contemporary healthcare transformations

Sanofi Aventis sued the Austrian Startup Diagnosia in a Viennese court. The lawsuit reached the Viennese start-up that offers a clinical decision support systems for drug prescription, on 23 December. It requested Diagnosia to remove information about specific adverse-events of their most prominent painkiller Novalgin immediately from its database. Without knowing detailed information, I can only assume that the adverse events information from Diagnosia, are not part of the officially published adverse events from Sanofi Aventis.

(Photo: David Versus Goliath - Glenn Beck showed some of the art in his Dallas studios on his radio program Jan. 9, 2014. TheBlaze TV)

Recently the New York Times pointed out, that the main system for keeping track of the dangerous side effects of prescription drugs is deeply flawed, primarily because drug makers are submitting incomplete information about the problems to the Food and Drug Administration, according to a new study by a nonprofit group that tracks drug safety issues

Drugmakers have to comply with specific regulations that describe on how the industry must handle and report adverse events. In the US Pharma’s reporting requirements are defined in the U.S. FDA Code of Federal Regulations. Essentially, a U.S. Drug Manufacturer is required to report serious, unexpected, drug related individual case safety reports within 15 calendar days of initial receipt as well as to report any follow-up information within 15 calendar days of receipt of new information.

In the EU the Pharmacovigilance guidelines that describe the adverse events are defined by a set of Council Regulations and Articles. The Summary of Product Characteristics is the key communication to physicians, including data on treatment effects, serious adverse effects, contraindications and special warnings. Communication to the patient is principally through the Patient Information Leaflet provided as a package insert with every prescription, supplemented with advice from the physician at the time of prescribing. If the Drug Maker is aware that a health-care professional has reported a reaction to one of its products directly to the authority of a member state, the Drug Maker should report the reaction, informing the authority. The drug maker is expected to screen the world-wide scientific literature and report promptly published suspected serious adverse reactions associated with the use of the active substances of its medicinal products, as relevant. 

This seems to be a system with a lot of gaps, that allow multiple versions of the truth. In an article published in Forbes Magazine, John LaMattina, the former R&D president of Pfizer Global mentions that “I will often get attacked that I am defending an evil empire. Many believe that the industry hides negative data on its drugs. According to John the most common comments is that s ide effects should be monitored and updated and told to patients and doctors. Not hidden as they are right now.“

During the last few years there has been enormous progress in the digitization of everything that is related to healthcare, we have seen unprecedented scientific breakthroughs and technological advancements. We have seen health care providers adopting to digital documentation and diagnostic systems. And slowly, we start seeing the adoption of longitudinal health records that capture and store all the relevant data over a lifetime, even though these data set are limited. At the same time, we see new data layers becoming available. We have access to genomic, metabolic or micro-biome profiling services, that can detect molecular markers that signal disease risk or presence before clinical signs and symptoms appear, and it offers the opportunity to focus on prevention and early intervention rather than on reaction at advanced stages of disease. We see app’s and wearables collecting lifestyle information. There is nearly a wearable and sensor for everything.

So in the future of medicine, a patient record will give us a 360-degree view of each patient. This holistic view of each patient will include a wider array of information such as:

large amounts of ‘molecular measurements’ on a person. 

information of ‘routine measurements’ that goes beyond the usual signs and symptoms that are related to a specific disease or symptom.

social, demographic, environmental and behavioral information relating to patients 

And on top of these large personal data pools, we will see cognitive systems such as IBM Watson, which will assist physicians in selecting the most precise treatment. These systems will predict and interact with humans to prevent the onset of diseases. These systems will learn, sense and reason as we progress. These systems like IBM Watson will provide us with a number of options for each case, backed up with supporting evidence. Physicians will enjoy the luxury of practicing personalized medicine while the data unfolds in real-time. The old way of “keeping up with the literature” by reading medical journals will gradually disappear extinct. Data-driven medicine will enable the discovery of new treatment options based on the multi-model molecular measurements on patients and learning from the trends hidden among all population health data.

There is an unseen potential for optimizing our medical treatments for all kind of diseases and to assist healthy individuals for managing their health and prevent diseases. Data driven medicine, is poised to enable earlier and more accurate diagnosis of disease risk and occurrence, guide prevention and individualized intervention as well as facilitate monitoring of healthy and treated patients. It a role in the prevention and recurrence of future disease. Heart monitoring systems will use all this available data to predict heart attacks hours, if not days or years,  in advance.

Thinking further into the future, I don’t have to mention how this is going to impact everyone who practices medicine.

NO DIAGNOSE NEEDED

One of the potential outcomes of this technological evolution, might be that we won’t need a diagnosis as we know it. Current healthcare systems, are designed and use a health care classification systems, providing diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. These classifications are a central in our healthcare systems. Over the last few years, US providers were pushed to switch to ICD-10.

So if data driven medicine is the future, and health monitoring will be moving from episodic and symptomatic towards continuous and preventive, what will happen to the diagnosis? Was the diagnosis a classification system that we humans needed to manage and process the vast amount of information? If the future of medicine will be data driven and data mining techniques (such as pattern recognition, clustering algorithms, machine learning and computational statistics) will give us precise treatment or lifestyle recommendations, are we still going to talk in diagnose terms?

For instance, current cancer classification includes more than 200 types of cancer. For the patient to receive appropriate therapy, the clinician must identify as accurately as possible the cancer type. We are familiar with cancer diagnosis that are based on the location of the morphologic characteristics of biopsy specimens, which leads to imprecise treatments selection, and is the reason why, on average, 75% of the particular cancer drugs within a patient population are ineffective. Molecular oncology is adding gene expression–based on molecular subtypes. This will lead to an unpredictable amount of different combinations, that never can be classified by humans.

Dr Dennis Ausiello, Professor of Clinical Medicine at the Harvard Medical School, mentioned that diabetes will go the same way as Dropsy went 100 years ago, for the description of cardiovascular events. Diabetes will be focused on the phenotypic expression of the multiple pathways, such as abnormal gluconeogenesis or abnormal free fatty acid metabolism. In a while from now, we won’t have diabetes type 1 and 2, but a range of factors that express the disease. Better understanding of these factors will lead to a better stratification of the denominator, more precise drugs and better targeted treatment plans.

Medicine currently defines many polygenic complex diseases as homogenous, and classifies them into ICD codes. Data Driven Medicine, will be focusing on collecting continuous data through non-invasive and non-intrusive technologies to get a 360 degree view with actionable knowledge on the patient. This data will lead to more accurate therapies and recommendations. Due to the increased complexity, it will be humanly impossible to handle all possible combinations. Which leads me to advise that data driven medicine needs to focus on selecting therapies more then on selecting a diagnosis.

