WHAT’S INSIDE
NEWS, REVIEWS, CLINICAL DATA, mHEALTH APPLICATIONS
The
Journal of mHealth The Global Voice of mHealth
December 2015 | Volume 2 Issue 6
Opp ort in C uni ties onn ect ed Improving Patient Care, Reducing Provider Cost and Enabling New Business Models INDUSTRY NEWS ResearchKit App to Assess Heart Conditions
Announcing
INSIGHT
INNOVATION
Medical IoT: 5 Tips for Healthcare Organisations
The SugarCube for Diabetes
mHealth Interventions Wheel
Assessment Set up any form of information capture
Clinician
Patient Data
Providing required level of support & integration to healthcare providers
Capture data directly from medical & healthcare devices
Caregiver
Alerts
Helping carers to support & monitor relatives
Intelligent monitoring for patients, carers & HCPs
Treatment Management
Careplan Patient’s summarized view of their key data & progress
Helping manage treatments, clinical visits, tests & vaccinations
Content
Goals Management
The right information & educational content delivered in the right way & time
Setting and managing pre-defined & personalized goals
Reward Acknowledging patient progress & achievement
Exco InTouch’s health solutions are patient centric self-care models that allow patients, carers and healthcare professionals to interact, support and be involved in patient care remotely. The system is built on a modular platform of functionality that can be combined with individual workflows, rules and content to create a highly specialized therapeutic product. These functions, part of a larger library, are built as generic modules that can be configured and adapted to deliver specific programs, as well as being presented with a look and feel that reflects patient and customer needs. These programs and platforms are built on the background of systems that have supported hundreds of thousands of patients in clinical trials.
Editor's Comments
Welcome As we come to the end of 2015 it seems like a good time to reflect upon what has been another fantastic year for the mobile, connected and digital health industry. If 2014 was the year that digital health gained widespread recognition then 2015 should be known as the year when digital health came of age. It seems that people are no longer simply discussing the possibilities of digital health and the potential changes it can bring, instead we have made a positive step forward to actually asking; how are these solutions changing the industry? And, how can we use these solutions on a wider scale? What this means in reality is that we are now in the hard work phase - the period whereby solutions from across the clinical, patient and consumer spectrums will ‘live or die’ by the outcomes that they can demonstrate and the benefits that they can deliver. 2015 has proven that it is not good enough to simply demonstrate the efficacy of a digital or mobile health solution, but that is necessary to prove effectiveness in order to secure a place within the health ecosystem. This means that a digital solution cannot just be a new way of doing something, but that it must be a better way of doing something! As we look forward this trend is likely to continue. In 2016 we can expect to see the supporting landscape mature, with regulation, commissioning, reimbursement methods, and new business models all beginning to ensure that only the solutions and services that have genuine merit will thrive. This is great news for the users of these solutions. As patients, consumers, healthcare professionals or providers we can all benefit from knowing that the solutions we use are supported by evidence and a robust development process. For solution developers this shift should also be a positive step. It recognises those developers who have committed to the long-haul and ensures that for those who strive to deliver best-in-class services that they are rewarded for their hard work. In this issue we look at how the connected health industry is delivering on some of these promises by considering how we measure benefit, reduce costs, and support new and more effective ways of working. We are also very pleased to be able to announce our 2015 Global Digital Health 100! Compiled from nominations and industry research this list recognises the most innovative and effective companies, from around the world, operating in the mobile, digital and connected care industries today. Congratulations to all of the organisations that made the list, we applaud your work and hope that 2016 proves to be another year of innovation and achievement! Thank you to all our readers for your support this year! Your contributions and feedback continue to help us grow and we appreciate your input! We have some exciting themes and projects planned for 2016, including the launch of our new Digital Health Innovation Lab events, so stay tuned for more updates. May all of us at The Journal of mHealth wish our readers and supporters a very Happy New Year and all the best for 2016!
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 Subscribe at www.thejournalofmhealth.com 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. 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. ISSN 2055-270X Š 2015 Simedics Limited
Matthew Driver Editor
The Journal of mHealth
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Table of Contents
In This Issue 8
Announcing the Global Digital Health 100 We are very pleased to announce the 2015 Global Digital Health 100! Compiled from nominations and industry research this list recognises the most innovative and effective mobile, digital and connected health companies, from around the world.
32
The Evolution of Digital Health and the Era of Cognitive Computing In this article Tim Davis, CEO of Exco InTouch, kindly provides his expert opinion on the evolution of the Digital Health industry and provides an insight into some of the principle opportunities that digital is bringing to healthcare.
35
Wider Standardisation for the Connected Healthcare Market In this interview with Stefan Gonnet, Director of R&D and Marketing at eDevice, we discuss the issues facing the connected health industry when it comes to standardisation, and consider some of the positive implications from the recent oneM2M Interoperability Tests, for the digital health industry.
2
December 2015
Table of Contents
4
Medelinked Partners with Samsung S Health
Opportunities in Connected Health: Improving Patient Care, Reducing Provider Cost and Enabling New Business Models
22
MI7 and ReelDx Bring Doctor and Patient Generated Video to Patient Records
Philips Launches Lumify Smart Device Ultrasound Solution in the United States
23
How to Reach the Holy Triad of Health IT
26
The Medical Internet of Things (MIoT): 5 Tips for Healthcare Organisations Looking to Create Value Ahead of the Competition
28
How mHealth is Spearheading NHS Technology Adoption
30
Europe’s Largest Accelerator Announces its First U.S. Program for Digital Health
33
Opportunities in Connected Health: How Do We Help & Hinder?
34
Realising the Potential of Connected Health
37
Showcase of a Successful Connected Health Project
38
The ‘SugarCube’ for Diabetics
40
Patient Self-Care: The Value of SelfMonitoring at Home
41
Large-scale Coordinated Care and Telehealth Deployment: A Cookbook for Success
43
Upcoming Events
43
Advertisers Index
Industry News 12
13
13
GE Health Cloud and Apps to Connect 500,000 Imaging Machines
15
New Zealand Health Boards Introduce Patientrack to Deliver Safer Care
16
Canada’s Largest Hip & Knee Joint Replacement Centre to use Mobile Technology to Help Patients SelfManage at Home
16
Partnership to Bring Insights to Hospitals Worldwide
17
91% of U.S. Healthcare Workers Believe Their Organisations are Cybercrime Targets
18
Aeri Health and Canadian Lung Association Launch New Mobile COPD App
19
LifeWIRE Issued U.S. Patent for Interactive Communication Platform
20
ResearchKit App to Assess Heart Conditions
20
Venture+ Forum Pitch Competition Winners
21
Researchers Use Gaming Technology to Create Better X-Rays
To subscribe to The Journal of mHealth Please visit our website at www.thejournalofmhealth.com To advertise with us, please contact matthew@simedics.org
The Journal of mHealth
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Opportunities in Connected Health: Improving Patient Care...
Opportunities in Connected Health Improving Patient Care, Reducing Provider Cost and Enabling New Business Models
By Connie Wilkinson and Paul A. Gomez
I. Connected Health Defined
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All eyes are on connected health as the future of the health care industry, from entrepreneurs and investors who develop devices and applications, to providers and payers, to patients, to public health policy experts. Connected health involves taking advantage of information technology to help providers and patients manage chronic conditions, maintain health and wellness, and improve patient engagement, adherence to treatment and medication regimens and, ultimately, improve clinical outcomes. The technology may include
December 2015
smart phones and applications, social media, other devices and remote monitoring tools, personal health trackers, sensors in clothing or other wearables, to computers and networked devices. Specific applications may range from text reminders for smoking cessation or sunscreen application, to visual acuity screening performed by teachers using smart phones and reviewed by remote health care professionals, to the full diagnosis, treatment and monitoring of diabetes through mobile solutions. At its best, connected health has the potential to advance the U.S. National Quality Strategy, developed in response to the Affordable Care Act, and the “Tri-
ple Aim� it set as a goal, of better care, better health and lower cost. It implicates key strategies enunciated under the Triple Aim such as patient engagement and empowerment, by delivering information to the consumer that allows him or her to make better choices about health and wellness and to engage in self-management of chronic medical conditions. It enables capture and delivery of patient information and data obtained through remote monitoring to clinicians and electronic health records and thereby extends access, even into the patient’s home, and as a result may improve clinical outcomes. And it lowers health care costs by improving the quality and value of health care.
Opportunities in Connected Health: Improving Patient Care... II. Connected Health Can Help Address Health Care Cost Containment Issues Payment for health care is moving from more traditional fee-for-service models toward value-based purchasing models. Changes in payment are also generally placing more risk and financial burden upon providers and patients. Generally, the changes are aimed to promote better health care outcomes and reduce health care costs. Advances in connected health technology may help facilitate greater capabilities for patients and their providers to detect early warning signs of ailments or health conditions, which may, in turn help ward off progression to levels that requires more acute and costly care. Several technologies now exist or are in development that are designed to help diagnose illness, alert providers and/or patients to certain early warning signs of illness or complications and continuously monitor certain vital signs. Moreover, connected health capabilities allow providers to monitor and interact with patients remotely. Increasing the instances in which patients are able to receive treatment and recover in less costly venues than hospitals and closer to their home, which not only reduces costs but increases patient satisfaction.
tion in remote delivery of care to reduce the need for qualified health care professionals to be with or in relatively close proximity to the patient. And although there are still only 24 hours in a day, the availability of healthcare professionals remotely to provide care and monitor health care developments should help to alleviate the effects of the shortage of qualified health care professionals, and thereby also ease upward pressure on health care professional labor-related costs as well.
III. Payment and Business Models Must Change to Facilitate Adoption of Connected Health
These kinds of advances in connectivity between provider and patient have the potential to increase capabilities to engage in more effective preventative care measures, to employ proactive care management strategies and to better manage chronic health conditions. All of this generally leads to decreased instances in which patients require lengthy treatment and care in more acute care settings. It also helps to drive down costs, both in terms of health care dollars spent and in terms of time and opportunity costs for both patient and provider.
Business models that promote greater use of connected health will have difficulty developing to their full potential so long as there are not reliable and adequate payment sources available to fund their use. The traditionally more prevalent fee-for service payment system pays providers based on volume of services provided to the patient but has not done much to incentivize or reward care management, proactive patient monitoring and preventative care services of the type that connected health technology may be applied to. To capture the reduction in health care costs avoided by the use of connected health, payment models need to take into account not solely health care delivery but health outcomes and the longer timeframe over which these outcomes can be measured. Partially as a response to some of these concerns, various alternative payment models have been implemented by commercial and government payers alike for health care services, including, but not limited to accountable care organizations, bundled payments and other forms of value-based payments that are designed to measure and reward achievement of improved quality of care, cost savings and patient satisfaction.
In addition to the above, advances in connected health capabilities can also help to address ongoing health care labor shortages. It is well-publicized that the shortage of qualified and available health care professionals is an ongoing problem, both in some parts of the U.S. and in many other parts of the world. Advances in connected health can help alleviate some of the effects of this shortage by promoting access and greater collabora-
Achieving these goals requires greater coordination among providers, as well as cooperation and communication between providers and patients. It also requires effective treatment and monitoring of patients in an appropriate, but less expensive and less acute care setting. For example, incentives under these payment models aim to reduce hospitalization rates and to reduce preventable hospital readmissions. Greater imple-
mentation and further development of these kinds of payments models will encourage and support greater investment in and use of connected health technologies. The proliferation of further technologies will further enable the coordination among providers, and communication between providers and patients on care management and intervention activities that can bring about desired improved health outcomes and reduced health care costs. Alternative payment models and value-based pricing is less prevalent for drugs and other health care products, but the industry has begun to test approaches despite the regulatory hurdles created by government “Best Price� or most favored customer requirements and the challenges of structuring health outcomes measures. By way of example, payers have typically taken the view that care management services are already included within fees for face-to-face evaluation and management services. Many providers, however, have complained that such payment models do not provide adequate support to cover the investments that they need to make in staff, training and technological investment for effective and proactive care management. On January 1, 2015, Medicare began paying physicians and certain non-physician clinicians under the Medicare Physician Fee Schedule for care coordination services related to several chronic conditions that did not require face-to-face contact, which may spur greater willingness to invest in remote and mobile care coordination services enabled by or through connected health technologies. Further progress in securing additional and more consistent payment for care management services could contribute positively to the greater adoption of connected health technology, staff, training and the increased care management activities. Finally, in addition to the incentives for providers created by alternative payment models and increased payment for care management activities, increased implementation of payer incentives for patients to obtain and use connected health technology in certain prescribed ways could also encourage greater acceptance and use of such technology by patients, potentially improving their Continued on page 6
The Journal of mHealth
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Opportunities in Connected Health: Improving Patient Care... Continued from page 5
health care in the process. For example, certain health care payers have offered reductions in premiums and/or different levels of patient deductibles to those beneficiaries with a chronic disease that use prescribed connected health technology in order to help monitor their own conditions and engage in more frequent and regular communication with their care providers. Increased and continued implementation of these kinds of strategies will also likely contribute to greater demand for connected health technologies which, in turn, can potentially further unlock their potential.
IV. Typical Legal Considerations and Risks in Pursuing Connected Health The key legal issues identified below will apply to connected health technology, although the risks may vary depending on the particular technology or application. Regulatory Compliance Is the technology a medical device that will be regulated by the U.S. Food and Drug Administration (“FDA”)? If the device is a “low-risk general wellness device”, FDA has announced that it does not intend to regulate it. If the product makes only general wellness claims and it does not present inherent safety risks, it may qualify as a low-risk general wellness device. Privacy If the technology collects data on behalf of a health care provider or health plan, it would be protected by the Health Insurance Portability and Accountability Act (HIPAA). In either case, state privacy laws may apply. If there is a security breach related to a personal health record, the Federal Trade Commission may exercise its oversight. Such risks may be increased if health care providers are using personal smart phones for work purposes. Intellectual Property and Data Ownership
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Who owns the data collected and how can it be used? The value of individual patient data and its aggregation into “big data” is undeniable. In addition to the patient consent to the use of
December 2015
the data for specific purposes required by HIPAA, where applicable, the provider or plan may wish to obtain a license to use the data for intended (permissible) purposes. Other issues, such as potential medical malpractice claims, could arise if the data is not effectively incorporated into the electronic health record or it is not considered in the clinical decisions of the provider.
V. Conclusion The benefit of connected health for all health care industry stakeholders is readily apparent. Expanded data capture and collection, access of that data to patients and providers, and sharing among providers and payers will better inform lifestyle choices, clinical decisions and coverage and payment determinations. The individual’s involvement in recording, reporting and analyzing the data with the tools built into the technology leads to greater patient engagement and responsibility for his or her own health and health care as well as greater patient satisfaction. Care coordination improves provider workflow and patient health. Improved outcomes reduce health care system costs. Development and adoption of this technology and applications is well underway. While there are legal issues and risks connected health presents, the real remaining barrier to accelerating implementation of connected health solutions is the reimbursement landscape. This barrier can be overcome if health outcomes research can be used to refine the metrics for measuring performance of specific therapies or treatments to better inform the value-based payment models such that they provide appropriate incentives for further use.
