Join us at EyeForPharma’s Value Added Services and Multichannel Marketing Conference in London

July 19, 2014

Value Added Services Summit 2014

We’re really pleased to be collaborating again with EyeForPharma and would like to invite you to join their efforts to bring together senior-level pharma execs, patient advocacy groups and leading healthcare expertise for discussions on the mHealth future of Pharma.

As I’ve detailed in this interview with EyeforPharma’s Robert Imonikhe the Pharmaceutical Industry faces incredible uncertainty as the lines between provider, payer and manufacturer are blurred. New business models and revenue streams are critical if pharma is to be able to survive ‘beyond the pill’.

Thankfully EyeForPharma have an unique reach into the Pharma industry and there’s no better indication of this than the influential speaker list that they’ve already confirmed for the two day meeting in September:

> Omar Ali, Formulary Development Pharmacist, Surrey & Sussex NHS Trust & ERG Panel for Cost Impact Modelling, NICE
> Baba Awopetu, European Marketing Director, Leica Microsystems
> Miles Ayling, Director of Innovation, NHS England
> Dr Junaid Bajwa, GP & NHS Fast Track Exec Programme, NHS
> Emre Basar, Medical Science Liaison Manager, Baxter
> Mike Bellis, EU Multi Channel Marketing – Senior Quality Manager, Pfizer
> Carlos Bezos Daleske, Head of Value Creation, IVF Spain
> Matthew Bonam, Project Director, Intelligent Pharmaceuticals, AstraZeneca
> Eddie Chan, Global Head of Customer Solutions & Innovation, Sanofi-Aventis
> David Doherty, Director, 3G Doctor
> Hervé Drevot, Vice President, CrossWorlds Healthcare
> Mark Duman, Non-Exec Director, Patient Information Forum
> Laurent Flouret, Senior Project Manager, Global Digital & Multichannel Marketing, Sanofi
> Nicola Fontanella, Director of Value Added Services, Pfizer
> Kaush Gandhi, International Digital Manager, Roche
> Mads Holmen, Founder, Bibblio
> Becky Hutchinson, Regional Commercial Lead EMEA Diabetes, Janssen
> Pelin Icil, Marketing Manager – Women’s Healthcare, Bayer Healthcare
> Christian Isler, Former Global Head of Product & Solution Development, Pfizer
> Felix Jackson, CEO, MedDigital
> Nikoletta Karagianni, EU Markets Champion for Hepatitis B, Bristol Myers Squibb
> Tommy Kok Annfeldt, Northern European Cialis Brand Manager, Eli Lilly
> Graham Leask, Academic, Aston University
> Rick Lee, Former CEO, Healthrageous Inc
> Mario Giulio Levrero, Director, Global Healthcare Providers & Market Access, Vifor Pharma
> Soeren Mattke, Managing Director, RAND
> Francois Meyer, Advisor to the President & Director, Haute Autorité de Santé
> Paul Midgley, Patient Leader, NHS England Derbyshire Nottinghamshire Area Team and Director, NHS Insights
> Marco Mohwinckel, Global Head of Integrated Care Solutions, Janssen Healthcare Innovation
> Michael Morgan-Curran, Global Director of mHealth, Personal Connected Health Alliance
> Philippe Mougin, Director of Public Affairs, Bayer France
> Julie O’Donnell, Global Head of Digital Interaction Management, Lundbeck
> Irina Osovskaya, Digital Manager, Janssen
> Samuel Pygall, Innovation Lead Associate Director, MSD
> Kay Rispeter, Associate Director Multichannel Marketing, MSD
> Michael Seres, i-Patient
> Dr Julian Spinks, General Practitioner, NHS
> Andrew Stainthorpe, Market Access Expert
> Matthew Thomas, Vice President Spine, Medtronic
> Albert van Eijk, Director of Oncology, Boehringer Ingelheim
> Francis White, EU General Manager, AliveCor
> Tim White, Senior Director and Head of Global Customer Interaction Management, Lundbeck
> Stephen Whitehead, CEO, Association of British Pharmaceutical Industry

Industry insights into the mHealth future of Pharma

To help ignite the discussions we’ve been working with EyeForPharma to produce and share the different outlooks of key industry participants. The first effort in this is a series of video interviews with mHealth industry leaders in which I try to get answers on the following questions:

> How do you think mHealth solutions can provide payers and physicians with a better understanding of patient experience?

> What are the benefits of this for the pharma industry?

> How do you engage both payers and clinicians on mHealth services?

> What´s the place of ´intelligent pharmaceuticals´ in the future of the industry?

> Is a disease-specific focus necessary or are there lessons that can be spread across multiple therapeutic areas?

> What comes first — the product or the outcome?

> Do you think things would have been different if Samsung, for example, had made a bid for AstraZeneca rather than Pfizer? In the future, will pharma companies be competing with mobile organisations?