Wearable Activity Devices Comparison Chart

Running App Comparison Chart

Pedometer App Comparison Chart

Sleep Apps & Devices Comparison Chart

Mood Apps Comparison Chart

Food & Calorie Apps Comparison Chart

As Star Trek nears its 50th anniversary, most of its imagined technologies remain light years away. Since a decade research has been focussing creating new technologies that can approximate the functions of the tricorder, that handheld device used to instantly diagnose a disease. Since a few years over hundreds of startups have been working on a range of products that sit in the palm of your hand and monitor your vitals - temperature, respiratory rate, oximetry, ECG, systolic blood pressure and diastolic blood pressure,... Here is a list with the most important devices and developments:

  Albumin/ Creatinine ratio (ACR)

Axis-shield - with Afinion [in use]

UCLA - with Kidney Test [in development]

Breathing and Apnea

BreathResearch - with MyBreath [in use]

NovaSom with Home Sleep Test [in use]

Omron - with diverse modellen [in use]

Philips with System One [in use]

Phyode - with W/ME [in development]

Somnarus - with Somnapatch [in development]

Vivonoetics - with Equivital EQ02 Lifemonitor [in use]

Vivonoetics - with NOX-T3 [in use]

Respiration and Spirometer

Asthmapolis - with Asthmapolis [in use]

AstmaSense - with AirSonea [in use]

Cityzen Sciences - with Smart Sensing (kleding) [in development]

Distributed Health Labs - with OASIS [in development]

EarlySense - with EarlySense All-In-One [in use]

Fraunhofer - with FitnessSHIRT [in development]

GeckoCap - with GeckopCap [in use]

Hexoskin - with diverse kledingstukken [in use]

Intelesens - with Zensor [in use]

Isonea - with WheezoWither [in use]

Isansys - with LifeTouch [in use], ook voor 24-uurs withing

LifeWatch - with PMP4 SpiroPro e.a. [in use]

MonBaby - with Smart Baby Monitor [in use]

Microlife - with PF100 (peakflow wither) [in use]

PMD Healthcare - with SpiroPD [in use]

Rest Devices - with Mimo [in use]

SecuraFone - with SecuraPatch [in use]

Spire - with Spire [in development]

Toumaz Group - with Sensium Vitals [in development]

Universiteit van Washington e.a. - with SpiroSmart [in development]

Valencell - with PerformTek [in use]

VitalConnect - with Biosensor [in development]

Zensorium - with Tinké [in use]

Zephyr - with BioPatch [in use]

Alcohol

Alcohoot - with Alcohoot [in use]

Breathowither - with Breathowither [in use]

Lapka - with Breath Alcohol Monitor [in use]

Alzheimer

OPKO - with POCT [in development]

Movement

A&D - with XL20 e.a. [in use]

ActiGraph - with GT3X+ Activity Monitor [in use]

ActiveReplay - with TRACE [in development]

Adidas - with miCoach SPEED_CELL [in use]

Adidas - with MiCoach SMART RUN [in use]

AGENT - with Smartwatch [in use]

Airo - with Airo [in development]

Amiigo - with Amiigo [in development]

Angel - with Angel Sensor [in development]

Apple - with iPod Nano [in use]

Atlas - with Atlas [in development]

Basis - with Basis [in use]

Bodybugg - with bodybugg system [in use]

BodyMedia - with BodyMedia FIT [in use]

Bragi - with The Dash [in development]

BSX Athletics - with BSX Insight [in development]

Camntech - with MotionWatch [in use]

Cityzen Sciences - with Smart Sensing (kleding) [in development]

Climbax - with Climbax [in development]

Digifit - with Digifit [in use]

Epson - with Pulsense [in use]

Fitbit - with Fitbit [in use]

Fitbug - with Fitbug [in use]

Fitlinxx - with Pebble Activity Tracker [in use]

FlyFit - with FlyFit [in development]

Garmin - with Vivofit [in use]

Geak with Watch [in development]

GeoPalz - with ibitz [in use]

GOQii - with Life [in use]

GymWatch - with GymWatch [in development]

Heapsylon - with Sensoria [in use]

Hexoskin - with mulpitle wearable t-shirts [in use]

Hopelab - with Zamzee [in use]

iewei - with Wellness Wristband [in development]

iHealth - with Wireless Activity and Sleep Tracker [in use]

i'm Watch - with i'm Watch [in use]

innoXplore - with iX-S70 Bluetooth Pedowither [in use]

Intelesens - with Zensor [in use]

Iqua - with Iqua Beat [in use]

iRiver - with ON (in cooperationwith Valencell, PerformTek) [in use]

Jawbone - with UpBand [in use]

Jaybird - with Reign [in use]

Ki Performance - with Ki Fit [in use]

KREYOS - with Witheor [(in use]

Lark - with LarkLife [in use]

Leapfrog - with Leapband [in use]

LG - with Lifeband Touch [in use]

MC10 - with Heart Rate Activity Wristband [in use]

Medisana - with ViFit [in use]

MIO Global - with Alpha [in use]

Misfit Wearables - with Shine [in development]

MOOV - with MOOV [in development]

Motion - with OpenGo [in use] in kleding

Motorola - with MOTOACTV [in use]

Movea - with G-Series [in use]

Moves - with Moves [in use]

Muve - with Gruve Solution [in use]

Mytrack - with Mytrack SmartCoach [in use]

Nike - with Fuelband en Fuelband SE [in use]

Nike en TomTom - with Nike+ SportWatch GPS [in use]

Nintendo - with Wii Fit [in use]

Ollo Mobile - with CloudPhone [in use]

Omron - with multiple models [in use]

OMsignal - with OMsignal (in clothes) [in development]

Pear - with Pear Pro [in use]

Pebble - with Pebble [in use]

Philips - with Directlife [in use]

Plantiga - with Plantiga [in development]

Polar - with meerdere Sensoren [in use]

Quanttus - with Vital Intelligence [in development]

Razer One - with Razer Nabu [in development]

Recon Instruments - with JET [in development]

Runtastic - with Bluetooth Smart Combo Set [in use]

Samsung - with S Health [in use]

SecuraFone - with SecuraPatch [in use]

Sensaris - with Move-It [in use]

SenseGiz - with Star [in development]

Sony - with SmartBand [in use]

Spree - with Spree Headband [in development]

Striiv - with Striiv [in use]

TapTap - with TapTap [in development]

Technogym - with fitness apparatuur [in use]

TomTom - with Runner en Multi-Sport [in use]

TomTom - with Runner Cardio [in use]

Valencell - with PerformTek [in use]

Virgin Pulse - with Max [in use]

VitalConnect - with Biosensor [in development]

VitaMove - with Activ8 en VitaSense [in use]

Wellograph - with Wellness Watch [in use]

Withings - with Pulse [in use]

Yamasa - with Yamaxx [in use]

Yorbody - with Yorbodyguard [in use]

Zamzee - with Zamzee [in use]

Bilirubin

uChek - with Urine Analyzer [in development]

Blood Pressure

A&D - with UA-851THX e.a. [in use]

Blip - with Blip BP [in use]

BodyTel - with PressureTel[in use]

Codulis - with Blood Pressure [in use]

Distributed Health Labs - with OASIS [in development]

Elfi-Tech - with Elfi mDLS sensor [in development]

Fitbug - with Fitbug Luv [in use]

ForaCare - with D Monitors [in use]

Healbe - with GoBe [in development]

i-CalQ - with POCT [in development]

iHealth - with Wireless Blood Pressure Monito [in use]

iHealth - with Wireless Blood Pressure Wrist Monitor [in use]

Isansys - with LifeTouch [in use], ook voor 24-uurs withing

LifeWatch - with PMP4 Easy2Check e.a. [in use]

MedApps - with healthPall [in use]

Medisana - with o.a. CardioDock Blood Pressure Module [in use]

