Britain’s NHS is Best! US is worst of 11…

Congratulations Britain!  You’re the best…and the second least expensive.

There was a recent study by the Commonwealth Fund which looked at 11 developed western nations: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US.

They were compared on the following criteria: Quality Care (Effective Care, Safe Care, Coordinated Care, and Patient-Centered Care), Access (Cost-related Problem, Timeliness of Care), Efficiency, Equity, and “Healthy Lives” (meaning: infant mortality, mortality from conditions that could have been survived with more effective treatment and life expectancy at age 60).  They were also compared by the amount spent on health services per capita.

The US was by far the most expensive, and scored terribly overall (last place).

Federal Government Closed, VeaMea Open

snow day veamea resized 600

The Washington DC area is being clobbered with a massive snowstorm. Well, ok, so far it is only about 1/2″ but the forecast is for up to a foot by the end of the day.
This has led the Feds to shut down.  Whatever happened to “neither rain, nor sleet, nor snow, nor dark of night…”?
You would think a Government with multi-trillion dollar annual budgets would be able to keep the doors open when something as predictable as a winter snowstorm rolls through.

Memo to BHO/POTUS: Tell OPM to expand SVC.

For those who live outside the Beltway, the above translates to:
Memo to Barack Hussein Obama/President of the United States: Tell the Office of Personnel Management to expand Secure Video Collaboration.
How hard is it to set up a telework program?  (Not very) Can people be productive when they aren’t in the office?  (Yes, arguably MORE productive) How can you manage people when they are remote? (By using technology that allows you to have “in-person” interactions without being physically in the same place).
If you want to talk through your business continuity strategy, process and technology, give us acall.

swyMe – Expanding Telehealth, Mobile, Cloud

reprinted with permission by Mobile Cloud Era


Photo: By Tim Evanson, [CC BY-SA 2.0], at Flickr

In a merger of telehealth, mobile and cloud, Massachusetts-based swyMe is offering video conferencing in ambulances. The basic system includes three cameras in the vehicle: a standard “fish eye” 360º camera mounted high on the ambulance wall; a webcam attached to a touch screen monitor; and a handheld HDTV 720p IP camera.

The combination of the three affords a remote physician a view of the overall situation in the ambulance, the ability to communicate face-to-face with attending EMS workers and capability to zero in to close-up views of the patient. The system is HIPAA compliant and uses AES256 security.

swyMe COO Jeff Urdan explained that the system provides high quality video using public Internet with low bandwidth mobile, about 384 kbs for a quality video signal. It can accommodate multiple carriers. The software comes standard with a handheld examination camera, otoscope and stethoscope, but can include any USB or Bluetooth medical diagnostic device including ultrasound or EKG. The system is interactive.

Among the benefits of their system is the obvious fact that many emergency patients may be in locations that require long rides to hospitals and may need doctor’s care immediately. Urdan points out that EMS workers are regulated and have limited authority to treat. This also enables additional levels of care in the ambulance with a doctor in contact. It also does lead to additional stocking of supplies in the ambulance and added training. Of course, a doctor could be in telephone contact with an ambulance during its journey, however, the video adds greatly to the physician’s ability to diagnose and treat the patient.

The system was released in early May. Urdan states that the first client is conducting a technical evaluation until August. The test is not using an actual ambulance in the field. It is done with a suitcase with the system parts.

swyMe has partnered with Michigan-based MaxLife to produce the system. swyMe’s expertise is in software for video and communications. They sought out a supplier of video surveillance cameras for this app, which brought them to MaxLife , a Verizon M2M partner.

Pricing is $25,000 to outfit an ambulance, including software and Verizon service for the first two years.  Then annual renewals for software and Verizon are $3,000/year after that. swyMe is a Delaware C Corp, and a wholly-owned subsidiary of VeaMea BV, (Netherlands-based).  HitCast (Italy-based) has an ownership stake in VeaMea BV. The company deals primarily with healthcare clients, but also offers video and related solutions to financial services companies.

