Fall Issue October 2009
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Better Living Through Technology

Wouldn’t it be wonderful if doctors and nurses gave their chronically ill patients coaching about their medical treatments that was tailored specifically to their ability to self manage? A recent study clearly demonstrates the benefits of this patient centered approach. The Patient Activation Measure (PAM) survey tool used in the study is a social science-based assessment to measure an individual’s underlying health belief structure. This reflects the degree to which a person feels in charge of his or her own health and healthcare as a basis of a spectrum of health behaviors. Answers to the 13 question survey assigns a person into 1 of 4 activation score levels, which shows their health coach how much or how little health management is required. Patients in the study had better clinical outcomes, fewer hospitalizations, and even the high activation individuals showed benefits that allowed them to stay on course in times of stress or change to their routine.

A nonprofit organization whose stated mission is to be the voice of brain injury, the Brain Injury Association of America (BIAA), has long recognized the need to extend military health care coverage to include cognitive rehabilitation. This need is critical, as 20% of injured American soldiers in Iraq and Afghanistan have experienced a traumatic brain injury. The BIAA, along with Congress and major national insurance companies, is urging President Obama to “follow through on your commitment to ensure that our nation’s wounded warriors gain access to the best brain injury care this nation has to offer.” They want him to direct Secretary Gates to immediately enact TRICARE coverage of cognitive rehabilitation. TRICARE is the healthcare program for active duty and retired members of the uniformed services.

Ask anyone who they think is the world leader in personal robot development and if they think it is Japan, they may be surprised. Robotics in the US has been developing along the lines of personal companion robots that are cost effective and expected to become popular for eldercare, care for the chronically ill, and childcare throughout the current recession. The CareBot has an aluminum frame, plastic shroud, two independently driven wheels, multiple sensor systems, microprocessors and several onboard computers connected in a local area network (LAN). The microprocessors directly interact with the sensor systems and transmit data to the onboard computers. The onboard computers each run independent, highly specialized cooperative artificial intelligence (AI) software programs, which interact to complete tasks in a timely, intelligent and common sense manner. This is a win-win for both caregiver and care receiver. For the caregiver, a CareBot decreases the difficulty and stress of watching over family members for most, if not much, of the time day in and day out due to concerns about their well being, safety, and security. For the care receiver, a CareBot is a new kind of companion that always stays close to them, enabling family and friends to care for them from afar. It tells them jokes, retells family anecdotes, reminds them to take medication, reminds them that family is coming over soon (or if there has been a change of plan), and can play favorite songs. It alerts them when unexpected visitors, or intruders are present. It notifies designated caregivers when a potentially harmful event has occurred, such as a fall, fire in the home, or simply being not found by the CareBot for too long. It also responds to calls for help by notifying those determined by the caregiver.

is a seattle-based on-line health network site dedicated to helping people who share relevant experiences to inform important health and life decisions. According to Keith Schorsch, CEO, “There's a sea change going on today in the consumer's health experience. People are increasingly taking control of their health. At Trusera, we are dedicated to putting the consumer at the center of their health experience so they can take a more active role and not just be a passive participant. At Trusera, we are focused on addressing the whole person, not just the patient. We invite everyone who wants to take control of their health to join us in building and growing the site by adding their health story and engaging in the conversation."

I am grateful to be in a collaborative business with many talented and skilled professionals. Additional feedback and recommendations for our products and services at TM Information Services are always welcome.

- Mary M. McLaughlin

From the Front Page of TMIS News
Click on links below to view Full Stories.

New Study Shows Coaching to Patient Activation Levels Improves Disease Management Outcomes
Irvine, California

People with chronic health conditions who receive coaching tailored to their level of health activation showed significant improvements in clinical outcomes, and experienced fewer hospitalizations and visits to the emergency room than those coached using traditional methods, according to a study published in the June issue of The American Journal of Managed Care. The study, led by Judith Hibbard, Ph.D. and colleagues at the University of Oregon, compared the behaviors of patients receiving standard telephone disease management (DM) coaching with those who received more tailored coaching based on their "activation level" as part of a DM program offered by the health improvement company LifeMasters Supported SelfCare, Inc. Activation levels are determined by the Patient Activation Measure, a survey tool developed by Hibbard and colleagues to assess an individual's knowledge, skills and confidence in playing a role in one's own health and healthcare.

