Ways mHealth can help GPs manage Patient needs in a lockdown

This fascinating Twitter thread by NHS GP Dr Renee Hoenderkamp reminded me how how poorly the RCGP has prepared GPs to manage care in 2020 and got me thinking of specific practical ways that mHealth can meet care needs in these exceptional times (if you have any suggestions please add them below in the comments):

“1. You are in your 70’s and had a fall and rendered your shoulder unusable with a rotator cuff injury. You need a steroid injection; i can’t refer you because that service is not open currently. You pay to go privately because you can’t function in simple personal activities”

All NHS Services that are not open in September 2020 should get a MobileFirst redesign.

Take histories from Patients & GPs using advanced medical history taking questionnaires and have these forwarded to orthopedic teams for evaluation. IF they deem a steroid injection is required (perhaps after a video consult with their Patient) send advice and have the GP call to the home to administer it as directed.

“2. You are 38 & have been trying desperately for a child. We have done the work up for the fertility clinic & you know the wait list is very long (6m +). I refer you and it gets rejected; ‘we are not accepting new referrals due to covid for at least 3m”. Thats your valuable time”

Huge opportunity the NHS to innovate with clinically validated mHealth apps and wearables eg. Duofertility:

“3. You have an appointment to discuss your knee replacement. Your mobility is so compromised you can’t walk to the end of the road. The appointment is rescheduled for 6m. You are trapped indoors; gaining weight, mood deteriorating, can’t visit friends/relatives”

Great opportunity to sign post Patients to the thousands of apps that can help Patients connect with friends, learn about healthy cooking/eating, physical therapy, etc.

“4. You spend 3 days in labour but your partner can only come for the last few hours to delivery. He can only stay for an hour after. Baby goes to NICU for a week and you stay in but partner is not allowed back AT ALL to visit you or new baby. You have PTSD from the experience.”

This seems to be another one of those ridiculous examples of Hospitals over reacting to the risks of COVID19. Suicide is the leading cause of death in expectant and new mothers in the UK and COVID19 has clearly not changed had.

“5. You go for your 8 week pregnancy scan and tragically the baby has died and there is no heartbeat. You are on your own for this news because your partner was not allowed to come to the scan.”

This seems to be another one of those ridiculous examples of Hospitals over reacting to the risks of COVID19. Suicide is the leading cause of death in expectant and new mothers in the UK and COVID19 has clearly not changed had.

“6. You are shielding at home alone. Your only contact with the outside world is via telephone and you have a recurring ear wax problem meaning you can’t hear/use the phone. I can’t get your ears syringed. You have pay to have it done privately if you want it.”

Imagine the potential for Practice Nurses to do this type of invaluable work if the NHS had worked to free up GPs time using the tools of our time.

“7. You have been having chemo for terminal but controlled cancer. You are due a scan to check control in March. You receive a phone call to say that you are ‘no longer a candidate for treatment’ due to covid. You spend the next 4m of your life shielding, not living.”

This seems to be another one of those increasingly common examples of the NHS using COVID19 as cover for cuts to care services. A great example of why those working in the NHS should never tolerate wasteful out of date ways of practicing medicine.

“8. You have a vaginal prolapse. Your ring pessary needed changing in March. It has been cancelled. Things are deteriorating. You have to go to the toilet 10x a night and worsening. You are exhausted, in pain and no new date to change it”

This seems to be another one of those increasingly common examples of the NHS using COVID19 as cover for cuts to care services. A great example of why those working in the NHS should never tolerate wasteful out of date ways of practicing medicine.

“9. The the date for the scheduled hysterectomy which will sort the problem more permanently is cancelled indefinitely

This seems to be another one of those increasingly common examples of the NHS using COVID19 as cover for cuts to care services. A great example of why those working in the NHS should never tolerate wasteful out of date ways of practicing medicine.

10. You are waiting for a cataract operation. The pre appointment was May. It has been rescheduled for March. You can’t drive, you can’t work. Your anxiety is spiralling.

This seems to be another one of those increasingly common examples of the NHS using COVID19 as cover for cuts to care services. A great example of why those working in the NHS should never tolerate wasteful out of date ways of practicing medicine.

