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 11th, 2009

Why not pay for what works?

Posted by Dana Blankenhorn @ 11:44 am

Categories: Drugs, Gadgets, General, Government, Home Health Care Equipment, Hospital Equipment, Insurance IT, Medical Equipment, Medical IT, Medical Office Equipment, Rehabilitation, U.S., state government

Tags: Patient, Health Care, McCaughey, Insurance, Financial Planning, Vertical Industries, Benefits, Healthcare, Business Operations, Corporate Insurance

In all the hullabaloo over health reform, Charles Silver and David Hyman write at The Health Care Blog, a key point of cost control has been lost.

Paying only for what works.

Silver and Hyman are law professors, not doctors. They point to a RAND Corp. study saying that “one-third or more of all procedures performed in the United States are of questionable benefit.” (The illustration is from the study.)

What happened to this simple idea?

The way to enforce it is through comparative effectiveness. Analyze data from millions of patients, develop best practices, and move physicians toward the most cost-effective solution.

This is what every other country does, regardless of how they pay for care. Formularies drive care, based on cost effectiveness. Anyone who wants to go outside what works had better have a good explanation. Often, going outside what works is simply forbidden, or patients are told to buy it with their own money.

Isn’t that how you set priorities? Why should governments or insurance companies act differently?

Unfortunately this was one of the first dominoes to fall in the debate. Reform opponents like Betsy McCaughey called this “getting between a patient and their doctor.”

This happened in conjunction with the debate over the Obama stimulus, and the subject was health IT. The purpose of the HITECH Act’s $19.2 billion in stimulus was to collect the data that would drive decisions on what to pay for.

McCaughey’s scare worked. Explicit promises were made not to use comparative effectiveness in any way to deny care, not to use evidence to decide what we should pay for.

The alternative to evidence is politics. Silver and Hyman note that millions of insurance dollars are spent annually on entirely non-medical treatments like Christian Science, but there’s more:

Lobbying from providers and supportive patients explains why many states already mandate coverage of elective services like in-vitro fertilization, massage therapy, and visits to athletic trainers. Concerns about the efficacy and cost-effectiveness of treatments are washed away by a stream of campaign contributions, and sad stories about patients who can only obtain the “necessary” services if the insurer will pay for them.

This is what is wrong with the present system. State regulation of insurance is based on politics, so your coverage includes any procedure that becomes politically powerful in your state. That’s why insurance costs are rising through the roof.

There is nothing wrong with paying for prayer but it’s not medicine, they write. There’s nothing wrong with in-vitro fertilization but it’s optional, not something everyone should have to cover.

Thus, by tossing away evidence as a way to rule-out certain coverages, you pay for a lot of stuff you don’t need.

Silver and Hyman wrote to argue against a politically-motivated individual mandate. Any mandate should be based on science, not politics, and by giving up on comparative effectiveness early in the process, it became impossible to set that standard, either through the federal government or through the states.

If this was Betsy McCaughey’s intent, she is fiendishly clever. Health care will remain a growth industry, because Americans will keep having to pay for stuff that doesn’t work, regardless of whether reform passes or fails.

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.

July 31st, 2009

Making visiting nurses more cost-effective

Posted by Dana Blankenhorn @ 9:10 am

Categories: Consumer Information, General, Home Health Care, Home Health Care Equipment, Medical IT, Medical Office IT, Medical Records

Tags: Software, Patient, Back-office, Operational Accounting, Finance, Dana Blankenhorn

Home health care is growing fast. It’s cheaper than a nursing home, it’s more personal, more people are growing older, and sick people find it more satisfying.

But the back-office requirements can be hell. Management software for such services represent a big industry. But when you’re selling to providers, as HealthCareFirst is, you concentrate first on things like billing and coding, the parts of the software that make money for your customer.

Will Hicklin doesn’t look at it that way. He looks at it, instead, from the point of the view of the patient, and the patient’s family. That’s because his late wife Sandy, who passed away in January, 2008 was on that end of the market, and thus so was he.

The result is a start-up called Ankota, which is delivering what it calls a three-tier solution of resource optimization, paperless reporting and care management.  He claims he can save providers $1,000 per employee per month. The software was shown at an industry conference in Boston this week.

Sounds good. But integration is the question that must be asked. Integration with hospital systems, with payment networks, and with Personal Health Record (PHR) systems like Google Health and Microsoft HealthVault.

Standards can be created, and you can claim to adhere to them, and you may in fact adhere to them. But will things work together as they should when a patient or family member wants to connect with the rest of the Web?

Those are the questions agencies need to be asking of vendors and prospects. Not just what’s in it for me, but what’s in it for the people I serve.

July 1st, 2009

WellAWARE of watching grandma

Posted by Dana Blankenhorn @ 11:43 am

Categories: Aging, Always On, General, Home Health Care, Home Health Care Equipment, Internet, SaaS, Wellness

Tags: Woman, Sensor, WellAWARE, VOA, Dana Blankenhorn

Working with two of the largest faith-based nursing charities, WellAWARE of Charlottesville, VA has begun delivering on the promise of passive monitoring just weeks after its official launch

That is partly because the company has been in the development and trial for nearly five years, said CEO Jeff Noce. But it’s also because its two key customer-partners can deliver significant market share quite quickly.