Microlife - with WatchBP e.a. [in use]

Nihon University - with ICMe [in development]

Omron - with diverse modellen [in use]

Philips - with Bloeddrukwither [in use]

Quanttus - with Vital Intelligence [in development]

Quardio - with QuardioArm [in development]

Samsung - with S Health [in use]

Scanadu - with Scout [in development]

Sensaris - with ZAO [in use]

Sense - with ContiPress [in development] ook voor 24 uurs withing

SHL Telemedicine - with TelePress [in use]

Sotera Wireless - with ViSi Mobile [in development]

STBL Medical Research - with Bloodpressure Watch [in development]

Teddy & Co - with Teddy The Guardian [in use]

Withings - with Blood Pressure Monitor [in use]

Blood glucose  

Abbott - with Freestyle [in use]

Acon - with On Call Chosen [in use]

Bayer - with Breeze en Contour [in use]

BodyTel - with GlucoTel [in use]

BlueGiga - with Glucotel [in use]

Cellnovo - with Cellnovo [in use]

Dario - with MyDario [in development]

Debiotech - with JewelPUMP [in use]

Dexcom - with Dexcom SEVEN PLUS [in use] '24/7 withing onder de huid'

Dicomed - with SensoCard en SensoLite [in use]

Dropsense - with Dropsense [in development]

Echo Therapeutics - with Symphony tCGM System [in use]

ForaCare - with D Monitors [in use]

Fraunhofer - with FIT [in development]

Gima - with BG5 Wireless Glucose Monitor Kit [in use]

Glucovation - with Glucovation [in development]

GlySens - with GlySens ICGM [in development]

Google - with Smart Contact Lens [in development]

Grove Instruments - with Optical Bridge [in development]

i-CalQ - with POCT [in development]

iHealth - with iHealth Align [in development]

iHealth - with Wireless Smart Gluco-Monitoring System [in use]

Integrity Applications - with GlucoTrack [in development]

Klinion Diabetes Care - with BGM211 [in use]

LaBelle Lab - with Tear TOUCH Glucose Sensing [in development] - traanvocht withing

Lifescan - with OneTouch [in use]

LifeWatch - with LifeWatch V [in use]

MedApps - with healthPall [in use]

Medisana - with o.a. GlucoDock Blood Glucose Module [in use]

Medtronic - with Enlite [in use]

Medtronic - with Guardian [in use] 

Medtronic - with iPro Professional CGM [in use]

Medtronic - with MiniMed [in use]

Medtronic - with mySentry (monitoring blood sugar level for sleeping children [in use]

Menarini Diagnostics - with diverse Gluco* products [in use]

MicroChips - with Continuous Glucose Monitoring [in development]

Microsoft - with Contact Lens [in development] - traanvocht withing

MyGlucoHealth - with MyGlucoHealth [in use]

Noviosense - with Glucose Sensor for DM1 [in development]

OneTouch - with Verio IQ (en andere producten) [in use]

Panasonic - with Contour [in use]

Philosys - with Gmate SMART Glucose Wither [in use] 

PositiveID - with iGlucose e.a. [in use]

Qloudlab - with Qloudlab [in development]

Roche - with Accuchek [in use]

Samsung - with S Health [in use]

Sanofi-Aventis en AgaMatrix (BGStar) - with BGStar en iBGStar [in use]

Scanadu - with Scanaflo [in development]

Sensaris - with ZAO [in use]

Senseonics - with Senseonics [in development]

Socrates Health Solutions - with Socrates Companion [in development]

Telcare - with Telcare BGM [in use]

uChek - with Urine Analyzer [in development]

YOFIWither - with YOFIWither [in development]

Ypsomed - with Mylife [in use]

Glooko connects multiple blood glucusoe measurements via smartphone

Biomedtrics connects multiple blood glucuse measurements via smartphone and portal

mySugr connects multiple blood glucusoe measurements via smartphone

Blood test and diagnosis, multiple components (in health)

Abaxis - with Piccolo xpress Analyser [in use]

Alfa Wassermann - with Ace Axcel [in use]

Bioengineering Department at the University of Washington [paper, in development]

BlueGiga - with Mindray [in use]

Diagnostics for all - [papier, in development] together with Whitesides Research Group

i-CalQ - with POCT [in development]

Sano Intelligence - with een 'API for the Bloodstream' [in development]

Sysmex - with KX-21N [in use]

Technion - with new non-invasive way for blood analysis [in development]

Pulse oximetry

Bragi - with The Dash [in development]

DELTA - with de ePatch [in use], voor 24-uurs withing

Distributed Health Labs - with OASIS [in development]

Fraunhofer - with FIT [in development]

iHealth - with Wireless Pulse Oxiwither [in use]

LifeWatch - with LifeWatch V [in use]

LionsGate Technologies - with Phone Oxiowither [in use]

Masimo - with iSpO2 [in use]

Maximo - with Rainbow SET platform [in use]

MedApps - with healthPall [in use]

Nonin - with diverse modellen [in use]

OMsignal - with OMsignal (in kleding) [in development]

Owlet Baby Monitors - with Owlet Vitals Monitor [in use]

OxiTone Medical - with Wearable Pulse Oxiwither [in development]

Philips - with Pulse Oxiowither [in use]

Phyode - with W/ME [in development]

Reflectance Medical - with CareGuide Oxiowither [in use]

Scanadu - with Scout [in development]

Sensaris - with ZAO

Sotera Wireless - with ViSi Mobile [in development]

Teddy & Co - with Teddy The Guardian [in use]

Vidawith - with Viadawither [in development]

Vivonoetics - with Equivital EQ02 Lifemonitor [in use]

Zensorium - with Tinké [in use]

BMI measurement

Fitbit - with Aria [in use]

iHealth - with Wireless Body Analysis Scale [in use]

Wahoo Fitness - with Wahoo Balance Smartphone Scale [in use]

Withings - with WiFi Bodyscale [in use]

Calorie consumption (Joule)

Basis - with Basis [in use]

BodyMedia - with BodyMedia FIT [in use]

Fitbit - with Fitbit [in use]

Healbe - with GoBe [in development]

iewei - with Wellness Wristband [in development]

iHealth - with Wireless Activity and Sleep Tracker [in use]

Jawbone - with UpBand [in use]

Stir - with Kinetic Desk [in use]

Stratos - with Medamonitor [in development]

GE - [in development]

Cholesterol

Cornell University - with smartCARD [in development]

Fraunhofer - with FIT [in development]

Communication en eHealth

Airstrip - with Airstrip [in use]

Bosch - with Health Buddy [in use]

Bosch - with ViTalCare T400 [in use]

CJPS - with VitalPoint Home Monitor [in use]

Digifit - with Digifit [in use] - verzamelen van meetgegevens op één plek

Facetalk - with Facetalk [in development]

FocusCura - with Pal4 [in use]

General Electric & Intel - Care Innovations Connect [in use]

Ginger.io - with Ginger.io [in use]

Hicare - with Home Doctor [in use]

Intel - with HealthGuide [in use]

Mextal - with VieDome [in use]

Nantcare - with Nantcare Care Services [in use]

Philips - with Motiva [in use]

Simac - with Vicasa [in use]

Communication and Data Transport e (Data Hub)

Alere - with Connect [in use]

