The Impact of mHealth Interventions: Systematic Review of Systematic Reviews

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A classic case of error carried forward in this paper published today in the “JMIR mhealth and uhealth” Journal.

mHealth Insights

“Conclusions: Although mHealth is growing in popularity, the evidence for efficacy is still limited”

How can anyone hold this opinion in 2018? Surely it’s blatantly obvious that billions of citizens use mobile phones and healthcare roles are critical to the adoption (the fastest and most pervasive ever adoption of tech in the history of mankind).

Even if you’re a Doctor who works all day in a clinic with a queue out the door it’s likely your mobile phone is the only thing you have that you would return home for if you forgot it on your way to work.

“In general, the methodological quality of the studies included in the systematic reviews is low.”

Aren’t the reasons for this obvious?

If you appreciate the mHealth opportunities and are unscrupulous and unethical you can make yourself a huge financial fortune trading Patient data (like they do at the big Cancer Charities or Google eg. they got the EHR for millions of NHS Patients without their consent for free in exchange for building the NHS a basic app for dialysis Patients and most of the public haven’t the first idea about how they are tracking internet use and abusing the sensitive data they are compiling to make £millions in profits from the sale of highly targeted adverts that have created a industry of referral agents masquerading as ‘free helplines’ etc).

If you on the other hand appreciate the mHealth opportunities and are ethical and want to make a good living and do some good why not just implement even the most basic innovation with the supercomputers we are all now carrying in our pocket instead of publishing another critical research paper looking at the failure of other academics to see the opportunities to use the newest and least understand mass media? It’s not like it’s a hard to uncover secret that for most Patients today the consults they have with their Doctors are little more than encounters with strangers that are undocumented, it’s not as though it’s a secret that most qualified Doctors are still wedded to outdated tech like fax machines and don’t even think to use their Mobiles with Patients, no one is really surprised to learn that most Doctors don’t even use or share digital content with Patients/Carers, etc, etc.

“For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates”

This is a common conclusion from people who can’t see the wood for the trees. They should try and think what would happen if you turned off the mobile phone networks and tried to run a modern healthcare service. Perhaps the author has little/no clinical experience but here in Ireland the entire out of hours GP service would fall over (as it’s organised via SMS) and within a few minutes Patients lives would be lost.

I wonder how the authors think their locality (Washington DC) would respond to a major public health emergency eg. like the ‘Ballistic missile threat’ SMS transmission in Haiwaii last week.

“Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries”

I would  rephrase this statement as follows: Most studies were published in high-income countries where there is a huge profitable industry for academic institutions that pay money to have their papers published in expensive journals. In low-income countries people just get on with using the tools of our time as explained in this great TedX talk from 2011 by Alexandra Oswald:

It’s interesting to note that a scam industry has grown in low income regions where they think the publication system in more affluent countries is so ridiculously wasteful that they create and run very lucrative predatory conferences and journals that play on the interest ‘academics’ have for getting their egos massaged.

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Why do Mothers ask strangers in Facebook Mom Groups when they could waste everyone’s time & visit the office of a Doctor who doesn’t even know why they’re there?

“I am left wondering: Why are people so deathly afraid of talking to their primary care providers? Why are they willing to risk receiving downright dangerous medical advice from the internet? Why is it, that despite our best efforts, we are failing our patients? It’s a moment of introspection, as I’m explaining that since stomach acid is a buffered system, drinking “3 cups per day of grape juice” (I’m not even joking) does not appreciably change the pH of stomach acid. I think of all the gaps in communication that occur when I’m sitting in doctor’s appointments with my parents. In my mind’s eye, I see that look on my mother’s face when she does not understand a piece of medical jargon, but thinks she should, and nods along. I look back on all the times that I’ve skipped over an explanation of a pharmacologic mechanism to a patient, then received a phone call two days later asking something along the lines of why taking double the dose of a medication isn’t “twice as good.” Or, even worse, there are the times that they feel so alienated by us that they run to an anonymous internet forum for urgent medical advice. Seeing the questions of these women, and the rather alarming answers, is a portal into everything that our patients are afraid to ask us. For me, it is a wake-up call to go beyond the standard explanations with my patients. It is a tangible reminder to try to bridge that often-invisible gap of understanding”

I found this article by Neurologist Audrey Nath fascinating because a lot of medics tell me privately that they have struggled with feelings of guilt when they go “snooping” about on the internet to try and learn more about their Patients so that they are better placed to understand and help them. While corporations and charities with their focus on profits seemingly don’t give a second thought to the privacy issues most Doctors seem to be very uncertain about the legalities of activities like this and will often admit to using some basic techniques to try and remain undetected (eg. by trying to use Private or Incognito mode on their browser etc).

The surprise that Dr Nath has about the behaviour being observed astounds me. How is it hard to understand when we all know that most Patients don’t have access to the Electronic Healthcare Record, most interactions with Doctors are still pretty much undocumented stranger visits and most Patients/Carers have never been given a website or video by a Doctor (Note: Finding information on the internet is completely different from being given that exact same information by your Doctor).

