“Remote Monitoring in Heart Failure: No Additional Benefit”

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mHealth Insights

The executives at Medical Device companies who have sat on their hands doing nothing to connect their devices or create interactive experiences will be cheerleading these results but we shouldn’t let them as this is exactly the type of discrediting that they need to keep getting away with failing Patients, raising the sale prices of their decrepit tech and maintaining barriers to market for new entrants who are taking innovative connected approaches: The failure to use data effectively doesn’t mean the data doesn’t have value.

Imagine what the BornMobile would think/say if Dr Martin R Cowie tried to explain the design of this study to them:

> What do you mean the Patients have no idea if the live saving medical device you have implanted in their body is switched on/off, is faulty, has a flat battery, has the latest patched software installed, etc?

> Why have you not even tried to connect the Patients in your race to get data from the devices?

> Why is your monitoring focused on these devices and not on your Patients?

> Why do you make these patients travel and do things every week when I can just press my phone and an Uber arrives?

> I’m surprised the Patients in your connected group didn’t have worse outcomes with all the extra unnecessary hassles your made them undertake as part of your study.

> Did this study pass your mother test eg. is this how you would care for a Patient who was also your Mother?

we could find no evidence of additional benefit from remote monitoring,” Dr Martin R Cowie (Imperial College London, Royal Brompton Hospital, UK) told conference attendees

If you are a clinician or researcher who is unable to find benefits from remote monitoring find someone to collaborate with who can. There are a lot of very senior people in organisations like the NHS who are bluffing about Big Data etc so you’ll probably need to kick some tyres before you’ll find someone good but check out the introductions to the mHealth group as there are some really smart professionals to be found there and via Linkedin you can check out their backgrounds/connections/work experiencee.

researchers found that remote monitoring did not reduce mortality or the number of cardiovascular hospitalizations compared with usual care”

I wonder why these researchers think every car manufacturer is following Tesla’s lead and embedding connectivity into their vehicles to deliver a modern ownership experience? Imagine how Elon Musk would be mocked if he said they were going to remove the embedded connectivity in Tesla cars because they made no difference to breakdown and crash rates and didn’t save Tesla engineers any time or money?

“Patients (mean age 70 years) had one of three types of CIEDs equipped for remote monitoring: a cardiac resynchronization therapy (CRT) device with pacemaker, a CRT device with defibrillator function, or an implantable cardioverter-defibrillator (ICD)… …Researchers analyzed automatically downloaded weekly data from patient devices and advised the patients about medication, lifestyle, the need for clinic visits, or other recommendations. Usual-care patients did not have automatic downloads but had usual remote monitoring every 3 to 6 months plus usual care for heart failure”

Were these Researchers also the Doctors who were caring for the Patient or do we have unfamiliar ‘researchers’ who have little/no medical training with clipboards as the value of these interactions will be very different.

Imagine the laughing stock if a car manufacturer tried to conduct research that was designed like this and presented it at a big auto industry meeting: a control group had to go to the garage receptionist every week to do a data dump and get some boiler plate advice about their driving style and the other group had to drive around in their car with all the dashboard lights/alerts disabled and turn up every 3/6 months.

“70% of the patients had additional actions taken by looking at the remote data”

Amazing that so little is made of this finding in the article. This sounds just like the type of data you might like to compare and contrast the devices that are being bought from different manufacturers at widely varying retail prices. This data seems like exactly the type of data needed to calculate value for money for the NHS.

Perhaps these Heart Failure researchers aren’t aware of the calls for connectivity to be embedded in medical devices by organisations like the International Diabetes Federation (millions of Patients with diabetes are already self managing medical devices and are benefiting from remote monitoring)? What do you think?

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What if your mobile could detect Parkinson’s before symptoms appear?

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A low cost eye test developed at the UCL Institute of Ophthalmology offers hope of detecting Parkinson’s disease before symptoms develop.

I’ve been learning so much and having some very interesting experiences since I started carrying an Eye and Retinal Imaging System (by attaching a D-Eye device to my iPhone) and it’s stunning to think of the potential for this technology to be used in Primary Care Screening programmes like you can already see happening across the world with community screening initiatives for AF with the Alivecor ECG.

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Can you imagine the potential if big charities investing in Parkinsons research (like the Michael J Fox foundation, Parkinsons UK, etc) worked with an innovative company like D Eye to introduce screening programs and then recruit Citizens and Patients to participate in Mobile First Clinical Trials?

