Cancer Research UK: GPs are failing thousands of Cancer Patients

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The Royal College of General Practitioners hasn’t taken too kindly to the headline media attention generated by a Cancer Research UK funded paper published in the college’s official BJGP publication.

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mHealth Insights

I think it’s  fascinating that this paper has come just weeks since Cancer Research UK was fined by the Office of the Information Commissioner for researching and paying for data on their donors in efforts to get more money from them and their loved ones and don’t think either organisation comes out well from the finger pointing going on here.

Wouldn’t we get better outcomes if Cancer Research UK had the smart data analysts they have working on fundraising working to help Patients with the challenges of collecting and sharing of symptom information with their GPs, and shouldn’t we expect the RCGP to be doing more than just calling for new and improved diagnostic tools when we know that they don’t teach/encourage GPs to use mobile phones during consultations (and even ban their use in the membership exam) and in 2017 are promoting websites to Parents and printed toolkits to busy GPs in the hope that this will help the NHS pick up on extremely rare brain tumours in children (rather than getting behind ways that have been proven by NHS GPs to improve Patient access and help Patients share info about their symptoms).

Related Posts:

The HeadSmartUK campaign calls on GPs to suspect brain tumour in any child presenting with a range of non-specific & vague symptoms (Jan 2017)

Our failure to make Doctors accessible is reducing the effectiveness of cancer treatments and killing Patients (Feb 2014)

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Join the “Mobile Health: What it is today?” Hangout at 7pm on Saturday 22 April 2017

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Tomorrow at 2pm in Miami (7pm London/Dublin) I’ll be joining Dr John Bennett MD and three students on a Google Hangout in the mHealth Studio (a new initiative from InternetMedicine.com).

Refresh this blog post at the scheduled time and you will be able to watch the livestream video and ask questions.

Transcript/Links:

Dr John Bennett: Good afternoon this is Dr John Bennett broadcasting from sunny Miami today at InternetMedicine.com in the mHealth studio we have the honour of having David Doherty of 3G Doctor. I’ve been following him for a couple years now on mhealthinsight.com and we’re going to have a kind of free form discussion. First we’ll introduce students before we turn things over to Dave. Hello Diana! could you please describe what you do etc.

Diana: I’m currently in a master’s program at Larkin University here in Miami studying biomedical sciences and looking forward to taking my MCATs pretty soon and going into
medical school.

Dr John Bennett: You’re welcome Diane, welcome Mary Lonnie’s

Mary Lonnies: Well I’m also going to Larkin University studying a masters in biomedical sciences and studying for the mcat and I’m very glad to be here.

Dr John Bennett: okay Ehsan how are you from Ireland?

Ehsan Ghaffari: hi there i’m Ehsan from trinity College a third year med student and it’s a pleasure to meet you.

Dr John Bennett: yeah in the backyard of David almost and Marco

Marko Antonio: good afternoon my name is Marko Antonio and I’m from Bolivia and dr. I’m glad to be here thanks for invitation yeah

Dr John Bennett: Marco is a frequent participant in our shows here and the main man Simon how are you doing Simon?

Simon R Downes PhD: I fine thank you it’s 3am here Tokyo it’s an honor to be here I’m a medical student in Japan and looking forward to the presentation thank you

Dr John Bennett: Good day David how are you doing?

David Doherty: good morning, good afternoon and good evening from us here in Dublin

Dr John Bennett: yeah with every way welcome David. I’ve been telling the panelists before we started I’ve been following you for years on your blog and that you’re a very honest reporter of what’s going on if you don’t like something you say. can you please describe your career how you got started in mhealth etc and your background?

David Doherty: yeah my first experience in life that I remember was actually using telephones in healthcare. I was in a sick children’s hospital with a brother of mine and I noticed that the Doctors made a noise that sounded as they came down the corridor and the reason they made a noise is that they had money in the bottom of the big deep white jacket pockets and I noticed when they told news to parents they would proffer those coins to the parent and it was when my mother was given these coins I was particularly interested because I thought it was money for the sweet shop but we went out of the ward, down the stairs and into the lobby of the hospital and she put them into this incredible machine that was sitting there and it was literally a payphone. but I thought obviously my mom was wasting the money and then I saw that emotional connection that she was having to our home and it was a dawning moment for me that the you know that this hospitals most powerful piece of technology was out there were all the smokers were in the lobby and you know it was letting you access billions of pounds of infrastructure the world over for just 10 pence. You could call the Mayo Clinic on that telephone line and then about 15 years later I enrolled at the Medical School next door to that hospital at UCL in London and I was the only student there with a mobile phone and people used to think why has this crazy kid got a mobile phone? what would you use that for, what a crazy device. And they actually fought i had taken the phone from home and took it with me for the day. They couldn’t believe that with this little digital cell phone I could actually make telephone calls but i actually had no reason to have that phone it was really expensive and I had somehow managed to get it by convincing my brother who was a Veterinary Surgeon, as I was living above a Vet Surgery at the time and helping him and so I got a Mobile to take to college by explaining to him the value of it as an alternative to the pagers and answer machines that were in use back then, You’ll remember those days yourself John, but literally there was me in my Medical School Library which I’ve since gone back and lectured in that had no internet connection and now when you go back there are no books there are just screens on desks. but the incredible step is that I’m still gobsmacked as to how slowly we are to adopt technology. In the UK the Royal College of General Practitioners has got a global reputation for training the best family Doctors in the world yet when you go to your MRCGP (membership) exam you are immediately failed if you actually bring a mobile phone into the exam, yet every single Patient in your waiting room has got a smartphone in their pocket and every Doctor is not going to work a day of their future career without the equivalent of something like an iPhone 7 in their pocket, yet we’re making these people not use this incredible cyborg technology – as Elon Musk calls it we’re already cyborgs whether we accept it or not so why aren’t we letting our Doctors use these superpowers? Part of my mission in starting a company that lets you video call a Doctor was also to help Doctors realize how we can actually use use these superpowers and I’ve developed the first CPD accredited course for doctors to teach them about mobile healthcare and I have provided that to esteemed colleagues at events across the world from the World Diabetes Congress in Vancouver to events in Istanbul Turkey. I’ve literally gone around the world learning from people about how they use mobile technologies in their markets and also sharing the insights that I get from that with other Clinicians because I think it’s time we moved on from stamping stuff on dead trees and started using these incredible technologies that are already the tools of our time. You know it’s nothing groundbreaking anymore so it’s really good timing because not only are we seeing all digital technologies converging to mobile phones but also we’ve seeing this incredible thing where mobile phones are going inside other technologies to power this thing that’s being called the Internet of Things because literally the internet is evolving from something that we manoeuvre around with a cursor or a mouse and click on things to something which is used by things interacting with machines so think of things like embedded glucometers or ECG machines with their own connectivity. Now there’s huge value that can come from these data insights but unless we all start using our mobile phones as Clinicians and letting Patients use their phones with us none of these things will be able to ever realise their potential. So that’s my biggest concern and biggest passion for making sure we all get on board and learn about this fascinating new mass media which is mobile the most misunderstood newest mass media most people just think it’s a device in their pocket providing a little internet and they don’t realize it’s as big a step change as we had with the TV or the printed press with Guttenberg. We’ve got this new mass media it’s very misunderstood at the moment and there’s a huge their wealth of potential that we can get when we understand it and utilize it.

Dr John Bennett: (7:30) you know Dave we’re in kind of a similar situation with hangouts we have a hard time convincing a lot of Doctors just to get on the internet to talk, to talk about whatever subject. some people seem to be afraid of the video screen almost. and I’m sure you start from the very beginning like the iPhone came around what 2007-2008 was that the first year?

David D: no we were launched before that. Actually in Europe we had 3G video calls long before Facetime and back in 2006 as soon as mobile operators launched video calls we had the service live. We launched this at the royal society of medicine in November 2006.

Dr John Bennett: so you’ve been battling the whole way trying to get Physicians to use it?

David Doherty: (8:12) well it’s hard to call it a battle when you look at the adoption that we’ve seen since then. We came at this from the Physician side so my business partners are all GPs who have their own clinical practices built out of bricks and mortar so you know we didn’t have to challenge them. Patients want this, all we had to do was tell Patients we were there, make sure the service was safe and we did a bit of design to the service with 3GDoctor that’s worth filling you in on essentially what happens is the patient goes online completes an interactive medical history questionnaire that was actually developed initially in america by a company called Primetime Medical. The product is called Instant Medical History and it was clinically validated several years ago by Professor John Bachman who’s the Professor of Primary Care at the Mayo Clinic and it provides an incredible opportunity for patients to have their own time giving their history. Literally patients when given a blank email page or a page will write 10 pages or two lines. Patients aren’t always aware what things are relevant but this process also gives them time to consolidate their thoughts and feelings and share things. They can also complete things like depression scalings, you know the stuff that you’d be familiar with Consultant Psychiatrists using, Patients can actually fill this stuff in themselves. I see doctors complaining all the time that patients waste their time but the incredible thing we know is that US Doctors spend over half of their time doing clerical work that we know Patients are interested in doing, that they can do and that they’ve got the tools in their pockets to do it so it’s time we started letting patients give that history. This also provides opportunities for Doctors to not just be some sort of drone asking the same questions of their patients but go straight into really trying to help Patients with their information and so if we twin that with other stuff like a website you’ve seen – I mean seriously in 2017 we still have patients who go to their Doctor and try and share a webpage and the Doctor is like laughing at them thinking this is the most stupid thing that they’re ever going to do, what look up the YouTube video with their Patient. Whereas because our service is completely online and we don’t have the brick and mortar office we don’t have any problem with discussing online content with patients and just that alone is a huge opportunity. Since we started I’ve seen an awful lot of companies start up offering video consults and what they often try and do is the very difficult and dangerous prescribing part of the Doctor role rather than actually trying to help patients with information. With most Patients getting interrupted within 18 seconds of coming in the door and starting to talk to their Doctor, we here have an opportunity for the Patients to give all their history through the interactive questionnaire and then at the end they get free text box that they can use to share websites or any extra information they wish to share and the Doctor gets this in a concise familiar format before they actually do the video call. It means that Patients don’t pick the Doctor but the Doctor gets to pick the Patient. So we have a Doctor who looks at the output from the interactive history and decides which Doctor would be best suited to consulting with that Patient. Some of the things we find that actually aren’t going to be suited to a mobile video consult and what we can do in these instances is instead of charging the Patient for that consultation we can give them a null fee and just advise them to go to their Family Doctor with this printed report as it will make a help their Doctor make sense of their needs. And what the patient finds is that when they go to the Doctor with this letter from their Doctor will see this history printed out for them and realise we’ve done their job for them. It also means we support continuity of care. when we’ve seen a Patient they get access to a written report from us because immediately after the consult our Doctor writes notes and then Patients can just log in and download the PDF or share it. This report details all that was shared via the questions and answers and the info mentioned in the free text box together with the Doctors written report on the bottom of that. This supports continuity of care as when you go to see the next person you don’t have to repeat it all. This is a major problem facing telephone helplines or the insurance paid for video call services where the Patient has to go back to another Doctor and tell them all the things they said on the video or telephone call and that’s really ineffective because most doctors will just cut past a recount of events and just ask their Patient to tell them why they’re presenting and so you might’ve spent half an hour talking to a Doctor over video but because it lacked documentation you still have this complete disconnect and it just doesn’t support continuity of care because you can’t go back and easily review audio or video recordings. We also look to follow up with patients to for example check on how the advice worked out so that we can learn from our experiences and monitor how well we are doing and and that too just wouldn’t be possible if the content we were looking at was a 10 minute recording of a video call so the documentation part is very important. That’s a real key message with with the mobile phone everything’s documented you know every website you’ve been on big tech companies like Google and Facebook are tracking and they have all this data but you know when Patients go to the Doctor they walk in and it’s all new: “who are you? what do you do?” and it’s just quite bizarre that we just don’t have data sharing. One of the first things that’s needed to enable that is that we move care from the old way of doing it it was undocumented and you sort of tried to remember what the doctor said to this fully documented way which also helps the Doctors be concise and also helps them learn from the information that’s being shared but on top of that interactive history you can now add things like the Alivecor ECG readings, data that you can capture with your phone and so more and more increasingly going to see diagnostic stuff with bespoke questionnaires that go into that. so we are working with a paediatrician in London’s Harley Street and he’s probably the most experienced Consultant Paediatrician in Europe – his name is Professor Sam Lingam,  and we’ve taken the questionnaires this guy starting creating in the 1970s. I think it was 1979 he was giving all of his Patients at Great Ormond Street Hospital in London access to their patient notes and another doctor looked at this and thought what is this bizarre doctor doing and so he wrote a paper reporting on what this experimental weird Doctor doing. and today he uses what he found is he had these long queues going out the door of Parents and he just didn’t have the time to sit with every one of them and take a history so he made a very basic questionnaire and it grew into a huge wad of paper that captured all the history info from the Parents and Grandparents. A lot of it was genetic history that today people are thinking they have to run to companies like 23andme for but actually you get most of this information by asking specific questions of parents you know things like how babies were delivered etc and he’s produced all this and we’re putting the questions into the Instant Medical History tool and also developing a service for him so it’s not just really basic stuff what we find we can help with. We can actually manage some of the most complex and difficult to diagnose patients that exist. Patients who in many cases have ding donged around doctors without documentation that when they actually take the time breathe deeply and complete their questionnaire they can give the best history they have ever given.

Dr John Bennett: (15:30) it seems probably no accident that Google’s seems to have access to a lot of NHS Patient records, is that correct?

David Doherty: I think we’re going to find that the NHS has given it all and we will probably find out in the future.

Dr John Bennett: yeah it’s funny Google seem to be making more headway in England with access to patient records than they are in America

David Doherty: yes but it’s quite contentious and there’s been a great paper published by a really smart lawyer who’s working at Cambridge University that reports on how Deepmind – they call it Deepmind but it’s owned by Google so it’s the AI part of Google -went into the Royal Free Hospital Trust to produce a very small app for Patients who are on dialysis but it turned out months down the line that someone found out through a  freedom of information access request that actually they had been given access to Patient records going back 6 years and going forward ten years which is just literally half of all Patients in North London who have ever been in that trust despite the very small requirement for record access to produce the app. It appears that the rules don’t seem to apply to Google, you know the sort of things that they stop Clinicians like you John doing because of Patient Privacy issues, well these don’t seem to apply to Google. Possibly no one is big or brave enough to actually take on Google because like a lot of major tech companies their senior management appear to have a swinging door that let’s them move in and out of powerful PR jobs in government. So there are big issues but maybe there’s an upside because there’s certainly no value in squirrelling away all these records like the NHS has been doing for years. They’re still posting records through the postal system on CDs and stuff so that’s also not good you know. I think we should really welcome some of these tech companies but we should be careful to make sure that they’re very transparent and they should apologize when they make mistakes like this because clearly those millions of Patients who went into that Trust never gave consent for a company that sells advertising for a business to get their medical records and there’s privatization of the NHS really coming in that is going to confer huge value to companies like Google because as you know the insurers will pay for this information all day.

Dr John Bennett: yeah well going back to your the percentage of physician time spent on clerical tasks just today I saw a statistic that says exactly you said, in the uSA Doctors say that they spend 50% of their time doing clerical work. Would you say that percentage is a little better with your GP service?

David Doherty: I think what we’ve got to do is realize that the most underutilized resource in the whole healthcare industry is the Patient. They’ve got the capacity they’ve got the interest in getting this information correct. You know whenever they reveal Patient records to Patient’s the first thing is they find things are completely wrong, oh that wasn’t me, what are you talking about, this isn’t information about me, etc. I mean can you imagine if people’s bank accounts were being run in such a way that only the bank manager could ever look at your account statement and see what’s going on. We’d all be broke on the road you know so yeah we’ve just got to move beyond the status quo and there’s been some really good pioneers in the UK for example the fabulous Dr Amir Hannan, everyone should follow this GP and support him because he’s doing groundbreaking work since he took over the surgery that had been previously run by Dr Harold Shipman – the Doctor who was struck off and convicted of killing a lot of his Patients and he really got away of it because there wasn’t visibility of healthcare records. he was killing a lot of elderly patients and getting away with it as their children couldn’t really see what was going on with medications being prescribed. So when Dr Hannan went into that practice as their new GP  obviously there was this huge lack of trust with the doctor so he came in and literally opened up the medical records to his Patients as these are yours. I think it’s sad that you needed a really harrowing situations like this that you have to just stop trying to keep going on the way you have been but actually the way he’s been practicing is interesting because he also used Instant Medical History with his Patients because you find that as soon as Patients can see their medical records immediately they want to talk about them and they have questions. As a smart Doctor letting Patients communicate with you enables you to provide more value because you can both see all the stuff that was done before and you can see why the patient’s got these concerns. Literally our job has got to evolve into being more about guiding Patients towards better information as it’s no longer good enough just to complain that Patients are looking up the wrong things on the internet. The opportunity here is to be more like the librarian and sign post Patients to good resources and knowing what resources will be useful comes from experience and having the medical records and letting Patients share with you their presenting concerns. We’ve actually had patients use our service that we just needed to point to a YouTube video and when I’ve shown this the doctors they were surprised that we didn’t call the patient but just asked them to check out a video and then decide if they  still wanted a video consult. Doctors are just amazed at this and it’s clear this is a huge unmet training opportunity. Medical schools aren’t teaching future doctors how to share content with Patients and many of the older Doctors and Tutors are scratching their head and will say to me but you know these Patients could just look this up on YouTube themselves anyway but the difference between something given by you is similar to the value of buying drugs on the internet and being prescribed a medicine by a Doctor. This is the thing with digital content so we have to teach this, bake it right into how we teach medical students and the sad thing is I go to medical students they and they are sitting in their Anatomy room looking at dumb pieces of printed paper just like I did over 20 years ago and its  a disgrace but one of the things i find is that there was a population of girls who all had iPads and iPad mini’s and they all had 3D4Medical all downloaded and I went up and I talked to them and I found they had all bought these themselves and there hadn’t been encouragement from the lecturers, I mean you cannot be a Professor of Anatomy and be thinking that somehow teaching people with printed pieces of paper is a 2017 thing to do. Children are growing up today thinking nothing of pressing a few buttons on this thing here and getting a car come and pick them up, or a food delivery or next day delivery of an ECG machine they can stick on the back of their phone. It’s a different world and we all have to live in that world because we’re supposed to care for Patients in that world.

Dr John Bennett: so generally medicines is kind of slow in acceptance of the digital world you feel?

David Doherty: a little bit slow but you know there’s there’s elements where it’s really flying, One of the other things I’m working on because I have some experience of Veterinary Medicine where they had electronic healthcare records 15 years ago. I noticed recetnly the CEO of the MacMillan Cancer Trust found  her child who had a serious medical condition and was being seen by number of hospitals but had no access to medical records, and the two different NHS hospitals treating her themselves couldn’t access one anothers electronic healthcare records. And then she phoned up the out of hours Vet – and I know the person who installed this electronic healthcare record over ten years ago, and she was surprised how her little puppy dog had fully electronic records accessible from anywhere on an iPad. So we can learn from other medical practices and I gave a lecture recently at the Royal Veterinary College in London talking about how we should have One Medicine as you know half of this problem we have with antibiotics is an animal problem – anyway we can learn lots from looking at the bigger picture and  I’m learning why Vets have been able to innovate in ways Physicians can’t. I normally find that the veterinary/human medicine difference provides a perfect sniff test of if something’s valuable or irrelevant and exists just because of a political reason, as you know there are a lot of  EHR conferences you could actually spend literally about nine ten months a year touring around these big EHR events but they don’t have that in veterinary medicine at all. Vets would laugh at a lot of the things that the human medicine doctors are doing and so we can learn from that, there are differences clearly, but we have to realize that the reason why is often  political and the big data companies are doing other things with the data relating to humans. we have to stop that you know and mHealth is how we’re going to make a lot of these very opaque company operations like within the pharmaceutical industry clear, this is the big opportunity Doctors have to help clean up their industry and really add value to what they are offering and start working more directly with Patients and taking out some of the powerful middlemen because the time Doctors waste on clerical duties is all too often serving some insurance corporation and not the Patient. Physicians need to stop serving other masters and get right back to their Patients. That’s really what we try to do at 3G Doctor as there’s no insurance company involved it’s just you the Patient with an independent impartial doctor and we really try to style it more like you’re accessing the advice of an uncle or auntie who’s a Doctor and how they would talk to you. So say you know you might meet your Uncle at a dinner party at Christmas or something you say hey uncle Chris I’ve got this issue with XYZ, uncle Chris doesn’t pull out drugs from his pocket, uncle Chris doesn’t sell you something, uncle Chris might give you a note and say go to your doctor and say this and this. And when you go to your Doctor you say your uncle Chris is a neurologist in Cambridge and he told you to bring this up. That’s the sort of thing we want to be doing, we don’t want to replace your family doctor as we know that that’s the best place for you to get care but so many young people particularly have lost that relationship and so many older people can’t connect to their busy GP. We’ve had a patient who had a parent who had a stroke and they’ve called their GP to talk about their Parents care and the GP has told them that because of privacy issues they can’t talk about this other Patients care and they’ve said what do you want me to do, bring my mum who you know has had a stroke in here with me? and they are told well that’s what has to happen. It should be obvious we just have a completely bizarre thing going on here whereas with us if they want to talk about something like their mom who has had a stroke it’s simple as just sharing this is her age this is what’s happening and they can do that over a video call with her present if need be. This is another big advantage of  going on information that the Patient shares with us. Isn’t it a really weird thing that we’ve let this a big clerical job also disrupt our ability to actually care for people which is even more concerning than just being a waste of half of our time.

Dr John Bennett: okay david let’s see it the students have any questions or comments.

Simon R Downes PhD: I have a question… …thank you very much is very interesting to hear and i’m happy to hear about the company called  interoperability and that one of the hangouts we’ve had is the difficulty particularly in the USA where the computer systems cannot talk with each other. I would like to see this change as it would be wonderful to be able to do this. another thing i was thinking about is that you are using video i was working for a company for a couple years where as a psychologist I was using text only to communicate with clients and the idea of bringing video came up but we never got to that point and I was wondering firstly do you have a text-based system if for example for people in remote areas that may not have video capability and well who is able to use video. thank you.

David Doherty: yes a great point. text is obviously the way people prefer to share information and with the service that actually comes through in the preconsult care that we provide through the questionnaire, so when you go on the questionnaire it asks about how you’re feeling, have you suffered from depression, how long you have felt depressed for and all those routine questions which would send any sane Doctor in need of care themselves if they had to spend the day asking them. Because the history is taken from the patient before the consult starts we’ve a new starting point. In terms of access to video calls almost 98% of the UK and Irish population have this and all of our Doctors are General Medical Council or Irish Medical Council registered and as part of the Insurance conditions we only provide care for Patients in the UK and Ireland. If for any reason a Patient can’t access video we of course can always fall back to a voice call because Patients register for our service using their mobile phone number so we text them before we call and then we call you on your number and if you can accept a video call then you’re fine if. If you’re in a rural area that doesn’t have 3G coverage you might have Wi-Fi in which case you can choose to have a FaceTime call even though mobile reception is poor.

Simon R Downes PhD: this wonderful I mean just throwing one more thing I mean I live in Tokyo and we have something come out last year called Pocket Doctor and that’s a video-based a similar system I think I’m if I’m catching you right but what we’re finding is that the younger people are there on to it but people who are maybe they’ve even into their both 40s 50s are a little bit behind in the technology. How can we train them to be ready to use this and to accept it in Japan where they’re very afraid of privacy and maybe how they look on the phone perhaps even. How do you prepare the patients for the experience

David Doherty: yeah like I say innovation happens very differently in different countries and we’ve had in Japan incredible things happen where for example you will know as this is five year old data but more than 80% of old age pensioners in Japan today have used mobile data services. so they are in ways more ready because as you know they’ll play CartRider with their grandkids like the South Koreans. But in some markets mHealth is completely illegal so when you sit there wondering how are Samsung and LG  completely missing out on the opportunity to innovate and apply tech in the healthcare space it’s because it’s literally illegal in their home countries, so when their executives come over and they see people doing it here they go we could do that maybe as like a research project in a hospital but we couldn’t do that with ‘real’ Patients and so in these markets this still looks like a really experimental approach because of their mindset because like you say the legislation and privacy issues are restricting things. I once got to see details on LG’s big failed rollout of a telemedicine project and they had Patients who all had 50 inch TVs in their homes set up with webcams to let them video call their GP around the cornerand they showed me all the data on why this approach failed and yet they couldn’t identify the reasons. The first thing I asked was what healthcare content did they put on the TV and they’re like oh it wasn’t about content and I was like well what were you expecting them to discuss? And so it’s this type of disconnect that’s going on, if you don’t have content to discuss with the remote Medic and you don’t have access to your medical records none of these meetings will be very valuable and you might as well just go around the corner and walk into your GPs clinic – and in South Korea they have also got a very high GP per head of population ratio so it’s actually quite easy to go around and see the GP you know. In our case sometimes Patients don’t have an accessible GP, or they’re not registered with a GP, or they’re bed bound so they can’t get to the GP but it’s clear that every country seems to have its own unique little reasons why
this hasn’t taken off. From Korea and Japan the powerhouses for mobile tech outdated legislation has just stopped innovation in its tracks. In Russia they’ve just recently passed a telemedicine bill and for the first time it has become legal and I’m over there next week trying to learn about what needs to be done. Japan’s really interesting because they have prioritized the responsibility society has to seniors but for some reason this disconnect still exists so clearly we have to learn from how others are innovating. One of the things we’re seeing in England is a much slower adoption of mobile by senior citizens so I’ve written a blog post about ‘how to teach your senior to use text messaging’ because we don’t have those things you have in Japan – in japan you have the Raku Raku phones and you can go in a phone shop and there’s a 70 year old there to help you, but when you tell this to a Doctor in the UK or Ireland their jaw would drop because they’ve only ever seen spotty young people working in phone shops. Things can be completely different in different markets but there are huge opportunities to learn from one another which is something I really try to do with the mHealthInsight.com blog and with the LinkedIn mHealth group that now has 8,000 members from all over the world. I get to see what companies like NTTDocomo are doing and it just baffles me because they’re trying to innovate in the face of outdated legislation. Samsung for example even have their own hospitals but they’re just completely missing the opportunity to lead this market.

Dr John Bennett: (33:55) we’ve had a really hard time getting doctors on to do hangouts Dave, we haven’t had one Korean Doctor and we’ve tried to get Japanese neurosurgeons but so far no success. it’ll take time I think in those countries but Simon you say it’s because the culturally the Oriental people don’t like to get in front of a camera?

Simon R Downes PhD: um it’s that and also yes privacy issues they’re very afraid. I can’t get doctors on Skype or even individuals they feel very worried about privacy issues in Japan it’s all very interesting but it is changing so I expect we’re going to be seeing acceptance and there’s this new laws passed for remote care of people in the country so they will be able to communicate with a company called Cure.Ly and we were trying to make some headway but it was all ready but it just didn’t get the take up.

Dr John Bennett: Any one else have any questions or comments?

Ehsan Ghaffari: I do first of all David thank you so much I love the talk i love you the great field that you’re interested in. i love it too.  I’ve got three questions if you can answer quickly. The first question is so you mentioned really interesting point that the Patients don’t pick the doctors on your platform how do the doctors choose what Patients they can you know offer consultations to on your platform?

David Doherty: (35:36) so that is done on an individual basis, what we find today with triage is that healthcare organizations typically have the least experienced person trying to do it so for example when you ring up the NHS’s 111 telephone service they literally have a school leaver who’s reading a script off a screen and actually that’s where you should have your most experienced. so it might seem completely counterintuitive but if you gave a medical history to someone like John he could look at it in seconds and say that’s what we need to do with that Patient, that’s the type of Doctor that would be able to clear that up. In our case our first priority is which doctor we’ve got available for the Patient you know we have to be realistic about who’s available to make the call and the second thing is we get a very good feel for it you know. Some people will want to talk about something emotional so then it’s about which doctor is available who’s really emotive whereas if we’ve got someone who’s got done a lot of research who’s got the best internet research skills. That’s actually a big challenge and and is a skill we struggle to find in doctors when recruiting. We have to do more to develop these skills within doctors but also find ones who’ve got an actual interest in doing this, the reason I just fell at the feet of one Doctor colleague was because he had a sign in his waiting room which said that there was a weekly prize awarded for the patient who brought the most interesting research from the Internet to their appointment. Cool right? Well that is just the type of Doctor who needs to be providing this service. so if a patient for example wanted to discuss issues debated in a protracted argument on MumsNet, a website in which young mums discuss issues, this Doctor would be an ideal one to chuck in on that because there are all these opinions and some of them will be related to sales materials produced by commercial companies so a savvy doctors who has been around a while and heard all the sales pitches can and they are perfectly placed to get to the bottom of this stuff really quickly and help explain things to patients.

explain that 37:32so some it’s really dependable and what
37:34the patient comes through and into the
37:35medical history we bought and that’s the
37:38best way of doing it in our situation
37:40many of the times we just go near what
37:42you can go straight your family doctor
37:43they don’t have one so you know you
37:46manage it and you really try and work
37:48with that patient to make sure they do
37:50 take that first interaction

Ehsan Ghaffari: so the
37:53doctors on your platform will pick the
37:56patient’s they want to treat or do they
37:59get one at random to look at?

David Doherty: so we’ll
38:01have a doctor always on you will screen
38:03the ipods of Deeds the medical history
38:06questionnaire it comes food to last we
38:09see it we go who would you put that too
38:11okay and so I said the individual by
38:14individual basis who’s who’s available
38:16tonight you know if you’re working for us in 38:19Dublin and you’re on available and I say
38:22I’ve got a patient he’s got blood in his
38:24urine yeah I’m sure you can handle that
38:26you know get on with it ma’am but if we
38:30see something where you know it’s
38:33someone who’s got many of the people
38:35come into the questionnaire and end up
38:37with a completely different no they
38:38often start with a keyword and then end
38:40up answering questions on completely
38:42different issue some really really
38:43sensitive issues and so the patient
38:46might have come in with that start on
38:48the branch but these are interactive
38:50questionnaires and they might lead to
38:51something else and then you might think
38:53somebody’s a bit more gifted emotionally
38:56and you’ll just say look to patient
38:58do you mind if you know we call you in
39:00an hour and we’ve got dr. Kavanagh who’s going to be available then and I
39:07think she’d be really suited to this all
39:09we’ve got a doctor who sees this all the
39:11time and we scheduled you to see to talk
39:14to that doctor because you know once
39:17you’ve done a few patients the same you
39:20can get really good you can learn and
39:23because doctors spend so little time in
39:26training and experience dealing with
39:28things from the internet which is mostly
39:30what we do mm-hmm and you find doctors
39:33just get more talented at doing certain
39:35things and like doing something I think
39:37doctor should really be encouraged to do
39:39things they like doing. so often I see
39:42the morale in doctors is so low you know
39:45we’ve gotten young mum doctors are we’re
39:48dragging them out and tell them or I can
39:50hospital shifts 12 hours and two hours
39:52driving there and back
39:53it’s just ridiculous why are we letting
39:56this incredibly talented human person
39:59you know force fitting into this this job
40:02structure because we can’t imaginative
40:05Lee think you know how many homework why
40:07/ in UK and Ireland has millions but
40:10there’s no home working dr. opportunity
40:12offered to any graduate in medicine at
40:15Trinity

Ezra: silly isn’t I’m crazy there’s

David Doherty: (40:20) all of us in here talking away every
40:23doctor in the country’s got a mobile
40:24smart firing their pocket but no one’s
40:26ever talked to them about you so what we
40:28have is we have them leaving the career
40:30in droves you know and here we have an
40:34opportunity to be home workers Doctors we should have I keep saying
40:39we should have em health units teaching
40:41people in in medical schools and the
40:44medical school should be oh yeah where
40:46I’m going to work from home we’re really
40:48going to work on my veranda in Australia
40:50and I’m going to see patients in the UK
40:53I’m gonna have my feet up I’m a big deal
40:56and I’m gonna have the best like
40:58tripadvisor reviews people are going to say I’m brilliant at this
41:01i’m going to raise my family i’m gonna
41:04have this fantastic life and i’m going
41:06to really add value to patients who were
41:08struggling of stuff but instead what we
41:11have is and i write about this stuff on
41:14my blog i write about a doctor who wrote
41:16a paper in a broadsheet newspaper in the
41:19UK and i believe it was the guardian and
41:21wrote about how you scheduled a suicidal
41:23woman for a consult at
41:27something like nine o’clock in the morning
41:29and then complained that the patient was
41:32late why would they be scheduled in
41:34patients who are suicidal and the reason
41:37why the patient was suicidally he revealed
41:38in a guardian article was that the
41:41patient didn’t have much money well I
41:42bet the patient might have money if
41:44they’ve gotta sit all weekend worrying
41:45about their life and then somehow make
41:48it to a thing first thing on Monday
41:49morning. what take off work I’ll be even
41:52more financially disadvantaged that bomb this is this
41:55bizarre world when you think everything
41:57must be forcefully into an office visit
42:01no that’s that’s the change we’ve had
42:03two thousand years of learning how to
42:05perfect office physic only model we have
42:09to claim mobile phone provides the
42:12makers change so it’s hard we gotta
42:16learn we’ve got to share everything we
42:17do widely you know initially when I
42:22started this business the doctors used
42:23to say to me oh David you’re going to
42:24give all your ideas away given ideas
42:27away is the value you get it’s how I end
42:31up marketing my company but also I meet
42:34with people like you John the people are
42:36watching this and that’s the value so if
42:40you’ve got value to give start giving it
42:42away. We’ve just heard there’s a company in
42:45Japan just started out doing this you
42:48know 10 years ago people were saying
42:49that we were mad doing this but no
42:51patient would ever want to do it but
42:53we’d never have been able to recruit single GP
42:55to do this so sharing information has
42:58been the root trust recruiting just
43:00making money you know keeping this as a
43:02profitable venture and and developing
43:07this entire business in the future on
43:09most of our work will be remotely done
43:12with Patients. so we have to realize we’re
going there;

John Bennett MD: (43:00) a you have a training program
43:17correct for healthcare professionals
43:19learning hell em hell yeah so I produced
43:22that for the health informatics society
43:24there in Dublin there next to the
43:26American Embassy they also up their part
43:28of your Irish computer society and
43:30that’s this really progressive
43:31organization that produced the European
43:34computer driver license and when the
43:36founder of the inventor of the European
43:39computer driving license which is this
43:40we in a balloon thing for people to
43:42learn how to use IT professionally and
43:45about 20 million European citizens have
43:47already done it when they saw what we’re
43:50doing is that you know we need this as a
43:51course we need a course to teach  people
43:54how to start using because literally IT
43:57companies are going into a hospital
43:58saying hey we’ve got its iPad project
44:00you buy it from willing I know gazillion
44:03million pound and then what we’ll do is
44:05we’ll train your staff how to use it and
44:07what actually happens in IT firms is
44:09they think that they are being paid to
44:12train the staff to use their app
44:14nakshi use the technology and literally
44:18mobile phones have been invented and
44:19deployed so quickly it’s magic like an
44:23ambulance or a helicopter right it was
44:25invented in the last five years and we
44:28were just giving staff keys for the m1’s
44:30the keys to the helicopter going go off
44:32and pick a patient up. you know we don’t
44:35do any tests to see whether the nurses
44:37competent whether the port is competent
44:39whether the doctor knows how to use this
44:42and we deep doctors up all the time
44:45because they use things like what’s act
44:46to share a picture of an x-ray. They did a
44:49survey in the UK how many the doctors
44:52working really enjoys hospitals because
44:53the IT systems were so buggy and
44:56expensive and just hard to use and
44:58uninterconnected they were using whatsapp
45:01to take a picture of the x-ray and send
45:03it for their friend and then they said
45:06how he she’s terrible you’re doing this
45:07then it just clamp down on it no no no
45:10you need to train them how to do these
45:12things and so it’s like you train people
45:14how to drive the owners training train
45:17people to use the most powerful tool
45:19you’ve ever put in your hand. why not?
45:21because the upside of it is that you
45:24have people get much more value from
45:26that device. so the mobile health care
45:29costs that we do we’ve done it for bespoke
45:32focuses on cardiology at the Irish
45:34cardiac society that it is for diabetes
45:37the world diabetes Congress but I mean I
45:40think you’re working such a great work
45:42there in John that’s why I’m so keen to
45:43help you because I went to the World
45:45Diabetes Congress a biannual event the
45:48biggest event in the world diabetes
45:49industry ran by the International
45:51Diabetes Federation and they flew places
45:54all over the world companies on
45:56bursaries when the patient’s got there
45:58started tweeting pictures that are taken
46:00of the slide they were told off by the
46:02organizers incredible imagine what an
46:05insult you flown from Brisbane to
46:07Vancouver you’re trying to help all the
46:10other diabetic patients and you’re like
46:13wow what are they doing you know they’re
46:15insulting me for doing this you’re
46:16getting a slap in the face for doing that . So what we have here is this you
46:21know this opportunity to tell people to
46:23share and we have to enable these people
46:27so the only hour of
46:28content at that entire world diabetes
46:30Congress was the hour I recorded and put
46:34on youtube I just find that amazing has
46:36no one got anything in diabetes they
46:38want to share with people and do we not
46:42see that we shouldn’t be doing the same
46:44conference every two years which you say
46:46that’s been said that’s been done let’s
46:49move forward and this is what content
46:51like this does it says there’s that
46:53that’s being said you can’t keep saying
46:55that every year because you can watch
46:57tower new tube that’s done we need to
46:59use that collective intelligence move
47:01everyone on and I think that’s what
47:03you’re in a really unique place to do
47:04with this internet medicine we got

John Bennett MD: you
47:07know I’m glad you feel that way Dave you
47:10know I could understand when when I was
47:13talking to a group of physicians & phd’s
47:18the on the internet saying once you just
47:22take a smartphone to a conference and
47:24interview people and they looked at me
47:26like I was crazy there’s a wait a minute
47:28you have an excellent camera a means of
47:31communication from a place where people
47:33would like to be at a conference talking
47:36to the guy that just presented I mean
47:39what’s the huge change in mindset that
47:42has to take place for people to do that?

David Doherty: (47:46) it’s taken out of them it’s taken out of
47:48you for your training you know if I sit
47:50you in a desk and I’ll make you copy
47:52stuff out of books and learn it you know
47:55if I need you to memorize stuff and bugs
47:58and do exams okay I’ve taken out of you
48:02all the ability you will have to work in
48:04an environment where all that
48:07informations on your phone all that
48:09information is on the phone in your
48:11patients pocket. you know I say the doctors have
48:12you ever been googled by a patient to
48:14your patients use the instantly go know
48:15are going away to reverse aging out
48:17there doing their Google in you they’re
48:20writing reviews about you and they say
48:22where and I show them on facebook where
48:24 but some of it is ego so when you
48:27work we did a really cool project and
48:29it’s called Harley Street TV about eight
years ago and it’s this really bizarre
48:34thing that we found the way to get
48:35doctors interested this was to say that
48:38this were really senior medics – the most
48:40successful people in
48:42in European medicine – we’d save them what
48:44happens when I google your name and
48:47which showed them and when you google
48:49their name often it was like a clinical
48:51and the corner that was competing with
48:52him the first thing you know they put
48:54google ad up and he’d say that and he
48:56said I’m going to sue them how dare they
48:59do that then we look down we get page 2
49:01or something and it’s all just rubbish
49:04stuff about him where he’s based, old
49:06hospitals he worked at done all that and
49:08we’d say look do it for your colleague
49:11who’s already working with us and you
49:14would see a lovely YouTube video of him
49:16talking about specific area about his
49:19expertise about patients talking about
49:21exactly what he does and that was it you
49:24know why they were most interested in that for was that they
49:25didn’t realize we found that what they
49:28were most interesting that for was not
49:30the business it would create or how i
49:31would do with their peers and stuff like
49:33that it was that they found that their
49:35children when they went to school or
49:37when trying to frame sizes they all
49:39asked what does your dad do and then
49:41they would google them and they would be
49:44sitting around their friends and their
49:45friends would say dad you doesn’t think
49:48about you and it’s this ego thing where they
49:52want it to be proud of how they look on
49:54the internet so some of it you have to
49:57say if I was you John I just be saying
49:59what’s your internet look here’s his
50:01what here’s your top 10 on google and I
50:02look at you you go on internet medicine
50:05and do an interview of me that’s going
50:06to be the first thing plus you can put
50:08that link on your Twitter account and
50:10you’re good to go you know how could
50:13they say no to that? when you showed them
50:15hey look how bad you look. I find
50:18sometimes you’ve got to play people’s ego  to make them want to do it but the
50:22young ones we need to go and train them
50:23it’s all about training.

