cyber Watch. The FBI has failed to provide any additional comment on the private industry notification, or PIN. In January the FBI issued a PIN advising retailers to expect more credit card breaches following last year's unprecedented attack on Target Corp. Details of PINs are typically unclassified, but generally only shared with affected organisations who are asked to keep their contents private. A series of privately commissioned reports published over the past few years have urged healthcare systems to boost security. Experts applauded the FBI for responding with its own warning. "I'm really happy to see the FBI doing this. It's nice to see the attention," said Shane Shook, an executive with cybersecurity firm Cylance Inc who helps companies respond to breaches. Retailers and financial institutions have taken steps to bolster security of financial information after the attack on Target as well as smaller breaches at Neiman Marcus, Michaels and other merchants. Hackers accessed millions of bank card numbers and other customer data.

As those stolen payment card numbers flooded underground markets, the value of that information dropped, leading to "fire sales" by criminals seeking to unload them, said Angel Grant, senior manager for fraud and risk intelligence at EMC Corp's RSA security division. Demand for medical information, however, remains strong on criminal marketplaces, experts said, partly because it takes victims longer to realise the information has been stolen and report it, and because of the different ways the information can be used. Cyber criminals were getting paid $20 for health insurance credentials on some underground markets, compared with $1 to $2 for U.S. credit card numbers prior to the Target breach, according cybersecurity firm Dell SecureWorks. Some criminals use medical records to impersonate patients with diseases so they can obtain prescriptions for controlled substances, Grant said. Several U.S. states, including Massachusetts, have reported a surge in opiate addiction, along with a jump in heroin overdoses that the Obama administration has called a "public health crisis". Others criminals are purely interested in using the medical data for financial fraud. "They are harvesting information to make it easier to conduct identity theft, to open new accounts," Grant said. Pieces of health information are also sometimes combined with other pieces of data into complete packages known as "fullz" and "kitz" on underground exchanges where they can fetch $1,000 or more when bundled with counterfeit documents, according to Dell. The two-page FBI alert cited a February 2014 report from the non-profit SANS Institute, which trains cybersecurity professionals. SANS had warned the healthcare industry was not wellprepared to fight growing cyber threats, pointing to hundreds of attacks on radiology imaging software, video conferencing equipment, routers and firewalls. Source: Reuters n

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October 2015

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Building Connected Ecosystems

Building Connected Health Ecosystems By Keith Nurcombe Keith Nurcombe has worked in healthcare for over twenty years spending the last few years working with businesses in the health and technology space, most recently building O2 Health where he was Managing Director until the end of 2012, since then he has been providing consultancy services to businesses. For me, this is key - what can be done, and how we can really take healthcare forward digitally? There are always questions about how can this system or this application make a difference to patients or users or possibly change the way that certain practices are delivered? In healthcare we often forget about how we build a really connected ecosystem, where multiple systems interact and deliver a better experience for the user, patient or citizen than the individual systems on their own. Sounds easy, I know, but it is something that those of us working within digital healthcare have to really focus on. By example, in the UK market - where we are in the infancy of this kind of connected ecosystem - billions of pounds have been spent trying to link healthcare systems together in a connected way - i.e. to allow your primary care physician to speak to your specialist and use the same system which you, as the patient, can also see and interact with. You can even decide who to share

your records with, dangerous in some people’s eyes but radical and refreshing for others. All this means you own and control your own data and health record. Unfortunately, in the UK, this remains a pipe dream. Currently primary care systems don’t even talk to secondary care systems, let alone the wider world. Here’s my dream – if we could first get primary care systems talking to specialists in hospitals, we could then add social care to the mix followed by mental health services and then government systems such as social support and tax systems. Only then will we be at a place where we have a truly connected user, patient, citizen who has access, through a single sign-on, to all the services that they might need through multiple agencies. The real question for me is, why is this a pipe dream and not already a reality? Well I think there are a number of reasons for this: »» Often the providers of these systems don’t want to allow interactiv-

ity because that damages their commercial opportunities and control going forward. »» The government procurers of these systems are often too concerned with permissions, legality, data protection between countries, protection of patient information (which is rarely a patient issue at all), as well as multiple contract issues with legacy systems. »» We have never done it and it is too easy to find reasons not to rather than to find reasons to try and see what happens. What I want as a user, patient or a citizen is one entry point that gives me access to anything I want, ideally with one log-in and one password - so why can’t I have this simple (in my eyes) request? I would like the people that procure and manage and the organisations that innovate to think about connecting it all up and not delivering it in little pieces that I have to try and put together myself, it shouldn’t be that hard in my eyes... maybe next year eh? n

The Journal of mHealth

BOOK REVIEW: mHealth: Multidisciplinary Verticals

mHealth: Multidisciplinary Verticals Edited by Sasan Adibi. 754 Pages - 83 B/W Illustrations. CRC Press, 2014. £108. ISBN 978-1-4822-1480-2 (Hardback)

ogy: A Guide for Decision Makers and Policy Makers’ (p591) provide useful and practical methodology for industry professionals dealing with deployment and service integration, whilst chapters like the one titled ‘mHealth and Medical Imaging’ (p651) deal specifically with particular healthcare disciplines.

By Matthew Driver As healthcare plays catch-up to many industries that have already been significantly altered through the introduction of mobile and connected technologies, it is often overlooked that the digital revolution across the medical and health disciplines is actually already well underway. Projects and pilots that utilise these mobile delivery methods have been trialled for a number of years around the world, often with very successful results. The problem is that dissemination of this evidence-base has, until recently, been slow. In this book the editor brings together a comprehensive collection of evidence and discussion that assesses the role mHealth is already having in healthcare delivery around the world and analyses the relevant impacts this can, and will, have throughout the industry vertical. The book goes beyond discussion to introduce specific analysis, research and targeted guidance frameworks for professionals working in the industry. The volume’s 36 chapters span a range of inter-related themes from the rapidly changing mobile and digital health landscape. Demonstrating significant collaboration, the title draws upon contributions from over 102 professional authors and quotes exemplar projects and case studies from over 20 different countries. This collection of global evidence provides a sound synopsis which allows the reader to gain a broad understanding of the many different areas where mobile technologies are changing the delivery and management of modern healthcare. Each contribution differs in its approach and relevant subject matter. These have been edited to give a wide-ranging discussion of the current use and deployment cases of mobile and digital health solutions. Covering the multidisciplinary verticals of mobile health the book introduces nine main domains of mHealth, namely: Preventative and curative

October 2015

Whilst many titles covering the mHealth theme focus solely on the technological aspects, here the editor has taken a refreshing step to try and encompass the complete multi-disciplinary nature of mobile and connected health technologies. The title successfully moves beyond a simple discussion of the diverse technologies to consider the full spectrum of implications these technologies bring to the healthcare industry. medicine; consumer and patient-centric approaches; psychological, behavioural, and mental verticals; social perspectives; education, adoption, and acceptance; aged care and the aging population; regional, geographical, and public-health perspectives; technology implications; and cloud applications. Each section includes articles and case studies which explore the principle aspects of the different sub-topics and reviews the role that digital solutions are playing in that particular medical or health discipline. Of particular note, from a development perspective, are the chapters: ‘Going Beyond - Challenges for Using mHealth Applications for Preventative Medicine’ (p37) which considers the current challenges for future mHealth applications dealing with preventative medicine and proposes a modular framework for overcoming these challenges; and, ‘Stepby-Step Guide to Designing Effective Wellness Apps’ (p83), which provides an essential read for app creators looking to design effective wellness apps. This focus of practical advice and industry insight extends throughout the book. The chapters ‘Enhancing Decision Support in Healthcare Systems through mHealth’ (p511) and ‘Economic Approaches to Assessing Benefits of mHealth Technol-

