Join us at Imperial Trauma, 19-20 November 2016

alex fleming

We’ve been invited to present a mHealth workshop at Imperial College London (Europe’s largest medical school) 2nd Trauma conference being held in the Alexander Fleming Building on the South Kensington  campus (19-20 November 2016).

The workshop will double up as the a new “mHealth for Emergency Care” module of the Healthcare Informatics Society’s CPD accredited mHealth course and will profile:

Speakers at Imperial Trauma will include:

To Be Announced.

Submit an Abstract to Present at Imperial Trauma

ICSM Surgical Society invites abstracts from all medical students on any topic related to Trauma Medicine and Surgery take part in The Professor Kenneth D. Boffard Abstract Competition.

The authors of shortlisted abstracts will be invited to prepare a poster on their chosen topic. These posters will be on display throughout the conference and will be judged on Saturday 19th November 2016. First and second-placed winners will have their abstracts published in the British Journal of Hospital Medicine and also receive a year’s subscription to the journal. More info can be found here.

Join us at Imperial Trauma

Click here to buy a ticket to attend as a delegate.

Sponsor Imperial Trauma

If you are interested in becoming a sponsor or exhibitor for the conference, please contact the organisers via email at sponsortrauma.icsm@gmail.com

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We’re seeking help reviewing a new mHealth app

Prof Lingams LTC and Allergy Questionnaire

We have been busy working with Professor Sam Lingam MD (Hons) FRCPCH FRCP (Glas) DCH DRCOG to produce an app that helps Parents to share complex Paediatric and Allergy histories with their Doctors. To get some final feedback before the app goes live to the world we will be hosting a meeting in London’s Harley Street. There are a few places available to attend that we would like to offer to readers of mHealth Insight.

Background

Professor Lingam is a very talented and experienced Paediatrician who has published some of the formative work in this area eg. the first ever paper on allergies by a Paediatrician (in 1984!), a paper discussing why Paediatricians should share all their notes with their Patients (in 1986!), the basis of this questionnaire and it’s template (he’s been providing it to Parents in a paper based format since the 1980’s!).

At 3G Doctor we have been using Instant Medical History (the world’s most advanced Patient History Taking Questionnaires) for nearly 10 years and it has taught us so much about the opportunities that emerge when Patients get the opportunity to share their medical history  via their mobile. As partners with Prof Lingam on this global project we want to take the innovative paper based questionnaires he developed in his work at world leading children’s Hospitals and make them accessible to billions of Patients the world over who don’t have access to such interactive tools. They will also be added to the Paediatric history taking questionnaire sets used within Instant Medical History.

The feedback event

The event (date to be confirmed) will be held at Professor Lingam’s 117A Harley Street Clinic (London’s first Walk in clinic). As an attendee you will get the opportunity to:

> Learn of the clinical value of this Patient empowering tool and the Clinician template.

> Trial the app and share your feedback.

> Meet with world class medics who we’ve already confirmed for the meeting

> Meet with the world class Mobile Developers who we have building the app and learning from your insights.

Places are limited but if you would like to apply to attend and contribute to making this incredibly powerful tool available free of charge to Patients and their Parents the world over please get in touch via the following form:

Note: if you are selected to attend all of your travel expenses will be reimbursed.

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Does mHealth = data overload for docs?

I noticed this “Data Overload: Doctors, Apps, and Wearables” video of Dr Robert Watcher being promoted on Twitter and it seems to be peddling a very common misconception amongst people who don’t actually understand or use mHealth with Patients eg. Forbes “Doctors Don’t Know What To Do With Data From Fitness Trackers” (Dec 2015)Laurie Orlov: mHealth Mania – beware the hype (Feb 2013)“Mobile health = Hype” (Dec 2012), etc.

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mHealth Insights

“more and more patients are using wearables and apps that’s both exciting but it’s also creating some real problems for physicians why is it exciting because patients now have the ability to monitor their own sugars or their breathing rates or their steps and for many of them that kind of engagement is very positive but for many physicians when you talk about the idea of all 2,000 their patients collecting data all day long and streaming and wirelessly to the physicians medical record for most doctors they find that prospect terrifying”

Why do people peddle such nonsense? There’s plenty of evidence showing that healthcare utilisation isn’t even increased when you give Patients ECG machines! (so long as they’re Mobile First designed/make sense to the born mobile generation).