VeaMea and HitCast have extensive, software-centric solutions for unified conferencing, via the internet TCP/IP protocols and a wide range of standards: H.323, SIP, LAPD, as examples. This provides a magic sauce for swyMe to implement across a host of existing legacy systems. These solutions also are remote video signal processing oriented and specifically adapted for 3G/4G UMTS systems, thereby providing an unusual level of quality transmission. The collaboration brought by this joint venture is directed toward mobile telemedicine applications. One other interesting aspect of VeaMea’s products is the integration of a “cloud Console” for client administration of the service.

swyMe is apparently going to be the branding trademark of VeaMea in the US. The Ambulance product offering is apparently only the beginning of a broader marketing front in video conferencing via the mobile cloud.

There are about 15,000 ambulance companies in the U.S., with approximately 50,000 vehicles. The company is also looking to the European market for expansion.

Mobilecloudera.com is produced by two leading information industry experts, Al Boschulte and Victor Schnee, who have published four studies about the ‘Future of the Mobile Cloud.’

Hackers and Telemedicine Security – Thoughts?

hacked

Today’s reporting (and here, here, and many other places) that Community Health Systems hospital network was hacked for personal information is alarming.  Although no credit card–and NO CARE INFORMATION–was taken, social security, birthdays, and addresses all were.  That is, everything necessary to open bank accounts, sign up for credit cards, and nearly anything else that counts as identity theft.

As potentially bad for the patients as this is, it’s equally bad for Community Health Systems.  Apparently their stock took only a brief hit (CYH), although it wouldn’t be shocking if it moves lower again assuming the news becomes more widespread and if they are sued.  This scenario is possible because although–and I would like to emphasize this yet again–NO CARE INFORMATION WAS TAKEN (medical histories, treatments, etc.) the information was still covered under HIPAA.  (They do have insurance to cover cyber liability, but even so…)

I do not know how the data was kept or encrypted.  It’s interesting…and somewhat heartening…to know that the care information was not accessed by the hackers.  However, I believe it helps us remember that no system is completely safe, and that the highest available level of security should always be used.  Currently, regarding encryption, that would be AES 256-bit encryption.  It also means use of secure one-time-use keys for communication software endpoints and conscientious use of regularly changed passwords by users.  It means keeping devices used within networks either on VPNs (vitual private networks) or, again, using 256-bit encrypted, password-secured communication over non-VPN networks (and why not do it on the VPNs anyway?).

So, now the question is: Does this security breach have any implications for telemedicine and mHealth?  My guess is that mHealth is probably at the greater risk.  I think there’s less of a general use for cybercriminals for care data than simply personal data, and that certain types of personal data, such as location data combined with the pedometer on (could indicate you’re out jogging 10 miles from your house…might be a good time to break in), make mHealth a little more nerve-wracking.  Just a guess.  There may be very creative ways to make use of mass medical histories and treatment information that just hasn’t been discovered yet.  Thoughts?

Bikers and Teddy Bears: 9th Annual Teddy Bear Ride

biketeddys

photo credit: Jeff Schrier | MLive.com

Starting at 2 p.m. this Saturday, children in the pediatric center of Covenant Healthcare in Saginaw, MI, which is a customer using HitCast, an earlier release of what has become our swyMed solution, will be receiving between 200 and 400 teddy bears courtesy of the Great Lakes Harley Davidson and Tri-County Michigan Hogs.

This is a fantastic tradition that’s been as wonderful for the kids in the hospital as for the bikers giving of their time and resources.  However, the children generally are not able to go outside the hospital to see the bikers arriving with teddy bears often attached to the bikes, or to see them dismounting and coming in.  Covenant has, in the past, utilized some of the telemedicine capability to stream video of the bikers arriving into the pediatric center.

Please follow these links for more of the story, and be inspired to do something similar in your area if you can:
http://www.abc12.com/story/26164728/ninth-annual-teddy-bear-ride-to-take-place-this-saturday
http://www.minbcnews.com/news/story.aspx?id=929540#.U-TSmvm-2-0

5 Things I Learned on ATA’s This Month in Telemedicine Webinar

As with last month, this is largely geared to updates about legislation along with reminders about the upcoming Fall Forum conference in Palm Springs, CA, which I’ll have to consider as I live out Orange County.

This month’s takeaways are a little more subdued than last month which had some pretty big news (see here).  The ATA had just done a survey on online consultations and had over 500 respondents.

1)  45% of respondents are using telemedicine TODAY.  This is fantastic news and, in my mind, is possibly underreported because, as Mr. Linkous and Mr. Capistrant pointed out on the last call (and pointed out in our 3 Things from last month), nearly every institution is already using some form of telemedicine and the boards don’t realize it.

