mHealth Insight: the blog of 3G Doctor

Last week (12-14 June 2013) at Nuance’s Global Healthcare Partner event at the wonderful Penha Longa Resort near to Lisbon, Portugal, I was honoured to have been invited as guest speaker to present a ‘Beyond the Beep’ mHealth talk on how I think listening devices will radically transform Healthcare as a result of my experience using Nuance technology.

Nuance Healthcare is the world’s leading provider of speech recognition, dictation, and transcription systems and services that simplify and enhance the production and management of electronic patient documentation. Today, thousands of hospitals, clinics, and group practices and hundred thousands of healthcare providers, use professional speech recognition for healthcare providers by Nuance to transform the high cost of medical reporting to a low cost high-quality process, for increased doctor productivity and better care, through easier, more immediate access to electronic patient information. Click here for more information on Nuance Healthcare products.

The full list of presenters will include:

Paul Adams, Director Product Management Dragon Medical
Frederik Brabant, EMEA Marketing Director
Dr. Campos Costa – Innovating Since 1943 Guest Speaker
Janet Dillione, Executive VP and GM, Healthcare Division
David Doherty, Co-Founder of 3G Doctor, Ireland
Jonathon Dreyer, Director, Mobile Solutions Marketing North America, Healthcare
Martin Held, Product Manager EMEA
Milko Jovanoski, Partner Marketing Manager EMEA & Nuance Healthcare EMEA Partner Program
Gerald Kotzian, Director Professional Services and Support Healthcare
Gonçalo Marcelino, Executive Director, Radiology Clinic Dr. Campos Costa, Grupo de Mello Saúde, Portugal
Dan McGraw, VP Sales – General Manager EMEA, Healthcare
Ljubomir Milanovic, Research Director Healthcare
Mert Oez, Director, Product Management EMEA, Healthcare
Jörg Studzinski, Senior Consultant, HIMSS Analytics Europe (HAE)
Nick VanTerheyden, Chief Medical Information Officer, Healthcare
Markus Vogel, Chief Medical Officer DACH
Joachim Walter, Pre-Sales Manager Northern Europe
Nick Wilcox, Senior Managing Consultant, IBM Healthcare Center of Competence, Abu Dhabi, United Emirates
Davide Zacchagnini, Director of Clinical Informatics

Event sponsors:

In the Experience Zone delegates got a chance to learn more about solutions from the following leading companies:

> Grundig Business Systems GmbH
> Philips Dictation
> Plantronics
> Olympus Professional Voice Recorders

My presentation:

Here’s the Slide Deck I used and below is an overview of some of the key topics I discussed in my talk:

> Personal introduction
> Overview of 3G Doctor and the Documented Consultation Process we provide
> The contribution Nuance technology makes to 3G Doctor consultations
> How your vision and thoughts about how computers see the world make it difficult to see disruptive sound based mHealth opportunities
> Imagine Google Glasses without the glass or the camera…
> Audible Augmented Reality opportunities might be more disruptive than Visual AR: Mobiles as acoustic sensors
> How a Smartphone might look to you if you’d never had sight
> Medical Devices: Beyond the Beep
> The tailspin that (m)speech is going to put regulators in and the disruptive opportunities this will fuel
> Image the future… demo of how Patients can use the device that’s in their pocket to document their care and Doctors can support these Patients with rich template based clinical content that’s made for mobile.
> Analogies between the Qwerty Keyboard (initially created to enable Blind people to write on paper) and (m)speech (initially created to enable people and machines to talk)

My key takeaway:

The tipping point for Healthcare Professionals will come when we start using our mobiles for basic speech recognition and command roles and then start asking why we can’t use these technical advances to advance our productivity at work.

The tipping point for Patients is materialising because Nuance (m)speech technology is making interacting with technology so seamless that it needs no learning and this is reinventing the relationship between people and technology. Great experiences of this tech can already be found with Samsung’s new Smart TV’s (which can be controlled via speech) and the opportunity for Healthcare providers emerges from an understanding of these new sensory possibilities and ways in which healthcare experiences can be redesigned to leverage these (think of a Patient completing an Instant Medical History questionnaire by just talking with their Mobile/Tablet/TV).

(A blind Apple Store Staff member using Nuance text to speech technology to fix the smartphone of a Space X Engineer)

Thank you

A big thank you to all the Nuance Healthcare team – especially Dr Nic – and Partners for the fascinating conversations and the chance to participate in so many brilliant educational workshops.

Looking forward to chairing the Going Mobile Summit on the 18th June 2013 next week at Croke Park in Dublin.

The Going Mobile Summit (part of the Enterprise Technology Event) will feature presentations from the following speakers:

Garvan Callan, Head of Business Development, Danske Bank Ireland
Paul Dunne, Head of Business Development, Realex Payments
Philip Harrison, Technical Director, CWSI
Rick Love, IS Project Leader, Mayo County Council
Lauren Morris, Solutions Consultant, Vodafone Ireland
Lavinia Morris, Head of IT Operations, Friends First
Ronan Murray, Infrastructure Manager, LeasePlan Information Services
Eugene McCarthy, Head of On-Line & Mobile Banking, Bank of Ireland
Louis Marinos, Senior Expert, Risk Management, European Network & Information Security Agency
Anthony Quigley, Director, Digital Marketing Institute

Sponsors

Fujitsu
Vodafone
William Fry
Oracle

Register today

Click here to register

Reading this Telegraph article quoting Anna Soubry and I’m amazed that a politician could somehow think it might be a good idea suggest that the massive contribution that females are making to the positive changes in the medical professional are being undermined because they may want to have children.

I feel that a government that wastes more than £100 Million per annum having telephone medical helplines answered by the least experienced should not be trying to blame female Doctors because NHS funding remains tied to antiquated views where all Doctor work must be done within the four walls of a clinic premises.