Also what’s the point in making this all seem like it’s new and terrifying? I have friends who have been monitoring their blood glucose for 20+ years and there’s no question that their self care has increased the workload of their GP (AND it’s also enabled them to live much longer healthier lives).

“and so we have to figure out a way of managing this data and I suspect what it will be is having more sophisticated computer programs that essentially triage the data and in particular larger practices there may need to be other individuals than the doctors health coaches case managers and others were monitoring the data helping patients manage their own care and getting the doctors involved in  the patients seem to be doing poorly”

Endocrinologists working with Patients who use Telcare medical devices (that have their own embedded mobile connectivity) have been doing this for years. Check out this talk  Prof Jonathan Javitt (coFounder of Telcare) gave back in 2013 that explains how this new model of care is empowering Patients and their Care Teams.

John Maynard Keynes The biggest problem is not to let people accept new ideas, but to let them forget the old ones

Related: The future of health monitoring is here but it’s being used to make animals run faster.

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“Diabetes doesn’t change what you can do” Theresa May, British Prime Minister

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This week Theresa May became the first British Prime Minister who will have to manage Type 1 diabetes (on top of managing a country that’s just voted to exit from the European Union).

I’ve tried to follow the monitoring schedule that an insulin dependent diabetic is prescribed and it’s incredibly time and energy consuming. I can’t imagine that Theresa May’s lived experience won’t lead to her helping the NHS get behind the International Diabetes Federation’s call to embed mHealth and make it a compulsory part of how we provide quality care to citizens who have diabetes.

Follow Theresa May on Twitter.

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Dr Sanjay Gupta: mHealth will revolutionise the Healthcare Industry

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“As CNN Chief Medical Correspondent Dr. Sanjay Gupta says, “In the world of telehealth, the doctor will always make a house call by mobile device or other technological means. Surely, this is a way to improve the global health of the world.”… …According to Gupta, there’s no question that mobile health (mHealth), or communication via mobile technology in real time to improve and change the outcome of health, is coming fast… …“It will revolutionize the industry,” says Gupta. “If you have an established relationship with your M.D. and they are available via mHealth, then continuity of care is a big win for you.”

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Join us at the Kings Fund’s Digital Health & Care Congress

KingsFund Digital Health and Care Congress

The annual Digital Health and Care Congress at the Kings Fund in London the 5-6 July 2016 provides a key opportunity for you to join with peers to explore how the better use of technology and data can support and enable the developments needed to transform outcomes for patients and citizens.

Keynote speakers include:

Raj Adgopul, First Byte Community Interest Company
Mr Hasib Aftab, Head of IT and Systems, Camden Clinical Commissioning Group
Chris Boulton, Nat Hip Fracture Database Project Manager, Royal College of Physicians
Lisa Brunton, PhD Research Student, University of Manchester
Beverley Bryant, Director of Digital Technology, NHS England
Dame Fiona Caldicott, National Data Guardian, Health and Social Care
Paul Chamberlain, Professor, Sheffield Hallam University
Aimie Chapple, Accenture
Robert Dunlop, Elsevier
Dr Neel Gupta, GP Representative and GP Governing Body Member, Camden Clinical Commissioning Group
Professor Chris Ham, Chief Executive, The King’s Fund
Julian Hamann, Medical Director, Cupris Health
Hazel Harper, Independent Living Innovation Platform Programme Manager, Innovate UK Rt Hon Jeremy Hunt MP, Secretary of State for Health
Heather Joy, Nervecentre Software Ltd
Phil Koczan, Chief Information Officer, NHS Waltham Forest Clinical Commissioning Group
Richard Murray, Director, Health Policy, The King’s Fund
Dr Niels Peek, Reader in Health Informatics, The University of Manchester
Sally Pezaro, Doctoral Researcher, Coventry University
Luke Readman, Chief Information Officer, Waltham Forest, Newham and Tower Hamlets CCG
Alyson Scurfield, Chief Executive, Telecare Services Association
Inderjit Singh, Head of Enterprise Architecture, NHS England
Mustafa Suleyman, Co-founder and Head of Applied Artificial Intelligence, Google DeepMind
Matthew Swindells, National Director, Commissioning Operations and Information, NHS England
Frances Taggart, Warwick Medical School
Dr Robert M. Wachter, author of ‘The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age’ and Professor and Interim Chairman, Department of Medicine, University of California, San Francisco