Related Posts:

The Smartphone Physical

mHealth Insights from the American Academy of Ophthalmology Annual Meeting

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Patients need the ATTENTION not the TIME of their GP

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This BBC News article reporting on the BMA’s recent report on “Safe working in general practice” shows how complex it is when we think the only thing a GP can do is provide timed office visit appointments to their Patients:


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mHealth Insights

As a rule of thumb I find that if in General Practice you need to resort to using buzzword terms to get a point across (eg. “controlling GP workload through a locality hub model“) the concept you’re promoting is probably too complicated or you don’t yet actually understand what you’re trying to do. If you struggle with this Dr Wendy Sue Swanson’s TedX talk about using the tools of our time should be of help because very often the tools that we need to use with Patients don’t need to be bought in multi-year multi-£billion tenders because they’re already in our pockets.

It should be obvious that attempts to measure the work of a GP by how long they spend with a Patient is a losing battle when you realise there are NHS GPs writing in national newspapers that they spend much of their day consulting with Patients who they think are wasting their time.

The NHS makes no sense if you think the product GPs make is office appointments so wouldn’t it be better if the BMA stopped calling for more of the same and backed efforts by NHS GPs who have moved beyond the office visit model?

Making champions of smart GPs like Dr Rupert Bankart who are sharing evidence on new models that work for GPs and are popular with Patients would be a great start.

Related Post: Does John need your Time or Attention?

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Share this with someone you couldn’t live without & make roads safer for everyone #ITCANWAIT #mHealth

Related posts:

Road Safety is a key feature of Samsung’s new Galaxy J3

Google launches Android One accessible smartphones in India without even a nod to mHealth

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Join us at the Irish Street Medicine Symposium at University College Cork

Irish Street Medicine Symposium 2016

On Saturday the 24th September 2016 at University College Cork the annual Street Medicine Symposium will meet to share information and best practice on Health and Homelessness. The meeting is being organised by the Adult Homeless Integrated Service, HSE South in partnership with the Department of General Practice and GP Vocational Training Scheme, UCC and The Partnership for Health Equity.

There will be plenty of opportunities to interact and connect with ‘Street Medicine’ colleagues from around Ireland and further afield, confirmed speakers include:


My talk will discuss the opportunities to take a Mobile First approach to help meet the complex challenges of homelessness. It will only be a short session but will introduce the 1 hour online CPD accredited HISI course I’ll be launching at the event titled “mHealth: Helping meet the challenges of Homelessness”.

Key points I’ll be looking to introduce/cover include:

> Why we should think ‘Mobile First’ when designing services to serve homeless populations.
> How mobile can help encourage inclusion and ensure homeless populations stay connected and aren’t left behind.
> How Mobile connectivity can help bridge language barriers and create independence and wealth.
> Mobile Communities and Addiction Treatment programs.
> The opportunity Mobile provides us with to serve immigrant Patients.
> The Mobile opportunities for Mobile Fundraising and Awareness.
> mHealth success stories from around the world.

If you have any ideas or suggestions for my please share them in the comments below and I’ll try to add them.

To register for the meeting click here (this event is CPD accredited).

Unfortunately the call for papers closed in July but if you would like to get involved in the event with sponsorship or a booth etc you can contact the organising team on streetmedicinesymposium2016@ucc.ie

*** UPDATE 23 August 2016: A background reading list ***

Some great shares by Claudia Pagliari kick off a recommended reading list:

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CNET: Homeless, not phoneless: The app saving society’s forgotten tech users If you became homeless, would you keep your smartphone? One app offers life-saving guidance, in the recognition that someone might not have a bed but likely still has a phone.

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U.S. Minority Homeless Youth’s Access to and Use of Mobile Phones: Implications for mHealth Intervention Design.

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Journal of Substance Abuse: Factors Associated With Patterns of Mobile Technology Use Among Persons Who Inject Drugs

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Journal of Health Communications: Perceptions, Attitudes, and Experience Regarding mHealth Among Homeless Persons in New York City Shelters.

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UPDATE 24 August 2016: HomelessSMS is interesting SMS based service in development in the Netherlands and UK that was shared by Keith Grimes over in the Linkedin mHealth group:

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Thanks to a nurse colleague (who doesn’t yet have a social media presence!) for this link: STAT: 4 trends in health care that were pioneered in homeless medicine:

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“To make health care more accessible and higher quality, insurers and providers are experimenting with a number of new approaches — from storing patient information in the cloud to opening clinics inside of grocery stores.