As the book discusses in the introductory chapter there are a number of verticals associated with mHealth and the goal of the book has been to try and coalesce these elements into a single volume. From this, it then becomes possible to identify the connections, interdependencies and synergies between stakeholders within the market, as well as determining the variety of possibilities for building health services around connected health technologies. The breadth of themes and case studies in the volume is exhilarating, but this variation is also a reflection of the challenges facing the wide spread adoption of mHealth technologies. The contrast between author contributions in terms of style and experience provides the reader a comprehensive understanding of mHealth and its relevant opportunities. What becomes clear to the reader is the growing mHealth evidence-base, revealing the positive effect connected technologies can deliver across different elements of healthcare. The evidence is clearly presented in a way that provides a compelling case for wider mHealth adoption. Just as mHealth in itself is providing the vital connections across healthcare, the editor has succeeded in drawing together this disparate evidence-base in order to present a comprehensive overview of the potential for these technology-led services. n

mHealth Summit 2015 Feature

Delivering Effective

Digital Health Featured Inside

Teletriage vs. Telediagnostics

Next Generation Diabetes App Provides a Complete Integrated Care Environment

Data Visualisation Empowers UK Healthcare Organisations to Modernise Services & Enhance Care

Real-time Clinical Information Platform Driving Improved Outcomes

Is Your Digital Health Strategy Thriving, Surviving or Non-Existent?

The Secret Recipe of Meaningful Digital Health

How Crowdsourced Insights can Drive the Future of Digital Health

Next Generation Diabetes App Provides a Complete Integrated Care Environment First real-world implementation of the Philips HealthSuite digital platform - CareCatalyst in a clinical situation In a partnership with Dutch Radboud university medical center, Philips has piloted a connected digital health prototype that enables people living with type 1 diabetes, and their health care providers, to make care decisions more confidently, while managing the complexity of diabetes self-care. The system, consisting of a patient app and online community, is the first to collect and connect data from electronic medical records, multiple personal health devices – including a wireless glucose meter or activity monitor – and an individual’s selfreported data. Via a smartphone or tablet, the app allows people

with diabetes to report and access important parameters such as blood glucose levels and provides coaching guidance, at home and on the go. The secure online community is where enrolled patients, healthcare professionals and caregivers can interact via private messaging or shared posts within a healthcare organisation’s clinical guidelines. In this way, patients can get feedback from their care team using the combined data and can easily share experiences with fellow patients, clinicians and caregivers. Enhancing Collaboration between People with Diabetes and Healthcare Professionals Nearly 400 million people worldwide live with diabetes1. On Continued on page 24

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Next Generation Diabetes App Provides a Complete Integrated Care... Continued from page 23

average, people with diabetes make up to 1802 decisions about their health every day, collecting and evaluating valuable information on personal and medical factors from blood sugar levels to exercise to food choices. The care team of people living with diabetes can add up to more than 10 different types of caregivers3. This makes living with diabetes complex to self-manage and for many also very stressful. Speaking to The Journal of mHealth Dr Andrade, Director of Product Management at Philips HealthSuite, said; “The goal of the app is to reduce the burden of care faced by the millions of people living with type 1 diabetes, and empower them in self-management and enable collaborative, continuous care. People with diabetes in our clinical partners’ medical practices

asked for a solution that would support them in dealing with the unexpected situations that arise daily and that would reduce the burden of decision-making.” “It uses their own medical data and the knowledge derived from the real world experience of their peers, validates it with the inputs of their healthcare team and tailors it to their needs. This prototype solution spans multiple episodic events and encompasses disease-specific information, self-management guidance and personal support.” Via the integrated app and online community people with diabetes can: »» Schedule readings and reminders and track data for a variety of measurements needed for the management of diabetes. These readings from connected devices and manual input include; blood sugar levels, insulin doses, food intake, physical activity, carbohydrate calculation, mood and stress »» View trends in individual or multiple measurements via trend graphs »» Collaborate with healthcare providers using the combined data from their personal health records, self-measurement and healthcare electronic medical records

mHealth Summit Feature - November 8-11, 2015

Real-time Clinical Information Platform Driving Improved Outcomes »» Communicate with and learn from other people with diabetes and healthcare providers within a secure datadriven online community »» Receive notifications for missed and out-of-range readings »» Receive data-driven coaching guidance based on patient data when needed, to support patients in self-management “I am excited that we are providing people with diabetes the tools to connect all of their relevant health data and share data and experiences in one community, where they can collaborate with fellow patients and all of their different care providers,” said Jeroen Tas, CEO Healthcare Informatics Solutions and Services, Philips. “There is a growing need for solutions that enhance self-management and continuity of care for those with chronic conditions such as diabetes to decrease health deterioration, re-admissions and mortality rates. This system has been designed by patients for patients and is enabling fully integrated health management and care delivery in a new, connected, efficient and highly patient centric way.” “Empowering patients to be true partners in their own health care by giving them access to their data and by facilitating collaboration is the key to driving change across populations,” said Lucien Engelen, Director REshape Centre at Radboud UMC. “By collaborating with Philips, we’re creating the digital framework necessary to make data actionable and transform how healthcare consumers engage with their caregivers and social community.” The system is built on the Philips HealthSuite digital platform and its new CareCatalyst solution. CareCatalyst securely connects devices and collects, integrates and analyses patient data from connected consumer and medical devices, electronic medical records,

and personal health data. This capability makes it easy for health systems, institutions and care providers to utilise the HealthSuite platform - CareCatalyst in dedicated localised solutions for diabetes that are aligned with their existing clinical pathways. “This is the first real-world implementation of the Philips HealthSuite digital platform - CareCatalyst for a clinical situation.” continues Andrade. “We believe it is the only diabetes management solution that brings an individual’s personal health data together with clinical health data from electronic medical records in a secure environment.” “Many applications provide a window for viewing portions of PHR and EMR data. Philips’ Diabetes Support Solution uses the CareCatalyst solution to bridge the silos that currently exist between the PHR and EMR data and allows people to collect and connect data from both sources with appropriate privacy and security.” The joint prototype development is expected to be available for evaluation in limited markets before the end of year, and there are plans to introduce similar connected care solutions addressing other chronic conditions. References 1. www.idf.org/worlddiabetesday/toolkit/g p/facts-figures. Accessed Sep 10th 2015 2. www.scopeblog.stanford.edu/2014/05/08/new-research-keepsdiabetics-safer-during-sleep/. Accessed Sep 10th 2015 3. www.diabetes.org/living-with-diabetes/treatment-and-care/ whos-on-your-health-care-team/your-health-care-team.html. Accessed Sep 10th 2015 n