In 2013 Britain has a workforce of approximately 4 million who work mainly at or from home so perhaps it’s about time for the NHS to make provisions that would enable Doctors to also find employment in this way? Then instead of denigrating those who don’t find it possible to work in full-time clinic based roles we could start talking about the massive contribution that these GP’s are making to return out of hours responsibilities to GPs, supporting Patients and Carers in the community, etc, etc.

Maybe MPs should start reading the tabloid newspapers who seem to be much more aware of the value that Patients would receive if they could access the advice of home working Doctors rather than the sorry state we have today with unconnected 1990′s style call centre based models that involve untrained call handlers who are reading scripts on computers that it’s been clearly shown most Patients/Carers could quite easily use themselves…

I’ll be in London next week for the DHF13 investor meeting and Saatchi and Saatchi’s ThinkDigital 2013 meeting and we’ve had some fun with this before so please feel welcome to join us for lunch during the first day of Commissioning Live/Health + Care 2013 at London (Excel Convention Centre, 12-13 June 2013) for a networking session with others who are in London and are interested in mHealth.

The meet up will start from 13:30 hrs on Wednesday 12 June at a meeting point in front of booth G15.

Can you make it?

All are welcome as the meet up isn’t just for members of the mHealth networking group on Linkedin but please let us know you’ll be attending and introduce yourself/your interests to other attendees by completing the phrase “Talk to me about…” in the comments below:

This Telegraph article quoting Dr Clare Gerada (Chair of the Royal College of General Practitioners who feeling pressure from the persistent media blame being levelled at GPs felt the time was right to tell a few home truths) highlights the extent to which Primary Care has been stretched in the UK.

Perhaps it’s about time the NHS adopted the published best practice that Prof John Bachman MD, Prof of Primary Care at the Mayo Clinic, has shared in this 2009 Mayo Clinic Proceedings paper that showed how through the use of an online interactive patient history taking tool (an adaptation of which we utilise as a key part of the documented consultations we offer here at 3G Doctor) it is possible to make 40% of office visits unnecessary.

For how long more can the front line of our healthcare system continue to resist using the tools of our time?

This excellent “My Near Miss” article by Dr Danielle Ofri in the Opinion Pages of the New York Times leaves readers with the suggestion that “Until we attend to the culture of shame that surrounds medical error, we will be only nipping at the edges of one of the greatest threats to our patients’ health“.

Unfortunately while I’m sure there would be great insights to be had from stories about “how a person in authority handled the emotional fallout and the feelings of incompetence” I think there are some deep seated cultural challenges that will ensure that this problem will not simply disappear if we simply have “the chief of medicine or the director of nursing stands up and talks about his or her biggest medical error” because the example that we will be told about will be a self selected error and we’ll still be pandering to this concept that you can categorise clinical practice as either correct or at fault.

For me the most revealing line in the article is where Dr Ofri explains that “I never told anyone about my lapse — not my intern, not my attending physician, certainly not the patient’s family“.

In 2013 it should be really be obvious to anyone involved in the healthcare industry but imagine if we put the patient and their family at the centre of the medical documentation process? Went with the (some might think it crazy!) idea of making a Patients medical records theirs. Wouldn’t all the other problems that Dr Ofri encountered quickly fix themselves eg. you’d be quick to tell your intern and your attending physician just incase the Patient’s family notice it, you’d be more honest about your mistakes because they were documented, you wouldn’t need to be spending days of the valuable time you could be spending caring for Patients having your clinical skills assessed because reviewers could just open a document to review your work, you’d be more enthusiastic about using tools that could help you avoid errors in future, etc.

Of course once healthcare is all documented decision support tools can be provided to help Medical Residents (who as a result of working hour directives etc are now getting less opportunity to meet “classic eye-roller’s” on which to master those important skills of efficiency) so that when they are approaching the end of their shift and meeting with their first nursing home Patient with dementia who’s been sent to the ER with symptoms of altered mental status the Medical Resident caring for them will be specifically asked “Did you check the head CT for an intracranial bleed?”

It fascinates me that Amazon uses technology like this to make sure we don’t buy a battery powered toy without picking up some batteries, or to recommend another book that we might be interested in…

“…(Jeremy) Hunt said that “Every patient is the only patient.” Is the man mad? My first patient in my morning surgery yesterday had complex visual symptoms that did not fit into any textbook description of eye disease. I had to tease out a clear description of her difficulty, that had already baffled her optician. She needed a careful eye examination and a full neurological examination, and then a referral for a secondary care opinion. By the time I had achieved this, I was already 25 minutes late for my next appointment despite having started five minutes early. Her Patient Satisfaction Questionnaire indicated that she was very happy with what I had done for her. Two more patients like this in the course of the morning meant that I was nearly an hour late for my last patient who made a formal complaint about me to the practice manager. It is no longer possible to practice good medicine in ten minute slots. The “quick” patients are now seen by nurses, making the case complexity of the people who consult the doctors much greater. Hunt makes the point that,

Does he think that such patients can be cared for appropriately given the current pressures on primary care physicians in general practice, out of hours services, and emergency departments?“

Dr Peter Bailey, GP, Cambridge (UK) writing for the BMJ Group Blog

My thoughts:

Can you imagine the opportunity the NHS has to commission England’s most talented ophthalmologist to spend a day writing down all the questions she would ask of Patients who present with an eye condition and then having that expert knowledge added to a clinically validated Interactive Patient History Taking Questionnaire (that could also include the 9 million questionnaires that GP’s will deliver through QOF this year) that GPs could make available to all of their patients 24×7 via their practice website (something that would greatly assist their current efforts to take back responsibility for out of hours care) and on an easy to use touchscreen tablet devices that Patients could use in their waiting rooms?