2)  Specialty Care and Behavioral Health were the leading segments.  Not terribly surprising, as specialty care often needs to use leading edge tools to leverage resources for special care, and behavioral health lends itself well to an old-school videoconferencing set up (patient and doctor meet via video), leading to less push-back on its use while providing maximum benefit to both patients and providers.  The industry will have to really work, I think, to make sure providers and CDOs are aware of the more specialized applications and the benefits to be had.  Telemedice will not yield a large harvest if we only pick the low-hanging fruit.  As if to prove that point:

3)  77% use video, 57% use audio and 28% use medical peripherals.  Just over a quarter are using peripherals, while three times that are using video.  Being at a video-primary solution provider: Yay!  Being a proponent of telemedicine as a whole: We can do better.  Even the video-primary medical solutions offer a lot of specialized or integrated offerings that provide more than just adding a visual element to distance care.  Again, the question is, how do we get this to the doctors and CDOs?

4) Of the 55% of respondents that replied they are not using telemedicine today, 75% plan to implement it very soon.  I present that as Exhibit A to the tipping point naysayers…although I concede that if you responded to a survey about telemedicine from the American Telemedicine Association, you’re probably already predisposed to an interest in telemedicine.  Having said that, interest in telemedicine has been on the rise, and 75% of that growing crowd being interested in giving it a shot can only be a good thing.

4)  Mr. Linkous pointed out something toward the end that I assumed would be a primary driver (or at least remove an obstacle) but assumed would take several more years:  Private insurance is increasingly taking the lead in pushing telemedicine.  I’ve been noting that the reduced cost/better outcome/reduced readmissions scenario HAS to eventually turn private insurance into champions of telemedicine.  Amongst the names he mentioned were Kaiser Permanente, Aetna, WellPoint, and others.

iPods and Raising Telemedicine Adoption

or

What about the Doctors?

telemediPod 2000 try it bdr

The seeds of this article began when my CEO forwarded a Gartner case study from 2008[1]with the question, “If a hospital could do 345,000 video visits up to 2007, why hasn’t telemedicine expanded more?  Is the issue technological, cultural, managerial, or..?”

Fantastic question.  The issue definitely isn’t technological–at least from a capabilities standpoint.  It may be from a design standpoint…but more on that later.  I’d argue that it is indeed cultural and managerial, although some of that culture and management reflects back on us, the telemedicine solution providers.

We are presented with a quandary: 1) Where telemedicine has been systematically implemented, it has radically improved patient care, lowered costs, improved doctor/staff morale, and even increased revenue…even in the face of lingering payor reimbursement questions currently being worked out by insurers and state legislatures, and yet… 2) Adoption by both individual healthcare providers and organizations has been, well, lackluster, and often outright resisted.

The gap is caused because Read more

Telemedicine Reimbursement vs. Decreased Readmissions

readmission

The question of reimbursement is very, very important. But not as important as you might think.  As promised a couple weeks ago, we want to look more in depth at the third of our takeaways from the 2014 American Telehealth Conference…especially in light of new developments that have popped up in the news since then.

First, to  bring new readers up  …read more…

3 Things I learned on the ATA Webinar

I wonder if this might become a monthly feature?  After all, the ATA webinar I’m talking about was titled: This Month in Telemedicine.

I won’t go into great detail about legislation and such.  For that, I highly recommend the replay which can be found here.

The three items I’d like to look at are:

1.  The FDA has released draft guidance for devices for review and comment.  It can be found here.  What’s notable is …read more…

Past the Tipping Point

tipping point

Last Thursday I promised to discuss our takeaways from the ATA conference individually in more detail, starting with

#1 We’re past the tipping point.

I won’t belabor the point of the overall importance of this takeaway, as you can read about it here.  However, I will re-quote ATA CEO Jonathan Linkous because his numbers make a good launching point: “Today, 20 million Americans get some part of their healthcare remotely, and that number will grow as telemedicine expands its reach.”  And the ATA President, Edward Brown, believes that mHealth/Telemedicine will grow by 50% every year.

According to a study by IHS Technology and published in January, the almost 350,000 telehealth patients in 2013 will swell to Read more