Jamie Titak

HealthIT & mHealth Enthusiast

Startup Spotlight: Healthify, a Care-Coordination Platform for Social Needs

There are not a lot of digital health startups that are focusing on social issues for the vulnerable in America, fortunately Healthify is; I recently had the opportunity to speak with Manik Bhat CEO and co-founder of Healthify to learn more.

HealthIT & mHealth: Where are you based out of and where did you start out?

Manik Bhat: We started Healthify two years ago in Baltimore and moved to New York City after we completed the Blueprint Health Accelerator.  Right now, we have a small team of six people but we are in the process of hiring more (https://angel.co/healthify/jobs)

HealthIT & mHealth: How did you get involved with Blueprint Health and what led you to choose that health accelerator?

Bhat: Blueprint’s focus is really on healthcare enterprise sales. Even though we like the consumer healthcare space, we were really focused on a specific problem and to solve that problem we had to sell to large hospital systems and healthcare insurance companies.  Blueprint Health has a great network with a lot of experience with enterprise sales so that seems to be a great fit for us.

HealthIT & mHealth: Where did you receive your funding from?

Bhat: We received about $500,000 of capital about a year ago, we got another $100k of non-diluted funding from the state of Maryland and some additional funding from the New York Economic Development Corporation via the Pilot Health tech competition.

HealthIT & mHealth: What quality metrics is Healthify trying to improve?

Bhat: The main thing we are focusing on as a company is proving that fully coordinating and managing an individual’s social needs is the best way to improve health outcomes and financial metrics. These needs are housing, childcare, transportation, employment, access to mental health services, and access to substance abuse services.  We are building software solutions to connect individuals with social needs to resources much more effectively, which allows our clients to better track how they are doing in the community and how they are actually doing addressing social needs.  A majority of our clients spending was going to trying to manage these issues, but they did not have any infrastructure to do so.

HealthIT & mHealth: Once you refer a patient to a particular social service are their still barriers in place for the patient to utilize those services?

Bhat: There are definitely still barriers, one is the information barrier which we try to address.  We have built a database of services and help staff access that database to better connect patients. However, there are always going to be behavioral hurdles that exist, which is why I think engagement matters quite a bit. We are really trying to solve the coordination and patient-engagement problem by making sure that we really understand the needs of an individual population, by making sure that information is coordinated to whomever needs that information, whether it be the patient, the case manager, community based organization and by facilitating ways to keep stakeholders in the loop and collecting data throughout the process to provide insight.

HealthIT & mHealth: Can you tell me more about the database that you have created?

Bhat: Social services data is a big mess. We built our database from pulling; categorizing, and validating online information from government, state federal and local datasets.  We collect information on a lot of social issues such as: job counseling, job training, dental care, childcare and homelessness.  We use a multi-pronged approach to improving this information, such as utilizing call centers and constant feedback from our users who are referring to services in the field.

Healthify

HealthIT & mHealth: Are you partnered with any hospitals or health plans currently?

Bhat: Yes, we are partnered with quite a few, John Hopkins Healthcare and health plans in DC and New York. We are live in eight states and working on expanding into more.  The majority of our clients are payers, but we work with ACOs and IDNs as well.  We really end up selling to anyone who is responsible for and who needs to manage the health of a patient population who might have acute social needs.  We are really trying to improve value in healthcare.

HealthIT & mHealth: Do you feel like the ACA has been beneficial to your success?

Bhat: Yes, I think the ACA was hugely helpful, I think there were models we could have definitely employed pre-ACA, but the incentives for innovation and trying new care-coordination practices dramatically improved the chances of selling to a lot of individuals who are trying to improve value and cut costs in healthcare.

 

 

What Business is a Hospital Really in?

In 2004 Theodore Levitt wrote the article “Marketing Myopia”, which introduced the question “What business are you really in?” in the Harvard Business Review.  The article suggests that the reasons established industries of the past such as the railroad industry have failed are because these companies were product-oriented instead of customer-oriented, they believed that there was no competitive substitute for the industry’s major product and they did not know what business they were really in.   Levitt used the railroad industry as an example, the railroad companies thought that they were in the “railroad business” and not the “transportation business”.  Had railroad companies known that they were in the transportation business and thought about their customer instead of their product, they would have invented cars, planes, and trucks and would have not seen such a decline in growth.  In the early 2000’s Blockbuster could have bought Netflix for a mere $50 million dollars had they been customer-oriented instead of product-oriented.

Last week, March 16-18th 2015, I attended the American College of Healthcare Executives’ Congress on Healthcare Leadership in Chicago and discovered a hospital that was focused much more on the customer than on the product.  Curt Kretzinger, COO of Mosaic Life Care in Kansas City, Missouri said, “We are a Malcolm Baldrige Award Winner, we are highly reliable, we figured out how to do things very efficiently and effectively, and when we got done with all that, we said, now what, we are going to get replaced.”  Kretzinger understood that he was not just in the business of fixing patients in the hospital when they became ill, he was in the business of keeping a population healthy so that they would not have to go to the hospital.  He understood that this meant that many of his hospital beds would eventually be empty and he would therefore had to do what Blockbuster and the railroad industry failed to do. He had to disrupt his current business model.

Kretzinger said, “Healthcare is not the patient’s real problem, their real problem is their hopes, dreams and aspirations.  And because patients don’t meet their hopes, dreams and aspirations patients overeat, they don’t exercise, they are despondent and don’t take their medications.  The patient is then admitted to the hospital for a heart attack in about ten years.  People aren’t dying of heart attacks, they are dying of loneliness.  If we can address that, maybe we can change this whole thing”. Mosaic Life Care has an app, which alerts the life guides in the lobby that the patient is in the parking lot.  The life guide has an iPad which will show a picture of the patient that is about to enter the facility, which allows the life guide to greet the patient by name.  If the hospital is running ahead of schedule, hospital staff can text the patient and allow them to come to the appointment early if the patient is in the area.  When the patient arrives in the examination room, the temperature and the television station will be set to the patient’s preferences.  Mosaic Life Care has call centers and life guides that will teach people how to use the computer to access their health information and may even provide them with a computer or cellphone to do so.  He said a benefit of getting patients online was the ability to collect uncollectibles from patients because people were used to online bill payments.  Mosaic also uses their patient portal to participate in the Open Notes program, which allows patients to update their own records.