_________________________________________________________

The series begins with @GoogleSunglass wearing Dr Gerard Crotty, Consultant Haemotologist & President of the Irish Hospital Consultants Association:

Next up is an interview with Google Explorer Trauma Surgeon Dr Raphael Grossmann MD FACS (a big hero of mine):

If you would like more information about the event and exclusive first access to the rest of these video interviews simply complete the following form with your contact details:

Alternatively get in touch with Aidan Brain the event Director at EyeForPharma directly on +442073757513 or email abrain@eyeforpharma.com


Latest insights from McKinsey claim it’s a myth that mHealth is a game changer

July 11, 2014



McKinsey and Company Healthcares Digital Future

Myth 3: Mobile health is the game changer.

Mobile health—the practice of healthcare supported by mobile devices—is often hailed as the future of digital services in healthcare. Still, our survey shows that demand for mobile healthcare is not universal. It is therefore not the single critical factor in the future of healthcare digitization.

Of course, there is certainly demand for mobile healthcare applications, and it is strongest among younger people. Health systems should therefore create mobile solutions that target this audience—for example, apps that focus on prenatal health or those that could be classified as lifestyle apps. Beware of solutions that could have a lot of impact but are not of interest to the segment in question—digital applications to manage chronic conditions typically found in older people, for example

Perhaps there is no more reliable indicator that now is the time for investors to pile into the mHealth sector but this is incredibly poor advice and should be dismissed for the following reasons:

> This is a complete about turn for McKinsey eg. back in 2010 I was at Mobile World Congress in Barcelona listening to McKinsey telling an audience that the ‘Global mHealth Opportunity is worth $50-60 Billion.

> McKinsey have a terrible record with mobile eg. they told AT&T that cellphones would be a niche market reaching only 900,000 US subscribers by year 2000 (it actually reached 108 million by 2000).

> Claims that the demand for mHealth applications is strongest amongst younger people is completely contrary to the evidence (eg. Walgreens are generating $325 Million per month via their mHealth apps and the average age is 60+, Kaiser is also reporting 65+ average age of their mHealth services, etc) perhaps they’re confusing these with fitness applications?

> It’s very difficult for humans to evaluate algorithmic change but that’s critical to understanding the unthinkable opportunities that mHealth is making happen.

Note: Click here if your company would like personalised mHealth market insights.


mHealth Insights from Doctors 2.0 & You Paris

July 11, 2014



Denise Silber Doctors 20 and You Paris

On the 5-6 June I presented and led a workshop at Doctors 2.0 & You in Paris thanks to an invitation from superstar event organiser Denise Silber. The event has continued on the success of the original Health 2.0 Europe (that I also presented at back in 2010 – read my review of that meeting here).

Billed as “The international event in Healthcare Social Media, Mobile Apps, & Web 2.0” it proved to be a fascinating 2 days in Paris learning from Patients, Healthcare Professionals, Healthcare Insurance/Provider execs, and Research and Marketing Professionals from practically all of the big pharma giants in a healthy mixture of keynote talks, panel discussions, workshops broken up by plenty of delegate networking sessions in the salubrious environment of Paris’ Citie Universitie.

Networking session at Doctors 20 and You 2014

The twitter coverage of the event exceeded any Healthcare meeting I’ve ever attended (check it out via the #Doctors20 hashtag) and the talks were all video recorded (you’ll be able to view these at this link) and the event is produced by a very passionate team so I’m confident the discussions will continue on long after the meeting.

Organising Team #Doctors20

Speaker list

I found it very impressive that nearly every speaker had an active presence on social media – as well as a great research resource that will give you plenty of ideas there’s also a diverse range of new people for you to follow on twitter in the following links:

Beate Bartes, founder, Vivre Sans Thyroide, Nathalie Beslay, Lawyer, Christine Bienvenu, ePatient and Founder, Seinplement Romand(e)s, Catherine Cerisey, coFounder, PATIENTS & WEB, Dr Larry Chu, Exec Director, Stanford Medicine X, Dr Luc Colemont, Gastroenterologist and Founder of STOP DARMKANKER, Bertrand Damien, Account Manager, LexisNexis BIS, Dr Mark Davies, GP & Director, Health & Social Care Info Centre, Uwe Diegel, President, iHealthLabs Europe, David Doherty, co-founder, 3G Doctor, Dr Jacques Durand, Founder, blabladoctor.com, Dr Loic Etienne, Doctor and Blogger, ZeBlogSante, Francesca Fedeli/Roberto D’Angelo, Familydan.org & FightTheStroke.org, Jorge Juan Fernández, Blogger and eHealth & Health 2.0, Hospital San Juan de Dios of Barcelona
Emmanuel Fort, Biomedical Imaging, AXA Research, Christian Funk, VitaDock by Medisana, Dr Philipp Goos, CEO, jameda.de, Kamalesh Goswami, Digital Strategy, E-Healthspace, Henri Gracies, Ophthalmologist and blogger, Mediamed, Dr Rafael Grossmann, General and Trauma Surgeon, EMMC, Thibaud Guymard, MSD (Univadis), Erard de Hemricourt, Writer, Esperity, Dr John Hixson, Clinical Director, VA Medical Center and UCSF, Evert Hoogendoorn, Designer, IJsfontein Interactive Media, Thomas Lee, Co-founder, Symplur LLC, Tiantian (Stanley) Li, founder, DXY.com, Aad Lievaart, Trainer and Coach, Muriel Londres, Living Without Thyroid Association, Dr Jacques Lucas, Cardiologist & VP of the French National Order of Physicians, Giovanna Marsico, CoFounder, Patients & Web, Greg Matthews, Managing Director, W20 Group, Dr Hubert Méchin, Founder, Drugee, Olivier Meignen, Haute Autorite De Sante, Didier Mennecier, Consultant, French Army hospital of Saint-Mandé, Dr Bertalan Meskó, founder, Webicina.com, Panos Papakonstantinou, Digital Marketing & Sales, Novartis Pharma, Maarten Ponssen, Consultant, Medix Publishers, Kathleen Poulos, co-founder, InCrowdNow, John Pugh, Digital Innovation, Boehringer Ingelheim, Dr Tessa Richards, Patient Partnership initiative, BMJ, Jurriaan van Rijswijk, founder, Games for Health Europe Foundation, Dr Homero Rivas, Surgery, Stanford & coFounder, Apps4Patients, Sylvie Royant-Parola, Respir@dom, Eugenio Santoro, Medical Informatics,
Mario Negri Institute for Pharmacological Research,
Franck Schneider, MultiMedia & AV expert, University Hospitals of Geneva, Michael Seres, ePatient, Denise Silber, President, Basil Strategies, Mitchell Silva, Founder, Esperity, John Stamler, Partner, Ben’s Friends, Patrice Thiriez, General Manager, e-Santé.fr, Paul Tunnah, CEO and Founder, Pharmaphorum Media, Audun Utengen, coFounder, Symplur, Jamie Tripp Utitus, ePatient and Blogger, Dr Vincent Varlet, Marketing & Communication, Novartis, Thierry Weber, Partner, Vivacity Group.

Lessons from Superstar Patients

The Doctors 2.0 & You meeting is a “Patients Included” conference and I found this odd. At one point the “Patient’s in the audience” were asked to stand up and about a dozen delegates (me included) stood up and were invited onto the stage. I then realised that these were the ‘Patients Included’ Patients (if that makes sense?) and I wasn’t considered one of those.

I think this is a backward direction we’re taking by reinforcing an arbitrary line that we try and paint between Patients and Healthcare Professionals. I think it’s much more productive if we recognise that we’ve all been Patients and we will be once again.

I think before a commercial event organiser talks about including Patients they really should try and be clearer in terms of how they reward Patients for the work they put into making their events a success. There is an important need to set everyone straight on much more basic things like who’s paying for this conference? and why aren’t we sharing all the slide decks and talks openly to Patients who can’t make it?

All the same I have no doubt that the presence of Patients who are active on social media kept the pharma marketing people on their toes and that was good to see (I found the lack of self promoting, back-slapping Big Pharma marketing guru’s who know and have done it all was very welcome!).

Michael Weiss interviews Michael Seres #Doctors20

Michael A Weiss (@HospitalPatient) had such passion and was so hardworking that I was left completely humbled. A complete gentleman, Michael is very aware of the challenges facing Patients and Payers and I saw him producing some incredibly powerful interviews in which he got great answers to key questions. I have no idea how he’ll find the time to edit all the videos he made (if you’re interested in helping Patients make a difference get in touch with Michael and see if you can help him with his work?) but what a compliment to an event. I’m trying to think of ways I can get him involved in the mHealth Summit that we’ll be exhibiting at in December (it’s in Washington DC so a bit closer to home for him).

Follow him on Twitter to see the videos when they’re ready in the meantime check out

> Dr Larry Chu discussing “digital health and Stanford Medicine X” the Doctors 2.0 partner event that takes place in California 5-7 September.

> Uwe Diegel, President of Health Labs EU, discussing the work of iHealth Labs and the variation in adoption rates across the world

> Dr Rafael Grossmann discussing the use of Google Glass in Surgery & Medicine

> Thomas Lee, co-Founder of Symplur, discussing Healthcare Social Media Analytics

> Seth Ginsberg, President of the Global Healthy Living Foundation (GHLF.org), discussing how they share best practices amongst Online Patient Communities and Patient Advocacy groups and explaining the work of ‘Seth’s 50 State Network’ to help train Patient Advocates.

> Evert Hoogendoorn, Technology Strategist at IJsfontein, discussing the approach they’re taking to develop Serious Healthcare Gaming and simulated experiences they are providing to carers to help them better appreciate disease states.

> Tal Givoly, founder of Medivizor, discussing what it took to take first prize in the Doctors 2.0 Start-up Contest.

> Marlies P. Schijven, Google Glass Surgeon at the University of Amsterdam, discussing her research into developing serious gaming to teach Surgeons.

> Tiantian (Stanley) Lee, founder of DXY.com, discussing the background to China’s largest Physician Only Social Network and Medical Content provider (employing 200 staff and serving more than 50% of – about 1.5 million – Physicians in China) and the universality of mHealth amongst hard working Chinese Doctors.

There was a lot of interesting discussions but stand out for me were the discussions Michael Seres led in his workshop.

