Blending mHealth and Telemedicine

The World Congress hosted three conferences in one space this week at the Colonnade here in Boston with a great pool of innovators and thought leaders in the mHealth and telemedicine space.

While the three conferences – mHealth, mHealth Innovation Exchange and the Leadership Summit on Telemedicine – were all unique in focus, I think they could have easily been combined into one conference. With discussions on the latest technologies and initiatives transforming healthcare today, it was hard to choose between attending an mHealth or telemedicine sessions, as they are really one in the same.

Alex Nason, Director of Telehealth at Johns Hopkins Medical, summarized the three conferences’ theme well. ‘It’s the connection to health service delivery that matters.’ Both mHealth and telemedicine are services and means for improving the quality and delivery of care. Connecting payers, providers with patients, we’re all in the ‘service’ of innovating care. And it’s a good service to be in.

In case you missed it, here are the highlights:


-Consumer Trends for Mobile Solutions

-Building Scalable and Sustainable mHealth Behavior Change

-Joslin Everywhere Diabetes Mobile Health Initiative

-Connected Mobile Health Apps and Consumer Engagement

-Intersection of Social Media, Games and mHealth

-Mobile Monitoring for Chronic Conditions

-Global mHealth Perspectives and Challenges

Telemedicine Summit:

-Transitioning to Virtual Care Models

-Telemedicine Funding Opportunities and Current Initiatives

-Pediatric Specialist Care Delivery via Telemedicine


-Legal Requirements of Telemedicine

-Virtual Care Team Coordination

-Social Media and Telemedicine

-Prescribing via Telemedicine

The Virtualization of Care

This year’s World Congress Leadership Summit on Telemedicine features a great lineup of speakers. Joining innovators from major hospitals and healthcare delivery organizations, we’re excited to hear about the industry-wide interest and demand for telemedicine use in care delivery.

One of the more interesting sessions was the keynote panel discussion on the Joslin Diabetes Center’s ‘Joslin Everywhere’ diabetes mobile health initiative and efforts to virtualize the delivery of care.

Panelists included Chief Medical Officer Martin Abrahamson, Chief Information Officer Ed Charbonneau and WebCare Program Manager Paul Penta. The focus of their panel was on efforts to improve quality, extend their specialist reach by supporting providers at affiliate sites, improving clinical metrics and collaboration with partners in the healthcare field. Through the use of new and innovative tools to train and engage patients to promote better care management, Joslin is establishing itself as a leader in diabetes care and ensuring care anywhere and ‘everywhere.’

Stay tuned for more updates throughout and after the conference.

What’s wrong with telemedicine?

While studies have shown that successful use of videoconferencing and real-time communications can profoundly benefit patients and doctors alike, how do we define success?

Telemedicine has been in use now since the 80’s but due to complexity, specialized equipment, expensive network infrastructure and poor Medicare/Medicaid reimbursement policies, it remained limited to a small number of users. These challenges made it impractical to use televideo technologies for care delivery on a larger scale.

Today, low cost and ubiquitous technologies do exist that can facilitate a world in which videoconferencing has a place on the desk of every doctor, nurse and clinician. However, what is needed at the clinician level are applications designed specifically for the health care industry with televideo as a method of communications.

What does this mean?

As studies have shown that health care outcomes improve when truly collaborative communication takes place among patients, doctors and specialists, televideo is becoming more mainstream. But for televideo to be both successful and effective, televideo technologies must be user friendly, highly secure, low cost and fully customizable.

Is that all?

Fixing televideo goes beyond cost and complexity. While there are a number of innovative televideo technologies, there is still the problem of integrating televideo seamlessly into clinical workflow. The success of any technology depends only 10 percent on the technology and 90 percent on how the technology is integrated with existing workflows.

To deliver care successfully and effectively across the healthcare continuum, televideo must be mapped to existing workflows to improve patient and clinician use experiences and to minimize change management issues.

Change is good but it’s not always great.

To make televideo great, let’s start with improving the usability.



iMedicine and Mobile Panel

SBR Health hosted a panel discussion at Boston’s first ever iMedicine and Mobile Summit on ‘Trends in Utilizing Mobile Televideo Technologies to Improve Healthcare Access.’