About the authors: CONSTANCE A. WILKINSON is a Member of the Health Care and Life Sciences practice of Epstein Becker & Green. She focuses her practice on pharmaceutical pricing and investigations, government contracts, and commercial pricing and contracting strategies, including health care fraud and abuse considerations, involving the pharmaceutical, medical products, and biotechnology industries. Ms. Wilkin-
son advises direct and indirect providers in the health care industry regarding pharmaceutical pricing and program compliance under Medicare Parts B and D, the Medicaid Drug Rebate Program, the 340B Drug Discount Program and the Veterans Health Care Act/Federal Supply Schedule Program. Ms. Wilkinson also provides advice and counsel to government contractors performing health care quality review and technical assistance under federal and state health care programs. Ms. Wilkinson is a current (and former) co-chair of the Health Care Contracting Committee of the American Bar Association’s Public Contract Law Section. PAUL A. GOMEZ is a Member of the Health Care and Life Sciences and Corporate Services practice, of Epstein Becker Green. He represents a wide variety of health care providers, including nonprofit and for-profit hospitals, health systems, dialysis providers, medical groups, ambulatory surgery centers, laboratories, and other health care entities. Mr. Gomez’s practice focuses on all of the transactional and regulatory aspects of the health care industry. He has been ranked in Chambers USA for health care law in California for years and is recommended by The Legal 500 United States for M&A (Middle Market). He is a frequent author and speaker on health care hospital and physician alignment strategies, strategic affiliations, joint ventures and other health care corporate and regulatory matters. n
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Announcing the 2015 Global Digital Health 100
Announcing the Global Digital Health 100
Recognising Innovation in Mobile, Digital and Connected Healthcare We are delighted to be able to announce our Global Digital Health 100 Award List for 2015. Building upon the amazing response that we had from the industry to our 2014 award list this year’s 100 have been compiled from a combination of nominations and industry research to identify the most innovative and effective companies, from around the world, operating in the mobile, digital and connected care industries today. And, what a remarkable 100 they are! The diversity of this year’s list stands out straight away. With innovations targeting just about every corner of healthcare the honouree companies offer technologies across a range of categories including, clinical solutions, wearable technologies, healthcare applications, medical devices, and data analytics. These are all solutions and services that are transforming, or have the potential to transform, and disrupt the way in which healthcare is delivered.
8
Reflecting the growing prominence of mobile, digital and connected solutions in the healthcare sector, the Global Digital Health 100 acknowledges the significant work being carried out by organisations from around the globe. This year’s list similarly recognises an industry that is showing the signs of early maturity. As we progress from what some would describe as digital health 1.0 to digital health 2.0, 3.0 and beyond, then we can expect the role that these organisations play in everyday healthcare delivery to become greater and more widespread.
December 2015
The Global Digital Health 100 represents 6 months of analysis by the editorial and advisory team at the Journal, who consider the offerings and innovations from companies across the digital health ecosystem, prior to selecting the final 100. The judging criteria analysed 10 different quantitative and qualitative evaluation metrics including: disruptive impact; proof of concept; technology innovation; social value; effectiveness; execution of strategy; and, industry integration. The selected 100 companies demonstrate true innovation and the opportunity to disrupt the delivery of healthcare at scale. The selection criteria ensure that companies are considered truly upon innovation, allowing startup offerings to be compared alongside established and larger organisations. Digital health solutions from 15 different countries The Global Digital Health 100 is already seen by many as a benchmark of industry activity for digital health solutions and we hope that this year’s list will provide critical insight into the sector that will be beneficial across numerous perspectives. This year’s list reveals some interesting insights into the growing adoption
of mobile and digital technologies. The largest proportion of honouree companies (53 per cent) come from the North American market which is down from 63 per cent in 2014. European companies make up a larger proportion of the list this year rising to 40 per cent, with 7 per cent or recipients coming from the rest of the world. This seems to reflect a wider growth trend for digital healthcare solutions across European markets. We would like to take this opportunity to congratulate all of the organisations honoured in this year’s list. We applaud your work and hope that 2016 proves to be another year of innovation and achievement! We will be releasing further insight on the recipients of Global Digital Health 100 over coming weeks and watch out for our next issue of the Journal in February that will include in-depth coverage of the 100. Submissions for the 2016 Award list will begin in February, so if you are interested in nominating you may register your interest now by emailing journalofmhealth@simedics.org. n
Announcing the 2015 Global Digital Health 100
The 2015 Global Digital Health 100 List Company Name
Location
11Health
UK
Accel Diagnostics
USA
AdhereTech
USA
Adherium
New Zealand
Aeri Health
Canada
AirStrip
USA
Allscripts
USA
Aseptika (Activ8rlives)
UK
Avizia
USA
Babylon
UK
BaseHealth
USA
Big White Wall
UK
BleepBleeps
UK
CareInnovations
USA
CareMonster
USA
Chino.io
Italy
Clinical Ink
USA
dacadoo
Switzerland
drchrono
USA
eClinicalHealth
UK
eDevice
France
eKincare
India
eko
USA
emocha
USA
Empatica
Italy
Emperra
Germany
Facts & Figures »» Global review process »» 10 different assessment criteria »» From 15 different countries »» 8 categories
Categories »» »» »» »» »» »» »» »»
Healthcare Applications Clinical Solutions Wearable Technologies Medical Devices Hardware Assistive Technologies Telehealth/Telecare Data Analytics
By Region 53 North America 40 Europe 7 Rest of the World
By Country
46 United States 22 United Kingdom 7 Canada 5 Ireland 4 Israel 2 Germany 2 Italy 2 Switzerland 2 France 2 Spain 1 New Zealand 1 India 1 Turkey 1 Holland
The Journal of mHealth
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Announcing the 2015 Global Digital Health 100
The 2015 Global Digital Health 100 List
10
Company Name
Location
Company Name
Location
Endoscope-i
UK
Medilinked
UK
eTreatMD
Canada
Medopad
UK
Exco InTouch
UK
Medxnote
Ireland
Eyeread
Canada
Memotext
Canada
Figure 1
Turkey
Mendor
Finland
Flatiron Health
USA
MI7
USA
Galvanic
Ireland
Mindful Scientific
Canada
gobiquity
USA
MobileODT
Israel
GoMoHealth
USA
Moodmetric
Finland
HCi Viocare
UK
NeuroDigital
Spain
Healthbank
Switzerland
Nuvo
Israel
Healthline
USA
Orange Healthcare
France
HealthPrize
USA
Oxehealth
UK
Ieso Digital Health
UK
Oxitone
Israel
iHealth
USA
Patagonia Health
USA
Isansys
UK
PatientIO
USA
LifeMap
USA
Patients Know Best
UK
LifeWIRE
USA
PatientSource
UK
Lincor
Ireland
Peek Vision
UK
Lumo BodyTech
USA
Philips
Holland
MDLive
USA
PowHealth
UK
MD Revolution
USA
Psious
Spain
Medable
USA
Qardio
USA
MedAware Solutions
USA
QoC Health
Canada
Medic Creations
UK
Qualcomm Life
USA
Medidata Solutions
USA
ReelDX
USA
December 2015
Announcing the 2015 Global Digital Health 100
The 2015 Global Digital Health 100 List Company Name
Location
Company Name
Location
Rise Health
USA
Tinnitracks
Germany
SeamlessMD
Canada
Touch Surgery
UK
Sensium Healthcare
UK
TruClinic
USA
Sensogram
USA
Tyto Care
Israel
Sentrian
USA
Validic
USA
SilverCloud Health
Ireland
Visible Health
USA
swiftQueue
Ireland
Vizr Tech
USA
Talkspace
USA
Wellbe
USA
Teladoc
USA
Wellflix
USA
The Learning Clinic
UK
Welltok
USA
Tiatros
USA
Zoeticx
USA
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INDUSTRY NEWS News and Information for Digital Health Professionals
Medelinked Partners with Samsung S Health Medelinked has been appointed a Samsung S Health partner to make the Medelinked App available for Galaxy and other Android devices.
Android measurement and management devices from vendors including Bontrager, iSENS, OneTouch, Polar and SD. Built-in sensors in the Samsung Galaxy and Gear devices help track heart rate, steps, walking, running, cycling, hiking, sports, sleep, food, water, caffeine, weight, blood pressure, blood glucose and Sp02 so that users can easily get a comprehensive overview of their health and fitness status using S Health. It can set fitness goals and provide charts outlining daily progress, with the app providing useful tips along the way.
Joining other S Health partners such as Cigna, Nike and Virgin Pulse, as well as existing Medelinked partners iHealth and Your MD, Medelinked now provides Samsung S Health Android app users with one place to manage their own, and their family’s, health and peace of mind that if they need urgent medical treatment at home or abroad, their secure medical history can be quickly and safely accessed and shared from their Samsung or other Android mobile device.
Ian Gallifant, Medelinked founder and CEO, says: "We are now seeing a dramatic shift in healthcare. Individuals have a heightened interest in their own wellbeing and are increasingly interacting with personal technology to manage their lives.”
Record, connect and share Medelinked enables individuals to record a range of medical details including allergies, conditions, immunisations, medications and tests and the ability to store clinical standard DICOM MRI scans and x-rays to complete their health profile as well as storing insurance and other documentation. Individuals are also able to create personal and family health profiles online that are secure, locate healthcare specialists and connect and share their health records with their network of trusted health partners and providers (including doctors, dentists, physiotherapists, trainers, insurers, clinical researchers).
12
Managing all health data in one
December 2015
place helps individuals securely track, monitor and improve their health state, ensuring their latest health data is accessed and enabling the provision of the best possible care, keeping individuals in control of their own health. Samsung launched S Health, which provides users with interactive and easy-touse health management functions, on the Google Play store earlier this year. S Health also enables seamless connection with Samsung Gear wearables as well as
“It starts with such health information being stored in an easily accessible way and provides users with the ability to add to their records and share information easily to ensure the best advice is given based on previous history, wherever they are around the world.” “This collaboration with Samsung means Medelinked is now front and centre of the Android ecosystem, bringing together the S Health platform and a host of sensors and devices to ensure personal, portable electronic health records are the way forward for improved healthcare and better outcomes in the future.” n
Industry News
MI7 and ReelDx Bring Doctor and Patient Generated Video to Patient Records Two industry-leading service providers have committed to tackling elusive healthcare interoperability challenges for their clients. MI7 and ReelDx have announced a partnership that provides patient and doctor video capabilities to Electronic Health Record systems (EHRs) for follow-up care.
CEO and co-founder of ReelDx. “When our customers use medvid.io to capture and store video of telemedicine sessions or live interactions between patient and provider, they want that video to show up in their normal workflow. MI7 makes that happen in EHRs and patient portals.”
The duo addresses follow-up care as the patient leaves the medical facility with medvid.io, ReelDx’s HIPAA-compliant video management system, paired with Q, MI7’s software. Q enables real-time access to follow-up instructions alongside the ReelDx video of the doctor’s instructions. This can be placed within a patient portal, mobile application, or anywhere the patient needs.
Q provides software developers with a cost-effective solution for exchanging patient data with EHRs using JSON. Q allows a healthcare software company to eliminate the need for costly and insecure Virtual Private Networks (VPNs) while at the same time using modern technologies for communication.
Secondly, patient generated data and video can be transmitted back into the patient’s chart at the hospital and all associated medical facilities using Q. In many cases, the patient needs to record video of their recovery progress, where medvid.io stores the video and links to it within the patient’s chart for the doctor’s review alongside the other patient generated data. “Working with MI7 is a natural fit for ReelDx,” said Bill Kelly,
“Our partnership with ReelDx brings the leading technologies together to improve the quality of patient care, regardless of whether the patient is at the hospital, doctor’s office, or in their home.” said Zac Jiwa, CEO of MI7. Q has integrated with over 20 of the industry's top EHRs representing over 60% of the install base. It is a turnkey solution for application developers. Companies using Q can connect to hospitals, doctors' offices, and clinics within minutes. n
GE Health Cloud and Apps to Connect 500,000 Imaging Machines GE Healthcare has unveiled the GE Health Cloud at the 101st annual Radiological Society of North America (RSNA) meeting in Chicago, last month. Designed exclusively for the healthcare industry, the new cloud ecosystem and its applications will connect radiologists and clinicians to speed, efficiency and collaboration across care pathways and multidisciplinary teams – both inside and outside the hospital setting. "Our ultimate goal is to help improve patient care and drive superior clinical, financial and operational outcomes alongside healthcare providers," said Jeff Immelt, Chairman and CEO of GE. "As a digital industrial leader, we are betting
big on the GE Health Cloud. By connecting clinicians with the insights needed, when and where they need them clinicians can take action to improve healthcare outcomes and delivery around the globe." Today, survey data shows that up to
35 per cent of patient cases are misdiagnosed, partly due to a lack of access to images, data and records1. Industry consolidation and cost pressures are squeezing margins and pushing providers beyond hospitals' four walls. The interoperability of systems could save healthcare ecosystems $30 billion per year2. The cloud-based apps quickly connect clinicians with imaging, data, analytics, insights – and other clinicians – to increase efficiency, effectiveness and collaboration. "Healthcare devices are generating enormous amounts of data, and that data is expected to increase 50-fold by 2024," Continued on page 14
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Industry News Continued from page 13
said John Flannery, President and CEO for GE Healthcare. "The GE Health Cloud can help unlock the value of this data, quickly and seamlessly for better patient care. The GE Health Cloud will help clinicians turn data into insights, and insights into tangible actions for decisionmakers to drive better outcomes." The new cloud will connect to more than 500,000 GE imaging machines, shifting image post-processing from on-site machines to the cloud. From the cloud, 3-D images can then be viewed on multiple devices – inside and outside the hospital setting. The GE Health Cloud and apps will give clinicians on-demand, flexible computing power that can scale up or down. By opening its cloud for third party app development, GE also intends to attract independent software vendors (ISVs) to develop their apps in the new cloud ecosystem. The new health cloud follows GE's September Minds + Machines announcement of the company's transformation to becoming the world's leading digital industrial company. There, Immelt pointed to new data that revealed a potential 20 percent increase in performance through new software and products powered by PredixTM, GE's cloud platform. The GE Health Cloud is the first industry-specific cloud to be built on the Predix platform. New Apps Push Speed and Efficiency The company announced four radiology apps that will run in the new cloud – all targeted at advanced imaging and clinical collaboration. "Our new apps will bring incredible
computing and mobility power to radiologists and clinicians," said Jan De Witte, President and CEO of GE Healthcare IT. "By enhancing radiologists' speed and confidence through the apps, we can help improve their ability to collaborate with referring clinicians inside and outside the hospital." The new apps announced include: CentricityTM Cloud Advanced Visualization –This app will manage image postprocessing and allow radiologists and clinicians to view advanced 3-D images anytime, anywhere.
hospitals and freestanding clinics. "Building on our long partnership, UPMC and GE Healthcare are collaborating on cloud-based applications that promise to transform the delivery of health care as we know it," said Rasu Shrestha, M.D., M.B.A., Chief Innovation Officer for UPMC. "These innovations will bring measurable changes that benefit patients and physicians."
