On competition from the world’s most affluent and profitable corporation:
“we were kind of like a lone voice in the wilderness, like a restaurant in a remote part of town, and Apple have opened up the biggest restaurant right next to us and so we’ve got to congratulate Apple for bringing awareness to this space – that you can take a lifesaving EKG at home – and I don’t think most people realise that heart disease is the biggest killer in the world”
On why Alivecor is grateful for Apple entering into this space:
“we have a $99 product and it turns out the people who need this device the most are those that can afford it the least. So if you can’t afford a $400-$500 Apple Watch our $99 product is a pretty good way to go”
On if Alivecor will be able to compete with Apple’s marketing might:
“Apple just gave every Android user a life saving reason to move to their platform and of course they’ve got to be commended for that. But at Alivecor we’re not standing still. Today on CNBC we’re introducing our next generation device which is quite an extraordinary leap. today’s device is a single lead device like the new Apple Watch but the new device is 6 lead and it can give you 6 times the resolution for you and your cardiologist to see and really it goes after the holy grail, today you can detect AFib but you cannot pick up the earliest signs of a heart attack. Our goal, pending FDA clearance, is that we will be able to pick up the earliest signs of a heart attack even possibly before you are even feeling symptoms”
“Researchers found that 41 percent of responders said they would be willing to install an app that would help doctors better diagnose mental health problems and provide treatment. An additional 43 percent said that they “may be willing to use such an app, provided they were given more information about how the app functioned.” Sixteen percent said they were not willing to use such an app”
I think the positive conclusions being made in this study are completely wrong. We live in a time when 99% of medics don’t realise that most of their Patients are already (perhaps unwillingly or unknowingly) sharing info with Apple and Google (and all their various affiliates and advertisers) that they would not even consider sharing with them…
“Whether you call them millennials or digital natives, there’s no denying that a generation of Americans, one that grew up along with their devices, is perceived to be more tech savvy than any that preceded it”
“Because of that technology and an unending roster of apps—from Snapchat to Stitcher and everything in between—today’s physicians in training seem to be more proficient in communicating and obtaining information. How does that translate to medical school or residency? When it comes to EHR training, one expert believes, it doesn’t”
“AMA Wire® spoke with Blaine Y. Takesue, MD, a research scientist at the Regenstrief Institute and assistant professor of clinical medicine at Indiana University School of Medicine. Dr. Takesue offered three reasons digital natives may still be in foreign territory when it comes to learning the ins and outs of EHRs.
EHR data doesn’t effectively translate to devices
While smart devices have in many ways replaced clunky computers in a number of arenas, that is less the case in the EHR realm. The smaller screen is a hindrance when it comes to reading and entering data, Dr. Takesue said.“If you’re used to a mobile solution to problems, that’s a much different paradigm than sitting at a computer,” Dr. Takesue said. “It has a lot to do with real estate. EHRs haven’t translated well to a phone. You need to see a lot of data. There’s not enough real estate on a phone to do that without moving through multiple screens.””
I wonder what Dr Takesue thinks of popular smartphone apps like Skyscanner or AliBaba. Perhaps he doesn’t realise that there are people in the aviation/retail industry who were similarly challenged to see the opportunity to press a few buttons on a mobile phone to arrange their travel/shop. Perhaps he doesn’t know that it was unimaginable to millions of retails that their work could be done by customers interacting with the screen of their mobile phone? If you’re struggling to imagine the future a good exercise is trying to imagine the unthinkable things that mHealth makes possible…
The EHR systems with which large health care organization’s work were created decades ago, and because of that, they don’t feature the same user functionality as newer devices.
“The problem is that many of the most widely used EHRs were not created from 2000 on—they were created last century,” Dr. Takesue said. “What we use in medicine and what we train our students on is legacy technology. There may be a solution that translates really well to mobile, which will allow questions to be answered quickly, but it’s not in wide use.””
Your smartphone, search engine or voice-activated device seems at times to know what you’re going to say before you do. Products that function this way—when the server anticipates potential communications—use a form of artificial intelligence to push out answers and solutions. EHR systems work the opposite way.
“We call it a content pull,” Dr. Takesue said. “As a user, you have to go and pull content you want to see when you want to see it.
