FierceMobileHealthcare

For perspective on mHealth challenges, look to developing countries

Gienna Shaw — Tue, 07 Feb 2012 11:09:53 -0500

Mobile healthcare shows promise in developing countries, but when you look closely at some of the great programs and dedicated people that are out there with boots on the ground, it quickly becomes apparent that Western ideas about technology don't always translate.

The past decade has seen remarkable growth in the availability of cell phones in developing countries, a recent iMedicalApps article notes. "As a result, millions of people are now connected in ways they have never been before. This brings new opportunities for disease prevention efforts, through means such as ... texting."

And we often hear stories of mHealth applications developed in the U.S. that hold potential for use in developing countries. But it's not as easy as it sometimes sounds.

Take, for example, a program called eHealthNigeria, which recently was featured in a Wired magazine blog blog post. The organization implements mHealth solutions in Nigeria to allow healthcare workers to give better patient care and receive better data collection while they are working in the field, according to its website.

"We focus on using mHealth tools [that] are proven to be effective and have already been implemented in other countries," the site says. "In this way, we ensure sustainability of mHealth projects and the continuous improvement and advancement of the [software] that we implement."

Two members of the organization, Evelyn Castle and Adam Thompson, are working in another area of focus for the group-data collection. They're creating digital records of daily births and the health records of adults across the region, including polio cases and expectant mothers who've tested HIV positive across northern Nigeria.

"It's an enormous task, but the size is only part of the problem," Wired notes. "Castle and Thompson are introducing western technology to facilities that aren't familiar with it--and may not have the resources to handle what they are familiar with."

If you want a deeper understanding of that challenge, check out this video of eHealthNigeria teaching birth attendants how to use cell phones--or, to be more specific, teaching them how to turn the device on and off. Click on the "interactive transcript version" to see how much confusion there is over something you and I might assume everyone knows--the difference between the red button on the phone and the green one.

I don't know about you, but it gave me a true appreciation for the work these folks are doing.

If you'd like to keep up with eHealthNigeria's work, check out their Facebook page and Twitter feed. - Gienna

Texting helps with at-risk pregnancies, Partners plans to expand program

Sara Jackson — Fri, 03 Feb 2012 14:18:31 -0500

Sending supportive text messages to moms-to-be, both during and after birth, can improve patients' prenatal and postpartum care, according to a study conducted by Partners Health in Boston, and just published in the journal The Female Patient.

The study, which FierceMobileHealthcare alerted you to last November, provided text messages three times per week to high-risk pregnant women between the ages of 14 and 34 reminding them of clinical milestones, appointments, fetal development and childbirth preparation. One sample message described in the study: "Hi, it's your OB team. We want to make sure u have a plan to get to the Birthplace. Let us know if we can help."

The study was small, just 25 patients, but found 100% of participants read all or most of the texts, and 84 percent said it helped them take better care of themselves during pregnancy and their babies after birth.

In more objective terms, the group receiving the text messages had a higher level of attendance to prenatal visits than a control group that didn't receive the messages, according to the study.

As a result, Partners' plans to expand the program from its initial location, Lynn (Mass.) Community Health Center, to other hospitals in its network.

"Text messaging provides a big opportunity to better engage patients in their care by communicating with them in a channel they prefer," said Joseph Kvedar, Director of Partners' Center for Connected Health. "As this pilot suggests, texting programs have great potential for providing low-cost, accessible educational messaging to patients."

The study's findings build on those of University of California, San Diego, which tested the federally funded messaging program Text4Baby in late 2011. The UC-SanDiego study found the text messages made women more likely to discuss pregnancy-related problems with their physicians, remember key appointments, and get immunizations they or their babies needed.

The Text4Baby program is officially two years old this month, and now has hundreds of thousands of users across the U.S.

Other mom/baby messaging systems are tackling the population of low-income, at-risk pregnant women. We alerted you to momEcare, generated by the app challenge, Imagine Cup, last spring--aimed specifically at using text messaging to help with prenatal care in developing countries.