Michael Seres Personal Blogging #Doctors20

I encourage all clinicians to watch this video of Michael explaining the opportunity to engage with social media but he’s an even more effective communicator in a workshop setting and I enjoyed some fascinating debate about some of the very sensitive issues that exist when Healthcare Professionals and Patients are active on Social Media.

If you are trying to develop a social media strategy in healthcare it would be a very smart move to try and get your team working with Michael Seres Consulting.

Michael Seres leading Workshop on Personal Blogging #Doctors20

Andrea Borondy Kitts (@findlungcancer) is a Lung Cancer Advocate, Retired Aerospace Engineer and MPH Student who lost her husband to lung cancer on the 12th April 2013 and is doing incredibly important work advocating for Patients with Lung Cancer.

Lung Cancers Stigma #FindLungCancer

Prejudices abound about Lung Cancer because people have prejudices that its the result of lifestyle choices and is avoidable. As a result there’s a bullying culture that exists which blames Patients for lifestyle choices they may or may not have taken and discourages Patients (and the media) from sharing their important experiences. To varying degrees other diseases face this type of challenge so I think the frontline experiences from a Lung Cancer advocate who is very active on social media will be an critically important bellwether for the challenges Patients will face.

both sides of the argument

Andrea also wore a beautiful piece of jewellery featuring her twitter handle (@FindLungCancer). The story of it being a gift from her 13 year old niece was incredibly moving. How do we ensure children as thoughtful as this get an opportunity to study Medicine?

FindLungCancer #Doctors20

Every Healthcare conference should have a walking challenge

Doctors20 delegates getting set up with their iHealth fitness trackers

I thought the FitBit challenge at Mobile World Congress was interesting but iHealth Labs took this to a whole new level by providing every delegate with their cool new activity and sleep tracker device. Even though there was one for every delegate it was interesting to see the rush of delegates keen to ensure that they didn’t miss out. I sent this picture to a friend who works for a mobile phone retailer and it’s convinced them that there’s a business case bundling trackers together with new phone sales offers. It amazes me that this isn’t yet being done in the high street mobile phone stores (so far I’ve only seen iHealth devices getting shelf space in electronic retailers like Maplins).

Maplins selling mHealth tech in UK high streets

It’s a great strategy to have some of the most connected healthcare industry professionals in Europe using your devices but iHealth took this a step further with their leader board that enabled delegates to compete with one another to win prizes (and a little fame!).

I don’t think there was a delegate who didn’t appreciate the competitiveness that this community game triggered. For me it really highlighted how the addition of seamless connectivity can create powerful motivational forces within individuals and across communities.

Uwe Diegal iHealth Labs

If the game had been measuring the zygomaticus muscles the outright winner would’ve been iHealth Labs Europe President Uwe Diegel. He bills himself as an ‘official manufacturer of happiness’ but I imagine this was topped up by the high profile iHealth’s latest range of mHealth devices were given by Craig Fereighi, Apple’s SVP of Software Engineering, during the HealthKit announcement at Apple’s Worldwide Developers Conference that was being held at the same time over in San Francisco.

Uwe Diegel iHealthLabs presenting at #Doctors20

Big Pharma struggling to understand the innovation process

Sanofi Marketing Team at #Doctors20

Sanofi had a big booth demoing their iPad apps and a Microsoft Kinect game designed to teach the basics of surgery with a work out.

In their presentation they also talked more about the pan european train trip they organised for developers. Apparently the trip enabled the participants to meet with different people in a variety of major cities (Paris, London, Barcelona) and makes for the perfect environment to get loads of collaborative work and coding done in-between the stops. This contrasts starkly with my experiences and I wonder how anyone thinks trains are productive developing environments (if I’m wrong how come the developers at Facebook, Google and Apple aren’t being shunted about on railways during their working days):

European Train Station #Doctors20

Disappointingly the names of the apps that have launched startups as a result of the program aren’t being made public as Sanofi have lawyers working with them to ensure they have watertight IP and can’t be copied. It’s remarkable that they are going with such an outdated approach. Perhaps they think there are blockbuster apps that they will be able to develop and no one will be able to copy?

I wonder how long before they realise that they need to not only think beyond the pill but that the pill business model isn’t going to work in this new environment?

Why Big Pharma struggles to innovate with mHealth

Exhibitor: Activ8rLives.com

Active8Lives #Doctors20

Activ8rLives is a Cambridge UK based startup that is developing ‘self monitoring solutions for health and wellness’. The company was demonstrating the ability of it’s platform to support diverse groups who are interested in tracking their health/wellness using a wide range of different pieces of mobile connected hardware:

Activ8rLives booth #Doctors20

I found the rapid test strip reader smartphone casing particularly interesting as it highlights the potential of ever lower priced smartphones eg. it’s becoming easier/cheaper to put an Android Smartphone inside a custom plastic casing for a Rapid Diagnostic Test than to make a mobile embedded device (as per the Deki Reader from Fio):

Android Smartphone RDT casing Activ8rLives #Doctors20

Doctors 2.0 & You Start-Up Contest

This was an interesting addition to the event. Taking the top prize was Medivisor (a website that provides ‘personalised information updates that are relevant, understandable, and actionable’ to Patients and Carers) but my personal favourite was I-Nside who have designed a device similar to Cellscope’s proposed Oto product (that despite spinning out of the lab a few years ago and gaining the support of Billionaire backed Khosla Ventures has yet to make their low cost device commercially available).

i Nside #Doctors20

I can think a lot of Doctors who would find a disposable attachment accessory like this to be a useful additional feature of their Alivecor ECG equipped smartphone case and perhaps it will take the arrival of some competition to get the Cellscope to launch something for medics to start trialling.

