November 12th, 2009

What Intel wants in health care

Posted by Dana Blankenhorn @ 6:10 am

Categories: Aging, Assistive Technology, Gadgets, General, Home Health Care, Home Health Care Equipment, Medical Equipment, Rehabilitation

Tags: Health Care, Intel Corp., Venturebeat, Vertical Industries, Benefits, Healthcare, Sales Strategy, Human Resources, Sales, Dana Blankenhorn

Our Tom Foremski is shocked, shocked that Intel is launching a camera that reads.

What’s going on, he asks? Intel is terrible at consumer products. (Picture from Intel.)

But the Intel Digital Health Group is as serious as a heart attack, and the Intel Reader is part of it. The device is actually a specialized computer, combining a camera, optical character recognition, and a voice chip.

I have a stake in this, because my daughter is dyslexic and my mother blind. I appreciate the hard work that went into this. The $1,500 price tag is off-putting, but Moore’s Law tells me that in time it should come down.

And therein hangs our tale.

Intel produces what is now a commodity. It is the dominant supplier of chips but margins are thin. It needs higher margins to thrive.

Health care offers those higher margins. Health care and assistive technologies offer humongous margins because production runs are often small and sales channels thin. Venturebeat says the Intel Reader, for instance, will be going to CTL, Don Johnston, GTSI, Howard Technology Solutions and Human Ware.

None are exactly Best Buy. These are specialty resellers. Johnston, for instance, specializes in technology for dyslexic and autistic kids.

Still, these are growing markets. The Intel Health Guide, for instance, is aimed at the business of aging in place. There are 76 million of us baby boomers and we’re not getting any younger — ka-ching.

And let’s look again at the Reader. Products for the blind, for the autistic, and for the dyslexic are traditionally seen as separate markets. Here we have one product that addresses all of them. That means more sales which can drive down costs. In this business that’s an innovation.

So there is potential here for the perfect marketing storm. A company that can drive down costs enters a market with enormous margins. It can get fat on slimmer margins than those it finds in the market. As it drives down prices it expands the market — I might get that Reader for my daughter when it comes in at $400 (and in time it will).

This can truly be a win-win-win. The assistive technology and health care markets want lower prices, which Intel can deliver. Lower prices will expand the reach of things like aging in place technologies and readers for the dyslexic. Intel can build a highly-profitable business that in time delivers top line growth as well as bottom line growth.

Sure, there are specialty channels to figure out. Sure there are new marketing skills here Intel has not yet mastered. But price can cover that up while those skills are learned. This is the lesson Japanese and Chinese producers have been teaching us for decades.

And if they want to offer a review unit, I’ve got some good testers coming in for Christmas.

November 4th, 2009

How fast can remote monitoring move?

Posted by Dana Blankenhorn @ 12:07 pm

Categories: Aging, Always On, Assistive Technology, General, Government, Home Health Care, Home Health Care Equipment, Internet, Medical Equipment

Tags: Monitoring, Standards, Approval, MedApps, Quality, Business Operations, Dana Blankenhorn

Remote medical monitoring, the use of sensors and networks to detect changes in patients and deliver alerts to caregivers, has been growing throughout this century. (Picture from Abledata.)

This week’s approval of an Alcatel-Lucent TeleHealth Manager by the FDA is just the latest 510(c) approval in a long line.

• RODA got approval for remote heart monitoring in 2002.
• St. Jude’s Medical has been getting remote monitors approved since 2004.
• Medic4All got approval on its VMS-01 telemedicine system in 2006.
• Medtronic has had heart monitors that can be pinged remotely for over three years.
• MedApps has been selling a remote diabetes monitoring system over the counter since 2007.
• ExpressMD got approval for its Electronic House Call system in April.

Not everything is rosy in this business, and not all the fault lies with government. Insurers are reluctant to reimburse, which makes no sense since these systems save enormous amounts of money. BIOTRONIK’s remote heart monitors have been approved to replace doctors’ visits.

Where Intel (and its new partner GE) can provide a service to the whole industry is by helping to streamline these approvals, from both industry and the FDA.

Electronics are insanely reliable. The links available between devices, base stations, and caregivers, via the Internet, are also improving thanks to Moore’s Law. You can even get remote health monitoring through WiFi.

What the industry needs to get past the analysts’ hockey stick graphs are standards. Technical standards, payment standards, approval standards. This is no longer rocket science, it’s not experimental.