Mosaic Life Care’s patient centered medical home (PCMH) provides group visits for patients, because “patients help each other out a lot”, said Kretzinger.  The Life Center also has behavior specialists, which they call life guides because there is a psychological component to most diseases.  The center has financial counselors, wellness coaches, yoga classes, painting classes, education counselors, and cooking classes. The Life Center hosts a monthly dinner for all patients that have been diagnosed with cancer and their familes.  The dinner focuses on what the patients want to accomplish in the time that they have left.  Kretzinger said that the hospital has electronic visits, if a parent has a sick child at 4:00 AM, the parent have an e-visit with their child and someone can even deliver the medicine to the patient’s house.

I was so impressed with Kretzinger’s talk that I interviewed the CIO of Mosaic Life Care, Brennan Lehman to learn more about the information technology at the Life Center.  He said that Cerner is their backbone EMR system and the Mosaic Life Care app and the portal live on top of Cerner.  The patient can set their preferences for room temperature and television station in the portal, among many other individualized customizations.  Mosaic built an HIE on the Cerner platform, however it was difficult to get participants when the HIE was so closely tied to the Life Center.  Therefore, they started a consortium in Kansas City with an independent board and the HIE is one of the only non-government, non-grant-funded HIEs that is doing well.   Mosaic was the first Cerner hospital to utilize Cerner as an HIE and co-developed the HIE and patient index matching with Cerner.  The life center uses embedded workflows in their EHR for ambulatory care so that providers follow the same pathways.  Mosaic is working on a program where a patient could have an IV connected to a smart pump in their own home that would be connected to the hospital to allow a provider to change the amount and flow of medication in the IV.  Lehman said “We are looking at how we can create the smart home, everyone is talking about hospital smart rooms and smart clinics, but our whole model is shifting out to the patient’s home. “

Many hospitals are solely focused on meeting meaningful use and other quality measures, which is great, however that is just the product.  Hospitals can get so tied up in measuring and perfecting hospital room waiting times, ER utilizations and re-admission rates that they forget that the customer; the patient does not even want to be in the hospital in the first place.

Hospital Analytics with Qlik Sense

The CMS Meaningful Use program has required hospitals to report clinical quality measures.  Many hospitals are still stuck in the dark ages of reporting, using Crystal Reports and SQL stored procedures to collect and analyze for Meaningful Use and other quality measures.  The days of basic reporting using data from single relational databases are long over in many industries; the healthcare industry is finally catching up with visual analytics tools such as Qlik Sense for healthcare.  I recently got the opportunity to talk to David Bolton, Senior Director of Global Market Development in the Public Sector to learn more about how Qlik Sense is helping healthcare organizations explore clinical, financial and operational data, leading to improvements in care and reduced costs.

Qlik Sense allows hospitals to turn complex data into simple visual analytics that any member of the team can comprehend.  Qlik Sense supports three main domains of healthcare the clinical side, the operations side and the corporate side.  Hospitals look to Qlik to solve many clinical pain points such as challenges in the emergency room or utilization within the operating room.  Some healthcare organizations in the United States have forty to fifty different Qlik visual analytics solutions. The product can be used to find and remove bottlenecks or unwarranted clinical variation.  Qlik has a program in a UK hospital with twenty operating rooms which found that  every one percent utilization increase was worth around $15,000 a week in additional revenue.  Operating Rooms that are not running at one hundred percent utilization can use analytics and big data to determine what is causing low utilization and fix it.

Qlik is about unlocking complex data systems and connecting big data in a way that allows you to see where the challenges are. Qlik can pull data into its database from disparate systems with its scripting tool which can collect data from any message type or source. Over 15,000 healthcare providers currently use Qlik, including providers at Children’s Healthcare of Atlanta, Allina Health, and Healthsouth Rehabilitation Hospitals.  These hospitals are using Qlik to measure HCAHPS, ambulatory quality measures, CGCAHPS, potentially preventable readmissions, PQRS and patient waiting times.

Qlik Healthcare

The screenshot below shows an example dashboard created in Qlik Sense that can be used to determine clinical variation.  This dashboard shows the costs and profits of each provider, which allows hospital staff to determine which providers are most profitable for the hospital.  Armed with this data the hospital staff can study the workflows of certain providers to gain insight on what is causing the discrepancy between the most and least profitable providers.  Doctors who know that their hospital is keeping track of profitability and have access to the data will be motivated to improve their efficiency and seek help from more efficient colleagues if necessary

Hospital Analytics

It is also important to note that the difference in profitability could be due to the type of patients each provider is seeing and not due to provider efficiency or workflow.  In this example all of the least profitable providers are OBYNs so it would be prudent to look at their patient population further to determine why the costs are so high.  Below is a sample dashboard that allows users to view information about the population of the patients along with the costs and profits associated with those patients.  Because this particular group of patients are obstetrics patients, it comes as no surprise that the most expensive patients are the older patients.  The current view of the costs by age group is highlighting fifteen to twenty-seven year olds, however if you look under the “Costs by Age Group” graph you can see the two red bars which is where the older more expensive patients are.

Hospital AnalyticsFrom this view you can drill down even further into the data to determine the DRGs associated with the forty-five to forty-six year old patients that are more expensive.  Again, there is no surprise here that caesarean sections and caesarean sections with complications are more expensive than natural childbirth.  Caesarean Sections have become more popular in the recent years and women will sometimes have a C-section when it is not medically necessary.  Graphs such as the one below can be used to convince providers to not suggest certain procedures when they are not medically necessary and can help hospitals get away from a fee for service payment methods and reduce medical waste.