"LifeMasters is continually implementing new methodologies and tools to improve outcomes," said Mary Jane Osmick, M.D., Vice President and Medical Director. "We have learned that deploying targeted interventions rather than using a 'one size fits all' approach is a critical success factor. Our nurses and coaches are the first in the DM industry to provide individual patient support by applying a fully integrated coaching model that includes the PAM. The findings reinforce our understanding that improved activation is an overarching measure of success that leads to significant clinical improvement and financial savings. "

The quasi-experimental research, which was conducted in a real-life DM setting, included an intervention group and a control group of nurse coaches and their patients in geographically separate call centers, which were selected based on the similarity of their nurse coaches' tenure and years of experience. The findings show those who received coaching with the PAM experienced a 33% decline in hospital admissions compared to the control group, which remained flat, and a 22% decline in emergency room visits compared with an increase of 20% in the control group. The PAM group also experienced statistically significant improvements in diastolic blood pressure and in LDL cholesterol levels relative to the control group, and increased their adherence to recommended immunization and drug regimens, including the influenza vaccine. The PAM score intervention group showed fewer hospital stays, which translated into a savings of $145 per person per month for the intervention population. A similar decline was seen in visits to the emergency room among this group, which equates to an $11 per person per month savings. "The PAM is unique among social science-based assessments in that it measures an individual's underlying health belief structure. This structure reflects the degree to which the person feels in charge of his or her own health and healthcare, and is the basis for a whole spectrum of health behaviors. This creates a more holistic view of the individual, one which is essential to providing effective support," said Dr. Hibbard.
Full Story

Brain Injury Association of America Urges President Obama to Include Cognitive Rehabilitation for Returning Service Members as a Part of TRICARE Coverage
Washington, DC

With an estimated 20% of injured American soldiers who have been deployed to Iraq and Afghanistan experiencing a possible traumatic brain injury (TBI), the Brain Injury Association of America (BIAA) has called on President Obama to extend military health care coverage to include cognitive rehabilitation, a proven treatment for this signature injury of modern combat. Senator Evan Bayh and then-Senator Barack Obama led a group of 10 United States Senators in issuing a letter on Aug. 4, 2008, to Defense Secretary Robert M. Gates urging coverage of cognitive rehabilitation within the military's TRICARE health insurance program. In a press release announcing this letter, then-Senator Obama described cognitive rehabilitation therapy as "one of the most accepted treatments for TBI." Congressional Task Force Co-chairs Congressman Bill Pascrell, Jr. and Congressman Todd Platts spearheaded a similar letter to the Department of Defense on Sept. 19, 2008, which was signed by 67 members of the House.

More recently, the Anthem Insurance Companies, Inc. (also known as Anthem Blue Cross Blue Shield and Anthem Health Plans) determined that cognitive rehabilitation is a medically necessary treatment for patients with TBI. Anthem cited BIAA's position paper, "Cognitive Rehabilitation: The Evidence, Funding and Case for Advocacy" among the authoritative publications consulted. United Health Care followed suit in May 2009 with a similar decision covering cognitive rehabilitation for individuals with brain injury.
Full Story

The US is Poised to Overtake Japan in Manufacture of Robotics Used for In-Home Medical Monitoring
Conyers, Georgia

GeckoSystems is a dynamic leader in the emerging mobile robotics industry revolutionizing their development and usage with "Mobile Robot Solutions for Safety, Security and Service." Many in the U.S. may mistakenly believe that the Japanese are world leaders in personal robot development. However, this is not the case. In the last ten years, the Japanese government has granted over $100M in R&D funding amongst their leading international manufacturers for the development of eldercare personal companion robots, but still have no viable products developed. An excellent illustration of this is Matsushita's recent failure when they attempted to sell their "Wakamaru" personal companion robot. Many observers believe it lacked sufficient cost effective utility that prevented it from being perceived as a "value" by the Japanese consumer. It has been taken off the market.

Due to the sufficiency and cost effective robustness of GeckoSystems' first product, the CareBot, near term in home evaluation trials have been recently announced. "In the U.S. we project the available market size in dollars for cost effective, utilitarian, multitasking eldercare personal companion robots in 2010 to be $74.0B, in 2011 to be $77B, in 2012 to be $80B, in 2013 to be $83.3B, and in 2014 to be $86.6B. With market penetrations of 0.03% in 2010, 0.06% in 2011, 0.22% in 2012, 0.53% in 2013, and 0.81% in 2014, we will anticipate sales, from this consumer market segment only, of $22.0M, $44.0M, $176M, $440.2M, and $704.3M, respectively. We expect these sales despite and perhaps because of the present recession due to pent up demand for significant cost reduction in eldercare expenses," concluded Spencer.
Full Story

