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mHealth’s Year in Review: From Texting to Wearables to Telehealth’s Tricks (And Treats)

The past 12 months have been exciting for mHealth and telehealth enthusiasts, as a review of mHealthIntelligence.com's top news stories shows.

By Eric Wicklund

- Text messaging for physicians, telehealth’s tricky definitions and wearables topped the list of popular stories on mHealthIntelligence.com during the past year – and may offer readers a clue of what to expect in 2017.

By far the most popular topic of conversation in 2016 is one that’s still taking place: The Joint Commission’s ban on text messaging for clinicians. The commission ended the five-year-old ban this past April, saying securing messaging technology had improved to a point that a doctor or nurse could send a secure message to someone without reasonable risk to patient data. Two months later, the commission restored the ban, saying it needed more time to come up with guidelines for providers.

Just this month, the commission announced a partial lifting of that ban. In a joint decision with the Centers for Medicare & Medicaid Services (CMS), the commission announced that providers could use a secure text messaging platform to consult with each other and send patient information, but they couldn’t text patient care orders.

Expect that issue to continue into the new year, as the commission and CMS work to further define the text messaging space for clinicians.

A tricky question came in second in the year-end poll: The difference in definitions between telehealth and telemedicine. While some organizations and boards have seemingly lumped the two together, others are taking great pains to separate telemedicine – the more clinical application of the technology – with telehealth – a broader term encompassing the consumer, care delivery and education.

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Facing an array of terms with no clear definition, the Connected Health Initiative, an offshoot of ACT | The App Association, released a consensus document defining asynchronous, or store-and-forward, telehealth (a term that has bedeviled Arkansas’ medical board). The board expects to issue more definitions in the future, and has plenty of candidates from which to choose.

Coming in third on the list was a story recently published in the Journal of the American Medical Association on a study conducted in 2010. The story reported on the results of a University of Pittsburgh study on wearables and weight loss, and concluded that wearables aren’t helping people lose weight because they’re uncomfortable.

One problem: The wearable used in the study, the BodyMedia Fit tracker armband, is no longer on the market. The admittedly vast wearables market, in fact, has evolved considerably since that study was completed in 2012. Comfort and fashion are now ingrained in most wearables – though healthcare providers are still reluctant to adopt consumer-facing products for clinical purposes.

This story highlighted one other facet of the mHealth industry: It’s moving quickly, so you’d better make sure your evidence is up-to-date.

This fall, Kaiser Permanente CEO Bernard J. Tyson announced at a San Francisco conference that his health network had seen more patients online than in person during the year – 52 percent checking in with their doctors and nurses through portals, mHealth apps and virtual visits. While some questioned Tyson’s definition of a “visit” – does that include e-mailed questions, say, or medication reminders, or just doctor-patient visits? – the implication was clear. Telehealth is becoming a standard tool for connecting the consumer with the healthcare provider. It may take a while before a doctor conducts more patient exams online than in person, but that time will come.

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Fitbit made news time and again this past year. The maker of the world’s most popular consumer-facing health and fitness wearable is slowly, but steadily, working its way into healthcare, with a long and impressive array of healthcare pilots and partnerships. The year’s most popular Fitbit story detailed Children’s Hospitals and Clinics of Minnesota, which had equipped young type 1 diabetics with the fitness tracker to monitor their sleep and activity at home.

Hospital officials pointed out that they weren’t necessary looking for super-accurate data upon which to make a clinical decision – they were looking for trends and patterns that could help them see what their patients were doing outside the office, and which could help them in creating care management plans that would be effective.

More recently, Fitbit announced a partnership with Medtronic that combines the latter’s blood glucose data with the former’s fitness and sleep data, enabling diabetic patients and their doctors to chart how activity and sleep affect one’s health. That once-huge distance between consumer devices and clinical uses is closing.

Next on the list of the year’s top stories is one detailing the efforts of Delaware’s medical board to mandate that nutritionists and dieticians meet with new patients in person before continuing the relationship via telehealth. Delaware is one of several states grappling with the definition of a valid doctor-patient relationship, one that pits traditional providers against telehealth and mHealth supporters who feel a provider can treat patients – new and long-time – online, via video or even by telephone (though that method is still banned in many states)

Even the American Medical Association weighed in, approving a new set of guidelines for the ethical practice of telemedicine (after more than a year of debate) that signal a support for the technology and an understanding that it has its limitations and can interfere with the doctor-patient relationship if done wrong.

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Expect this issue to continue well into the new year as more states and medical boards look to establish their own rules for telehealth.

Seventh on the list of the year’s top stories is the Expanding Capacity for Health Outcomes (ECHO) Act, a bill launched by Sens. Brian Schatz (D-Hawaii) and Orrin Hatch (R-Utah) to elevate the University of New Mexico’s groundbreaking telehealth platform for provider collaboration to the national stage. The bill sailed through both the Senate and House, and now puts in place a two-year study on how various Project ECHO programs around the country are performing. Eventually, supporters hope, the platform will be supported – and funded – as a national program.

Not all the news in the telehealth world was good this year. HealthSpot, the Ohio developer of high-end, room-sized, fully-enclosed telehealth kiosks designed for everywhere from pharmacies to health clinics to community centers to cruise ships, went out of business. The company had gained a lot of traction in its three years, appearing at several healthcare conferences and partnering with the likes of Rite-Aid, the Cleveland Clinic, Kaiser Permanente and the Mayo Clinic.

But the kiosk was big, loaded with tools and expensive, not a good combination considering it was intended for underserved communities and areas where healthcare might not be high on the list of funded priorities. HealthSpot couldn’t sustain its business plan, proving that sometimes simpler is better.

Coming in ninth on the list is the U.S. Food and Drug Administration’s efforts to regulate the “Wild, Wild West” of mHealth apps. The FDA has generally drawn praise for its plans to focus only on apps that affect clinical outcomes, and to stay away from low-risk apps and mHealth devices (such as health and wellness products). Still, mHealth supporters say the agency isn’t doing enough to establish guidelines for clinical decision support tools – and critics assail the FDA, the Federal Trade Commission and other agencies for being too restrictive, and thus hindering innovation.

With the passage of the 20th Century Cure Act and what is generally seen as a more business-friendly administration moving into the White House in 2017, expect the back-and-forth to continue.

Finally, there’s the Consumer Electronics Show, the massive conference-cum-celebration of all things new and geeky and exciting that takes over Las Vegas each January. With its two-day Digital Health Summit and ever-expanding exhibit space devoted to personal health and wellness, CES has attracted curious healthcare executives for years. The show offers a unique insight into what it takes to snag the consumer’s interest and entertain or engage him/her.

As hospitals and health systems continue to grapple with engagement issues and consumer-directed healthcare, they’ll look to CES for ideas, strategies, even advice on how to make a platform, device or app more appealing to the public.  

Dig Deeper:

Factors Behind the Adoption of School-based Telehealth

Telehealth Reimbursement and Its Interstate Licensure Problem

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