To learn more:
- read the study at The Female Patient
- see the Partners' announcement
- learn more about Text4Baby from the CDC

Smartphone-powered monitoring to hit 3M users by 2016

Sara Jackson — Thu, 02 Feb 2012 14:44:43 -0500

Remote patient monitoring with smartphone connectivity is set to skyrocket in the next few years, according to the latest study by British research firm Juniper Research. The study projects that by 2016, more than 3 million patients will be using remote monitoring devices that transmit data via smartphone.

The big drivers of the market are the growing number of peripheral devices for monitoring patient data--from wearable biometric sensors to testing and diagnostic plug-ins--and smartphones' increasing processing power, researchers concluded.

The most popular systems now are cardiac monitoring for outpatients, especially since U.S. insurers paying for the service. In the future, however, monitoring for chronic conditions such as diabetes and COPD may become just as critical a market factor, researchers found.

Interestingly, the Juniper findings contradict an ABI Research report from late last fall. ABI predicted that remote monitoring systems would quickly move away from using smartphones to transmit data, turning instead to embedded cellular connectivity.

The mHealth market is still in "very early days yet," Anthony Cox, associate analyst for Juniper, said in a video interview. However, the growing popularity of remote monitoring, particularly as a cost-saving maneuver for healthcare, is clear.

The report said that clarification from FDA on its mobile app regulations, as well as larger clinical trials of mHealth devices,will further prime the market for growth.

That matches up to earlier Juniper research, released last November, projecting the number of health apps would jump to 124 million by 2016.

To learn more:
- read the Juniper announcement
- see a video interview on the report from Juniper
- order the full report

Palomar's self-developed EHR app set for March debut, July rollout

Sara Jackson — Tue, 31 Jan 2012 11:36:48 -0500

It was kind of a crazy idea at the time: In early 2011 San Diego-based Palomar Pomerado Health set about building its own smartphone app to allow physicians access to its electronic health record.

With dozens of vendors working on their own mobile-enabled EHRs, it seemed like reinventing the wheel. And with a tiny team of three heading the project--only one of which is a programmer--it seemed destined for the dustbin.

But as the health system closes in on a planned pilot test of its Android app--Medical Information Anytime Anywhere (MIAA)--in March, the idea is actually inspiring other hospitals to do the same.

In fact, after hearing Palomar CMIO Ben Kanter describe the project at the Toronto Mobile Healthcare Summit last week, a host of CIOs all of a sudden seemed bitten by the app development bug.

"I leaned over to my IS director next to me and said 'Why can't we do that?' ... We've got smart people up here to do it," Dan Coghlan, finance vice president and CIO of Providence Care Centre in Ontario tells IT World Canada.

The app is basically Palomar's reaction to the Citrix process many hospitals use to gain mobile access. Kanter's team wanted a natively developed app for smartphones, with tools set up for touchscreens. The idea was to just not pull up clunky Citrix views of the EHR, but to display the patient records graphically, and even provide live feeds of patient vital signs, X-rays and other images.

Even more ambitious: The app needed to interface easily with a variety of EHRs, to allow for affiliated physician offices that don't use the hospital's primary Cerner EHR system. The health system already has an agreement with Cerner to allow the app to pull data from its EHR, but will need similar arrangements with other vendors before the app truly can do its job.

The team has informally tested interfaces with NextGen and the Veterans Health Administration's VistA systems, Kanter tells FierceMobileHealthcare. And he's committed to a "system-agnostic" app that physicians can use with virtually any EHR.

One of the big surprises for the development was the level of revision needed to core functionality, Kanter admits. His team did a good deal of thinking about exactly what functions the apps' true audience needed--rather than simply enabling the entire medical record for the smartphone.

The target audience in this case is the physician outside the hospital walls, he says. So, for example, the team reconfigured functions like CPOE for more limited use. Rather than being able to craft a full medication regimen, the mobile-enabled CPOE is set up for tasks the physician is likely to do on the fly--adjust medications or add an antibiotic based on a lab test--Kanter says.

"On a phone, the physician's intent isn't to sit down and do wholesale order entry. And that would be inappropriate" in a non-clinical environment anyway, he says.