Centricity Multi-Disciplinary Team Virtual Meeting – This app will help multidisciplinary teams do collaborative care planning, ultimately helping radiologists and pathologists reduce the time they spend preparing for meetings by up to 20 per cent3.
Apps on the GE Health Cloud will be delivered on a subscription basis, enabling hospitals and health systems to shift computing expense to a variable cost model. The cloud ecosystem will include a robust Software Development Toolkit (SDK), and its app store will host and promote new software solutions. To help ISVs run their cloud businesses more profitably, the cloud will also include a complete billing and subscription management infrastructure.
Centricity Case Exchange – This latest edition of Centricity Case Exchange will allow affiliated and non-affiliated systems to share images and reports and quickly confer on patient cases and treatment plans.
The GE Health Cloud will use key interoperability standards, including FHIR, HL7 and DICOM – and will have full attestations for HIPAA privacy compliance, and security including HITECH and HITRUST, and SOC2 certification.
Centricity Image Access Portal - This app will provide affiliated and non-affiliated physicians with longitudinal patient imaging data, potentially improving turnaround times for patient reports.
References 1. "Types and Origins of Diagnostic Errors in Primary Care Settings," Journal of American Medicine, 2013 2. http://www.westhealth.org/sites/default/ files/The-Value-of-Medical-DeviceInteroperability.pdf 3. BCM Medicine, 2007, "Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments," Bridger Kane, Saturnino Luz, D Sean O'Brian and Ronan McDermott
Cloud Spurs Collaboration, Sparks Innovation The cloud may soon become one of the greatest healthcare innovation enablers of the 21st century. Developers, hospitals, academic institutions and manufacturers will come together to solve for improved patient care across disease areas and care pathways, departments,
Source GE Healthcare n
Marketing & Content Publishing Packages We can publish your educational white papers, case studies, and research reports in The Journal of mHealth. We can work with you to develop engaging, creative, and informative content that will help promote the results of your work, to a targeted audience of industry professionals. Our publishing programs all include an integrated marketing plan to ensure that your content gets high exposure. Please contact matthew@ simedics.org for more information.
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The
Journal of mHealth The Global Voice of mHealth
Industry News
New Zealand Health Boards Introduce Patientrack to Deliver Safer Care New Zealand hospitals use electronic system from UK specialist healthcare system supplier Patientrack, to help clinicians identify deteriorating patients sooner Canterbury and West Coast District Health Boards (DHBs) in New Zealand are set to implement a new digital patient observation and alert response system, aimed at helping clinicians identify deteriorating patients earlier. The Patientrack system is designed to make patient observations immediately visible to clinical teams anywhere throughout hospital information systems. Susan Wood, director of quality and patient safety, for Canterbury and West Coast DHBs, said “Patientrack uses the patient’s vital signs to calculate the Early Warning Score (EWS) and automatically sends alerts to the appropriate clinicians. It will track more than a million patient observations, which are currently recorded on charts in 10 hospitals throughout Canterbury DHB and West Coast DHB every year.” “Replacing paper-based EWS with a broader suite of automated assessment and communication tools will reduce error rates and improve work flows, allowing clinicians to dedicate more quality time with patients, and ultimately reduce the number of adverse events,” said Wood. “Electronic capture of patient data will give our teams improved visibility of EWS, enabling more timely review and follow up of patients.” Wood said adopting the digital track and trigger system is partly in response to recommendations from the health and disability commissioner to error-proof and better adhere to clinical protocols, and also to reduce the paperwork from up to 40 different patient observation assessment forms. The system chosen was first conceived by a New Zealand
trained intensive care specialist. Since then, Patientrack, which has been developed by a UK company of the same name, has been put into practice across a wide range of NHS hospitals in collaboration with the clinicians who use the system. “Initial configuration of the new system has started at Christchurch Hospital, and will progressively go out across all wards over the next six months,” added Wood. “Joining up with the clinical management system will also provide more reliable data to assist planning and reporting on improvements in clinical and patient workflow.” Donald Kennedy, managing director at Patientrack, said: “Patientrack has a strong record in the UK in helping doctors and nurses to respond to patients quickly and appropriately when they need it most.” “It is really positive news that 10 hospitals in New Zealand will start using Patientrack in a matter of weeks. The fact that clinical staff who use Patientrack also share ideas and innovative ways of applying the technology through a dedicated user group, means that this is also a great opportunity for international collaboration in improving patient safety.” Hospitals in the UK that have implemented electronic early warning systems have been able to reduce avoidable mortality and adverse events including cardiac arrests. In addition to improving patient safety and improving the overall patient experience, Patientrack offers real operational and organisational benefits to New Zealand hospitals, by automating the scheduling, recording and communication of observations and EWS. Patientrack will be implemented in New Zealand by MKM Health, a local solutions company dedicated to healthcare. n
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Industry News
Canada’s Largest Hip & Knee Joint Replacement Centre to use Mobile Technology to Help Patients Self-Manage at Home The Holland Orthopaedic & Arthritic Centre has partnered with SeamlessMD to introduce a mobile app that patients can use to self-manage their recovery at home after hip or knee replacement surgery. The Holland Centre, part of Sunnybrook Health Sciences Centre, is Canada’s largest joint replacement centre, performing over 2,200 surgeries annually. Patients undergoing hip or knee replacement surgery at the Holland Centre can now download myHip&Knee, a free app to help them get ready for surgery and stay on track during recovery. The application provides patients with timely reminders leading up to surgery, a daily check in to track their progress (e.g. symptoms, pain levels, joint range of motion), a library of information including exercise videos and feedback on how to recover safely at home. The Holland Centre will use the data to derive insights on how patients recover to help the healthcare team continuously improve the patient experience. “After conducting focus groups, we learned that many of our patients had access to smartphones and tablets, and wanted to be engaged through mobile applications,” said Deborah Kennedy, Manager of Hip & Knee Program Development at the Holland Centre. “This led our team to pursue this additional partner in care – a mobile app for smartphone and tablet users.”
“We are excited to work with SeamlessMD to expand our strategy for patient- and family-centred care and improve the patient experience and health outcomes,” said Dr. Jeffrey Gollish, an Orthopaedic Surgeon and Medical Director of the Holland Centre. “The aim is that myHip&Knee will improve patient recovery by encouraging patients to complete exercises, checking in on pain levels and mobility, and advising patients when to seek more help.” SeamlessMD provides a cloud-based platform for hospitals to educate, engage and monitor patients through surgery. Available on smartphones, tablets and computers, the company’s platform provides patients with evidence-based education, timely reminders, video education, progress tracking tools and feedback for self-management. The platform also provides healthcare providers and administrators with real-time analytics to monitor patients remotely, derive insights about the patient experience and measure performance within the organisation. This enables hospitals to improve the patient experience, drive better outcomes and lower costs. “We started SeamlessMD with the mission of giving patients the best health outcomes for surgery. We are excited to partner with such a forward-thinking program as the Holland Centre to improve joint replacement care,” said Dr. Joshua Liu, CEO of SeamlessMD. n
Partnership to Bring Insights to Hospitals Worldwide Zebra Medical Vision has signed a multi-year agreement with Dell Services to deliver its Clinical Research and Analytics platforms to providers and researchers globally. Zebra's platforms will now be offered to any clinical site, including more than 1,000 Dell Unified Cloud Archive (UCA) customers. Through automated health insights, machine learning and decision support tools, Zebra's platforms have the potential to transform patient care, reduce healthcare costs and drive clinical insights.
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From research to reality and commercialisation, Zebra Medical Vision uses big data to deliver large scale clinical research platforms and next generation imaging analytics services to the healthcare industry. Its imaging analytics allow healthcare institutions to identify patients at risk of disease, and offer improved preventative treatment pathways to improve patient care. "The Dell Cloud Clinical Archive combined with Zebra's unique imaging analytics algorithms and research platform
will bring about true change in the way healthcare is practiced, which enables caregivers to provide patients with more personalised care," said Sid Nair, vice president and global general manager, Healthcare & Life Sciences, Dell Services. "A clinical analytics platform at this scale and integrated data management tools help healthcare organisations collaborate and improve the way we approach utilising big data in healthcare." Using Zebra's analytics platform, Dell will now offer any clinical site access to algo-
Industry News rithms that provide screening and diagnostic decision support, assist in creating disease based risk profiles, and help accurately identify patients eligible for preventive care and wellness programs. Enabling care providers with this type of information can identify patients at risk of osteoporosis, cardiac disease, liver disease or others pathologies, which can be treated more effectively when discovered early. Integrated care providers, HMOs, ACOs and organisations seeking to manage risk or build preventative care programs have the potential to significantly improve their operations and level of care.
Zebra's research platform, as part of the Dell Services partnership provides a comprehensive platform for medical imaging research that will accelerate scientific discovery and innovation. It provides large scale, cloud-based access to qualified clinical data and research tools that can help drive new machine learning –based algorithms. By driving research towards patient care initiatives, the partnership has the potential to impact cost of care delivery and create better preventive care for patients worldwide. "Big data analytics have taken an increas-
ingly growing role in many facets of business. The healthcare market has just begun to implement and benefit from large-scale analytics in a meaningful way," said Elad Benjamin, co-founder and chief executive officer, Zebra Medical Vision. "We look forward to collaborating with Dell Services and the best machine learning and computer vision research groups worldwide. Our partnership will provide millions of clinical records to create more robust, accurate diagnostic tools, with the goal of delivering them to clinical providers through the analytics platform and driving more efficient patient care.” n
91% of U.S. Healthcare Workers Believe Their Organisations are Cybercrime Targets keting at Trustwave. “Security challenges are nothing new for any business but the level of distress exponentially increases when someone’s life may actually depend on the protection of sensitive data.” Key findings in the 2015 Security Health Check Report from Trustwave include:
According to a recent study, undertaken by Trustwave, 91 per cent of technical respondents believe criminals are increasingly targeting health care organisations; however, only 10 per cent or less of their IT budget goes toward cybersecurity and protecting their patients’ highly sensitive information. The figures come from the 2015 Security Health Check Report - based on a survey of 398 full-time health care professionals – which quantifies the security snags and shortcomings facing the health care industry. The size of the global electronic healthcare record (eHR) system will grow at an annual rate of 5.5 percent and reach
$22.3 billion by the end of 2015, up from $18.8 billion in 2012, according to a study by Accenture. With incentives from the federal Affordable Care Act to move away from paper records, organisations are increasingly adopting eHR systems to track patient information. As businesses make the shift, the expanding threat is creating a critical need for health care entities to test everything across databases, networks and applications. “Today’s health care industry is under attack. From hospitals to physicians to urgent care clinics, health care organisations are swimming in consumer data and must make security a priority in order to protect it,” said Steve Kelley, senior vice president of corporate and product mar-
»» Health care under fire: 91 per cent of technical respondents believe criminals are increasingly targeting health care organisations, compared to 77 percent of non-technical respondents who believe similarly. »» Patients are a virtue: 79 per cent of technical respondents and 77 per cent of non-technical respondents are most concerned about losing patient data, above other types of information, if their organisation is breached. »» Cognitive disconnect: 77 per cent of non-technical respondents believe criminals are increasingly targeting health care organisations, but an overwhelming majority (86 per cent) said their organisation has not experienced a breach. »» No compromise over compromised data: 74 per cent of techniContinued on page 18
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Industry News Continued from page 17
cal respondents are concerned about their organisation getting breached, compared to 51 per cent of nontechnical respondents. »» Security expertise gap: 35 per cent of technical respondents said their company does not have enough staff and security expertise dedicated to security. »» Guessing, not testing: More than a third (34 per cent) of technical respondents say their business performs vulnerability testing just once a year. »» Under the knife: Nearly a quarter (23 per cent) of technical respon-
dents said their organisation has experienced a breach, yet studies have shown the rate to be much higher. »» Fatal budget diagnosis: Half of technical respondents said 10 per cent or less of their overall IT budget goes toward cybersecurity. And 27 per cent reported their annual security budget has not changed in the past year. »» Don’t blame us: 65 per cent of nontechnical respondents believe that external threats pose more of a concern than insider threats (35 per cent). »» Health care lacks the cure: A quarter of non-technical respondents believe their organisations don’t have
incident response plans. To obtain as complete a perspective as possible, the report is organised into two sections: One features technical respondents (predominantly CIOs, CISOs, IT managers, IT directors and IT vice presidents), while the other features nontechnical respondents (predominantly doctors, nurses, senior executives, board members, office managers, office administrators, and finance professionals). To download a complimentary copy of the report, which includes a list of recommendations for health care organisations, visit: https://www.trustwave.com/ Resources/Library/Documents/2015-Security-Health-Check-Report-from-Trustwave/ n
Aeri Health and Canadian Lung Association Launch New Mobile COPD App COPD but are currently undiagnosed2. Chronic lung diseases, primarily asthma, lung cancer and COPD, cost the Canadian economy $12 billion annually, including $3.4 billion in direct health care costs and $8.6 billion in indirect costs3.
The Lung Association, through its Breathing as One Research Campaign, and Aeri Health, a Vancouver-based integrated health management company, have announced the launch of a partnership based around a new mobile app that will enable Canadians with Chronic Obstructive Pulmonary Disease (COPD) to monitor their symptoms through their smartphones, track medication adherence, treatment schedules, and identify lifestyle and behavioural triggers to help manage and control their COPD. The Aeri COPD app can be downloaded to an iPhone or iPad, providing medication reminders for COPD patients, as well as enabling individuals to track their medication use and dosage. It also includes a clinically validated assessment questionnaire so patients can keep track of their day-to-day health and COPD symptoms and record potential behaviours or environments that could trigger respiratory episodes. Historical health information can be stored and shared with physicians and caregivers to help them identify trends and intervene early to manage COPD and achieve better health outcomes.
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Aeri COPD was developed by Aeri Health in close partnership with the University of British Columbia, the Child & Family Research Institute and BC Children's Hospital, with support from Grand Challenges Canada, funded by the Government of Canada. Grand Challenges Canada is a supporter of companies developing technologies benefitting health care in the developing world.
