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Digital Health Technologies for Alzheimer’s Disease

Digital Health Technologies for Alzheimer’s Disease | Healthcare and Technology news | Scoop.it

According to The Alzheimer’s Association, there are over 5 million Americans with Ad. It is the sixth leading cause of death. More than 15 million caregivers provided an estimated 18.1 billion hours of unpaid care at a value of approximately $221.3B. The impact of this disease is also well-illustrated in a recent  PBS documentary.  While it might seem incongruous on the surface to discuss digital technology and a population with significant cognitive challenges, I will illustrate how it can be beneficial at different stages of the disease’s course.

 

Cognitive Assessment Tools.  Most tools for assessing cognitive abilities have been of the traditional written form, as offered by the Alzheimer’s Association.  The ability of digital tools to detect early diagnosis of Ad is important in medical and social planning for the patient and family. Some have taken traditional diagnostic tools and transformed them into a digital platform. Such is the case with Quest Diagnostics’ CogniSense.  A more transformational approach is one seen with a utilization of the Anoto Pen which can measure the writing instrument’s position up to 80 times per second. An exciting study by the Lahey Medical Center and MIT’s Computational Science and Artificial Intelligence Laboratory looked at using the Anoto Pen versus traditional cognitive assessment tools for Ad and other diseases. This method has already shown advantages over traditional tools, described in an MIT News piece: “… while healthy adults spend more time on the dCDT [digital clock drawing test via Anoto] thinking (with the pen off the paper) than “inking,” memory-impaired subjects spend even more time than that thinking rather than inking. Parkinson’s subjects, meanwhile, took longer to draw clocks that tended to be smaller, suggesting that they are working harder, but producing less — an insight not detectable with previous analysis systems…”  A digital platform called Neurotrack claims it has the ability to detect Ad at its earliest stages by assessing recognition memory, a function specific to the brain’s hippocampal region which is affected early in the course of Ad. Digital assessment tools like these can also save clinician time and offer a better objective patient assessment.

 

Cognitive Improvement tools. A handful of small studies have shown that ‘brain exercise’ in the form of cognitive augmentation games decreases the risk in normal individuals of getting Ad. One would naturally ask if this carries over to those already diagnosed AD. Some earlier studies suggested this was the case. An older review of multiple small studies showed that while they suggest that brain exercises slowed progression of cognitive decay they did not affect mood or the ability to care for oneself.  It is worthy of noting that patients with larger baseline ‘cognitive reserve’ do better to a point then characteristically have a rapidly progressive course. In a previous post, I discussed the merits of music as an ideal digital health tool. Music should be considered as a potentially much appreciated and useful tool.  Relative to Ad specifically, I would reference the incredibly informative and moving award-winning film Alive Inside, documenting the response of patients with severe Ad to music relevant to their personal past. An intriguing interactive game/tool is Tovertafel, a Dutch technology which projects via suspended box visuals onto a table.  There are various exercises and games on the platform which are both enjoyable and mentally stimulating. Less sophisticated yet popular games are offered by the Alzheimer’s Association.

 

Tools for monitoring daily activities. Technologies have been developed to aid patients with mild to moderate disease and their caregivers to make daily activities easier and safer. SmartSole makes an innersole with a GPS locator with an associated smartphone app and call service for alerts. Silver Mother by Sen.se is a customizable digital tech platform (front door position, room temperature, and water and food containers) connecting caregivers with love ones’ activities of daily living.  For patients with early dementia or for caretakers to connect with loved ones at a distance, grandCAREis a very comprehensive platform and service.

 

While one might associate digital tools with those of us who are “connected,” their utility in the realm of Ad can be profound.  I would submit that the potential for digital tech to prolong independence and/or improve lives of caregivers in the home or at a distance must be the subject of clinical studies.  Public health policy might very well change as a result of such outcome studies.

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Precision Medicine: The Future Of Health

Precision Medicine: The Future Of Health | Healthcare and Technology news | Scoop.it

As science and technologies advance and demand continues to grow, healthcare systems have to evolve into a more sustainable model that maintains people’s wellness rather than just treating illness once it has occurred. Through a combination of proactive human interventions and decisions – supported and enabled by rich data and intelligence – that model will be more effective by being much more precisely directed at the individual.

Precision Medicine is based on four key pillars of care: Predictive, Preventive, Personalised and Participatory. A good illustration of how these four pillars work is the story of Dr Martinez, based on The Case for Personalized Medicine, Personalised Medicine Coalition, 3rd edition.

