mobihealthnews | February 26, 2009
Top Stories:
- Commentary: Fear and Loathing in mHealth
- How mHealth fits into the stimulus bill
- On privacy and text messaging reminders
- Pillbox vs. Pillboxer vs. The Pill Phone
- BlueCross BlueShield invests in wireless check-in
- Three wireless medicine companies to watch
- Mobile phones to diagnose via breathalyzer?
- Report: 71% expect health I.T. budget decreases
- More on mobihealthnews.com...
Commentary: Fear and Loathing in mHealth |
A rep from Kaiser Permanente captured the sentiment earlier this month when he said: It's easy to see how far behind the healthcare industry is on adopting technologies when a pilot using text messaging is labeled "innovation."
It's especially frustrating when a mobile phone-that clearly changed the way the world sees mobile phones-with nearly 1,000 healthcare, fitness and medical applications is ignored outright by many healthcare IT luminaries because it's popular (and easy) to say that all the healthcare applications available for the iPhone are "junk". Really? Out of 1,000 applications you know this? When probed many who claim to know all iPhone apps are junk will also admit they do not have an iPhone. I'd like to chalk this grievance up to the "eminence over evidence" crutch that Netspective CEO Shahid N. Shah has done well to root out over at The Healthcare IT Guy blog. The concept is that too many in the healthcare field use their eminence as the push of their argument rather than actual evidence of their point-"Trust me, iPhone applications for healthcare are junk." Too many ‘trust me's, Shah has contended, may be one of the drivers behind much of the EBM talk as of late.
"The iPhone is the missing link between a good mobile solution and a (potentially) fully-loaded healthcare application platform," Parks Associates Director of Health & Mobility Research Harry Wang told mobihealthnews recently. "It's very exciting to have the iPhone and the AppStore providing users wellness-related personal care apps because they are easy to discover, download, and put on the phone." Wang exaplained that right now most of the healthcare apps are wellness and fitness apps, but you cannot remove those from the realm of healthcare or apps that actually help treat patients with acute care. "The big trend is moving toward helping patients prevent and manage," he continued. "Most of the iPhone applications are fitness-focused today, but that will change as phones begin to track vital signs like with biosensors like glucose monitors, ECGs and so on. Apps are being developed to do that and some already are out there."
Wang said that suping up the mobile phone to become a better preventative device is relatively easy on the hardware side. The software is the hard part: Developers need to make sure that vital signs are correctly captured, categorized and sent to the appropriate person for monitoring. Software developers can leverage their skills from producing other apps for entertainment, but when it comes to healthcare there is a different set of skills involved, too. Here are three best practices Wang offered up for iPhone healthcare developers:
1) Be aware of adding biosensor modules to the handset (through USB, for example), because you may need to increase process power, too.
2) When the sensor captures data, what format will it transfer the data in? Leverage known standards for healthcare data-don't add more formats to the fray and increase the fragmentation in the marketplace.
3) In most cases there will be a need to simplify the process of reviewing data. Do physicians really want a data dump of all of the user's vital signs? Maybe but maybe not. Same goes for users.
The opportunity for the iPhone and similarly capable phones to help physicians manage their workflow, check reference guides, read medical journals and more is already here-the applications await your download. The next generation of mobile applications that effectively monitor users' chronic conditions and vital signs while informing them on best practices for staying fit and healthy are on the way. So feel free to dig in and download today, but let's hold our tongues just a little longer on the "Trust me, iPhone healthcare apps are junk" talk, because whether Your Eminence knows it or not, there's an entire industry working to prove you wrong. -Brian
How mHealth fits into the stimulus bill |
The stimulus bill has obviously generated a significant amount of buzz in the healthcare industry. No one, however, has asked what the stimulus bill means for mHealth-that is until we asked that very question of analyst John Moore from Chilmark Research. Moore and the rest of the team at Chilmark have been penning reports and consulting companies on EHRs and related health IT technologies for the last couple years. Moore has also been one of the most ardent analysts working to unravel the intricacies of the stimulus bill and its imminent effect on the industry. If you haven't yet, check out Chilmark's blog for more details on the stimulus bill and related incentives for physicians who demonstrate "meaningful use" of EHRs in the next couple years as well as the penalties in store for physicians who fail to adopt EHRs by 2015. Read on for Moore's take on whether mHealth will get any of that sweet, sweet stimulus money and also how mobiles could be the key to making EHR implementation actually work...
mobihealthnews: Do you think there is going to be a trickle down of stimulus money to these last mile mobile companies that, for example allow doctors to use PDAs or tablets to update EHRs/EMRs, or do you think companies that make those kinds of predictions are being ridiculous? [Ed. note: How's that for a leading question?]