COPD is now the fourth leading cause of death in Canada, and mortality rates have been climbing in the past three decades, particularly among women1. More than 750,000 Canadians have been diagnosed with COPD by a doctor and it’s estimated that another 750,000 Canadians have
“Aeri COPD acts like a mobile health coach, empowering individuals to take a more active role in managing their health and improving their quality of life,” said Vincent Lum, President and CEO of Aeri Health. “COPD usually requires attention and treatment correction more frequently than can be covered through routine visits to a care provider. Aeri COPD provides immediate information to caregivers and can help fill the gaps between doctor visits, providing ways for patients to provide
Industry News accurate information on the state of their health to the doctor, so the physician can provide the most appropriate level of care to manage the condition.” “Unfortunately many COPD patients take as little as 40% of their prescribed medications, which impacts their ability to manage their symptoms but more importantly makes them more likely to have exacerbations”, says Dr. J. Mark FitzGerald, Professor of Medicine and Head of UBC’s Respiratory Division4. The App is the first component of a more extensive COPD management platform that will be introduced by Aeri Health later this year. The Company will introduce a premium subscription service for Aeri COPD that will include a mobile pulse oximeter, which enables people to monitor their blood oxygen level (Sp02) and heart rate through their smartphone, two of the most important vital signs for COPD patients. A portion of sales from the service will be donated to The Lung Association’s Breathing as One Campaign for Lung Research. "We're extremely pleased to be entering
into this new and exciting partnership with Aeri Health, proceeds of which will support our efforts to develop the breathing breakthroughs of tomorrow. It's a very fitting partnership given our shared focus on health and innovation", says George Habib, Executive Lead of The Lung Association's Breathing as One Research Campaign. "By working together with companies such as Aeri Health, we will be able to spread innovative ideas that effectively treat and prevent disease, and build new collaborations that join together research and action." Aeri Health is currently developing an integrated service platform for its chronic disease monitoring technology which will enable patients to share their health data with physicians and other care providers through a secure cloud-based service. Caregivers can help their patient manage their disease on a daily basis providing support and encouragement. Physicians will be able to monitor patients’ symptoms and vital signs electronically in real time, assess the severity of symptoms and conditions, identify health issues early, provide support and guidance to patients, and adjust treatments as required. Real-
time mobile health monitoring provides a continuous view of the patient’s health status, which can help reduce hospitalisation rates, enhance care coordination, optimise the health and wellbeing of patients and reduce healthcare costs. The company hopes that the platform will provide broad expansion potential for treatment of a range of chronic conditions such as asthma, pneumonia, hypertension, sleep apnea, and cystic fibrosis. ReferenceS 1. Life and Breath: Respiratory Disease in Canada, Public Health Agency of Canada's Centre for Chronic Disease Prevention and Control, (2007) 2. Buist, A Sonia, et al. (2007) International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. The Lancet 370; 741-750. 3. The Conference Board of Canada, Cost Risk Analysis for Chronic Lung Disease in Canada, March 2012 http://www.conferenceboard.ca/e-library/ abstract.aspx?did=4585 4. Bryant, et al. Respiratory Research 2013, 14:109 http://respiratory-research. com/content/14/1/109 n
LifeWIRE Issued U.S. Patent for Interactive Communication Platform LifeWIRE Corp has announced that it has been issued a U.S. patent for its cloud-based mHealth communication engine. The LifeWIRE solution enables continuous, two-way dialogue, data collection and insight between providers and their clients/ patients in healthcare and other industries. “Ten years ago, I saw a trend towards stark impersonality in digital technology. The LifeWIRE communications platform was developed to bring a more human approach to digital dialogue by creating a warm handshake,” said Howard Rosen, LifeWIRE’s CEO. “We also sought to invent a more positive user experience; we have delivered improved outcomes, deeper insight into user behaviour, and greater population outreach.” The LifeWIRE engine provides a population management platform for continuous outreach and interaction. It has earned national and international recognition among governments, healthcare, and behavioural health organisations for its work with a wide range of populations. Nowhere has its impact been more clearly demon-
strated than in the care of US Armed Forces personnel and veterans suffering with mental health challenges such as post-traumatic stress, high risk of suicide, and substance abuse to name a few. “Innovative risk takers like LifeWIRE are driving change in healthcare that is benefiting patients, supporting healthcare providers, and improving overall performance,” said former Executive Director of the Institute for e-Health Policy, HIMSS, Neal Neuberger. “LifeWIRE’s platform gathers patient generated clinical data and analytics that will transform population care through automated, personalised outreach for distinct groups including veterans, persons living in rural or inner city areas, and those suffering from chronic diseases like mental illness, brain trauma, cardio-vascular disease, and cancer.” US Patent No: 9,144,381 is based on LifeWIRE’s 2006 Application and Provisional application filed in 2005. LifeWIRE has continued to enhance and expand its capabilities and has filed a continuation application for the current patent. n
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Industry News
ResearchKit App to Assess Heart Conditions Yale School of Medicine has launched the Yale Cardiomyopathy Index, an iPhone-based clinical study to better understand quality of life for people ages two to 80 who have or may develop a cardiomyopathy — an abnormality in the heart muscle.
Paediatric Heart Failure Program at Yale School of Medicine. “With a parent or guardian’s permission and co-participation, children as young as 8 can provide assessments of how their cardiomyopathy, or their risk of developing a cardiomyopathy, affects their daily lives.”
Developed by Yale School of Medicine researchers Dr. E. Kevin Hall, and Dr. Michele Spencer-Manzon, the app uses ResearchKit, a software framework designed by Apple, to easily turn an iPhone into a powerful gateway between leading medical institutions and patients around the world.
With the Yale Cardiomyopathy Index app, eligible individuals contribute selfassessments of their quality of life and heart-related symptoms. They may also perform six-minute walks to assess physical function and heart rate trends. Educational resources are available within the application to assist in understanding the cardiomyopathies.
Cardiomyopathies are diseases of the heart muscle that limit the heart’s ability to effectively pump blood through the body. They are present in as many as 1 in 500 individuals.
are modified to be appropriate for each age group. For the youngest group (ages 2 to 7), parents take part on their own. As the children get older, each age group has questions that reflect important issues for those children. Adults between age 18 and 80 participate on their own.
Parents and their children ages 2 to 18 can take part in the study together, with tailored questionnaires designed to assess how a cardiomyopathy affects children of different age groups. The questions
“Our study is the first to use ResearchKit to better understand these heart issues affecting children and young adults,” said Hall, assistant professor of paediatric cardiology and Director of the
“Understanding how these conditions affect people’s day-to-day lives is of significant importance in better treating patients,” said Hall. “We believe this app will go a long way in helping us learn how to improve patients’ quality of life.” Find out more at www.news.yale. edu/2015/09/30/yale-school-medicine-usesresearchkit-app-assess-heart-conditions n
Venture+ Forum Pitch Competition Winners CirrusMD Inc. and Wellpepper were named the winners of the 2015 Venture+ Forum Pitch competition for start-ups at the mHealth Summit. They were among four companies selected to deliver live pitch presentations during the 'final four' competition Tuesday evening. The finalists were selected from a field of eleven digital health start-ups who presented during the first round of live competition held on Sunday at the Summit. The 2015 Presenting Companies were chosen based on criteria for demonstrated impact and quantifiable results for improving health care delivery and outcomes. The Venture+ Forum
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provides a recognised platform for health entrepreneurs, fostering commercialisation of innovative health technology solutions to advance healthcare delivery. "The Venture+ Forum has become an anticipated event for health technology start-ups, with tangible results for pitch competition winners," said Richard Scarfo, Director, mHealth Summit, and Vice President, Personal Connected Health Alliance (PCHA). "Venture+ Forum is designed to support the start-up community, investors and entrepreneurs, and advance innovation in health technology. Congratulations to CirrusMD, Wellpepper and each of the finalists."
CirrusMD develops "closed loop" virtual care solutions for value-based healthcare, with a unique telemedicine methodology that ensures continuity of patient care and enables full data integration over multiple communications channels – text messaging, phone and video chat. Wellpepper is a clinically-validated mobile patient engagement platform, and is used in orthopaedics, rehabilitation, trauma and burns, pain management and neurology at hospitals and clinics. It enables healthcare professionals to create and prescribe custom treatment plans based on their own best practices and protocols, and personalize them for each patient. n
Industry News
Researchers Use Gaming Technology to Create Better X-Rays Researchers have developed software for the Microsoft Kinect gaming console that measures body part thickness and checks for motion, positioning and beam adjustment immediately before X-ray imaging, according to a feasibility study presented at the annual meeting of the Radiological Society of North America (RSNA). "Patients, technologists and radiologists want the best quality X-rays at the lowest dose possible without repeating images," said Steven Don, M.D., associate professor of radiology at Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Mo. "This technology is a tool to help achieve that goal. Patients will benefit from reduced radiation exposure and higher quality images to ensure diagnostic accuracy." Microsoft Kinect was originally developed as a motion sensor and facial and
voice recognition device for the Xbox gaming system that enabled players to play games without a standard controller. Subsequently, the technology has been adapted for select non-gaming applications. For this feasibility study, Dr. Don and colleagues combined the technology of the Microsoft Kinect 1.0 with proprietary software to address common problems that affect imaging results, including body-part thickness and motion. "To optimise radiation exposure and
image quality, X-ray technique should be set based on body-part thickness," Dr. Don explained. "Use of traditional calipers is time-consuming, intrusive, and sometimes frightening to young children. Using Microsoft Kinect with this software, we can measure body-part thickness automatically without patient contact." Additionally, the software provides valuable information on motion and positioning with respect to automatic exposure control (AEC) sensors, image receptor and body part within the X-ray field. Through real-time monitoring, the software alerts the user when any of these factors do not match the requisition—such as the wrong body part—or could compromise image quality. This fail-safe helps to reduce or eliminate common causes of unnecessary repeat image acquisition. "This device can help technologists and radiologists achieve the radiation dose goal of ALARA, As Low As Reasonably Achievable, while enhancing the quality and consistency of X-ray images," Dr. Don said. Dr. Don noted that the radiology research community is constantly improving imaging for patients to ensure accurate diagnoses while striving to reduce dose. "In the future, we hope to see this device, and other tools like it, installed on radiography equipment to aid technologists by identifying potential problems before they occur," he said. Co-authors on the study are Robert MacDougall, M.Sc., and William Clayton. n
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PhilipsLaunches Lumify SmartDeviceUltrasound Solution in the United States
Philips Launches Lumify Smart Device Ultrasound Solution in the United States Philips has announced that Lumify, a smart device ultrasound solution, is available for purchase by licensed healthcare providers or organisations in the U.S. Since debuting the smart device ultrasound concept in 2014, Philips has enhanced the solution for more clinical uses including acute care and office practice. As a comprehensive solution, Lumify extends the benefits of ultrasound to more places by leveraging cloud-enabled and tablet technology, and bringing connectivity, flexibility and mobility into the hands of more healthcare providers. Lumify is offered as part of a novel subscription model unique to the industry. From Philips' online portal, users will be able to order transducers, manage flexible subscriptions and access Philips' support, training and IT services through the new offering. Philips' new ultrasound digital health approach connects off-the-shelf compatible smart devices, a mobile application, advanced ultrasound transducer technology, integrated IT and support services to help healthcare providers improve patient care and reduce costs. "In an increasingly connected world where the power of technology is at our fingertips, it's no longer enough to create an ultrasound product or service. At Philips, we create solutions holistically with the patient at the centre," said Randy Hamlin, vice president and business segment leader, Ultra Mobile, for Philips. "Lumify leverages advanced digital health technology to provide critical information to the right people at the right time, transforming how we approach care delivery and connecting the various touch points along the health continuum." Available with a monthly subscription, Lumify allows institutions to scale their ultrasound solution to meet their needs and environment without having to purchase imaging equipment. The
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subscription includes a transducer, app, access to the online portal, warranty and Philips' support. Designed to help make ultrasound more accessible, Lumify operates on user-supplied compatible Android smart devices equipped with Internet and email functionality. To use Lumify, users download The Lumify App from Google Play, connect their Philips transducer to their compatible smart device via USB and launch the app to begin scanning. The Philips transducers, available as part of the subscription, support Lumify's use in acute and emergency care, internal medicine, musculoskeletal (e.g., orthopaedics, sports medicine and podiatry) urgent care and office practice. Philips' advanced transducer technology, paired with cloud-enabled and tablet technology, helps users make fast, informed diagnoses through a variety of scan types. Lumify's scanning app allows users to examine the gall bladder, abdomen and lungs, in addition to having ob-gyn, vascular, superficial, musculoskeletal and soft tissue functionality. "Lumify has the potential to provide on-demand, point-of-care diagnostics
in a more connected environment," said Bret Nelson, MD, associate professor of Emergency Medicine at Mount Sinai Hospital in New York. "We have been using the Philips Smart Device Ultrasound with our medical students. Leveraging a familiar device with portable diagnostic testing makes learning ultrasound easier for new users and more convenient for experienced imagers. I think that convenience and availability will increase the utility of this technology, improving patient care and efficiency." Beyond integrating with everyday technology such as personal, off-the-shelf, compatible smart devices, Lumify also uses cloud-enabled technology to connect with PACS, shared networks and system directories. Additionally, data will be accessible on the Philips HealthSuite Digital Platform, an open and secure, cloud-based IT infrastructure, allowing clinicians and health systems access to powerful data and analytics to help improve patient care. Lumify is a solution that will grow with its users, with plans for regular software updates and additional transducers, services and apps being released at regular intervals. n
How to Reach the Holy Triad of Health IT
How to Reach the Holy Triad of Health IT 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. I think everyone who will read this would undoubtedly agree that ‘digitisation’ of healthcare, whether you call it digital health, mHealth, connected health or some other term, has to be the future, and the gulf between other industries and their technology maturity and us, is pretty shameful for anyone working in the healthcare IT sector. But why is this the case? Other industries are as complex as healthcare, or even as bureaucratic, so why do we lag behind other verticals? Unfortunately, there is no magic answer for that question, and the complexity, the stakeholder number and variation, the innovation fatigue and the culture and mentality of healthcare will all contribute. Another reason might be that inventions in healthcare technology don’t hit all the right notes for all the right people when it comes to procurement and deployment. Satisfying the triad of improving the clinical side of the equation, benefitting the organisation delivering the care and saving money is actually a very difficult task. Most vendors struggle to prove their product’s effectiveness in these areas and end up falling back on weak evidence. The issue with that, is that to get a product or service from conception to adoption within a system, you will need to satisfy a huge number of individual stakeholders all with different agendas, success factors and power bases. The key question for any vendor is: How can I make my potential client run out of reasons not to buy? There are no one or two things you can say or prove that will seal every deal but I have developed and come across a number of
key tips that can help your case for the myriad stakeholders you will be up against. The Myth of Time Savings If a piece of technology can save a patient or clinician some time, then that’s great, I have no objection to that. If however, the bulk of your business case becomes the time saving of individuals, then you will struggle to convince the CFO that there is a real, tangible, cash-releasing benefit. Due care and attention should be paid to all areas that the technology might impact, from local and national guidelines (such as CQUIN), to penalty avoidance (such as the 4 hour emergency target), to national safety targets (such as C. Difficile numbers) and the national tariff setup (so you’re talking about income generation as well as cost cutting). All of a sudden you have a far more holistic view of the financial flows that your product may fit into, and then time savings suddenly become more relevant. Imagine saving a clinician 30 minutes on his/her day in A&E – suddenly you open up the possibility of more patients seen (tariff), a reduction in time taken to treat (targets) and overall organisation improvement (patient flow and cost reduction there). Don’t Forget the End User The assumption that buying an EHR, or a clinical portal, or a data analytics system or any other technology, will automatically give you the benefits that are espoused is one of the most pervasive and destructive. The only way technologies will succeed is with informed, motivated and happy endusers be they doctors, nurses, patients, back-office staff or whoever. Dumping technology on someone that will impede their daily routine, take more time or clash with their personal agenda will invariably
lead to lack of adoption and a poor return on investment. There are a number of key factors you can provide however to help mitigate these including: building in user feedback throughout the product process (from conception to final sale), programming-in flexibility such that each end-user can tailor the basic underlying technology to their personal needs and keeping it as simple and intuitive as possible such that workflows and on-boarding processes are not disrupted too much. Map the Organisation to Death This is such a critical area yet is rarely done properly in my experience. If you are putting in a tiny clinical solution for a very small stakeholder group then the surrounding impact of it will perhaps be fairly minimal. But consider a secure messaging service, or an e-prescribing tool or an individual departmental portal. The number of people affected by that will be enormous and you must breakdown and map every user group and what may or may not happen to them. But even further to that, you have to look at the relationships between end-users: How will the relationship between a pharmacist and a doctor change, for example, with an e-prescribing tool? Will there be a change in relationship? Will a new workflow be created (e.g. extra checks generated for the pharmacist to make)? Only by analysing these relationships through a combination of interviews and observations can you truly begin to understand the range of impact of your technologies. The above rules are only a few of the necessary ones needed to get your products into healthcare systems, but at least provide a starting point for vendors looking to reach that holy triad so sought after by technology purchasers. n
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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
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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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The Medical Internet of Things: 5 Tips for Healthcare Organisations...