In 2020 the NHS should go Mobile First on eye care, like the US Army did 5+ years ago!

11. You need a Mirena coil fitted for your HRT. You can’t use other methods because they are not working and you are bleeding. Your symptoms are debilitating so you need HRT just to function. Sexual Health services for this closed.

This seems to be another one of those increasingly common examples of the NHS using COVID19 as cover for cuts to care services. A great example of why those working in the NHS should never tolerate wasteful out of date ways of practicing medicine.

“12. You are disabled by a specific mental health issue. I manage to get a referral accepted into the best clinic for this in London, out of area, so not easy. Appointment cancelled and will not give a date for resumption of services. Your mental health is deteriorating.”

This seems to be another one of those increasingly common examples of the NHS using COVID19 as cover for cuts to care services. A great example of why those working in the NHS should never tolerate wasteful out of date ways of practicing medicine.

“13. You have been told that your hip surgery can’t be scheduled currently because the list is now so long. Meanwhile you can’t exercise, shop, go upstairs at home.”

This seems to be another one of those increasingly common examples of the NHS using COVID19 as cover for cuts to care services. A great example of why those working in the NHS should never tolerate wasteful out of date ways of practicing medicine.

I’m sure that if the RCGP had attempted to train GPs to use of mobiles effectively they would’ve been more helpful to Patients with these challenges eg. recommending resources like shopping apps, physcial therapy apps, etc.

“For clarity; I can always get 2 week wait cancer referrals accepted and patients seen within 2 weeks. This has been the case throughout. But just because it isn’t cancer and it may sound trivial, there is an individual suffering and for them it is often life changing”

The private detectives and political lobbyists working for the Cancer Charities seem to have made funding for Cancer Care resistant to the COVID19 Lockdown issues.

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mHealth in Times of Crisis: the Coronavirus

 

mHealth Insight MWC 2020

Concerns over the Coronavirus have created exceptional circumstances in which the  annual meeting of the $Trillion Mobile Industry (Mobile World Congress in Barcelona) has been cancelled. On Monday the 24th February 2020 we will be gathering together world leaders in the use of mHealth to produce a seminar that will inform and educate attendees on where mHealth is today (after a decade that was defined by the convergence of mobile and health) and the best practice and lessons that can be drawn from the current methods being deployed to manage and contain Coronovirus.

The “mHealth in Times of Crisis: the Coronavirus” event will be live streamed and made available to watch/share free of charge and we intend for it to provide a best practice resource that can help prevent and manage future emerging viral pandemics.

Agenda/Timings (we’re still finalising the program so please refresh this page to see updates):

9am Opening Keynote

Li-Qun Xu (Chief Scientist, China Mobile Research Institute)

As Chief Scientist of the Research Institute of China Mobile Communications Corporation (CMCC), Li-Qun leads primarily the R&D activities of CMCC’s in M2M area in general and in mHealth applications and services in particular, responsible for setting the viable business strategy, establishing core research competence in related disciplines, and building an open, scalable and intelligent platform for delivering end-to-end mHealth services. This involves close collaboration with CMCC’s business operations divisions, medical device vendors, healthcare solution providers, academics and healthcare professionals in the value-chain, leveraging CMCC’s huge customer base, ubiquitous network coverage and multiple networking capabilities.

mHealth in Crisis LiQun Xu China Mobile

9:30am “A review of the mHealth decade”

David Doherty (coFounder of 3GDoctor and author of mHealth Insight).

In 2006 David co-founded 3G Doctor, a service providing fully documented Mobile Video Consultations with registered Doctors. Since then he’s made it his mission to ensure it remains the world’s best Doctor video consulting service. 3GDoctor has an open approach to innovation and seeks to collaborate to help bring new mHealth and wellness services to market through our unrivalled appreciation of the needs for improved access, quality, safety and patient privacy. David’s work has been cited by the BBC, Guardian, Telegraph, Harvard Business Review and other leading publications.

mHealth in Crisis David Doherty

9:40am “An introduction to Coronavirus”

Play video from 3D4Medical and discuss.