For device users, “it hurts expectations,” he added. EHRs “don’t provide the information to the user at the time that they need that information.”
Digital quackery is a thing. It’s the big thing right now.
The hype on health apps. Here’s an overview of systematic reviews of trials on their impact. You’ll be astonished to hear there are very few trials, and gazillions of apps making health claims.https://t.co/yPbAy10leP
It’s all given me an idea to compile a list of the best examples of “Digital Quackery”. I’ll kick off the list with a few I’ve seen and please feel encourage to add your favorites in the comments (with the reasons):
CNBC have it captured well: A MAN IN WHITE COAT WITH A STETHOSCOPE TAPPING AT HIS MOBILE is a perfectly valid and useful depiction of telemedicine today. But watch a Patient using their own ECG machine and having their medical data read by a computer and referred if necessary to a Doctor (who may be casually dressed working from home while her children are at school) and you’ll realise just as video killed the radio star the incredible sensors in the super computers in our pockets have removed the tele (meaning is ‘distant’) and we now have to understand that healthcare is becoming a mobile experience (this is why it’s wiser to use the ‘mHealth’ term I coined 10+ years ago) because the potential for medicine/care is now always with us, continuously carried within arms reach and never turned off.
At the end of watching that video ask yourself do these Patients look like they are ‘distant’ from their medicine/care?
We have elderly Patients using these mHealth devices for years and when you ask them about their experience they’ve never felt closer to their medicine/care. There is no doubt that the convergence of healthcare to mobile (mHealth) has enabled us to evolve from TeleMedicine/Telecare.
“Telemedicine, or apps that let you consult with a doctor via video, was supposed to be the next big thing in health care But lack of awareness, questions about cost and reimbursement, and the human desire to talk to another person when sick have hampered the sector. Tech giants like Apple may ride to the rescue… Billions of investment dollars have been poured into apps and websites that offer this virtual consultations with physicians, ranging from Doctor on Demand to American Well. The theory behind them is that millennials would opt for a digital alternative to an in-person physician’s visit, if the option were available. And patients in remote, rural areas who are miles away from the nearest doctor would have few alternatives… …But telemedicine is still far from mainstream. Even a study sponsored by a telemedicine provider from late 2017 still found that 82 percent of U.S. consumers do not use it”
I think this is an easy to have predicted outcome of telemedicine meeting with the needs of the USA’s Insurer led SickCare model. VC money has unsuprisingly been haemorrhaging from failing ventures because a subsidised video consult isn’t a substitute for a Doctor visit.
People may be gullible when it comes to sharing their data in exchange for online services (just look at the level of personal health info sharing that Patients provide to advertising networks like Facebook or Google) but most of the more experienced older people (who have healthcare needs or care for children or elderly Parents with them) realise there is value in sharing info with a Doctor who isn’t in the business of trading their personal health data.
Yes you can obviously bluff some naive people with the offer of cheap or free chats with a Doctor advice call but communities dominate brands and Patients/Carers are increasingly becoming aware that it’s not smart to subsidise/exchange your incredibly personal and revealing information with unnamed corporations for the advice of a Doctor.
“Why the lack of adoption? Several factors are to blame. The biggest, and most important, is that many U.S. consumers are still not aware they have the option to chat with their doctor over the phone or via video”
“The awareness piece is a big problem,” admits Ian Tong, a physician and the chief medical officer at Doctor On Demand, an app that offers smartphone consultations for $75. Tong believes that part of the problem is the branding of the term “telemedicine,” which isn’t particularly descriptive, so he’s opting to use the term “video visits” instead when he talks to patients about it”
I think this is a mistake and is not realising the additional value that can be offered now that +100 million Americans can connect via video calls on devices that they always carry with them.