Right now the app remains in a test environment, as a prototype. Its first big rollout starts March 1, with a pilot test with 12 in-house medical staff, Kanter notes. It's an accelerated pilot of only six to eight weeks, though, and by July he hopes to have the app ready for prime time, and in use by physicians enterprise-wide.

There's a plan to port the platform to iOS, too, for use on iPhones and possibly iPads, although interestingly, Kanter is rather fiercely anti-tablet when it comes to healthcare. His take: Tablets are too big for true mobility (outside the clinical environment), but not big enough to provide PC or laptop-sized images, screens, and functionality.

"We're really focused on the doctor on the go," he says. And doctors "don't go to a baseball game with an iPad in their pocket."
Down the line, the product may well have commercial potential, he says. The hospital created a subsidiary of its charitable arm as a for-profit entity, Palomar Health Technologies, to allow for commercialization in the months or years ahead. He envisions possible licensing arrangements with health IT vendors, although no potential customers, such as individual hospitals or health systems, are off the table just yet. - Sara

drchrono moves to next level with $2.8M investment

Sara Jackson — Mon, 30 Jan 2012 12:07:39 -0500

iPad electronic health record vendor drchrono has officially made it past "startup" status. The company just netted another $2.8 million in funding from Internet investor Yuri Milner, more than four times the initial $650,000 Milner provided last summer. Add all that to the $675,000 the company earned in seed funding last fall, and that puts drchrono squarely in the $4 million-plus club. Along with the funding announcement, the company also launched its new billing module, which it says allows physicians to do create and submit bills and receive payments on their iPhones, iPads and other tablets. Announcement

VA creating tablet-based triage system for its ERs

Sara Jackson — Mon, 30 Jan 2012 11:48:05 -0500

The Veteran Health Administration is continuing its move to tablet-based clinical practice with new emergency room triage software the agency says will debut in August.

As part of its VA Employee Innovation Competition, VHA officials just chose DHSI Systems of Orlando, Fla., to create a system ER nurses can use to triage patients via touchscreen tablets, officials say.

The solution--ER Mobile--is basically a mobile upgrade of the call-center based triage service DHSI has provided to the VHA for more than 12 years. The system uses algorithms, written by physicians, to guide nurses through the patient's symptoms and diagnose their condition and acuity, according to company officials.

The algorithms are built on a 50,000-question library, with a decision-tree type system steering clinicians to recommendations on which patients need emergent care first. The in-person call-center process reportedly takes about eight minutes to complete. No word yet on how long it will take nurses to move through the mobile version.

The new tablet system will connect to the VHA's electronic health record system, giving nurses instant access to a patient's online medical records, and even real-time vital signs, to help with triage decision-making. It also will allow nurses to automatically order additional testing and resources, such as CT scans, X-rays, and blood tests, according to a company press release.

The deal could be a huge boost for DHSI as the VHA moves full-speed toward deploying 100,000 tablets to its medical centers across the U.S.

To learn more:
- check out the DHSI press release
- get detail from Healthcare IT News coverage

CDC launches health information iPad app

Sara Jackson — Fri, 27 Jan 2012 13:04:18 -0500

The Centers for Disease Control and Prevention just launched its first-ever app specifically enabled for iPads, CDC officials said today. The new app, called the CDC Mobile iPad Application, is optimized for iPad touchscreen functionality, officials say.

The presentation is pretty slick, and the main screen appears comparable to most commercial apps, with small icons available for users to tap. The app offers access to CDC health articles, popular journals, health news updates, blogs, and podcasts, CDC officials say. The app also includes tabs for users to engage with social media, including Facebook, Twitter and YouTube.

This is far from CDC's first foray into mobile apps. The agency has had a mobile-optimized website for more than two years, and run several app challenges to create apps for flu and other conditions. However, the new app represents its first attempt at developing a native iPad app.

One interesting note: App review site iSnoops.com rated the new app as "hot," calling it a "highly rated app" at 4.5-stars.