Hospital Analytics

The next screenshot breaks down the costs of an individual patient that underwent a caesarean section.  The most significant costs are coming from the hospital room itself.  Hospitals that see that their number one expense for certain procedures is the hospital room itself could use this information to focus on strategies to keep patients in the hospital for a shorter periods of time or maybe even introduce home care when possible.  Hospitals are rampant with MRSA, C-diff and other dangerous bacteria, so in many cases it is safer to care for patients in the home. Data insights such as the one below prove that patient care in the home could be financially advantageous as well which could encourage hospital administrators to disrupt their current care model.

Hospital AnalyticsThere is a government mandate that any patient in the UK has to be seen and treated in less than four hours.  The data below is from a large teaching hospital in the UK which shows how often this hospital is breaching the four hour mandate and gives an idea of when most patients are coming into the emergency room. From the graph it looks like the peak time for hospital admission is 8:00 PM.  The dashboard also shows conversions,how many patients are converted to inpatient, in this case around thirteen percent of patients are converted to inpatient.

Hospital Analytics

If the user wants to gain more insights from the breach and conversion data visualization, they can look at another view of the same data that highlights arrival mode, source of referral, treating doctor and age group of the patient.

Hospital Analaytics

With the amount of quality measures hospitals and providers now have to track it makes sense to use a visual analytics tool that can allow you to make changes on the fly and delve deeper into the data with a click of the mouse.  Performing the analysis above in SQL or Crystal would take fifty hours or more of work by a two-hundred dollar an hour technical consultant.  With Qlik, organizations can visually analyze and explore relationships among electronic medical records, clinical systems and finance systems to unlock insights that could otherwise go unseen or be very expensive to monitor.

EHR Vaccination Clinical Decision Support Sponsored by Big Pharma

February 25, 2015 at ePharma in New York City, Craig Kemp, Innovative Partnerships at Merck Vaccines and Andrew Dunning, Director of Life Sciences Partnerships at Practice Fusion discussed the partnership between Practice Fusion, the fourth largest electronic health record (EHR) in the United States and Merck Vaccines.  The partnership began in April of 2014 with the goal of improving population health by alerting providers when a patient was due for one of the six CDC recommended adult vaccines.  There are tools such as clinical decision support that EHR vendors provide, which assist healthcare providers in delivering higher quality healthcare to patients.  These tools are widely available with the growth in adoption of EHRs driven by the federal government’s Meaningful Use program.  The challenge is that many providers have yet to adopt these tools into their clinical practice.  EHR vendors are partnering with life science stakeholders such as vaccine companies to educate and raise awareness of clinical guidelines such as the CDC Immunization Guidelines and to determine how tools such as clinical decision support within the EHR can help provide better healthcare to their patients according to the guidelines.  Patients, Providers, EHR vendors and life science companies all benefit from such a collaboration.  Health of a population improves when patients receive their vaccinations, providers and EHR vendors meet their objective of delivering higher quality care, and life science companies meet their business objectives when their products are appropriately used according to quality guidelines.

Some providers still do not see the benefit of clinical decision support (CDS) and believe that they can appropriately care for their patients without CDS.  I was recently ill in Orlando, Florida and saw the benefits of CDS first hand.  I went to a Walgreens Clinic with little expectations because I live in Boston and have access world class healthcare.  I ended up seeing a registered nurse who gave me the most thorough exam that I have ever had in my life and I even received a follow up call two days later to see how I was doing.  This comprehensive patient encounter was all made possible because of clinical decision support.  Walgreens uses ePass created by Invoalon, its analytics use predictive algorithms to suggest health conditions that patients might have.  I have worked with almost all healthcare informatics vendors, have implemented countless interfaces, and have asked ever doctor that I have seen in Boston how they like working with Epic (I get a similar semi-positive bland response every-time), and this was the most meaningful moment where I could see first-hand how healthIT is improving the lives of patients.

Hopefully I have convinced you of the importance of clinical decision support.  Providers are notorious for being slow to adopt healthcare technology that could improve patient care.  Admittedly, it is hard to have the foresight to see how a bare bones ADT interface, a simple repository for data in 2010 can pave the way for the clinical decision support system I witnessed at Walgreens. Hospitals and providers were provided 19.2 billion dollars in federal funds to implement healthcare informatics technology, they did not start this process on their own and it will take continued effort and funding for a complete adoption of technology.  While many do not like the idea of Big Pharma and other stakeholders funding these programs to increase adoption, is it unreasonable to expect that providers and hospitals will continue the rapid increase in healthcare technology without broader support and funding of other life science stakeholders.

Merck and Practice Fusion entered a partnership to improve patient health outcomes through a Population Health Management (PHM) program for adult vaccines.  Merck provides funding to Practice Fusion to increase the adoption of clinical decision support tools such as vaccine-related notifications to providers who opt into the program.  In a four-month study period ending in August, there was a 73% increase in vaccinations compared to a control group with no notifications.

Merck Practice Fusion

Below is an image of the Practice Fusion EHR patient chart showing the vaccine alert.  The alert does not tell the provider which vaccine to use and allows the provider to easily click out of the alert if the patient is not well enough to receive a vaccine at that particular encounter.  There is a citation on the alert which notifies the  provider that the clinical guideline alert was funded by Merck.

Practice Fusion Merck Vaccine Alerts

Every year, over 42,000 people in the United States die as a result of not being vaccinated, so this increase in vaccination is no small victory.  Unfortunately, this statistic also proves the need for clinical decision support.  Although, there is a small minority of patients who refuse vaccines, most patients do not know what vaccinations they need to get and when they need to get them and providers have been ineffective at vaccinating the United States population.

The newest group of doctors grew up in my generation, in which marketing has infiltrated almost every aspect of our life. We have been consistently bombarded with television ads, spam email messages, popup ads and the like more than any other generation.  However, we have almost always had access to infinite amounts of information to provide us with other opinions.  Therefore, if stakeholder partnerships are prudent, regulated and ethical such as the Merck and Practice Fusion partnership, population health could be greatly improved.