John Bennett MD: (50:10) well I think the
50:27stewardess till you could probably
50:28answer this one I mean I wish I was as
50:31soon again but you must get from day one
50:35digital information how to do things
50:37digitally is that correct uh you guys?
50:43well you know first of all you guys grew
50:45up with you know it’s a little different
50:47with me and Dave I didn’t go off with
50:49computers but all you guys grew up with
50:51computers and you’re very very adept at
50:55Facebook
50:56etc was it an easy transition Prague
50:59students to kind of get into the
51:01digitalization of medicine the digital
51:06really I mean for me like once you start
51:10getting into the internet young so just
51:13like I started through YouTube and
51:16Facebook and then automatically because
51:18those two platforms become a part of
51:20your daily life anything else would be
51:23so much so much easier to adapt to
51:25whereas I feel the older people when
51:28they come in they they don’t come
51:30inbound today internet they’re not bound
51:32by Facebook or etc so they’re just like
51:35basically lost they don’t have their own
51:37little home on the internet whereas like
51:40we’ve already have our own niche where
51:43we constantly have visited you know
51:45click the notification button every day
51:46and the internet sort of becomes home
51:50for you you know it becomes second
51:51nature and everything else is easier to
51:53learn mm-hmm in terms of college we only
51:57had one project in three years so we’ve
52:00had one this year where they told us to
52:04do a study or an essay on how on or
52:10about health behavior changing apps and
52:14how useful they are etc which I did
52:18about some Chinese app which measures
52:20everything so you it’s called I care
52:23health by one finger behind the camera
52:27one finger in front it measures your
52:30blood pressure your blood lipids gives
52:35you um your heart rate all these are oh
52:43yeah your your SATs your cell your
52:45oxygen saturation on all of that and
52:47then you can like you can self monitor
52:50so it provides it puts it into a graph
52:54and you can monitor over time and then
52:57it gives you little ways on how to
52:59improve on each of them and it tells you
53:01if your results are normal or not but
53:05then when you come to use the coins
53:07which you get for measuring
53:09the shops and Chinese so you can’t
53:11really use the coins or anything okay
53:14but pretty awesome what is it okay Diane
53:20you’re being quiet today is you don’t
53:22have to you don’t have to say anything
53:24but does the every comments or questions
53:26for David oh I just wanted to say a
53:29little bit about the topic that you just
53:30mentioned um it’s a little bit difficult
53:32kind of growing up in the internet world
53:36and having Google right there you always
53:39want to google search anything for a
53:41project or before you start actually
53:42finding resources or journals the
53:44reference right for any kind of paper
53:46and it’s difficult growing up in that
53:50and then trying to go to school and
53:51everything is like out of the book for
53:54out of this really old textbook or
53:55having to just search and get all your
53:58information from there as opposed to
54:00utilizing the new tech and the new apps
54:03that we have available in medicine so I
54:06kind of feel like education is
54:08definitely a little bit behind in that
54:10sense where they’re trying to teach us
54:12the old way but we were we’re learning
54:15in a totally different I just still
54:18occurs huh yeah well don’t Victor so
54:21again what food food a network that i’ve
54:23got i get really bizarre things like
54:25students who are on the ipad project
54:27they’re using iPads so some of the
54:29medical schools in the US I’m just
54:31completely thrown out the books but all
54:33printed content on the arrive you see
54:35your students have written to me saying
54:37hey David I really like your blog and
54:39I’ve said hey can you give me your app
54:42to download and he said yeah yeah here’s
54:45my password everything logging just
54:47don’t write anything as me and so I get
54:49to see what these students are doing and
54:51when I showed this to a student over
54:52here they’re like just like man from the
54:55future how come he’s got all that stuff
54:57in in the ipad that makes it so easy and
55:01the reality is it has a nice i wrote a
55:03blog all about this basically UCIrvine published a paper
55:07that showed if you were one of the
55:09students that was given the ipad that
55:10year you scored twenty-six percent
55:13higher yeah so I said you know what’s so
55:16funny if I failed in the u.s. medical
55:18school that hadn’t got the ipad project
55:20I’d nearly take my school my medical
55:22school
55:23to court because it cost you so much
55:24money to go to medical school in the US
55:27and I’d say you failed me because as long as I’m
55:29within twenty six percent of the
55:31pathmark another medical school has
55:33proven that the students perform better
55:35and the reason they perform better is
55:37because you know when I’m going along
55:38with my histology book on the bus it’s
55:41hard to getting out in front of people
55:42and stuff like that but I can do the
55:44quizzes and all of that on the iPad app
55:46and so it’s much easier to fit this with
55:48your lifestyle and not break your back
55:50carrying every book around but also use
55:52five-minute opportunities to deep dive
55:54into a subject and do some research but also a
55:56book is better than a book so one of the
55:58things I tell you know we’ve got to get
56:01these students using it and a really sad
56:03thing we have in the UK and Ireland is
56:05that we still my medical school was one
56:08of the ground breakers in this but we still
56:10really hit this thing where people has
56:12to be have to be ultimate high achiever
56:14and actually what that does I’m at a
56:17medical school I always say get your
56:19phones out okay get your other phone out
56:21and no one’s got a second phone none of
56:23the students have second phones and they
56:25have rubbish phones now and I say if I
56:28went out onto that bus on top and Court
56:30Road the kids have got better phones and
56:32they’re kids that aren’t at Medical School
56:34and you know why it is? I find it’s because these Medical Students are all grade a violin he can
56:40play the clarinet you can do and they
56:42aren’t the sort of little more studious
56:44type and so actually I think we’ve got
56:46an endemic problem of these young medics
56:48coming through is that unlike these guys
56:50are all hang out tonight these ones that
56:53are common food they’ve got other sort
56:54of skills that aren’t matching is so
56:58they’re not the sort of mobile looking
57:01ones they’re not the ones that know how
57:02to play the games yet guess what that’s
57:04how they’re going to do surgery. you know
57:07they’re never going to do surgery of
57:08these old scalpels and stuff them and
57:10that you got experience doing John and
57:12they’re going to have to be using robots
57:15and understanding how this technology
57:16works so we’ve got to have to modernise. My anatomy lecturer told
57:21us go and get a Nintendo Game Boy so
57:24that was at UCL in 1995 he said come
57:27learn how to play a game boy and so that
57:29was very inside we need people like that
57:31now to be saying you know every student
57:34should come in and should be exams
57:36it’s like a member of maths exams used
57:38to be without calculators your old up me
57:40and John would know that and but now
57:43it’s not like the maps is easier they do
57:46more complex problems with really
57:49powerful calculators you know they’re
57:51better at engineering bridges and stuff
57:53like that because they trained with that
57:55stuff and we have to look at as Doctors and
57:58that’s why I picked up at the beginning
57:59that we have General Practitioners literally being failed
58:02if they bring a mobile phone into an
58:03exam oh where are they going to be on
58:06the moon the lack of mobile phone them
58:08if they ever if you ever practice
58:10medicine on the moon you’ll have a
58:11mobile phone so why are we telling them
58:14they can’t use this because isn’t that
58:16what the problem is you know patients
58:18want to discuss youtube videos something
58:20they heard John discussing at larkin
58:22Community Hospital on the internet on a
58:25hangout and Linda going to a doctor
58:27who’s sitting there with paper binders
58:29and an EHR that no one else can look at

John Bennet: 58:32you know I thought it’d be a done deal
58:34David when they come up with a study you
58:35mentioned about UC Irvine about being
58:38twenty six percent better on their exams
58:40then their associates who were
58:43traditionally trained I thought it’d be
58:45a slam dunk were all schools would go
58:47oh wow let’s let’s let’s become iPad
58:51base as far as education but it hasn’t
58:54seemed to occurred it sounds like

David Doherty: yeah
58:56ten years ago a good friend of mine dr.
58:59Henrik understand from sweets Sweden
59:02started a company and they produced this
59:03product called I dog and I dog went into
59:07the Welsh Deanery and he stipulated it
59:09for every student and a telephone
59:12company gave them all the initial
59:14iPhones but before that had given these
59:16sort of PDA things that would be using so
59:18really early on but just kept picking the wrong format every year
59:22you’d go oh this the future of you know
59:25education but they kept buying these
59:27rubbish Microsoft things and in flash
59:29wouldn’t work and in the next year this
59:31one work and they just kept burning
59:32themselves in a hole whereas these ones
59:34have come in with the iPad and the
59:36community of developers that Apple have
59:38brought you know the best talent in
59:40usability the best talent knee
59:42developing stuff is is being developed
59:44for this iPad and that’s why these
59:45things growing like dambusters but if
59:47you actually get the app right so you
59:49big one of those
59:50students to give you access to what
59:51they’re doing the most groundbreaking
59:53things I’ve ever seen a really easy
59:55example is 3d for medical anyone got
59:58that hands up no pretty might get it on
60:01your face 3d4medical they do all
60:03these Anatomy apps right they’ve got
60:05this anatomy at and what it allows you
60:07to do is a strong you crap they let you
60:09a plate play the quizzes write multiple
60:12choice quizzes yeah but it lets you mark
60:14scores and what they allow you to
60:17join a Facebook group at your medical
60:19school okay for anatomy and what they
60:22now do is they mark the groups on how to
60:25group performs. and guess what no
60:28other medical school is doing that in
60:30the world right. what happens is they
60:32train these people to be individual
60:34performers and then they go straight out
60:36into the job market place and you’ve got
60:38a work of a team, now what they’re doing
60:41because they’ve got the ipad thing and
60:43the administrative hurdle for the
60:45lecturer isn’t massive the students can
60:47all go in this thing and they can pick
60:48up members of their team who they can need a
60:51bit of help in study revision instead of
60:53waiting to the end of year where he
60:54fails because he’s score is part if we
60:56were all in a team yeah we’d be doing
60:58hangouts and stuff like that because if
61:00all our marks were helping each other
61:02you know we’d be motivated to work as a
61:05team. so we have now a tool allows
61:08training of medical students in team
61:10like fashion and that’s the career that
61:13they are going to have to do so it should be a
61:17done deal you know some of them go I’ve
61:20got reservations about buying iPads and
61:22they’re going to play games there you’ve
61:23got to realize if you’re at Medical
61:25School your motivation isn’t to play computer games is it?