To learn more:
- read the CDC announcement
- check out TechSnoop's rating

iPad proves equal to regular screens for TB evals

Sara Jackson — Fri, 27 Jan 2012 11:03:43 -0500

iPads are just as good as LCD monitors when it comes to diagnosing tuberculosis, according to a follow-up study recently conducted by the University of Maryland.

The original study, which took place in mid-2010, tested only 30 images found that the original iPad's resolution wasn't quite as good as that of LCD monitors and wasn't sufficient for a primary diagnosis.

In the new study, five radiologists tested 240 images--200 positive and 40 negative--on iPad 2 tablets and on a 27-inch Mac monitor. The agreement between the two displays was statistically equal, researchers report.

"Mobile displays should provide an effective extension of the radiologist's reach," researcher Samir Abboud told radiology news site AuntMinnie.com.

The two big negatives for the mobile technology were speed and size. All of the radiologists reported the iPad2 was far slower than the LCD monitor and that the screen size just couldn't compete with the larger monitor.

"It took, on average, twice as long to view the dataset on the iPad than on the traditional workstation," Abbout said. "Readers also commented on how much smaller the iPad's screen was compared to the 27-inch monitor."

The university's findings are an interesting turnaround for the industry, considering that experts reported to AuntMinnie last fall that tablets were "impractical" for viewing medical images, and likely would never take the place from LCD workstations.

"You won't find a radiologist who wants to read a chest X-ray off an Apple iPad," Dr. David Hirschorn, director of radiology informatics at Staten Island University Hospital said at the time.

To learn more
- read the AuntMinnie article (registration required)

MRC pushes for more time on FDA's mobile medical app guidance

Sara Jackson — Thu, 26 Jan 2012 13:33:45 -0500

In a bit of a surprise move, the mHealth Regulatory Coalition has asked the U.S. Food and Drug Administration to revamp and republish its proposed guidance for mobile medical apps--but as a second draft, not a final regulation.

MRC made the request in a letter, crafted by founding member and attorney Bradley Thompson of Washington, D.C.-based law firm Epstein Becker Green, which it posted on its website on Tuesday. The letter lays out industry fears that FDA regulators, overwhelmed with more than 500 pages of industry comments from more than 100 interested parties, are planning to scale back the proposed guidance.

The letter indicates that the FDA may be considering publishing a "high-level," general guidance document in the short-term and holding off on more controversial issues--such as how to regulate accessories--until it has time to come to grips with them.

The MRC offers an option that would buy FDA regulators a bit more time to wrangle with the multi-layered complex regulatory proposal before they publish a final document. Their idea: Have the FDA publish a second draft guidance that incorporates any changes they have settled on, MRC co-founder Dane Stout tells FierceMobileHealthcare.

For example, if they've developed definitions for important terms such as "high-risk" or "general health and wellness," then go ahead and incorporate those into a second draft proposal, and allow the public time to review and comment on those issues. Then regulators can continue to work on more complicated issues such as how to handle clinical decision-support software or accessories.

"[C]ore elements cannot simply be cleaved off," Thompson writes. "[T]he integrity of the guidance system requires that FDA give public comments serious, mature consideration and respond with appropriate modifications, not just promises of future action."

We may know more next week. MRC officials are scheduled to have a meeting with FDA regulators Wednesday, Feb. 1, about the proposed guidance, MRC's comments, and the timeline for final publication, Stout says.

He estimates the process of re-issuing a revised draft proposal might add up to three months to the process, but would be time well spent. "This is a complicated issue. We just feel a measure twice, cut once, approach is warranted here," he says.

To learn more:
- read the MRC letter (.pdf)

West Wireless to test Sense4Baby in Mexico

Sara Jackson — Thu, 26 Jan 2012 10:12:21 -0500

West Wireless Health Institute will conduct a year-long study of its experimental remote fetal monitoring device, Sense4Baby. West Wireless is partnering with the Carlos Slim Health Institute in Yucatan, Mexico, to study whether using the monitor can improve maternal health and reduce costs at the same time.

The technology itself is a handheld mobile unit that monitors both mother and baby during high-risk pregnancies, and transmits readings to clinicians via cellular service, according to a West Wireless statement.