 

  • Dr Martinez is sitting down with his laptop. On the website that he uses to manage his practice, an alert pops up warning him that several new mutations found in 10 percent of people have been discovered to be associated with the likelihood that they might convert to type 2 diabetes. All of his patients have had their entire genome sequenced and entered into their electronic medical record. He conducts a quick search of this 2,000-patient database and finds about 80 who are at risk (Predictive care).
  • To half of those patients, he sends a strong reminder and advice on diet and lifestyle choices they can take to avoid the disease (Preventive care).
  • For the other half, whose medical records reveal pre-diabetic symptoms, he sets up appointments to consider more proactive treatment with drugs that can prevent the onset of the disease (Personalised care).
  • Patients can download an app certified by the healthcare system that will allow Dr Martinez to remotely monitor their glucose blood levels (Participatory care).

 

As that example shows, Precision Medicine depends on clinicians and citizens being proactive and working together to look after health and wellbeing. The success of that partnership relies on the healthcare system’s ability to transfer breakthroughs in data analysis across into healthcare settings – ‘from the bench to the bedside’. Massive volumes of raw, complex and heterogeneous data have to be acquired, validated, stored, processed and analysed using high performance computing systems. They then need to be interpreted and presented (through dashboards and reports) in meaningful ways to clinicians. Individual citizens can become more proactive in starting specific preventive treatments, or make lifestyle changes that prevent the onset of the disease or minimise its impact.

 

In this democratisation of medicine, genomic testing plays a very relevant role. DNA sequencing technologies are being adopted as part of routine practice as a powerful tool for early diagnosis and for personalised treatment. Getting access to the molecular profile of patients and correlating this data with phenotypic information (the expression of specific traits, such as stature or blood type, based on genetic and environmental influences) is an enormous cultural shift. This fast-evolving, immensely powerful new diagnostic tool is revolutionising healthcare and supporting clinicians, citizens, carers and society to work together in new ways to make predictive, preventive, personalised, participatory health and social care a reality for all.

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Vendors lagging with patient engagement technology

Vendors lagging with patient engagement technology | Healthcare and Technology news | Scoop.it

Despite conditions across the healthcare industry that should be driving big changes in between-visit and post-discharge communications, most providers are still doing the "bare minimum" with regard to patient engagement, according to a new report from Chilmark Research.

Advances in mobile and cloud technologies, consumerization of care delivery, meaningful use incentive payments and a broader move toward value-based reimbursement would seem to be creating ripe conditions for more fruitful engagment initiatives. But Chilmark's 2014/2015 Clinical Patient Engagement Market Trends Report shows a healthcare industry "still struggling to catch up with basic consumer expectations set by banking, airline and other major consumer industries."

Part of the fault for that lies with vendors, the study shows, since many healthcare organzations lean heavily on their technology providers to help drive their patient outreach projects.

"The majority of today's market is operating at a kind of standoff: provider organizations are relying on their existing vendors to lead the way on new engagement tools, while those companies have been reactive, not proactive, with their customers' engagement needs," said Naveen Rao, author of the report, in a press statement.

[See also: Patient engagement: Are docs doing it all wrong?]

"The more innovative products – the mobile apps, cloud-based care plans, remote-monitoring plays – are coming from outside traditional legacy vendors' purview. While some of the bigger vendors are showing signs of updating their products, we expect to see most legacy vendors follow a buy rather than build strategy to address market needs more rapidly."

Vendors profiled in the Chilmark report include: Aetna/iTriage, Allscripts, Axial Exchange, Cerner, Dossia, Emmi Solutions, Get Real Health, GetWellNetwork, Influence Health (MedSeek), McKesson/RelayHealth, MedFusion, Microsoft HealthVault, NoMoreClipboard and WebMD.

In his report, Rao found that basic patient portals, usually tethered to electronic health records, are still the basic tool for most patient-provider interactions.

Chilmark found a mixed market for new approaches to clinical patient engagement, where some provider organizations have yet to adopt even these basic patient portals, others have begun piloting advanced, "smart" tools.

Still, it seems clear that patient engagement remains a lower priority for most providers as they work toward building analytics capabilities, mastering risk-based contracting and other projects aimed at laying the groundwork for better population-based health management, according to Chilmark.

For those organizations looking for better engagement tools, Chilmark points to several vendors – including some with backgrounds in information exchange or customer relationship management – that are finding footholds with products untethered from EHRs.

Still, even with this group, most offer limited or no mobile-friendly technologies or advanced care planning applications, Rao finds. Other tools that have found success so far – from standalone mobile tools to interactive inpatient platforms, "do not represent complete, end-to-end solutions," according to Chilmark.

