As Healthcare increasingly becomes focused on consumer retail models will CEOs who aren’t active on social media survive?

January 22, 2015



FoxBusinessNews Aetna CEO on the state of health care

What spurred you to raise staff wages and how well was it received: …it was very well received and it was pretty emotional meeting with the employees when I announced it in the auditorium. I wasn’t quite prepared for that but it was a pretty big moment. You know I’m active on social media and my employees were contacting me about how hard it was to make ends meet and so I said to the team ‘why don’t you give me a look at what these folks do for a living, who are they, how much do they make, what do they do inside the company? Then we found some interesting statistics: most of them were working single mothers and they have families at home. They were doing phone and claims kind of service. A lot of them had their children on medicaid because they couldn’t afford our own employer sponsored plan, because of the out of pocket cost, and a good number of them were on food stamps (WOW) and so when you look at that and say wait a minute we’re a fortune 50 company and we have employees who are on food stamps and are putting their kids on medicaid does this work? Is this fair? And can we afford it? So we looked at turnover costs: $120 Million a year. We looked at you know retention of our customers: Lower than we’d like it to be. We looked at customer satisfaction: You know our net promoter score has us in the middle of our industry but the industry is below everyone including airlines and cable companies. The only people we have to stand on the shoulders of is Congress, Congress is lower than we are from a net promoter score standpoint. So when you look at that you say we’ve got to do better on the frontline when dealing with customers particularly if it’s going to be more of a retail market. And so how do we invest. How do we make an infrastructure investment in our people. Let;s get them engaged. Let’s get their attention. Let’s get them trained and let’s make them better knowledge workers for the future. It’ll help us with our customers but more importantly it will help them live healthier lives and take a lot of the stresses off at home that we don’t want them to have at work

Mark Bertolini, Chairman and CEO, Aetna Inc (an American managed health care company that sells health care insurance plans and related services) talking to Fox Business about lessons he took from engaging with employees on Twitter and how the company has increased pay for employees as part of their strategy to reposition itself to service the direct to consumer retail models.

Twitter MTBERT


How do you think Patients might benefit from ‘Zero Marginal Cost‘?

January 20, 2015


A great talk by Union Square Venture’s Albert Wenger on the fundamental implications of Zero Marginal Cost:

Why is everyone going online? It turns out there’s a simple answer to that: Kittens. Everyone wants to see Kittens. Well there’s actually something more to this, there’s something serious to this because when I downloaded this image from Flickr there was no noticeable cost to anybody. The marginal cost of creating a copy in the digital world is zero and that is driving all the changes that we’re seeing… …and we’re just at the beginning of this change

I think this is something that is having a very interesting impact on how medicine is practiced and the outcomes that are achievable with mHealth. Things to look forward to:

> We will stop talking about healthcare records in terms of out of date property ownership laws and the siloed uninteroperable approaches that today prevent collaboration will die away. In 2022 (when the RCGP envisions that Patients will be able to incredible things like book appointments with Doctors on their mobile) talking about who owns an Electronic Health Record will seem as daft as us today trying to talk about who owns a picture of a cat that’s been shared openly across the internet.

Zero Marginal Cost

> Talented Doctors who until now worked like the shoemaker with one Patient at a time will advance the experience of Patients and Carers today, be rewarded for documenting the care of their Patients and be able to distribute their talents much wider and will be able to get rewarded for their online reputation (I think there’s a lot to learn from smart clinicians like Howard Luks MD who are already doing this).

> Turning Atoms into Bits will transform how we manage chronic disease and make it nonsensical for us to think about going somewhere to share some medical data.

How do you think ‘Zero Marginal Cost‘ will transform healthcare?


The Doctor Can See Your Data Now

January 20, 2015



NPR Sure You Can Track Your Health Data But Can Your Doctor Use It

An interesting NPR story by Amy Standon asks if Doctors can use Health Data that Patients track.

mHealth Insights

Dr. Paul Abramson is no technophobe. He works at a hydraulic standing desk made in Denmark and his stethoscope boasts a data screen. “I’m an engineer and I’m in health care,” he says. “I like gadgets.” Still, the proliferation of gadgets that collect health data are giving him pause

A desk “made in Denmark” and a stethoscope that “boasts a data screen” seem to me to be very unusual ways to explain that a Doctor isn’t a technophobe. I suppose that’s just another symptom of the systemic failure to provide documentation of consults.

Besides outcomes my qualification of whether a Doctor is behind/ahead of the times is a simple: does she provide 24×7 access, compassionately listen to her Patients and document their consultations? I’m not at all surprised that I’ve not once read about the country of origin of the desk of the Doctors that I think are particularly smart and innovative.

