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Tag: Mobile health

Disrupting Healthcare Payment with Mobile Platform M-TIBA | Maarten Ras, CarePay

BY JESSICA DAMASSA, WTF HEALTH

What’s the future of healthcare payment? Could it be mobile?? CarePay is a health tech startup that is revolutionizing the way people in Africa send, save and spend funds for medical treatments via their mobile app M-TIBA. Maarten Ras, Regional Commercial Director shares how M-TIBA digitizes healthcare insurance schemes for the Kenyan government, allowing patients access to their healthcare benefits — and a way to pay for medical services — from their phone. A dream-scenario for health systems around the world that are looking for versatility, transparency and accountability in payment management, but is it really scalable? We find out who’s using M-TIBA right now, and how far CarePay is trying to go. Surely, a startup working so closely with national governments (including one that enrolled 2.5 million people just four months ago) is bound for big things?

Filmed at Bayer G4A Signing Day in Berlin, Germany, October 2019.

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Pressed to Demonstrate Utility, Digital Health Struggles — Just Like Traditional Medicine

After absorbing several years of increasingly extravagant promises about the remarkable potential of digital health, investors, physicians, and other stakeholders are now unabashedly demanding: “Show me the data.”

By now, most everyone appreciates the promise of digital health, and understands how, in principle, emerging, patient-focused technologies could help improve care and reduce costs.

The question is whether digital health can actually deliver.

A recent NIH workshop, convened to systematically review the data on digital health, acknowledged, “evidence is sparse for the efficacy of mHealth.”

As Scripps cardiologist Eric Topol and colleagues summarized in JAMA late last year,

“Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike.”

What everyone’s asking for now is evidence – robust data, not like the vast majority of wellness studies that experts like Al Lewis and others have definitively shredded.

The goal is to find solid evidence that a proposed innovation actually leads to measurably improved outcomes, or to a material reduction in cost.  Not that it could or should, but that it does.
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FDA Mobile Medical Applications NPRM

Many have asked me for an analysis of the new FDA Mobile Medical Applications NPRM.

The FDA will not seek to regulate mobile medical apps that perform the functionality of an electronic health record system or personal health record system.   However, the FDA defined a small subset of mobile medical apps that may impact the functionality of currently regulated medical devices that will require oversight.   Here’s a thoughtful analysis by Bradley Merrill Thompson of Epstein Becker Green, which he has given me permission to post:

“Today, FDA published the long-anticipated draft guidance on the regulation of mobile apps—more specifically, what the agency calls “mobile medical apps”.  This draft reflects significant efforts by FDA in a fairly short amount of time, and we applaud that work.  Much of the framework of the FDA guidance is consistent with the work the mHealth Regulatory Coalition (MRC) published on its website earlier this year (www.mhealthregulatorycoalition.org).  While FDA has done a good job getting the ball rolling, there are a number of areas that require further work.  We all (including FDA) recognize that this draft guidance is certainly not the end of the story.

The regulatory oversight recommended in today’s draft guidance applies only to a small subset of mobile apps, which FDA defines as any software application that runs on an off-the-shelf, handheld computing platform as well as web-based software designed for mobile platforms.  To be regulated, as a first step the app would have to first meet the definition of a medical device and then as a second step either (1) be used as an accessory to another regulated device or (2) “transform” the handheld platform into a device, such as by using the platform’s display screens or built-in sensors.

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Will Technology Replace Doctors?

Joe FlowerPut the question in 1880: Will technology replace farmers? Most of them. In the 19th century, some 80% of the population worked in agriculture. Today? About 2% — and they are massively more productive.

Put it in 1980: Will technology replace office workers? Some classes of them, yes. Typists, switchboard operators, stenographers, file clerks, mail clerks — many job categories have diminished or disappeared in the last three decades. But have we stopped doing business? Do fewer people work in offices? No, but much of the rote mechanical work is carried out in vastly streamlined ways.