“Another setback: Patients heard of telemedicine apps often fear the expense, especially if it’s unclear whether they can use their health insurance. And in some cases, the apps are offering cash prices that are out of reach. $75 might be a stretch for some”
“Another common theme is that the doctors who are willing to work with app makers are inexperienced, or low-quality. Companies like Doctor on Demand will say they go out of their way to vet — and pay for — the best clinicians. But there is some merit to this concern, especially with the lower-quality services”
“In 2016, researchers posing as patients turned to 16 different telemedicine apps to diagnose skin issues. The results? Some of the online doctors misdiagnosed conditions like syphilis, others prescribed unnecessary meds, and two of the sites used doctors who aren’t licensed to practice in the state the patient was located. The authors concluded that these apps repeatedly missed diagnoses by failing to ask simple, relevant questions”
but I think the websites tested were quite scammy eg. they published “a variety of disclaimers that they do “not provide health care services,” and do “not create a physician-patient relationship,” but we found that they did make diagnoses and offer specific treatment recommendations (without sending prescriptions to pharmacies)“.
I can’t see how Dr Resneck hasn’t been obliged to report the Doctors involved to their credentialing authorities before/at same time as publishing a public paper about how they are working dangerously and without licensure.
“Finally, even in the digital age, a lot of people simply want to see their doctor in person. They’re not Luddites. But sick, vulnerable people often need in-person reassurance from another human being in the room. A smartphone app simply won’t cut it”
“Will this ever change? Roy Schoenberg, the CEO of American Well, believes that doctors, insurers and employers will increasingly inform their patients about the option to use telemedicine, which will help consumers get over many of their fears. If they’ve already got a relationship with that doctor, a virtual consult might seem like an easier alternative to getting across town to a doctor’s office and sitting in a waiting room”
I think this is a very good measure of how wedded the USA healthcare system is to serving health insurers. Amercian Well has taken $210million in venture funding over 6 rounds yet still hasn’t realised the big opportunity is in offering services direct to Patients. Imagine the CEO’s at Uber/AirBnB/Spotify thought that the Taxis/Hotels/MusicLabels would inform their customers about the option to use their mobiles to get their product via their mobile phones!
“But getting doctors to jump on board is easier said than done, and takes time. Many are afraid of liability, as it’s possible to miss something during a remote visit. And for years, it wasn’t clear whether they would get paid as much as an in-person visit. Reimbursement questions are still getting resolved across different states, but most of the commercial and government plans are on board with the idea of telemedicine — at least in specific circumstances.Another marketing boost for telemedicine could come from the big tech companies. American Well got its a plug from Apple, which announced it would work with the company for its heart-health study, so that participants could get easy access to a doctor’s office if they needed it.”
“Finally, many consumers who use high-quality telemedicine apps are spreading the word. “Consumers are realizing that it can all be done via an app, whether it’s getting a prescription, an exam or ordering labs,” said Doctor On Demand’s Tong. “There’s no need to sit in that waiting room anymore.””
Tomorrow at 11am GMT I’ll be discussing this post in a FaceBookLive video discussion with Dr John Bennett MD (and guests) from InternetMedicine.com.
Follow InternetMedicine on Facebook/Twitter to get updates. Click back here after the discussion and refresh the page and you’ll be able to replay the video recording of the discussion.
Some interesting feedback via Twitter chat with Irish GP Valerie Morris MD who has now for some unknown reason deleted her tweets which is a great shame as I was going to enjoy hearing Dr Morris explain how a ‘fully computerised’ GP doesn’t yet have a website nor offer Patients any access to Healthcare Records:
@DrVBMK: David, don’t kid yourself. Telemedicine won’t replace the traditional Dr-Px consultation which includes EXAMINATION. Vocationally trained GPs know the risks involved if you don’t examine a patient. And guess what, Medical indemnity is higher for those engage in telemedicine.
@mHealthInsight: I think the issue is so many presume telemedicine must be about diagnosis & prescribing. You can also provide care, management, followup etc
@DrVBMK: Quick comment: Busy surgery all day – 2 emergencies this morning – child & adult – managed here then sent the ED. And I’m only halfway through my morning list. of patients. Lunchtime is for home visit to see palliative patient. How on earth do you provide care using telemedicine
@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.
@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.
@DrVBMK: It’s your words, not mine. You haven’t answered my question In earlier tweet.
@mHealthInsight: Video of the discussion with Dr John Bennett is now posted on @InternetMeds (skip the first 30 mins) http://internetmedicine.com/mHealth-studio/
@DrVBMK: Are you a GP? Your tweets don’t reflect that you are one nor does it reflect real life General Practice.
