The Value of Information Technology-Enabled Diabetes Management

Reviews different technologies used in diabetes disease management, as well as the costs, benefits, and quality implications of technology-enabled diabetes management programs in the United States

Improving the clinical value and utility of CGM systems: issues and recommendations : a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group

The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionise the use of intensive insulin therapy in diabetes; however, progress towards that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardised format for displaying results and uncertainty on how best to use CGM data to make therapeutic decisions. This scientific statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes

Improving the clinical value and utility of CGM systems: issues and recommendations: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group

The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionize the use of intensive insulin therapy in diabetes; however, progress toward that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardized format for displaying results, and uncertainty on how best to use CGM data to make therapeutic decisions. This Scientific Statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes

How 5G wireless (and concomitant technologies) will revolutionize healthcare?

The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution

European Arctic Initiatives Compendium

Julkaistu versi

Who approves/pays for additional monitoring?

Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems

Increasing the Capacity of Primary Care Through Enabling Technology.

Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow

Telehealth Parity Laws - Ongoing Reforms Are Expanding the Landscape of Telehealth in the Us Health Care System, but Challenges Remain.

Despite the fact that no other developed country even comes close to the United States in annual spending on health care, 20 percent of Americans still live in areas where shortages of physicians and health care specialists exist, and the United States still ranks the lowest overall among eleven industrialized countries on measures of health system efficiency, access to care, equity, and healthy lives. Many believe that the answer to issues of cost and access in the US health system lies in telehealth, which increases access to care, alleviates travel costs and burdens, and allows more convenient treatment and chronic condition monitoring.With the implementation of the Affordable Care Act (ACA), the federal government announced the move toward encouraging and including telehealth services in health care coverage. The ACA, however, only implementedtelehealth at the federal level through Medicare, in selected circumstances; the power to determine which, if any, telehealth services is covered by Medicaid still remains largely within the powers of individual states.Also, states can govern private payer telehealth reimbursement policies. This means that telehealth implementation varies from state to state in terms of what services providers will be reimbursed for delivering, as well as what sort of "parity," defined as "equivalent treatment of analogous services," is expected between in-person health services reimbursements and telehealth reimbursements. This variation affects providers' ability to implement telehealth options, thereby reducing the patients' ability to use these services and become comfortable with the telehealth processes. Consequently, telehealth faces significant obstacles in becoming an accepted and used health care option for individuals, and states and the nation as a whole cannot fully realize the cost savings of telehealth

Business Case and Technology Analysis for 5G Low Latency Applications

A large number of new consumer and industrial applications are likely to change the classic operator's business models and provide a wide range of new markets to enter. This article analyses the most relevant 5G use cases that require ultra-low latency, from both technical and business perspectives. Low latency services pose challenging requirements to the network, and to fulfill them operators need to invest in costly changes in their network. In this sense, it is not clear whether such investments are going to be amortized with these new business models. In light of this, specific applications and requirements are described and the potential market benefits for operators are analysed. Conclusions show that operators have clear opportunities to add value and position themselves strongly with the increasing number of services to be provided by 5G.Comment: 18 pages, 5 figure

Personalised mobile services supporting the implementation of clinical guidelines

Telemonitoring is emerging as a compelling application of Body Area Networks (BANs). We describe two health BAN systems developed respectively by a European team and an Australian team and discuss some issues encountered relating to formalization of clinical knowledge to support real-time analysis and interpretation of BAN data. Our example application is an evidence-based telemonitoring and teletreatment application for home-based rehabilitation. The application is intended to support implementation of a clinical guideline for cardiac rehabilitation following myocardial infarction. In addition to this the proposal is to establish the patient’s individual baseline risk profile and, by real-time analysis of BAN data, continually re-assess the current risk level in order to give timely personalised feedback. Static and dynamic risk factors are derived from literature. Many sources express evidence probabilistically, suggesting a requirement for reasoning with uncertainty; elsewhere evidence requires qualitative reasoning: both familiar modes of reasoning in KBSs. However even at this knowledge acquisition stage some issues arise concerning how best to apply the clinical evidence. Furthermore, in cases where insufficient clinical evidence is currently available, telemonitoring can yield large collections of clinical data with the potential for data mining in order to furnish more statistically powerful and accurate clinical evidence