Keynote Topics will include:

The digital future of the NHS
Telehealth, Well Designed and Designed for Wellbeing: Design Guidelines for User Experience
Assessment of a smartphone-connected otoscope and associated healthcare communication platform
Active clinical decision support – empowering primary care clinicians to deliver preventative care to that can cut costs and save lives
Using real-time online reports to improve care for patients with hip fracture
The importance of digital health in the implementation of the Five Year Forward View
UK Healthcare Pathway App for migrants
Electronic Handover to increase Patient Safety
Digital technology for communication between clinicians and young patients with chronic conditions (LYNCS study) – An international review
Perspectives and experiences of health professionals on the implementation and use of telehealth for COPD services: towards personalised and holistic support
The Camden Integrated Digital Record tale – enabling the clinical transformation agenda across Health and Social care
The impact of Artificial Intelligence (AI) in healthcare
Data security in the NHS: Overseeing the safe use of personal health and care information, holding the health and social care system to account and acting on behalf of patients and care users.
Supporting self-care for patients
Overcoming barriers to interoperability: lessons from Central London Community Healthcare NHS Trust
Digital solutions for allied health professionals
Using informatics to improve systems and services
Web-based tools and apps supporting patient wellbeing
Innovation in digital health: using the internet of things
Using apps to support clinical decision making
Accenture Doctors Survey 2015
Improving access through the use of technology
The Dementia Challenge: A Human-Centred Approach
Involving an expert panel in the development of an online intervention designed to support midwives in work-related psychological distress: Exploring the outcomes of a Delphi study
Out-of-home activity recognition from GPS data in schizophrenic patients

Sponsors include:

Orion Health
Digital Healthcare Management
Vivify Health
GlooDoo

Register:

Click here to register here (ticket prices: £240-605 + VAT)

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AMA CEO calls out mHealth apps as Snake Oil…

In a presentation titled “Digital Dystopia” at the American Medical Association’s 2016 Annual Meeting in Chicago the associations Executive VP and CEO James L Madara MD shares his thoughts on “the emerging digital environment” and calls out Eric Topol’s books and mHealth apps as ‘snake oil’.

mHealth Insights

I think James L Madara MD has made a careless mistake here and shown that the American Medical Association is out of touch with the opportunity to adopt the tools of our time. He’s clearly reading a script and I get the feeling he hasn’t written it so perhaps it’s not too late to hire in a Mobile Industry guru to run a mobile training camp for the team there at the AMA and then build on this with mHealth training for all AMA members before launching some progressive initiatives that show real leadership eg. a mandate requiring members use smartphones (that are loaded with high quality clinical content and up to date reference texts) when practicing, etc, etc.

“But today, I’d like to provide thoughts on the emerging digital environment we find ourselves in: and what we might do to move toward digital tools that lead to professional satisfaction and improvements to care, rather than to further practice disruption”

I think it’s critical that we are very clear: the work Doctors do today would be completely impossible to achieve without mobile technology:

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“Our AMA predecessors engaged the very heavy lifts of stamping out quackery, creating standards for medical education, and developing the first code of medical ethics. Simply put, the AMA stopped the flow of the snake oil remedies of that time”

I think James L Madara MD‘s referral to how the AMA stamped out the snake oil industry quackery is an interesting nod to where the organisation is struggling with the new landscape. The business model for the AMA used to be in providing the seal of approval for medical products and as they’ve had their eye off the ball for so long they’ve lost this first to the internet giants (Google was practically seed funded by all-too-often-illegal adverts for medications) and now to the mobile giants (the app store owners Google and Apple).

“But you know something, appearing in disguise among these positive products are other digital so-called advancements that don’t have an appropriate evidence base, or that just don’t work that well—or that actually impede care, confuse patients and waste our time. From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality. This is the digital snake oil of the early 21st century”

I think there’s an intentional attempt here to ignore the obvious difference. These apps of mixed quality automatically come with an obvious clear rating score. Instead of thinking there’s some point to beating up on junk cookie cutter apps that no Patient would ever even think of using, I think the AMA would find it much more productive having a productive conversation with Apple and Google to add something like “AMA member ratings” to the medical app sections of their app stores so that Patients and Carers can better compare and contrast these when looking for and evaluating apps they are considering using.