Real-time Clinical Information Platform Driving Improved Outcomes Having access to timely and relevant data that can provide a complete clinical perspective on an individual patient should be the foundation for modern, efficient and effective health services. Ensuring that data is mobilised across the healthcare network can deliver improved patient outcomes, ensure that resources are properly allocated and drive significant efficiencies. The task of developing such a network though is significant. Medopad is a digital health platform that has been designed to provide doctors and nurses with the capability to access real-time data feeds from across

the healthcare system. As a point-ofcare solution it integrates existing clinical data, delivers it to mobile devices and provides a platform to create clinical and productivity apps that can intuitively use that data. The system works by collecting information from disparate hospital databases and collating them into a central source. By integrating with the wide variety of data streams from within the hospital organisation and the wider primary care environment it enables a collated view of an individual patient’s record. Allowing access to data from historical medical

files to X-ray and MRI scans, all at the touch of an iPad. Developed closely with BMI Healthcare and the UK NHS, Medopad has identified key problems associated with interoperability, security concerns, and other issues that have in the past prevented systems like this from succeeding and then worked to develop a solution that fits within existing workflows and care pathways. This has meant that the solution is intrinsically tailored to overcome real, everyday problems associated with healthcare technology. Not only has Continued on page 26

The Journal of mHealth

Real-time Clinical Information Platform Driving Improved Outcomes Continued from page 25

the solution been designed to improve access to information, it has also been built to operate as a platform that can be integrated across many different clinical and operational activities within the healthcare organisation. It is already in use at a number of hospitals, including London’s Royal Free. Collaboration is a major component and by giving doctors the information they require and then also giving them the option to share that information with colleagues, specialists and patients it becomes much easier to make informed decisions based upon a full picture of the available data. With the ability to make informed joint decisions comes an increase in the overall quality of care. By developing bespoke applications that work with particular cohorts of patients, or patients receiving particular treatment, Medopad can also integrate real-time information from monitoring technologies and health wearables used to monitor patients during the course of their treatment and care plans. This facility enables clinicians and care teams

to easily receive and access real-time, actionable data, from which more accurate insights about treatment and condition management can be determined. Collecting a complete picture of a person’s medical condition and treatment, rather than the traditional snapshots of health, that are generally recorded during one off appointments, means that it is possible to more accurately understand a patient’s complete medical experience. This in turn improves the clinical decision process and can result in improved outcomes. The company has gained significant recognition in recent months for an application designed, using the platform, to work specifically with the Apple Watch that allows for the monitoring and management of cancer patients receiving chemotherapy treatments. Effective cancer treatment relies heavily on the administration of strict drug regimens, however the complexity and potency of prescribed drugs often leads to a range of side effects. As a result, patients sometimes struggle to stay motivated, forget to take their prescriptions

mHealth Summit Feature - November 8-11, 2015

and see a lapse in the accurate recording of side effects. As soon as a patient experiences a negative reaction they can record their symptoms using the smartwatch and the data is sent instantly and securely to doctors using the Medopad platform. This delivers a number of powerful outcomes. Doctors can adjust drug regimens in real-time to provide even greater levels of proactive care and patients are provided chemotherapy treatment tailored specifically to them. Furthermore, connecting patients directly to doctors reduces side effect-related visits to hospitals, which in turn alleviates the pressures on medical staff and the associated financial costs. Dr Rich Khatib, CEO at Medopad, said, “The latest statistics show one in every two people are expected to experience cancer during their lifetime. It is clear that treatment and patient monitoring must improve if we are to continue our global fight against cancer. Our easy-to-use Apple Watch application transforms how patients monitor their illnesses on a daily basis. Individuals can directly contribute to their own treatment regimens and regain the feeling

The Secret Recipe of Meaningful Digital Health of control, a vital component of dealing with challenging illnesses.” “Cancer treatment is a challenging journey. Adherence to complicated treatment regimens, and the streamlined recording and reporting of health issues during treatment are of paramount value. Medopad's Apple Watch chemotherapy application is an exciting new development in medical technology that can transform the quality and safety of care

for patients, carers and care providers. This can eventually reduce the cost and improve the outcome of treatment for cancer patients,” said Dr Siamak Arami, MD, MRCP, MD (Res), FRCPath - Consultant Haematologist at King’s College Hospital NHS Foundation Trust. Approximately 10% of the UK NHS’s annual budget is dedicated to cancer treatment and a single pill can cost upwards of £1,000 per day. When a

patient misses a drug, not only is there the potential for a significant physical impact, but there is also a compliance concern. Doctors trust their patients to take their prescriptions regularly and the comparatively low cost of an Apple Watch assists doctors and patients during that process. The Medopad platforms ensure that this relatively complex project can be easily managed and deployed and is designed for patients of any technical level to use. n

The Secret Recipe of Meaningful Digital Health Extending the Patient-Provider Relationship + Proven Clinical Effectiveness In the United States, “meaningful use” metrics are defining high quality healthcare not simply on an interventional basis, but rather from a holistic perspective. Lifestyle management, educational counseling, and disease prevention strategies have been deemed requisite to the highest standard of care. Yet, this presents a logistical challenge for even the most efficient providers. First, the management of patient behavior – whether it is related to nutrition, exercise, or use of medication – requires appropriate tact and painstaking attention from the healthcare professional. Providers lament the fact that, given their workload, they do not have sufficient time and resources to adequately devote to their patients, especially as it relates to education and counseling. Moreover, in order to deliver precise, personalized care, providers require timely and accurate patient data. Whether it is the management of chronic hypertension, diabetes, heart dis-

ease, or pregnancy, the collection and analysis of clinical data is critical to the improvement of medical outcomes. Clinical data needs to reach the provider often in a time-sensitive fashion, yet not be overwhelming to the provider by the presence of “noise.” And then, of course, the data must be rigorously analyzed to discover medically-meaningful trends. Sorting through the data can therefore be a massive headache. In short, in order to manage patient behavior and monitor their clinical data, there is more work to be accomplished than there are providers. While the adequate management of a patient population can be daunting, the majority of doctors believe that these approaches are nonetheless necessary for the delivery of high quality care. The Emergence of mHealth and Internet of (Health) Things Can the behavior of the everyday person provide the healthcare community with a clue to the solution? Given the affordability and accessibility of smartphone technology, mobile applications (“apps”) and other digital tools have become nearly universal. A large swath of Americans use mobile digital tools to manage some facet of their lives. In the medical space, 31% of cell phone owners look up health information while one in five users have downloaded a healthrelated mobile app, not to mention the prevalent use of medicallyrelated Internet sites by non-cell phone users, such as WebMD1. Through the internet-enabled immediacy of medical knowledge, the average user has not only become actively interested in their health, but now can actively collect data about their lives. In particular, the high-resolution collection of health data has engendered the so-called “quantified self ” movement. The widespread use of wearable technologies, like the Fitbit and Apple Watch are popular examples of this trend. By 2016, there will be 80 million wearable wellbeing sensors, and the market for health apps will represent $400 million2. All in all, this wireless Continued on page 28

The Journal of mHealth

The Secret Recipe of Meaningful Digital Health Continued from page 27

exchange of digitally-encoded data, known to the specialist as the Internet of Things (IoT), is beginning to pervade the everyday lives of the average person.

of healthcare-related apps, physicians and patients face a decision that is at once confusing as well as risky. The Best mHealth Solutions Extend Patient-Provider Relationships Recently, a handful of mobile digital tools are emerging which demonstrate clinical effectiveness; thus, the JAMA articles concedes that, if done right, there is great promise in this space.

