Healthrageous

The wireless remote health monitoring market is white hot these days. Seems like a lot of creative folks are looking at the increasing ability of connected devices, sensors and wondering why aren’t these disrupting healthcare. Some luminary research centers rooted in academic institutions have found enough financial support to establish formal presence specifically in this space. West Wireless Institute in San Diego, UCLA Wireless Health Institute are good examples.

Established in 1995, the Center for Connected Health is another such example within Partners HealthCare in Boston. They’ve dabbled in a number of remote monitoring pilots- diabetes, dermatology, heart failure, etc. Healthrageous is their first spin-off. It started as a pilot project conducted in 2006 with EMC Corp. to give employees self-management tools for blood pressure. In June 2010, Healthrageous raised $6 million in a Series A funding led by North Bridge Venture Partners of Boston.

Having read enough of them, I think the marketing message around the concept of continuous care through remote monitoring has now been perfected from multiple angles. Read the descriptions from Welldoc, HealthBuddy, Telcare, iMetrikus, Hommed, Cardiocom, Gentag, BL Healthcare for example. Healthrageous also does a good job at describing the high-level value proposition.

But it seems that the transition from online paragraphs to a generally available, well-known and affordable solution has not happened. I searched for what product/service I could buy through Healthrageous to help a close friend manage her hypertension, but couldn’t find anything. There are some encouraging success stories on the website, but no explanation as to where can one sign up for becoming a success like that. I wish these websites were more transparent and lucid, maybe even at the risk of being less enchanting.

PS: Found two candidate consumer-oriented solutions for remotely managing hypertension. One is not available yet (Withings BP Monitor), and other needs an Apple iOS device to work (iHealth Lab’s BP3) and didn’t get great reviews. If anyone knows of other products/services, please share through comments below.

Enhanced by ZemantaUpdate Oct 2013: Healthrageous closed shop this month. Apparently the backing of big names like Partners Healthcare and millions in funding ain’t enough. Who would have thought..

Cellnovo

People with type 1 diabetes need to take insulin in a similar way their pancreas would produce if it were normal. Older therapy used to be multiple daily injections, which were poor approximation of the insulin need. In Continuous Subcutaneous Insulin Infusion (CSII) or Insulin Pump therapy, a small device delivers a constant stream of rapid-acting insulin through a tiny tube; according to a programmed plan unique to each wearer. Insulin pumps are not automatic but they let patients make immediate adjustments, enabling them to lead a more spontaneous lifestyle.

Companies like Cellnovo represent the key role IT is playing in the evolution of medical devices. UK-based Cellnovo began in 2002 as Starbridge Systems Ltd. to develop a novel micropump with only one moving part that made it smaller, more accurate and less expensive. Somewhere along the line, their conventional medical device transformed into a mobile health offering. It now consists of:

1. Pump: A small, waterproof device that can be easily applied, removed, and repositioned on the body. Also includes a built-in accelerometer that registers and stores user activity data.

2. Handset: A hand-held device that communicates wirelessly to control the pump and sends data to a secure website. User can manage dosage, schedule, log supplemental data like food intake, activities, emotions, etc. through this device. The look-and-feel has been compared to today’s appealing smartphones with icon-driven intuitive graphical display and touch screen ability.

3. Online: Websites customized for various participants that are usually involved in managing diabetes- provider, patient, caregivers, etc. Given the variety of people that can be involved in the care team (primary doctor, dietitian, diabetes nurse educator, eye doctor, foot doctor, endocrinologist, exercise trainer…), communication and coordination is an often under-served part of diabetes management. Seems like Cellnovo Online is an attempt to improve just that.

The overall concept is not new. OmniPod by Insulet Corporation (a public company) has a pump and handset. Big players like Medtronic, Sanofi-Aventis, J&J have shown signs of moving in similar direction. With the February 2011 series B financing round of $48.4 million, Cellnovo also seems to have enough runway in this space. As an interesting aside, combining insulin pumps with Continuous Glucose Monitoring System (CGMS) makes a terrific combo- uninterrupted sensing and coordinated, intelligent drug delivery. OmniPod does this.

Solutions like Cellnovo provide not just a way to deliver therapy, but a novel way to collect detailed data about given patient population. Analyzing aggregate data like that can lead to insights at multiple levels- clinical evidence (EBM), provider performance, population health, etc. An interesting decision fork in this evolution would be whether manufacturers leverage commercial computing hardware like smartphones or create their own (like Cellnovo). The former gives wider reach, while latter provides better, medical-grade control (something that FDA probably mandates).

But the key point in all this is about the future of traditional consumer medical devices. The next-generation devices seem to be less conspicuous, continuously connected, more personalized and come with an integrated online component that becomes the window to interaction with multiple parties (caregivers, friends, insurers…like an evolved, niche form of social networking). The new value proposition doesn’t stop at just a hardware device, but becomes a continuous service for managing chronic disease.

One can argue that managing all chronic diseases requires understanding an ever-changing constellation of information continuously generated by a whole ecosystem of participants. This ever-connected disease management approach that removes the burden of keeping journals and pushes information to healthcare professionals can to be applied to many diseases besides diabetes. I’m sure a number of those are already underway.

 

Welldoc

Patient Monitoring is one of the mature, established markets in healthcare industry. A promising trend in that is the emerging ‘Remote Patient Monitoring’ (RPM) paradigm. (If you don’t know much about RPM, this 2009 report from Frost.com is one of most insightful ones out there. It requires paid subscription though).

The underlying concept is nothing new in medical device industry, with it’s origins perhaps in holter monitoring fifty years ago. But true at-home remote monitoring began gaining traction in early 1990s; and today some major names are in the race: Honeywell Hommed, Philips, Health Hero, Cardiocom, Corventis. All of these companies have had an actual device as a part of the overall offering-  some piece of electronic hardware that enables capture and transmission of given physiological parameter(s). LifeStream, Motiva, HealthBuddy, Commander, PIIX are the respective names of the hardware from companies mentioned before. Even the recent consumer-oriented solutions like GlowCaps, Zeo, Fitbit etc. have a proprietary piece of electronics central to them.

And that, is what makes Welldoc is interesting. They have a disease management solutions that are entirely mobile and web-based. No proprietary hardware. It’s an interesting approach that points to an underlying need as well as an overall weakness of such models.

The unmet need here is for solutions that help engage patients at home and provide round-the-clock assistance in chronic disease management (e.g. what insulin dose to take, when to see your physician, etc.). That doesn’t require a device hooked to patient necessarily- it can be accomplished by manual data entry, easy-to-use software and intelligent algorithms. The value proposition is across many soft (as in, hard to quantify ROI on) aspects: enabling patient self-management, promoting health education, improving compliance, effecting positive behavior change etc. Of course, all these lead to some hard benefits that can be quantified (like improved Hb A1C values over time), but the cause-effect relationship can never be established beyond doubt.

The weakness in this approach is that all this depends on manual data entry by the patient or caregiver. It assumes that the affected individual is capable and disciplined enough to interact with the software consistently and reliably. Offering mobile applications is one way to start making that assumption partially valid. As a constant companion with computing power and internet connection, mobile phone makes it easier to use such software. But not enough to cover what I call the ‘last mile‘ of remote patient monitoring- from the patient’s body to an electronic data capture device. No matter how sophisticated the software is, it’s no good if there is not enough data to run its logic on. And our fundamental human behavior tends to revert back to lazy, undisciplined ways sooner or later. So yes, there is a role for pure disease management software but its a stretch to assume that it’ll suffice on its own.

WellDoc was founded by endocrinologist Suzanne Sysko Clough, MD in 2005. Their first solution, focused on Diabetes managment, was piloted in Baltimore in early 2006. Digging through their news it seems they have been fortunate enough to find substantial angel and grant funding, starting with $5M in 2007 and totaling nearly $17M to date. Recent years have also brought some big milestones for WellDoc: deal with Jitterbug (April 2009), FDA clearance (August 2010), deal with AT&T (October 2010), and integration with AllScripts EHR (December 2010). WellDoc website is skimpy on the actual details of their product, but there is a high-level demo. They seem to be expanding beyond diabetes into cardiovascular, wellness, medication adherence and clinical trials data management areas. That is a smart move. Also smart is their attempt at a business model. As their CEO explains in this article, they are aiming to get paid by large employers, plans and payers for making chronic disease management programs more effective.