That suggests an emerging best-of-breed approach, the report argues, where providers will pick and choose multiple vendors in an effort to meet the diverse clinical and business needs across different departments and patient populations: "No one technology vendor has shown an ability to do it all."

The Chilmark report profiles 14 vendors of clinical patient engagement solutions, rating them on both the completeness and sophistication of their product offering as well as their performance in serving the provider segment of the healthcare industry. Most of them "fared poorly in creating longitudinal records" and offering the mobility most consumers expect.

"While the patient portal reigns as the default engagement platform, we are seeing a blossoming industry full of novel techniques, innovative technologies and even some fresh ideas for how to keep patients involved in their care," writes Rao in the report.

"These typically involve a far greater degree of collaboration between clinicians and patients, and often result in the production of patient-generated health data that can serve as a valuable piece of patients' overall longitudinal record," he adds. "A complete record, with patients' data stored alongside clinical notes, lab values and so forth is able to serve as both a "single source of truth" on a patient across multiple care settings, as well as a medical "home base for their ongoing care journey."

Nonetheless, while these newer approaches "are being piloted in dozens of pockets around the country," Rao writes, "entering 2015, more comprehensive deployments remain elusive."


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Anna Dunmeyer's curator insight, February 18, 2015 11:10 AM

According to a new report, vendors are doing the 'bare minimum' regarding patient engagement and many are leaning heavily on their technology providers to help drive their patient outreach projects. This could be a great chance for the EHR providers to move things forward.

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Digital Technologies can Address Cancer

Digital Technologies can Address Cancer | Healthcare and Technology news | Scoop.it

There have been remarkable strides in prevention and treatment of disease in the past 5 decades.  Few have rivaled targeted cancer therapies based on digital health, specifically genomics in scope and breadth.  I’d like to touch on a few ways in which digital technology is impacting cancer.

 

1. Targeted therapies. One only has to watch the avalanche of television commercials for cancer centers both local and national to appreciate the role genomics now plays in choosing therapies today for cancer. In simple terms, cancers have genetic fingerprints which are becoming specific targets of newer drugs. Different types of cancers may share similar genetic markers. Getting more layered in complexity, the same cancer may experience genetic changes during its course.  The National Cancer Institute offers a more in depth discussion of genomics and cancer.  An ambitious initiative with far-reaching implications is the National Cancer Institute’s NCI-MATCH (Molecular Analysis for Therapy Choice) trial. IBM Watson Health has recently partnered with Quest Diagnosticsto provide clinicians with recommended “… unbiased, evidence-based approaches based on a detailed view of the tumor’s mutations, scientific journals, and MSK’s OncoKB, a precision oncology knowledge base..” The possibilities are indeed many in this space and the use of digital tools like genomics and artificial intelligence are accelerating our knowledge and successes.

 

2. Registries.The traditional collection of information on cancer has been with the collection of limited data derived from patient demographics, health history and episodic office encounters. There are now digital technologies now which incorporate raw data from pathology, genomics, imaging studies, patient reported symptoms and follow-up and more. In a previous post I describe ways in which a well-designed registry can address multiple stakeholder needs. The value of an excellent tech-based registry is best appreciated in oncology and rare diseases. As someone who has a family member with a very rare cancer, I have seen first-hand the potential benefits of and resistance (primarily ‘political’) to such registries which would expedite decision-making via pooled experiences.

 

3. Connected care: apps: Connected care today includes such technologies as wearables and mobile health apps. Benefits of connected care include triangulating the transmission of information (among clinicians, patients and caregivers), convenience, and timeliness. Three impressive mobile apps in the oncology space are:

 

a. Pocket Cancer Care Guide. Helps patients and caregiver obtain information about specific cancers, understand medical terminology, builds lists of questions to ask physicians, and provides the ability to record and save clinicians’ answers to questions.

 

b. Cancer Side-Effects Helper by pearlpoint. “…offers trusted nutrition guidance and practical tips to help survivors feel better, maintain strength, and speed recovery from common cancer side effects…”

 

c. My Cancer Genome. Managed by the Vanderbilt-Ingram Cancer Center, this award-winning app has both clinician and patient-facing information on cancer genomes, targeted therapies, and provides updated appropriate available clinical trials.

 

4. Connected clinical trials. The rising cost of clinical trials, the increasingly recognized importance of patient reported outcomes, and the transformation of trials with electronic data capture all suggest the value proposition of digital tech in clinical trials. Obtaining real-time vital sign trends, patient-reported adverse events (drug side effects/toxicities, unplanned ER or office visits), and outcomes data will make clinical trials more relevant (by recruiting a larger and more diverse patient population via digital tools), less costly and safer.