Abramson is a primary care doctor in San Francisco and lots of his patients work in the tech industry. So it’s not surprising that more and more of them are coming in with information collected from consumer medical devices — you know, those wristbands and phone apps that measure how much exercise you’re getting or how many calories you’re eating

For me these comments highlight how important it is for us to move on from the 2,000 year old office visit model and start providing Patients with the ability to interact with and share information with their Doctors BEFORE presenting in the consulting room.

Abramson says all the information these devices collect can be overwhelming. One of his patients arrived with pages and pages of Excel spread sheets full of data — everything from heart rate to symptoms to medications. Abramson says he didn’t know what to do with it all

We’ve all known for years that the conventional undocumented in/out 5 minute unprepared Doctor consult is overwhelmed by the basic information that Patients bring to the consultation from the Internet so why in 2015 is anyone surprised that data capturing wearables are making things even more challenging for Doctors who won’t evolve beyond the office visit?

Of course mHealth sensor companies need to evolve from offering products to offering services but there’s plenty of very good examples of that which NPR could be highlighting the important work of instead of bemoaning the failure of startups who have developed standalone gadgets eg. Telcare’s m2m glucometer and Diabetes Pal apps, Alivecor ECG monitor and the Alivecor Read services, etc.

I think it’s important that we’re all mindful that it’s not a failure of the Patient that we’ve not kept up with times and provided a way for them to use the powerful devices in their pockets to manage their health eg. could you imagine how long a bank would last if it took the same approach and offered no mobile interactivity while expecting customers to do all the record keeping?

Going through it and trying to analyze and extract meaning from it was not really feasible,” he says. To Anderson, the spreadsheets just didn’t say all that much. “I get information from watching people’s body language, tics and tone of voice,” he says. “Subtleties you just can’t get from a Fitbit or some kind of health app

I think this really highlights how strikingly different times are from when Doctors were trained and underlines importance of proper mHealth training for Healthcare Professionals.

When I studied how Doctors here in Europe renew driving license application forms for Commercial Drivers with Diabetes I was astounded at the practices that I witnessed. Patients and Doctors bluffing one another along with the Doctor focused on ‘body language, tics and tone of voice’ but actually having no real idea how frequently the Patient was testing or what insights could be drawn from the data that was being expensively gathered but completely overlooked because it wasn’t even being properly collected in the first instance never mind charted to help with understandings. (Note: There is a legal case going through European courts that will prove very significant for this market and I’ll be sharing it as soon as I can with readers).

Blum says, “We can’t make the leap that just because the data from these low-risk devices is coming in digitally doesn’t mean that it’s accurate.” He says validation studies are needed. Often that task falls to doctors and hospitals. At UCSF, Blum now heads an entire new department created to sort out which technologies are game changing and which are dead ends

The approach to mHealth that’s being taken by US Hospitals continues to astound me. If you have future predicting abilities and can sort the game changing from the dead ends I think you should spin that out of your Hospitals business of providing healthcare and start making billions as a tech/patenting company because even global tech giants are struggling with this.

Other health care groups are following suit, running pilot studies that give devices to people with certain illnesses to see whether they help

Why are Healthcare Groups still talking about pilots in 2015 when +90% of glucometers are still unconnected, diabetes is the most expensive chronic disease and there’s a paper published in a peer reviewed publication showing that there’s a cost reduction of $3,300 per year per Patient when we connect their care?

Bret Parker is taking part in one such study for Parkinson’s disease. He’s 46 years old, lives in New York City and has blogged about his illness. “When I heard there was a trial that involved a wearable that would help me better manage my symptoms and my condition, I said to myself, ‘Well, that’s a pretty cool thing. I’ve got to try that.’ Parker enrolled in a pilot study to see whether an activity tracker made by Intel would be useful to track the severity of his tremors. It creates a digital diary showing how tremors respond to minor changes in diet, sleep patterns or what time of day Parker takes his medication. Parker says in the early stages of his disease, he didn’t pay close attention to those kinds of details. But as the Parkinson’s progresses, he believes he’ll have to change his approach. “This is going to be a battle between me and Parkinson’s in the years to come,” he says. “As it advances, it means I’ve got to be better and smarter at my role in it. He hopes the wearable will help him do that.

This Patient makes a great contribution to helping raise awareness of the needs that the tracking market must focus on and I think it’s this paradigm shift towards self care that the Healthcare industry needs to wake up to eg. the wearable market is very quickly maturing and any Doctors who understand it aren’t going to be trying to service these opportunities with bricks and mortar office visits.