Make it part of the technology mainstream, let remote monitoring benefit from Moore’s Law economics, and medicine will be truly transformed, in Internet time.

August 28th, 2009

Health IT start-ups can avoid the political minefield

Posted by Dana Blankenhorn @ 7:51 am

Categories: Always On, Assistive Technology, Consumer Information, Finance, General, Government, Home Health Care, Home Health Care Equipment, Internet, Networking, U.S.

Tags: Health Care, AthenaHealth, Wireless Health Care Application, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Venture capitalists are suddenly getting all dewy-eyed over the potential for health IT start-ups, pointing to the success of AthenaHealth.

One reason is that sweet, sweet stimulus cash, Michael Greeley of Flybridge General Partners told The Wall Street Journal.

Trouble is that cash will be tough to come by. The definitions for meaningful use under which the cash will be doled-out are functional, with the first kicking in less than two years from now. That’s an eyeblink in health IT.

One reason this field does not move in Internet time is HIPAA, for which the late Sen. Edward Kennedy is being lionized today. It has had the unintended side-effect of layering regulatory compliance on top of any innovation or marketing plan, leading to an industry mired in the architectures of the 1970s.

It can take enormous effort to break through this regulatory stranglehold, as witness AthenaHealth itself. Co-founder Todd Park was criticized as a partisan when nominated recently to be CTO for the Department of Health and Human Services.

But Athena’s other co-founder is Jonathan Bush. First cousin to George W. Bush, and nephew of George H.W. Bush. AthenaHealth is nothing if not bipartisan.

If it takes that much political pull to make a health IT success, why bother?

Rather than focus on the stimulus money, perhaps start-ups would be better advised looking to what FCC chair Julius Genachowski said in his notice of inquiry into the wireless market. Wireless health care applications are of particular interest to the agency, which seems dedicated to opening the market so these can thrive.

Back in 2003 I spent much time studying what I called “the world of always-on,” applications that live in the air and deliver value not just for health care but home automation and inventory.

In health care such “killer apps” would include heart and glucose monitors that use wireless networks to give patients, caregivers or doctors alerts when the wearer starts fibrillating or going into hypoglycemic shock.

These devices are starting to come to market, and the agency has reassured the market that connecting them should not be a problem.

To me that sounds a lot more promising than hoping stimulus money will fall from the sky. Especially if, like most of us, you don’t have friends or relatives in high places.

May 22nd, 2009

People beat tech in New Zealand wellness studies

Posted by Dana Blankenhorn @ 8:00 am

Categories: Assistive Technology, Curioisities, Gadgets, General, Home Health Care, Home Health Care Equipment, Research, Wellness

Tags: Nurse, New Zealand, Diabetes, Dana Blankenhorn

Two studies from the same New Zealand university show technology failing but human kindness succeeding in maintaining wellness.

The school is the University of Otago in Dunedin, now celebrating its 140th anniversary.

The failure, published in Diabetes Care, involved 78 kids with Type 1 diabetes. They were given pedometers which measured the steps they took and nagged them with text messages to do more.

The kids with the electronic nags actually wound up walking less than those without them, wrote Kirsty Newton, a diabetes nurse specialist. Differences on measures like blood sugar with a control group were not statistically significant.

The success, reported in the Canadian Medical Association Journal, involved 200 women who had just lost weight, half of whom were supervised intently by nurses. On alternate weeks they got either a phone call or a brief 10-minute visit and weigh-in.

In a commentary accompanying the study, Dr. Robert Ross of Queens University in Kingston, Ontario wrote that exercise specialists and dieticians could easily fill in for the nurses, who are in short supply there, because “the content, approach and frequency of care provided in support programs may be more important than who provides it.”

The content, approach and frequency of care in support programs are more important than who provides it. We need more coaches.

Oh, and care does not have to be intense in order to work. It just needs to be regular, and human.

I know some of you will say this just proves the obvious. But until the obvious is proven it’s not obvious.

May 20th, 2009

More good design in medicine please

Posted by Dana Blankenhorn @ 8:58 am

Categories: Assistive Technology, Curioisities, General, Hospital Equipment, Medical Equipment, Rehabilitation

Tags: Pole, Core77, Healthcare, Dana Blankenhorn

In the rush to produce and distribute medical products efficiently good design is often ignored.

(Picture from Core77 design magazine.)

It should not be. Good design can make anything more personal.