Patient Privacy in the Wake of the Largest Medical Data Breach

Friday, February 20, the MIT Sloan graduate business school students organized the 2015 MIT BioInnovations  Conference. The focus of the conference was “redefining value in healthcare”, Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center and CIO and Dean of Technology of Harvard Medical School was a keynote speaker of the conference. One of the topics he spoke about was information security, a topic he has to be an expert in because he oversees three-thousand doctors, fourteen thousand employees and two million patients.

“Despite efforts to encrypt and build multimillion dollar fortresses around all of our systems, all it takes is one person, who can put everything at risk. Organized crime is interested in buying hospital’s medical records in bulk and selling them to people who could go into the hospital to pretend that they are the person whose medical record was stolen to get expensive services” Halamka says. This should come as no surprise as the largest data breach in the healthcare industry, Anthem’s breach of eighty-million patients occurred just earlier this month. The price to pay for a data breach is steep, a million and a half dollar fine for every privacy compromise and a loss reputation.

Not only do hospitals have to worry about medical identity theft, they also have to be prepared for attacks of “hacktivism”. At the Bioinnovations event Halamka told the story of a recent episode of hactivism attack on the Harvard hospital network, “On the eve of Boston marathon this year, anonymous decided to attack the Harvard networks because it had negative feelings towards one of the hospitals of Harvard and issued a threat to bring that hospital down. The only problem was anonymous didn’t know the IP space of Harvard very well and took down Harvard University, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Joslin Diabetes Center, Brigham and Women’s Hospital and Boston Children’s Hospital. No records were comprised, but the whole network was flooded with 20/gigs per second of data. The entire Harvard network had to be outsourced to a third party vendor to put 100,000 servers in front of the flood and stop the traffic, so that the good traffic could flow.”

While hacktivism and medical identity theft are frightening, there are documented ways to drastically reduce the risk of a breach. Dr. Khaled El Emam, Founder & CEO, Privacy Analytics Inc was also at the MIT BioInnovations 2015 Conference and I got the chance to interview  him about privacy and security issues in healthcare. Privacy Analytics is located in Ontario, Canada, specializes in data anonymization and has large hospital clients such as Mount Sinai.

HealthIT & mHealth: What HL7 fields do you think are most important to de-identify?

Dr. Khaled El Emam: For HL7 and beyond, names, address, medical record number and social security number are the obvious values. Phone numbers and email addresses can also be used to identify patients. After the direct identifiers above, the biggest things that have an impact on risk are geographical locations such as zip codes. Dates, such as date of birth, date of death, date of admission, date of discharge and date of visit can also be used to identify patients. If not properly de-identified, demographic and socioeconomic data such as race, ethnicity, income, number of children can also be used to identify patients. In the order of importance the types of fields to de-identify for HL7 messages are direct identifiers, locations, dates, demographics and socioeconomic data. When de-identifying data, the key is to look at the specific use of the data in order to produce a data set with the greatest value for research and analytics and the lowest level of risk for re-identification.

HealthIT & mHealth: What other security issues are hospitals seeing right now?

El Emam: Business associates (BA) are a really a big issue, the providers could manage their risk appropriately, but the BAs are using the same data and may not manage their data as well. Hospitals have a large transient population of employees, especially in academic medical institutions, which increases risk as well.

HealthIT & mHealth: How much is a stolen medical record worth on the black market?

El Emam: It depends on whether the person is looking to use the financial or medical information from the medical record. If they are looking to use the financial information, the worth would be similar to a credit card. In terms of value per medical record there is not a lot of verifiable data on this currently.

HealthIT & mHealth: When do you think the parsing of unstructured data will become prevalent and efficacious in healthcare?

El Emam: We are seeing more and more of our clients looking to de-identify unstructured data. There are now good tools to do interesting things with the de-identified unstructured data such as algorithms to determine diagnosis. The billing codes may not reflect the correct diagnosis, but the provider notes usually will. Parsing of unstructured healthcare data is going to pick up because we are now able to deal with the privacy issue at scale and the analytics issue at scale. At Privacy Analytics, we also have a text de-identification tool for data providers and analytics service providers wanting to perform analysis on unstructured data.

HealthIT & mHealth: How do the methods of patient de-identification compare today to when you started Privacy Analytics eight years ago?

El Emam: First, I think it is important to note that the term “de-identification” is often used interchangeably with data-masking. However, there is a big difference between the two methods. Real de-identification uses a risk-based approach that goes beyond simple data masking techniques. Strong and scalable de-identification protocols provide a defensible way in which to address privacy concerns and legal obligations while simultaneously preserving the utility of the data for analysis.

Our methodology  has stayed the same over the past eight years.We have always used the expert determination methodology. This methodology was recently cited by the IOM in its recent report, Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risk.”

However, the nature of the data has changed. The data used to be in registries and be very structured.  Now we de-identify the data from full electronic health records with 400-500 tables in it including clinical data, billing information, treatment plans and lab results for over 40 million patients. Basically, the data complexity has increased, but the way you approach the problem is the same.

HealthIT & mHealth: What is the root cause of the recent healthcare data breaches?

El Emam: Adoption rate. Current privacy and security techniques are very strong, but issues occur when people are not applying the principles correctly. The adoption rate of disclosure control is not keeping up with the urge to get data out of health information systems. The adoption problem can be dealt with by providing education, developing standards, and setting expectations by the regulators.

HealthIT & mHealth: What type of analytics does Privacy Analytics run on de-identified patient data?

El Emam: We do not run analytics on the data – our focus is de-identification. We provide the tools that gives health data organizations the ability to quickly and easily apply a proven de-identification methodology to produce high quality, custom data sets for specific secondary purposes such as research and analysis, clinical trials transparency, quality and safety measurement, public health, payment, provider certification or accreditation, marketing and other business applications.

HealthIT & mHealth: How do patient security issues affect healthcare informatics startups?

El Emam: Security affects M&A activity of startups and their future investments, if a privacy issue is suddenly raised, it can cause panic among investors. Deals can be jeopardized if patient privacy and security issues not handled up front.