The study will run in two phases. The first clinic-based phase starts in the spring. West Wireless will provide its monitoring units to up to 10 clinics in the Yucatan region, along with devices for checking blood pressure and blood glucose levels. Local clinicians will be tracking and monitoring the transmitted data, Joseph Smith, West Wireless' chief medical officer, tells FierceMobileHealthcare.

"Physicians will be able to use the technology in the primary care setting for routine care for expectant mothers," West Wireless officials said.

The first step in the study, though, won't be handing out devices, Smith says. First, project coordinators will be training physicians and allied health professionals to use the equipment, and analyze the data.

Phase two will start later this year, and push the monitoring kits out into rural areas. Community health workers will be provided Sense4Baby kids to monitor high-risk pregnancies in patients' homes.

It took a while to get the Sense4Baby study off the ground. West Wireless developed the technology itself in 2010 and launched the West Wireless/Carlos Slim partnership in July 2010. But now the group seems to be building some momentum. "WWHI is investigating opportunities to engage in additional research collaborations throughout rural and urban regions of the United States," officials said in a release.

To learn more:
- read the West Wireless press release (.pdf)
- check out the Union-Tribune's article

Hospital CIOs: App developers may be doing an end-run around you

Sara Jackson — Tue, 24 Jan 2012 10:22:57 -0500

Be on the lookout for mobile app developers trying to find a way into your enterprise without your knowledge or consent.

A recent article at CIO.com sounded the alarm on this practice, saying entrepreneurial app developers are learning at conferences, and from each other, to go around the IT department and sell their wares directly to the end user.

It's a chilling idea for a hospital CIO trying to manage thousands of mobile devices, and the even greater number of apps, services and software that users download onto them. CIO.com paints a picture of app developers meeting with users, business execs and others inside an organization, pooh-poohing the concerns of "stodgy," and obstructive CIOs, and encouraging user to purchase their product and tell IT about it later.

"We encounter this frequently," Kevin Larsen, CMIO for Hennepin County Medical Center in Minneapolis, told FierceMobileHealthcare. Todd Richardson, CIO for Deaconess Health System in Evansville, Ind., said it usually ends badly, with users buying into a product they know little about, on the technical side. He's had users purchase web-based subscriptions without authorization, only to have to bring IT in later because they didn't work. "[We had to] do a wholesale update to our currently supported version of Internet Explorer," Richardson told FierceMobileHealthcare.

Larsen said a strict protocol for IT purchases can help, as can linking IT request back up the chain of command. His hospital requires a security review, then a technical review, and finally a review by the executive IT steering committee to "determine if something we already own can do" what the user wants.

How you handle your discussions with users after the fact can help prevent rogue purchases in the future. Richardson said he tries to keep the "I-told-you-so's" to a minimum, and uses any buyers' remorse to educate users on the existing process. He also encourages them to involve him up front in any purchase negotiations.

With vendors, though, Richardson is less gentle. "There's no better way to get on my black list as a vendor than to go around me. I will do everything [I can] to get rid of vendors who practice like this," he said.

Paul Lanzi, mobile application team manager at biotech giant Genentech, pointed out that IT execs need to be open to users' requests if they don't want them working their own deals, however.

"You want the first call to be to you," Lanzi told CIO.com. "If you keep saying, 'no way,' they'll stop calling you. Instead of saying no, ask them, 'What capability are you looking for?'" - Sara

AT&T to secure tablets for health professionals

Sara Jackson — Tue, 24 Jan 2012 09:16:24 -0500

Stepping into what it sees as a gap in the mobile device management market, AT&T has launched a new tablet-specific management service for healthcare, AT&T Managed Tablets. The product provides network access and security controls for tablets, as well as remote wiping, the company said yesterday.

The big question: Why just tablets? With companies like MobileIron and Voalte Connect offering multi-device management services, what is the competitive advantage of having a single-device product? According to some, the move allows AT&T to wedge its way into the market without having to create an entire MDM solution right away.