The Medical Internet of Things (MIoT):
5
Tips for Healthcare Organisations Looking to Create Value Ahead of the Competition By Bhoopathi Rapolu, Head of Analytics, EMEA at Cyient
You’ve probably noticed that in the last few years, the Internet of Things (IoT) has emerged as something of a phenomenon. The concept has become so popular that its impact is being felt across a huge number of industries, and healthcare is no exception. In fact, it is playing a leading role in this transformative process. Just five years ago, the medical device connectivity market was largely insignificant, but has since caught up rapidly, and is expected to grow at an astounding CAGR of 38% over the next 5 years by adopting the capabilities of the IoT. This intense growth owes much to the increasing connectivity of medical devices and personal health tracking devices on the market, which is leading to an explosion in healthcare big data. Medical equipment and personal health and fitness trackers collect terabytes of data each day, most of which goes unutilised beyond monitoring any potentially catastrophic situations.
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However, in the future, the application of advanced analytics to healthcare ‘big data’ will have far reaching implications on the industry overall, with the global healthcare analytics market expected to reach $20.8 billion by 2020. The growing bank of data derived from patients, devices and healthcare operations is opening up new avenues for building silent intelligence, which has the potential to transform the way we look at healthcare. We call it silent intelligence because these new data sets are going largely unnoticed by the mainstream medical industry, but instead are being carefully evaluated by bold entrepreneurs with a ‘big data mindset’. It is this mindset that has brought to market some of the most disruptive companies in recent times, such as Uber and AirBnB, and we should expect equivalent companies to soon emerge in the healthcare sector. On the whole, most companies that have achieved success thus far have followed fairly common strategies which are becoming increasingly pervasive in industry today. While some of these strategies are clearly apparent in fast-moving, digital and technology-led industries, the healthcare industry seems to be reluctant to adopt them at the outset. With this in mind, here are five recommendations for healthcare organisations to ensure they fully embrace the power of the IoT:
Look beyond your IT department
Today, the cloud has become the default platform for digital innovation, and the IoT is no exception to this rule. IT departments have often been accused of holding innovation back in the past, yet nowadays it’s hard to find a single fast-growing health app which utilises in-house IT departments and ignores independent cloud platforms. The latter is favoured not just for its scalability and cost advantages, but also for promoting rapid adoption amongst like-minded entrepreneurs which has allowed them to pitch in with their value-added services so that the value of the network within the IoT ecosystem increases exponentially. In our interactions with our customers, we understand that the cloud has become the default option for consumer facing applications. When you are speaking of security of connectivity and information, cloud is not any less secure than those provided by corporate IT departments.
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The Medical Internet of Things: 5 Tips for Healthcare Organisations...
Democratise your product with the power of IoT
The power of the Internet of Things is dependent on the value of the network from which it originates – and as affirmed by Metcalfe’s Law, ‘the value of a network is proportional to the square of the number of connected users of the system’. How does this apply to IoT solutions? The more users interact with the solution, the more valuable it gets. It is therefore vital that entrepreneurs design their IoT medical equipment, applications or solutions in a way that democratises the big data they generate – thus allowing all the relevant stakeholders to join the party. They should do this by creating open architectures which allow stakeholders to freely interact with the product in question, permitting them to record the number of people who interact with it and making the information surrounding the use of that equipment completely open. This allows entrepreneurs to open up innovation to numerous stakeholders within healthcare organisations including patients, doctors, service engineers, dealers and so on. By collecting data from these stakeholders within the supply chain, they are able to generate a huge compound value and provide them with insight beyond that which is expected. For example, this data could establish the effect of specific medicines doctors prescribe on patients, or inform patients with additional information on their condition, either in terms of their ‘positive’ health or severity of a specific disease. In order to produce a much broader compound value, first of all at the device level you need to resolve any disagreements in protocol within the connectivity community. The ideal scenario is to build a whole state-based distributive information architecture which can thrive independently and collectively, although this can prove difficult for those who grew up within client-server architectures. Our main struggle today revolves around understanding and producing the kind of reference technology architecture needed to realise the potential of the IoT, and this consequently makes it hard to visualise the shared business models.
Remote monitoring is by no means done yet
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You’d be forgiven for reading the above and thinking that ‘remote monitoring’ was a thing of the past – yet in personal health it remains a huge market, for a variety of reasons. From tracking hospital assets and patients with real-time location systems and radio-frequency identification to remotely monitoring hospital equipment, the global healthcare sector is in for a dramatic change. Soon patients won’t need to visit the doctors for a blood-pressure reading: machines will be able to automatically take their readings and inform both them and their doctor if any anomalies arise. Compare that to say your bank notifying you when your account is overdrawn, and it doesn’t seem such a crazy suggestion. Some companies such as BodyMedia, a leading medical technology company, have already begun exploring this space by developing sophisticated algorithms which measure patients’ physical activity and designing dashboards which interpret and illustrate readings taken in real-time – a simple and straightforward solution that actually sells today. The potential within this sector is enormous, and it’s conceivable that in the not-too-distant future, every human body will be connected to the network through worn, nonintrusive biomedical devices, many of which will be embedded in everyday clothing. Manufacturers may initially consider launching such technologies in less-regulated markets in the developing world, from which more innovation originates and laws governing the use of such devices aren’t yet in place.
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Embrace unholy alliances
We are living in an age of knowledge spillovers, where innovation within one firm/sector often has the unintended effect of stimulating growth within a neighbouring sector or rival firm. These spillovers make spectacular innovations possible, as firms begin to identify seemingly unrelated players collaborating with them to create value. For example, Ford is working with the healthcare industry on a solution that would notify a nearby hospital if a person suffers a heart attack in their car, and can send an ambulance before the person is even aware they are having one. General Motors’ subsidiary OnStar is also one such application built with on the back of an ‘unholy alliance’; based on wide-ranging vehicle sensor data, OnStar is an in-built software installed in GM’s cars which notifies emergency services and hospitals of car crashes and potential injuries. Continued on page 26
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How mHealth is Spearheading NHS Technology Adoption Continued from page 25
Look for secondary and tertiary value from data
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Usually it’s easier to come up with a use-case that solves a well-known (old) problem in a new way (through technology), as just described in the asset tracking use case. But it’s often the subsequent uses of data that can create interesting solutions in the market.
For example, many people exercise unevenly, distributing more weight on one leg than the other, which can lead to injuries. Wouldn’t it be beneficial if your shoes could warn you about your unhealthy exercise habits so that you can do something about it and avoid an injury? Second, surely a running shoes manufacturer would benefit from knowing how their products are being used, how often, and where most wear and tear occurs, so that they develop better shoes? What’s more, the data that these devices generate will only help to improve their quality, as this intelligence is added back into the devices and other healthcare applications. This could help create a cycle of improvement, which is undoubtedly a positive development and could see the MIoT market really explode into life.
In summary, by looking beyond IT departments, democratising products, embracing remote monitoring, welcoming knowledge spillovers and looking to draw secondary/tertiary values from data, firms can give themselves a definitive head-start in the race to the Medical Internet of Things. It’s clear that connected medical devices will soon become commonplace within the healthcare sector, and that they will form part of an enriched and broad MIoT. Furthermore, with this exponential increase in both connected medical devices and the continual improvements being made in processing data showing no sign of abating, imagination is the only remaining hurdle to overcome if developers are to bring the next big app to market, and bring to the world the healthcare of tomorrow. n
How mHealth is Spearheading NHS Technology Adoption By Jamie Prangnell, MD of Appadoodle
developers Appadoodle.
appointment, and update my care plan.”
Mental health disorders are the ‘single largest cause of disability in the UK’, said life science minister George Freeman when he announced the creation of a £650,000 prize fund1 to develop new mental health apps.
Key features include the ability for the user to track medication, mood and wellbeing, access well-developed content to help understand their condition, and build coping strategies as a result. This helps young people keep on the road to recovery, even in between appointments.
A powerful clinical application
Using technology to support greater self-care is a key part of the NHS’ digital vision for both physical and mental health. Apps are central to this ambition; they can deliver personalised care in the palm of your hand, and their potential for use in mental health is fast becoming recognised. But this technology does not replace the need for face-to-face clinical care; a fact that is clear to the young people who are now trialling Silver Linings, an app that supports young psychosis service users at Birmingham and Solihull Mental Health NHS Foundation Trust, and which has been developed with app
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“The app is an extra tool that I use as part of my treatment,” says Joe, a service user with the early intervention service (EIS) at the trust. Joe uses Silver Linings to record how he is feeling every day, so that he can then share this with his doctor to show how he has been coping over a period of time. “When I wasn’t using the app, I would try to write things down, but often forget to do so, especially if I had had a bad week. But I find it easier to record whether I am feeling anxious, or how I was getting on with new medication, using the app. The doctor can then review this at my next
Using the technology as part of the treatment was an important part of the thinking behind the app. Dr Erin Turner, consultant psychiatrist in the EIS team, was a driving force behind the app’s creation. She noted how the app can help patients that use the service understand and manage their illness, and empower them on their road to recovery. For clinicians, it can provide additional insight into how they can best treat the individual. “From a clinical perspective, it helps us know patients are involved in managing their own recovery, and can give us information that helps us to tailor our treatment plans.” Much of the information that doctors need to tailor those plans comes through talking to the patient. With an app, the human element is absent. Appadoodle
How mHealth is Spearheading NHS Technology Adoption
used some of the latest design techniques, alongside an appreciation of the needs of both user and clinician, to create an app that become part of a patient’s everyday life as well as an important part of care. “We had to overcome various challenges to interpret user input and translate this into something useful for users and clinicians,” said Jamie Prangnell, managing director of Appadoodle. “For example, the app’s dashboard displays a range of information entered by the patient, such as their mood, whether they have taken their medication, sleep patterns and so on. By using a customised graph display, the user can see all their responses at once, or select a handful to see if there is any correlation, such as if a dip in mood followed missing medication. “We also built a number of algorithms to provide supporting advice based on what the patient entered. So if the user says their sleep has been ‘rubbish’, they get advice specific to their needs, drawn from the well-respected YouthSpace website2. If their sleep was just ‘bad’, the advice differs. “If patients do give a negative response,
they are prompted to give the reason why. And, by using dropdown options for the user, we translated these responses into visual elements such as pie charts that clinicians can quickly understand,” Prangnell added. Gamification supporting clinically driven goals Setting goals is another important part of those treatment plans, and this is where Appadoodle brought their experience of working with young people and technology to the fore. The firm could see how gamification – the art and science of applying game-like badges and rewards – could support clinically-driven goals. By working with doctors and patients, they designed a user experience that worked for both. “Gamification should make it simple for patients to achieve certain treatment objectives, such as understanding triggers for particular episodes. We created an entire gamification engine for the Silver Linings app. New users are assigned a personalised avatar. They unlock new levels as they progress through the app, and earn a reward when they level-up or unlock an achievement, such as undertaking some exercise,” said Prangnell.