Moore: It's kind of ridiculous. I don't see that happening. Right now [the stimulus] is very focused on getting physicians to adopt and use, in a meaningful fashion, EHRs. That's all they are looking at right now in the HITECH act. They are giving ONC discretionary money, but $300M has been earmarked for health information exchanges-that has nothing to do with mobile-that's all about getting clinical data liquid. Within the meaningful use of the EHRs, one of the criteria they are certainly looking at is electronic prescriptions (e-prescriptions) and another criteria is care coordination and using an EHR in such a way that it's sharing records and clinical notes, which has nothing to do with mobile. Sure, mobile can say it is at the point-of-care and it can be at the point-of-care with a mobile solution but it's not the software itself, it's the modality by which it's delivered. They can sing that song and make that case, but I don't think they are going to get funding. They can try, of course, but I doubt anyone thinks a physician is going to get reimbursed just because they picked up a BlackBerry. The physician is going to get reimbursed if he shows meaningful use of an EHR and I'm not sure how mobile solutions will be able to message to that and help a physician capitalize on that reimbursement schedule.
mobihealthnews: That said, putting electronic records into hospitals and doctors offices really does put the industry into a better position to take advantage of the mHealth solutions out there, right? Whether it has anything to do with the stimulus money directly, that money will really prime the industry for mHealth solutions. Agree? Read on
On privacy and text messaging reminders |
The AIDS.gov site, which is a joint effort put together by a number of federal agencies and programs involved in AIDS prevention, research, testing and treatment, has published its fourth and final post on using text messages for HIV appointment and medication reminders (but most of the advice works for any implementation of text message reminders in healthcare settings.) Here's a quick run-down on the latest post from AIDS.gov-this one focuses on best practices when it comes to text messages, privacy and HIPAA:
1) Always ask clients to opt-in to receive text message reminders and be sure they know regular text messaging fees will apply. Those fees vary by carrier but it's unlikely a user would have an unlimited text messaging plan and not know it.
2) Remember: Text messages are not completely confidential. They are most similar to voicemails on answering machines, which could be listened to by parents, partners or friends. There is also potential concerns with cell phone companies having access to and a record of text messages, so be sure to use HIPAA-compliant guidelines like those used for leaving voicemail messages. Those include not identifying the type of service your providing or even your clinic's name in some cases. An appointment time and clinic phone number should suffice.
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Pillbox vs. Pillboxer vs. The Pill Phone |
Indianapolis-based Community Health Network announced today that it will launch its myCommunity Pillbox application for the Apple iPhone and iTouch at the Leadership Summit on Consumer Connectivity in Carlsbad, CA. The company describes the app as "an innovative, user-friendly method for patients to manage medications and important medical information." The company said the app's Version 1.0 will be available "this month" at the Apple iTunes app store, however, as of this writing it is not yet listed. While it's possible the Pillbox application is an innovative take on the popular concept, it's hard to judge since it hasn't launched at the App Store yet. Here's how myCommunity Pillbox stacks up against its competition, at least according to each apps' stated offerings:
> For iPhone and iTouch
> Users can create a list of current medications with dosages and time schedule.
> The app lets users connect to a comprehensive medication database.
> Users can search a list of local personal physicians with office contacts.
> The app is aimed at increasing treatment compliance, patient education, safety and consumer empowerment.
> For iPhone and iTouch
> Search through a database of more than 11,000 FDA-approved medications.
> Track intake of medications, supplements, vitamins
> Visual pillbox buttons quickly identify which meds have been taken
> Email your medication list right from the application
> Notification engine let's you know when your medications should be taken (only if the application is always running on your iPhone, which is Apple's policy)
> Patented mobile medication reminder software available on many wireless phones.
> Only wireless app with FDA approval for medication management.
> Based on the best selling guide, The Pill Book.
> Provides visual/audible prompts.
> Tracks/stores pill-taking records.
> Shows what most pills look like.
> Confirms dose was taken.
> Displays potential side effects.
"Individuals of all ages are using smart phones to manage schedules, lists, email, the phone, internet browsing, music and video games," said Dan Rench, vice president of e-Business for Community Health Network. "It's a natural evolution to have medication tracking or health care management tools, like Pillbox, on the smart phone."
The Pill Phone and Pillboxer certainly agree. I'm curious to see how Vocel, the company behind The Pill Phone app, leverages its patent on The Pill Phone, which I can only assume is this patent that the US Patent and Trade Office granted the company last April. Pillboxer and myCommunity Pillbox aren't the only applications that could be infringing, it looks to include many, many mobile applications both mHealth and otherwise.
For more, visit the myCommunity Pillbox site here. Also, check out the abstract text from The Pill Phone patent below.
BlueCross BlueShield invests in wireless check-in |
New York-based Phreesia, which provides a free patient-intake solution for physicians' waiting rooms, raised $11.6 million in venture capital. The company's third round of funding was led by BlueCross BlueShield Venture Partners, which has a $116 million war chest into which eleven independent BlueCross and BlueShield companies have committed capital. Return investors Polaris Venture Partners, HLM Venture Partners and Long River Ventures also contributed to the most recent round. Phreesia's second round of VC funding was disclosed in the fall of 2007 when the company announced $10.25 million in VC, led by Polaris. The company's first round of funding was never disclosed, but it was announced in December 2006 and was led by HLM.
Phreesia said it will use the most recent funding to expand its already expanding footprint of thousands of doctors in 49 states. The company's CEO Chaim Indig noted that "Given the push by the new Administration towards advanced healthcare IT adoption, this is an exciting time to be at the forefront of technology for patient-centered care. We are proud to have such a strategic partner lead this round."