For insights into the leading examples of mHealth being put to use in Clinical Trials be sure to follow the developments announced with the Mobile Clinical Trials Congress that I’ll be presenting at in Edinburgh, March 24-25 2015.

In 2015 the focus should not be on asking IF Doctors can use Health Data that Patients provide but how do we flip the clinic so that interactions with Doctors START with data that Patients provide.


Congratulations overzealous regulators: The blind can use Mobile Video calls to check expiry dates on milk cartons but we can’t use them to save lives in Medical emergencies

January 18, 2015



ReCode profiles Be My Eyes App to help the blind and visually impaired

Dawn Chmielewski profiles a stunning mHealth innovation from “Be My Eyes”:

A new app created by Danish craftsman Hans Jørgen Wiberg seeks to make life easier for the blind by connecting them with sighted volunteers. Be My Eyes allows anyone with a visual impairment to ask a sighted volunteer for help with something that requires normal vision. “As a blind person, you are 100 percent sure that the person who answers the call is willing to help you,” said Wiberg, who has tunnel vision and expects to eventually go blind. “As a helper, if you don’t have the time, you don’t answer.” Wiberg, who serves as the regional chairman of a Dutch organization for the blind, said many of his blind friends use Apple’s FaceTime video conferencing application to ask sighted friends for help when they’re alone in their homes, and need a second set of eyes. But that can feel like an imposition, he said. Be My Eyes seeks to build upon the success of live video-conferencing technology by recruiting a network of volunteers who were willing to lend a hand. In April 2012, Wiberg the pitched his idea at a Startup Weekend technology competition in Aarhus, Denmark — and won the prize for the most innovative concept… …Since launching this week in Apple’s App store, the app has already attracted 29,287 volunteers and 2,600 blind and visually impaired users. It’s available worldwide, in 10 languages live in the AppStore and has been translated to 31 languages (10 of them crowdsourced)

I wonder how long it will be before the innovative team at BeMyEyes launch a reversed service eg. so people with sight can get help from those who are visually impaired.

Blind Apple Store Salesman fixing a technical problem for a Space X Engineer

Related posts:

You can’t yet video call 911 but ambulances in the US will now drive to you with an iPad so you can video call a Doctor!

Vermont becomes first US state to provide SMS access to 911 emergency services

“End of the doctors surgery? GP visits to be replaced by Skype consultations in bid to save NHS £3BN”

The first rule of FDA regulation of mHealth: You don’t talk about FDA regulation of mHealth

Surgeons at the Henry Ford Hospital now using FaceTime to provide post-op consultations

What will it take for 3G Video Emergency Calls to take off?

“President Obama’s favorite mobile health use case”

Cincinnati Paramedics get 3G Video Calling Technology fitted to their stretchers

Apple FaceTime Calls now possible on 3G


Join us at the Mobile Clinical Trial Congress, Edinburgh, 24-25 March 2015

January 15, 2015



MCTCongress Edinburgh Scotland

Held on the 24-25 March 2015 at the Edinburgh International Conference Centre the MCT Congress is dedicated to the business of mobile technology in the clinical trial space.

The clinical trial market provides invaluable insights into the future consumer mHealth market as not only is it a rapidly growing market but the exponential advances in mobile sensor tech are enabling services to be made available today in clinical trials that will be available at a cost that can be met out of Patients pockets within just a few years.

It should be obvious that this is where the rubber meets the road for many of the ‘beyond the pill’ strategies that Pharmaceutical giants are chasing to stay in business – if you’re not familiar with these check out this EyeforPharma webinar that I participated in with Pfizer and the CEO of a NHS Clinical Commissioning Group and read this press release from Qualcomm Life to get an idea of the size of cheques that pharma giants like Novartis are already writing to fund startups that can help them capitalise on this disruptive opportunity.