MedApps - with HealthPal [in use]

Mega - with eMotion Biolink [in use]

Nantcare - with HBox [in use]

NetMedical - with iModem [in use]

Qualcomm - with 2Net Hub [in use]

Sensaris - with Bridge [in use]

Tunstall - with Lifeline Vi [in use]

Vignet - with Vignet [in use]

Personal Health Data Aggregator / Record

Aetna - with CarePass [in use]

Apple - with Health [in development]

Azumio - with Argus [in use]

BodyTrack - with BodyTrack [in use]

CommonSense - with Sense Observation Systems [in use]

Decadoo - with Decadoo Health Score [in use]

Google - with Fit [in development]

Hello Code - with Exist [in use]

Human API - with Human API [in use]

Microsoft - with HealthVault [in use]

Narratao - with Journal [in use]

Open.Sen.se [in use]

OptimizeMe - with OptimizeMe [App, in use]

Proteus Digital Health - with 'personal monitoring device' [in use]

RunGap - with Rungap [in use]

Sandalbay Life [in use]

Samsung - with Sami [in development]

Tactio - with Tactiosoft [in use]

T2 - with Biozen [in use]

Tictrac [in use]

Validic - with Validic [in use]

DNA Analysis

23andMe - with 23andMe [in use]

Biomeme - with qPCR [in development]

DeCODEme - with DeCODEme [in use]

DNA Electronics - with Genalysis [in use? UK]

Exogen Biotechnology - with Exogen [in development]

Genome Liberty - with IMSP [in use]

Knome - with Knome [in use]

LifeTechnologies - with Ion Proton Sequencer [in use]

Nanobiosym - with Gene-RADAR [in development]

Oxford Nanopore Technologies - with MinION [in development]

Quantify - with Quantify [in development, tijdelijk niet bereikbaar]

Spartan Bioscience - with Spartan Rx [in use]

Echoscopy

Envisioner - with Endogo HD e.a. [in use]

General Electric - with VScan [in use]

Mobisante - with MobiUS SP1 [in use]

Siemens - with ACUSON P10 [in use]

Universiteit van Newcastle - with KT101238 [in development]

Vitacon - with VitaScan LT Bladder Scanner [in use]

Proteins

i-CalQ - with POCT [in development]

uChek - with Urine Analyzer [in development]

Electrocardiogram (ECG)

AliveCor - with AliveECG [in development]

Camntech - with Actiwave [in use]

Camntech - with Actiwave Cardio [in use]

Cardiac Designs - with ECG Check [in use]

CardioComm Solutions - with HeartCheck Pen Device [in use]

CardioNet - with MCOT [in use], ook voor 24-uurs withing

Cognionics - with Cognionics Core Technologie [in development]

Corventis - with Nuvant [in development]

DELTA - with de ePatch [in use], voor 24-uurs withing

Distributed Health Labs - with OASIS [in development]

Epi - with Epi Life [in use]

Everist Genomics - with CardioDefender [in use]

Fraunhofer - with FitnessSHIRT [in development]

General Electric - with MAC i [in use]

Hartis - with Hartis Holter [in use], ook voor 24-uurs withing

Hidalgo - with Equivital EQ02 LifeMonitor [in development]

Holst Centre (imec) - with ECG Patch [in development]

Huneo - with HuNet [in use]

Infobionic - with MoMe [in development]

Intelesens - with Aingeal VS200 e.a. [in use], ook voor 24-uurs withing

Isansys - with LifeTouch [in use], ook voor 24-uurs withing

InvisionHeart - with InvisionHeart [in development]

ithlete - with ithlete ECG Reciever [in use]

Intelesens - with V-Patch [in use]

Intelesens - with Zensor [in use], ook voor 24-uurs withing

LifeWatch - with LifeStar e.a. [in use], ook voor 24-uurs withing

LifeWatch - with LifeWatch V [in use]

Maestros - with UNO-R10 [in use]

Mega - with eMotion ECG [in use]

MobilECG Laboratories - with mobilECG [in development]

NeuroSky - with NeuroSky ECG Biosensor [in use]

Nuubo - with nECG [in use] in kleding

Omron - with HCG801 [in use]

Philips - with ECG [in use]

Plessey Semiconductors - with Impuls [in use]

Preventice - with BodyGuardian [in use]

Quasar - with PSM [in use]

Scanadu - with Scout [in development]

SHL Telemedicine - with SmartHeart e.a. [in use]

VitalConnect - with Biosensor [in development]

Vitaphone - with Tele-ECG-Loop-Recorder e.a. [in use]

Vivonoetics - with Actiwave Cardio [in use]

Vivonoetics - with Equivital EQ02 Lifemonitor [in use]

Vivonoetics - with SmartexWearable Wellness System [in use]

WelchAllyn - with Holter Recorder (24-uurs withing) [in use]

Zephyr - with BioHarness BT [in use]

Zephyr - with BioPatch [in use]

Electro-encephalography (EEG)

Advanced Brain Monitoring - with B-Alert [in use]

Axio - with Axio Headband [in use]

Bio-Signal Group - with micrEEG [in development]

BrainAthlete - with BrainAthlete [in use]

Camntech - with Actiwave [in use]

Cognionics - with Cognionics Core Technologie [in development]

DTU Informatics - with Smartphone Brain Scanner [in development]

Emotiv Lifesciences - with Emotiv Insight Neuroheadset [in development]

Emotiv - with Emotiv EEG [in use]

iFocusband - with iFocusband [in use]

Imec, Holst Center & Panasonic - with Wireless EEG Headset [in development]

Imperial College London - with EEG [in development]

InteraXon - with Muse [in use]

Masimo - with Sedline Brain Function Monitoring [in use]

Mega - with BrainStatus [in use]

Melon - with Headband [in development]

Neuro Bridge - with B3 Band [in use]

Neurokeeper - with Neurokeeper Monitor [in use]

NeuroSky - with NeuroSky EEG Biosensor [in use]

NeuroVigil - with iBrain [in development]

Quasar - with DSI 10/20 [in use]

Shimmer - with Shimmer 2R [in use]

Wave - with Wave EEG Monitor [in development]

Electromyografy (EMG)

Camntech - with Actiwave [in use]

DELTA - with de ePatch [in use], voor 24-uurs withing

Mega - with eMotion EMG [in use]

Shimmer - with Shimmer 2R [in use]

Vidawith - with Viadawither [in development]

Epilepsy

Artefact - with Dialog [in development]

Weight Measurement

A&D - with UC-324THX e.a. [in use]

Bedscales - with Bedscales [in development]

Blip - with Blip Scale [in use]

BlueGiga - with Fairbanks [in use]

BodyTel - with WeightTel [in use]

Fitbit - with Aria [in use]

Fitbug - with Fitbug Wow [in use]

Gima - with HS5 Wireless Body Analysis Scale [in use]

iHealth - with Wireless Body Analysis Scale [in use]

iHealth - with Wireless Scale [in use]

LifeWatch - with PMP4 Selcheck Weight Scale [in use]

MedApps - with healthPall [in use]

Medisana - with o.a. TargetScale Body Analysis Scale [in use]

Omron - with diverse modellen [in use]

Philips - with Standard Scale [in use]

Philips - with Steady Scale [in use]

Picooc - with Latin [in use]