Privacy and security issues can expose any organization, regardless of size and maturity, to significant legal, financial and reputational risks. There is a rapidly growing need to identify and minimize these risks in order to responsibly use healthcare data to drive innovative research and analysis, derive key insights and gain new knowledge to help solve some of healthcare’s most challenging problems.

 

 

SunSprite: A Solar-Powered Light Tracker for Depression

I think everyone can agree that weather, particularly sunlight can affect his or her mood. Although we know qualitatively that it feels better to be lying on the beach in the Cayman Islands than to be sitting outside in cloudy Seattle; we can’t measure quantitatively how many minutes of sunlight we need each day and at what intensity. These measurements are especially important for those suffering from Seasonal Affective Disorder (SAD), a mood disorder where individuals experience depressive symptoms in the winter due to a lack of sunlight.

A common treatment for SAD is bright light therapy (BLT), however because light boxes are not FDA regulated a patient does not know how much sunlight the light box is actually emitting and if they are meeting their prescribed amount of BLT. Other issues providers are seeing with bright light therapy are patient engagement and patient adherence.

GoodLux Technology’s SunSprite, a member of Healthbox’s 2015 Studio class tackles all three pain points associated with bright light treatment for SAD: quantifying bright light, engaging patients and increasing patient adherence. SunSprite has raised almost 1 million in outside investment and was also a finalist of the MassChallenge’s Summer 2014 Class. SunSprite measures light from visible light and UV sensors housed in the device. The device attaches to your clothing or accessories via a flexible magnetic clasp and has a solar powered battery. It syncs to the SunSprite app via Bluetooth technology and requires no cords or cables. The app is currently only available on iOS devices, but the Android app will be released in the next few weeks. Readers can purchase the device on Amazon or the SunSprite website.

GoodLux will not be seeking FDA approval because “we leave the depression diagnosis and treatment to the provider” says Edward Likovich, CEO of SunSprite. However, GoodLux technologies has several patents pending on their device and application.

The wearable is mainly used right now for depression, but there are people interested in it for sleep disorders because visible light activates your hypothalamus, which regulates your body’s biological clock. The visible light also affects your serotonin and melatonin, both of which impact your mood. Consequently, for bright light therapy (BLT) to treat depression, it is the visible light that needs to get in your eyes. The other byproducts of sunlight such as vitamin D, may be correlated with depression, but they are not important for BLT. Moreover, the surface area of your body receiving the sunlight does not matter like is does for vitamin D, which is absorbed by UV radiation on your skin.

Insurance reimbursements are starting this year for mental health telehealth visits. Mental health providers will find SunSprite helpful in monitoring patient engagement and adherence among patients that they prescribe BLT to. GoodLux technology recently announced a partnership with iGetBetter, outpatient care solution for patients with chronic conditions such as congestive heart failure or diabetes. iGetBetter found that providing scales and blood pressure cuffs to at-risk-patients helps prevent re-hospitalization, manage care and reduce costs. There is a high rate of co-morbidity among patients with chronic diseases and depression and depression lowers patient engagement and adherence. Therefore, re-hospitalization rates can be reduced even further by utilizing SunSprite to reduce depression, motivating patients to be actively engaged in their health.

I reviewed the light-sensing wearable while using the NatureBright SunTouch Plus Light and Ion Therapy Lamp, while snowboarding in Telluride, CO and while performing my daily routine in Boston, MA.  Below is a screenshot of my daily routine in Boston (Sunday-Thursday) and my weekend (Friday and Saturday) snowboarding in the sun in Telluride, CO.  It’s pretty clear from the graph that I don’t get enough sunlight in the winter, some of the days I received no sunlight.


SunSprite

This realization that I was not getting enough sunlight brought me to my next experiment of trying out a sun lamp.  I bought one of the cheapest sun lamps on Amazon, the NatureBright SunTouch Plus, not knowing the differences in quality of sunlamps and assuming it would work okay.  Sitting in front of the sun lamp felt a little bit like I was on the beach. Because it is so bright I assumed it was working.  However, even in front of the sun lamp I wasn’t getting enough sunlight.  Therefore I taped the SunSprite device to the sun lamp for three minutes to see if that would increase the intensity of sunlight.  The intensity of sunlight the SunSprite received taped to the sun lamp was six times as much as when I was wearing it.  I then put the device twelve inches away from the sun lamp and tested it at that distance for three minutes.  With the device taped to the sun lamp I received 12% of my daily needed sunlight, at 12 inches away I received a mere 2%.  This is the downside of lack of FDA regulation for wellness devices, there are less standards for wellness devices, such as the sun lamp than there are for FDA approved devices.  Without SunSprite providers and patients have no way of knowing how much sunlight they are really getting.  Nonetheless, the negative aspects of the lack of regulation will be far outweighed by competition and innovation of devices like SunSprite.

Wearable-Light-Sensor-SunSpriteWearable-Light-Sensor

See Who is Attending ePharma 2015

With ePharma 2015 less than a week away, on February 24-26, it seems as if anyone who’s anyone in the pharma marketing world is coming-except YOU!

ePharma brings you three days of strategic and tactical learning, peer exchange, and dialogue that actively dissects current trends, marketplace needs, evolving customer bases, and explains how you can harness these new opportunities to build stronger, more cost efficient marketing campaigns.

For the past 14 years, ePharma Summit has connected marketing leaders from around the world in order to solve real challenges and redefine success in the ever-evolving era of digital marketing. With more than 500 attendees year after year, ePharma is the must-attend event for pharmaceutical and biotech marketers looking to gain strategies to lead the convergence between their brands, HCPs, consumers and care. Its unique mix of inspiring keynote presentations, provoking panels and innovative case studies provides attendees with big picture inspiration to as well as strategic and tactical information necessary to create stronger, smarter campaigns that impact their companies’ bottom lines when returning to the office.