“Even those digital products that might be helpful often lack a way of enriching the relationship between the physician and the patient. It’s like trying to squeeze a 10-gallon product idea into a 2-gallon health care knowledge base. More and more we’re seeing digital tools in medicine that, unlike digital tools in other industries, make the provision of care less, not more, efficient. And these digital tools often don’t connect with each other—interoperability remains a dream. We were told that interoperability was the future; we didn’t expect that it would always be in the future. The age of digital snake oil”

This is a common feeling among Doctors who are jaded by the successive failures of digital technologies that initially promised so much. It’s important to appreciate that in 2016 things have moved on and it should be obvious that the mobile industry has fixed interoperability issues eg. I can text some money via mPesa to a worker in a rural village in Kenya and they could use it to sms or place a call to the President of the United States.

In 2016 the AMA should not be whining about the lack of interoperability but using it’s immense power to back progressive things that are available to fix the lack of interoperability that results in poor outcomes for Patients eg. backing the International Diabetes Federation’s call to make mHealth an embedded compulsory part of how we provide care to Patients with chronic conditions and ending the nonsense we have today where expensive consultants waste everyone’s time fanning their faces with the diaries that Patients are diligently completing.

“Energizing this rush of new products we find popular books predicting a future of digital health care, that in the near future, will bypass physicians altogether—where patients can largely look after themselves. These extravagant claims did achieve their primary goal: Lots of books were sold. These claims also drew the attention of the lay press and private sector, two groups that couldn’t have known any better. One highly praised book touted how patients could order their own blood tests by the hundreds—do it today!—then follow algorithms to essentially self-treat. Snake Oil Stanley would be so proud! Anyone been reading the papers of late? Been following the many evolving investigations and apparent fraud of such touted new pathways? … That hallucination didn’t turn out so well, did it? As one of our presidential candidates might tweet: “DUMB!”

I think it’s clear that the book(s) being referred to here are Eric Topol MD’s brilliant “The Patient Will See You Now” and “The Creative Destruction of Medicine”. I can’t see Eric being harmed by this (sales will probably spike again with inquisitive Doctors wanting to find out what he is actually predicting – click here to order your copy of “The Doctor will see you now” on Amazon) but I think it’s very unfair to  label a book in which a Cardiologist shares his thoughts on a possible future of medicine by comparing it to the outright scam of Theranos that put Patients lives at risk eg. writing that Patients will be able to order their own high quality blood test and actually giving someone a blood test result that you know is inaccurate and unverified are two totally different things.

It’s quite bizarre that the AMA CEO has gone on record in 2016 stating that it’s somehow unbelievable that we might arrive at a time in the future when Patients will be able to ‘look after themselves’. Isn’t that what they’re already doing in the thousands of hours they have in-between office visits? Isn’t that what every diabetic has been doing since glucometers were introduced and they no longer needed to go to a Doctors office to test their blood glucose?

We practice medicine, new evidence comes to light, we debate it, we adopt it. We should not label the progressive smart Doctors who are brave enough to lead the debates as snake oil peddlers. Where was the AMA’s statement and advice to members on Theranos (before the WSJ expose)?

“Fortunately, more sober analysis of the current state can be found elsewhere, as in Bob Wachter’s wonderful book, The Digital Doctor. A more promising digital future can be envisioned that enhances the physician-patient relationship, produces better and more efficient care, and allows more time for physician-patient interactions—the type of outcome that has been so falsely promised by much of the current digital snake oil”

I think it’s more than a little naive to be thinking that the future is just more of the same especially as there is absolutely no evidence whatsoever to suggest that technology is being used by the big healthcare companies to increase the amount of time a Doctor spends with Patients.

In fairness to Eric Topol’s books they make a powerful case for the important role Patients/Carers need to play to influence this direction and for Patients to do more to manage their health and ensure that the time they have with Doctors is better spent.