SHL Telemedicine - with TeleWeight [in use]

Tanita - with diverse modellen [in use]

Wahoo Fitness - with Wahoo Balance Smartphone Scale [in use]

Withings - with WiFi Bodyscale [in use]

Flew (Influenza A en B virus)

BD - with Veritor System [in use]

Cue - with Cue [in development]

Pulse Measurement

4iiii - with Viiiiva [in use]

60Beat - with BLUE Heart Rate [in use]

ActiGraph - with ActiTrainer Activity Monitor [in use]

Adidas - with MiCoach SMART RUN [in use]

AiQ - with BioMan [in use] in kleding

Basis - with Basis [in development]

BabyWatch (hartslag ongeboren kind) - with BabyWatch [in development]

Bellabeat - with Bellabeat Connected System [in use] voor hartslag baby

BlueGiga - with Polar [in use]

BodyTel - with CardioTel [in development]

Bragi - with The Dash [in development]

BSX Athletics - with BSX Insight [in development]

Camntech - with Actiheart [in use]

CardioMems - with Champion HF [in use]

Cityzen Sciences - with Smart Sensing (kleding) [in development]

Corventis - with Avivo [in use]

EarlySense - with EarlySense All-In-One [in use]

Epson - with Pulsense [in use]

Garmin - with Vivofit [in use]

Healbe - with GoBe [in development]

HeartMath - with emWave2 [in use]

Hexoskin - with diverse kledingstukken [in use]

iewei - with Wellness Wristband [in development]

Instabeat - with Instabeat [in development]

Intelesens - with Zensor [in use]

Iqua - with Iqua Beat [in use]

iRhythm - with Zio Patch [in use]

Isansys - with LifeTouch [in use], ook voor 24-uurs withing

ithlete - with ithlete Heart Rate Variability App [in use]

LG - with HRM Earphone [in development]

LifeBEAM - with LifeBEAM [in use]

LifeWatch - with LifeWatch V [in use]

MC10 - with Heart Rate Activity Wristband [in use]

MIO Global - with Alpha [in use]

NuWithrex - with Heart Rate Monitor [in use]

Omron - with Heart Rate Monitor [in use]

OMsignal - with OMsignal (in kleding) [in development]

Owlet Baby Monitors - with Owlet Vitals Monitor [in use]

Pear - with Pear Pro [in use]

Philips - with Motiva [in use]

Philips - with Vital Signs [in use]

Phyode - with W/ME [in development]

Polar - with meerdere Sensoren [in use]

Preventice - with BodyGuardian [in use]

Proteus Biomedical - with 'personal monitoring device' [in use?]

PulseOn - with PulseOn [in development]

PulseSensor - with PulseSensor [in use]

Quanttus - with Vital Intelligence [in development]

Samsung - with S Health [in use]

Scanadu - with Scout [in development]

Scosche Industries - with MyTrek [in use]

SecuraFone - with SecuraPatch [in use]

Sense4Baby - with Sense4Baby [in development]

Sensilk - with Smart Clothes [in development]

Sensiotec - with The Virtual medical Assistant [in use]

Somaxis - with MyoLink [in use]

SOS International - with Hartis [in use], ook voor 24-uurs withing

Spree - with Spree Headband [in development]

Sproutling - with Sproutling [in development]

Teddy & Co - with Teddy The Guardian [in use]

Tedi - with TediKnows [in development]

TomTom - with Multi-Sport [in use]

TomTom - with Runner Cardio [in use]

Toumaz Group - with Sensium Vitals [in development]

Under Armour - with UA Innovations [in use]

Valencell - with V-LINK [in use]

Valencell - with PerformTek [in use]

VitalConnect - with Biosensor [in development]

Wahoo Fitness - with BlueHR [in use]

Wellograph - with Wellness Watch [in use]

Withings - with Pulse [in use]

Zensorium - with Tinké [in use]

Zephyr - with HxM Bluetooth Heart Rate Monitor [in use]

HbA1c

Alere - with Afinion [in use]

Axis-shield - with Afinion [in use]

Axis-shield - with Nycocard HbA1c [in use]

i-CalQ - with POCT [in development]

OrSense - with Glasswing [in use]

Siemens - with DCA Vantage Analyzer [in use]

Hemoglobine

i-CalQ - with POCT [in development]

Masimo - with Pronto-7 [in use]

Orsense - with diverse producten [in use]

HIV Test

MBio Diagnostics - with MBio CD4 [in development]

i-CalQ - with POCT [in development]

Imperial College London - with 'Sensor' [in development]

OPKO - with POCT [in development]

OraSure - with OraQuick ADVANCE Rapid HIV-1/2 Antibody Test [in use]

Rice University - with Programmable-Bio-Nano-Chip [in development]

Head Trauma

MC10 (with Reebok) - with CheckLight [in use]

Third Eye Diagnostics - with Cerepress [in development]

Posture

Giraffe Tech - with Giraffe tech [in development]

LumoBodytech - with Lumo Back [in use]

LumoBodytech - with Lumo Lift [in development]

SensimatSystems - with Sensimat [in development]

Skin analysis(dermatology)

CellScope - with CellScope Derm [in development]

Handyscope - with Handyscope [in use]

iDoc24 - with iDoc24 [App, in use]

MelApp - with MelApp [in use]

Skin Scan - with Skin Scan App [in use]

Stichting Melanoom - with Huidmonitor [App, in use]

INR Monitoring (Trombosis)

Axis-shield - with Coagulation [in use]

Elfi-Tech - with Elfi mDLS sensor [in development]

Philips - with INR Selftest [in use]

Qloudlab - with Qloudlab [in development]

Roche - with Coaguchek [in use]

Cancer

Breast Health Technologies - with Eclipse [in development] Breastcancer

Delphi Bioscience - with Delphi Screener [in use]; Cervical Cancer

Imperial College London - with 'Sensor' [in development]; Prostate Cancer

MobileOCT - with MobileOCT [in development]; Cervical Cancer

OPKO - with POCT [in development]; Prostate Cancer

Rice University - with Programmable-Bio-Nano-Chip [in development]

Ketones

uChek - with Urine Analyzer [in development]

Lactate

BSX Athletics - with BSX Insight [in development]

University of California - with Biosensor Tattoo [in development]

Lifelogging

Aro - with Saga [in use]

Artefact - with Meme [in use]

KAPTURE - with Lifelogging audio [in development]

meMINI - with meMini [in development]

Memoto - with Narrative [in use]

OMG - with Autographer [in use]

ParaShoot - with ParaShoot [in development]

Respiratory tract infection (pneumonia)

Axis-shield - with Afinion (CRP test) [in use]

Axis-shield - with NycoCard CRP (CRP test) [in use]

EuroLyser Diagnostica - with EuroLyser Smart CRP Test [in use]

Orion Diagnostica - with QuickRead CRP [in use]

Stomach (intestine)

G-Tech Medical - with G-Tech Patch [in development]

Malaria detection

Lifelens [in development]

QuantuMDx - with Q-POC [in use]

Rice University - with Vapor Nanobubbles [in development]

Micro-organismn

uBiome - with uBiome [in use]

WellBiome - with WellBiome [in use]

Microscope

Arcturuslabs - with Magnifi [in use]

Bodelin Technologies - with ProScope [in use]