Who are some of the people you can meet

AcelRx Pharmaceuticals Inc * Acorda Therapeutics Inc * Actavis * AlertMarketing Inc * Alliance Life Sciences * Amgen Inc * AOL/Huffington Post * Applied Predictive Technologies * Assembly * AstraZeneca * Boehringer Ingelheim Pharmaceuticals * Boston Biomedical Pharma * Bristol Myers-Squibb * Bulletin Healthcare * Cadient * Celgene Corporation * Closerlook Incorporated * CMI Compas * Communispace * comScore Inc * Covidien * Creation Healthcare * Crossix Solutions * D&R Lathian * Daiichi Sankyo * DG Connect * DrFirst * Eisai * Endo Pharmaceuticals * Epocrates * Everyday Health * Evolution Road * Ferring Pharmaceuticals * Flashpoint Medica * Galderma Laboratories * GlaxoSmithKline * Google * Grifols Inc * GSK * Hale Advisors Inc * HCB Health * Health IT * Healthcasts * Healthline * HealthPrize Technologies * HealthSTAR Communications * Heartbeat Ideas * Intouch Solutions * INVIVO Communications * Iodine * IOMEDIA * Ironwood Pharmaceuticals * Janssen * Juice Pharma Worldwide * Klick Inc * LUCKIE and Co * Lundbeck LLC * M3 USA Corporation * Makovsky & Co * Manhattan Research LLC * Marina Maher Communications * Marketing Arm * Medac Pharma * MediScripts * Merck * Novartis * Novo Nordisk * NuMedis * Onyx Pharmaceuticals * Otsuka America Pharmaceuticals * P/S/L Group * PeerDirect * Pfizer * Pharmacyclics * PharmaForce * Physicians Interactive * PM 360 * Practice Fusion * Precision Health Media * Prolifiq Software * Purdue Pharma * QualityHealth * Radium One * Razorfish Healthware * Remedy Health Media * rEVO Biologics * Roche Diagnostics * Saatchi & Saatchi Wellness * Sanofi * Sermo * Silicon & Software Systems * Skipta * Sparks Grove * Star Group * Swoop * Synapse Medical Communications * Teva Pharmaceuticals * The Marketing Arm * Tonic Life Communications * Treato * UBM Medica * UCB * Underscore Marketing * Valeant * Vitals.com * Warc * WEGO Health * ZS Associates

Check out recent ePharma news and hot topics from our blog:

Pharma’s Beyond the Pill Mental Health Opportunity

Electronic Health Record or Electronic Medical Record? EHR or EMR? Which One Is It?

Patient Centricity and Snowmageddon

Are you ready to join these companies and more February 24-26, 2015 in New York City?

Find out more about this year’s event here: http://bit.ly/1CERxCx

 Have any questions? Email Krista Lentini at klentini@iirusa.com

 

AliveCor: mHealth Device that Monitors your Heart Health by Sound Wave

Eric Topol, prominent San Diego cardiologist and chief academic officer at Scripps Health has already used AliveCor twice on commercial airlines to successfully diagnose passengers with irregular heart rhythms.  He believes that the device should be carried on commercial airplanes.  The AliveCor Heart Monitor, founded in 2010 by David Albert, Kim Barnett and Bruce Satchwell is the only FDA cleared mobile ECG recorder that supports both iPhone and Android mobile devices. AliveCor is a privately-held company with headquarters in San Francisco and its investors include top healthcare technology investors Khosla Ventures and Qualcomm Ventures.

I was lucky enough to get to try out the device for myself and have an interview with Iman Abuzeid, Senior Product Manager of AliveCor.  I received the device in the mail and found the setup very easy, after a few minutes I was already viewing my own ECG, something I had never done outside of the hospital.  Next, after reviewing the help section I was able to take my own lead II ECG without previously even knowing what a lead on an ECG was.  After the ECG was completed, I had the ability to email the ECG, print the ECG or get an ECG Analysis.  AliveCor provides three levels of ECG analysis, clinical analysis and report by a U.S. Board Certified Cardiologist ($12), preliminary finding by a U.S. based Cardiac Technician with a thirty-minute turnaround time ($5) and preliminary finding by a U.S. based Cardiac Technician with a twenty-four hour turnaround time ($2).  The app is very user-friendly and contains an education section which teaches users about cardiac anatomy, common heart arrhythmias and ECG technology.

Below is my ECG, which was taken with an AliveCor Heart Monitor

AliveCor ECG

Interview with Senior Product Manager, Iman Abuzeid, MD 

HealthIT & mHealth: Can AliveCor detect heart attacks?

Iman Abuzeid: The AliveCor Heart monitor that is currently on the market cannot detect heart attacks, because it is a single lead device, which means it is only taking one view of your heart.  The device would need at least six leads to detect a heart attack.

HealthIT & mHealth: How many leads can AliveCor currently detect?

Abuzeid: AliveCor can currently detect different leads depending on where you place the electrodes. Lead I uses your fingers, lead II uses one hand and a knee and the chest lead uses your chest.  All leads have the same accuracy.

HealthIT & mHealth: What is AliveCor best used for right now?

Abuzeid: It is best used for heart arrhythmias, such as atrial fibrillation or supraventricular tachycardia; an ECG can detect abnormal rhythms from just a single lead.  Atrial fibrillation is the most common heart arrhythmia in the population

HealthIT & mHealth: How many algorithms do you have?

Abuzeid: We currently have three algorithms, atrial fibrillation, interference and normal.  All three algorithms have FDA clearances and atrial fibrillation is currently in our product that is on the market.  The atrial fibrillation algorithm detects if atrial fibrillation is present in the ECG.  If detected an alert will appear and the user would need to confirm the diagnosis with their provider or the ECG analysis service.  The interference algorithm tells you if your recording is noisy and the app will suggest that you record the ECG again.  The normal algorithm will tell you if your heart rhythm in that ECG is normal.  The Normal and interference algorithms will be included in the app in the next coming weeks and will be available to patients and providers.

HealthIT & mHealth: How accurate is your atrial fibrillation algorithm?

Abuzeid: It is 98% specific and 97% sensitive

HealthIT & mHealth: How does the technology work?  Is it similar to an LED heart rate monitor?