Visit the following websites and discuss:

https://www.imi.europa.eu/apply-funding/future-topics/

http://cdc.gov/coronavirus/2019-nCoV/lab/index.html

NHS Homepage

Google “CoronaVirus”

10am “How mobile is being used to contain & manage Coronavirus”

Janet Jadavji (Founder/CEO, Yecco)

Janet has been in the Health, Social Care and WellBeing profession for over 25 years and has spent the last five years growing the brand Yecco (a social media platform for carers) in the health and social care market. Janet has a wealth of experience and contacts within the space of retail, technology, insurance and public and private healthcare sector.

mHealth in Crisis Janet Jadavji

10:30am “Livestreaming Conferences: Why, How and Now”

Dr John Bennett MD (Editor in Chief, InternetMedicine.com)

John read Eric Topol MD’s book, The Creative Destruction of Medicine, and it changed the course of his life.  And it was fortuitous, too,  because his total dedication to digital medical content curation on the net combines  his  two passions; healthcare and computers. InternetMedicine.com makes it possible to have ONLINE Medical conferences and is gathering people from around the world to discuss medical topics. These conferences prove to be less expensive, more convenient, and increasingly more popular.  The sharing of the minds and networking are the two core traits of a medical conference and with the right tools we’re showing that it can be done very effectively online. In the event of an infectious disease pandemic it’s critical that education and best practice are available when and where needed and InternetMedicine have the expertise and experience to help medical organisations make the transition online.

mHealth in Crisis InternetMedicine

10:50am “How Mobile has transformed the Doctor/Patient Relationship”

Dr Fiona Kavanagh MRCGP (coFounder, 3G Doctor).

Fiona graduated in 1998 from University College Dublin (Ireland) and qualified as a member of the Royal College of General Practitioners in 2003. Fiona has enjoyed a wealth of relevant experience including work with the worlds most famous remote care service the “flying doctors”.

mHealth in Crisis Dr Kavanagh

11:10am “How mobile has transformed the Medical Record”

Dr Chris Bickford MD (Chair, Health Information Committee, Scripps Memorial Hospital La Jolla at ScrippsHealth) and Prof Linda Travis Macomber (Program Director & Faculty MS Health Informatics, National University, San Diego).

mHealth in Crisis Dr Bickford and Prof Macomber

11:30am “mHealth in the time of Coronavirus: Protecting Health Workers & Caregivers

Dr Kate Tulenko (CEO at Corvus Health)

Kate is a physician and global health industry specialist with broad experience in developed and developing country settings. Kate has globally recognized expertise in health workforce and health systems and have served on expert panels for the World Health Organization, World Bank, Institute of Medicine, Global Business Schools Network, the US Agency for International Development (USAID), PEPFAR, Hope Street Group, and the African Union. Kate currently serve as CEO of Corvus Health, a global health workforce services firm. Corvus Health provides recruitment, staffing, training, HR management, teleHR, and quality improvement and provides advisory services to governments, hospitals, health professional schools, health professional associations, and regulators. Previously Kate worked as Vice President of Health Systems Innovation for IntraHealth International, a global health nonprofit. Kate led IntraHealth’s work on new private sector business, and other responsibilities included digital health, global health security, facility data, and health economics. Kate served as the Director of USAID’s CapacityPlus Project, the world’s largest global health workforce program. I was responsible for increasing global production of health workers, including physicians and nurses and for developing and expanding systems that increase health worker retention, productivity, and quality of care. Kate represented the World Bank in Asia and Africa and worked with country governments to provide technical assistance and financing for projects on health systems efficiency, human resources for health, public-private partnerships, and water and sanitation, etc. Kate served as Coordinator for the Africa Health Workforce Program, working with in Africa to help solve the global health worker shortage. Our program achievements included expanding new worker training, increased worker retention in under-served areas, and maximizing worker productivity.

mHealth in Crisis Kate Tulenko Corvus Health

11:50am “Monitor and manage your child’s health with the eRedBook”

Jill De Bene (Founder, eRedBook)

Jill has worked extensively in Healthcare in the UK and spent time commissioning a Hospital in Africa. She is first and foremost a force for change. Someone who understands organisations and how to get the best out of the people to deliver change. She has an inclusive style which recognises that creativity and achievement and success is based on a mixture of skills, behaviours, beliefs and capabilities converging together. Jill has high energy and has worked in the NHS at Executive level and in the Private sector at Senior Consultant & Delivery Director level. She has delivered complex IT & Change Programmes of up to £100million in value with teams comprising directly employed staff and a range of subcontractors across multiple organisations over a wide geography. She has spoken at a number of conferences about how process change isn’t enough and to have a truly transformational approach you have to move people with you, engaging them and prompting them to think differently and to embrace change.

mHealth in Crisis eRedBook

12:10pm “Create accurate, widespread communications now!”