Such techniques complement the goals agreed between the clinician and the patient. And whilst the use of gamification in health is still in relative infancy, there is growing evidence for their effectiveness. A Canadian study3 of the Pain Squad app, aimed at adolescents with cancers, showed that the game-based nature of the app could be seen to have helped with high treatment compliance rates. Maintaining patient engagement is an important part of care; if you stop taking the medication, you may well have less chance of recovery. Anything that can help will be welcomed, and gamified apps are certainly a step in the right direction, as is the use of excellent app design approaches. The app uses Google’s material design principles4 and Android’s Lollipop operating system to ensure that effective design is applied to innovative technology. One example of this is the use of a card view, in which the advice given to patients is presented as a card for the user to swipe away once read. This in turn helps to encourage greater engagement. Another is the use of alerts and notifications, so that patients get remindContinued on page 30
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Europe's Largest Accelerator Announces its First US Program... Continued from page 29
ers when to take medication even when the app is not running. “Being able to offer patients information and help in a ‘user friendly’ medium should help young people engage with their care, as well as enhance the therapeutic relationship,” said Dr Turner. mHealth set to grow Turner recognises the potential for technology in the treatment of mental health, as did the NHS Confed in a seminal 2013 discussion paper5. This extolled the potential for technology to help people manage mental health issues, and to aid with prevention and recovery, as well as address resource challenges within the NHS. Technology is destined to become an important part of care for youth mental health, where early intervention and prevention is essential. It is thought that one in five young people6 have a mental health problem in any given year. Further research says that around half of all mental disorders begin before the age
of 15, and 75% by 24. Many adults with mental health problems saw such issues manifest in childhood, but were not formally diagnosed, let alone treated. So with mobile phones in use among around 80% of 16 to 24 year olds7, and mobile game use soaring, a well-designed, gamified app is a sensible approach. The trust is now prescribing Silver Linings as a core part of patient treatment, and is now working with Appadoodle on an app for attention deficit hyperactivity disorder (ADHD). This takes many of the principles and innovations of Silver Linings and applies it to a condition that is the most common behavioural disorder8 in the UK. The technology firm is also developing app to help young people with building emotional resilience that could help those in most need to build the selfesteem and coping strategies they need to deal with a society that puts ever increasing demands on the young. The NHS has had a difficult relationship with technology – most notably
the troubled National Programme for IT, which cost around £10 billion but failed to deliver the digital infrastructure required for modern healthcare. But there is renewed vigour for the use of technology in the NHS, and the use of apps in the treatment of young people’ mental health is showing the way. References 1. http://www.digitalhealth.net/digital_ patient/46628/mental-health-apps-givenprize-fund 2. http://www.youthspace.me/ 3. http://www.jmir.org/2013/3/e51/ 4. https://www.google.com/design/spec/ material-design/introduction.html 5. http://www.nhsconfed.org/~/media/ Confederation/Files/Publications/ Documents/E-mental-health.pdf 6. http://www.mentalhealth.org.uk/helpinformation/mental-health-statistics/children-young-people/ 7. http://stakeholders.ofcom.org.uk/market-data-research/other/research-publications/adults/media-lit-10years/ 8. http://www.nhs.uk/Conditions/Attention-deficit-hyperactivity-disorder/Pages/ Introduction.aspx n
Europe’s Largest Accelerator Announces its First U.S. Program for Digital Health Startupbootcamp, a global family of industry - focused accelerators, has announced the launch of its first accelerator programs in North America, Startupbootcamp Digital Health. The Miami-based, Startupbootcamp Digital Health will focus on accelerating early-stage companies in the areas of digital health and will utilise Miami’s reputation as a centre for healthcare and life sciences to scale start-ups working on health-tech solutions. With a $2 million investment from John S. and James L. Knight Foundation, the program aims to help eradicate health disparities by attracting and scaling innovative start-ups working on digital solutions that could democratise access to health care. Support for Startupbootcamp is part of the Knight Foundation’s efforts to invest in Miami’s emerging innovators and entrepreneurs as a tool to build the community, while fostering talent and expanding economic opportunity. Over the past three years, Knight has made more than 100 investments in entrepreneurship in South Florida.
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“By bringing Startupbootcamp to Miami we intend to create a foundation for a robust accelerator and mentorship base, which is so crucial to a thriving entrepreneurial ecosystem,” said Christian Seale, Managing Director of Startupbootcamp Digital Health. “Around the world, emerging entrepreneurial ecosystems have benefited from building ties to rising local industries. We see an immense opportunity to make Miami into a top health-tech destination globally and leverage the city’s diversity to build and scale solutions to help in the eradication of health disparities.” “We are really excited, and I am personally passionate about looking at diverse and underserved communities and the eradication of healthcare disparities which cost the U.S. on average over $300 billion per year,” continues Seale. “We are looking for solutions that can help those needs that really cost the system. There are 87 healthcare accelerators in the U.S. but we are first to focus on underserved and diverse communities.” Startupbootcamp’s proven model for igniting entrepreneurial
Europe's Largest Accelerator Announces its First US Program... ecosystems will help attract world-class talent to Miami and cultivate our growing community of local innovators, providing them with the resources they need to succeed,” said Matt Haggman, Knight Foundation program director for Miami. “The accelerator's Miami program will support Knight's larger effort to invest in our city’s emerging innovators and entrepreneurs as a way to build community." Seale believes that now is the right time to be focusing on the growing digital health sector. “We have been watching this space for a long time having seen the first wave of digital health in the U.S. along with a massive funding boom, this year, of over $4 billion of investment. My belief is that in any industry where you have wave 1.0 then wave 2.0 and 3.0 are going to improve on that. There will no doubt be a lot of failed companies as people experiment, but, where we have a $4 trillion U.S. healthcare market of which $1 trillion is waste then there is ample opportunity to optimise upon the digital health 1.0 wave and build some very successful businesses.” Successful companies will need to stand out from the crowd. “Entrepreneurship should be the flower on the rock, it shouldn’t be there, and so if you have been able to grow a flower on a rock then we want you,” says Seale. “What this means in concrete terms is that companies will need to demonstrate some type of customer demand, whether that is through revenue or in the healthcare world it might be through a pilot; there also needs to be some type of evidence base supporting the product or solution. In addition to this you need a team that is uniquely positioned to be able to capitalise upon the opportunity that will also bring a passion for what they are doing. Finally, you need a product that has some ‘magic’ that customers couldn’t live without. Obviously, we will reserve space for a ‘Mark Zuckerberg type’ with an idea on a piece of paper, but, what we would really like to see are companies where people have built something substantial and are now looking to take it to the next level.” Startupbootcamp has 11 accelerator programs running in
Europe and Asia, making the launch of a new program in the U.S. a landmark move for Startupbootcamp’s increasing global presence in cities with a strong entrepreneurial activity. “Our viewpoint is that we want to be a global accelerator,” describes Seale “So we pick a vertical and then roll out programs on a global scale. Fintech is a great example of where we have succeeded with this. We have a program in Singapore, we have one in London, we just launched one in New York, as well as a few others that we will be announcing soon and I think that Digital Health will be the same. We would like to cover all continents. So that if you are a Founder and you are coming to us, in addition to what we currently provide we would then also be in a position to offer access to international markets for those companies that would like to grow internationally.” For the companies joining the Digital Health program the reward will be an opportunity to fast track development and market penetration from within a highly supportive environment. “Our high-level promise is to provide a year of progression within 3-months and we set out to deliver that through immersive education and by helping founders to expedite their progression,” details Seale. “We do this by providing an innovation ecosystem of the most relevant clients, mentors and investors. There is then the funding component, which involves providing companies with funding to come to the program and then making an investment, above and beyond that, if they raise an institutional round. This is in addition to six months of co-working space, alongside $500,000 worth of partner services.” “Our ‘special sauce’ though is the mentors and the connections! We have had over 600 founders go through our programs to date and, hands down, they will say that the main reason that they come to Startupbootcamp is to get the connection to this ecosystem that will really propel their business and leapfrog the progress that they could achieve by themselves.” Continued on page 35
The Evolution of Digital Health and the Era of Cognitive Computing
The Evolution of Digital Health and the Era of Cognitive Computing By Tim Davis, CEO and Founder, Exco InTouch I recently discovered the concept of telehealth was first put forward in the 1920s by Hugo Gernsback. Gernsback was a pioneer in both radio and publishing and in 1925 wrote an article in one of his magazines proposing a device called the “teledactyl” which would allow doctors to not only see their patients through a view screen, but also touch them from miles away with spindly robot arms1. The premise behind the concept was not too dis-similar to the issues we face today predicting in 1925 that “the busy doctor, fifty years hence, will not be able to visit his patients as he does now” so technology could provide the conduit to allow patients to come to him. This visionary concept was clearly ahead of its time as the technology required to achieve such a service was not sufficiently advanced, nor was it adequately available to provide practical solutions for delivering healthcare in remote settings. Although basic computing was being developed, it was not until the 1950s that programmable systems began to appear, allowing simple responses to yes/no styled questions, and even this was not sufficiently developed to provide the depth of information required to make telehealth systems a reality in delivering healthcare. Since then we have, of course, come a long way. Over the last 20 years or so telehealth, and more recently digital health solutions, have become more valuable, and therefore more commonplace in healthcare delivery. The real advance in digital health however has come in the twenty-tens, enabled by the significant advances in technology capabilities combined with its availability across the globe. This has allowed us to develop more advanced digital health solutions that utilise cognitive algorithms to assess a wide variety of data, enabling systems to learn at scale, reason with a clear purpose and interact with users naturally, hence it has now been termed the ‘Cognitive Computing Era’2. Through this era of cognitive computing the age of digital health is set to spiral. It is predicted that by 2020 there will be over 44 zettabytes (1021) of data collected from 20bn connected sensors via the Internet of Things each year3. With this quantity of data collection options, the possibilities for health data are almost endless, giving rise to the concept of the ‘Internet of Medical Things’, the ability for each of us to be connected via a raft of sensors, from wearable technology through to biomedical sensors that report back on physiological data such as medication release, body temperature and heart rate. This will enable people to monitor their health as they walk around their home, with sensors continually reporting key measures to track progress. For digital health providers, the challenge will be to develop programs that are able to take this level of data and use
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it to provide meaningful feedback to patients, their caregivers and healthcare professionals. To achieve this there needs to be a paradigm shift away from the relatively basic, consumer driven health apps that we see today, towards interactive programs that use a variety of source data (for example medication tracking, medical devices or biometric sensors) alongside patient assessments – diaries and questionnaires – to create a complete picture of patient progress. It is essential to tailor personalised responses, for example, progress feedback, automated alerts to care teams, relevant content and encouragement, in order to make the service interactive and personalised to each individual. Through this approach digital health programs can be designed to engage users over extended periods of time, which is key to long term health improvement. However, we should also be aware that people are fallible, and no matter how interactive and engaging a program is, life will get in the way so adherence to the program may fall from time to time. In that sense we should accept that patients are allowed to fail, in fact we should plan for them to fail and build in mechanisms to help them come back on board and re-engage even after significant periods of inactivity. Beyond this, we understand the psychology of user behaviour. For example trust in the service provider is key; in a talk at the recent mHealth Summit in Washington DC Pfizer reported that 90% of users said they would use a health app if their doctor had prescribed it, but were less trusting of health programs provided by pharmaceutical companies, with 76% of patients stating they would expect to see evidence that Pharma had evaluated the value of a program before they would commit to using it. We have come a long way from the original telehealth concept proposed by Gernback in the 1920s, technology is now widely accessible across the globe and sufficiently advanced to make a valuable contribution to modern healthcare. The challenge, and enormous opportunity for healthcare providers, is how we harness this level of health data and yet still develop mHealth programs for individual users. How can we truly personalise mHealth programs to each individual patient and how can we minimize the barriers to long-term engagement? To me, the answer is to start from the insights into users’ lives, then develop health programs that incorporate features which address their needs. Through this approach we can make it simple, make it relevant, but most of all, make it enjoyable to use. References
1. Telemedicine Predicted in 1925: With video screens and remote control arms, any doctor could make a virtual house call http://www.smithsonianmag.com/history/telemedicine-predicted-in-1925-124140942/#BCx5S06Awzkoxirp.99 2. Smart Machines: IBM’s Watson and the Era of Cognitive Computing https:// books.google.co.uk/books?hl=en&lr=&id=U9arAgAAQBAJ&oi=fnd &pg=PA301&dq=cognitive+computing+era&ots=LGvK5V6pla&sig= oAHgjTQguwcYo3_0Jm_3hvC3Lc#v=onepage&q=cognitive%20computing%20era&f=false 3. The Digital Universe of Opportunities: Rich Data and the Increasing Value of the Internet of Things http://idcdocserv.com/1678 n
Opportunities in Connected Health: How Do We Help & Hinder?
Opportunities in Connected Health: How Do We Help & Hinder? 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.