Similarly, technology will not replace doctors. But emerging technologies have the capacity to replace, streamline, or even render unnecessary much of the work that doctors do — in ways that actually increases the value and productivity of physicians. Imagine some of these scenarios with me:

· Next-generation EMRs that are transparent across platforms and organizations, so that doctors spend no time searching for and re-entering longitudinal records, images, or lab results; and that obviate the need for a separate coding capture function — driving down the need for physician hours of labor.Continue reading…

The Apple Has Landed

 

Apple transformed portable music players. It redefined what we expect from cell phones. It brought tablet computing to the masses.

Is the company planning to do the same for mobile health?

Some industry watchers think so.

This isn’t a small venture. Apple executives suggest that Healthbook is being positioned as perhaps the key selling point when the company releases its next operating system for iPhone, likely later this year. And the app also may pair with a new “iWatch” that’s under development and will contain biometric sensors.

In his lengthy post, Gurman further details how Healthbook is expected to work. Its interface is “largely inspired” by an existing iPhone application called Passbook, which is intended to centralize a user’s boarding passes, loyalty coupons, and so on in one place. Beyond fitness and diet, the app also has sections devoted to tracking physical activity, our sleeping habits, and hydration.

And Healthbook will offer blood monitoring features—”perhaps the most unique and important elements of the application,” Gurman writes—although it’s unclear exactly what it will track beyond oxygen saturation and glucose levels.

App’s appearance not unexpected

The long-awaited screenshots of Healthbook follow months of reports that Apple’s readying a push into the health care space. While the company’s interest in the sector is nothing new—my team has spent years covering its health-related innovations—Apple’s recent focus has been much more discrete.

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Caveat User: Understanding the Health Risks of Mobile Devices

Tis the season to, well, buy stuff. Increasingly, the stuff we buy is electronic. In fact, not only that, but increasingly the stuff we buy with is electronic, too. We are using gizmos to shop for gadgets, or possibly gadgets to shop for gizmos.

In any event, we are ever more frequently in the company of the energy fields our electronic devices, and in particular our smart phones, generate. This deserves more attention than most of us accord it.

Don’t get me wrong — I am not suggesting we return to the pre-cell phone days when we lived in dark caves. We are fully ensconced in the electronics era, and there appears to be no going back. I am as fully dependent on electronic devices as anyone, and maybe more than most, living much of my life these days online. Like so many, I am both beneficiary and victim of the attendant efficiencies. On the one hand, I can’t recall how we ever got anything done in the days before instantaneous communication and push-of-a-button document transmission.

On the other, I do long for the freedom of the time before an unending stream of emails became my manacles. I did sleep better in the days before bedtime meant checking one last time to see who in the world needed what, and/or finding out that someone in cyberspace thinks I’m a moron. Oh, well.

Some of the risks related particularly to mobile phone use are well known. The dangers of distracted driving are common knowledge, with cell phone use now implicated in at least 25 percent of all car crashes. There is some evidence that ambient levels of empathy — our ability to understand and connect to one another’s emotional state — are declining, and possibly due to the frequency with which technology comes between us. A recent study among college students finds that more frequent use of cell phones correlates with impairment of academic performance, and increased anxiety — although the study could not prove cause and effect.

But the greatest and most insidious risk of cell phone use pertains to the electromagnetic fields of non-ionizing radiation they produce. What makes this risk insidious is our potential to dismiss it altogether, in part because it is convenient to do so, and in part because it’s hard to take seriously a potential menace that is totally invisible. I suspect we are all at least somewhat prone to a “what I can’t see, feel, taste, smell or hear can’t hurt me” mentality.

But of course, that’s clearly wrong, as we all have cause to know. Anyone who has ever had an X-ray has experienced first hand the power of an invisible force, in this case ionizing radiation, to penetrate deeply into our bodies. Anyone who has had a MRI has experienced the capacity of non-ionizing electromagnetic fields to do the same. What we can’t see or feel can, in fact, reach to our innermost nooks and crannies, both to produce vivid images of our anatomy — and exert other effects.