Given this context, mobile applications, connected devices, and wearable technologies might assist the healthcare professional in at least three salient ways: 1. Provide useful and timely education to patients between their scheduled in-clinic visits. 2. Given the ubiquity of data collection, these devices can also help to establish a digital monitoring environment that enables providers to collect patient vitals remotely from a patient’s home or work. With this high-resolution data, such real-time monitoring might further facilitate early diagnosis and intervention.

For example, WellDoc, a Baltimore-based company, has developed BlueStar, a mobile app that enables type 2 diabetics to continuously manage their condition. BlueStar is data-driven, and is based upon the most up-to-date behavioral science. By way of patient-entered data, the app analyzes trends in blood glucose levels, carbohydrate consumption, and medication use in order to provide dynamic feedback and real-time coaching. What separates BlueStar from the other 968 diabetes-related apps is that WellDoc has shown, through a robust clinical trial, that the patients who used the app had a 1.9% decrease in glycated hemoglobin (A1C) levels over the course of 12 months, as compared with a 0.7% decrease in the standard of care group6. Finally, BlueStar is seamlessly integrated into the provider’s clinical care workflow: it is a mobile therapy that is given only in the form of an official prescription and it automatically delivers real-time patient data to the provider through a secure web portal. Thus, BlueStar is unique in the sense that it is clinically proven, it is seamlessly integrated into clinical practice, and it extends care beyond the four walls of the clinic. Another company, 1EQ, based out of Washington, D.C., has taken a similar approach to obstetric care. They have designed a mobile app, named Babyscripts, as the first mobile, clinical solution that enables obstetricians to remotely monitor lowrisk pregnancies. Like BlueStar, Babyscripts seeks to extend the patient-provider relationship, and it is designed to be integrated into the provider’s clinical care workflow. Babyscripts is pre-

3. Finally, on the patient side, through self-awareness of one’s clinical values, personalized goal-setting and dynamic feedback logics, mobile apps might influence patient behavior. Unvalidated Health Apps = Noise Given this great opportunity, it is unsurprising that more than 40,000 medical apps have become available to patients and providers alike. Yet, despite the recent proliferation of mobile digital tools in the healthcare space, key questions remain surrounding the efficacy of these tools to improve quality of care, expand access to health data, and reduce healthcare costs3. The general consensus, particularly in the scientific community, is that, at this point, mobile digital tools generate inordinate buzz, with little efficacy4,5. A recent article, by the The Journal of the American Medical Association (JAMA), concluded that “medical app development is outpacing the vetting process5.” Few apps, if any, even attempt to prove the stated claims of their products. And, given the bewildering array

mHealth Summit Feature - November 8-11, 2015

The Secret Recipe of Meaningful Digital Health scribed to an expectant mother at her initial pregnancy visit. It comes in the form of a mobile app that provides gestation-specific, provider-approved content as well as two Wi-Fi-connected devices (a wireless scale and blood pressure cuff) that are delivered to the patient's home. Through the app and the devices, Babyscripts has the ability to remotely capture data in real-time and algorithmically filter aberrant data points in a risk-stratified manner so that providers can intervene more precisely. They have shown through a prospective observational study at The George Washington University’s Medical Center that their product can enhance patient compliance with recommended tasks as well as data collection, while enhancing patient satisfaction and increasing ROI for a provider’s practice7.

data, such as blood sugar, weight and blood pressure. What’s more, the Mayo Clinic and the Cleveland Clinic have already worked with Apple to develop the HealthKit, while Duke University and Stanford University have recently joined in the effort.

Another example is Omada Health, a company based in San Francisco, CA whose Prevent program is designed to alter the health course of at-risk patients for diabetes, hypertension, high cholesterol and obesity. Prevent functions as an intense 16-week system to lose weight using connected devices such as a pedometer and digital scale to monitor progress, a personal health coach, weekly fitness and nutrition classes, and a way to track food and activities via a website and smartphone app. The program has also been evaluated in peer reviewed clinical literature8.

Given this preliminary work, mobile apps, connected devices, and wearable technologies can be used to improve the quality of care as well as enhance the operational efficiencies of healthcare providers.

Finally, as an indicator of the great opportunity in this space, Apple has recently devoted massive resources to developing the HealthKit, a centralized hub that collects a person’s health data from other connected devices and mobile apps so as to organize that data into a convenient interface. This interface has been developed to be interoperable with non-Apple devices that collect clinical

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The poster children of academic rigor and quality of care already see the great value in these products. This is the cutting edge of healthcare, and mobile digital tools represent its future. And, unlike the tools of the past that incrementally increase performance with a greater price tag, mobile digital tools seem capable of enhancing clinical effectiveness in a cost-efficient manner. Conclusion

For patients, these tools enhance the clinical experience by connecting them to their providers in a more intimate fashion, while at the same time empowering patients to take charge of their health. For many providers, these tools represent a cost-effective way to efficiently influence patient behavior through lifestyle coaching, improve patient compliance with recommended tasks, and riskstratify their patient populations through the use of algorithmic analyses of remotely-generated data. And, all of this can be accomplished through the bidirectional flow of information and communication between patients and providers. It seems then that most promising use of these tools is to creatively extend the patientprovider relationship. References 1. Fox, S. Mobile Health in Context. Pew Research Center Internet Science & Tech. (Accessed May 7, 2015 at http://www.pewinternet. org/2013/10/22/mobile-health-in-context/.) 2. Dolan B. By 2016: 80M wearable wireless fitness sensors. mobiHealthNews. (Accessed July 5, 2015 at http://mobihealthnews.com/11224/by-2016-80mwearable-wireless-fitness-sensors/.) 3. Dolan B. How should we evaluate a health app’s efficacy? mobiHealthNews. (Accessed July 5, 2015 at http://mobihealthnews.com/14241/how-shouldwe-evaluate-a-health-apps-efficacy/.) 4. Versel N. Scientific mobile health research found severely lacking. mobiHealthNews. (Accessed July 5, 2015 at http://mobihealthnews.com/19903/scientific-mobile-health-research-found-severely-lacking/.) 5. Kuehn BM. Is There an App to Solve App Overload? JAMA. 2015;313(14):1405-1407. 6. Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldinin AL. ClusterRandomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control. Diabetes Care, 2011; 34(9): 1934-1942. 7. Krapf JM, Gaba ND, Ganju N, Marko KI, Martinez AG. Remote Capture and Monitoring of Clinical Data During Pregnancy [54]. Obstetrics & Continued on page 34

The Journal of mHealth

Crowd Testing Digital Health Overview of Services for Organisations The Digital Health Crowd provides organisations with the tools necessary to effectively incorporate open innovation strategies and leverage the passion from individuals worldwide by enabling participation and co-creation experiences that are both rewarding to users and, at the same time, enhance innovation, testing, evidence and market vigilance capabilities. The Digital Health Crowd allows us to collectively improve the way that Digital Health solutions are developed, deployed and delivered, by harnessing the shared knowledge, thoughts, ideas and skills of the community.

Open Innovation Crowdsourced Insight Crowd Testing User Experience Testing Digital Champions & Brand Ambassadors

The Digital Health Crowd provides a diverse, on-demand community of testers from across many different healthcare disciplines. We aim to offer organisations an easy route to scalable industry testing, quality assurance, user experience development, and assessment of clinical workflow integration.