Dino-Lite - with 7013-serie [in use]

Jodo Gyan - with Microscope [in use]

Micro Phone Lens - with Micro Phone Lens [in use]

Stanford University - with Foldscope [in use]

The Ozcan Research Group - with Microskia [in development]

Neuropathy

Orpyx - with SurroSense [in use]

Stool (faeces) Zie: Micro-organisms

Infection

Cue - with Cue [in development]

Eye Analysis

EyeNetra - with EyeNetra [in use]

PeekVision - with Peek [in use]

Sensimed - with Triggerfish [in use]

Stanford University - with EyeGo [in development]

Stanford University - with Adapter [in development]

Welch Allyn - with iExaminer [in use, FDA]

Otoscopy (visualizing the ear)

CellScope - with CellScope Oto [in development]

pH value (acidity)

uChek - with Urine Analyzer [in development]

protein

Scanadu - with Scanaflo [in development]

Röntgenapparatuur

Stanford University and here [in development]

Tribogenics [in development]

University of Missouri - with Portable X-Ray Source [in development]

Sleep Management

ActiGraph - with ActiSleep+ Monitor [in use]

Advanced Brain Monitoring - with Sleep Profiler [in use]

Airo - with Airo [in development]

Angel - with Angel Sensor [in development]

BAM Lab - with Touch Free Life Care System [in use] 

Basis - with Basis [in development]

Beddit - with Beddit [in use]

Bedscales - with Bedscales [in development]

BiancaMed - with SleepMinder [in use]

Camntech - with MotionWatch [in use]

Epson - with Pulsense [in use]

Fitbit - with Fitbit [in use]

Fitbug - with Fitbug [in use]

Garmin - with Vivofit [in use]

GOQii - with Life [in use]

Healbe - with GoBe [in development]

iHealth - with Wireless Activity and Sleep Tracker [in use]

iMPak Health - with SleepTrack [in use]

IQ Intelclinic - with ZIZZ [in development]

Jawbone - with UpBand [in use]

Lark - with LarkPro [in use]

Melon - with Headband [in development]

Nike - with Nike+ Fuelband SE [in use]

NiteWatch - with NiteWatch Home Sleep testing [in use]

Omron - with Sleepwither HSL 101 e.a. [in development]

Razer One - with Razer Nabu [in development]

Samsung - with S Health [in use]

Sleepnumber - with Sleepnumber x12 Bed [in use]

Sleeptracker - with SleepTracker Elite [in use]

SnoreLab - with SnoreLab [in use] Voor withen snurken

Sony - with SmartBand [in use]

Tedi - with TediKnows [in development]

VitalConnect - with Biosensor [in development]

Withings - with Pulse [in use]

Withings - with Aura [in use]

Density

uChek - with Urine Analyzer [in development]

Muscle Development

GymWatch - with GymWatch [in development]

PowerDot - with SmartMio [in development]

Skulpt - with Aim [in development]

Spiro-metrics

Carefusion - with multiple Spirometers [in use]

MIR (Medical International Research) - with Spirodoc [in use]

NDD - with diverse Spirometers [in use]

WelchAllyn - with SpiroPerfect [in use]

Mood meassurement (fitness, stress)

Affectiva - with Affdex [in use]

Airo - with Airo [in development]

Beyond Verbal - with Beyond Verbal [in use]

Curavista - with Stemmingswither [in use]

Galvanic - with PIP [in development]

Healbe - with GoBe [in development]

iFocusband - with iFocusband [in use]

LifeWatch - with LifeWatch V [in use] Stress Test

Mega - with eMotion Faros [in use]

Mindmasters - with Mindmasters [in use]

Moodpanda - with Moodpanda [in use]

Moodscope - with Moodscope [in use]

Neumitra - with Bandu [in development]

Scanadu - with Scout [in development]

Stethoscoop

3M Littmann - with 3100 en 3200 [in use]

AUM Cardiovascular - with CADence [in development]

Peter J. Bentley - with iStethoscope [in use]

StratoScientific - with Steth IO [in development]

Thinklabs Electronic

Metabolism

Breezing - with Breezing [in use]

Ki Performance - with Ki Fit [in use]

Temperature (thermowither)

Amiigo - with Amiigo [in development]

Basis - with Basis [in development]

Bragi - with The Dash [in development]

Braun - with Forehead [in use]

Braun - with Thermoscan [in use]

Cityzen Sciences - with Smart Sensing (clothes) [in development]

Distributed Health Labs - with OASIS [in development]

Exergen - with TemporalScanner [in use]

Fraden - with Non-contact thermowither for Smart Phone [in development]

Hidalgo - with Equivital EQ02 LifeMonitor [in development]

iewei - with Wellness Wristband [in development]

iTherm - with iTherm [in use]

Kinsa - with Kinsa [in use]

LifeWatch - with LifeWatch V [in use]

Medisana - with ThermoDock Infrared Thermowither Module [in use]

Microlife - with NC100 e.a. [in use]

Omron - with diverse modellen [in use]

Owlet Baby Monitors - with Owlet Vitals Monitor [in use]

Raiing - with Wireless Thermowither [in use]

Rest Devices - with Mimo [in use]

Scanadu - with Scout [in development]

SecuraFone - with SecuraPatch [in use]

Sensible Baby - with SensibleBaby [in development]

Sensaris - with ZAO [in use]

Spree - with Spree Headband [in development]

Sproutling - with Sproutling [in development]

Teddy & Co - with Teddy The Guardian [in use]

Tedi - with TediKnows [in development]

Toumaz Group - with Sensium Vitals [in development]

Vidawith - with Viadawither [in development]

VitalConnect - with Biosensor [in development]

VitaMove - with VitaSense [in use]

Vivonoetics - with Equivital EQ02 Lifemonitor [in use]

Testosteron

Cue - with Cue [in development]

OPKO - with POCT [in development]

Triage

Caracal Diagnosis - with Caracal App [in use]

Healthagen - with iTriage [in use]

Isabel Healthcare - with Isabel [in use]

Moet Ik Naar De Dokter - with Moet Ik Naar De Dokter? [in use]

Senstore - with Virtual Nurse [in use]

WebMD - with WebMD (Symptom Checker) [in use]

Urinetest and -diagnosis

Scanadu - with Scanaflo [in development]

Toto - with Intelligence Toilet [in use]

uChek - with Urine Analyzer [in development]

Nephrosense – With Urine Analyzer focusing on Kindey diseases [in development]

Fat meassurement

Fitbit - with Aria [in use]

LifeWatch - with LifeWatch V [in use]

Withings - with WiFi Bodyscale [in use]

Vitamine D

Cue - with Cue [in development]

OPKO - with POCT [in development]

Fertility

Cue - with Cue [in development]

Sandstone Diagnostics - with Trak [in development]

Acidity

University of California - with Biosensor Tattoo [in development]

Detoriation

EarlySense - with Sensors for [in use]

Pregnancy Monitoring

i-CalQ - with POCT [in development]

Monica Healthcare - with Monica AN24 [in use]

Nemo Healthcare - with PUREtrace [in development]

Sweat measurement (transpiration)

Basis - with Basis [in development]

Holst Centre [in development]

MC10 - with Hydration Patch [in use]

Preventice - with BodyGuardian [in use]

Sources:

http://ic25.blogspot.nl/

http://www.pocket.md/

http://myhealthapps.net/

http://www.medhelp.org/health_tools#/mobile_apps

http://www.earlysense.com/

Austria

Diagnosia       

The Viennese startup founded in 2011 is providing healthcare solutions as a web and mobile application and has a comprehensive databank with all of the licensed medications in Austria and is internationally connected. The system is designed especially for doctors, who can use it to check medications and possible side effects with prescriptions a patient already has. More on the team can be found here.

mySugr

The Vienna-based startup tries to turn the cumbersome supervision of diabetics’ blood sugar into an easier routine. By now, mySugr has entered the American market and has over 100,000 users. They have also developed a specialised version for children that should make keeping an eye on their blood sugar fun and less annoying. Read more about the venture and their founder here and here.