A little concerning was the presence of a startup by the name of Kosmo (LINK INTENTIONALLY NOT INSERTED):

Kosmo e cigerette #Doctors20

I can’t imagine how they convinced the Doctors 2.0 & You organisers to lend them credibility by permitting them to exhibit and present. I’ve shared my views on these apps in this Linkedin mHealth group discussion and I find it astounding that in an age of social media anyone is thinking that making e-ciggerettes more appealing to young smartphone users by connecting them with fun interactive apps is going to do anything but make them even more addictive. This really should not in any way associated with health promotion as until there’s evidence it’s merely exchanging one type of addictive unhealthy behaviour with another that’s in all likelihood going to be even more addictive.

EyeForPharma Beyond the Pill Interviews

There was such a great mix of delegates from around the world that we decided to record some interviews as part of the preparation for the EyeForPharma Value Added Service Conference that I’ll be again chairing in London in September.

The full series of interviews will help take the pulse of Patients, Payers, Healthcare professionals, Pharma, mHealth app developers, etc on ‘Beyond the Pill’ strategies and we think it will be interesting to present different perspectives on a set series of questions.

The first one to be shared is the following short interview with Dr Gerard Crotty, Consultant Haemotologist and President of the Irish Hospital Consultants Association:

There will be a series of these videos being launched over the next few weeks within the EyeforPharma community so download the brochure for the Value-Added Services event here if you’d like to be first to these videos.

Google Glass Doctors

GoogleGlass Doctors #Doctors20

The Google Glass Doctor session was interesting but left me even more convinced that Google should focus first on the type of Veterinary Surgical applications that we’ve been experimenting with for sometime now. Here are a couple of the more obvious reasons for this:

> The role of a Veterinary Surgeon is typically much more varied than a Surgeon working in a modern Hospital OR. Veterinary Surgeons often manage their own Anaesthesia, change their surgical plans at the last minute (they can’t as easily take a history from the Patient and will typically undertake multiple procedures when they have the animal anaesthetised), need to work with fewer staff and much smaller budgets, etc. In my experience this tends to make Google Glass videos of human surgery rather boring training tools because the staff all have their own limited focal areas and this can more often than not be better recorded with HD Go Pro’s mounted on the lighting etc. The Veterinary Surgical training videos that we’ve produced are strikingly different as they show how surgeons are expected to be able to manage many roles while operating and the areas surgeons might operate also vary considerably and opportunities to share lessons with others arise spontaneously eg. in large animal practices one minute they might be delivering a cow in a farmers remote field the next they could be administering a horse in a well equipped stable neither of which would feature any video recording equipment or the time to set it up etc.

> Veterinary Surgery is very similar to frontline Battlefield Medicine an area where the ability to summon real time assistance from a remote expert would be invaluable but where the risks to life are often so considerable that you would not want to experiment with unproven tech. With a few modifications Google Glass will obviously transform the work of first responder/paramedics but there should be more research conducted to ensure this is safe.

> It’s extremely rare for Patients to be interested in watching videos of themselves under anaesthesia being operated on. In contrast the owner of a valuable animal is very likely to have an interest in watching a video recording of some surgery conducted by their Veterinary Surgeon.

> This cool Google Glass Checklist demo video that Dr Homero Rivas (@mHealthSurgeon) played to the audience appears to me to be exactly the type of tool that would be useful in low resource Veterinary settings but I can’t imagine being very helpful in large operating rooms where you typically have entire teams that need to be involved in checklists (eg. it’s useful to have the team communicating, everyone should be able to see the confirmatory text, etc).

Here’s are a few articles on the use of Google Glass that I think you may find helpful as further reading material:

> mHealth Insights into Wearables
> Google Glass has a long way to go in the OR
> Did Google Glass really save the life of Patient in Hospital or was it just the EHR?
> Has the experience with Google Glass opened Google’s ears to the Augmented Audio Opportunity?
> The biggest impact Google Glass will have on Healthcare: It will enable Patients to Document care (and that will then force Healthcare Providers to follow)

Disrupting the Practice of Medicine through Digital

Doctors20 Disrupting the Practice of Medicine through Digital

I recorded the session I moderated featuring Liana Lianov, Jacques Durand and Dr Tessa Richards so click back here as I’ll post the link to the podcast when I get the chance.