Improving Patient Care Reducing Provider Costs Enabling new Business Models For me the trick is how do we make the triangle above work in harmony so that all three elements are equally delivered? Without this working well either the delivery is too expensive, the patient doesn’t get a good outcome or service and or the model of care that we are actually delivering doesn’t actually change anything! As always in these articles I make it sound so very simple but actually it isn’t as hard as we are often in the digital world led to believe. First, let’s look at what each of these elements means in the world of digital healthcare and then we’ll try and understand how they can be put together to create positive outcomes for all. Improving patient care - Sounds easy, but it is a really critical measure for the success of any digital health program. We have to remember that at the heart of every delivery model is a patient wanting an outcome from their clinician or health
related service. The real key here is that the outcome needs to improve on current practice - whether that is a faster solution, a more local solution, or a solution that completely changes the outcome of their treatment or management, for me it doesn’t matter as long as the patient or the user perceives that improvement has been made. The measures for this can be really simple and often the best ones are; "I am better than I was", "I have got that service more quickly and efficiently", "the service was delivered to me at home rather than in a hospital". It is really essential that these have clear KPIs and measures around them that provide answers for the payer and for the clinician but actually the patient matters most in this. Reducing provider costs - However we try to make digital healthcare better, if we don’t bring the payer on that journey with us then we are wasting ours and their time. ROI is the hidden gem within digital health and it is hidden for a reason! It is not always easy to prove that a new model of care or a new way of working actually delivers ROI straight away. Sometimes the notion is more fluid than that. There is data and also a view that suggests that this will deliver better ROI for the payer but actually you have
to get on and try it, for a period of time, to really deliver those concrete savings. Seeing is believing here and therefore I am all for getting on and proving delivery at scale and proving the model, as you go, for the provider. Enabling new business models - For me, this is the easy part in the process I see so many organisations capable of genuinely changing the model of care for health providers that we just have to persevere and do more and challenge the norm at every opportunity. All the intelligence and experience exists out there we just have to focus it at delivering solutions for healthcare issues that need solving and where the patient and the provider are currently underserved or not served at all. So, if we combine all of these elements then what we have is a triangle that delivers for all three aspects of connected digital health. 99 Patients / Users --- Better experience, better outcomes 99 Providers --- ROI, proven delivery, increased capability 99 New models of care --- genuinely changed models of care n
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Realising the Potential of Connected Health
Realising the Potential of Connected Health By Simon Jones, Commercial Director for Inhealthcare Consumer use of technology is without doubt fundamentally changing many traditional markets: banking, retail, leisure and communications to name a few. Those same consumers who want to maintain their health, or access healthcare, have the potential to drive change in the way care is delivered. Over the last few years we’ve seen much noise around taking more responsibility for our own health – smoking, weight, yet the use of technology has been often overlooked. How easy is it to swap a face-to-face conversation with an alternative method of communication? Why can’t we trust a wellinformed patient to take their own readings and use their favoured communication method to send the information? Whether it’s enabling clinicians access to frequent blood glucose levels of a diabetic patient, or a blood pressure reading, or a residents weight within a care home, technology has the means of digitising care in a safe, secure and cost effective way. Enhanced patient outcomes and reducing provider costs The main components of provider costs are staff and the estates. Communicating with patients via widely used technologies can reduce the need for physical environments and increase the capacity of clinicians. County Durham and Darlington NHS Foundation Trust are an example of technology working. They have adopted a digital health approach to delivering care to patients taking warfarin. Rather than attending the clinic monthly, or even weekly, they now self-test their INR. Using a device, patients take a blood sample and send the result to their care team via an automated phone call or by going online. Results of this service in action showed that not only were clinic visits reduced from an average of 18 trips a year to 1, but clinical outcomes also improved significantly. Time in therapeutic range (TTR) increased from an average of 59% to 76% which reduces the chance of a stroke. Again in the North East, care for those at risk of undernutrition has been digitised for care home residents and patients in the community. The region uses an online service to monitor weight fluctuations and the intake of oral nutritional supplement to quickly identify those who are losing weight, or who no longer require oral nutritional supplements. In a sample of 130 patients over the course of a year, £20K in pharmaceutical savings were made, not to mention the reduction of 58 outpatient visits and 126 care home visits, which is equivalent to £2,287 in dietetic time. New business models National Policy describes an aim of shifting care from expensive secondary care based organisations to primary care led services. Traditional primary care models centre around small to medium sized GP practices with limited resources. Digital
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health enables primary care to rethink its role in the health spectrum. As independent businesses, practices are now looking at themselves as a vehicle to deliver a wider range of services and digital health enables them to do this. Take the recent activity in Wigan, where a GP Federation has transformed the way in which they provide anticoagulation services. With secondary care clinics in the region at full capacity, the federation saw an opportunity. With their newly formed federation, they were able to collaborate and pool resources to provide a more efficient service than working as independent practices. Traditional faceto-face clinics can be typically resource intensive, and through the use of digital health, they were able to deploy self-testing which avoided the need for these appointments. Digital health has the potential to transform services as we know them today. Clinicians should be monitoring patients outside of the clinic, if and when it can be done. Clinicians need to take the driving seat, developing services that reduce real areas of strain. The service must be tailored around patient lifestyles, easy to use, convenient and be inclusive of all, regardless of age, technical ability, access to smart phone or broadband. Digital health technology can enable pathways to be digitised quickly and simply using a drag and drop type functionality, with clinicians creating their own rules and protocols. These technical advancements are giving clinicians the control and new found freedom to develop services that are right for them and their patients. Digital health providers must also think on their feet, developing solutions that won’t be outpaced by the technology which surrounds them. Whilst today it might be all about smart phone apps, tomorrow may bring something different and we must be prepared for that. Yet we must not lose sight of what digital health is all about; it’s about delivering safe and convenient healthcare in a way that alleviates pressures on NHS resources. It’s about enhancing existing care, promoting self-care and reducing costs. If it doesn’t address a real clinician’s problem and if it doesn’t work around patient lifestyles, it isn’t going to gain widespread adoption. n
Wider Standardisation for the Connected Healthcare Market Continued from page 31
Founded in 2010 in Copenhagen, Startupbootcamp has accelerated 290 start-ups which have raised more than €100 million in funding and created in excess of 1000 jobs around the world. Startupbootcamp Digital Health will select 10 start-up teams who will each receive $20K in seed funding, free office space,
mentoring from industry specialists, introductions to investors as well as access to the global partner technologies. Startupbootcamp Digital Health is now open for applications and start-ups from around the world are encouraged to apply at www.startupbootcamp.org. n
Wider Standardisation for the Connected Healthcare Market In September, thirty major organisations and companies from the Internet of Things sector came together in SophiaAntipolis (France) to test their equipment and technologies against each other. These successful tests represented an important step for the digital health industry, which requires standards for widespread expansion of connected care technologies. Organised by oneM2M, these tests are part of a wider remit to foster standardised, end-to-end, Remote Patient Monitoring solutions by connecting together the medical standards of the industry, including Continua, BLE, HL7, and more. With more than 200,000 connected medical devices currently in the field and a strong position as pioneer of the connected healthcare market, eDevice was a key representative of the telehealth industry participating in this first oneM2M Interoperability Test. eDevice provides solutions that securely and safely transmit medical data between their patients and their systems. The result of the tests demonstrated interoperability between eDevice’s HealthGO Mini medical hub for Remote Patient Monitoring (RPM) and oneM2M servers from various companies, including Cisco Systems (CSCO), Huawei Technologies, LG, Qualcomm (QCOM), HP & Fraunhofer, amongst others. With HealthGO Mini, Healthcare organisations can now benefit from a scalable, robust and interoperable solution for retrieving vital signs from patients at home enabling advanced telehealth programs. We spoke to Stefan Gonnet, Director
of R&D and Marketing at eDevice, to understand some of the issues facing the connected health industry when it comes to standardisation: What are the main difficulties facing the healthcare industry in terms of the interoperability of connected devices? “A complete RPM [Remote Patient Monitoring] solution is a complex medical system built of several products from different manufacturers that measure and transfer patient medical vitals from home to remote caregivers. All of these products need to communicate together and require interoperability for reducing time-to-market and preparing for massive roll-out.” “When looking at home, most, if not all, of the medical sensors such as BPM, scales or oximeters are, or will be soon, communicating over Bluetooth or USB with Continua compliance. Devices based on BLE (Bluetooth Low Energy) usually require adaptation using recommendations supplied by the manufacturer. Seamless integration of such devices in a medical hub installed at
home then becomes possible.” “This hub will communicate using wellknown networks such as Cellular, PSTN or WiFi. With traditional PSTN/POTS being sunset in a number of countries in North-America and Europe, the Cellular option becomes the most interesting one with its plug&play installation, high-level of coverage, and decreasing subscription costs. The main drawback of WiFi is the level of support required, mainly due to the complexity of installation with encryption keys that the patient may not be aware of. Once connected, the hubs need to securely send medical data to the cloud to make it available to a variety of authorised care partners. One or several existing medical applications per care partner must then have the means to access the medical data in conformance with a user-rights policy driven by national regulations (e.g. HIPAA).” “The major interoperability issue in the healthcare industry then lies in this connection with already-existing medical applications based on standards (e.g. HL7) or proprietary protocols.” Continued on page 36
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Wider Standardisation for the Connected Healthcare Market Continued from page 35
Would you say that the healthcare industry has more challenges to overcome than other industries when it comes to implementing connected devices and services? “The level of quality required for medical device design can be compared to what is expected from safety-related systems such as automotive or rail. IEC62304 is the standard for management of the software development lifecycle for medical devices and IEC60601 rules the hardware design. Their application must be correlated with ISO14971 where risks for the patient must be identified and mitigated in a clearly defined process.” “From a manufacturing perspective, ISO13485 certification is required to comply with guidelines listed in Good Manufacturing Practices for pharmaceutical products.” What sort of standards do you feel should be more widely adopted to enable wider deployment of connected health solutions? “To create conditions for massive projects to improve the lives of patients with chronic diseases, it should be possible for care organisations to run devices from several manufacturers within the same environment. This is nearly the case for sensors where communication architecture is streamlined by USB, Bluetooth and Continua. On the other hand, medical data transferred through medical hubs is never available in a standard format making it difficult for caregivers to use different systems/hubs at the same time. Taking into account that several large business modules, with their own protocols, already coexist in medical IT, it is a nightmare to introduce a new medical data format for injecting RPM values within each of the appropriate business modules.” What are the principle elements of the oneM2M framework and how do these relate to the connected health community? “oneM2M is a cross sector international initiative for standardisation of M2M and IoT communications. Actually oneM2M defines a set of interfaces/ APIs allowing all the components (hubs, applications, servers) within a M2M system to exchange information.”
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“At the core of the oneM2M architecture a oneM2M server will act as a secure repository on the cloud where hubs & devices can record their data on one side and applications can download it on the other side. It acts as a sort of middleware, dealing with user rights and providing solid and well-defined interfaces.” “For example a smart meter can connect to a oneM2M server (several are already available from Cisco, ETRI, actility or CNRS) to download the meter index. Then a billing application will connect to the same server for invoice generation while a "green" application will retrieve the same data for sending eco tips to the consumer and a utility application will gather all the data to adapt power production.” How will the positive results from this first oneM2M interoperability test benefit telehealth hubs going forward? “Then let's get back to telehealth. oneM2M compliant hubs can connect to a variety of servers to make their data available to several types of authorised applications. oneM2M brings interoperability making it possible to use several types of oneM2M-compliant hubs that will communicate themselves with one or several other oneM2M compliant servers. The customer's applications will use the same interface to retrieve the medical data regardless of hub or server used.” How do you envisage that improved industry interoperability and standardisation will benefit connected health devices and services? “From an industry perspective, stan-
dardisation is a key point for creating healthy competition where clients such as ACOs are not dependent on a single provider and can then reduce the business risk and benefit from better price/ quality ratio.” “In terms of service just imagine that a patient has a medical hub at home but also has a smart meter installed by the utility. Then oneM2M architecture could allow authorised applications to check water consumption patterns in case a patient has not taken his vitals as he/ she does every morning. If no water has been consumed, then there might be a problem and a message could be sent to family members. Obviously this scenario should be accompanied by guarantees in terms of privacy but from a technological perspective almost everything is already there to achieve it.” What are the main features of the HealthGO mini and how does its use benefit healthcare providers? “HealthGo Mini is an economical home device designed to acquire over Bluetooth standard vital sign medical sensor data (e.g. blood pressure, Spo2, weight, glucose) and data from proprietary medical sensors. It acts as a hub in the patient’s home always ready to receive the sensor data and forward it to the cloud over cellular 3G networks worldwide. As it requires no set up (except for powering up), pairing and configuration are automated and remote, it is super user friendly and very suitable for elderly and less tech-savvy patients. For the foreseeable future, healthcare providers will continue to need easy to use hubs
Showcase of a Successful Connected Health Project that are cost effective and easy to deploy in large volumes. This will allow them to reach the entire population requiring home monitoring and will drive telehealth adoption in large numbers.” How close are we to achieving wider standardisation? “We believe we have made the first step for medical hub standardisation. Due to its valuable technical architecture and
to the presence of major international telecommunication institutes or vendors, oneM2M consortium is the right candidate for spreading interoperability in the IoT/M2M industry sectors including telehealth.” “However it's a long road to standardisation...” “On the caregiver side, standardisation efforts are also huge in medical IT with
HL7/FHIR that brings a clear interoperability framework. Compliance with this framework is usually a prerequisite in tenders for new applications. However another question is how long it will take to migrate legacy applications using proprietary protocols. Since no one has the answer, an ability to integrate applications dedicated to protocol conversion (gateways) in the oneM2M architecture is crucial.” n
Showcase of a Successful Connected Health Project By Dr. Matthew Bromwich FRCSC, Founder, Clearwater Clinical Limited Today I discussed a case, reviewed a video, and developed a care plan with an international expert in airway surgery from another country. We did not speak a single word. My patient had had a one-of-a-kind surgery and I needed quick, reliable advice from someone I trusted. He doesn’t work at my hospital, so cannot access my healthcare information system. I needed instant collaboration to treat my patient so using my mobile device was the quickest and most effective tool at my disposal. However, given the current regulatory climate and concerns about patient privacy I was looking for a secure way to take and share these images. I took several photos and a short video of my patient, shared them with my colleague and compared notes using a mobile medical camera app downloaded to my iPhone called MODICA. MODCIA is a purpose built app for clinical photography and secure sharing. Of particular interest is the password protected camera roll that encrypts medical data and prevents images from mixing with the personal photos on my phone. The archive of photos and videos are all backed up to a HIPAA-compliant cloud service then deleted off of my device. In the event that my phone is stolen or lost I have already mitigated the risk of privacy breach. There are many clear examples below of how mobile technology and image sharing, in a controlled environment, can benefit patients: Team Communication Many doctors already know that solid communication among teams can dramatically improve patient outcomes. This flow of information may be between residents, among care team or with consultants. Each morning our team meets to review the inpatient list and synchronize on the activities of the day. However, as is the case with any plan, it can become quickly derailed by emergencies, delays, and schedule changes. Throughout the day it is essential to keep pace with patient
investigations and status updates. In many cases, members of our team function semi-independently and thus are required to report back to the senior consultant prior to implementation of a new care plan. We often rely on the sharing of patient images or videos to supplement and enrich the conversation. With these additional sources of information in hand, both trainee and supervisor feel that a deep understanding of the patient has been achieved and the right plan can be implemented. However, without these images and videos, care can often be delayed and sometimes-invasive procedures like an endoscopy need to be repeated. These risks and benefits are more obvious during on-call periods when the trainee and supervisor are not physically at the same location and may be unable to meet in person due to distance or coincident responsibilities. As a result, we use the MODICA solution daily to capture and share images, and communicate patient care plans. Documentation Although not all clinical photos taken on a mobile device need be documented, the best and most informative images, upon which decisions are made, should become part of the permanent patient record. Currently, MODICA rapidly uploads images to a secure cloud without the need for cables or the need to import from your phone. Routes for EMR integration using a web portal and other direct methods are in development. Multi-Site Physicians More than 30% of physicians work at more than one site or institution. In most cases this means interacting with more than one EMR. The sad truth is that most EMRs do not communicate well between each other. Having platform agnostic mobile software enables the benefits of mobile clinical photography without the limitations of a custom built EMR specific app. All images and videos can be captured and stored securely in a single location on the device yet they can be exported to any EMR. Continued on page 38
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The 'SugarCube' for Diabetics in improved efficiency.
Continued from page 37
Research Most discoveries don’t arise from Eureka moments; rather they follow comments like “hmm” or “that's odd”. It is observation and curiosity that most often leads to innovation and discovery. I have found that by using my mobile device to record images and video, I now document more patient cases. Archiving interesting cases has led to more sharing among our clinical team and more insights about patient care. It also enables better comparison of images over time, which is a powerful tool for wound management and the analysis of slow changing findings. Having this archive has also resulted in more engaging presentations at conferences and facilitated research about unusual conditions. Patient Communication Patients can be their own best healthcare advocates and often have the deepest understanding of the progress of their condition. Many patients are now bringing videos or images to show their physicians during clinical visits. These patients understand the value of this form of communication. Interestingly they also worry that without this evidence their doctor might not believe their symptoms. Regardless of the reason it is clear that patients want to digitally share videos and images with their doctors and still maintain patient confidentiality. Referrals We all agree that the best care comes from teams. In the case of rural, remote or isolated communities these teams are nonexistent and referrals must be made to larger centers. Referrals take time and are expensive both for the healthcare system and the patient. In many cases questions about patient care can be addressed quickly using images or short videos. This type of “sidewalk” consultation proves very cost effective in hospitals. Avoiding unnecessary formal referrals is a key way to reducing healthcare costs. Alternatively, in cases where referrals are necessary they often have to be triaged without a complete understanding of the situation. Images and video enable better prioritization and result
Workflow and Billing In many cases documentation of billed procedures can avoid any dispute regarding remuneration from 3rd party payers. Using MODICA not only enables documentation for the purposes of medical decision making but also for the purposes of remuneration. It may also be the case the recorded image or investigation is conducted by a technician, as is the case with some endoscopy, and reviewed by a consultant later. This type of workflow is well supported by mobile image capture and sharing. Education It is clear that recording of video and images impacts education in several ways. Firstly, the patient benefits from the ability to review the video and discuss the actual findings and treatment plan. Second, trainees can expect longer more detailed discussions when reviewing patient videos as compared to simply discussing cases. Finally, interesting cases form an archive of unusual cases that can provide essential education to students who may otherwise never encounter certain rare cases. In summary, there is no question in my mind that mobile device technology in clinical settings is having a tremendously positive impact on patient care. However, the capture, storage, management, and sharing of clinical photos and data must be done with privacy and security in mind. Simply using a suitable app to ensure compliance with security regulations and physician best practices can mitigate much of the risk associated with mobile images in patient care. Now more than ever it is important to take the appropriate steps to protect patient privacy, enhance patient care and reduce physician risk. About the Author Matthew Bromwich is Fellow of the Royal College of Surgeons of Canada specializing in Otolaryngology, Head and Neck Surgery (ENT). He completed his residency training at the University of Western Ontario and sub-specialized in Pediatric ENT at the Cincinnati Children’s Hospital in Ohio. Dr. Bromwich is currently an Assistant Professor of Otolaryngology with the University of Ottawa in Ontario Canada. n
The ‘SugarCube’ for Diabetics Using crowdfunding to finance the development of medical devices and digital solutions has rapidly become a regularly used route to help finance bringing new products to market. Not only does it have the benefit of providing a viable option for accessing funding the process can generate a significant following to help establish the service within the marketplace.