Symptoma

With the Austrian startup Symptoma, patients and doctors alike can type in a symptom, add additional parameters such as sex and age, and can so find the possible causes for a certain symptom. Among the information they get is statistics such as the incidence of a disease, distribution of the disease among the genders, distribution of age and geographic indicators. Read our profile on founder Jama Nateqi here.  

Bucinator

Bucinator, supported by Innsbruck-based incubator CAST Tyrol, is an alarm system for nurses and other caretakers in hospitals and retirement and caretaking facilities. It’s a fall prevention system attached to matrasses that sends off an alarm signals to the nurse’s station if a patient e.g. sits up or is in danger of falling off the bed. Bucinator has won the Newcomer Innovation Award for Geriatric Care 2014.

Vira Therapeutics

Also a CAST Tyrol-supported venture, Vira Therapeutics raises the bar: The startup that has its roots at the Medical University Innsbruck seeks to fight cancer the innovative way. They are developing a highly potent oncolytic virus that can be used for cancer treatment. It has so far helped the biotech startup win first prize at the Best of Biotech business plan competition in 2012. Read more about them here.

Bulgaria

Smart Hand

The Bulgarian team of Smart Hand has an ambitious goal: to produce the perfectly usable hand – artificially. To help amputees, the team wants to engineer the ultimate robotic hand, minimise the risk of phantom pain and – literally – give amputees their limb back. Read more about them here.

Slovakia

Vestigen

The Slovakian Startup based in Bratislava, develops sensor technologies for portable diagnostic use with applications in multiple fields. They are working on a breakthrough technology - a lighter-sized device capable of precise measurements, which has only been seen in science fiction movies before. Science fiction is becoming reality. Read more about them here.

Diagnose.me

The Slovak startup specialises in giving patients the possibility to get a second opinion on their radiologic diagnosis. Via their website, patients who want to have their X-ray, MRI or CT scans looked at by radiologists other than their treating physician can send in their images and get a second or third opinion. For that purpose, Diagnose.me has partnered up with radiologists from around the globe and employs medical interpreters to translate medical reports so people can be helped in confirming, editing or correcting their initial diagnosis.

ASANA

The Slovaks from Asana have created a special chair inspired by the ancient tradition of Yoga (Asana is also an expression from Yoga, frankly just meaning “sitting down”) that allows people to solely sit on their hips and part of the buttocks. Thus they create a very comfortable seating position, with one of their main goals being to prevent hemorrhoids.

Slovenia

Mediately

The Slovenian startup Mediately has programmed an app that contains basically all relevant drugs and medications available. With it, doctors but also patients can cross match prescriptions and check if the drug the doctor is going to prescribe could interfere with another one the patient already takes. Read their Startup Pick here.

Serbia

TeleSkin

The Serbian enterprise, founded already in 2007, wants to fight skin cancer and other dermatologic diseases with high tech. TeleSkin develops and produces hard- and software for tracking moles and provides the infrastructure to share the newest findings on one’s skin with a doctor. In 2013, they won Microsoft’s healthcare innovation award and now have partner clinics throughout Serbia.

Estonia

Cognuse

Cognuse is management and aid software for healthcare administrators in hospitals, as well as experts and patients undergoing rehabilitation. The CognuseManager programme collects data about the progress of a patient and provides medical professionals with viable information about how rehabilitation exercises are working on their patients. Originally from Estonia, the team of four has in the meantime made it to California and has international distributors in Japan, Hong Kong, China and the US.

Croatia

Greenpie

The startup from Croatia has developed an online service available for computers, tablets and smartphone that allows nutrition experts or dietitians to optimise nutrition counseling processes virtually. Dietitians, nutritionists or doctors can track the progress of their patients online, give them advice or set new goals for them by editing their nutritional schedule. 

IDerma

The Zagreb-based startup created an app that lets doctors easily keep track of their patients. Appointments can be scheduled, postponed or rearranged as well as prescription plans updated or edited. Doctors can directly communicate with their patients, give them advise on their treatment or use a database connected with the app for research. The duo Ana Burica and Josipa Majic are also on the forefront of Teddy the Guardian, a plush teddy bear toy that monitors a child’s vital signs. Catch up on them here.

IBM recently published their Healthcare Industry Point of View paper. This new global report on healthcare transformation, gives an overview on the general problems of the healthcare systems, brings some good facts on costs and efficiencies and analysis what could be the core of the problem. It offers a clear overview of the industry dynamics as well as a unique and differentiating perspective on where the greatest opportunities for transformations are.

According to the report most healthcare systems is that they are not run as systems at all. There is little coordination of data, care, or services. The scale of fragmentation and waste is well understood by most healthcare industry stakeholders. Healthcare organizations should not feel powerless and wait for some new legislation to fix it. Systems this complex don’t transform from the top down. Change happens in a more organic fashion, through the efforts of pioneers within the system. According to the author the problem is not just that it is complex. There are plenty of complex systems in our world that run efficiently.

Healthcare organizations need to make hard, thoughtful and informed decisions about every aspect of their operations and their business. Many healthcare organizations have already begun to develop new competencies to support strategic decision making, while also building the organizational agility that will be necessary to adapt to changing market conditions. Based on the global experiences, IBM has identified essential competencies healthcare organizations should focus on for the future;

Collaboration and Partnering

Information Proficiency

Patient-centric, coordinated and more personalized care

Talent Creation and Retention

Technology Enablement

in order to become become a true “system of systems” that is focus on value, coordinated around the patient, and integrated into our communities.

During the next few days I will publish 3 posts on the TedXMaastricht event that took place on Monday 2nd April 2012. the central theme was the future of healthcare, and the presenters talked on:

emerging technology and big data

epatients

research & design

transformation & organization

In this first part I will summarize two talk that focused on emerging technology and big data Naveen Jain is trustee of the board of the Singularity University and a philanthropist, entrepreneur and technology pioneer. According to him the core of the system is broken and we are currently working on the edges. The necessary transformation in healthcare will come through innovation driven by an entrepreneurial movement. Emerging technology allow us to do things differently and design new systems. His analysis on the business model and the incentive systems was a bit simplistic, and even though the bottom line of what his message was, he might have lost part of the audience when telling that doctors have no incentive to keep you healthy.