Phreesia has nearly 100 employees with offices in Ottawa and other parts of Canada, Indig said during an interview with The Health Care Blog. Indig also said all of the company's vendor partners participated in the most recent round of funding. Phreesia has up until now provided doctors' offices with free, wireless-enabled tablets that replace the old-fashioned, pen-and-paper clipboards. The company offers the tablets for free because after the patient has checked-in, the tablet asks permission to share some health information, which may or may not be sponsored by a pharma company.
"Right now... You could have the best EMR in the world but you still have to hand patients a clipboard [for check-in]," Indig told The Health Care Blog during a podcast interview. "After you've checked-in... We ask your permission if it's OK to show you healthcare information, and some is sponsored and some un-sponsored. The vast majority of patients are OK with that and the information is applicable. If you have a problem with your bladder and you are going to the bathroom all the time you are OK with that," Indig said. "You are at the doctor, this is the right place to learn about that... Empowering patients with information is never bad." Read on for more from the podcast.
Three wireless medicine companies to watch |
GigaOM (via BusinessWeek) published a thorough trend piece on wireless medicine this morning that outlines some of the top emerging telemedicine 2.0 companies in the mHealth space today: CardioNet, Triage Wireless and Proteus Biomedical. The companies are favorites in the San Diego wireless medicine scene, which is a veritable hotbed of mHealth activity. Here's a quick intro to these three companies if you've yet to meet them:
CardioNet
Key product: ECG sensor that wirelessly transfers data to a handheld device, which then sends the data to a doctor over Sprint's CDMA 1X network. Some studies claim the CardioNet solution is 300% more effective than legacy inpatient monitoring systems. Qualcomm is one of the company's key partners and investors.
Outlook: Demand for their solution grows quarter after quarter. The company is bullish on dominating wireless medicine in general, potentially beyond cardio applications.
Triage Wireless
Key product: Another Qualcomm partner company, Triage Wireless develops "smart bandage" technologies (Can't call them Band-Aids because of J&J's tm). Smart bandages collect data using biosensors and transmit the data to handheld devices or doctors offices using a combination of Bluetooth or ZigBee and 2G or 3G wireless networks. Metrics to monitor include activity levels, heart rate, perspiration, body position, blood pressure, and others.
Outlook: Triage is just one of a handful of players in this space: Intel is also working with partners on competing products.
Proteus Biomedical
Key product: A complementary product to smart bandages is Proteus Biomedical's edible microchip, called Raisin, which can monitor whether a person actually ingests their medicine. Proteus Biomedical is working on a companion technology to such "smart bandages," an edible microchip meant to signal to the skin-stuck sensor when it's been ingested.
Outlook: There are many ways to increase a person's adherence to a medicine regimen and a smart pill, at least for now, is one of the most expensive out-patient solutions. While the company is focused on initial plans for pilots in emerging markets still battling tuberculosis medication adherence, the company is likely to have a more difficult time finding payers in the U.S.
Which other wireless medicine start-ups are worth keeping an eye on?
Mobile phones to diagnose via breathalyzer? |
A UK nanotech company reportedly developed a mobile phone prototype with Nokia that can detect various diseases or medical conditions from a user's breath. The company, Applied Nanodetectors, claims the device can detect asthma, diabetes, lung cancer, breath odor, breath alcohol concentration and a certain type of food poisoning, according to Nikkei Electronics. The company demoed its prototype at the recent International Nanotechnology Exhibition and Conference in Japan.
The chip reportedly determines the composition of the user's breath and tabulates the density of certain gases present, including CO2, NOx and ammonia. The software then matches the results to characteristics of various diseases and determines whether the user might have a given disease or medical condition. It is similar to fingerprint matching, Applied Nanodetectors' Managing Director Victor Higgs said.
"We contacted Nokia first because mobile phone manufacturers have more influence than carriers in Europe," Higgs said. "But we are intending to discuss business with carriers in Japan because they are more influential in this country. If the handset is commercialized in Japan, it will be just a matter of time before the handset spreads all over Asia."
For more on the report read this post in nanotech publication Small Times. See below for a video report from Reuters about the nanotechnology company winning an award in the UK last fall.
Report: 71% expect health I.T. budget decreases |
No surprise here, but maybe some of that stimulus money could change the story for 2010?
According to a study conducted by Healthcare Informatics Research Series: 71 percent of hospitals surveyed said budget allocations for IT are expected to be smaller this year than in 2008. NCR, a global technology company, commissioned the study.
That said, a full 26 percent of hospitals surveyed do not expect a budget allocation change for IT this year, and 3 percent expect an increase in their IT budgets.
Because of the economic downturn 36 percent of hospitals surveyed said they are being more cautious about IT spending, while 19 percent of hospitals surveyed said they have even delayed certain IT purchases. Some 16 percent have delayed all non-essential IT projects.
For more on the study: Check out Healthcare Informatics, "The Economy's Impact on Healthcare IT Spending" (pdf)
More on Mobihealthnews.com... |
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mEHRs to get a piece of the $19B?
FDA: No inspecting labs testing medical devices
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