Firdaus Kharas (Chairman, Chocolate Moose)

Social innovator, renowned director and global humanitarian Firdaus Kharas produces animation, documentaries, films and television series designed to educate, entertain, and change societal and individual behavior via a process he calls Culture Shift. His goal is to positively influence viewers’ knowledge, attitude and behavior, especially that of children and young adults, in order to better the human condition.

Kharas’ work provides innovative solutions to some of the world’s toughest issues by confronting and overcoming the fault lines which separate us: language and culture; religion and ethnicity; tradition and history; stereotype and stigma; racism and prejudice; hatred and fear. “I get around the obstacles that separate human beings. I go beyond them to think of us as a human family. Using basic, core human values, we can take any issue and create cross-cultural campaigns to tackle those issues and save or improve the lives of people”, says Kharas. In a nutshell, Firdaus Kharas’ work saves lives.

mHealth in Crisis Chocolatemoose

12:30pm “The convergence of Medicines & Diagnostics to Mobile”

Professor Sam Lingam MD (Hons) FRCPCH FRCP (Glas) DCH DRCOG (Harley Street Paediatric Chambers).

In 1984 Sam established the Medical Express Clinic at 117A Harley Street as London’s first walk-in clinic. Staffed 7 days a week by a highly skilled team of friendly, empathetic staff that I have hand picked to ensure we can accurately find and treat the root cause of your health issues and work together with you to achieve your personal health goals.

Sam’s private clinic on Harley Street provides a comprehensive range of medical care for children and adults and we welcome all patients, from overseas visitors and daily commuters, to Londoners looking for an exceptional private clinic. Walk in or pick up the phone and make an appointment today and we will ensure you will get to quickly see an expert Harley Street consultant from the relevant specialty.

mHealth in Crisis Prof Sam Lingam

1pm “More than 80 clinical trials have been launched to test coronavirus treatments but none of them are Mobile First designed, why does this matter?”

Discussion of the following post:

https://mhealthinsight.com/2015/04/01/mobile-first-clinical-trials/

1:20pm “How using mobiles to take the Medical History can help diagnose Coronavirus & improve the safety of Vaccines”

TBC

2pm “FakeNews, Conspiracy Theories & Coronavirus… Who can I Trust?”

Jon Rappoport, Investigative Reporter, NoMoreFakeNews.com

John is a graduate of Amherst College (BA, Philosophy) who has worked as a free-lance investigative reporter for over 30 years. He is the author of three explosive collections, THE MATRIX REVEALED, EXIT FROM THE MATRIX, and POWER OUTSIDE THE MATRIX and has written articles on politics, health, media, culture and art for LA Weekly, Spin Magazine, Stern, Village Voice, Nexus, CBS Healthwatch, and other newspapers and magazines in the US and Europe. In 1982, the LA Weekly submitted his name for a Pulitzer prize, for his interview with the president of El Salvador University, where the military had taken over the campus. Jon has hosted, produced, and written radio programs and segments in Los Angeles and Las Vegas (KPFK, KLAV). He has appeared as a guest on over 200 radio and television programs, including ABC’s Nightline, Tony Brown’s Journal (PBS), and Hard Copy. In 1996, Jon started The Great Boycott, against eight corporate chemical giants: Monsanto, Dow, Du Pont, Bayer, Hoechst, Rhone-Poulenc, Imperial Chemical Industries, and Ciba-Geigy.  The Boycott continues to operate today. Jon has lectured extensively all over the US on the question: Who runs the world and what can we do about it? Since 2000, Jon has operated largely away from the mainstream because, as he puts it, “My research was not friendly to the conventional media.” Over the last 30 years, Jon’s independent research has encompassed such areas as: deep politics, conspiracies, alternative health, the potential of the human imagination, mind control, the medical cartel, symbology, and solutions to the takeover of the planet by hidden elites.

