tag:theconversation.com,2011:/us/topics/e-health-2195/articlesE health – The Conversation2016-02-17T04:22:39Ztag:theconversation.com,2011:article/516652016-02-17T04:22:39Z2016-02-17T04:22:39ZNew app helps people with neurological conditions practise speech<figure><img src="https://images.theconversation.com/files/111082/original/image-20160211-29207-yszbft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with neurological disorders sometimes need to practise speech daily.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Researchers at <a href="https://aehrc.com/">CSIRO</a> and <a href="https://www.uq.edu.au/">University of Queensland</a> have developed an app called <a href="https://play.google.com/store/apps/details?id=org.harlie.thechatbot&hl=en">Harlie</a> that is designed to chat with humans. Unlike <a href="http://www.apple.com/au/ios/siri/">Siri</a> and <a href="https://www.google.com.au/landing/now/">Google Now</a> – which are designed to answer specific questions – Harlie is designed for small talk. Its purpose is to help the user and health professionals understand the impact of neurological conditions on communication and <a href="https://www.researchgate.net/publication/280726980_Chat-Bots_for_People_with_Parkinson%27s_Disease_Science_Fiction_or_Reality">well-being</a>.</p>
<p>People with neurological conditions such as Parkinson’s disease and dementia can have trouble finding the <a href="http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjwuPmJvpHKAhXMkZQKHYzGApgQFggcMAA&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F16540492&usg=AFQjCNFfuzYKuD7uIwrK43EgQAj0q06Eqg&sig2=WSAYDwd_4UqbPk6B0x9r0w">right words</a> and may lose track of their message <a href="http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjwuPmJvpHKAhXMkZQKHYzGApgQFggcMAA&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F16540492&usg=AFQjCNFfuzYKuD7uIwrK43EgQAj0q06Eqg&sig2=WSAYDwd_4UqbPk6B0x9r0w">mid-sentence</a>.</p>
<p>Users of the app have a conversation with the chat-bot, which then analyses aspects of the health of the user’s voice and communication. This includes how well vowels are articulated, vocabulary and duration of mid-sentence pauses.</p>
<p>People who might be working on improving their voice or communication due to difficulties related to a neurological condition, like Parkinson’s disease or stroke, may need to practise and get feedback daily. Conversation with a partner is much more motivating than voice exercises and means people are practising in context too.</p>
<p>But not everyone has easy access to a conversation partner. People increasingly live alone and may have difficulty accessing the community. </p>
<p>Concerns about a future shortage of formal and informal carers are also growing. When people are working on their communication, they may lack confidence and prefer an unrushed and nonjudgmental conversation partner.</p>
<p>As well as offering someone to practise speech with, the app records their speech. This provides objective information about the user’s voice and communication to their health teams.</p>
<p>Change in vocal qualities or conversation patterns can show the impact of speech and language rehabilitation treatments, encouraging people to keep working on their voice. This also indicates the positive and negative impact of medications and other treatments. </p>
<p>Getting treatment dosages exactly right to minimise symptoms, while not leading to side effects, is one of the biggest challenges for people living with Parkinson’s disease. This additional information could help optimise medical treatments. Large changes to communication abilities could also indicate the need for a review by the healthcare team.</p>
<p>Changes in conversation, such as increased difficulty with finding the right word or following the conversation, could indicate a change in cognition and language. It could also indicate the user is still communicating well, recalls recent memories and is thus less likely to need immediate intervention. </p>
<p>With respect to Parkinson’s disease, it could tell the researchers how well their speech rehabilitation is going – for instance, if they are speaking more loudly and articulating words much more clearly.</p>
<p>A demonstration of how the app works can be seen in this YouTube video:</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dshD3FY4l1A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A demonstration of Harlie the chat-bot.</span></figcaption>
</figure>
<h2>The rise of e-health</h2>
<p><a href="http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjwuPmJvpHKAhXMkZQKHYzGApgQFggcMAA&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F16540492&usg=AFQjCNFfuzYKuD7uIwrK43EgQAj0q06Eqg&sig2=WSAYDwd_4UqbPk6B0x9r0w">Research</a> shows people may have more problems with communication than they realise. Undiagnosed communication issues might lead to frustration, embarrassment and social withdrawal. These issues all place strain on the person and on their relationships with family members and caregivers.</p>
<p>Technology can help in two ways. First, technology that can monitor progress and the impact of difficulties with communication could help the person, as well as health professionals and researchers, understand the impact of health conditions on communication. </p>