Dr Tessa Richards (a Patient, Carer, experienced Doctor and senior editor for the BMJ) talk was brilliant, calling for us to let the Patient Revolution begin:

Dr Tessa Richards #Doctors20

The Q&A at the end is particularly interesting as it has me challenging Liana’s confidence that a focus on ‘Lifestyle Medicine’ can flip the pyramid and shrink government healthcare budgets (I think all the evidence shows that unless we move to self care models it’ll just make a much bigger pyramid) and challenging her views that the growth of Chronic Disease is due to a failure of healthcare providers:

Liana Lianov #Doctors20

I also challenge Jacque on his strongly held belief that it’s not right for Doctors to charge Patients for their time and the BMJ’s lack of any formal plan to pay Patients for their contributions to their Patients Included initiatives.

Disrupting the Practice of Medicine through Digital #Doctors20

My presentation:

My key take away was that when healthcare is designed to meet the needs of Patients much of it will look just like a mobile experience (see ‘Why we’re more likely to drop the “Health” than the “m” in mHealth). The talk and discussions afterwards were recorded so I’ll update this post with that content when it’s available.

David Doherty presenting at #Doctors20

We’re sorry but this post is incomplete. Check back again soon for more mHealth Insights from Doctors 2.0 and You Paris.

workinprogress1


The National Institutes of Health launches a mHealth Online Training Course

July 9, 2014


I think this is a great initiative by Wendy Nilsen at the NIH. A few of my notes on watching the introduction video:

> “What is mHealth?”

at NIH, we think about this really as diverse application of wireless and mobile technologies designed to improve health research, healthcare services and health outcomes and I think this is really important because it’s not just cell phones. You can think of it as sensors, any kind of sensors you can think of

I think it’s critical that organisations agree on a definition of mHealth as it makes little sense to be offering training courses about things that an organisation hasn’t itself yet reached an accepted definition.

In the introduction video Wendy Neilson reminds us of the importance of this (“always remember in mobile to ask what the acronyms mean, ask what the words mean. When we’re communicating across disciplines, we often don’t know each other’s words“)

I’ve offered this robust and time tested suggestion back in 2010 that might be useful:

mHealth is the leverage of Mobile for Health (where Mobile is the newest Mass Media and Health is the state of complete physical, mental and social well-being)

Failing that it’s interesting to consider alternative definitions that have been put forward by others eg. “What is mHealth”.

> Beyond Telemedicine

I also want to stress, too, this (mHealth) is really beyond what we traditionally think of as telemedicine

I think this is a very important point. A lot of people who have worked in telemedicine think that mHealth is a subset. Then get disorientated when I tell them to describe how it’s telemedicine when I’m at 30,000 ft in a plane accessing a full medical library on my smartphone and taking the ECG of a panicking passenger using the Alivecor app.

> SMS

We talk about SMS all the time but it is Short Message Service. It’s really the most widely used data application in the entire world, billions and billions of active users. And the thing is that this is changing by the hour

It’s critically important that the healthcare industry understands SMS so please read this fascinating post by Tomi Ahonen from 2010 (also don’t miss his 2013 ‘Mobile Moment’ Almanac). Key takeaways that you will gain include an appreciation of SMS as not just the most widely used ‘data application’ but as the most popular and accessible means of electronic communication eg. back in 2010 87% of the total population who have a mobile phone do not originate voice calls but do send SMS – it’s for this reason that most people in the world don’t refer to their ‘mobile’ as their ‘phone’ (because while it can be a talking device it’s not owned for it’s voice call purposes but for messaging).

> The office based model isn’t going to work for young people

And young folks. I think if we don’t worry about mobile for any other reason, we have to think about a generation coming up where we have a chance to embed health in their life from the very beginning to have health and health interventions whether they be public health, whether they be clinical, whether they be epidemiological, we can start from the very beginning. Kids are going to have phones, We know even the youngest have phones and what’s really Important Is thinking about the world they are growing up in, and they have never been in a brick and mortar bank. They think that ATMs are it, you deposit through your phone. When they finally go to get a mortgage, should they be that lucky, they’ll do it online. So they are never going to use a brick and mortar bank and the idea of only being able to access a world with brick and mortar, as we do in healthcare, I think we’re going to have to be really there with them

I think this is a big misconception. From my experience of the last fortnight talking with hundreds of Consultant Psychiatrists at the RCPsych’s International Congress in London it’s clear that young people are driving transformational change in healthcare services as they simply refuse or avoid using services that fail to modernise. More concerning is the fact that we’re leaving senior citizens behind as we adopt mHealth. Note: There are many things we can do to change this but it’s also critical we appreciate that there are also opportunities to implement mHealth that seniors are already expecting.