Studies have shown that successful use of real time communications such as televideo can profoundly benefit patients and doctors alike. Health care outcomes improve when truly collaborative communication takes place among doctors, specialists. However, until recently the specialized equipment, complexity and expensive network infrastructure required by video, as well as poor Medicare/Medicaid reimbursement policies made it impractical to utilize televideo technologies for the delivery of care unless the patient was a great distance from the doctor.

Now, changing reimbursement models and low-cost mobile based televideo technologies are making it easy and cost effective to utilize televideo in a wider array of patient and inter-clinician interactions. Hence, it is now practical to utilize televideo for a much larger population of patients who may not need to travel long distances but still be able to be better served if they could avoid traveling. With these types of applications, health care professionals would have simple efficient communications tools to increase access to specialists, raise the overall levels of patient care, and improve delivery of treatment.

Our featured panelists included Rick Hampton, Wireless Communications Manager at Partners HealthCare; John Moore, Founder and Managing Partner at Chilmark Research; Adam Strom, Director of Research and Design at WorldClinic; David Judge, Medical Director, Ambulatory Practice of the Future at Massachusetts General Hospital; and Shawn Farrell, Telemedicine and Telehealth Program Manager at Children’s Hospital Boston.  Chris Herot, CEO of SBR Health, served as moderator for the panel.

ATA 2012

Pete Eggleston demonstrating SBR Health's applications at ATA.

This week we showed SBR Health’s applications in San Jose at the annual meeting of the American Telemedicine Association. As part of our recently announced partnership with Vidyo we set up our station in their large booth in the center of the show floor.

This year’s ATA was the largest ever and most of the attendees who came by our booth had active telemedicine programs that they were looking to expand. In order to do so, they were looking for a way to manage the workflow and create a straightforward experience for both patients and clinicians.

We look forward to following up with all of you who we met at the show.

Check here to get an inside look

SBR Health Q&A: The mobile shift in healthcare

Everything is moving to mobile these days, and healthcare is no exception. Christopher Herot, co-founder and CEO of SBR Health, is a recognized business and technology leader who has spent years developing and evaluating video, mobile and real-time video communications solutions. In this one-on-one interview, Chris shares his thoughts and predictions for how mobile technology will transform the healthcare space and beyond. From how we buy care to keeping in touch with family, mobile’s intersection and influence on our daily lives is significant.

How have you seen this shift?

There was a time when every young ambitious professional had a day planner. The iPad is now the equivalent. It’s your phone, calendar, email, entertainment, and computer – your method of communication for everything. This has really transformed a number of industries. Retailing is now different. People can do comparison-shopping using their phone. It’s even changed travel to some degree. You can get your boarding pass on your phone and check into places on Foursquare. For the longest time, it looked like healthcare was not a tech-savvy field but this is quickly changing.

What role does mobile play in the healthcare space?

iPads are taking the medical world by storm. They’re just the right form factor for healthcare. Apple reimagined what you can do with a tablet and has provided for an entirely new experience. Doctors don’t want other tablets. They want the iPad.

Some thought early tablets failed in terms of usability based on size but Apple demonstrated it wasn’t just about size but more about the user experience. There’s something truly unique about being able to type medical information while looking at your patient. This increases physician-patient engagement.

What’s the benefit?

There’s proven clinical value. Tablets have given doctors better access to tests and other medical information. A recent study published in the Archives of Internal Medicine found that iPads help doctors be more efficient at ordering tests and procedures for their patients. My thesis is that iPads allow physicians to do more in real time and make healthcare more convenient.

The real and long-term benefit of mobile technology is in bending the cost curve in healthcare. This goes beyond getting doctors to accept lower fees and cut down on unnecessary tests. The bulk of the cost is to get Americans to stop eating so many donuts. The way you make people healthier is to make it easier and convenient for people to see their doctor. This will drastically cut healthcare costs.


The demand for mobile reflects where we’re at as a society. The doctor is not always in his office ready to take your call, and so many of us are on the go. Being able to get access to the healthcare system wherever you are – work, home, out and about – is really critical. To make that work, we have to be able to see the patient and share what we see with other people. Tablets are small enough to be portable but also have real data on the screen.

How will this be adopted?