Drive Digital Adoption â&#x20AC;&#x201C; Assess Clinical Workflow Integration Collect Quality Peer Review and Evidence Build a Network of Digital Champions and Brand Ambassadors

A Crowdsourced Community with a Focus on Digital Health Cost efficient process tied to your development needs

The Digital Health Crowd helps organisations evaluate, optimise and actively engage with a global community of digital health users and testers. Working with the crowd you can rapidly acquire market advantage and gain critical insights that will drive successful product development and marketing strategies. The crowd can help deliver a cost effective approach to continual development, process innovation, evaluation and validation.

Use Cases Collect expert opinion and reviews Iteration testing and pre-market validation Build a loyal network of advocates Drive adoption and sales Find and access specialists with expert skills Survey actual digital health users – understand their needs

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Branded Digital Health Crowd We can develop a private, branded Digital Health Crowd from your users and stakeholders. Gain specific insight from your users, understand the needs of your customers, and develop a campaign for continual improvement.

For more information contact enquiries@simedics.org

Teletriage vs. Telediagnostics

Teletriage vs. Telediagnostics Dr. David Whitehouse, Chief Medical Officer – UST Global David is the Chief Medical Officer at UST Global where he uses his extensive clinical and health systems experience and insights to help UST clients understand the significance, influence and possibilities of technology advances; from the impact of big data on analytics and prediction; of ubiquitous sensors and the quantified self-movement on advancing concepts of “expert patients” and in home capabilities; of micronetworks and social networking on everything from gauging satisfaction to improving communication and resource allocation among providers, patients, their families and community care givers; to the impact of mobile applications on just in time information, enhanced communication and the use of avatars to put a trusted advisor in every home.

The digital health revolution offers to transform the routine ‘pain points’ of care into ‘bliss points’ of compassion, caring, assurance and high quality care. This is to be delivered conveniently, at a lower cost, and securely with an ease we never imagined. Along the way we have to shift some of our opinions and embrace the possibilities in a way that looks for solutions not barriers to change. In the old days the doctor came to the house, however house calls are now very much a thing of the past (although concierge medicine seems to be on the rise). Practices have changed over time – Let’s imagine a typical scenario; these days, symptomatic patients go to the doctor’s offices or clinics, generally during office hours (often the same office hours as a working person which means leaving work). The patient then waits to be seen, often with no absolute conclusion - frequently follow up tests are required; which means further delays and once the lab work is finally received the patient still needs to call for a prescription and then generally go and wait in a pharmacy for the necessary medicines. In rural settings access is often harder still, so that the threshold of symptoms becomes even greater - add inclement weather conditions and the visit can become impossible. The epitome of a broken system for me has always been a child in the dead of winter who gets an ear infection. The parent bundles up the struggling screaming child, who now thoroughly wrapped won’t easily fit into the car seat – meaning more chaos. It is then to the doctor’s office to sit among other infected children, exposed to now new pathogens; only to get a prescription and start all over again in the pharmacy line.

However, now with the growth of the smartphone and its inbuilt camera, along with the adaptability to use apps and add on technologies to create an entire platform, there is the ability to change this equation. Whether it is a snap on EKG capability like AliveCor, an otoscope from Cellscope, or ophthalmoscope from iExaminer, or even a remote kiosk with rudimentary X-ray - The physical exam at a distance is here! Most importantly these solutions allow the physician and the patient to converse; freeze pictures of an ear drum or a rash, discuss what the doctor sees, look together at the medical record and past history, even invite a second opinion from the same location as the doctor or completely separate. When these capabilities first came out we saw the growth of separate secure health networks like CISCO’s, designed with broad bandwidth for fear that images or sounds would be degraded. The interesting thing about this is that the remote places, where one might most need these new telemedicine capabilities, are actually the least likely to have access to broadband. Patient convenience and patient access was suddenly hostage to concerns about poor quality medicine and misinterpretation of data. The solutions ballooned in cost and in some countries, where I have consulted, telemedicine, which started first in the medical centers, were linked to remote sites using extremely expensive and often too expensive technology. Yet while 3G and 4G capabilities require the disassembling and reassembling of

mHealth Summit Feature - November 8-11, 2015

large files they do work in these remote settings; and for face-to-face remote consultations are completely adequate. So I began to ask a question - to which I have been amazed how many people pause before they answer - Are you interested in telediagnostics or teletriage? By way of example, if we were to look at a teleradiology image are we conferring at the level of trying to pin down a diagnosis? In which the integrity of that image has to be of the quality as if I was in the room with the original. Or, is this teletriage? Where I cannot completely make a diagnosis as to a mass or an effusion but I certainly know enough to know that the patient needs follow-up in an equipped diagnostic center. While regulatory bodies may worry about the use and misuse of my apple otoscope, if my GP in the middle of winter says “You know what, I really am not getting a clear enough picture to make a diagnosis, you will have to come in” I am no worse off than before. But, if the doctor says “No need to come in, it is clearly an ear infection. I will call ahead to the pharmacy who can run an instant test on the likely pathogen so we pick the correct antibiotic”, then I am way ahead of the game. Sometimes in urban settings traffic can make access to the nearest medical center as complicated as a remote rural setting, and in such instances telemedicine and teletriage can help make the world safer. Telediagnostics, second opinions, and consultations make the whole referral world simpler.

Data Visualisation Empowers UK Healthcare Organisations to Modernise... I have watched as my daughter confers with her physician over the phone, telling her child’s physician the symptoms, the signs, her temperature and sharing a picture of her rash. When that is good enough then the comfort, the ease, the

simplicity are the ‘bliss points’ that we hope for. Knowing what you want to do before you invest in expensive equipment is vital. Access and affordability, compas-

sion and connectedness can go hand in hand if we really look at our goals and what we need. Teletriage vs Telediagnostics you decide then choose accordingly. n

Data Visualisation Empowers UK Healthcare Organisations to Modernise Services & Enhance Care

For healthcare organisations looking to remove inefficiencies from care pathways and operational processes, while simultaneously delivering improvements in quality and safety, the ability to turn patient and hospital data into insight is critical. Managing patient pathways - from the point of admittance to discharge and beyond requires effective and easy-toimplement analytics solutions. For large healthcare organisations finding solutions that can deliver insight at scale can be problematic. The Christie NHS Foundation Trust is the largest single site cancer centre in Europe, treating more than 44,000 patients a year. It recently implemented a data analytics solution from Tableau to ensure instant insight into patient and ward status so that the timeliest clinical care can be provided to best meet the needs of patients. For The Christie, the aim has been to deliver fast insight for busy patient clinicians, including nurses. Tableau provides the hospital with powerful and fast dashboards and reporting that enable the organisation to offer a num-

ber of performance enhancing tools to clinical teams. Daniel Tibble, Head of Business Intelligence and Software Development at The Christie NHS Foundation Trust, said, “It’s about putting data in the hands of the decision makers when they need it. A lot of our dashboards centre around vital patient care delivery, so anything we can offer that makes that faster, and better, directly contributes to better medical care.” “Presentation of data can be as important as its processing. We’ve found that by improving the delivery of the format staff are able to use the systems faster and more effectively. We are keen to share our experience with Tableau to help the wider healthcare community learn from our work with critical data and ultimately affect patient outcomes.” Tibble has set up an online portal for the 2,500 staff across The Christie hospital where they can easily view Trust data and gain insight into their areas of service delivery. Some of the immedi-

ate impacts have included: »» Better prediction of bed assignments for patients in need: By quickly blending updated information across the hospital into one simple model, teams can visualise and refer to results in minutes rather than days, as was previously the case. »» Better patient and care recording: The assessment tool is used by the nursing staff to record vitally important clinical data. »» Saving valuable time: Using the suite of forms, nurses can record tens of thousands of data values a day, compared to manually writing down the observations nurses must monitor for their patients. »» Information sharing: A newly created dashboard shows staff where case notes are located prior to booking patient appointments. The Christie teams, from nurses and consultants, to finance and administration teams, now have more time to help patients and the hospital move forward and spend less time searching for and reporting information. James Eiloart, VP EMEA, Tableau Software, commented: “Value is derived from data only when it provides useful insights that can inform effective decisions. In the case of The Christie, Tableau is allowing users to gather the kind of insights that can deliver tangible lifechanging results to a range of front-line services at the speed of thought.” For years hospitals and clinics have relied Continued on page 34