> Obsession with the ‘Randomised Controlled Trial’ approach to mHealth

My boss, Robert Kaplan and Art Stone just recently did a review in looking at the evidence in mHealth and they only found 20 randomised control trials, 20 projects that were mature enough for randomised trial, because you don’t want to start a randomised trial at the beginning. You want to do it when you have something that you think really is going to work. But of those, 55%, 55%, 11 out of 20, showed no clear benefit, So what does that tell me? And what does it tell you? I mean, the one thing I think about when I think about that is, wow, we got a long way to go. We’ve got to learn, we’ve got to learn what works, we’ve got to learn what didn’t, and we need to know how to do this better. There is some problems with the current literature, too. There aren’t many published studies. Caroline Free recently did a review, there’s been a whole bunch of reviews that have been happening. But there’s not a lot of research. There’s a lot of projects without a lot of research. And a lot of times they are with a few people and they may not be with the people you want to generalise

I think this really highlights a major issue I see presenting when non techies get bowled over by the mHealth that is envisioned by technologists. Big Pharma makes similar oversights and I’m always encouraging clients to stop looking to the future possibilities and focus on the issues with the fundamentally broken ways in which we care for Patients today and the opportunities mobile offers for the modernisation of processes:

Why Big Pharma struggles to innovate with mHealth

The rate of change can seem overwhelming but the alternative is wasting your time trying to clinically validate outdated tech. Asking for yet another RCT showing the effectiveness of using SMS or mobile calls instead of stamped addressed envelopes won’t make a piece of difference because there is no logic to printing and sending snail mail in 2014.

Why would a rapidly growing mHealth company that has proven it’s mHealth service can save an employer $3,300 per employee per year in healthcare costs and hasn’t yet even got competitors in the market go and waste money and time waiting for more research to further prove that it’s valuable to collect data when the continually improving search algorithms used by Google prove to us everyday the valuable insights that can be made when data is seamlessly collected?

> It’s critically important for us to move beyond the in-office model before mHealth will make any sense

NIH is funding mHealth, but how do we think about augmenting this in different ways. It’s interdisciplinary research. As a leader of NIH’s mHealth Training Institute, including this online course. One of the things we’ve been really trying to think about is how do we get what Bonnie Springs and others have labeled team science? How do we get that to happen all the time for mobile? We have the genius of behavioural scientists, the genius of computer scientists, the genius of medical providers, nurses, doctors, healthcare professionals, dentists. We have engineers building devices. But you know what? If you’re not working together you are going to end up with a device that seems like it makes sense but it isn’t. I know when I first started at this one of the things that really prompted me to think about our role in this was someone who showed me a great cardiac monitoring system. It was really lovely, lovely interface, lovely everything. But when I said what happens when there is a cardiac event, this was for people with congestive heart failure. What happens when there is a cardiac event? And the man looked at me and said, we email the nurse. And I know there is many of you out there now chuckling because it’s not a chuckle-able event in some ways, but it’s almost funny. Email a nurse should never be in the same sentence. And he said, well do nurses have email? Yes they do, we know that. But emails and cardiacs don’t go together. So how do we have nurses and doctors working together with people that are building these devices with behavioural principles, because if we don’t know how behaviour works we’re not going to be able to change it. Just monitoring your cardiac function may not be enough. We’ll probably want you to change your diet, your physical activity, your stress, your smoking. How do we do all that? We’re going to need to work together to get there. Also, research methodology

Other industries have got over this challenge of being always on (eg. I can use by bank card anywhere in the world even when my local branch is closed) so I see no reason why healthcare is going to different as soon as we all realise a ‘video call to a properly staffed bank of trained nurses with up to date access to all your information’ can achieve more than an email to your nurse (who might be asleep, out at dinner, on holiday, etc, etc) will ever be able to manage.

But more importantly very few mHealth innovations will make any sense until we all appreciate that:

a) The Healthcare experiences we’re all familiar with are fundamentally undocumented or inefficiently documented.

b) The product we choose to make should not be visits.

c) ‘the 2000 year old model of healthcare is broken forever’.

d) mHealth is introducing algorithmic transformation to what healthcare services are possible eg. in 10 years mHealth will make many unthinkable things possible.

What were your thoughts on the NIH introduction to their mHealth Online Training Course?

Related: Click here (on the Healthcare Informatics Society of Ireland website) or here (another page on the mHealth Insight blog) to find out more and book the mHealth for Healthcare Professionals Course that we developed together with the Healthcare Informatics Society.


mHealth to Transform Healthcare Interview

July 3, 2014


EyeforPharma mHealth to Transform Healthcare interview with David Doherty

When you realize the amount of data mobile telecoms companies are gathering, you realize they are in a very different position and that this enables very different opportunities to personalize healthcare delivery. If pharma brands don’t transform, I have every confidence that mobile phone giants will cannibalise them just like they did with consumer brands – like computers, watches and music players – in the last ‘Nokia’ decade

3G Doctor’s David Doherty being interviewed by Robert Imonikhe ahead of EyeforPharma’s Value Added Services Conference (September 17-18, London).

Related: 2000-2009 – the Nokia Decade, but why should it stop there?


I’d Never Admit That to My Doctor. But to a Computer? Sure

July 1, 2014



We share more honestly with impersonal methods of communication

Writing in the Pacific Standard Magazine Tom Jacobs discusses recent research (Computers in Human Behaviour: It’s only a computer: Virtual humans increase willingness to disclose) revealing that Patients are more likely to respond honestly to personal questions when they are posed by “Virtual Humans” rather than in face to face encounters with Doctors:

Admit it: The last time you sat down with a physician and revealed your medical history, did you fudge a bit? Were there certain incidents you were too embarrassed to admit? Did you gloss over certain behaviours that might make you look bad? It’s a serious problem for health professionals and patients alike. With less-complete information to work with, doctors are more likely to misdiagnose an illness, or prescribe an inappropriate drug.