 

5. Social media support. The convergence of social media and healthcare was both inevitable and beneficial for patients. The advantages of online support groups over traditional in real life organizations are many. Access to information, governmental agencies, empathy, and convenience are some of them. Twitter has contributed greatly in this regard. TweetChat groups focusing  on specific diseases abound.

 

Critics of digital technology in healthcare raise valid issues regarding accuracy and reliability of information, privacy and security, and patient safety. There are existing regulatory guidelines addressing these, arguably not comprehensively enough.  Accurate and reliable information about cancer is available via many digital avenues. Digital technologies are an integral part of cancer diagnosis and treatment today.  We are living in an age where they might be among the most important tools we have as clinicians, patients, and caregivers. Hats off to those dreamers who make it possible!

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Why Doctors need an All-rounder Healthcare Solution?

Why Doctors need an All-rounder Healthcare Solution? | Healthcare and Technology news | Scoop.it

Every person loves technology just because it makes your life easy. Each day a new problem is discovered, a solution is also researched for. This is how the tech world is growing each day. Just like the synapses connecting neurons in the human body, every doctor would like an interface which connects his entire clinical workflow. It’s a common requisite that a single solution meets many problems simultaneously.

 

A doctor’s time table has a tight schedule where he would be meeting many patients a day and some days would have unexpected numbers too. As a doctor you have to be more service minded and attend patients whenever there is a need. The doctor would be desirous to have a system which can save his time as well as take a good record of his complete clinical workflow.

 

Any doctor would find it helpful if he finds a flexible system which is cost effective and easy to use. The doctor would be comfortable to control activities from patient scheduling to the inventory management on his own rather than depending on the admin alone. A doctor needs an all-rounder healthcare solution as it is tough to handle when there is a large volume of data. An organized connection will allow a smooth work flow which will reduce chaos and makes it easy for doctors as well as the patient. A doctor would want an all-rounder healthcare solution.

 

  • To keep a record of patient data and record of the day-to-day activities
  • To have a single ‘touch point’ for data access
  • To have a seamless control over the entire continuum of care
  • To be cost effective by using a single set up rather than purchasing many and connecting them
  • To be able to access data from any point of the world and also for easy sharing
  • To have an efficient space management

 

There is no wonder why doctors are shifting towards using EHS(Electronic Health Solution),Patient portals, etc. as they have found advantages in such systems which can an efficient interface connecting them with the patients. The advantages of using the internet connection and the cloud in the medical sector have helped them trust HITaaS which they have already accepted to be a part of their profession. The future will see doctors using more of systems like BlueEHS and completely move from their conventional methods so that their professional life becomes more easy and flexible.

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Experts: Tech is changing health care, but with caveats - Nashville Business Journal

Experts: Tech is changing health care, but with caveats - Nashville Business Journal | Healthcare and Technology news | Scoop.it

Everyone has examples of the way technology could transform health care (and in many cases, how it already has).

A Nashville Business Journal panel Tuesday morning focused on digitally connecting with health care consumers, and a handful of local experts shared some of their favorites.

Through use of a bedside tablet, patients and their families could have more control over non-clinical aspects of a hospital stay, like food service or room temperature, said Julie Groos Van Tassel of Microsoft. Or, others suggested, physicians can use advanced communication tools to share information with their patients after they leave the office, or quickly access information they need to answer a patient query in the middle of the night.

But all these transformations come with some caveats, the panelists said. Many technological transformations in the industry, like the switch to electronic health records, are being driven by government mandates. But those mandates haven't always taken into account the need for functional workflow and interoperability, said Keri Cullity, managing director of health care advisory for KPMG.

Plus, patient portals, one of the primary patient-facing aspects of EHRs, don't cultivate the engagement the panelists want to see from patients.

"From my perspective a portal is not engagement," said Robert Taylor, chief medical officer of RoundingWell and a practicing partner at Nephrology Associates in Nashville, because patients simply access information, they aren't "activated" to make changes in their health.

Overall though, providers and health care observers are optimistic about the potential of technology to change patient and physicians lives. But when moderator Michael Beaty of KPMG asked what the return on investment is for digital connection tools, the answer was not a whole lot — for now.

"The big barrier … is the fact that we haven't pulled the band-aid off of fee-for-service," said Groos Van Tassel.

Jeff Patton, CEO of Nashville-based Tennessee Oncology, agreed. A great patient experience is a plus for patients visiting his practice group, but that's not the marketing edge that's going to increase volume. And in a fee-for-service world, there aren't many financial rewards for using those tools to improve the outcomes of a patient's visit.

"Once we're value-based you'll see these tools take off. … But for now it's not in the black, it's in the red," Patton said.



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