The Journal of mHealth

Data Visualisation Empowers UK Healthcare Organisations to Modernise... Continued from page 33

on IT departments to provide answers to data questions, creating a never-ending cycle of long wait times and inflexible results. IT has faced the inverse challenge. They spend dozens of hours churning out reports and responding to requests that often fall short of what the requester wanted to know. Healthcare providers are turning the tables on this status quo, empowering individuals throughout their organisations to explore data to answer their own questions. Not only is this yielding faster, more insightful actions, it’s letting IT get back to the business of building and maintaining a reliable infrastructure backbone. Clinics and hospitals have accomplished this by providing easy, intuitive tools to individual users. By creating a self-service model, IT and business intelligence teams are shifting away from reacting to business intelligence requests and toward training individuals and departments to ask and answer their own questions. Using data from multiple systems to reveal trends and outliers allows healthcare providers to answer complex questions when it comes to delivering timely, effective treatments. When empowered to investigate information with intuitive tools, departments throughout healthcare providers can more aggressively explore data that’s relevant to them. Departments now proactively investigate patterns in data and work to understand why these exist.

The impact of ‘thinking big’ about what data can reveal is significant. Hospitals have uncovered underlying, recurring issues with claims processing that have let them proactively identify claims codes that need a different level of attention to be processed on time. Physicians running studies are identifying patients who not only haven’t been adhering to protocols, but glean insight as to the possible reasons behind this in order to take action. Scotland’s public healthcare system is rich with data, including important details about patient demographics, healthcare professionals, diagnoses and treatments. The business development team at NHS National Services Scotland is responsible for defining, collecting, and distributing this information to their customers in a simple, safe and accessible way. To do so, they are using data visualisation software from Tableau which is helping to modernise the NHS Scotland’s approach to healthcare data. The NHS National Services Scotland collects 1.6 million records each year relating to patients being admitted to hospital, 4.5 million records for patients attending outpatient clinics and 100 million records for people getting prescriptions from community pharmacies. The type of data being collected includes items pertaining to patient age, gender, location, types of visit, how long and why they were in hospital etc. Turning that data from information to translational intelligence is really

Continued from page 29

Gynecology, 2015;125. 8. Sepah SC, Jiang L, Peters A. Long-Term Outcomes of a Web-Based Diabetes Prevention Program: 2-Year Results of a Single-Arm Longitudinal Study. Journal of Medical Internet Research, 2015; 17(4):e92. About the Authors Nihar Ganju MD Affiliation: George Washington University, Medical Faculty Associates Nihar Ganju, MD is an Obstetrics and Gynecology physician and faculty at The George Washington University, a fellow in Digital Health Technology in ObGyn, with a degree in computer science from The Johns Hopkins University. He is a founding member of THINK for OB-Gyn (Technology in Healthcare: Innovation, Networking and Knowledge, www.thinkobgyn.org) which is a Washington, D.C. based center devoted to using digital technology to improve the health of women.

important for them. Michael Muirhead, Head of Business Development: “Tableau has allowed us to visualise data with a much more modern interface. It's making a lot more information a lot more accessible in an understandable way to a lot more of our customers.” “A lot of the data that flows through the NHS comes to our organisation. And we're responsible for the definition, the collection, the collation, and dissemination of all this information to support the NHS as it carries out its duties.” Tableau is being used to develop a product called Discovery, which is a product for NHS National Services Scotland’s customers to use. The Health Board chose Tableau as they needed a server-based solution with a browser-based offering, because they didn't want to put the onus on the end user to have to procure software or change working practices. Customers can now actually get their hands on comparative data that the NHS National Services Scotland has prepared for them, and cut, dice, and splice that data themselves in order to make it meaningful to them. The result? Customers are able to better assess their level of care, review prescriptions records and manage their appointments. It is a win-win for both the Health Board in terms of times savings, and for customers who are now empowered to make better decisions by seeing and understanding their own data. n

James A. Brown Affiliation: Babyscripts James is a former researcher in the Lab of Nutritional Neuroscience at the National Institutes of Health. He is currently a medical assistant at the Spanish Catholic Center Medical Clinic and he is the research coordinator at Babyscripts, a digital healthcare start-up based in Washington, DC. Anish Sebastian Affiliation: Babyscripts Anish Sebastian is the CEO and co-founder of Babyscripts Inc. He has been named a ‘Champion of Change’ by the White House in their Precision Medicine campaign and a Healthcare Transformer by the Startup Health Academy in New York City. Under his leadership, he has built Babycripts into the leading mobile therapeutics company in prenatal care. The company has raised more than $2 million dollars in capital, developed and clinically validated the first in kind risk stratified approach toward prenatal care and commercialized its product in multiple markets. n

mHealth Summit Feature - November 8-11, 2015

Is Your Digital Health Strategy Thriving, Surviving or Non-Existent?

Is Your Digital Health Strategy Thriving, Surviving or Non-Existent? More people than ever before are using technology to monitor and track their own health or the health of a loved one. According to Parks Associates, the fitness tracker market is set to nearly triple, reaching $5.4 billion by 2019. These digital health devices are becoming a part of our socio-cultural fabric; mobile fitness trackers and connected clinical devices will be as common an accessory as a smartphone in the next five years. This quick and significant growth represents enormous potential for healthcare providers as they explore new ways to extend their reach and connect to their patient populations. Care is moving beyond the four walls of the hospital or physician’s office, and provider organizations are beginning to invest in the infrastructure and programs to help launch data-driven initiatives. These new, remote sources of patient health data provide valuable information to caregivers−whether it is a physician, nurse, clinician, or lab technician−that can be used in the treatment of a patient. With technology, healthcare providers are now able to monitor existing conditions, diagnose earlier and with more accuracy, and provide better preventative care. In order to incorporate information from all of these new sources, providers need to establish a clear digital health strategy that incorporates telehealth and virtual visit services, remote patient monitoring, and analytics. All of these initiatives are critical to the future success of a healthcare organization. And, key to the success of those initiatives is patient-generated data. The Landscape: Where Is Digital Health Today? Most providers have yet to implement or successfully launch a digital health strategy. In the summer of 2015, Validic, a health-

care technology company, surveyed more than 450 healthcare organizations to gain a better understanding of the current state of their digital health strategies. According to the “Global Progress in Digital Health” survey, the majority of respondents (59 percent) are either behind schedule with their strategy or have no digital health strategy at all. The remaining 41 percent of organizations say they are on schedule with their digital health strategy. Respondents were primarily healthcare providers, but also included pharmaceutical companies, wellness companies and healthcare technology vendors. The survey garnered responses from healthcare professionals, who are members of the American Telemedicine Association, as well as subscribers to MedCityNews and MobiHealthNews. For organizations that are behind the curve in formulating and executing their digital health strategy, there are tactics and technology partners available to help quickly kickstart programs and initiatives. To learn more about the five key steps to launching a digital health strategy, or reinvigorating an existing one, download the white paper from http://pages.validic.com/DigitalHealthSurveyWhitePaper2015.html. n

How Crowdsourced Insights can Drive the Future of Digital Health From clinicians to patients, digital solutions are being driven by a wealth of skills, expertise and knowledge, leading to new ways of delivering health and medical services that would previously have never been possible.

the heart of this transformation process, and it is people who can provide the wealth of understanding and practical expertise that will help ensure technology in healthcare becomes a true enabler and delivers better outcomes!