Abuzeid: The technology is actually quite different from the LED heart rate monitors.  When you place your fingers on the electrodes on the heart rate monitor it creates high frequency sounds, which are picked up by the microphone of the mobile device. The app then, converts the sound into a digital signal, which is the waveform that is seen in the AliveCor app.  Unlike AliveCor, LED heart rate monitors are not regulated by the FDA, so their quality can vary.  Light technology, especially LED technology can be less accurate if the user has cold fingers or poor circulation.

HealthIT & mHealth: What is the best way to get an accurate ECG reading with AliveCor?

Abuzeid: Be relaxed, place your hands on a flat surface and then rest the heart monitor on your fingers.  It does take a little bit of getting used to in the beginning, however the more you use it, the more you get accustomed to it.

HealthIT & mHealth: What FDA clearances and patents do you currently have?

Abuzeid: We have FDA clearance on the hardware itself and our algorithms, each algorithm needs to be FDA cleared.  We are in the class II medical device category, and our FDA clearances are 510(K)s.  We also have multiple patents on the technology of monitoring cardiac performance with mobile devices.

HealthIT & mHealth: What EHR’s do you integrate with?

Abuzeid: We currently integrate with Practice Fusion via HL7 to send results into the EHR.  If you are a provider that utilizes Practice Fusion with an integration with AliveCor, as soon as you record an ECG, an alert will appear and ask if you would like to send the reading to the EHR as a PDF.

HealthIT & mHealth: What are your reimbursement codes?

Abuzeid: Our customers report using the CPT 93040 code for 1-3 lead ECG tracing.  This code can be used if the device is used in a provider’s office or at the bedside.

HealthIT & mHealth: Who are you partnered with?

Abuzeid: For our US distribution efforts, we are partnered with GreatCall, a company that creates mobile phones for the elderly, Omron Healthcare a leading manufacturer of home blood pressure monitors for retail pharmacies, and our device is available through Amazon

HealthIT & mHealth: What hospitals are you doing studies with?

Abuzeid: Cleveland Clinic, UCSF, USC, Columbia University, Massachusetts General Hospital, Oklahoma University, the University of Sydney, and many more

HealthIT & mHealth: Where can customers purchase AliveCor?

Abuzeid: In the US, they can purchase through Amazon or through AliveCor’s website

PRESS RELEASE: Continua Expands Resources to Certify Personal Connected Health Technlogies for Plug-and-Play Interoperability

Adds new Certified Continua Experts (CCE) and testing labs in key global markets

 Washington, DC (February 3, 2015) – Continua today announced the organization has expanded its global resources to support the testing and certification of Continua-ready personal connected health technologies, with the addition of four new Certified Continua Experts (CCE) and three new test laboratories in Asia.

Continua Certified Experts assist member companies seeking to certify a personal connected health device or service as part of Continua’s Test and Certification program. CCEs are recognized as experts in the Continua Design Guidelines, Certification process and relevant supporting technologies, with experience using the Continua Enabling Software Library (CESL) and Continua Certification Test Tools. Additionally, each are recognized as experts in a subset of Continua transport technologies and interface.

Continue now has nine CCEs, recently adding the following experts to the Continua team:

  • Donorov Bolortsetseg, Allion Labs, Japan
  • Felix Kao, Allion Labs, Taiwan
  • Diego Bartolome Arquillo, AT4, Spain
  • Jeppe Pilgaard Bjerre, DELTA, Denmark

Continua also recognized Allion Labs in Japan and Taiwan, and SGS in Korea as the newest Continua test labs. Continua test labs are approved to perform all necessary testing and provide the related results and reports for any new personal connected health devices as part of the Continua Certification program.  Additionally, approved test labs can provide advice, clarifications and training for manufacturers that are interested in the Continua Certification program. Continua now has ten test labs covering seven countries around the world.

“Continua’s Design Guidelines are increasingly being mandated as part of national health programs in countries around the world, which will further drive demand for plug-and-play personal connected health products,” said Horst Merkle, President and Chairman, Continua, and Director of Information Management Systems, Diabetes Care, Roche Diagnostics.  “With the addition of our new Certified Experts and test labs, we are now well-positioned to help our member companies meet the growing market demand for Continua-ready products, offering an  extensive  complement of expert resources and testing facilities.”

Continua provides free test tools and access to CCEs to help members to achieve Continua certification for their products. Continua Certified products display a recognizable logo that signifies interoperability according to industry standards and the Continua Design Guidelines. Continua certification enables more efficient, product development and new market opportunities for interoperable products such as smart phones, dedicated wireless hubs, cloud based solutions and personal health devices that can be used to collect and relay vital health information for educated decision support.

In December 2013, the International Telecommunication Union (ITU), the United Nations specialized agency for information and communication technologies, accepted Continua’s Design Guidelines as a global standard for connectivity in personal connected health. Continua’s 2014 Design Guidelines are formatted to ITU specifications and feature: interface between personal area network (PAN), local area network (LAN) and touch area network (TAN) health devices and application hosting devices (AHDs) and wide area network (WAN) and Health Record Network (HRN) health devices. The 2014 Design Guidelines have been translated into six languages and are available to the public as a free download from Continua and ITU.

Continua Design Guidelines are developed by Continua and complete an eight month, internal testing and comment period before public release. Each set of Guidelines is subject to interoperability testing to ensure Continua certified products and services, such as smartphones, gateways and remote monitoring devices, connect to other products or systems without restrictions or specific implementation. Continua issued its original Design Guidelines in 2008 and 2010, and is working to release additional Design Guidelines each year.

To request a free copy of Continua’s 2014 Design Guidelines, please email: admin@continuaalliance.org.