Even an IV pole.

Modo, a Beaverton, Oregon producer of medical carts, many of them made for Cardinal Health has just won a design award for its new IV pole.

Core77 has published a case study of the design process. There were many things to consider. Most poles ride low on the ground and get filthy. They lack identification and become commodities.

Goo Sung described the “ah-ha” moment. “The father had his arm on his son’s shoulder. The boy had his arm on his IV pole. It was as though three people were walking together. I saw the IV pole as the boy’s companion.”

The result was a pole with cup holders and a tray for people to use, a ring with room for a photograph of loved ones, and a wheel base a few inches off the ground for cleanliness.

The design should give Cardinal a temporary boost in the pole business, but it also holds important lessons for the rest of the medical industry.

1. Good design is worth the money.
2. Design from the user’s point of view, not just the customer’s.
3. Humanize.

What other lessons do you have?

May 13th, 2009

Wireless health moves into design phase

Posted by Dana Blankenhorn @ 10:46 am

Categories: Aging, Always On, Assistive Technology, Consumer Information, Gadgets, Home Health Care, Research, Wellness

Tags: Health Care, Wireless, Mobile Tool, Vertical Industries, Benefits, Healthcare, Wireless And Mobility, Human Resources, Dana Blankenhorn

When I first started writing about wireless applications which live in the air, under the title The World of Always On, applications mainly lived in labs.

Now these applications are moving into the design phase, and undergoing initial beta tests.

The Digital Healthcare Conference in Madison, Wisconsin is one place taking reports on this evolution.

Madison was a logical place for the conference because Wisconsin professors like Patricia Brennan (right) are active in the design and delivery of systems. (Go Badgers.)

Among the key lessons she sought to deliver, as reported at WTN:

1. Know the customer. That means you understand how they interact with technology, and how they access health care.
2. Observations of Daily Living (ODL) needs to be unobtrusive. The collection of data on how people interact with this stuff must be transparent, delivered without user involvement.
3. Mobile tools are key. Health diaries the size of a key fob, and food intake applications on a cell phone, work best.

Data collection and analysis is just one piece of the puzzle, Brennan added. How you educate people in healthy lifestyles and gain compliance with doctor directives remains a question.

The answer may lie in concepts like dignity, autonomy, well-being and community. It’s one thing if your doctor or a machine tell you to do something. It may take the magic of friends to make wireless health applications truly valuable.

May 5th, 2009

Is our health coordination better than in Malawi

Posted by Dana Blankenhorn @ 7:42 am

Categories: Assistive Technology, Consumer Information, Curioisities, Ethics, General, Home Health Care, Networking

Tags: Health Care, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Last time I visited my doctor she was still working on paper.

The chart she used contained scribbles from another doctor. The analysis she made of my condition was mostly guesswork.

It’s true that, if we were in Malawi, she might not be a doctor. But she might be carrying a mobile phone she could use to text message a database, and if I had the flu follow a standard regimen to not only get me well but keep my family from getting sick.

She might have been able to warn every health professional within 100 miles if I had an infectious disease, and just that quickly protect everyone in the Atlanta metro area.

Frontline SMS is delivering this coordination now, with Josh Nesbit its man on the ground. He is being joined by other college graduates, and having success with a tech platform consisting of a donated laptop and 100 recycled phones.

(The picture above is from a collection Nesbit loaded to Picasa of his work in Malawi.)

Nesbit got started after learning the hospital he was volunteering at had to serve 250,000 people in a 100 mile radius, and most of the community health workers actually working in villages had no contact back to base.

The point here isn’t that Malawian care is the best anywhere, but merely to point out that technologies we take for granted here are still miracles, and if these can be applied with effectiveness then the failures we have with health IT here are not due to our platforms, but our lack of imagination and reluctance to try.

April 21st, 2009

Is the paralysis estimate science or politics

Posted by Dana Blankenhorn @ 7:24 am

Categories: Assistive Technology, Consumer Information, General, Internet, Research

Tags: Paralysis, Public Relations, Marketing Research, Marketing, Corporate Communications, Dana Blankenhorn

Since I asked this question yesterday concerning videogame addiction it’s only fair to ask it today concerning the estimate of the paralyzed population put out by the Christopher and Dana Reeve Foundation.

Is this science or politics?

Just as Dr. Douglas Gentile used a poll to create his videogame addiction scare, so Anthony Cahill of the University of New Mexico used a telephone survey, with 33,000 participants, to estimate the number of people suffering paralysis.