What is interesting is - despite all of the amazing things that technology, by itself, is capable of doing – people remain at

The Power of Community When it comes to personal health, everyone understands the concept of getting a

second opinion. But what about a third, fourth or even a thousandth opinion? Crowdsourcing the thoughts and ideas of a community can result in a wealth of collective knowledge, that, when analysed correctly, can significantly improve our understanding of our personal health. So what happens if we apply a similar approach to the way that we develop digContinued on page 36

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How Crowdsourced Insights Can Drive the Future of Digital Health Continued from page 35

ital health solutions? Can crowdsourcing opinions, ideas and expertise help us to create more effective offerings? The fundamentals that lead to the success of technology in healthcare are: Effectiveness (will it produce a benefit to the way services are delivered, improve outcomes, or increase efficiency?); Adoption (will the technology be adopted by enough people to make it viable across organisations and can those services be delivered at scale, as well as fit within existing care pathways?); and Recurrent Engagement (will the technology continue to produce benefit over time, and will people or organisations continue to use and need it?). Crowdsourcing and Crowd Testing are effective methods of obtaining collective opinion, insight, ideas, and expertise from participants across the healthcare spectrum to help guarantee that digital products and services are ‘fit-forpurpose’. When Harvard Medical School wanted to optimise the calculation of edit distances between DNA strings they ran competitive challenges that received over 120 submissions with nearly 90 unique approaches to solving the problem. More than half the solutions performed better than the original solution with the winning submissions performing 100 times better. On social networking sites like PatientsLikeMe, individuals with certain health conditions share and compare their symptoms and responses to different treatments. Experts are also turning to crowdsourcing as a faster alternative to traditional methods for predicting and monitoring infectious disease outbreaks. Projects like HealthMap and NCB-Prepared analyse data from informal and formal sources — World Health Organisation alerts, local health departments, news aggregators, and social media — to detect outbreaks and provide real-time surveillance. Following the recent Ebola outbreak in Western Africa informal sources such as news reports, discussion groups and Twitter revealed the outbreak’s dynamics well in advance of official reports. Similarly, when it comes to Digital Health development, delivery and adoption having access to Crowdsourcing, Crowd Testing and Open Innovation tools can provide a significant advantage.

Introducing the Digital Health Crowd At The Journal of mHealth we believe strongly in open innovation and allowing all stakeholders to come together in the creation of the solutions that are going to impact the way they work and their own health conditions, which is why we have taken the steps to launch the Digital Health Crowd. The Digital Health Crowd provides organisations with the tools necessary to leverage the passion from individuals worldwide by enabling participation and co-creation experiences that are both rewarding to users and at the same time enhance innovation, testing, evidence and market vigilance capabilities. The Digital Health Crowd allows us to collectively improve the way that digital health solutions are developed, deployed and delivered, by harnessing the shared knowledge, thoughts, ideas and skills of the health community. Open Innovation Our goal is to build an ecosystem that will allow stakeholders from across the healthcare industry to have direct input in the ideation, creation, development, deployment and adoption of mobile, connected and digital health solutions/ products. We want to enable members of the crowd to participate in an array of activities in collaboration with our partner organisations. These crowdsourced experiences allow healthcare participants to have an immersive and participatory relationship with the development and delivery of technology-led healthcare solutions and produce disruptive user driven innovations. Driving Adoption The digitalisation of healthcare is already well underway, and at times keeping up can be difficult. Finding the right solution for your organisation’s requirements, or adopting the necessary technology for a particular clinical need is difficult. Even finding the right app to help you manage your illness or medical condition can at times be overwhelming. Similarly, many amazing technology developers fail simply due to a lack of adoption within the industry. This is something we hope we can begin to change. Through the crowd we are looking to recruit digital champions and technology ambassadors who can help disseminate technologies across organisations and health systems.

mHealth Summit Feature - November 8-11, 2015

Crowd Testing The challenges facing modern healthcare demand that technology-led health services are effective. This means that from patient facing apps to complex clinical decision management systems the technology must fit seamlessly with the activities of the user and provide benefit or improved outcomes. The Digital Health Crowd provides a diverse, on-demand community of testers from across many different healthcare disciplines. Providing a user-based testing community we aim to offer organisations an easy route to scalable industry testing, quality assurance, user experience development, and assessment of clinical workflow integration. Research Platform for the Design, Testing and Implementation of Digital Health Technologies and Products The Digital Health Crowd is a unique research tool to help companies, device manufacturers, start-ups and investors better understand what clinicians, patients, and consumers need and how they use digital health solutions. Companies working with the Digital Health Crowd benefit from unparalleled access to a large global research panel of healthcare consumers, patients, caregivers and healthcare professionals to help support the design, testing and implementation of health technologies, apps and products. The benefit of the crowd is that it can be used throughout the product life-cycle allowing for agile development, user consultancy, collection of quality peer review and assessment, and accumulation of evidence supporting market claims. Learn from the people who will ultimately use your product or service. Discover actionable insights that can help to save valuable time to market and resources and recruit brand ambassadors that will help establish your digital health solutions firmly in your chosen market. This is your chance to have your say when it comes to Digital Health! If you are interested in joining the Digital Health Crowd then visit thejournalofmhealth. com. Similarly, if you are an organisation looking to harness the power of the Digital Health Crowd to help your digital health activities then we would love to discuss how we can work with you. Get in touch at enquiries@simedics.org. n

Report Finds UK has Potential to Become a Global Leader in Digital Health

Report Finds UK has the Potential to Become a Global Leader in Digital Health A report commissioned by the UK government has found that the UK is well positioned in many elements of digital health and has the potential to grow into a global leader in this segment. It has also cautioned that there are barriers to be overcome in order for this potential to be realised, and that strong growth in other markets could begin to erode the UK’s global market share. The report which was commissioned by the Office of Life Sciences was undertaken by Monitor Deloitte as one of a series of reports reflecting work on key healthcare and life science industry segments in the United Kingdom. The global market for digital health is worth £23 billion in 2014 and is expected to almost double to £43 billion by 2018, a CAGR of c. 18%. The UK market size is £2 billion and with the right support, is expected to grow to £2.9 billion by 2018 with a CAGR of 11%, driven predominantly by high growth in markets such as mHealth apps (35% CAGR) and health analytics (24% CAGR). Therefore, the UK market represents a c. 9% share of the global market in 2014, which is predicted to fall to c. 7% in 2018 due to stronger growth in other markets. In order to assess the wider dynamics of the Digital Health market the report authors assessed four sub segments: »» Telehealthcare (telecare and telehealth): support and assistance provided at a distance using ICT and the remote exchange of clinical data between a patient and their clinician »» mHealth: mobile phone applications relating to health and/or wellbeing and connected wearable devices »» Health analytics: software solutions and analytical capabilities needed to assimilate big data »» Digitised health systems: digital health information storage and exchange of digitised patient medical records. The report analysed trends in the digital health industry based on discussions with stakeholders, literature reviews and other work across the sector. While it focuses on the United Kingdom it does so within the context of the global market and draws on examples from other countries. It also considers the challenges to growth, barriers to adoption, shifting dynamics and how the emergent industry is developing with the intention of provoking discussion and providing an overview of the industry challenges and dynamics in the United Kingdom. Key findings from the report: »» Telehealthcare - The UK has a large installed telecare base and this position should be maintained in the shortto medium-term; however in the long-term this sector will likely integrate with mHealth.

