Visually this is all just ridiculous: Wearing white coats while video calling (CHECK), carrying a stethoscope (CHECK), reading from technology from ancient Egypt (CHECK), windows 95 user interface (CHECK), claims that it is affordable to deploy at scale the precise telehealth kit used onboard the Presidents $400Million modified Jumbo Jet (CHECK), etc.
President Trump: “Today, I’m pleased to announce another historic breakthrough that will expand VA services to many more patients and veterans. We will do this through telehealth services. It’s what it’s called — telehealth services. We’re expanding the ability of veterans to connect with their VA healthcare team from anywhere using mobile application on the veteran’s own phone or the veteran’s own computer”
I think we should be mindful about the terms that are being used to describe how we are modernising the 2000 year old model of healthcare. TeleHealth means “remote health” (‘tele’ is a Greek derived word-forming element meaning “far/far off/at a distance”) and surely we can all easily see that this isn’t what veteran’s are going to be getting here.
President Trump: “This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health, which is a bigger and bigger request – and also in suicide prevention. It will make a tremendous difference for the veterans in rural locations in particular”
President Trump: “We’re launching the mobile app that will allow VA patients to schedule and change their appointments at VA facilities using their smartphones. So, this is something they were never able to do. Technology has given us this advantage, but, unfortunately, we have not taken advantage of that until now. We’re working tirelessly to keep our promises to our great veterans. Very important”
Secretary Shulkin: “What we’re announcing today is a big deal for veterans. It’s really going to expand access for veterans in a way we haven’t done before. And, as you may know, VA already has the largest telehealth program in the country. Last year we had 700,000 veterans who got telehealth services through the VA, and we actually can do this for 50 different specialties”
I think the VA shouldn’t be so ready to clap themselves on the back as 700,000 may seem like a large number but it’s still means that less than 4% of veterans are using the VA’s telehealth services (there are 18.3Million Veterans in the USA).
Secretary Shulkin: “what we’re announcing today dramatically expands our current capabilities. Mr. President, by working with the Office of American Innovation and the Department of Justice, we’re going to be issuing a regulation that allows our VA providers to provide telehealth services from anywhere in the country to veterans anywhere in the country, whether it’s in their homes or any location. We call it “anywhere to anywhere” VA healthcare. That’s a big deal”
Secretary Shulkin: “…you talked about mental health and suicide prevention; this is one of those areas that we can really use that expertise. And today’s announcement is going to allow us to do that. What we’re going to be rolling out nationally with a rollout across the country is what’s called VA Video Connect. VA Video Connect allows VA providers to use mobile devices to connect with veterans on their mobile devices or their home computers. That’s a big deal”
Secretary Shulkin: “And there’s one more thing, Mr. President. We’re going to be announcing a new technology called the Veterans Appointment Request. And what that is, is it’s allowing the veteran, on their smartphone, to be able to schedule their appointments directly with VA providers, or to change their appointments, or cancel their appointments with VA providers. Now, today, this is available in all 18 of our regions across the country. And we’ve already booked more than 4,000 appointments from veterans directly from their smartphones so that they can schedule their own appointments. But now we’re announcing the national rollout of this”
Secretary Shulkin: “Now, let me show you how this works, Mr. President. If we come over here — we use technology in a way that’s pretty incredible. In fact, Mr. President, I’m one of those doctors. I practice right here in Washington to my clinic in Grants Pass, Oregon. And I want to say hello to our veteran today. Mr. Amescua, how are you? Mr. Amescua is a veteran. He served in the Coast Guard for 26 years. He was a helicopter rescue swimmer and served the country. And here we are in Oregon. And this is our great team — Peggy and Denise and Terry. And, Peggy, would you mind — I understand there might be some area of concern on Mr. Amescua’s skin. Can we take a look at that, please? Team Member: Yes, sir. Dr. Shulkin, this is the area that is of concern. Secretary Shulkin: Okay. So, as we focus in on that, you can see, Mr. President, I can take a look at that area and if I have any concern about it we can send this to a specialist or we can take a look at it”
Secretary Shulkin: “Mr. President, if you walk over here, this is actually the new doctor’s bag – the doctor’s bag of the future. And you may actually recognize this because this is the doctor’s bag that travels with you when you go on Air Force One. And so we have Dr. Ronny Jackson, your doctor here that usually takes care of you, Dr. Jackson. And we now are able to bring this doctor’s bag into the home of our veterans. Our nurse practitioners, our technicians are able to use this type of technology now – the same technology available to the President of the United States. And that’s the way it should be, because our veterans deserve that type of technology”
The first thing I’m thinking is that this aluminium encased laptop must cost a bomb but seriously how many nurse practitioners are going to put out their backs in the next year if they are having to lug that in and out of their trunk and into every Patients home?
Secretary Shulkin: “Now, I’m going to show you just one or two other things. Dr. Neil Evans over here, one of our doctors, is going to show you VA Video Connect that I talked about. So here we are in Grants Pass, Oregon. Hi, Mr. Amescua, how are you? Can you raise your hand? Good. So, here we are in Grants Pass, Oregon on our mobile device, and this is how we can use VA Video Connect. But watch this, Mr. President. If we need to bring in a specialist from anywhere
in the country into Grants Pass, Oregon, we can”
I can’t see why the President of the United States is supposed to be impressed by a video conference call? He’s probably been using it at least once a week for the last 10 years (eg. when being interviewed on the TV news channels).
Secretary Shulkin: “Dr. Watts is a specialist – an internal medicine specialist in Cleveland, Oregon, and she is now connected in with Mr. Amescua in Grants Pass, Oregon. So, we can get the expertise from anywhere in the country immediately. The VA is able to do this right now. So, thank you very much. And so, Mr. President, this is how we’re expanding access. This is how we’re bringing the very best technology available in the country. And really thanks to your help in cutting through the regulation, the Office of American Innovation, we’re able to expand that success dramatically today and to roll this out”
I think it’s clear that the terrible design of this synchronous system will have no chance of expanding access to expertise. By utilising staff and Patients so efficiently it will waste resources and ultimately limit access to expertise.
Very unlikely there will be a livestream (as the event organisers aren’t even using Twitter etc) but I’ll add the links to the speakers etc in the below (refresh post later to see these) as it will make for some good research and background reading (especially as the meeting is being conducted in English).
Seizure detection using scalp EEG Christoph Baumgartner, Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology; Sigmund Freud University, Austria
Ear-EEG for mobile long-term EEG monitoring of interictal and ictal events Ivan Zibrandtsen, Neurological Department, Zealand University Hospital (Denmark)
QNeuro – cloud-based medical assistance and decision support system for effective treatment and assistance of epilepsy patients Piotr Zwolinski and Mariusz Chmielewski, EnQuant (Poland)
Feasibility of home video telemetry polysomnography for assessing sleep related neurological disorders Peter Muthinji, Specialised Clinical Physiologist, King’s College Hospital (UK)
“What Used to Be Fraud Is Now Alternative Medicine… …Sometimes a very, very common story that I hear is, “Yeah, I saw two or three physicians. I think I have Lyme disease, and my physicians say I don’t have Lyme disease because my tests are negative and I don’t meet the criteria,” whatever. “But I looked up the symptoms on Google and I have all the symptoms. So then I went to a naturopath and he did a lot of tests on me, and he says I do have Lyme disease, and he gave me this homeopathic remedy for it. This is unfortunately a common occurrence. Obviously, we have to form a therapeutic relationship with our patients and you can’t be judgmental towards them, so it’s a very challenging framework in which to confront these issues. But I think a few things. One, if a patient is in my office, they’re there to get my professional advice and they are already acknowledging by their very presence that they have some respect for science-based medicine, for evidence-based medicine. I do think that they expect that I’m going to give them my honest opinion, and so I give it. I say, “Listen, I looked at the research on this, and in fact, I do not think that this is a valid treatment. I don’t think that this is going to be effective,” or “I don’t think that you have Lyme disease for these reasons.” They generally appreciate the fact that I took the time to actually look at the literature even though it may be more of a fringe treatment and not something that physicians are giving, and they appreciate that I take the time to explain to them why I feel the way that I do. I don’t pull my punches, but I say just very non-judgmentally, “These are the facts. This is my interpretation of the evidence,” or “Here’s the standard recommendation of the relevant professional society. This is why we think…” You also have to gauge what’s the patient really thinking? You can’t just lecture them. You have to sort of interact with them. Sometimes they have misconceptions that are pretty easy to fix. So, it takes … you have to invest the time to understand the narrative, understand what the patient is thinking, understand what they want, address the information that they’re being given. So, yeah, we live in a time where we have to spend a lot of our time, I think, undoing a lot of misinformation that’s being fed to our patients, but it’s absolutely worth it and the effect could be definitely worth the time that you’re investing. Because if you think about it, you could have the best plan for your patient that’s all science-based and has class I, double-blind, placebo-controlled clinical trials, but if they don’t believe it because they were told something else by their naturopath or whatever, it doesn’t matter. You have to get them to buy into how to approach the therapeutic strategy that you’re going to be taking. Patients do share with us. We all want to use what works, right? We want to know what works and what is safe. We all have that same goal and you should have a pretty sophisticated understanding, I think, as a practitioner of how we know what works and how we decide what is above the waterline in terms of using it. You should get the patient to understand that at least … they’re going to buy into your treatment recommendations…”
“so we’re excited this year that ASCO has continued to emphasize the importance of mHealth or Mobile Health to its membership, this is an exciting area that’s now exploding”
Last week I was in London attending London Tech Week (check out the comprehensive mHealth guide here) and was going to post a few notes on my experience but couldn’t bring myself to publish them as the event for me was overshadowed by how a complete lack of tech adoption in London has led to a 24 story Grenfell tower block being clad in flammable and toxic fume producing cladding/insulation and residents being given instructions to stay in their apartments within a building that had no sprinkler system (the authors presumably had no idea about the dangerous cladding materials?).
In reaction similarly clad social housing towers across the UK are being evacuated and 4000 residents in London have already been made to sleep in temporary shelters within council properties like leisure centres until the cladding on their blocks is removed.
How did anyone think it would be a good idea to have the Council authorities (who paid for and expensively installed these dangerous materials) to be in charge of handling how to react to it now being clad all over their buildings?
Has no one done a risk assessment and realised that the families here are probably at more risk of coming to harm from being relocated to live with one another within buildings that weren’t designed for high density habitation and don’t have the facilities.
I see no point talking about being the Capital for Technology when you don’t try and use tech to temporarily fix these issues, for example:
> Instead of issuing advice to remain in burning buildings update the advice given to residents and have them register their mobile numbers to enable personalised updates to be made as well as contact in emergencies.
> Work with the Fire Services to let citizens Facetime/3G Video Call the emergency services (it well help collect information and enable emergency services to more speedily make more appropriate responses to calls).
> Position fire fighting equipment on the landings so that residents can manage small incidents themselves and provide a training session for residents on it’s use.
> Fit mobile embedded smoke alarms in all council buildings and program them so that Fire Services respond to them knowing their precise location and building details.
> Fit Kidde Remote Lync devices in the council buildings so that residents also get early notification of nearby smoke/co monitors being activated:
I don’t like to be so negative so here’s a bit of balance: the tragic fire led to an outpouring of generosity and community spirit amongst Londoners. Of the many things I saw one was this guy anonymously (I covered up his face as he might not want to be recognised) gifting lunch to the heroes in his local firestation:
A couple of years ago I made the mistake of recording and sharing (freely on YouTube) the talk and slides that I was paid/invited to give at the biannual World Diabetes Congress in Vancouver (the world’s biggest diabetes industry conference). It remains the only talk from the entire event that you can find online (and there were over 300+ hours of presentations given by experts who travelled from every corner of the world).
By taking this step we’ve built a little more trust with Patients, Carers and Clinicians but guess who won’t be invited to ever again present at an International Diabetes Federation Congress?
RT @mHealthInsight: "free is not free" when you pay with your data & it's especially not cheap or free when it's your health data... https:… 2 days ago