<p>Second, technology can provide people with a way to privately practise their communication without feeling frustrated or judged, while receiving encouraging and productive feedback.</p>
<p>Various technologies help people with Parkinson’s disease with walking, eating and remembering medication. There has been less focus on communication and speech, and using small talk on a smartphone to monitor and help is a new innovation. </p>
<p>Being able to use everyday technology like smartphones makes the technology easier to access, cheaper and more acceptable than specialised medical equipment.</p>
<p>We would like people from the general public to chat to Harlie so we can understand how well it engages in conversation and copes with language, particularly Australian slang, and improve its repertoire of topics. In doing so, we can better prepare Harlie for more clinical studies. We hope this will improve our understanding of health conditions and keep people communicating.</p><img src="https://counter.theconversation.com/content/51665/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Ireland works for the Australian E-Health Research Centre, CSIRO. He receives funding from the Australian Research Council Centre of Excellence for the Dynamics of Language</span></em></p><p class="fine-print"><em><span>Christina Atay receives funding from the Australian Research Council Centre of Excellence for the Dynamics of Language. Christina is also employed by the Asia-Pacific Centre for Neuromodulation (APCN) at the University of Queensland. APCN is in part funded by unrestricted research and education funding from Medtronic Inc, and St Andrews War Memorial Hospital. Neither of the above-mentioned organisations had any part in the research reported or preparation of the document.</span></em></p><p class="fine-print"><em><span>Jacki Liddle is employed by the Asia-Pacific Centre for Neuromodulation (APCN) at the University of Queensland. APCN is in part funded by unrestricted research and education funding from Medtronic Inc, and St Andrews War Memorial Hospital. Neither of these organisations had any part in the research reported or preparation of the document.</span></em></p><p class="fine-print"><em><span>Daniel Angus receives funding from the Australian Research Council Centre of Excellence for the Dynamics of Language, and other Australian Research Council competitive grants. </span></em></p>Researchers at CSIRO and University of Queensland have developed an app called Harlie that is designed to chat with humans.David Ireland, Electronic Engineer and Research Fellow at the Australian E-Health Research Centre, CSIROChristina Atay, Postdoctoral research fellow, The University of QueenslandJacki Liddle, Quality of life researcher and occupational therapist, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/502482015-11-11T02:08:23Z2015-11-11T02:08:23ZBig data can improve health but first we need to build the foundations<figure><img src="https://images.theconversation.com/files/101404/original/image-20151110-21190-12j165n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There have never been more ways to monitor our personal health and well-being.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-146721359/stock-photo-medical-doctor-holding-a-world-globe-in-her-hands-as-medical-network-concept.html?src=CIeJlsjTvmnUdttpebpmrQ-1-10">everything possible/Shutterstock</a></span></figcaption></figure><p>“What if we, as government, got out of the way and gave consumers full access to their own personalised health data and full control over how they choose to use it?” Health Minister Sussan Ley asked in her recent <a href="https://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley151028.htm?OpenDocument&yr=2015&mth=10">speech</a> to the National Press Club.</p>
<p>Ley sketched out a new health landscape populated by consumers who shared their personal e-health records with app developers, dietitians and retailers in return for products and services tailored to their particular health needs. </p>
<p>“The great digital health revolution,” the minister concluded, “lies literally in the palms of consumers, rather than government.”</p>
<p>On one level this rings true. There have never been more ways to monitor our personal health and well-being, and share and compare our findings. We can track our activity, diet, exercise, emotions and sleeping habits on our mobiles, Fitbits, Apple watches and apps. We can even have our genomes sequenced.</p>
<p>And with Ley’s announcement we may now start to see a real upswing in people accessing and using their own medical record data. </p>
<p>But the availability of data is just the starting point – we then need to make sense of the data. </p>
<h2>Opportunities</h2>
<p>Conventionally, insights from health data have come from research studies that test hypotheses by systematically collecting and analysing data. Findings are published in scientific journals and pooled to determine the “bottom line” on any given health topic, using a process called “evidence synthesis”. This information is then used to create the guidelines and policies that shape health-care practices. </p>
<p>For instance, when pharmaceutical companies develop a new drug, they conduct a set of research studies and estimate the benefits and harms of the drug by combining data from these studies. They submit a summary of these findings – together with costs and comparisons with alternative drugs – to the government for marketing approval and reimbursement through the <a href="http://www.pbs.gov.au/pbs/home">Pharmaceutical Benefits Scheme</a>. </p>