The study counted people as paralyzed if family members even found “difficulty” moving, and half of those identified are only having difficulty. The result was an estimate that 1.9% of Americans, nearly 6 million, suffer from full or partial paralysis.

The study also found twice as many people suffering from multiple sclerosis as previously estimated, nearly 1 million.

And the results were driven by the late Mr. Reeve’s own agenda, admitted a foundation spokesman.

Still, the PR work preceding the release was masterful. There is no skepticism evident anywhere except at the New York Times concerning the estimate. The Washington Post even personalized the story by interviewing a man whose disability has grown worse as he aged.

None of this is to suggest that the study or its results should be dismissed. But extraordinary claims demand extraordinary proof. The idea that there are nearly 6 million paralyzed Americans is an extraordinary claim.

More research is needed.

April 3rd, 2009

Health IT excitement bleeds into wireless show

Posted by Dana Blankenhorn @ 10:47 am

Categories: Aging, Always On, Assistive Technology, General, Home Health Care, Home Health Care Equipment, Internet, Networking

Tags: Industry, Health Care, Wireless, Health IT Excitement, Vertical Industries, Benefits, Healthcare, Wi-Fi, Wireless And Mobility, Enterprise Software

The cha-ching embodied in the HITECH bill is luring many other industries to the trough. (Picture from the Scripps Institute.)

Take the cellular industry.

I attended the CTIA show a few years ago and heard not a word about medical applications. And I was looking for them, having recently done a long series of blog posts advocating the use of wireless technology for medical monitoring.

The smell of money changes things. This year’s CTIA featured a keynote address from Dr. Eric Topol (right) of the Scripps Institute, all about mobile health or mHealth. Verizon CEO Ivan Seidenberg also featured mHealth in his own keynote address.

This is the revolution in health care I was trying to describe at the 2004 Stanford Accelerating Change conference. (I still have the t-shirt.) In my view it was just one potential application space, along with personal inventory and home automation, although I did joke medicine was the “killer app.”

In mHealth patients wear monitors for their health conditions and blood sugar levels, or are surrounded by sensors which detect their movements (useful if you have Alzheimer’s). The idea is that emergencies can be detected before they happen, saving the lives of those we love.

The dangers here are proprietary technology and price, the one leading to the other.

WiFi is an open standard. WiFi routers are cheap. Many hospitals have improved their operations by building WiFi networks linking departments and people on their campuses. If you want to extend these applications to the world, cellular minutes and SMS messaging are also cheap, especially when bought in bulk.

But the cost of getting a solution, even an existing solution, onto a wireless network and through the FDA process is bound to lead folks to proprietary technologies, with security as their excuse.

It doesn’t have to be that way. Wireless data solutions can be built for very little money and deployed widely. Over the long run that will bring in more service fees than an expensive, proprietary solution. Trouble is that in the short run the opposite is the case.

If the industry looks at the long run, instead of the short run, it can build a revolution.

April 2nd, 2009

Intel and GE put $25 million per year each into monitors

Posted by Dana Blankenhorn @ 8:04 am

Categories: Aging, Always On, Assistive Technology, Gadgets, General, Home Health Care, Medical Equipment, Networking, Rehabilitation

Tags: Monitor, General Electric Co., Health Care, Intel Corp., Vertical Industries, Benefits, Healthcare, Wi-Fi, Wireless And Mobility, Enterprise Software

Intel and General Electric have signed a co-marketing agreement covering their wireless monitoring systems.

Intel delivered its Health Guide to the market a year ago, and went through a product launch in October. But within the health care space it does not have a big brand name.

GE does. It also has a system it calls QuietCare which also does wireless monitoring and is sold to nursing homes.

Under the agreement, announced with some fanfare by CEOs Paul Otellini of Intel and Jeff Immelt of GE, each company will put $25 million per year, over five years, into the joint venture. This led them to trumpet a $250 million investment.

The two companies will do research jointly, but GE Healthcare will handle the marketing, which takes that hassle off Intel’s plate. The two companies think the telehealth market will be worth $3 billion this year and $7.7 billion by 2012.

When I first started writing about the idea of such monitors, linked to wireless broadband, in 2003, I referred to it as “Always-On” technology. The applications live on the network and the collection points are interfaces between sensors and the Internet, with some intelligence for preliminary analysis.