mHealth in Crisis NoMoreFakeNews


Refresh this page to see updates and complete the following form if you’d like to register to attend (it’s completely free) or have suggestions/ideas for the organisers:

 

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LINKS:

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RCGP publish Roger Neighbour’s ten tips for successful Video Consultations

“Many GPs and most Patients will have little previous experience of consulting remotely by video link or smartphone. Using an unfamiliar format at a time of high workload and high anxiety increases the risk of making errors of  judgement, but this risk can be reduced by paying attention to some basic principles”

RCGP COVID19 Resources

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mHealth Insights

Where’s the video?

It’s incredible that it’s taken the COVID Panicdemic and GPs fearing for their own health for the RCGP to begin taking video consulting seriously but can there be a more obvious missed opportunity to produce a video than the RCGP using what are effectively just powerpoint slides to help GPs use this technology?

Here’s a video of a talk I gave in 2014 which is an useful backgrounder on the opportunity for GPs to safely offer documented video consults:

Surely the RCGP could’ve put a easy to watch/share video like this together for quick distribution to GPs and their teams during this lockdown?

Consulting Patients Vs. talking to complete strangers

The ‘Introducing yourself’ slide really highlights why it’s pretty much a catastrophic  failure from the outset if we have highly experienced GPs talking to Patients when there hasn’t been some data shared before hand. I wonder why GPs don’t ask themselves why no other successful service provider in 2020 is doing this as surely when they ring utility companies or even to book a haircut or a plumber they realise that the company is using a ‘Customer Relationship Management’ software to improve business relationships and manage the company’s relationship/interactions with you?

A GP introducing themselves and ‘telling the patient what they would like them to call you’ isn’t only an ineffective use of their but it has the potential to immediately reduce a Patients confidence in the GPs medical knowledge because as we know if a Patient sees you are uncomfortable using technology that children have mastered they may lose confidence in how current your medical knowledge is.

In 2020 the RCGP should be telling GPs to never call Patients they don’t know and can’t immediately and easily confirm whom they are talking to. The use of a clinically validated interactive medical history taking questionnaire by the Patient BEFORE the Doctor calls them allows Patients to not just identify themselves, their needs, what they would like you to call them as well as countless other important questions, but it also ensures that the Patient is better prepared for the consultation and the GP can quickly get past the confidentiality issues and move to much more productively addressing the Patients most important medical needs with their introduction eg. “Hi Dave, I’m Doctor Kavanagh. You’re looking well today (because they can see you and your on-file headshot). Thanks for putting so much effort into completing the medical history questionnaire, reviewing your report, that you’ve already received a copy of, has been of great help to me and clearly it seems the thing I can help you the most with today is your XYZ. Would you agree?”

Pacing cues

This slide is clearly written by a GP who has never used a Video Consultation to effectively communicate with a Patient. The RCGP should be summoning Doctors who have actual first hand experience eg. Dr Amir Hannan, Dr Rupert Bankart, any of the GPs that are already using the Engage Consult Consultation system from Engage Health:

Closing the consultation

This advice from the RCGP has fundamentally overlooked the importance of the Doctor sending a copy of their notes and advice to their Patient. Without this the Patient is going to have to rely on recall or will be encouraged to surreptitiously record the consultation for their own records (which can lead to extensive issues with regard to misinterpretation, privacy, medical negligence claims, etc, etc).

The COVID19 pandemic is an opportunity for the GP profession to transform and offer Patients more than just somewhere they must go to to get help and for GPs to focus on the opportunity to work at the top of their licence.

The best way in our experience to close a consult is by providing a Patient with access to a copy of the medical history information they submitted, a summary of the advice the Doctor gave and links to additional sources of information they might find useful (eg. websites, online videos they can watch, etc, etc) and a means of providing feedback to build in a means by which we can learn from Patients on ways to improve the service.