<p>But the side effects of drugs are not always apparent at the time of marketing approval. This is because initial studies are often relatively small, with short follow-up times, selected (“clean”) study populations and a modest set of outcomes. </p>
<p>Systems that monitor drug effects in large and diverse populations over time can therefore add a lot to our understanding of a drug’s real effects. The <a href="http://www.fda.gov/Safety/FDAsSentinelInitiative/default.htm">Sentinel system</a> in the US and <a href="https://www.cnodes.ca/">CNODES</a> in Canada, for instance, use electronic medical record data from millions of people to better understand benefits and harms of drugs. </p>
<p>An even clearer understanding of a drug’s effect might come from incorporating genetic data. US President Barack Obama’s <a href="https://www.nih.gov/research-training/precision-medicine-initiative">Precision Medicine Initiative</a> seeks to identify new ways to treat cancer and other conditions by analysing the genomes and electronic medical record data of a million people. </p>
<p>We can also capture additional data from social platforms where people contribute their own experiences with illnesses and treatments, such as <a href="https://www.patientslikeme.com/">Patients Like Me</a> and <a href="http://www.iodine.com/">Iodine</a>. </p>
<h2>Challenges</h2>
<p>The greatest value is often generated when different types of data are combined, such as genomic and medical record data. Or clinic data and Google search terms can be used <a href="http://www.sciencemag.org/content/343/6176/1203">to track</a> a fast-moving flu epidemic. </p>
<p>But current systems are not up to the task of combining and making sense of our increasingly rich and diverse data – from genomes to Facebook profiles. As my colleagues and I argue in the <a href="http://www.nature.com/polopoly_fs/1.18691!/menu/main/topColumns/topLeftColumn/pdf/527031a.pdf">current issue of Nature</a>, consumers and health professionals can’t make the most of the abundance of health data until we build systems to efficiently and reliably convert diverse data into knowledge. </p>
<p>Scientists need to work out:</p>
<ul>
<li>why, when and how to combine different types of data</li>
<li>how each data source’s strengths and weaknesses can be taken into account</li>
<li>the technical systems able to capture the required metadata (data about data).</li>
</ul>
<p>Bringing big and diverse data together will require new methods and systems to be built by collaborations between computer scientists, health researchers, experts in evidence synthesis and others. </p>
<p>Importantly, these systems must be built in a way that enables consumer trust. In Ley’s “great digital health revolution”, new products and services will ingest our personal health data and suggest to us and our doctors what treatment we should take. </p>
<p>They will be delivered to us by “decision support” systems, which will inevitably be proprietary, complex and dynamic, such as those deployed within <a href="http://www.ibm.com/smarterplanet/us/en/ibmwatson/">IBM Watson</a>. How will we trust these recommendations? </p>
<p>Data is the new oil of the 21st century, but is not the engines, factories or transport systems. Their digital equivalents are being built now and how we – individuals, corporations, governments and societies – build these systems, products and services will have far-reaching consequences, in health as in other sectors.</p><img src="https://counter.theconversation.com/content/50248/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Elliott works for Cochrane, a global, non-profit network working to improve health decision making through the use of evidence. </span></em></p>The availability of data is just the starting point – we then need to make sense of the data.Julian Elliott, Head of Clinical Research in the Department of Infectious Diseases, Alfred Hospital and Monash University and Senior Research Fellow at the Australasian Cochrane Centre, CochraneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/498912015-10-29T03:30:30Z2015-10-29T03:30:30ZApp technology can fix the e-health system if done right<p>On Wednesday, federal Health Minister Sussan Ley announced <a href="http://www.smh.com.au/business/sussan-ley-to-trial-new-ehealth-record-for-the-fitbit-generation-20151027-gkk8ep.html">two new trials</a> of the so-far-unsuccessful, personally controlled electronic health record – rebadged as “My Health Record”. </p>
<p>These will run at the start of 2016 in rural north Queensland and the Blue Mountains in New South Wales.</p>
<p>The key difference from the current system is that enrolment has been switched to opt out rather than opt in. This means any of the one million patients included in the trials who don’t want their data shared will have to actively ask not to be part of the system.</p>
<p>Ley also suggested that patients should be able to make their health records available to third parties and app developers to facilitate the management of their own health. </p>
<p>She said, for instance, that were the data incorporated into an app, a doctor could use the technology to remotely monitor their patient’s blood pressure or insulin levels.</p>