Key programme topics will include:

> The psychology and design of mHealth devices
> mHealth strategy within clinical trials
> Regulatory barriers and opportunities
> Data deluge management and interpretation
> The realities of the on-site adoption of mobile technologies

Keynote speakers will include:

Urs-Vito Albrecht, Deputy Director, Hannover Medical School
James Batchelor, Clinical Informatics, University of Southampton
Marc Buyse, Founder, IDDI & CluePoints
Tim Davies, CEO, Exco InTouch
Kara Dennis, Chief of Staff, Medidata
David Doherty, coFounder, 3G Doctor
Matt Kibby, Director of Market Intelligence, BBK Worldwide
Jeff Lee, CEO, mProve Health
Craig Lipset, Head of Clinical Innovation, Pfizer
Johann Proeve, VP Global Strategy & Development Advisor, Bayer
Oliver Stokes, eClinical Solutions, Chiltern International
Jack Whelan, CEO, Jack Whelan Associates

If you would like to get involved please click here to visit the MCT Congress website (the cost of a delegate place is £995 +VAT) or complete the following form:


Celebrity TV Doctor Dr Phil to headline Consumer Electronic Show explaining the value of Mobile Video Consults with Doctors

January 5, 2015



USAToday CES 2015 mHealth

What if you could get an appointment to the doctor within seconds, and not have to pay a fortune to see the medical pro? That was the notion that TV’s Dr. Phil McGraw and son Jay (the executive producer of TV’s “The Doctors”) came up with in 2012. They saw DOD as a way to use the growing array of smartphone and tablet cameras to get medical help to people instantly… …”With Doctor on Demand, you don’t have to get dressed, you don’t have to wait two weeks for an appointment, you don’t have to sit in a waiting room where everyone’s sick,” says Dr. Phil. “You push a button and get it dealt with right there.”… …The average wait time to get an in-person appointment with a doctor is 20 days, say the McGraws, compared to 2 minutes for DOD… …”There’s no reason that seeing a doctor should be any harder than buying a song on iTunes,” says Jay McGraw. “More deaths occur during Christmas or the Super Bowl, because people put off going to doctor, and it’s so inconvenient to get an appointment.

Don’t miss this interview of TV’s Dr Phil McGraw by USAToday’s Jefferson Graham ahead of the Consumer Electronics Show debut of “Doctors on Demand” a Google Ventures, Andreessen Horowitz and Shasta Ventures backed Mobile Video Doctor Consulting on demand service.

mHealth Insights:

I’m really hopeful that Dr Phil’s very high profile celebrity status will help Mobile Video Doctor Consults get the mainstream US media attention that the Presidents Favorite mHealth use case deserves as this is critical if we’re ever going to move beyond todays’ focus on the 2,000 year office visit model of healthcare.

With more than a million free app downloads in just over 12 months Doctors on Demand has proven that there’s an enormous US consumer demand for help with simple health queries via their mobile (something that we observed here in the UK back in 2005) and I’m sure it’ll generate much greater awareness in the US of the opportunity for Patients and remote Doctors to work collaboratively on the informational challenges.



Related: If you’re attending CES in Las Vegas be sure to get the chance to discover what that little pocket on your jeans is for…


Dr Eric Topol’s “The Patient Will See You Now: The Future of Medicine is in Your Hands” now available

January 2, 2015



Eric Topol MD The Patient Will See You Now

The doctor will see you now via your smartphone screen without an hour of waiting, at any time, day or night. It might not be your primary care doctor, but it will be likely be a reputable physician who is conducting part of his or her practice through secure video consults. And those consults will involve doing parts of the standard physical examination remotely. More importantly, they will incorporate sharing your data—the full gamut from sensors, images, labs, and genomic sequence, well beyond an electronic medical record. We’re talking about lots of terabytes of data about you, which will someday accumulate, from the womb to tomb, in your personal cloud, stored and ready for ferreting out the signals from the noise, even to prevent an illness before it happens

Following on from the best selling Creative Destruction of Medicine Dr Eric Topol’s latest book The Patient Will See You Now is now available on Amazon/Kindle.

I hope he’ll demo a 3G Doctor consult when he’s invited back to the Colbert Show

Don Jones VP Qualcomm Consulting with 3G Doctor's Dr F Kavanagh MRCGP



************UPDATE SUNDAY 4 JANUARY 2014************

At 18:00 on 8 January 8 2014 at San Diego’s Museum of Contemporary Art in La Jolla, Eric Topol MD will give a talk on the future of medicine in which he’ll discuss the opportunity to collect personal health data, share it and Video Consult with a Doctor with just your smartphone.

Joining Dr Topol for the discussion panel will U-T San Diego journalists Gary Robbins (Science & Technology) and Bradley J. Fikes (Biotechnology).

To register for your free ticket click here. For any questions email ut-talks@utsandiego.com.

All attendees will receive a FREE copy of the new book.