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Developed by a diabetic for diabet-
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ics, The SugarCube is one project that recently launched a campaign on Indiegogo to crowdfund the money needed to bring its state-of-the-art Bluetooth® glucose testing kit and supporting mobile app to market.
glucometer kit is a Bluetooth® enabled testing and insulin-delivery device. This device communicates directly with The SugarCube App to track, store and analyse a user's diet, exercise, glucose levels, insulin administered and more.
Replacing the need for diabetics to carry multiple supplies required for testing blood glucose levels and administering insulin, The SugarCube all-in-one
Early feedback has been positive, one Type 2 diabetic that evaluated The SugarCube in beta test mode said, "The SugarCube App keeps me in check when life
The 'SugarCube' for Diabetics gets hectic and I forget to test myself," adding, "The developers clearly understand the risks of falling into a hypo- or hyperglycemic state; because with the option to extend app notifications to my roommate, parents and boyfriend, I no longer feel alone." While 29 million Americans suffer from diabetes, together The SugarCube and The SugarCube App aim to provide an easy-to-understand, interactive gaming and doctor-patient-community connected approach to Type 1, Type 2, and pre-determined diabetics for a more holistic lifestyle management. Johnnie Refvik, CEO & Founder of The SugarCube and a Type 1 diabetic himself, describes the background to the project: “I had half my pancreas removed when I was 16 due to a sports accident. I was told by doctors that I would most likely lose complete function of my pancreas and become a diabetic later on in life. My journey with diabetes started in 2009 when my mother’s last request was for me to get a physical shortly after her last days of battling cancer. I had spent the last few months of her illness driving to upstate New York from Brooklyn NY daily, fuelling up with soda, coffee, and candy. I wasn’t sleeping enough and the effects from being over stressed were obvious. A physical, I reasoned, would probably do me well, even though I expected a clean bill of health. I became a type 1 at the age of 33 with a A1C of 11.2. I spent the next few years searching the markets for better glucometers and technology that would help me better manage my diabetes and lower my A1C. Not able to find anything that I truly thought would make
a difference I grabbed a pen and paper and came up with The SugarCube Kit. I am an active person, who is constantly on the go and running around with a backpack or bag with my supplies, just didn’t make my life any easier or efficient.” The SugarCube system hopes to provide a complete testing and insulin solution, designed with the aim of simplifying the daily routine of diabetics. “This is the first all-inclusive testing device that supports insulin delivery. Other devices have added key features but none of them have all the testing and insulin needs in one. It’s small, compact, and holds all your daily testing supplies and insulin in one device. The SugarCube Kit accepts several different types of insulin pens on the market and has been designed for both type 1 and type 2 diabetics.” “Lowered A1C level is the highest priority of The SugarCube lifestyle management system. We want to not only give diabetics back there freedom from larger and multiple kits but want to ensure the best care possible but utilising the mobile app and kit together. It really
allows you to manage your diabetes like never before. From high level overviews for the more OCD diabetic to digging down to the data in easy to use interface that are customisable to each user. The system will make a world of difference to the diabetic community.” "It's true the majority of diabetes management apps available have a data tracker; but most tend to look like a bunch of dots on a graph," said Refvik on the associated app. "When it's that difficult to understand and not at all userfriendly, people get easily frustrated and lose interest. The SugarCube will make taking care of your health easier and fun. We want diabetics to understand how past behaviour can help them determine better choices for their future." “The SugarCube app continually informs the user of their current and past BG readings and overall health. The system is 100% full customisable based on the users colour preferences. A lot of apps will keep red or black for bad or good. What if you love red? Our colour coding allows users to enjoy using the app. Additionally, we have added the food tracker which will allow users the ability to track past meals at specific locations. This allows the user to make healthier choices in the future when eating at that location by reviewing user friendly data on a map or list view.” The response to the device in early prototyping and testing has been extremely positive. “We have a large group of diabetics that Continued on page 40
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Patient Self-Care: The Value of Self-Monitoring at Home Continued from page 39
have assisted us with fine tuning the device and app,” said Refvik. “We wanted to be true to the diabetic community by taking their needs into account first hand. Initially, I designed this for me. I never had any plans to sell it to others. I thought it would help me live a healthier life. As the development progressed, I showed other diabetics friends and quickly realised the need for better tech was not in my head
but rather a shared concept.” “Trying to develop a device that incorporates so many moving parts was the biggest challenge. There are so many different needs for diabetics. We wanted to incorporate as many solutions as we could without sacrificing the simplicity of our compact design.” The SugarCube's Indiegogo campaign
has set a 45-day goal to reach $300,000 by December 26, 2015. The company aims to use funds raised from the campaign for tooling and manufacture of the device and to undertake tests necessary to achieve FDA approval. For more information on The SugarCube project visit www.thesugarcubeapp.com or the Indiegogo page at www.indiegogo.com/projects/ the-sugarcube-a-diabetes-management-system. n
Patient Self-Care: The Value of Self-Monitoring at Home With the onset of winter GPs, pharmacies, hospitals and health and social care partners are on alert to detect early signs of respiratory exacerbations, especially in the elderly. The challenge for hospitals is that they are already running at full capacity and scheduled operations are being cancelled to reduce demand. In the UK recent data, collected by the Royal College of Emergency Medicine, has shown that 88% of Accident & Emergency patients were treated or admitted within four hours – significantly below the 95% target. Waiting times in A&E departments across the UK are worsening as pressures grow in hospitals, figures suggest. The figures are based on evidence submitted by more than 40 trusts - one in five of the total in the UK. One of the key issues is that hospitals continue to report significant problems discharging patients. In some places, a fifth of hospital beds are occupied by patients who are ready to leave hospital but cannot be discharged because of a lack of community services available to care for them. The need to redesign care pathways to prevent hospital admissions in the first instance, and provide care and support at home for those most at risk of hospitalisation is now more than ever a priority for health systems. Self-monitoring of vital signs by the patient themselves as part of an agreed programme of self-care constructed in collaboration with the patient can form a cornerstone in reducing admissions and readmissions. Self-monitoring brings with it education, engagement and empowerment when undertaken with the encouragement and support of healthcare professionals. In this 12 month case study Pauline shares details of the selfcare she has undertaken to improve her health and wellbeing as a sufferer of Bronchiectasis. Pauline’s story demonstrates how many small changes collectively bring significant improvements in wellbeing, reversing a downward spiral of bouts of ill health, loss of life quality and reducing the risk of hospitalisation. 12 Months of Self-Care
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Pauline developed a cough 2-3 years ago and couldn’t shake it. A
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respiratory nurse at her GP’s surgery referred her to the local hospital for clinical evaluation and she was then diagnosed with Bronchiectasis, which is a long-term respiratory condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus. This made her lungs more vulnerable to infections. The most common symptoms of bronchiectasis are a persistent productive cough and breathlessness that gets worse with each chest infection. Pauline volunteered to join the Aseptika clinical trial in which patients undertook the recording of their vital signs and recorded their symptoms, using the Activ8rlives simple medical monitors which connect to an iPad using the Company’s Lung Health App. Each day, Pauline recorded up to 41 parameters of health with the built-in questionnaires and recorded her own blood oxygen levels, heart rate, blood pressure, temperature, weight and body composition, levels of physical activity with wrist-worn activity
Large-scale Coordinated Care and Telehealth Deployment tracker and her lung function (Peak Flow and FEV1 values). Pretty impressive for someone who had never measured these at home before. The trial was undertaken to discover how these vital health signs changed before, during and after a chest infection or exacerbation (flare-up of symptoms) and how the levels of certain bacteria in volunteers lungs changed before, during and after a flare-up. When asked what motivated her to join the Trial, Pauline replied “That if it was going to do any good, I was willing to have a go.” Just before she started the trial, Pauline had been very ill. She had been issued with a rescue pack of antibiotics in the event of a chest infection and had two severe bouts, losing weight and lung function while ill. When she became ill, she was prone to losing half a stone in weight very quickly. The daily self-monitoring fitted in very easily with Pauline’s routine and she got on with collecting 41 pieces of information first thing in the morning, taking less than 10 minutes to complete. Pauline attended twice weekly sessions for six weeks of Pulmonary Rehabilitation during the period of the clinical trial, these are funded by the NHS and are specifically tailored for respiratory disease patients who are assisted through breathing exercises, general exercises to improve pulmonary health, lung clearance and lots of helpful learning about living with a respiratory condition. Pauline continued to self-monitor beyond the completion of the clinical trial as she found it provided her with considerable health benefits - less coughing and better control of her breathing. As a result of dedicated effort on her part in managing her health, she has learnt better breathing and lung mucus clearance techniques. “I don’t like doing the exercises, but it really does work for me”.
Pauline has regained 20-25 per cent of her lung function since she started using the Lung Health App and is actively engaging in self-care. She has also put on weight and muscle mass from being underweight prior to the change in self-care. One of the many health benefits of Pauline’s continued daily self-care routine is that she has also been able to become more physically active. Using her wrist activity tracker, she has increased her daily step count by about 2,000 steps per day. Pauline has also been able to reengage with formal exercise activities and attends aqua aerobic classes twice a week, and although she doesn’t always feel like going she always appreciates it when she has gone along for the session. Pauline continues to use the techniques of breathing that she has learnt at Pulmonary Rehabilitation and they have become second nature to her now. The breathing techniques have helped her through periods of exercise to recover her breath quicker and to maintain it whilst still exercising. For example, climbing stairs no longer sets off a coughing fit or breathlessness. “I would have liked to have continued with the Pulmonary Rehabilitation classes which gives you the discipline and encourages you to go out and do the self-monitoring, exercises and it was fun as well. But they are not available in my area.” As a consequence of better health this year “I’ve visited friends in Norway and although she doesn’t live in the mountainous region it is certainly hilly and I can get up and down those far more easily this year than a year or two ago”. Life is very full for Pauline at the moment and a trip away is already planned for next year. “Previously I would have 2 or 3 days in bed feeling unwell but I haven’t had any of that this year and it’s been lovely to be so well”. n
Large-scale Coordinated Care and Telehealth Deployment: A Cookbook for Success Consortium partners of the Advancing Care Coordination & Telehealth Deployment (ACT) Programme have announced the debut of a ‘cookbook’ outlining key enablers necessary to scale connected care and telehealth programs. The ACT Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and tele-
health (CC&TH) services on a large scale. The cookbook is the result of a two-and-a-half year scientific evaluation of data from different connected health programs in five European regions. It provides new insights that apply across the EU on why certain telehealth programs are more successful than others. Connected care is seen by many governments as essential to enable more
efficient, patient-centric and continuous care for the aging EU population; however, although many local connected care pilot programs are successful, they fail to scale and their potential impact is not fully leveraged. The consortium researched data from patients with COPD, diabetes and heart failure in programs in the Basque Continued on page 42
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Large-scale Coordinated Care and Telehealth Deployment Continued from page 41
Country (Spain), Catalonia (Spain), Scotland (UK), North of the Netherlands, and Lombardy (Italy) and conducted 2,500 surveys and group interviews with participating patients and care providers. The consortium found that the scalability of care coordination and telehealth is possible, but requires significant organisational change to successfully execute the process. It also unveiled critical areas in which progress is required in order to enable the transformation to more sustainable healthcare systems. The Cookbook advises that patients are assigned a single point of contact when enrolled in care coordination programs with several institutions and care providers to prevent them from feeling lost amid diverging advice. Staff engagement is critical as in programs where staff understanding and engagement levels were high patient adherence was better compared to programs with lower engagement scores. Preventative care programs outperform reactive healthcare delivery. Improved standardisation and interoperability within the European Union would enable benchmarking and leveraging successful programs beyond local pilots. “A significant portion of our population is 65 years or older, and managing chronic conditions continues to put stress on our healthcare systems,” said Andrus Ansip, Vice President, Digital Single Market, European Commission. “Smarter use of innovation is crucial in order to enable active aging and healthy living. The ACT-program illustrates care coordination and telehealth can be very successful instruments to address care needs. The cookbook will inspire the necessary debate on system transformation and will help with the scaling of future connected health programs.” A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU.
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Some of the key recommendations included: Staff Engagement Findings from ACT suggest that no single intervention can ensure staff engagement. Frontline staff should give a clear insight into the potential benefits of the programme. What was demonstrated to be effective were interventions in training, early engagement of staff, introducing feedback loops, and ensuring recognition of professional expertise. Patient Adherence Healthcare systems, programmes, personalities, and – importantly – patient profiles vary substantially. For this reason, there is a need to design adherence strategies that are adapted around the needs of the patient - Not only clinical, but also social support and socio-economic needs. Stratification It is recommended that health risk assessment should employ a population based approach, both for risk prediction modelling and indicators. This is a priority for scaling up integrated care at EU level. Assessment European regions should agree on a minimum dataset of outcome indicators to be collected by all CC&TH programmes, addressing data collection challenges (comparability, ambiguity), with a small set of strictly defined indicators. The EC should facilitate unified data collection through interfaces, conforming to data privacy and protection legis-
lation, and promote further initiatives in the implementation of evaluation of integrated care programmes. “Successful coordinated care and telehealth are principally about organisational change,” said Professor Stanton Newman of Health Psychology, School of Health Sciences, City University London, UK. “To achieve the best outcomes for patients, we need to review the way these organisations are structured and make sure everyone is aligned on the objectives and goals of integrating care coordination and telehealth into patient care pathways.” “Connected care is critical to the future of our healthcare systems,” said Jeroen Tas, Chief Executive Officer, Healthcare Informatics Solutions and Services, Philips. “The ACT research shows that successful connected care services may start with having the right technology, but it is truly about the holistic approach of technology, processes and people to make an effective transformation.” Uniting leading European healthcare experts from a number of domains, the ACT program is part of the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA). The EIPAHA is an initiative from the European Commission under its Innovation Union strategy, and aims to increase the average healthy lifespan by two years by 2020. The cookbook is available for download and more information can be found on the ACT Program’s website www.actprogramme.eu. n
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