@mHealthInsight: would you like a job?
@DrVBMK: Medical indemnity for full time Irish GPs is no less than €20,000 per annum (more if you provide telemedicine, OOH, minor surgery etc). Will you pay that upfront???
@mHealthInsight: How big is your HSE list as if 500+ it’s well worth us meeting up as I’m sure I could save you a small fortune
@mHealthInsight: Probably best to email me as documented video consults with Patients that aren’t enticed with offers of prescription drugs is very low risk
@DrVBMK: 98% of GP practices are fully computerised. The only time I use a pen is to sign my name. I am from the old School of Medicine. A computer will never be the interface between me and my patient. I respectfully decline your offer. I love my job.
@mHealthInsight: Do you really think there is a single “fully computerised” GP practice in the whole of Ireland?
At the Apple World Wide Developer Conference (WWDC) today Apple announced that the latest iOS12 software update for the iPhone, iPad and Mac (expected to be live later this year) will support FaceTime group video calls with the ability to coordinate video calls with up to 32 participants supported by messaging features during the calls. FaceTime call participants can be added at beginning or mid-conversation and can select to join via video or audio only.
Imagine how powerful this will make FaceTime calls for Healthcare uses? Imagine how much more efficiently 911/999 Emergency FaceTime Calls would be? Imagine how amazing it would be for GPs to be able to dial up other Carers, Family Members and Specialists when they need assistance during a Consultation? Imagine how much more effectively Video Consulting services are going to be able to perform?
What uses and new services can you think of for this new mobile video calling service?
“The Global Clinical Trials Connect 2018 conference focuses on introducing pioneer technology, developing better patient engagement and collaborating strategies in clinical trials. With the right commitment and attention to detail, contract research organizations (CROs) and pharmaceutical companies can drive collaboration with greater efficiency.
The global pharmaceutical industry has seen a downturn in recent years because of the challenges and cost associated with pharmaceutical development, procrastination in drug development, etc. Clinical trials field is also faced with such challenges. Cases of failures, cost and delay are high. It is high time that we look into innovative strategies, new technologies, effective and quality collaborations to address these issues, which can cater to the needs of the patient and the industry. Due to complex clinical trials and bygone data standardization methods, we need algorithms and lucrative strategies that will enhance the clinical trials outcomes. There are vast data collected across clinical trial process, the standardization of these data will turn into an opportunity for companies to trap the information and raise clinical trial design, patient recruitment, monitoring insights and augment decision-making”
Key Topics:
Partnership & Collaboration – Sponsors, CROs, Sites and External Vendors
Outsourcing strategies and models
Patient centric clinical trials
Real World Clinical Trial Strategies
Electronic Clinical Outcome Assessment and Electronic Patient Reported Outcome
Clinical Technology and Driving Innovation
M-Health, Wearable and Consumer Technology
Artificial Intelligence Technology in Clinical trials
Patient Recruitment and Site selection
Keeping the Patients Informed After the Trial – Post-Clinical Trial closed communities
How to future proof your clinical operations
Data Quality & Technology
Big-Data and IoT in Clinical Trials
Clinical Data Strategy & Analytics
Implementing Risk Based Monitoring
Streamlining R&D and lower costs in clinical trials
Adaptive Trial Model
Clinical Trial Auditing
ResearchKit & Mobile First Clinical Trial Design
Get in touch via the comments if you’ll be in London and would like to meet up. Refresh this page on Friday April 27th 2018 for my slides and a video of the talk. In the meantime you might like to watch a presentation I gave a couple of years ago on the topic of “What would happen if we took a Mobile First approach when designing Clinical Trials”:
RT @3GDoctor: Why FaceTime an independent impartial Doctor when you can "go & get help" from someone who still uses a fax machine 😂https://… 4 days ago
RT @mHealthInsight: Imagine how many organ donors the brilliant "Orla Tinsley: Warrior" documentary could've recruited if signing up was as… 4 days ago
RT @DrDave01: .@AliveCor can now detect dangerous blood condition via #ECG gets FDA 'breakthrough status'. I am very proud of our team and… 2 weeks ago