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After arsonists attack 5G Mobile masts Social Media firms have been ordered to censor discussions of negative health effects of 5G networks

redrum 5G
The BBC’s Leo Kelion reports on how social media firms have been asked by the British Culture Secretary Oliver Dowden to be more aggressive in censoring ‘crackpot’ 5G conspiracy theories linking 5G mobile networks to the the coronavirus pandemic following a number of 5G masts apparently being set on fire.

mHealth Insights
The telcos really are dead set on shooting themselves in the foot as they attempt to roll out 5G without addressing basic reservations held by people who have been detained within their homes as a result of what they’re told by the media is a deadly virus that either originated accidentally from a Laboratory or a Wet Market in Wuhan China.
Instead of investing in efforts to explain to the public the obvious things like what 5G is, why it’s needed, how it’s being paid for, what it will be used for and how they can ensure it’s never weaponised they’ve instead took to using government power and their influence with website owners to prevent online discussion.
I see that the discussions are already being throttled with shadow banning on Twitter for people who are even just sharing the BBC News article:
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I think it’s obvious to anyone that we’re going to see these online bans fueling people who make business from selling people on conspiracy theories and fear (because now they can easily tell cynics to try and ask something about 5G and COVID19 on their own twitter page and they’ll see for themselves that their voice is being silenced) driving lots of off-line conversations and this is going to be huge for driving audiences from what will increasingly be seen to be tightly controlled government approved social media sites to encrypted websites that require the TOR browser etc and to Off-Line meetings and printed materials.

Thanks to the foolhardy Mobile operators perhaps we’re going to have to get to live in a society where random people will give you a nod and a wink about how silent microwaves are being used to selectively sterilise people…
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Related posts:

Ontario Doctors Warn of Rising Health Care Costs after 5G Roll Out (June 2019):

 

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Review of #COVID19 Medical History Taking Questionnaires

Obviously there is 50+ years of history of computers being used to help take Patient histories but most medics are only learning about Patient History Taking questionnaires as a result of the COVID19 PanicDemic so I thought it might be interesting to review what’s being produced and upload videos here (as they’ll probably all disappear as quick as they appeared. Let me know if you’ve seen any I can trial and I’ll record a demo and upload it below:

Apple COVID-19 Screening Tool:

 

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Join us at London Futurists: What should we learn from the Covid-19 crisis?

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Starting at 14.00 UK time (GMT) on Saturday 14th March this online Zoom discussion is scheduled to run for around 90 minutes and will include a number of initial short talks followed by a group discussion (in which all online attendees can participate) of the lessons that futurists can learn as individuals, nations and as a global community from the Covid-19 crisis.

Talks/Panelists will include:

“Taking a Mobile First approach to the management of Infectious Disease”
David Doherty, mHealth Insight

“Options for developing medical cures faster”
Steve Buss, Citizen Scientist

“Seeing the crisis differently”
Adah Parris, Cultural Strategist

“Reforms for the post-coronavirus age”
Tim Pendry, Crisis Advisor

About the London Futurists

The acceleration of technology means that the near future may bring radical changes to all of us. Major developments in technologies like anti-aging, nanotech, genetics, computing, robotics, and geo-engineering are going to make the next few years very exciting – and possibly also very dangerous. We could gain god-like powers – but we might also lose sight of our humanity, and destroy everything that we used to hold dear.

What’s your view? Are things improving? Too slowly or too quickly? Are we are entering a new golden age? Or is the potential “Technological Singularity” something to fear? What does it mean to talk about “Human 2.0” and “Humanity+”? Or perhaps you view such talk as techno-hype? Maybe you just like the practical side of technology and want to find out more about possible paradigm shifts?

Anybody is welcome to this group – you don’t have to be a Techno Geek or work for some futuristic company to be in our group. The future applies to us all!

Register here to attend (completely FREE).