People disclosed information more honestly and openly when they were told they were speaking exclusively to the computer. The participants also “reported significantly lower fear of self-disclosure” under those circumstances.

“The power of VH (virtual human) interviewers to elicit more honest responding comes from the sense that no one is observing or judging,” note the researchers, led by Gale Lucas of the University of Southern California’s Institute for Creative Technologies. People have a strong tendency to want to look good in front of others, including doctors; this problematic tendency can be short-circuited using this high-tech tool.

Half of the participants were told that their conversation was entirely computer-driven and not being observed. The others were informed they were being watched by a person in another room who was also manipulating the machine to ask certain questions. In all cases, video images of their faces were recorded and later analyzed to gauge their level of emotional expression.

Afterwards, participants responded to a series of statements measuring their comfort level with the experience. Finally, an outside observer noted their responses to certain sensitive questions (such as “How close are you to your family?”) and gauged their willingness to disclose personal information.

The result: People disclosed information more honestly and openly when they were told they were speaking exclusively to the computer. The participants also “reported significantly lower fear of self-disclosure” under those circumstances. These results were reiterated by the analysis of their facial expressions, which found they “allowed themselves to display more intense expressions of sadness” when they believed no human was watching them.

So the perception of anonymity was the key. That conclusion was confirmed in several ways, including by noting the closing remarks of many participants. “This is way better than talking to a person,” one commented. “I don’t really feel comfortable talking about personal stuff to other people.”

When it comes to fixing our health-care system, very few people would agree that part of the answer lies in less human interaction. Patients generally want more, not less, contact with health professionals. Yet this study suggests that, at least for the intake interview, a little less of the human touch—and a little more perceived privacy—may be precisely what the doctor ordered

mHealth Insights:

> This work builds on lots of research that shows Patients will interact more honestly with online questionnaires (eg. Why telephone consultations with Doctors fail, At first I was very skeptical. How could a computer replace my excellent history-taking skills, which had been formed by a rigorous education, then honed by 10 years of small-town family practice and 5 years of academic teaching?, Computers take histories better than doctors – why don’t they do it more?, etc) but I wouldn’t be at all surprised if a lot of the value that a ‘Virtual Human’ interaction offers beyond the use of a well designed questionnaire on a device like an iPad will be lost as soon as the move is made to real Patients with real health concerns instead of citizens who have volunteered online to help with some research.

> I’m not sure there is any real distinction between what the researchers refer to as a “Virtual Human” and an SIRI style mobile interface to an interactive structured medical history taking questionnaire like Instant Medical History (the tool we leverage to provide documented mobile video consultations at 3G Doctor).

Nuance natural language interface for Instant Medical History


The Wall Street Journal: A Geriatrician explains why seniors need video call tech

June 30, 2014

WSJ Video Consults with a Doctor the single biggest tech product that could help seniors

This Why the Elderly Need Virtual Doctor Visits article in the Wall Street Journal asks Marc Agronin, Geriatric Psychiatrist, Medical Director for Mental Health & Clinical Research at Miami Jewish Health Systems, Affiliate Associate Professor of Psychiatry and Neurology at the University of Miami Miller School of Medicine, and Author of “How We Age: A Doctor’s Journey into the Heart of Growing Old” ‘What one new technology product do you think would be the biggest help to older people?’:

I see the age wave in my office every day since more and more patients are in their late 80s and 90s. They are typically sociable individuals with many enduring interests who are wholly reliant upon children or aides to coordinate their schedules and provide transportation for appointments and activities. Without adequate resources, many of these elders are homebound and socially isolated. Easily accessible and user-friendly telepresence is one technology that could make an enormous difference in their lives and provide critical cost-savings.

Consider the many potential services that could be provided by the telepresence of one or more individuals on a large screen set up in the home of an elderly person: interactive social groups, adult education, cognitive stimulation, medical and mental health assessments, psychological counseling, reminders to take medications, visits with clergy, and shopping. The key elements that telepresence provides are social interactions and observation of the individual. Certain medical and mental health assessments could prevent unnecessary visits to the hospital or alert caregivers to evolving issues that warrant prompt intervention. Greater access to mental health counselors, dietitians and other specialists could be provided. Much of what I do in our memory center to evaluate individuals for cognitive impairment could be done via telepresence. Telepresence could provide interactive socialization and education in a greater variety of languages, cultures and religious approaches than available at the local senior center. An entire industry of telepresence volunteers and services could be created to serve the exploding population of ageing individuals

Sir Stirling Moss 3G Video Calling 3G Doctor Dr Fiona Kavanagh

Related posts:

> There’s nothing Virtual about remote Video Consultations with registered Doctors

> So, exactly why would one need to video call a doctor vs. just talking to them? (2010)

> President Obama’s favourite Mobile Health use case (2011)

> “My mother is 93 years old and has an iPad. She wants to know why she can’t FaceTime the practice nurse. So do I”


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