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.

October 22nd, 2009

Immelt seeks to unite healthcare with Silicon Valley mainstream

Posted by Dana Blankenhorn @ 5:45 am

Categories: Events, Finance, Gadgets, General, Hospital Equipment, Medical Office Equipment

Tags: General Electric Co., Health Care, Immelt, Vertical Industries, Benefits, Healthcare, Web 2.0, Human Resources, Internet, Dana Blankenhorn

A lot was written about GE chairman Jeff Immelt’s appearance yesterday at the Web 2.0 Summit, but one key point can’t be emphasized enough.

Jeff Immelt was at the Web 2.0 Summit. He wasn’t at a health care show. He was pitching tech people.

Immelt deliberately brought something with him designed to get a little Silicon Valley wow, a handheld ultrasound called the Vscan the size of an old-fashioned cell phone.

Sounds cool, but African techs have been able to take complex readings on phones for some time, with results compiled elsewhere and reports delivered to the field.

More important than what was in Immelt’s hand was what was in his pocket, namely a pen GE can use to sign off on up to $250 million in venture capital money. The idea was “this is what we can do, now you show us something better and we’ll do business.”

It was probably no accident that GE Healthcare picked the same day to announce a screening test for cancer-related proteins with Eli Lilly. Immelt wants to link the creativity of Silicon Valley to the health IT and health technology mainstream. He wants the people on both sides of the divide competing for the same pile of cash.

All this is part of a general transformation of the company away from the Jack Welch era, which was about finance and entertainment, back to the company’s roots in technology. Every great GE chairman reinvents the company around a vision, and this is Immelt’s.

The vision is starting to pick up believers, like Alexander Wissel at Seeking Alpha. Calling GE “America’s largest mutual fund” because of its size and scope, he nevertheless rates it a buy as the “ultimate recovery play.”

Health technology and health IT both represent technology, but they have been focused outside the Valley. The health and cure tail has been wagging the technology dog. GE wants to reverse that, and if it can this Web 2.0 Summit will have turned out to have been a watershed.

October 21st, 2009

Don't tase me in the chest, bro

Posted by Dana Blankenhorn @ 9:01 am

Categories: Ethics, Gadgets, General, Research

Tags: Chest, TASER International Inc., Workforce Management, Training And Certification, Human Resources, Dana Blankenhorn

The stun gun game will never be the same.

Taser International has formally notified customers that shocking someone in the chest can cause an “adverse cardiac event.”

Publicly the company is not backing away from the idea that Tasers are relatively safe.

The company says its October 12 training bulletin should be seen only as a recommendation to “avoid controversy” and maintain safety by, say, shocking people in the gut.

The company’s home page still features this impressive picture of a new model with the slogan “upgrade to a semi-automatic.”

But customers, and the plaintiff’s bar, are now on notice. Next time a suspect is zapped in the chest and dies there is going to be a lawsuit.

Certainly political opposition to the Taser remains. A site maintained by relatives of a Canadian tasing victim features the names of 451 people it says died from use of the product, whose inventor, Jack Cover, went to his grave early this year insisting his aim was always to save lives, not take them.

Despite its protests, this is a serious reversal for the company. Police love the product, and politicians who love police also like to try and demonstrate its safety.

But the cops are now on notice. Don’t tase me in the chest, bro. Don’t go Taser happy if you want to stay out of court.

This will doubtless lead to some hesitation in firing the weapon at suspects. Yes, firing. The newest Taser product, the XREP, released early this year, is a tiny Taser bullet that an be fired from 12 mm shotguns.

Cops think using a Taser isn’t shooting a suspect, and that subduing people with a Taser is not harmful. Usually, it is. But now, the company admits, that might not always be the case. Police will have to consider that before pulling out the weapon, and probably have to file an incident report each time they do.

August 27th, 2009

Verichip is back seeking sweet stimulus cash

Posted by Dana Blankenhorn @ 5:53 am

Categories: Curioisities, Gadgets, General, Medical Equipment

Tags: VeriChip, Stimulus, CASPIAN, Government, RFID, Vertical Industries, Wireless And Mobility, Security, Biometrics, Dana Blankenhorn

Verichip, the controversial implanted RFID tag that was pulled from the market last year, is back in business, targeting cash from the government’s HITECH stimulus.

The move follows former CEO Scott Silverman’s puchase of a majority stake in the company from The Stanley Works, to which it had sold out in July 2008.

The sale and pullback followed by just a few months the launch of a consumer campaign for the chips, which are often implanted in animals and may help slow an epidemic of horse rustling in South Florida which turns the animals into meat for wealthy people.

Those implants, too, have been linked to tumors.

CASPIAN, the anti-RFID lobby that pushed an earlier report linking Verichips to cancer, is probably already at work on a press release condemning the move.

CASPIAN is not the most radical of the anti-Verichip lobbyists. There are also groups who call it the mark of the beast.