“But Wachter provides no false illusions as to the current state, and well describes the present. Something I’d call our digital dystopia: from direct-to-consumer digital health devices—which, only in the fine print say “for entertainment purposes only”—to our clunky electronic records, to ICU’s that sound like primitive swamps abuzz with a cacophony of bells, alarms, and whistles”

I think this statement is revealing because it suggests that Dr Bob Wachter’s book is okay because it discusses a familiar easy to understand gradual change that’s happening whereas Eric Topol MD has crossed a line because he sees the healthcare model being transformed not by tweaking a Doctor’s clunky EHR but by handing over ownership of the healthcare record to Patients.

Because (as William Gibson famously stated) “The future is already here – it’s just not evenly distributed”I think the AMA would be able to better build on it’s leadership by highlighting the good work of Doctors who have moved beyond the comfortable and embraced new ways of working rather than knocking 15 year old app developers who are just trying to share their ideas and showcase their talent. Good examples might be the GPs in the UK’s NHS who are using what are essentially early Mobile First Electronic Record systems, the Intensive Care Units in the NHS that have for some years now taken a mobile first approach to design and eliminated unreliable error-prone labour intensive paper based processes and replaced the alarms/buzzes/whistles with personalised mobile messaging systems, etc.

“Just as in the mid-19th Century when we separated the useful anti-toxins and compounds like aspirin from Stanley’s snake oil remedy, today we’re tasked with separating the digital snake oil from the useful ­­—and potentially magnificent—digital tools. The future is not about eliminating physicians, it’s about leveraging physicians”

If in 2016 you feel like James L Madara MD please order and read Communities Dominate Brands by Tomi Ahonen and Alan Moore now. It was published over ten years ago but the teachings in it will still be life changing for you.

“Leveraging you by providing digital and other tools that work like they do in virtually all other industries—making our environments more supportive, providing the data we actually need in an organized, efficient way, and saving time so we can spend more of it with our patients. A new AMA study analyzed a variety of settings and type of practices: 50 percent of physician time was devoted to the keyboard—50 percent! Only a third of their time was free to interact with patients.”

If the AMA can’t get American Doctors using anything better than clunky inefficient and super  expensive EHRs why do they think they’re in a position to influence and provide the quality control on mHealth apps that Patients will want to use?

“To compound this, physicians also spent two hours each evening on the keyboard finishing the data entry from the day… evening hours that used to be spent reading JAMA or decompressing with family. Our current state? American physicians have become the most expensive data entry workforce on the face of the planet. What a waste. How frustrating”

In what world is the solution to this the wholesale write off the idea of Patients using apps? (some of which we know are proven to save Doctors from the very administrivia he’s complaining about!).

“Let’s face this 21st century digital snake oil the way our predecessors confronted their task in the 19th century: by inserting ourselves into the processes from which digital tools emanate. So, how do we do this? What are we working on? To begin with, we’re intensively working with vendors and manufacturers as well as the federal agencies that regulate them. You’ll later hear from CMS’ Acting Administrator Andy Slavitt on enhanced federal pressure for interoperability and efficiency in our health records. For EHR 3.0, not 1.0”

Oh dear… the AMA thinks it’ll be able tackle what it deems to be ‘snake oil’ with unimaginative and meaningless buzzwords like “EHR 3.0”. Most Patients in the USA can’t even view their EHR!

“In retrospect, one might argue that our field was insufficiently embedded in the creation of the first wave of digital products. The result: defective products not informed by physicians”

I think the opposite happened and the healthcare industry is today littered with defective products that are not informed by the very Patients and Carers that need to use them and make absolutely no sense to the BornMobile generation eg. the implanted cardiac devices that don’t inform Patients if they’re on/off/defective, the expensive unconnected medical devices that we prescribe to children that are so dumb Parents are pressurised into DIY hacking efforts, the millions of unconnected ostomy bags that Medics have neglected to even think about even bothering to connect, etc.

“Today, we’re active in pursuits toward correcting this—toward having physician knowledge embedded in the development of new products. Here are a few examples: First, we’re conveying to manufacturers what physicians actually need. Digital tools that add layers onto our day are not helpful—those are digital snake oil, we hate them—hate, hate, hate them. In contrast, digital tools that would simplify and better organize our lives, and also adapt to the natural variations in our practices—those that would free more time for patient interactions—that’s what we want. Tools like that we’d love—love, love, love. There are too few of these today.”

I think this sentence highlights how obsessed the AMA is with measuring a Doctors time and how challenging it finds attempts to move beyond the office visit model where the only thing that’s being measured is the Doctors time.