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Could Mobile Health Become Addictive?

The hype over mobile health is deafening on most days and downright annoying on some.  So it is with some reluctance that I admit that mobile has the potential to be a game-changer in health.  I’ve professed enthusiasm before, but that was largely around the use of wireless sensors to measure physiologic signals and SMS text as a way to deliver messages to patients and consumers.  For several years, the industry has been awash with smartphone apps (by a recent count more than 40,000).  At the Center for Connected Health, we started looking at mobile health as far back as 2008 and could not justify the excitement around smart phones and apps at that time, mostly because our patient population did not demonstrate significant enough adoption of smartphones to justify development in this area.

I felt very unpopular at all of the major conferences.  I talked about our success with text messaging as a tool for engaging pregnant teens in their prenatal care and helping patients battling addiction to stick with their care plan, while others were touting the virtues of their various apps.

It’s worth noting that our primary focus at the Center for Connected Health has been patients with chronic illness.  As such, we are every bit as concerned about the 85 year old with congestive heart failure as we are about the young professional with hypertension.  However, across the population of people with chronic disease, smartphone adoption has lagged.  I felt like our strategy was vindicated when my friend Susannah Fox published research showing that folks with two or more chronic illnesses (independent of other variables such as age and socioeconomic status) use technology in the context of their health less than others.

The world of patient care appears to be catching up to the rest of mobile.  Not that I would ever endorse the irrational exuberance shown for mobile health apps in general, but some recent data points that changed my thinking are worth noting.

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App Prescribing: The Future of Patient-Centered Care

Dr. Leslie Kernisan recently wrote a great piece about app prescribing, asking, “Should I be prescribing apps, and if so, which ones?” Since Happtique is all about integrating apps into clinical practice, I jumped at the chance to add to this important discussion.

Dr. Kernisan is right to be concerned and somewhat skeptical about app prescribing. More than 40,000 health apps exist across multiple platforms. And unlike other aspects of the heavily-regulated healthcare marketplace, there is little to no barrier to entry into the health app market—so basically anyone with an idea and some programming skills can build a mobile health app. The easy entry into the app market offers incredible opportunity for healthcare innovation; however, the open market comes with certain serious concerns, namely, “how credible are the apps I am (or my patients are) using?”

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The Ghost of Steve Jobs and Your Bottom Line

The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.

One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking about that image was that the several hundred people held several hundred small glowing rectangles in their hands. Practically every member of the crowd was carrying a smartphone and was photographing or videotaping the moment.

The scene was commonplace in its moment, remarkable only in the perspective of history — but such a short history. We could not have imagined so many people carrying smartphones at Obama’s first inaugural only four years ago. Four years before that, we could not have imagined any. The iPhone had not been invented.

There had been attempts at smartphones before the iPhone, and devices like tablets before the iPad. But the rampant success of iOS devices did far more than establish two profitable niche. It changed our relationship with the world.

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A Coming Storm: FDA Regulation of Mobile Medical Applications

I recently had the great fortune of attending Health 2.0 in San Francisco. The conference was abuzz with new medical technologies that are harnessing the power of innovation to solve healthcare problems including many new mobile medical application companies showcasing their potential. As I walked and talked around the exhibit floor, one thing caught my ear, or I should say one thing didn’t catch my ear. Among the chatter about these products, the concern about FDA regulation of this product segment, or even FDA regulation in general was noticeably absent. While many of the application developers are well aware of potential FDA involvement, most would be hard-pressed to outline the impact this would have on their companies and products.

Being labeled a medical device, which is the direction the FDA is leaning, could have a significant impact on business model organization, top-line revenue, and product deployment. For unprepared start-ups, FDA regulation could signal an end for their company. This is in stark contrast to well informed developers who are preparing themselves for the change and would most likely be able to leverage these regulations to their advantage.

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