These new healthcare systems that Nayeen is talkin about will allow us to become the CEO of our own health. The vision that he promotes, using emerging technologies such as nanotechnoligies for body sensor networks and remote diagnostics, artificial intelligence systems based on medical knowledge, and algorithms to remotely or even auto-monitor humans and prevent diseases from happening is well in line with what Winod Khosla wrote in January on Techcrunch "do we need doctors or Alogrithms?"  - Nayeen closing statement: Be an interpreneur, make the world proud! Dr. Paul Grundy, IBM Global Director of Healthcare Transformation, concentrates his efforts on driving comprehensive, linked and integrated healthcare. Healthcare today, still uses the same concept as the master builders of the cathedral in the middle ages. These master builders, build there temples without a masterplan and by storing all data in the head of the architect. Doctors still do the same and act during their training and their profession as a data repository storage unit. And as medicine is increasingly getting complicated, we specialize, to be able to store all that data in one persons mind. Paul, proves that this model of care is broken, by emphasizing that one out of five diagnosis are wrong, 81% of the physicians spent less then 5 hours a month reading medical journals and medical information is doubling every 5 years.

Paul states that we should focus less on a system that does not deliver the best heart surgery, but more on a robust primary care system , that avoids heart surgery. The GP should be the system integrator, where data begins to flow and is held accountable. Patients need to be at the center in a long term comprehensive healing relationship, with a personal physician empowered with the right tools and linked to the care team. This is the concept of the patient centered medical home also known as the shared shared care or integrated care model.The be able to implement this successfully, some strong principles needs to be followed. These joint principles are published by the American College of Physicians (ACP) as the Joint Principles of the Patient-Centered Medical Home

According to Paul three trends are driving this concept. The first one is the sustainability of the healthcare system and it relation to the increasing costs. The second one is data and using data a actionable information to allow care givers to take better decisions. Paul mentions how IBM in the first time of history, will help primary care doctors to give them access to latest medical knowledge using IBM Watson. Watson is a powerful system that understands natural language, can learn and generate hypothesis at the point of care. The third driver is the raise of the digital natives in the healthcare system, as they grow.

At the end Paul presented the outcomes of this new delivery system:

36.6% drop in hospital days 32.2% drop in ER use 12.8 % increase chronic medication use -9.6% total cost (Mayo zero cost increase) 10.5% Inpatient specialty care cost down 18.9% ancillary cost down 15% outpatient specialty down

Whereas Nayees vision, is a disruptive model that as he said does not need a basic healthcare infrastructure, Paul's concept focuses more on how to use IT and emerging technologies best within the existing infrastructure.

As described in my last contribution on the COPD experiences with shared care in Spain and Denmark, Paul's concept will need strong leadership and is hard to integrate within the existing system, as you have to align all existing stakeholders into a new direction. Nayees, vision is disruptive. and we all know how Apple transformed the music industry, but the difference here is that the healthcare industry is well regulated and innovation within this industry is so hard, just as Regina Herzlinger (Harvard) wrote a few years ago.

video Nayeen Jain

During the last few month, I have seen more posts on the management of chronic lung diseases such as asthma and COPD. Both diseases have similar characteristics such as the signs of coughing and wheezing, but they are two distinct conditions in terms of disease onset, frequency of symptoms and reversibility of airway obstruction. With treatment, asthma patients have near-normal lung function and are symptom-free between exacerbations (source) The onset of asthma typically occurs during childhood or adolescence. COPD most often develops in smokers and former smokers who are in their mid-40s.[source]

According to the European Federation of Allergy and Airway Diseases Patients Association, approximately 300 million people around the world have asthma, and it has become more common in both children and adults globally in recent years.Estimates have shown that the number of people with asthma could grow to as many as 400-450 million people worldwide by 2025.

Around 30 million people in Europe have asthma, and as many as 6 million suffer symptoms which are characterized as severe. Around 1.5 million people in Europe live in fear of dying from an attack.

The total annual cost of asthma in Europe is €17.7 bn per year, and productivity lost to poor asthma control is estimated at €9.8bn per annum (source).

Chronic obstructive pulmonary disease (COPD) is the most costly respiratory disease in Europe, with annual costs estimated at €38.7 billion, of which 74%, (€28.6 billion) result from lost work days. The remaining costs for COPD, 26% of the total (€10.1 billion), cover inpatient care, medication, and ambulatory care. The indirect costs in productivity losses are almost 3 times the costs for direct health care (source).

The total annual financial burden of lung disease in Europe is estimated at €102 billion, a figure comparable the Greek bail-out of the European Financial Stability Facility.

With treatment:

asthma patients have near-normal lung function and are symptom-free between exacerbations.

COPD patients rarely experience a day without symptoms. Airflow obstruction in COPD sufferers is only partially reversible with smoking cessation and bronchodilator

TELEHEALTH PROJECTS IN EUROPE

Whereas John Chilmark focused in his latest research on mHeatlh and Asthma. I want to look more into the implementation of these technologies within the healthcare system, by looking at some key leanings from telehealth projects in Europe that focused on the management of COPD.

DENMARK

A lesson learned during the www.telekat.eu project that focussed on the prevention of re-admissions of patients with COPD by developing a preventive program of tele-rehabilitation across sectors for COPD patients. This research project showed that the adoption barriers within the inter-organizational context are not technological, but organizational. The obstacles identified included the mindset of the healthcare professionals, inter-professionals relations, views of technology as a tool and competing visions for the goals of tele-rehabilitation. During interviews, the clinicians expressed the view that is difficult to work in a creative mode and think utopia. They expressed the view that they were not used to working creatively in interdisciplinary groups across sectors for the purpose of developing a joint concept for tele-rehabilitation. All groups of healthcare professionals expressed the view that they found it difficult to combine preventive rehabilitation with technology. They raised questions, such as:

“What can we use all the measured values for?

“Will the COPD patients become more worried about their illness?”

“How will the patients' quality of life be affected by measuring the values?”

"What happens if we do not pay attention to measurements that are out of range?” 

An issue that reached a deadlock was how to share responsibility between healthcare professionals and COPD patients in facilitating tele-rehabilitation.

Transformation is difficult, and there are very few arenas in which stakes are higher and more sensitive than in healthcare. All too often this complexity and challenges that are of the magnitude are being ignored.

SPAIN

The Health Plan 2007-2015 of the Catalonian Healthcare System that transforms the care for chronic diseases such as COPD was a political mandate. The transformation program focused on a shared care approach, that increases effectiveness of the communication between nurses, physicians and patients, to influence behavior and decisions. IT and tele-monitoring was used to support well standardized care paths, resulting in integrated care strategies for chronic patients. The shared care model should allow the healthcare system to early prevent and diagnose and thereby avoid hospitalization. COPD was the initial focus because this type of chronic disease generates high use of health care resources. The Project focused on defining a set of actions from a multidisciplinary consensus among all health professionals in the area of Barcelona assisting people with COPD.

One of the key success factors of this projects were:

the inclusion of specific training program for doctors and nurses, primary care physicians and hospital

the inclusion of Management by Objectives. The program created economic incentives in primary care (medical and nursing).

The home hospitalization program, showed a cost containment from €2033 to €1255, and a reduction in annual admissions (source) from 67% tot 47%.

Other ongoing projects:

http://www.amica-aal.com/ http://www.epractice.eu/en/node/5346351 http://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/veneto.pdf

TECHNOLOGY AND TRANSFORMATION

The technology used to monitor and connect patients to caregivers, are just the tools. And we all remember Bill Gates quote: "The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency."