Any newcomer to the world of remote health will undoubtedly be challenged by the variety of different names and labels used to describe the technology. These include Telehealth, Telecare, Telemedicine, eHealth and Connected Health and depending on who you talk to, you will get different interpretations of these.

So here’s where I stand on these:

·         eHealth (or Connected Health): Health services, information and education delivered or enhanced through the internet and related technologies. This is the broadest of the labels used and eHealth encompasses all of the methods listed below.

·         Telecare: The continuous, automatic and remote monitoring of real-time emergencies and lifestyle changes over time in order to manage the risks associated with independent living. Social alarms such door sensors, smoke alarms, flood detectors and personal alarm pendants (PERS) all fall into this category.

·         Telehealth: Using communications networks to provide, access, and manage any type of health information or service. This name is commonly used to describe remote chronic disease management, with solutions such as the Intel® Health Guide.

·         Telemedicine: This is a type of Telehealth and is often used to describe the activity performed specifically by a doctor, who uses IT and the Internet for the diagnosis of a patient in another location. This term is often applied to a specialist providing a remote consultation or a second opinion to a doctor somewhere else in the country or the world.

To add to the confusion, the European Commission use the term Telemedicine to cover the delivery of and healthcare services at a distance, through the use of Information and Communication Technologies. Additionally, another term – Telehealthcare – is starting to emerge blurring the lines between Telehealth and Telecare. For all of these reasons, it is very important to understand where all parties in a discussion on these topics stand so that some of the confusion is eliminated.

In a recent customer meeting, the fall-out of all of these different labels became blatantly clear to me. This person was interested in deploying a Telehealth solution for the purposes of chronic disease management. Her challenge however, was that she didn’t have a budget line item for Telehealth (or any other tele- or e- activities), and that she was constantly getting frustrated with new labels being applied to solutions that effectively just improved existing service delivery activities. Her recommendation was that industry should stop using new labels to describe these technologies, and rather position them as enhancements to current care delivery, allowing for much easier procurement by healthcare providers.

An interesting argument indeed – but do you agree?

More information on remote health in the UK is available in this White Paper – Chronic Care at the Crossroads

In this morning’s opening keynote at the Partners Connected Health Symposium, Dr Jason Hwang, co-author with Clayton Christensen of the Innovator’s Prescription spoke about the application of disruptive innovation on the healthcare industry.

Disruptive innovation describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves ‘up market’, eventually displacing established competitors. This disruption allows new consumers to begin to use the technology whereas in the past it was inaccessible to them. This can be seen in the computing industry where the technology has moved from mainframes to mini-computers to PCs and to smart-phones, which has also moved the location of the technology from a central location to being accessible anywhere it is required. This decentralization through disruption leads to increased accessibility but it is important to note that companies often add functionality through innovation faster than consumer wants or needs the technology

In healthcare this same move to centralize everything, can be seen with the co-location of multiple services and technologies all under the same roof in a big hospital. The emerging trend however is to move this care provision from a central location out into the community and into the home. This also means that different people will be able to deliver the care such as nurses and empowered patients themselves, supported by new technologies.

This in-turn requires us to look at the dominant business model in healthcare where everything is centralized on the general hospital. This implies that many different types of technology and specialities in one location. The business model then has to support all of these resources but with the number of hand-offs that result, it can be prone to error and forces increased costs to maintain profitability.

Hwang asserted that hospitals are expensive conflations of three specific types of business models:

1)      Solution shops – typically very dependent on people offering diagnostic and intuitive activities on a fee for service basis

2)      Value-added process businesses – typically process dependent where a certain task is repeated enough times to where it becomes possible to accurately predict the outcome, for a fee.

3)      Facilitated Networks – where users, both providers and patients, transact and interact with one another on a fee for membership basis.

As disruption occurs in the healthcare industry, Hwang believes that a number of changes will occur to these business models

-          Specialist hospitals will emerge to address the solution shops model, bringing together a number of different specialties to reach a diagnosis sooner

-          Treatment centers focused on a particular procedure, e.g. heart by-pass, where technicians can be involved in delivering the treatment, rather than doctors, as they have been specifically trained on parts of the procedure and repeat it on a daily basis

-          Social networking through sites such as PatientsLikeMe, empowering individuals to do more for their own care delivery

Dr. Hwang concluded however, that each of these new propositions will require new value networks to gain traction in the market and for this to happen, having the right partners will be key to success.

The second keynote this morning was from James Mongan, MD, CEO of Partners Healthcare.

Within a few months there will likely be a bill signed on healthcare reform but Mongan believes that it will not have realised everything that was set out to be achieved. He asserts that the work on reform will continue for a number of years afterwards.

Despite the fact that there are huge numbers of uninsured, most still receive the treatment they need. What doesn’t happen though is that treatment for chronic conditions is not delivered in a preventative manner.

One proposal in the reform legislation is to introduce an Individual Mandate but Mongan asserts that this appears to be a new tax with another name. There may be restrictions on who actually pays this mandate but it doesn’t address the core need for insurance reform.

But what about the issue of controlling healthcare costs? Barriers to cost include the way costs are reimbursed and the lack of integration of the provider systems. With most items that you buy, you benefit immediately, but with healthcare payments you benefit later

It is likely that any new legislation will blend taxes, employer payments and individual payments but the key issue is the fairness of financing – who pays and how much? In Mongan's opinion, it needs to be a balance between individual liberty and justice for all.

Last week Adam Bosworth, one of the founders of Google Health and previously involved in many other successful ventures, launched his new company – keas. This is quite an interesting development as the goal of keas is to help you understand what your health data means and how you can use it to be as healthy as possible.

Keas works by getting you to complete a basic health questionnaire and to answer some questions about your family history and your wellness goals. It then assigns certain care plans to you, which, in theory, enable you to either manage your condition better or assist you in achieving your wellness goals. These care plans are designed by experts but do not constitute medical advice, diagnosis or treatment.

What makes this proposition interesting is that you can upload your medical data to the system from other services, such as Google Health, or enter details of clinical tests that you may have undergone. Keas will then attempt to provide an interpretation for you and assist you in dealing with possible next steps. This is one of the first sites to pull all of these different elements together to offer you comprehensive advice and guidance.

It sounds simple but in fact this can be a challenging area from a regulatory and a privacy perspective. Many clinicians are reluctant for data to be stored outside their country (and sometimes even outside their offices!) despite the fact that many countries have implemented stringent data privacy regulations. Additionally, providing care plans that are useful, while not crossing the line of delivering medical advice could be quite a challenge.

Keas is backed by a strong management and advisory team, and it will be interesting to see how it delivers over the coming months.