“Second, we’re forming interactions with the emerging companies that produce health-related goods and services—for example, working with MATTER, a Chicago-based incubator for emerging health care companies. More than 120 companies are now located in MATTER, as well as our AMA interaction space. There, we inform entrepreneurs of the exact needs of physicians at the creation of innovative ideas. Some of you have participated in this—and for that I thank you.”

I think the AMA need to be careful in taking shots at app developers because what if one of these 120+ startups turns out to be a lemon (or worse still a fraud) what’s the forfeit that the AMA is going to make for backing them with their support and vouching for their credibility when it’s been so quick to call ‘snake oil’ on the established companies that are already operating in this area?

“We do much better if new products and services are deeply informed by our actual problems and needs, rather than flying on an entrepreneur’s incomplete views. We bring the granular understanding of the physician-patient environment. That’s difficult to discern from the outside”

I remember hearing similar comments out of motor industry execs when they heard about Elon Musk‘s crack pot ideas for electric cars ten years ago…

“Third, in January we launched an innovation studio in Silicon Valley, Health 2047. Health 2047—(the 2047 in recognition of our 200th anniversary)—will take many of the problems identified by AMA studies and apply rapid prototyping and design to achieve tools based on physician need. Emerging prototypes will be iterated with physicians until the tool gets it right. This effort is attracting high-level talent in Silicon Valley. Talent that’ll be directed to the problems faced by physicians”

In this paragraph is everything you need to explain why this plan has no chance of working. It’s a strategy that would be like Elon Musk moving to Wolfsburg or Stuttgart and iterating his prototypes with petrochemical and combustion engine experts until they got things right!

As the old saying goes: an expert is someone who can tell you every reason why a new approach won’t work…

“Fourth, while shaping this future, we also need to address the current state. That’s why we’re identifying workflow and practice adjustments that can produce higher practice satisfaction today. These digital modules, which we call Steps Forward™, are available to all physicians and can be accessed through our website. I announced Steps Forward last year at this meeting; and since then more than 70,000 users have accessed these tools to improve practice”

It’s interesting that while the AMA see’s the value in physically moving to Silicon Valley it’s not adopting the silicon valley startup mentality to adding new products. Instead of buying an already operational business that excels in this area and will bring proven talent the AMA has gone and built it’s own new business unit. It’ll be interesting to see how this approach works, until then it gives the impression the organisation isn’t confident that the silicon valley approach is an effective way to develop new business units.

“We’re now fully engaged on many fronts—engaging not only the important aspect of legislation and regulation, but also directly engaging those who produce the products and services that’ll feed our practices … pipeline products that are now being informed from the start—with the knowledge of what physicians actually need”

Perhaps it’s just me but I think the AMA would have more success if it focused on new products that Patients and Carers need rather than “what physicians actually need”.

“I’ll end with something from Bob Wachter’s book: quote —”Even when that wonderful day arrives when we have finally coaxed the machines into doing all the things we want them to do, and none of the things we don’t, we will still be left with one human being seeking help at a time of great need and overwhelming anxiety.”—end quote. That relationship between the physician and the patient isn’t a transactional one—but it’s one that requires time; time that should be made available by helpful digital tools; tools that work effectively as they do in virtually every other field, but ours. We need that…..and we need to be directly involved to make it happen. What we don’t need, is more digital snake oil”

I get the feeling from this choice of quote that the AMA needs to move beyond the idea that the Physician Patient relationship is always about high intensity diagnostic moments that are spent in the clinic. We need to be clear that in 2016 the vast majority of Doctor consultations involve Patients who have already  been diagnosed and are managing long term conditions, before any of the major opportunities for tech to enhance the Doctor/Patient relationship will become apparent.

It’s also key to appreciate that in virtually every other field the digital disruption that happened because companies went mobile first was never initiated by the association that represents that industry eg. Apple Computers wasn’t a member of the GSMA when it launched the iPhone, Amazon wasn’t a member of the various retailer associations, Uber wasn’t a member of the New York City Taxi & Limousine Commission, AirBnB wasn’t a member of the American Hotel and Lodging Association, Facebook wasn’t a member of the any established media associations, etc, etc.

What thoughts did you have on watching the AMA CEO’s keynote talk?

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