The whole RPM industry has been praying for national direct reimbursement for decades now. Its been a tough journey so far- positive studies keep trickling out, and every year seems to be the one that will finally see payers admitting the cost-savings from RPM and starting reimbursement. WellDoc has also invested heavily in clinical trials to convince the industry. It’ll be worthwhile to see how successful a purely software-based company would be at making a living in the RPM market.

February 2011 Update: WellDoc announced that they have acquired Oncology Care Home Health, LLC, a education and consulting company helping home health providers implement specialized oncology home care programs. Probably the idea is to use that specialized knowledge to augment the logic behind their oncology offering (maybe get that FDA certified?).

Asthmapolis

Asthmapolis is brainchild of David Van Sickle a researcher at University of Wisconsin-Madison. The basic idea is to equip inhalers with a GPS tag to determine when and where was it used by the patient. When such individual (de-identified, of course) medication data is aggregated, it can provide population care insight like environmental triggers and disease impact.

Seems like there are three components of the overall offering:

  1. A hardware device called “Spiroscout” – a small add-on that mounts the inhaler canister. Every time it is pushed, the location and time-stamp data is recorded.
  2. Mobile app – a ‘diary’ to keep track of symptoms, triggers, medications, etc. Can also be used to view map of data received from Spiroscout, and to get sms reminders for taking medication.
  3. Online website – a ‘dashboard’ of sorts. Can help summarize submitted data to figure out disease patterns and trends.

The hardware device is not out yet (website says it’ll be out this summer), and the mobile app is currently in private beta. So there is not much of real world testing that has happened. But I’m still positive about Asthmapolis, for a number of reasons.

First, it’s the right kind of ‘focused’ monitoring solution that can potentially be transformative for managing a specific disease (kinda like Regina Herzlinger‘s argument about ‘Focused Factories‘ as one of the ways to salvage the entire healthcare system). It’s better than trying to find a solution that can monitor multiple conditions (example 1, example 2). I think the mobile diary and online dashboard would be key engagement tools in this regard. The more focused and customizable, the better.

Second, it helps in medication adherence which is a big issue irrespective of the medical condition. I think that knowing whether you took your medications and getting reminders if you didn’t,  is more powerful than knowing when/where you took it. The mobile app reminders would be a great resource there (automated calls to landlines may be good too…for seniors).

Third, it helps understand the individual triggers and community impact of asthma. For successful asthma management, a patient should know his/her triggers and avoid getting exposed to them. That is not an easy task for a number of reasons. My initial reaction was that GPS may be a bit of an overkill. But with rapidly decreasing cost of location-aware technology, why not? Much better than using it to check-in to nearby McDonalds.

Life Pebble

Toumaz technology is a spin-off from Imperial College of London , and they make what is probably the only ultra low-power silicon chip targeted for healthcare applications. In October 2009,  they launched the Sensium Life Pebble wireless monitoring device in EU.

The Life Pebble hardware includes a single lead ECG, skin thermometer, and an accelerometer. The data collected by the system is streamed wirelessly to a USB Network Adapter over short distances. According to MobiHealthNews, the device is currently in clinical trials are few US hospitals and Toumaz has declared an intention to submit for FDA clearance in 2011. This continuous physiological monitoring capability is currently marketed for assisted living, rehabilitation and professional sports applications by the company.

If we can put aside the “who will pay for this?” question for a minute, this kind of technology has myriad applications in both consumer and provider space. What is chunky hardware today, will almost surely be a disposable, thin patch tomorrow. If we can have a reliable way to do real-time monitoring of key vitals, disease management is no longer confined to interactions in the healthcare setting.

What intrigues me is how the trend of medical-grade remote monitoring (which is moving outside of hospital setting with technologies like Sensium) will interact with the trend of consumer-oriented remote monitoring (FitBit, DirectLife, BodyMedia, Zeo, etc.). There will be a shakeout, obviously. My guess is that the winners then will be not be defined by which way and how much data they gather, but what they do with that data. Analytics and interpretation will be the differentiators.

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