It will happen fastest where the payment model is evolving away from the fee for service. You’re seeing this with concierge practices. Once you make it easier for patients and doctors to do a virtual visit, I expect the adoption will expand to other parts of the world. There are places like the payers and insurance companies who see this as a way to improve healthcare delivery. You’ll see this first in places that have the luxury of not having to worry about restrictions. Concierge and post-acute follow up are prime examples.

SBR Health is developing the technology that will enable videoconferencing and real-time communications to benefit patients and doctors alike. Healthcare outcomes improve when collaborative communication that’s convenient takes place among doctors, specialists and patients, and we’re working to make it as simple and secure as possible.

Health Science’s Contribution to Health Care

The global expansion of the Internet and mobile communications technology has made a host of new connections possible, perhaps none so significant as those in the healthcare sector. Health science professionals have been hard at work over the past few years to harness technological avenues to bring less expensive, more efficient health care to patients all over the world. Telemedicine initiatives, digital information sharing between medical professionals, and the use of mobile phones to help diagnose and deliver care are only some of the ways technology is changing the face of modern medicine. Health scientists in all disciplines, from biology and chemistry to immunology and epidemiology, are actively contributing to advances in mobile health initiatives, known commonly as “mhealth.”

One of the most basic forms of mhealth involves digital exchanges between doctors and established patients. Video conferencing is one of the most common forms of communication. Rather than call the doctor for an appointment to check out a sore throat, a sprained foot, or other minor ailment, a patient can simply log on to a video chat with his or her primary care provider.

Christopher Herot, Chief Executive Officer of SBR Health, identified two primary benefits of video conferencing in a January 5, 2012 release  describing the company’s lessons learned over the past year. “The obvious role, as pioneered in dermatology and neurology, was using video as a diagnostic tool,” Herot said. This sort of remote care is generally viewed as quite efficient, as it reduces travel and wait times, and cuts down on interaction costs.

The other benefit was psychological. “Video, like an in-person visit, ensures a higher level of trust between the patient and doctor,” Herot said.  Other alternatives to an in-person visit, such as e-mailing or calling the office, can be a bit more impersonal, which can lead patients to withhold information or not disclose all symptoms.

Technology is also increasingly intersecting with health care in rural communities. More isolated patients can save long trips to see specialists in bigger towns or cities by logging on to internet-based medical portals or visiting local clinics with mhealth capabilities. With the right tools, a world of cutting-edge medicine is accessible almost anywhere. Local doctors can upload records, test results, and x-ray scans, and send them to specialists at larger tertiary hospitals instantaneously. Feedback and consultations happen just as fast.

The United States Department of Health and Human Services announced a nearly $12 million grant at the end of 2011 to help develop rural mhealth initiatives in the U.S. “We need health information technology to bring our health care system into the 21st century,” Department of Health and Human Services Secretary Kathleen Sebelius said in announcing the grant on September 2.  “These funds will help safety net providers acquire state-of-the-art health information technology systems to ensure the delivery of quality care to some of the most remote areas of our country.”

Innovations in bridging health science with technology are not limited to developed nations, however. Initiatives like the United Nations Foundations’ mHealth Alliance and the public/private Stop TB Partnership involve a range of health scientists in leveraging technology, particularly that associated with mobile phones, to bring medical care to countries in Africa and South Asia.

According to the mHealth Alliance, mobile phones are one of the best ways for health care providers to “reach the unreached,” particularly where treatment of specific illnesses and conditions is concerned. Phones “can empower the public with information, enable remote health workers, reduce inefficiencies, provide training, improve monitoring of activities and outcomes, support remote diagnostics, and support electronic payments,” the alliance said in a 2010 technology briefing.

Field workers studying disease outbreaks and mapping treatment zones in remote areas can easily connect with lab technicians, biologists, and researchers across the globe with a simple text message or phone recorded video. Bio-informatics specialists can easily analyze reported data, and public health experts can work with physicians to devise treatment and diagnosis regimens that can be immediately implemented. As more health scientists get involved in technology-driven health care, the more changes, advancements, and improvements the field is likely to see in the months and years ahead.

By Jocelyn Salada, Guest blogger, Contact:

Children’s Innovation Day

At the heart of innovation are ideas. Ideas for something new and different. While there’s no shortage of ideas in the medical world, innovation doesn’t come so easily.