<p>Politicians likely assume the simple combination of apps and data will lead to the same type of transformation in health that taxi and accommodation companies like Uber and Airbnb have achieved in their respective industries. </p>
<p>While a younger generation may indeed want to interact with health care in the same way that they stream a TV show or hail a taxi, it is optimistic to assume this transformation will be brought about simply by making My Health data available to app developers. </p>
<h2>Challenges of app technology</h2>
<p>Being able to use data meaningfully requires it be collected, managed and made available in very specific ways. Advocates of making government-owned data publicly available have <a href="http://opengovdata.org/">outlined</a> eight principles that should be met to ensure this can happen.</p>
<p>These highlight some of the challenges that need to be overcome before anything practical will come out of using information from the electronic record.</p>
<p>One of the most important of these principles is the need for data to be “complete”. This has been a major problem from the beginning with the entire concept of My Health Record. </p>
<p>Because the contribution of data to the electronic record is up to individual clinicians and limited by the systems they use, there are no guarantees there won’t be gaping holes in the information. Using the data to make clinical decisions would then be almost impossible without the missing pieces.</p>
<p>Another challenge is that for data to be understood by apps, it needs to be “machine processable”. In other words, it needs to be understandable by computer software, which traditional medical data simply isn’t. A letter between a GP and a specialist, for instance, might declare a diagnosis buried in everyday language. </p>
<p>It is a significant challenge for a software program to uncover this type of data. Unfortunately, a great deal of health information about patients is still in the format of letters and documents that limits their usefulness to apps.</p>
<h2>Positives of the new plan</h2>
<p>Although there are significant challenges to making data within My Health Record useful in the management of a person’s health, the move to make it more open is positive.</p>
<p>The very act of making health data visible to the patient will force providers to produce it in a more structured way. It could also put pressure on those who may not be publishing data into My Health Record to find a means of doing so. </p>
<p>But if people are going to be allowed to decide who has access to their data, this should automatically be extended to making it available to researchers. The government has long made it difficult for researchers to access population data from the Pharmaceutical Benefits Scheme and Medicare systems. </p>
<p>Patient data should be underpinning the management of their health on a continuous basis. The information should follow the patient in any journey that involves interactions with health providers or the health system in general. </p>
<p>Instead, it is locked up by health professionals, health organisations and the government. Very little of this information is available to the patient and certainly not in a form that allows them to make use of it in any meaningful way. </p>
<p>In fact, doctors have in the past taken a view that patients should not have access to their own laboratory tests or radiology reports because they would be liable to misinterpret them. </p>
<p>The principles behind sharing patient data should be encouraged. But the government’s attempts to implement this as the personally controlled electronic health record have so far been poor. </p>
<p>The technology, as it currently stands, would prevent the effective use of the data it might contain. Allowing for the data to be extracted practically and effectively would be a positive first step and one we can only hope the government will take.</p><img src="https://counter.theconversation.com/content/49891/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Glance does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although there are significant challenges to making data within My Health Record useful in the management of a person’s health, the move to make it more open is positive.David Glance, Director of UWA Centre for Software Practice, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/333602014-10-24T00:29:58Z2014-10-24T00:29:58ZTelstra gets serious about health, but will the public trust it?<p>Australian telecommunications company Telstra has this week <a href="http://www.afr.com/p/technology/telstra_inks_ehealth_deal_with_medgate_dfUoP2yhYylu0uxVskoPDI">announced</a> its intentions to significantly develop its health business. The latest addition to its portfolio of health services will come through a collaboration with Swiss company <a href="http://www.medgate.ch/en-us">Medgate</a>. Medgate currently offers Swiss patients the ability to consult with a doctor via telephone or computer and to order prescriptions online for home delivery.</p>
<p>The arrangement with Medgate will launch in Australia as Telstra ReadyCare, some time in 2015. It is unclear what the financial arrangements for this service will be and whether patients will be able to claim the consultations against Medicare or whether they will be required to pay the entire amount privately.</p>
<p>Telstra has <a href="http://www.theaustralian.com.au/business/telstra-answers-emergency-call-on-health-with-plans-for-services-unit/story-e6frg8zx-1227099078402">spent</a> A$100 million so far on a product and company acquisitions and investments to form the basis of its health services division The collection of companies and technologies were by no means leaders in their individual areas, and it’s yet to be seen whether Telstra, with little background in the health business, can really make a coherent whole out of these disparate parts. </p>
<p>This starting point hasn’t prevented Telstra retail group executive Gordon Ballantyne from claiming that the division will grow to a A$1 billion business within five years. Given that Telstra’s health services area was responsible for just A$43 million in fiscal 2014, hitting that target would require revenues to double each year until 2019. A big ask.</p>
<h2>A difficult market</h2>
<p>Other than the fantastic growth Telstra will have to achieve to reach its revenue targets, it faces other significant challenges if it is to reach its goal. The health market generally is already saturated with a large number of <a href="http://www.health-e-directory.com.au/">products</a> including, for example, several dominant players who control the majority of GP desktops. There is little scope to break into the market now in a significant way. This means Telstra will be battling with a large number of others over the “scraps”.</p>
<p>The Australian health IT sector has always been a <a href="http://www.theaustralian.com.au/technology/poor-prognosis-for-medical-software-sector/story-e6frgakx-1225989797345">tough</a> area to do business in because of the nature of the Australian health environment. Federal government funding makes up a large part of the money that drives health projects in Australia and this has largely dried up as a result of the current government’s conservative budget. In fact, health spending growth as a whole has recently slowed to <a href="http://www.aihw.gov.au/media-release-detail/?id=60129548933">record lows</a>.</p>
<p>Australian states have also been cutting back significantly on health IT spending, and where they are investing it tends to be on the larger system providers rather than the sorts of smaller products that Telstra and the majority of Australian IT health software companies provide.</p>
<p>The virtual GP market may represent a significant market opportunity, but developing it will take time as users adapt. Telstra will not be the first to offer such services. Companies like telehealth group <a href="http://www.lifehacker.com.au/2014/04/elevator-pitch-gp2u/">GP2U</a> already offer similar access to GPs online or over the telephone. Indeed, the Australian government has itself provided access to registered nurses and GPs over the telephone via its <a href="http://www.healthdirect.gov.au/">Health Direct</a> service. This service is provided by <a href="http://www.medibank.com.au/">Medibank</a>, and with its impending privatisation it may become a significant force in the health services sector. Medibank has significantly more experience and capability of succeeding in the market Telstra hopes to enter.</p>
<h2>Privacy concerns</h2>
<p>The other major significant barrier Telstra faces is its brand perception with the public and whether they will trust the telco with managing their health, and more importantly, the privacy of their data. </p>
<p>Telstra has faced significant <a href="http://www.smh.com.au/technology/bigpond-plugs-privacy-leak-20111210-1oox7.html">security breaches</a> including up to 60,000 Bigpond customer account details being posted on the internet, and a separate incident involving the mis-posting of 220,000 letters containing account information to the wrong customers. </p>
<p>More <a href="http://www.themercury.com.au/news/breaking-news/complaints-spur-training-change-at-telstra/story-fnj6ehgr-1227097137924">recently</a> Telstra had to retrain its staff after a large number of complaints to the ACCC about customers being misinformed about their customer rights. </p>
<p>On the plus side, Telstra has managed to grow and <a href="http://telstra2014ar.interactiveinvestorreports.com/">make money</a> from different parts of its business delivering media over its home set-top device the T-Box, and in its network applications and services division. This would point to Telstra being able to take new business areas and learn how to grow revenue and profits, even possibly with something as challenging as health. </p>
<p>The promise of e-health has yet to live up to the hype as a panacea for our ageing, overweight, and increasingly sickly population. It will definitely be part of the solution in delivering more efficient services, but we will have to wait and see whether Telstra will be one of the drivers.</p><img src="https://counter.theconversation.com/content/33360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Glance receives funding from the sale of a clinical product in the same sector as some of those offered by Telstra.</span></em></p>Australian telecommunications company Telstra has this week announced its intentions to significantly develop its health business. The latest addition to its portfolio of health services will come through…David Glance, Director of UWA Centre for Software Practice, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.