The UK advantage in telecare, and in part in telehealth, may be at risk over the short- to medium-term as the market is evolving. Fixed line and hardware-dependent systems, the current focus of large UK providers, are becoming increasingly mobile-based (i.e. merging with mHealth). Markets such as Spain and the USA are moving ahead with implementation of larger scale telehealth implementation, whereas the UK continues to be in pilot mode and this disadvantages local industry as the UK currently lacks the scale to drive growth in the sector. »» mHealth - Currently, mHealth is being used more commonly by consumers to make decisions about wellness, but the potential lies in supporting higher-impact clinical decision-making and developing the interaction between clinicians and patients. The UK is an attractive destination for app developers, with high levels of digital literacy and adoption, and a concentration of mHealth app companies around London. Wearables manufacture is concentrated in the US, particularly around Silicon Valley and there are few notable UK companies with a wearables focus, such as Fitbug. »» Health Analytics - There is great potential for health analytics in the UK; however, challenges around data access need to be overcome in order to maximise the benefits and grow the industry. Health analytics is an emergent and fast growing digital health sector. The market is currently still relatively immature but expected to grow rapidly, c. 24% up to 2018. This growth could be exploited by UK industry to become a world leader in this sector, but there are barriers to overcome, such as development of relevant skills and capabilities, data access challenges and information governance issues. »» Digital Health Systems - Large, North American companies dominate globally, but established local EHR providers may be able to leverage their track record in primary care to capitalise on the expected growth in secondary and acute care settings in the UK. The report suggests that the most promising market for growth potential is in mHealth apps, which is currently the smallest digital health market sub-sector but is predicted to grow at 35% in the UK and 49% globally from 2014 to 2018. Over time, it is anticipated that telecare and telehealth will start to merge with the mHealth apps market, and mHealth will be increasingly differentiated by the audience targeted for the app (i.e. consumer/ patient or professional). Continued on page 38

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UK NHS Approved Apps Failing on Privacy Standards Continued from page 37

There are a number of challenges for new companies when commercialising and scaling up digital health businesses in the UK. Whilst there is a strong heritage in research and idea generation there are often problems with achieving scale. The problems include a lack of commercialisation skills, shortages of IT and analytical capabilities, difficulties in funding and challenges with accessing a local revenue stream in the NHS. Government also has a key role in providing the infrastructure, such as regulatory frameworks and information governance, to support growth of the sector. Interviews with key stakeholders identified five potential areas of improvement to grow the UK digital health industry: 1. Addressing a skills shortage in health analytics

2. Building managerial skills within NHS to better understand the potential value of digital solutions across the healthcare cycle 3. Improving clarity on how to access, transfer and analyse healthcare data (including the necessary incentives and information governance procedures) 4. Improving reimbursement policy to accelerate the use of digital health solutions 5. Building capabilities to commercialise and scale up companies in the UK digital industry By addressing these issues and continuing to build on current initiatives, the UK is well-positioned to take advantage of the digital health opportunity. The full report can be downloaded at www.gov.uk/government/publications/digital-health-industry-uk-market-analysis n

UK NHS Approved Apps Failing on Privacy Standards Study finds some smartphone health apps accredited by the UK’s NHS leak data that could be used for ID theft and fraud. Published in the open access journal BMC Medicine the study has found that the apps, which are included in the NHS England's Health Apps Library, may not have been complying with principles of data protection. The research found that in some instances health apps were sending unencrypted personal and health information, meaning users may have had their privacy placed at risk. The apps that leaked the most data have now been removed from the library. The researchers from Imperial College London, UK, and Ecole Polytechnique CNRS, France, reviewed 79 apps that were listed on the UK NHS Health Apps Library in July 2013 and were available on Android and iOS platforms. The apps covered health areas such as weight loss, alcohol harm reduction, smoking cessation and long-term condition self-care. The apps were assessed over a six-month period by inputting simulated information, tracking the handling of this information, and looking at how this agreed with any associated privacy policies. Of the apps reviewed, it was found that 70 of the apps transmitted information to online services and 23 of those sent identifying information over the

October 2015

internet without encryption. Of the 38 apps that had a privacy policy and transmitted information, the privacy policy did not state what personal information would be included in the transmissions. Four apps were found to be sending both identifying and health information without encryption. Most of the data the apps gathered and shared related to a person's phone or their identity, with only a handful collecting information about the health of users. "If we were talking about health apps generally in the wider world, then what we found would not be surprising," said Kit Huckvale, a PhD student at Imperial College London, who co-wrote the study. “But given that the apps the study looked at were supposed to have been vetted and approved, finding that most of them did a poor job of protecting data was a surprise”, he added. “Our study suggests that the privacy of users of accredited apps may have been unnecessarily put at risk, and challenges claims of trustworthiness offered by the existing national accreditation scheme being run through the NHS. The results of the study provide an opportunity for action to address these concerns, and minimise the risk of a future privacy breach. To help with this, we have already supplied our findings and data to

the NHS Health Apps Library.” The UK’s NHS Health Apps Library, which is a curated list of apps for patient and public use. Registered apps undergo an appraisal process that examines clinical safety and compliance with data protection law. To be listed in the Health Apps Library, developers are required to declare any data transmissions and register with the UK’s Information Commissioner’s Office – the body that enforces the Data Protection Act. Whilst the results of the study are worrying, curators of the NHS App Library have been aware of the shortcomings for some time. The Library was closed to new submissions for a number of months throughout 2015 during which time significant effort was taken by NHS England to consult with industry participants with the aim of implementing a new and improved method of assessment and validation. This new endorsement model began piloting in September. In a statement NHS England said: "We were made aware of some issues with some of the featured apps and took action to either remove them or contact the developers to insist they were updated.” The results of the study are published in the open access journal BMC Medicine at www.biomedcentral.com/17417015/13/214. n

Upcoming Events

Upcoming Events 19-22 October

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Week of Health and INNovation (WHINN) 2015

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Beijing, China For more information visit www.americantelemed.org

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Odense, Denmark For more information visit www.telemedicineconference.eu

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mHealth Summit 2015 Washington, DC, USA For more information visit www.mhealthsummit.org

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Birmingham, UK For more information visit www.ehilive.co.uk

6-9 January 2016

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22-25 February 2016

CES 2016

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Las Vegas, NV, USA For more information visit www.cesweb.org/Show-Floor/ Marketplaces/Health-Wellness

Boston, MA, USA For more information visit boston.healthprivacyforum.com

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