Close cousins to many of these tactics, however, were implemented even earlier in the homeless health care system. Homeless patients’ unique characteristics — they frequently have multiple chronic conditions, they move around often — overlap with some of the pressures driving medicine’s evolving care model today. And the cost and time constraints of the homeless revealed the weakness of the health care system before others saw it”

UPDATE 1 September 2016: Handup is interesting app that helps charities to raise funds for homeless individuals online:

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UPDATE 1 September 2016: OurCalling is a non-profit based in Dallas USA that have developed an app that provides an aiding tasks that enables volunteers to lend their ‘knowledge not money’ to  homeless individuals in a quick and easy way.

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Key features of the app include an up to date database of service providers for the poor searchable on a map or by distance from your location (eg. shelters, clinics, food, rehab, etc), calendar listings of volunteer opportunities, etc. One feature I think looks very helpful is how it enables the volunteer network to identify locations for outreach teams to visit: 

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AsthmaUK: “We believe mHealth solutions are the future for asthma care and the key to reducing highly preventable deaths”

ASTHMAUK REPORT Connected Asthma How Tech will transform care

An interesting new report titled “Connected asthma: how technology will transform care” from Asthma UK. Find Asthma UK on Facebook, follow them on Twitter @asthmauk @AUKResearch.

mHealth Insights


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Apple CEO thinks mHealth revenues will dwarf the $Trillion Smartphone market

MASSDevice Apple CEO mHealth

A fascinating MASSDevice article reports on an interview with Apple CEO Tim Cook.

mHealth Insights

“CEO Tim Cook says that the healthcare market’s potential could dwarf the smartphone market that accounts for some 65% of Apple’s $234 billion in annual revenues”

Okay so we’ve heard Tim Cook’s enthusiasm for mHealth before (eg. does Tim Cook have plans to define this decade by making iPhone synonymous with mHealth, Neelie Kroes interviews Tim Cook at Startup Fest Europe, etc) but I think this is very important because it means everyone in the mobile industry now knows that the market leader is having another transition just as it did with the launch of the iPhone (a device that had a potential market that we know completely dwarfed the huge revenues that the company had been generating from the iPod and iTunes markets).

“The consumer electronics giant – which is rumored to be developing a stand-alone device to monitor heart rate, pulse, blood and sugar changes – has a significant advantage over medical device and drug manufacturers, Cook told FastCompany.com”

To me this rumour is nonsensical and illustrates a fundamental misunderstanding of what how digital technologies converge (as Tomi Ahonen explains when they converge they converge to Mobile). Why would Apple want to make a stand alone device that didn’t double as an iPhone 7/8/9 that society already wants to carry? Why wouldn’t Apple want to utilise every last drop of the market leading trust it has established in the iPhone brand to help differentiate it’s mHealth device from all the me-too rivals that will be hot on its tails as it starts generating $Billions in profits from this new and largely untapped $Trillion market?

““When you look at most of the solutions, whether it’s devices, or things coming up out of Big Pharma, first and foremost, they are done to get the reimbursement [from an insurance provider]. Not thinking about what helps the patient. So if you don’t care about reimbursement, which we have the privilege of doing, that may even make the smartphone market look small,” he told the website”

It stuns me that so many VC backed disruptive ‘digital health’ startups think the objective is to prioritise the needs of insurers when it’s even clear to economists that this focus isn’t even in the short term interest of insurance companies. To help illustrate the point that talk is cheap consider that the International Diabetes Federation CEO called for mHealth to become an embedded compulsory part of how we provide quality care for diabetics 2 years ago at a BUPA mHealth event on the top of a London skyscraper and the organisation with 32 million customers still doesn’t provide mobile embedded glucometers to it’s Patients in 2016!

PS. This is something we try and help clients do in the consulting work we offer eg. the BornMobile Generation wouldn’t even begin to think about reimbursement when designing a healthcare experience.

““We’ve gotten into the health arena and we started looking at wellness, that took us to pulling a string to thinking about research, pulling that string a little further took us to some patient-care stuff, and that pulled a string that’s taking us into some other stuff,” he said

I think this is a great example of the potential for markets to open up when you take a outsider approach to them. Get some ideas by watching this talk I gave at a Clinical Trial Industry event earlier this year on the topic of what would happen if we took a Mobile First approach to designing Clinical Trials.

*** UPDATE MONDAY 15 August 2016 ***

An exciting outcome of this development is that medics can now feel comfortable about taking the financial decision to leave their  work as clerks for insurance companies and start earning their living in the mHealth market serving Patient needs directly. Unless of course this mHealth just amounts to $3T of snake oil!

Who will make a bigger dent in the universe Steve Jobs or Tim Cook

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