****UPDATE WITHIN 24 HOURS TICKETS WERE ALL TAKEN****

UT San Diego A conversation with Eric Topol on the Future of Medicine

********UPDATE 8 Jan 2015********

Video clip from the talk:

…this is not a big ticket item… …but why isn’t this moving faster? That’s because of the resistance of the medical community. This represents change, it represents challenge of authority that’s been around since 2600 BC… …the first Doctor was a Priest

************UPDATE 6 Jan 2015************

NYTimes Patient Heal Thyself The Doctor Will See You Now

Abigail Zuger MD has shared a rather scathing review of the book in today’s New York Times that’s well worth a read:

Dr. Eric Topol and I appear to practice medicine on two different planets. This fact makes it difficult for me to comment sensibly on his books, let alone critique them. Instead, I read along with mouth slightly agape, marveling at this missive from a far-off place whose atmosphere, physical laws and inhabitants bear no resemblance to the ones I know.

Dr. Topol is a cardiologist who directs the Scripps Translational Science Institute in La Jolla, Calif., and also serves as editor in chief of the website Medscape. His title at Scripps, “Professor of Innovative Medicine,” says it all: Like a fundamentalist preacher heralding the apocalypse, he preaches the end of medicine as we know it and the dawn of rigorous, digitally perfected, accurate and cost-effective care

I understand some of the criticism as I also have concerns about a mythical future where Digital Health is the Answer to Everything but this is a book about the future so we shouldn’t feel surprised if we find some of it challenging.

For me the criticisms are a reminder of how challenging many Doctors find it working in a technical era that is very different from the one in which they were trained and in which they are expected to continue providing undocumented care with an unviable funding model that hasn’t evolved from the 2000 year old sickcare model with it’s focus on producing ‘visits’.

I think the key that will make Topol’s latest book have more impact and be even more successful than his previous “Creative Destruction of Medicine” is that he now has a much greater appreciation of how healthcare is being impacted by Mobile (the newest mass media) and that this tool driven revolution will be the key driver that will force us to discover new things that cannot be explained never mind served by a Sickcare industry that struggles with even basic documentation:

George Green & Physics Freeman Dyson Physics World 8:1993

Jumping to a few of the closing paragraphs and I think I see where the total disconnect exists for Dr Zuger:

Finally comes the interesting philosophical question of whether all patients really do want — or, indeed, should want — to be their own doctors. You could actually write a book on that question, a book that might penetrate a little closer to the essence of medicine than Dr. Topol ever gets.

Certainly, people who are engaged in their own medical care fare much better than those who are passive and disengaged. But how engaged must a person be? When does engagement become burdensome?

When you work within a system that involves forever trying to guess at what Patients want (how else do you think it’s possible to manage Patient needs while interrupting them before they’ve had 18 seconds?) it can become second nature to just presume you will always know what Patients want.

Within the Instant Medical History questionnaire that we utilise as part of the remote consults we offer at 3G Doctor a very revealing question that Patients can choose to answer is how much they would like to be engaged in their care. You’d be surprised how much better you can serve a Patient when you just let them tell you how much they want to be involved (I’d Never Admit That to My Doctor. But to a Computer? Sure).

Sick people have a primal need to be cared for; almost always, the sickest patients find that relinquishing the tough decisions to someone else brings huge relief. Healthy people may certainly enjoy monitoring their own physiology, but that activity can take up an awful lot of time. There are many wonderful things to do in this world other than keeping track of your own organs. Sometimes, it just makes sense to have someone do it for you

I think here there’s a presumption being made that decisions need to be made by someone else (eg. a person and not a compassionately programmed computer that is always on, doesn’t need sleep, etc) and that sick people and their carers somehow find it easy to manage their healthcare needs using out of date tools that don’t even make sense to the born mobile generation.

Check out this post and it should be obvious that just integrating mHealth into how we care for diabetics (eg embedding a mobile phone into a glucometer just like Amazon did with their Kindle reader) we have created a significant step change because:

> the Patient no longer needs to remember when to test (the M2M glucometer device and/or their mobile phone will automatically remind them when it’s required).

> data (the dumb numbers diabetics with unconnected glucometers need to interpret and collect) is automatically turned into actionable information.

> decisions can be made whenever/wherever by the specific individual protocols that carers can set.

> advice can be found and questions can be asked (my simply opening the Diabetes Pal app on a mobile).

> ‘tracking’ becomes redundant because the process of collecting the data just becomes seamless.

************UPDATE 7 Jan 2015************

The media are showing a lot of love for Dr Eric Topol and this “The Future of Medicine” Huffpost Live interview by Josh Zepps really gets into some of the key challenges:

Eric Topol interview HUFFPOST LIVE

JZ: you talk in the book about this being medicines Guttenberg Moment, what do you mean by that?

