The results from the National Institutes of Health (NIH)-sponsored Tele-HF trial are in, and the findings are worth considering . The results are counter to most of the findings of other studies examining telemonitoring for heart failure and at face value are disappointing to us, and the industry. Upon closer examination, however, this study offers us an excellent opportunity for further innovation, refinement of solutions and continuous improvement. It also provides a snapshot of how significant the challenges remain in transforming U.S. healthcare – from a system that is episodic, reactive, acute care based to a system of care that incorporates proactive, interactive, continuum-based chronic care management. 

The genesis for this study stretches back nearly 10 years, from conceptualization to the results we see reported today. This randomized, controlled multi-centered trial was designed to compare an automated, daily symptom and self-reported weight monitoring technology with “usual care” in reducing hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The boldness of vision should not be underrepresented: Tele-HF is the largest study of a non-pharmacological intervention for heart failure ever conducted. 

At a high level, the results showed “no significant differences” between the group receiving usual care and the group randomized to receive telemonitoring. I cannot say that these are the results we were hoping for. However, I urge those in our industry and other key stakeholders to take a closer, more informed view, and to reach their own conclusions and insights. 

The Details

First, I want to thank and acknowledge the great work of the investigators, study sites and everyone involved in this trial. It was a long process and everyone worked with the utmost integrity and professionalism. We were privileged to have been selected for participation.  I also want to acknowledge the value of conducting large, multi-centered, randomized, controlled trials in terms of advancing medical science. 

The patient interventions in this study took place in 2006-09 and omit many of the processes and techniques Pharos uses today to achieve the necessary critical mass of physician and patient involvement. Here are the limitations of this particular study – from my perspective:  (more…)

Compare the proportions that “users pay” for desktop Internet services vs. mobile Internet services (the area inside the red lines — click on the graphics to see larger versions).

What do these slides tell us?

(more…)

As demonstrated by e-CareManagement blog readership, there has been a lot of interest in LifeCOMM.  My first blog post on LifeCOMM in 2007 has been single the most commented on post and the second most widely read blog post.

It’s taken me a while to sift through my thoughts and feelings about saying “Goodbye” to LifeCOMM. At first I was deeply disappointed, but after further reflection think that LifeCOMM wasn’t the right type of platform for today’s consumer mobile health market.

Disappointment

My first reaction was one of disappointment. (more…)

They all relate to care coordination.  As shown in the diagram below from the Kansas Health Policy Authority (KHPA), there’s a lot of overlap.

A larger copy of the slide is available in this March 2 PowerPoint presentation by Marcia Neilsen , Executive Director, KHPA.

What are some of the implications?

(more…)

Mark E. Miller, Ph.D., Executive Director, Medicare Payment Advisory Commission testified recently in front of the U.S. Senate Committee on Finance. He opened his remarks by stating:

The health care delivery system we see today is not a true system: care coordination is rare, specialist care is favored over primary care, quality of care is often poor, and costs are high and increasing at an unsustainable rate.

About a quarter of Mr. Miller’s testimony focused on an issue that hasn’t received much attention: avoidable hospital readmissions . Here are some key excerpts:

(more…)

Continua’s work-to-date is a necessary, but not yet sufficient effort to make RPM devices mainstream.

Knocking down the barrier of device-incompatibilty exposes the bigger barrier of lack of data interoperability among RPM technologies and between RPM devices and health care IT systems.  Jonathan Edwards, research VP and lead telemedicine analyst for Gartner, nails the issue:

(more…)

Older Americans 2008: Key Indicators of Well-Being, AgingStats.gov, Federal Agency Forum on Aging-Related Statistics

Healthy@Home, commissioned by AARP and the Blue Shield of California Foundation

State of Technology in Aging Services, Center for Aging Services Technology (CAST)

These reports are succinctly profiled with links to the full studies at Profiles of older health care consumers: living longer, longing for technology on Jane Sarasohn-Kahn’s Health Populi blog. A great read!

The aha of “hospital as mainframe” came from reading Eric Dishman’s epilogue in Dr. Mike Magee’s excellent recent book, Home-Centered Health Care:

As with mainframe computers only a couple of decades ago, today we have to make a pilgrimage to that hospital mainframe to wait ever so patiently as we time-share those miraculous modern medical capabilties that have been gathered there.  In the midst of already ballooning healthcare costs, growing ranks or un-and under-insured, and epidemics of age-related illnesses and injuries, this mainframe model cannot scale to meet the needs of ouj aging population where neither the dollars nor the doctors will exist to deliver healthcare business as usual.

Just as we moved from mainframe to persional computers that are now part of our everyday lives at home, work, and play, so, too, we must redistribute healthcare expertise and equipment from  mainframe megaplexes to our homes and to our personal lives. Eric Dishman is General Manager, Health Research & Innovation Group, Intel Corporation. Disclosure: Intel has been a client of Better Health Technologies.