With tablets coming onto the scene so fast, and in such large numbers, hospital CIOs just might welcome a management option tailored to tablets' specific configuration and security vulnerabilities, Jacob Braun, president of health IT firm Waka Digital Corp., Amherst, Mass., told FierceMobileHealthcare.

Added Kerry Shackelford, healthcare services managing director for Louisville, Colo.-based security firm Coalfire Systems: "It's encouraging to see solutions such as AT&T's Managed Tablets out in the marketplace. Solutions such as these address the difficult issues we in audit and compliance see when we're out doing HIPAA assessments."

For CIOs, though, the product will need to be comprehensive, Braun said. He believes the manager will have to cover all tablet hardware, platforms, software, apps, and more, and be configured to protect against the particular security vulnerabilities of each. Plus, it will have to keep up with the dizzying speed of evolution in the tablet arena.

AT&T also launched a new text messaging management product along with the Tablet Manager. The new Global Smart Messaging Suite for Healthcare provides encryption for outbound messaging, "so patients can opt to receive highly secure healthcare communications, such as appointment reminders, payment notices and test results," officials said.

To learn more:
- read AT&T's press release

Kaiser Permanente debuts EHR mobile app

Sara Jackson — Mon, 23 Jan 2012 16:33:47 -0500

Kaiser Permanent today launched a mobile app giving more than 9 million patients access to their online medical records. The healthcare giant created a mobile-optimized version of its member website, kp.org, with a companion Android app. The company promises an iPhone app later this year.

Kaiser officials say members will be able to view information from past visits, access lab results and pharmacy orders and see other data from their records. They also will be able to check appointments and exchange texts with clinicians via smartphone.

It's remarkably quick work, considering that just last August, Kaiser IT reps admitted they had virtually no mobile strategy crafted, and no apps under development other than the KP Locator mapping app released at the end of the summer.

But they seem to have had a little push from users. In a 2011 study of Kaiser members, smartphone users said the ability to access kp.org's My Health Manager functions from their phones was what they wanted most. And even without the optimization for mobile devices, visits to the kp.org website from smartphones skyrocketed 46 percent during 2011, to make up 14 percent of total visits to the site.

To learn more:
- read the announcement

Could self-tracking lead to mobile hypochondria?

Sara Jackson — Mon, 23 Jan 2012 13:26:50 -0500

As fast as the tidal wave of mHealth innovations is rising, so too are the complaints about its potential ill effects. Security breaches, distracted doctors, patients gaining access to information they can't understand ... critics' voices are getting louder on a host of fronts.

Here's a new, particularly interesting one: That self-tracking health apps will create the "next generation of hypochondriac patients." mHealth Insight blogger David Doherty tackled this criticism, which he found leveled in a LinkedIn discussion group.

The basic complaint was that a small number of patients--often those with imagined or overestimated symptoms--consume an inordinate amount of health resources. Offering them new tools for "digitized navel gazing" will only increase their hypersensitivity, and their trips to the doctor, a commenter charged.

Doherty fired back that mobile data collection provides far more good than bad to the healthcare industry. And he predicted that while the initial users of mobile self-tracking apps may be "a few demanding early adopters," relatively soon, the technology will be mainstream.

Perhaps the more important point is that those early adopters may bring a much-needed consumer perspective to the healthcare industry, ultimately adding value to the way healthcare is delivered, he said.

"Why do we have to persist with this group think in which the end result will always be 'us' doing more for the patient?" he asked. "Maybe letting go of some of the control will mean 'we' do less and the patients do more."

To learn more:
- check out Doherty's blog post

Doctors: Beware the hidden dangers of touchscreens

Sara Jackson — Sat, 21 Jan 2012 21:03:21 -0500

Physicians may love mobile devices, but their mobile devices might not love them back. A recent study from InfoWorld found that the ergonomics of mobile device--and particularly touchscreen--usage may be creating a whole new class of repetitive injuries and other health problems. The ergonomics of keypad and mouse use associated with PCs and laptops is well understood at this point. But researchers just now are beginning to study how users physically interact with smartphones, tablets and other mobile devices, including their posture, hand and body positioning and more. Post