* * * Update: copy of my #PanicDemic slides * * *

* * * Video Recording coming soon… * * *

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Global Health Matters (the bimonthly newsletter of the National Institutes of Health Fogarty International Center) features a Focus on Mobile Health

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Download newsletter (.PDF)

It’s very sad that in 2020 we’re now seeing the NIH adding it’s weight to this incredibly dangerous promotion of using mobiles as laboratory equipment… 

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The European Commission funds the launch of the EU mHealth Hub

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The European mHealth Hub is funded by the European Commission under the Horizon 2020 research and innovation programme, under the action “Establishing EU mHealth Hub including evidence for the integration of mHealth in the healthcare systems” (Grant Agreement No 737427) and is a project promoted by the United Nations International Telecommunication Union and the World Health Organisation that has been developed by the Andalusian Agency for Healthcare Quality and has already attracted 19 partners including the CAMPANIA REGION, EHTEL (EUROPEAN HEALTH TELEMATICS ASSOCIATION), EMPIRICA GMBH, ERICSSON NIKOLA TESLA D.D., FOUNDATION TALLINN SCIENCE PARK TEHNOPOL – CONNECTED HEALTH CLUSTER, ESC (EUROPEAN SOCIETY OF CARDIOLOGY), DOM ZDRAVLJA ZAGREB – CENTAR (HEALTH CARE ZAGREB – CENTAR), HL7 INTERNATIONAL FOUNDATION, I~HD (EUROPEAN INSTITUTE FOR INNOVATION THROUGH HEALTH DATA), MDOG (MIJN DATA ONZE GEZONDHEID), SPANISH MINISTRY OF HEALTH – MINISTERIO DE SALUD, OSAKIDETZA (BASQUE HEALTH SERVICE), PCHA (PERSONAL CONNECTED HEALTH ALLIANCE), PROMIS (PROGRAMMA MATTONE INTERNAZIONALE SALUTE), JÄMTLAND HÄRJEDALEN REGION, SPMS (SERVIÇOS PARTILHADOS DO MINISTÉRIO DA SAÚDE, SHARED SERVICES FOR MINISTRY OF HEALTH), UNIVERSITY OF AGDER, and the UNIVERSITY OF APPLIED SCIENCES TECHNIKUM WIEN.

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mHealth Insight NOT @ GSMA Mobile World Congress 2020

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The GSMA is currently lobbying the Spanish Government to have Mobile World Congress cancelled (so that it can claim back insurance). UPDATE: The 2020 Mobile World Congress has been cancelled.

I had no plans to travel to Mobile World Congress as while it used to have dedicated mHealth conference tracks these were stopped a few years back and this year there was going to be no mHealth presentations which is a surprise considering that the senior management of Apple (the world’s most profitable mobile company) has publicly stated that they’re going all in on healthcare and in 2016 their CEO Tim Cook has stated that Apple’s mHealth revenues will dwarf the entire $Trillion smartphone market.

If you’d like to check them out you can click the following links to read my reviews and guides to Mobile World Congress here: Reviews; 2008/2009/2010/2011/2014   Guides; 2012/2013/2014/2015/2016/2019.

I attended the first Mobile World Congress (and even before that when it was the 3GSM Congress held in France) and have been advising the GSMA in various capacities over the years (helping organise meetings, select topics etc) so I thought it would be helpful to host a webinar on Monday 24 February 2020 to talk about the importance of mHealth to the Mobile Industry. The webinar will be live-streamed from a Hospital in Central London.

The webinar will be free to attend and you can find out more and watch the livestream on the dedicated conference website by clicking here.

https://mhealthinsight.com/mwc-2020/

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What is the clinical value of mHealth for patients?

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An interesting paper asking “What is the clinical value of mHealth for patients?” has been published in Nature by Simon P. Rowland (Department of Surgery and Cancer, Imperial College London), J. Edward Fitzgerald (KPMG International), Thomas Holme (Department of trauma and orthopaedic surgery, Epsom and St Helier University Hospitals NHS) and Alison McGregor (Nuffield Department of Primary Care Health Sciences, University of Oxford).

mHealth Insights

“Despite growing interest from both patients and healthcare providers, there is little clinical guidance on how mobile apps should be utilized to add value to patient care”

We saw a paper similar to this back in 2018 and I think it’s a classic case of not being able to see the wood for the trees.

I think this is because medical educators despite the evidence still aren’t teaching students to use the tools of our time.

If you are a medic who needs to modernise your skills please consider taking the “mHealth for Healthcare Professionals” certified programme that I developed to help educate healthcare workers about the opportunities presented by mobile technology for advancing access to and quality of healthcare.

In 2020 you fail the MRCGP exam automatically by having a mobile phone on your person. Examiners should be testing you on how you use your mobile with Patients because when Patients see you uncomfortable using a mobile they may doubt how current your medical knowledge is.

“We categorize apps according to their functionality (e.g. preventative behavior change,digital self-management of a specific condition, diagnostic) and discuss evidence for effectiveness from published systematicreviews and meta-analyses and the relevance to patient care”

This is a common misunderstanding that medics have about mHealth. It’s key to understand that basic features of mobile are often the most valuable apps used for mHealth. We don’t have to have Patients download apps to their smartphones before mHealth can totally transform care eg. it’s as easy as saying ‘here’s my number’.

I wrote all about this over at Mobihealthnews 10 years ago: Successful mHealth applications are already here.

“There are only a small number of clinical scenarios where published evidence suggests that mHealth apps may improve patient outcomes”

This is a classic misunderstanding of the motivations for publishing evidence. 9 years ago a hospital here in Ireland published evidence stating how appointment letters, reminders etc should be replaced by SMS but the HSE ignores it and still wastes millions every year on more expensive and less useful snail mail and missed appointments.

It’s important to appreciate that because mobile first designed care is typically a lot more efficient and less expensive than the services it doesn’t benefit from being published in the same way that a new therapy or drug would (as these innovations come with new growth opportunities for the healthcare businesses eg. increased staffing and/or costs that they can pass onto payers like the government or insurance companies).

If you think mHealth apps aren’t getting adopted without evidence being published in clinical publications study the emergency call business. The entire Irish out of hour Doctor rota is organised using SMS for years. +99% of all calls have been made using mobile phones for 10+ years now in places like UK/USA/Ireland. Very little/anything can be found on pubmed but lots of work has been done behind the scenes by engineers. If they hadn’t figured out things like caller ID, location awareness, mobile phone design etc etc the services we see today would be completely unmanageable.

“The World Health Organization (WHO) Global Observatory for eHealth (GOe) defines mHealth as medical and public healthpractice supported by mobile devices”

When I coined the term mHealth I realised this issue was going to be a problem. It’s incredible that most people still don’t realise that the biggest part of the mobile industry still lies in the $T networks that cover the world… Before you have any hope of appreciating the mHealth opportunity you must understand that the m is for mobile the newest and least understood mass media.

“In total, 2.5 billion peopleworldwide own a mobile phone and there is huge potential for mHealth to facilitate unprecedented access to specialist clinicaldiagnostics and treatment advice. In the US 56% of physicians have discussed mHealth with patients and 26% have been asked about mHealth by a patient (PWC Provider Survey)”

I would doubt the value of a ‘Provider survey’ as most ‘providers’ still use fax machines. The vast majority (+99%) of Patients in the US have used their phone to call someone for medical advice or to look something up. Note: Facebook is very much a mHealth app.

“Despite growing interest from both patients and healthcare providers, there is little clinical guidance on how mHealth apps should be utilized to add value to patient care, where value might include improvements in speed and accuracy of diagnosis, personalized treatment regimes, behavioral change advice, patient education or improved access to established therapies such as cognitive behavioral therapy (CBT)”

It’s mostly about training. The Internet and Mobile has totally transformed education but the Universities have for the most part not yet realised:

Please be patient im still learning

“This article discusses the potential valueof mHealth apps for patients and the challenges that cliniciansface in discussing mHealth apps in clinic”

I see this is a major hurdle to the value of this paper. It’s focused on how mHealth apps can support the 2000 year old office visit model but the biggest opportunity is clearly for the newest mass media to take us beyond that model.

The Doctor office visit only model no longer works because we can look it up.

It’s like thinking a paper on how mobile will transform the post office will be interesting whereas the real opportunity lies in how mobile has transformed (and continues to transform) communication.

“Despite the citations of diagnostic mHealth appsthere is huge potential and evidence is starting to emerge todemonstrate clinically significant improvements in morbidity andmortality outcomes in specific scenarios”

I think we’re long past talking about ‘Current limitations’. Check out the Smartphone Medical from 2013. I think it’s clear none of the papers authors have ever seen an experienced medic using a quality mHealth diagnostic app like that developed by Alivecor and unfortunately I think this substantially undermines the value of this paper.

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