Thank You
I don’t think so I don’t think so
61:32well day I won’t keep you too long
61:33you’ve spent a lot of time I really
61:35appreciate you coming out and also all
61:38those students but could we get a view
61:40of the Kerry countryside hey guys I live
61:45okay okay did you get a picture from
61:47there yeah you cannot just oh no what is
61:52it very good there’s a new song English
61:56Akbar stern darlin for you well that’s
62:00the line I’ll take that so
62:03yeah yeah you don’t know community the
62:06horses and that’s beautiful well I hope
62:10we do a lot more of these David and
62:12thanks again for all the students come
62:14or I’ll and the televised part and then
62:16we can just chat so thank you verdy much

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Let’s meet at the Russian mHealth Congress, 28 April 2017

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Finalising last minute plans for a trip to the Russian mHealth Congress being held on the 28th April 2017 at the Hotel Mercure Paveletskaya.

It’s an exciting time for mHealth as although Russia is very clearly another early adopter of Mobile the country has suffered like South Korea from outdated legislation preventing mHealth innovations so I’m hoping to learn lots about the opportunity to take mHealth innovations to Russian Carers/Patients and learn from how the Russians are approaching mHealth now that the government telemedicine bill has passed.

The event is being organised by Smile Expo and will comprise a range of presentations and talks on topics including: The newest Russian mHealth opportunities,  Investments in mHealth technologies,  Are we on the brink of technological singularity and what does it mean in terms of mHealth?,  Is our consciousness ready for the technological capabilities?,  Collaboration between the government and private companies while implementing telemedicine in Russia,  Application of modern digital technologies and Internet as a part of clinics group operation,  Personal remote patient monitoring with and without gadgets,  mHealth tools application in the complex of services of personal health manager,  Business approach to Health Management: new opportunities for staff efficiency improvement,  Data from gadgets and applications as biomarkers for early diagnosis of diseases,  Mobile technologies in stress management.

Speakers will include:

Aleksey Alekseev, Neurologist & General Director, Med-YurKonsalt LLC
Leonid Bugaev, Founder & CEO, Nordic Agency AB
Aleksey Danilov, Doctor of Medical Science, professor at I.M. Sechenov First Moscow State Medical University, director at Institute for interdisciplinary medicine
Svetlana Fominykh, Public Speaking Coach
Alexey Grinenko, Investment Manager, IIDF
Gayane Harutyunyan, Lead Architect, IBM Client Center
Irina Kargalskaya, Co-Chairman of the Patient-Centered Telemedicine Committee, Russian Patients Association
Roman Kataev, Product Director, GetDoctor
Airat Khanov MD, Academic and CEO, Telemedsoft LLC
Oleg Korzinov, CEO, KSI Ventures and Exec Director, Northern Biopharmaceutical cluster
Prof Petr Kuznetsov MD, Professor at National Research University and VP, National Association of Medical Informatics.
Alexander Lazarev, Managing Partner, Maxfield Capital
Georgiy Lebedev, Chairman, Internet+Medicine Committee at Internet Development Institute
Alexander Penkov, Manager, ONETRAK University
Eduard Segal, Head of Business Development and Innovations, PJSC MTS
Viacheslav Semenchuk, Surgeon & Development Director, ADITIM
Igor Shaderkin, Head, Research Institute of Urology and Interventional Radiology (branch of the Ministry of Health of Russia)
Evgeniya Smorodnikova, Co-founder, Welltory
Andrei Tsoi, Senior Editor, Evercare.ru
Anton Vladzimirsky MD, Deputy Director General for Innovations, Medstrakh (Medical Insurer)
Denis Yudchitz, Chief director at Mobile Medical Technologies Ltd and CEO/co-Founder, “Pediatrician 24/7” and “Online Doctor”.
Ruslan Zaydullin, CEO and co-founder, DOC+
Boris Zingerman, IT department manager, Hematology Research Centre

Let’s meet in Moscow?

Things are a bit last minute (we might even end up presenting an intro to the mHealth course we developed) but it would be great to check out healthcare services while there (at present it looks I’ll be in Moscow for an extra day) so get in touch via the comments if you know of anything I should check out on my visit.

Click here to register (tickets are available from just 10,000Rub/€167).

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Did the Smartphone win the Qualcomm Tricorder XPrize?

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Analysts may be talking up the end of Smartphone innovation but check out the Smartphone Medical and the profiles of the 2 winners of Qualcomm’s Tricorder X Prize and I think it’s clear Mobile is cannibalising the world eating up everything and that now even includes future medical devices that we haven’t even yet dreamed of!

FINAL FRONTIER MEDICAL DEVICES AND DYNAMICAL BIOMARKERS GROUP DEVELOP THE FIRST CONSUMER-FOCUSED, MOBILE DIAGNOSTIC DEVICES INSPIRED BY THE MEDICAL TRICORDER OF STAR TREK®

mHealth Insights

I’m not surprised and think it’s a positive omen for mHealth innovators that the winners of the competition both ended up being variants on the smartphone physical.

It’s been fascinating to follow this X Prize competition as it took a bold direction change etc especially as a few of the teams that were attempting to win it had asked me for help. I know of no more efficient way to get affluent researchers to commit themselves to finding a solution but I think the financial model could be better designed (eg. 300 teams paid in $25,000 entry fees to join the competition – generating $7.5 million before it even started) to encourage ideas/attempts from less well funded competitors. Imagine if 7000 entry bids had come in?

The winner profiles are very interesting to read up on and the organisers have made some cool video content that will hopefully inspire medical device developers to think like the Born Mobile generation eg. Final Frontier Medical Devices:

and Dynamic BioMarkers Group (who look likely to try and commercialise this with the HTC smartphone brand):

Related Posts:
What’s The Future (WTF?) & how is your imagination failing you? (Jan 2017)

Can you imagine a world where we have Tricorders but you still have to go & sit next to your Doctor? (March 2013)

Nokia joins Qualcomm in search of the Tricorder (May 2012)

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Cancer Charities: experts in data personal sharing just not yet in ways that help us better understand Cancer Care

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Are Airports more interested in your medical history than your GP?

“It has different tools and sensors: iris scanners, finger prints, facial recognition. It has video cameras and microphones, and eye trackers to measure pupil size and how that might change during the course of an interview. We also have floor sensors to judge how people are standing. It really is a myriad of sensors…   …we hope the passenger experience will be convenient and quick. Rather than having to waiting in large queues to get to border security officers, we envisage there will be a bank of AVATARs that can be used to self-screen by scanning your passport. It pulls up your information and the system knows what questions are pertinent based on your status, visa, country of origin of travel, and so on…  …you can get though the process faster, as the majority of the questions usually asked by a border official have been asked by the kiosk. The human component is filling in the blanks, or what the AVATAR suggests needs following up…   …when asked about drugs, for example, it might notice a pattern that someone is answering with more ager or uncertainty. It is essentially looking at the behaviour that might imply there should be further investigation…   AVATAR is an interviewer, actively listening. A lie detector evokes images of a polygraph We’re almost opposite to that… AVATAR is meant to gather more information for the decision makers”

April 2017 Issue 22, Airport Industry Review

I find it fascinating to read about how airports are trialling sensory kiosk technology to analyse health data while travellers complete interactive questionnaires as so little development has been made in the use of such tech in the healthcare industry despite the abundance of evidence going back decades:

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Can you imagine the situation where medical discoveries will be revealed to border officials and perhaps not to Patients?

It’s interesting to compare this to the situation we have in modern office visit only Doctor practices where Patients turn up and the time pressured Doctor is left having to guess what’s up and even complaining that Patients are wasting their time (when we know the availability of simple Q&As on their mobile could’ve let Patients self manage most of these health concerns and will help Patients share more honestly especially when it involves very sensitive concerns).

The office only visit model of Primary Care

It also confirms to me one other way that Digital Health will increasingly grow to be distinct from mHealth in that it will be something that will be seen to be done to Patients (rather than with them) and out of their control (it’s positive to note that Apple has strategically recognised the threat of this major issue).

Related posts:

Perhaps GPs are just too fatigued for innovation that has been clinically validated?

Videos from the Royal Aeronautical Society’s Mental Health & Well-Being Conference

Philippe Kahn shares his thoughts on Wearables

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Irish Times: New service to allow GPs to treat patients via smartphones

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At the NAGP’s Primary Care Partnership Conference in Dublin a new service called GP Online has been launched to enable Irish GPs to consult with their Patients via an app and Paul Cullen at the Irish Times got the scoop on this new service being funded by NAGP members.

mHealth Insight

“The first tele-medicine service that allows patients be treated by their GPs using a smartphone is to be launched on Friday”

It can’t be stressed enough mHealth startups need to be careful not to exaggerate or make up fake facts to get headlines because the currencies of anyone who wants to make change happen right now are attention and trust eg. rural GPs in Ireland have for years been routinely giving their mobile number to Patients and most Patients in Ireland have had a smartphone for years.

“GPs hold about 24 million consultations a year, of which 7 million are with private patients. Mr Callaly believes up to one million private consultations could move online in the initial phase”

It’s not at all clear how this gets around HSE requirements of GMS registered Doctors to treat their private and public Patients without preference. It seems that if GPs being paid by the HSE are offering this service to ONLY their Private Patients they’re going to get in a lot of trouble with the GMS (who can easily hold back their payments pending review of their practice) and it’s going to confuse the hell out of Patients (eg. what happens when you hit your 70th birthday and consults with your GP become free but you lose your entitlement to mobile access to your GP?, etc).

“The service operates via an Apple or Android app and can be used on a smartphone, tablet or laptop computer”

 

I’m not sure why the app is being bothered with. Wouldn’t Patients be better off  with a just a website and then using Facetime, Skype or a 3G Video Call to answer when the Doctor calls rather than an app?

In 2017 Facetime/Skype/3G Calls are much more usable and better designed than the Irish Times photo suggests this app makes the video connection which is actually quite similar to the 3G Video call user experience that was available nearly ten years ago (for proof check out this video call between 3G Doctor and Qualcomm’s VP Don Jones in 2009):

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

“The GPs can provide online treatment for “anything that doesn’t require a physical examination”, he said. Most of the initial demand is expected to come from patients requiring repeat prescriptions or those unable to leave home or work for a face-to-face appointment”

I think the major challenge with this approach is that Patients don’t know if they need a physical exam and nor do the Doctors have any idea until the Patient has shared some history with them about their concerns.

This is why I’ve been advocating for 10+ years for online Doctor consulting services to copy the approach we have taken at 3G Doctor (launched in 2006) and combine mobile video consultations with clinically validated online medical history taking tools.

 

I also wonder how the MedicoLegal Insurers and the HSE will react to GPs signing repeat prescriptions for private Patients via a mobile app. The way the HSE essentially closed down one of the world’s most biggest pharmaceutical companies when they tried to innovate in this area by accusing them of fraud (note: the legal defence team required to defend a case like this would probably bankrupt most Irish GPs) doesn’t bode well for Doctors who might not meet with or document a proper history on a Patient for over a year (eg. as can happen when you’re ordering 6month repeat prescriptions etc).

I think there’s also the question of the value of going to the hassle of downloading and opening an app to get a video connection for something like a repeat prescription when it’s your own GP calling you (something I learnt a lot about from the innovative Dr Tony Stern who in 2009 was seeing most of his GP consults to his registered NHS Patients over the plain old telephone). Outside of skin care the appearance of a Patient doesn’t really come into it for most repeat prescriptions.

“The National Association of GPs, whose members are funding the initiative, predicts that up to 100 family doctors will be offering video consultations by the end of the year…   …Doctors who opt to provide the service will pay €35 a month for the connection and set their own fee levels for patients”

It sounds like easy money and GP Online must have an incredible sales team to manage to sell this to the NAGP (the latest issue of the ICGP’s member magazine is practically dedicated to making the case that mobile video consults are dangerous/useless) but I don’t think there’s actually a viable business model in this for the app developer eg. why would Irish GPs want to pay £35/month to video call Patients when they could just call their Mobile number (and make a check to see if the Patent can accept a FaceTime/3G Call first)?

Even the Doctor (Dr Andrew London of the Aylesbury Clinic in Tallaght) who is involved in this pilot and is mentioned/pictured in this Irish Times article appears to be running his entire practices online communications with a just gmail account (and the HSE have wasted lots of energy and money with the ICGP and mobile operator o2/Three Ireland giving GPs a free secure alternative to these advertiser funded email accounts – see healthmail.ie) and from one glance at the Clinics website it’s clear paper based records are still being used there.

Maybe it’s just me but buying online consults from a GP who in 2017 still runs a practice on paper based records would feel a bit like buying my broadband internet from my coal  delivery man…

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“As the technology develops, it is expected that basic medical checks, such as blood pressure, pulse and blood sugar levels, will be carried out online”

It surprises me that this isn’t the primary focus of the service as in 2017 there can’t be a single rural Irish GP who hasn’t been woken out of bed when on call because of a reading on a Patients blood pressure monitor or glucometer (something that is exponentially on the increase as Mobile is cannibalising everything).

I think as soon as you start giving Patients access to their medical records, online tools to share their concerns and getting their medical devices properly connected the need to see a particular GP when a need arises becomes less critical. Perhaps it’s just the legacy group thinking (that your GP and your Medical Records are always bundled together) that has ensured the developers here have failed to appreciate this.

NOTE: Four years ago at 3G Doctor we started offering to consult with Patients who recorded ECGs on the world’s first made for mobile ECG machine and it taught us that this market is materialising incredibly quickly eg. in the most recent ICGP webinar for GPs a poll revealed that as many as 1 in 5 GPs in Ireland are now themselves using an Alivecor which is interesting to compare to the situation in 2011 when a Patient felt they were being told off for presenting with the ECG reading from my Alivecor to their GP..

“This is the first service to allow patients talk to their own GP from the comfort of their home or office. “The advantage is that patients are talking to the doctor who is familiar with their medical history and has all their records to hand,” GP online chief executive Aiden Callaly said”

The other side of the coin is that this initiative could make GPs appear to be have money grabbing motivations because this is being made available only to Private Patients who can’t access their healthcare records online and a key differentiator between this and other services is the gatekeeper role that these GPs are taking to their Patients electronic medical records eg. if the Patient had their own access to their own medical history they could share that with another Doctor of their choice or perhaps do some useful online research and avoid the need for a Doctor chat altogether (or have a much more interesting/useful consultation after they’ve done some medical record assisted research of their own).

 

Key takeaway:

I’m enthusiastic about GPs signing up for this new service as it’s much better than blaming Patients for not fitting with your view of the world but I think the NAGP would get much better outcomes by shifting it’s focus to educating members (about the opportunities mobile offers to transform their service from today’s completely outdated office visit only model of GP care) and the Public (about the disadvantages of Patients video calling multinational insurance companies and sharing their private personal info with advertisers instead of trying to develop a relationship with a Family Doctor) because the reality is the huge online ad budgets of big insurances and VC debt funded data trading companies will always enable them to reach Patients who are looking for services like GP Online anyway:

 

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In my opinion the Patients a HSE GP has who need a service like this the most are their Public Patients and Carers (eg. the Parent of a child or the Son/Daughter who looks after your 90 year old Patient) for whom this service will never reach (because in Ireland GP Care is free for under 6s and over 70s).

It is not viable for Irish GPs to give up 30 minutes of their time in exchange for 30 seconds of their Patients time so if you are an Irish GP serious about offering a mobile first practice please get in touch as I’d like to invite you to take the mHealth course I developed (free of charge) and show you a system that you can use today that has been proven to let your Patients access their records and share their medical concerns with you using their mobile.

 

 

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