At this writing, 60 facilities have the WellAWARE system, company officials told ZDNet. (Note: This actually refers to 60 units in assisted-living facilities, home healthcare and memory care, the company says.)

WellAWARE is offering a system of sensors that track a patient’s movement throughout their residence, comparing their activities to a baseline of normality, and alert caregivers to changes.

Noce explained how this worked recently with an 81 year old client aging-in-place in a Good Samaritan facility in Hastings, NE:

There was an alert that the woman had not slept for 26 hours. The woman was evasive, but we were able to be proactive, and the nurse was able to visit, knowing she hadn’t slept.

The woman finally admitted she’d been hallucinating. The nurse asked about medication, the woman said she had some, and the nurse found that one of the side effects of one medicine was hallucination. She was able to fix the situation in a day.

The patient didn’t have to do anything. The care giver was then able to provide an interaction that got correction.

The Hastings case was detailed at a recent forum sponsored by Volunteers of America, one of the company’s key customers, featuring Newt Gingrich, Tom Daschle, and Donna Brazile. VOA serves over 500 government housing and hospice communitiessenior care facilities, where it believes it can cut costs substantially improve care through WellAWARE and improve care.

The other key customer is the Evangelical Lutheran Good Samaritan Society, known as Good Sam. Between them the two have a fair share of the faith-based care market. (The other two segments are profit and non-profit care groups.)

From a technical standpoint, the offering features a proprietary wireless sensor array, a SaaS Care Engine that collects and analyzes data from the sensors, and screens for care givers’ mobile devices that offer alerts.

Proprietary sensors were developed, Noce said, so that WellAWARE can run up to 6 months on a battery. Components running on the Zigbee standard are being evaluated, he said, especially as the company prepares to look into active systems that might feature blood pressure or glucose monitoring.

Noce said the company is also buoyed by the pending entry of GE and Intel into the market, believing it will legitimize what WellAWARE is doing.

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.

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.

February 17th, 2009

The gigantic opportunity of mHealth

Posted by Dana Blankenhorn @ 7:57 am

Categories: Consumer Information, General, Home Health Care, Home Health Care Equipment, IT Management, Networking, Open Source, Research, SaaS

Tags: Mobile, Advertising & Promotion, Entrepreneurship, Marketing, Management, Dana Blankenhorn

In the developed world broadband is king. If faced with a simple dial-up line you can hear the complaints for days. (Picture from Flickr and the UN Foundation.)

But in most of the world mobile is the only way to go. Cellular links reach deep into the bush of even the poorest nations, connecting people and markets. It is as revolutionary as the telegraph because the service comes to you.

I have an abiding interest in mobile health, especially in Africa. The idea that you can take a diagnostic image with a mobile phone, and get a report back, I find amazing.

So the launch of the Mobile Health Alliance by the Rockefeller Foundation, Ted Turner’s UN Foundation and Vodafone is a milestone.

The aim is to create scalable, sustainable and standardized projects, meaning lower costs, more uniformity, and faster take-up.

The work will not be easy. Some countries see mobile links replacing the taxes which once made phone calls so expensive. Others see it as a concession to sell, a source of graft. As a result regulations and distribution channels vary widely, Vital Wave Consulting notes.

The work is being launched with a study of what is happening, which hopefully can quickly turn into an action plan. Information on the work is being hosted at the UN Foundation’s Web site.

My hope is these groups can create compelling business models that result in mHealth entrepreneurship. That’s how mobile telephony first succeeded, small entrepreneurs taking phones into the bush and charging a fee for each call.

Adding value to what this entrepreneurial infrastructure already provides would be ideal.

February 16th, 2009

How technology is saving tons of money right now

Posted by Dana Blankenhorn @ 8:24 am

Categories: Aging, Always On, Assistive Technology, Curioisities, Gadgets, General, Home Health Care, Home Health Care Equipment, Networking, Wellness

Tags: Friend, Testimonial Story, Vertical Industries, Healthcare, Benefits, Enterprise Software, Software, Human Resources, Dana Blankenhorn

While doctors resist networked systems, and politicians resist database-driven decision making, there is a medical technology system that is saving big money now with little controversy.

I called these Always-On systems back in 2003, but companies like HealthSense have more user-friendly names for it, like eNeighbor. (Picture from HealthSense.)

The eNeighbor system combines a pendant, sensors, WiFi, a database and monitoring into a $100/month application that can keep elderly patients out of $200/day nursing home.

Testimonial stories are starting to appear, like this one in the International Herald Tribune, in which a Philadelphia woman credits it with saving her life several times and letting her stay at home.

I live in a neighborhood with several elderly friends and the health problems endemic to age make staying at home extremely stressful for everyone.

One 88-year old friend has a 65-year old daughter whose diabetes sends her to the hospital regularly. Across the street a 69-year old man lives with his mother and a son whose COPD induced him to build a ramp to the driveway.

A few doors down from him is is a 95 year old friend who just had her first stroke, and across from her is a 70-plus friend who has to go in for dialysis twice a week.

I want to keep these friends. They are important to me. Monitoring systems will keep them close and save all of us money.

To me that’s a win-win-win.