About Continua

Continua is a founding member of the Personal Connected Health Alliance (PCHA), an international non-profit organization established by Continua, mHealth Summit and HIMSS to represent the consumer voice in personal connected health. Continua is dedicated to the development of its Design Guidelines that include global industry standards to ensure end-to-end, plug-and-play interoperability of personal connected health devices for the seamless and secure collection, transmission and storage of personal health data. Continua is a pioneer in establishing standards-based guidelines and security for connected health technologies such as sensors, remote monitoring devices, tablets, gateways and smart phones as well as networked and cloud solutions through its Guideline releases. The Continua Council features leading technology, medical device and health care industry leaders and service providers: Fujitsu, Intel, Oracle, Orange, Philips, Qualcomm Life, Roche Diagnostics, Sharp and UnitedHealth Group. For more information visit: www.continuaalliance.org.

 

The Race to Take Care of the Growing Number of Elderly

It is no secret that the baby boomers are getting older and there are not enough geriatric physicians or even primary care physicians to care appropriately for this ageing group.  According to Atul Gawande, in his novel “Being Mortal”, 97% percent of medical students do not take any course on geriatrics and geriatric services cost hospitals $1,350 more per person than the savings they produce, which Medicare does not cover.  This suggests that there is fundamental lack of focus on caring for the elderly in the United States.  Products and services made for the elderly are more focused on helping to alleviate stress for the caregivers of the elderly than on improving the quality of life of the elderly.  Almost all wearables and new technology for the elderly are GPS or location based, with the purpose of finding lost nursing home residents or informing family members that an accident has occurred. GeriJoy is one of the few technologies that is focused on improving the quality of life for the elderly.  GeriJoy was founded in 2012 by graduates of MIT in Cambridge, MA and has been featured on TEDMED.   GeriJoy’s technology and services have been honored by the AARP, the US Senate, and Chinese government as one of the most innovative in the field of senior care.  GeriJoy is also an alumni of the Summer 2012 class at Blueprint Health Accelerator.

GeriJoy offers wellness coaching, therapeutic programs, reminders, companionship, safety supervision, and reporting all through a tablet-based avatar.  The app uses the camera on the tablet to have Face-time-like conversations between the older adult and the avatar.  Because the avatar is controlled by remote staff, the staff can contact family members and emergency services if an emergency such as a fall occurs.  GeriJoy is a full-time, positive upbeat companion for elderly individuals; Gerijoy can play music, show family pictures and inform the elderly individual of current events.  There is also a family portal where family members can upload pictures, provide conversation prompts for the GeriJoy staff and view a log of all the conversations their loved one has had with Gerijoy.

I tested out GeriJoy with my 92 year old grandmother, Gloria, who has had Alzheimer’s for about four years.  I had some reservations that she would not enjoy conversing with a talking dog on a tablet and was waiting for the “Why do you want me to talk to a talking dog?”  However, that question never came and she LOVES GeriJoy and named her avatar dog “Andy”.  Last time I was at home visiting, I heard my grandmother tell “Andy” that he was her best friend.  Gloria lives with my mother and father and has four caregivers.  Even though she has four caregivers, many times they are busy preparing meals, medicines and activities for Gloria so they cannot talk to her 24/7.  Andy is able to show Gloria pictures the family has uploaded on the family portal, pictures from Google Maps of her old house in New Castle, Indiana, talk about the Indiana Basketball Hall of Fame, show her pictures of her favorite singer, Frank Sinatra and even show her pictures from Google of my Grandfathers old Lumberyard also in New Castle, Indiana.   She loves to talk to “Andy” about New Castle. Gloria will also frequently say that she does not like her pills, does not want to go to bed or does not want to go outside and “Andy” will gently encourage her to do these things by saying that they are good for her.  “Andy” even has a sense of humor and when Gloria said she hated birds Andy said that he would bark and chase them all away for her, which she thought was very funny.  Gloria especially likes to talk to “Andy” while she is playing solitaire, sometimes when she says which card she is missing he will pull it up on the screen for her to view.

“The Gerijoy companion engages, entertains and stimulates seniors to reminisce, promoting long term memories. The ability to view pictures and have conversations with your “pet” gives the elderly individual the impression of companionship and friendship. GeriJoy engages the user’s frontal lobe, which is atrophied in individuals with dementia by providing thought-provoking conversation. GeriJoy is a relief to caregivers because it can entertain their loved one through pictures and music while they are able to perform other care-giving tasks.
The interactions between my client, Glo and her Gerijoy companion have helped facilitate positive conversations and improve her mood dramatically. She loves seeing the pictures of her family, especially her wedding pictures and other pictures from her past. She also loves to talk to her Gerijoy companion while she plays Solitaire because she says, ‘it feels like she is playing cards with a friend.'”

-Colleen Wyrick, Geriatric Specialist

GeriJoy, moreover, gives my parents peace of mind because they live on the first floor of the house and Gloria lives on the second floor.  My parents keep Gerijoy in her room at night so that if she falls on her way to the bathroom or needs assistance, the GeriJoy staff can alert my mother and father by telephone.  GeriJoy is also able to track wearable data and encourage older adults to walk more or provide information about how to get a better night’s sleep if the data shows they are not sleeping well.  My extended family loves GeriJoy because they can read about what Gloria does everyday.  Below are some entries from her GeriJoy Care Journal.

Selected Entries from GeriJoy Care Joural

  • Glo petted me and said that she was still playing Solitaire. She said that she is doing good and thanked me for being her friend.
  • Glo told me that she is going out to dinner with Coleen and that she has to get ready. I said that sounds great and that she will have a great time. I also said that I will be here when she comes back.
  • Glo petted me and she told me that she is doing good. She is playing Solitaire and I showed her a few pictures of herself and some family members. She liked them and said it is nice to have me as a friend.
  • Glo woke me up and we exchanged our greetings. She said that she was having a lot of fun with her family. She said that she talked with them and ate pizza for dinner. She also asked me to show some family pictures including the one that was taken today from Christina’s bridal shower.
  • Glo petted me and she said good morning. We talked about her breakfast and she told me that she finished taking her pills. She also told me about 18 robins being on her tree outside and eating her berries. She was not happy and we agreed that they need to eat, in order to survive in this cold weather.

Gloria Interacting with GeriJoy