Children’s Hospital Boston’s first ever Innovation Day showcased the hospitals’ work to accelerate innovation by supporting innovators’ novel ideas. The featured innovators, which included chief officers, physicians and nurses at Children’s, shared their personal and professional motivation behind their ideas, the challenges they’ve faced along the way and hoped for outcomes. While the speakers’ ideas varied in complexity and development, they embodied Children’s commitment to advancing healthcare innovation.

‘Change is essential, and we need to invest,’ Dr. Pedro Del Nido, Chief of Cardiac Surgery and a longtime leader in innovation at CHB, said in his opening remarks. A featured speaker and moderator of the ‘Healthcare Device Innovation’ session, Del Nido attributed Children’s interest in supporting innovation to the inventors of new and novel ideas.

‘There are many challenges along the way but it’s rewarding to know that you’re doing something that no one else knows how or can do,’ Del Nido said.

To aid ‘inventors’ in the development of their ideas, Children’s assists with funding, testing and getting approval from regulators.  Two of the speakers—Dr. Hiep Nguyen, a man of many titles including pediatric urologist, surgeon and director of the Robotic Surgery Research and Training Center, and Dr. John Kheir, chief fellow in Critical Care Medicine, shared the inspiration behind their projects, and Children’s help in the overall development.

Nguyen, who is recognized as a serial innovator at Children’s, gave a talk on ‘Human Inspired Technology: an Implantable Kidney Dialysis Unit.’ From the spark of an idea and initial sketch on a tablecloth, Nguyen worked with Children’s to develop an implantable dialysis unit that offered the benefits of hemodialysis and peritoneal dialysis, while also avoiding the disadvantages of scarring and infection. Inspired by a friend and colleague undergoing dialysis, Nguyen is passionate in developing a technology that will improve the effectiveness of dialysis, and in turn, quality of life for patients.

‘You may have a lot of ideas but few things that you’re passionate about,’ Nguyen said. ‘Passion is the driving force. You have to go after the ones that mean the most to you.’

Like Nguyen, Kheir also shared the motivation behind his development in his talk, ‘When a Patient Needs Air: Injectable Microbubbles that Release Oxygen into the Blood.’ Focused on improving outcomes of patients who undergo cardiac arrest, Kheir developed a technology that packages oxygen in microbubbles for direct delivery via injection to blood and tissue. The technology can be used to treat patients who have undergone cardiac arrest by delivering oxygen to the heart issue quickly and directly. Developed to improve outcomes and ultimately save lives, Kheir is hopeful this technology will be deployed in every ambulance, operating room and emergency room. Children’s, he said, is helping make this a reality.

‘The most important thing is to believe in your idea,’ Kheir said. ‘The degree to which you believe is transmitted to others.’

With the help of Children’s, Kheir feels confident that his technology and other ideas can make a real impact on healthcare. Thanks to Children’s, the featured speakers at Children’s Innovation Day, all have ideas in development. Change has only just begun.


‘Innovate or Fail’

The role of innovation was the theme at the Harvard Business School’s 9th Annual Healthcare Conference. In the introductory keynote and subsequent panel discussions, the need for innovation in today’s healthcare industry was made clear.

Among the practitioners, healthcare organizations and consumers present, innovation was agreed to be the ultimate challenge at hand, and essential to the success of healthcare reform. Speakers offered different perspectives on the purpose of innovation and their approach to finding ways to innovate to avoid becoming artifacts of the old healthcare system.

Karen Ignagni, President and CEO of America’s Health Insurance Plan (AHIP) delivered the opening keynote, ‘Health Care Innovation in the Context of Rising Health Care Costs.’ As the voice of health insurance plans, Ignagni has a wealth of knowledge and passion for health policy.  In regard to innovation, Ignangi sees innovation as the tool for creating value. Through new payment models and the adoption of new technologies for care delivery, Ignagni sees an opportunity for collaboration and innovation. Innovation, she said, benefits both the public and private sector by enabling more efficient and effective care, which at the end of the day, creates value.

Katie Szyman, Senior Vice President and President of Medtronic’s Diabetes business, oversees research, development, sales and marketing for Medtronic’s insulin infusion pumps and continuous glucose monitoring systems. In the ‘Devices/Diagnostics: Enabling New Treatment Paradigms’ panel discussion, Szyman was one of three panelists that addressed how new markets and applications for devices and diagnostics are helping patients assess their health and take preventative action early to help improve health outcomes and control healthcare costs.