ET: well it’s really a remarkable parallel I think between the 1400’s when only the elite and the priest could access written materials and read, to now when now because of smartphones and all the medical information flowing through them generated by the Patients that they’re going to be able to read about their data and medical information really for the first time. So it’s a democratisation of information and now for medical information…

…(4min) so we’re an on demand I want it now culture and it’s now extending to medicine as well.

JZ: so we hear President Obama talk all the time about bending the cost curve of medicine and making this affordable because American medicine is wildly expensive, and we spend a huge amount of our GDP in this country on healthcare. I can wait two weeks to go and see my General Practitioner or I can force my insurance company to spend twice as much and I can spend twice the copay to go to an urgent care centre here in New York City, or if I use an app on my phone to get a Doctor to come to my house presumably that’s even more expensive. These are all fancy ways of doing things but can we afford a world in which we’re all doing everything on demand?

ET: Well the rest of our culture is getting that way and it’s inevitable that it will happen in medicine. There’s just no reason for these long waits. And it isn’t just the wait to get an appointment, then you’re waiting in the office reception room, and then finally you get into (the consult room) and you get this seven minutes with the Doctor (who is) typing at a keyboard. This is not the pinnacle practice of medicine! We can do better than this

I think Eric has it spot on. Josh should check out the PatientCommando campaign from Patients who would like their Doctors to provide them with another 18 seconds before interrupting, or interview Roy Lilley’s 93 year old mother as he’d learn that this isn’t about finding fancy ways of doing things this is simply about using the tools of our time to think beyond the office visit and make things easier for Patients who face enough hassles without having to endure avoidable journeys and waiting room experiences.

************UPDATE 10 Jan 2015************

Your Smartphone Will See You Now Saturday Essay in WSJ by Eric Topol MD

In a WSJ Saturday Essay Eric Topol has managed to boil the essence of his 100,000 word book down to 2000 words. Read it and then order your own copy.

The comments thread provides a treasure trove of interesting feedback:

Douglas Levene: Robin Cook wrote a great thriller about the future of Apple doctors, “Cell.” In it, [spoiler alert] the I-Doc software decided on its own to start culling the uncurable, and the authorities decided that was a good idea so they let it go.

It’s not really that difficult to imagine this type of scenario developing if we let AI take decisions because there will be few (if any) people capable of winning the argument against a computer that can really on much greater resources and has time on it’s hands that clinicians don’t have.

To my mind that’s exactly why a book like #TPWSYN is so important. We need to have wider debate of these issues – an area that David Woods (@DW2) is doing great work on in the UK (see the call for feedback on his Tranhumanist Political Manifesto here).

Sallie Smith: The problem with this type of medical care is that you have to teach the unteachable. You also have to have these devises available to the general population. How do you teach the person with the sore throat they don’t need to go the the emergency room. Then again with all of the technology it still won’t help the hypochondriacs. I guess that’s where the mental illness apps comes into play

Websites like this one or this one (with video content embedded in it) are great for sore throats?

It stuns me how many people have this impression of hypochondriacs (eg. that it’s a mental health problem). The worst cases I’ve seen are Doctors and often it’s the result of the frustrations sensible Patients and Carers get when they’re forced to interact with a system that is designed for a different era at a time when they really need all the help they can get.

Newell Everett: @Sallie Smith Some of us may be unteachable. But, there are generational transitions – the next one will grow up seeing & understanding technologies the oldies cannot, so will be more accepting of helpful devices

Spot on.

“George Eapen: “I am in atrial fibrillation, now what”. That is the rub. All these carnival barkers for the utopian vision of the smartphone/connected world are simpy exhausting”

We treat it and help you avoid suffering a debilitating stroke?

“George Eapen: …For all it’s many benefits, the internet is rife with misinformation when it comes to healthcare and the burden is now shifting to the consumer to sort out what is real and what is bogus. The facebook that he cites admiringly in nothing more than a giant waste of time. Every few months we hear about the alleged effects of social media, yet Boko Haram did not release those girls because the First Lady hashtagged anything. Siri can find me useless information about dry cleaners when I am seeking information about crop dusting services. Just saying……”

I love SIRI (I’m ‘typing’ this with it’s Nuance Speech Dragon relative) but it’s important to appreciate it’s limitations. Dismissing it because of it’s current failures will cause us to miss the opportunity eg. imagine civilisation had ignored the printing press because in the early years the books weren’t interesting to a particular reader.