A Site Dedicated to Helping People Share Relevant Experiences to Inform Important Health and Life Decisions
Seattle, Washington

Trusera, an angel-funded, Seattle-based startup founded in 2007 has announced the launch of its online health network www.trusera.com, which allows consumers to find and share real-world health experiences with others who've been there. Led by former Amazon executive, Keith Schorsch, the company vision was based on Keith's own struggle with Lyme disease and the difficulty in finding credible health insights from others. After meeting with 11 doctors, it was one phone call from a friend that finally led to his diagnosis and saved his life. During his diagnosis and recovery, Keith realized that there's actually too much health information on the Internet today. Many people find it overwhelming to navigate and hard to trust. He found the most useful information came from people with similar health experiences and their own personal health stories. He founded Trusera to inspire people to learn from each other to inform important health decisions.

There's power in sharing personal experience and knowledge to help others in their health journey. Trusera believes that people are more than just the sum of their conditions. They are multi-dimensional and need personalized solutions for a variety of life challenges when dealing with a health issue.
Full Story

PDX-Rx.com Works With Microsoft HealthVault to Make Prescription Data Available to Patients
Fort Worth, Texas

PDX and Rx.com have entered into a strategic agreement with Microsoft to make prescription data, which Rx.com manages for multiple chain and independent pharmacy clients, available to Microsoft HealthVault users by accessing a single site with aggregated prescription data. The agreement enables any pharmacy using the Rx.com Electronic Pharmacy Record (EPR) to export their patients' prescription history into HealthVault. Each PDX pharmacy client will have their own independent relationship with Microsoft, while PDX serves to technically integrate the pharmacy's data with the HealthVault platform. Meijer, Inc. is the first PDX client to start integration with HealthVault.

HealthVault helps people collect and store health information from many sources in one location, so that it is always organized and available to them online. HealthVault is working with doctors, hospitals, employers, pharmacies, insurance providers and manufacturers of health devices--blood pressure monitors, heart rate monitors, and more--to make it easy for people to add information electronically to their HealthVault records. Users can then share information electronically with family members and providers as they choose.

"PDX and Rx.com connecting with HealthVault helps put consumers in control of managing their own care and the care of extended family members - children, a spouse or an aging parent," said David Cerino, general manager of the Consumer Health Solutions Group at Microsoft. "Customers from thousands of pharmacies across the country will be able to integrate their prescription history into HealthVault, which will provide them with a more complete picture of their health, and allow them to make better healthcare decisions."
Full Story

Stereo Vision Provides Depth Perception to Help Unmanned Ground Vehicles Avoid Obstacles and Manipulate Sensitive Objects
Menlo Park, California

TYZX, the 3D vision technology company has announced that iRobot Corporation has chosen the TYZX DeepSea G2 Embedded Vision System (EVS) for several military robotics research projects requiring real-time vision and depth-perception. iRobot has demonstrated the ability to integrate the TYZX G2 EVS onto its PackBot and Warrior platforms: rugged tactical mobile robots designed to perform dangerous search, reconnaissance and bomb-disposal missions while keeping troops out of harm's way.

The combined Navigator and SEER payload enables more advanced autonomous behaviors demanded by the warfighter including building clearance and retro-traverse. The retrofit package is backwards compatible for up to 3,000 PackBots currently deployed in-theatre and is in the hands of warfighters in Iraq for the purposes of testing.
Full Story

Provision Interactive Joins Forces With University of Tokyo to Add "Touchable Holography" to 3D Video Technology
Chatsworth, California

Provision Interactive Technologies, Inc., a subsidiary of Provision Holding, Inc. has announced that a joint venture agreement with the University of Tokyo has resulted in a 3D video display that a user can actually feel. The product developed jointly by the two organizations is unlike anything on the market today. Those at the August 2009 Siggraph Expo in New Orleans were able to get a sneak peek at the extraordinary "touchable" technology.

"Our joint venture can add an invaluable new twist to our product line," said Provision CEO, Curt Thornton. "We created a product that responds to a user's touch. Our friends at University of Tokyo have added the element that allows the user to feel the interaction. Ultimately, the value of our products lies in the user experience."

The University of Tokyo has been developing the new technology that allows users to physically sense the touch-feeling in the air when they put their fingers on Provision's floating holographic 3D image. The University has named this technology "Touchable Holography." Tactile sensation requires contact with objects, but including a stimulator in the work space dilutes the appearance of holographic images. The "Airborne Ultrasound Tactile Display" solves this problem by producing tactile sensation on a user's hand without any direct contact and without diluting the quality of Provision's holographic projection.
Full Story

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