According to Katie, value is linked to the support of innovation. Through the use of new technologies, value is attributed from increased patient satisfaction and improved health outcomes. When asked about the FDA’s influence on the use of new and innovative devices, Katie acknowledged that FDA regulations have indeed slowed down development and caused shrinkage in investments in new technologies, resulting in the rise in medical tourism and or ‘inverse innovation.’ Despite the negative outlook, Katie foresees more collaboration between the CMS and FDA that she hopes will improve the review process and support of new medical products.

Innovation was also addressed at the ‘Healthcare IT: A Blueprint for the Data Revolution,’ a panel focused on the revolution in the quality and accessibility of data, and its potential to transform healthcare. When properly deployed, IT was said to be the true leader in innovation, spawning new business models and industries. Robert Cosinuke, Chief Marketing Officer of Athena Health; Graham Gardner, CEO and Co-Founder of Kyruus; and Steven Wardell, Vice President, Marketing and Business Development of Activate Networks  shared their insights on new IT developments that are improving collaboration and communications between patients and providers. The shared opinion among the panelists was that the key to value creation is through the support of health IT technologies.

Other discussions at the conference featured payors/providers, biotech/pharma, entrepreneurship/venture capital, and private-public partnerships. With leaders from some of today’s largest and most innovative healthcare organizations, the conversations were informative and tied to health reform. The pressure to innovate or fail was felt. This year, next year, and in the years to come, the focus on innovation to create value will persist.

SBR Health 2011: What We’ve Learned

As we start a new year, I looked back on all that we learned from the hundreds of conversations we had with doctors, patients and hospital administrators to pinpoint the top lessons that really stood out from 2011.  There was a lot of frustration with the fee-for-service model and the fragmented care that it engenders, but there were a few points of concern that surprised us that I thought I would share with our readers.

When we asked patients what they wanted from their doctors, we heard they wanted someone who would really listen, take them seriously, and didn’t keep them waiting. When we talked to doctors, we learned they were frustrated by patients who didn’t show up for their appointments, follow up with their treatment plans or take their medications. While it is often said that anecdotes don’t equal data, there are corresponding statistics on the sorry level of readmissions, which can often be traced to a lack of coordination among caregivers and the need for patient engagement.

As we looked into where video communication might help, we observed that video had two very different roles to play in medicine. The obvious role, as pioneered in dermatology and neurology, was using video as a diagnostic tool, for example looking at a photograph of a patient’s skin or observing his performance in a neurological examination.  The other role, which may be equally if not more important, was more of a consultative role to establish rapport and engender trust between the parties. Doctors refer to the “doorknob syndrome,” where the patient mentions the most significant problem as he has his hand on the doorknob to leave the room. As this is something that occurs most likely in person and least likely over the phone, video is more like being there in person. Video, like an in person visit, ensures a higher level of trust between the patient and doctor.

We also heard a lot from hospital administrators about “change management.” Doctors are avid consumers of technology, from surgical robots to smart phones, but they have little patience for tools that are supposed to help and instead create more work. Electronic medical records (EMR) are a case in point. Implementation of an EMR can cost millions (or even billions in some cases) but we have yet to encounter a health care professional who hasn’t expressed frustration with one. Enterprises everywhere need to deal with the high level of expectation conditioned by consumer IT, and health care is no exception.

When it comes to video communication, the technical requirements are pretty straightforward: high quality, low bandwidth, interoperability with existing systems, and straightforward user experience. While there may not be one technology that satisfies all those requirements at once, we at SBR Health see an opportunity in crafting a solution that combines the best of the available video technologies with applications that are compatible with the day-to-day workflow of busy clinicians, improve communication among clinicians, patients and family members, and enable more efficient and compassionate delivery of health care.


Chris Herot is the CEO and co-founder of SBR Health. Prior to launching SBR in 2010, Chris was Chief Product Officer at VSee Lab, a provider of high quality, low bandwidth and low cost videoconferencing solutions to enterprises and governments. Chris has been a successful business and technology leader in several high growth companies, and directed the advanced technology group for several years at Lotus Development (now IBM) where he was responsible for video, mobile and real-time communications solutions.

Chris received his BS and MS degrees from the Massachusetts Institute of Technology where he was on the faculty of the group that became the MIT Media Laboratory.