Marcos Lujan: What human touch? Your waiting for the doctor in the waiting room & the examination room 20 or more minutes, and he’s done in no time flat. Dr. Abraham Verghese’s Ted Talk also gives some insight on the future of a doctor

A stunning TedTalk.

DANIEL SCHROYER: This all sounds great except for a few little things like HIPAA, Obamacare, and CMS/insurance bureaucracy. Radical changes in gov’t policy are required for 5% of what is envisioned here. We are talking resistance worse than that for Uber.

There will never be a better time to start talking about these issues.

William Cheung: It’s a lot of marketing hype. All this tools can be confusing to patient. Just like information on internet, people thought they can be overnight expert on their medical problem, they are actually looking at the wrong place most of the time.

The internet is radically changing the Doctor Patient relationship. Buy the book and read it and that will become clear.

If you have any doubt consider this one fact: Family Doctors here in Ireland no longer see croup (because mothers use the internet to understand and treat it)?

Mary Alexander: The author is assuming a level of sophistication that the average patient does not have. Who will take responsibility for these masses? This also assumes the physical exam means nothing. Or the human element. He must be a highly paid consultant who has not seen a typical patient in years. Typical pompous academic/rich guy.

Never dismiss Patients and their Carers. They will continue to amaze and exceed all your expectations if you care enough to take the time to listen to their stories.

************UPDATE 13 Jan 2015************

Imagining a future when the Doctors office is in your home

Seemingly nothing can stop Eric Topol’s blazing trail with the media (even during CES – the world’s biggest consumer electronics event – he’s been captivating the attentions of the world’s top tech news reporters) and yesterday it was NPR’s Nancy Shute who led with “Imagining A Future When The Doctor’s Office Is In Your Home“.

Extracting medical care from the health care system is all too often an expensive exercise in frustration. Dr. Eric Topol says your smartphone could make it cheaper, faster, better and safer. That’s the gist of his new book, The Patient Will See You Now… …(BUT) won’t a lot of people be left behind because they can’t afford to do this or can’t manage the systems?

Eric Topol: “We’re talking about cheap stuff; smartphones you can get for $35 now from China. You have a cheap phone, you have mobile signal everywhere, pretty much, and you have very user friendly interfaces. My 93-year-old mother-in-law lives with us and she’s on her iPad constantly…

…We made this unbelievable switch from inpatient surgery to outpatient, so many operations are done now as an outpatient. So we did adapt. You can now do a stent as an outpatient in an hour. So that’s going to happen again. We’re going not from inpatient to outpatient but inpatient to home. Hospitals are going to need to become data surveillance centers. The data is going to be coming from the community, from the region

Although I think we should be careful not to refer to mHealth as “cheap” (as it’s much better to talk about the incredible value that is on offer eg. £35 documented consults with registered Doctors) it’s another great read and the comments thread reveals many of the very real key challenges that Patients and Carers will face with mHealth:

Mark Kropf: Whaaaaa…? I understand that a low risk patient with some chest fluttering and a fast heart rate with irregularity can have these examined while in the convenience of their home. Okay. I’m fine with that. The kitty can be fed, the home may not be robbed. One can walk about in undies or turn the Radio or Internet -You Tube – up full volume while doing Air Guitar at 3 AM without a nurse or fellow patients getting upset. And you don’t have to choke on (ugh) hospital food. But… Having an irregular heart beat with salvos of PVC s, an accelerated Idioventricular rhythm or, worse yet, Ventricular Fibrillation and well, what then? What does Dr. Topol do 4 miles or 40 miles away? What does one do with a Mobitz 2 Rhythm that progresses to Complete heart block? Does the patient put on an external pacemaker or does somebody anti-coagulate the patient and cardiovert him or her over the phone? Exactly what is the benefit of monitoring a patient if there are no facilities or equipment to act on the data? Duh

Read this Biotronik sponsored paper and appreciate what is acheiveable when we just turn on the connectivity in cardiac devices that Hospitals and insurers routinely ignore today (not a properly designed mHealth solution with embedded connectivity like Telcare have created for Diabetics). Understand that the 2000 year old healthcare model is broken and no longer viable. Now try and think like a member of the born mobile generation.

The reality is that cardiac events like those ‘Mark Kropf’ is concerned about are probably happening today but we’re largely ignoring them and failing to understand their implications because there’s a complete lack of real time connectivity (eg. Patients who have battery powered implanted cardiac devices don’t know if it’s switched on or off or even the status of it’s battery yet they nearly all know the same about their mobile) or because everyone apart from the Patient (who typically just wants the best care) wants to avoid the medicolegal implications that come with accurately documenting healthcare, and because we’re completely failing to learn from other industries that leverage data to reduce the impact of failure and prevent problems developing (eg. the auto industries warning lights and ‘limp home’ mode that trigger long before engines are irreversibly damaged).