July 30th, 2009

Sunset for the tanning business

Posted by Dana Blankenhorn @ 6:43 am

Categories: Consumer Information, Curioisities, Gadgets, General, Research

Tags: Radiation, World Health Organization, Ethics, Business Ethics, Strategy, Leadership, Management, Dana Blankenhorn

For Sarah Palin this may be worse than all the ethics complaints that forced her from office.

One of her favorite recreations, the tanning bed, is as deadly as arsenic or mustard gas. (Picture from TheWhitedSepulchre, a blog maintained by a Libertarian from Ft. Worth, Texas.)

This is not coming from some liberal special interest group. And it’s not just an opinion. It is the considered conclusion of the International Agency for Research on Cancer, part of the World Health Organization.

Combined analysis of over 20 epidemiological studies shows that the risk of cutaneous melanoma is increased by 75% when the use of tanning devices starts before age 30. There is also sufficient evidence of an increased risk of ocular melanoma associated with the use of tanning devices. Studies in experimental animals support these conclusions and demonstrate that ultraviolet radiation (UVA, UVB, and UVC) is carcinogenic to humans.

These findings reinforce current recommendations by the World Health Organization to avoid sunlamps and tanning parlours and to protect yourself from overexposure to the sun.

Keep doing that and you’re going to have something else in common with John McCain — an oncologist.

They blinded Sarah with science. Literally. According to The Lancet Oncology, a lot of these melanomas can occur in the eye.

Seriously, though, it would be nice if findings like this could be accompanied by discussions of alternatives. In places like Alaska, a tanning bed can be the only UV radiation you see for months at a time, and we all need our Vitamin D.

Maybe she can get a poem out of it.

One more thing. Democrats need to wipe those smiles from their faces. Tanning salons are estimated to be an $11.2 billion industry. Most salons are small businesses. They all just got a big kick in the teeth, and the resulting economic pain is going to be very real.

June 19th, 2009

Will smartphones make us healthier?

Posted by Dana Blankenhorn @ 7:38 am

Categories: Aging, Consumer Information, Gadgets, General, Mental Health, Sports Medicine, Wellness

Tags: Smart Phone, Health Care, Smart Phones, Cellular Phones, Handhelds, Consumer Electronics, Personal Technology, Hardware, Dana Blankenhorn

Smartphones, led by the iPhone, continue their march into the heart of the mobility market.

They bring with them a host of health applications, some useful, others just silly.

We are still at the start of the evolution but it’s time to ask the question. Will smartphones help make us healthier?

Right now the fitness-obsessed and hypochondriac are getting some serious help. Many doctors have a new toy. But is anything really happening?

I argue that it is. As smartphones become a platform as important as desktops they change the way we live in subtle ways.

I noticed this on my recent trip to China. Lacking a phone of any kind, I felt naked. Lacking a smartphone I felt lost. Especially so since everyone around me had one.

That’s because smartphone makers have broken the U.S. carrier monopoly on SIM cards, those plug-in chips that define services. The AT&T monopoly on the iPhone is now a local monopoly. Every American I saw at CompuTex with an iPhone had simply changed-out their SIM for one with a local carrier and gone back to work.

Another reason is that the “touch” interface is becoming ubiquitous. Everything next year will be a touchscreen, and not just that but every new interface will be a touch interface. It’s the first real advance in computing since the mouse.

A third reason is that smartphones are, thanks to the Web, gathering some unity of purpose. Widget sites like Plusmo support a variety of smartphones, and it’s no longer unusual to see widgets and apps that work on multiple devices.

All of which means we’re gradually gaining a more intimate relationship with the data defining our life and work. This includes health data. Whether you’re a medical professional or a layman, you will benefit from this intimacy in many, unexpected ways.

Agree or disagree?

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 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.

April 9th, 2009

FDA orders new approvals on old medical devices

Posted by Dana Blankenhorn @ 7:18 am

Categories: Gadgets, General, Government, Hospital Equipment, Medical Equipment, Medical Office Equipment, U.S.

Tags: FDA, Medical Device, Approval, Federal Government, Healthcare, Government, Dana Blankenhorn

Medical devices whose Class III approvals were grandfathered in during the 1970s must now go through the process of proving their safety.

The industry representing the makers, AdvaMed, is not upset. A press statement expressed the hope that some might be reclassified following the review into less-risky categories, making them more marketable.

The FDA has long had three classes of device, from non-risky Class I bandages to very-risky Class III pacemakers. Back in 1976 Congress asked the agency to classify the old gear based on this risk profile.

For 27 types of products, nothing has happened for a generation. Yet last year, in Riegel vs. Medtronic, the Supreme Court ruled that FDA device approvals trump a patient’s rights to sue.

So what we’re left with is risky devices that were never tested but lie beyond the reach of civil law because courts claim the untested approval is binding.

The new round of tests will close the loophole.