OK, sounds good…and just HOW is all this going to happen?

(more…)

What Will Microsoft’s HealthVault Mean to the Telehealth Community?

Our bottom line:  HealthVault overall is a positive for telehealth industry growth and scale, even though it will speed the inevitable commoditization of remote patient monitoring (RPM) devices.

Initial confusion put aside, I think HealthVault is strategically brilliant.  While I’d give Microsoft a C- for explaining HealthVault (HV), I’ll give them an A for laying the strategy and foundation for what can become an extremely powerful platform for the appropriate, free flow of interoperable and transportable personal health information (I’ve chosen my words carefully here).

Here are four initial impressions about HealthVault — please comment as I’m still trying to figure out myself exactly what HV is and isn’t.

(more…)

A Bluetooth heart monitor could text your local hospital if you are about to have a heart attack, according to research published in Inderscience’s International Journal of Electronic Healthcare. The device measures electrical signals from the heart, analyses them to produce an electrocardiogram (ECG) and sends an alert together with the ECG by cell phone text message. Portable heart monitor sends emergency alerts and ECG as text message, Virtual Medical Worlds, August 2007

Original article: Design of wearable cardiac telemedicine system, International Journal of Electronic Healthcare 2007 – Vol. 3, No.3  pp. 303 – 316

PowerPoint from Opening Keynote

Here’s a copy of the PowerPoint for my opening keynote presentation. My colleague and fellow blogger Tim Gee did a great job summarizing key points on his blog.  THANKS, Tim.

In a nutshell, my main theme is that the adoption of Healthcare Unbound technologies is becoming increasingly dependent upon adoption of broader health information technology (HIT) standards for interoperability and transportability of personal health information.  We should view the Healthcare Unbound ecosystem as highly interdependent — a crew team rowing in harmony rather than a bunch of kayakers in sleek craft that are independently powered and steered.

Major Takeaways from the Conference

Here are some of my key take away points from the conference:

(more…)

What is a MVNO?

More acronyms!  What is a MVNO? A Mobile Virtual Network Operator (MVNO) is a mobile operator that does not own its own spectrum and usually does not have its own network infrastructure. Instead, MVNOs have business arrangements with traditional mobile operators to buy minutes of use (MOU) for sale to their own customers.

You’ve seen MVNOs advertised on TV: Amp’d Mobile, Disney Mobile, ESPN Mobile.

What Will the LifeComm MVNO Do?

Here’s some information from the Wireless Week article:

(more…)

My colleague Tim Gee, respected fellow blogger and world renowned connectologist, summarizes this latest study under the headline “Impact of Remote Monitoring Still Inconclusive”.

Tim, I’m concerned that folks might draw the wrong impression from your use of the word “inconclusive”.  While I’d have to concede that the word “inconclusive” is technically correct, I don’t think your headline conveys an accurate picture of the state of RPM development.

The word “inconclusive” accurately applies to the quality of the evidence in the studies, but doesn’t accurately describe the robust state of developments occurring in RPM.  The quality of the evidence refers to the methodologies of the studies: lack of a control group, lack of randomization, small sample sizes, heterogeneity of studies, etc.

Here’s a related example.  The x-ray was invented in the year 1895.  An article in the year 1900 might have noted that the “evidence” to support the value of medical imaging was “inconclusive”.  Should we have backed off the future development of this technology?

Researchers tend to be a cautious bunch by nature and training. So while a researcher might accurately use the word “inconclusive” to describe the scientific evidence supporting RPM, an executive, manager, clinician or strategist shouldn’t necessarily draw that same conclusion.  

Let’s probe a little deeper into the very article that you characterize as “inconclusive”.  There are two sections of a scientific paper where researchers sometimes let their hair down — the “Discussion” and “Conclusions” sections.  Take a look at the conclusions the authors draw in the JAMIA article:

(more…)

I am a big believer in RPM technology — it WILL revolutionize delivery of health care.

However, I’m also a realist. Consider the following questions a collective “voice-of-the-customer” from my six years working in this market space.

The questions are tough ones, and some aren’t obvious. In this post I’m only listing the questions; I’ll offer perspectives on possible answers in a future post.

Here are the five questions:

(more…)

Lessons learned include:

• Feedback changes behavior
• Adherence is a forgotten opportunity
• Providers are ready to engage, but need to be led

Dr. Kvedar is Director of the Center for Connected Health at Partners Healthcare System in Boston. The Center for Connected Health is a leading provider focused organization promoting innovations in telehealth and remote patient monitoring technologies. Dr. Kvedar is an advisor to the e-CareManagement blog.

Joe, you also are the winner of today’s POE (plain old English) award for an article well written!