Male Kimp: I’ll have to decorate it with drug company swag to make it right

Watch this video: Eric Topol is no drug company shill.

SeaLady: Patients have to be able to develop medical skills, and anything that can aid them is a good thing. The fact is, doctors’ time has become so valuable to their employers that it’s quickly becoming worthless to the patients. The few rushed minutes you get with a doctor, after required waits of anywhere from twenty minutes to an hour or more, are increasingly not worth the effort and money, unless what’s wrong with you is easily diagnosed without thinking time and requires prescription medications or advanced procedures. But if you go into a clinic with something at all subtle, be prepared to leave no wiser than you were when you arrived. Learning to use the Internet intelligently for medical information is a must now. (Avoid dot coms–stick with .edu, .org, and .gov sites, and compare various opinions among them to come to a reasonable conclusion about what you can do for yourself.) Any consumer tool that can help is quickly becoming a necessity. I’m not saying the doctors are happy running a rat wheel to make money for investors, but many of them are stuck there, and the patients are increasingly on their own

Thankfully Doctors are increasingly seeing the opportunity to break with the revolving door 5 minute unprepared and undocumented consulting model. Let’s hope more citizens have the clarity enjoyed by “SeaLady” and are supporting the forward thinking Doctors who are prepared to spend their invaluable time learning about new tech and putting it to work to extend the care they offer to their Patients beyond the four walls of their clinics.

************UPDATE 16 Jan 2015************

Eric Topol Podcast chat with Neil Versel

An interesting 25 min chat with Neil Versel (NV) in Forbes features something (from 20min into this podcast recording) that I find very revealing:

ET: We need a Health Spring. We need consumers to activate and eventually we’ll get there. I mean…
NV: When you say ‘Health Spring’ you’re likening it to the Arab Spring that was driven by social media?
ET: and Smartphones
NV: and Smartphones yeah.
ET: Basically if it wasn’t for the Smartphone’s ability to you know to (capture) the photos the videos and all the other communications to get people revved up and you know we’ve seen that begin with the whole tragedy in Paris. That’s how people get activated today. We need something like that to happen like that in Healthcare. You know that’s one mechanism by which this will finally get capitalised and we can move forward

It’s a bit chicken and egg but it’s important to realise the Arab Spring didn’t happen because of social media but because of mobile – the newest mass media – and the ability it afforded to access social media.

This might be hard to appreciate when you live in a broadband connected home with 5 TVs, a PC, Laptop and 2 smartphones but citizens in the Middle East weren’t primarily activated by social media websites but from the SMS and MMS messages that were sent to their inexpensive mobile phones (typically Nokias) by other ‘revved up’ citizens with their own inexpensive mobiles.

Evidence for this can be found by looking at the distribution of technology around the world (eg. the mobile phone is the ONLY DEVICE that beeches the digital divide and has MORE OWNERS in emerging markets) and how quickly many governments in the Middle East went about taking down and blocking/monitoring internet access because clearly these activities would’ve undermined attempts by citizens to share messages (and content like videos) back and forwards with websites like Facebook.com. Instead they were sharing them P2P via mobile networks and in person (think screen sharing, Bluetooth, SD Card transfers, etc).

************UPDATE 16 Jan 2015************

Washington Post review of The Patient Will See You Now

Book review in the Washington Post by Perri Klass, Professor of Journalism and Pediatrics and the Director of the Arthur L. Carter Journalism Institute at New York University.

Topol sees a future in which “your smartphone will become central to labs, physical exams, and even medical imaging; and . . . you can have ICU-like [intensive-care unit] monitoring in the safety, reduced expense, and convenience of your home.” This is a book full of technical wizardry and intriguing questions about the nature — and the future — of diagnosing, monitoring and healing

************UPDATE 18 Jan 2015************

The Patient Can See You Now FoxNews HealthTalk

FoxNew HealthTalk’s Dr Manny talks to Dr Topol about how the future of medicine is at your fingertips.

************UPDATE 21 Jan 2015************

Eric Topol Bloomberg Market Makers Skype Video Interview

…we’re never going to get away from Visits of course but the main thing that’s exciting now is that we have the opportunity to democratise medicine. The Smartphone will be the hub, there’s so much you can do with that phone whether it’s your sensors, your labs, summoning a Doctor, getting the costs for your care, all these different things it’s really going to be quite extraordinary…


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