Note: All the evidence suggests Patients are more than happy to share information when Doctors make themselves available & let Patients ask and answer questions online in their own time.

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NEJM: In-Person Health Care as Option B

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This New England Journal of Medicine essay by Sean Duffy, B.S., and Thomas H. Lee, M.D. is very interesting to reflect upon.

mHealth Insights

“What if health care were designed so that in-person visits were the second, third, or even last option for meeting routine patient needs, rather than the first? This question seems to elicit two basic responses — sometimes expressed in the same breath: “The idea will upset many physicians, who are already under duress” and “I wish my health care worked that way.”

We have been practicing medicine in the same way for 2000 years so it should be no surprise that some physicians are uncomfortable but I think if you’re finding it upsets them then try rephrasing things by pointing out how little sense it makes in 2018 to be meeting with a Doctor who is a complete stranger when you’ve a social media account that is probably more revealing than your electronic health record.

To help make the point throw in a few examples of where in-person visits are the last resort (eg. the Australian Royal Flying Doctors (which despite the name has a policy of only flying a Patient as the last resort), the British Medical Association’s DocHealth service that provides the ability for every Doctor in the UK to video call a Doctor, etc) and where tech has made going to the Doctors office nonsensical for millions of Patients with Chronic Conditions (eg. Diabetics who now have glucometers that they carry with them, elderly Patients who have adopted consumer technology that leaves their Doctors looking a bit Freddy Flintstone, etc).

“Face-to-face interactions will certainly always have a central role in health care, and many patients prefer to see their physician in person. But a system focused on high-quality nonvisit care would work better for many others — and quite possibly for physicians as well. Virtually all physicians already use non visit interactions to some extent, but their improvised approaches could be vastly improved if health systems were designed with such care as the explicit goal”

I think we can do even better than this. It’s time to apply Mobile First design to healthcare services. With >80% of healthcare budgets being spent on the management of chronic conditions it should be obvious in 2018 that managing our Health needs to just become something else we do with our mobiles.

Om Malik I live with a disease and my phone is as much a part of it as my meds

“Progress in this direction is already under way. At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.”1 The organization has been able to innovate in this area in part because it spends about 25% of its annual $3.8 billion capital budget on information technology. Nevertheless, these virtual visits only scratch the surface of what’s possible with today’s technology”

In 2012 Kaiser Permanente was the first major healthcare provider organisation to take a Mobile First approach and it’s great to see it paying off.

Note: I think it’s important to avoid use the term “Virtual” when referring to remote medical advice. Kaiser probably provided 240,000 video consults last year and that’s a more useful statistic to use than “52 million virtual encounters” because presumably some of these encounters could be millions of virtual things like programmed automated SMS’s reminding Patients of appointments, asking for BP readings etc, etc

“Virtual visits involve secure email and video engagement, and the patient–clinician interaction time required is similar to that of an in-person visit”

I think this might be error carried forward from the inappropriate use of the term ‘virtual’.

When we design remote video consultations properly we can enable Clinicians to use their time much more effectively and make the move beyond measuring ‘time spent with Clinician” to ‘the attention being provided’:

With this simple redesign the duration of the “Clinical Encounter” is extended because Patients can take their time giving their history and ensuring their Clinician has the answers to all the important questions that a Clinician would wish they had the time to ask. Because Patients and Carers can do this activity in their own time, wherever they are, on the device they always carry and trust more than any other, this activity doesn’t need to subtract from the limited time they’ll get to spend with the highly trained, busy Clinician that they want to help them.

“Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome. Consider Kaiser Permanente’s teledermatology program,2 in which pictures of skin lesions are sent to designated dermatologists. Contrast this system with what most physicians do: encourage some patients to send them photos of rashes and then forward the images to dermatologist friends, hoping they won’t mind the request for help. Payment models are an obvious barrier to deemphasizing in-person visits, but every provider’s business success depends on market share. The best way to win market share is to design and deliver better care, then modify the payment system to support it. Moreover, payment systems are already evolving to support nonvisit care. For example, use of bundled payment programs and accountable care organizations — which reward nontraditional care delivery models that reduce spending and meet patients’ needs — is growing. If payment systems are changing slowly, opportunities to change care models are increasing at lightning speed. Smartphone penetration of the mobile-phone market increased from 17% to 81% between 2009 and 2016.3 Even these figures don’t capture the change in consumers’ expectations for how they engage with the world, including health care. Patients are increasingly asking, “Isn’t there a way to do this without my having to drive to your office?” Many physicians have responded by letting individual patients check their own blood pressure or send in photos of a wound. To make non visit care excellent and equitable, however, it needs to be a matter of routine”

An interesting paper from the Children’s Hospital of Philadelphia is well worth a read as it proves Parents can get Paediatric Dermatology Diagnoses without the need for Office Visits in Most Cases if we let them just share Cameraphone photos.

If you are a Clinician who realises that you are working to serve a payment model it’s time to go and get retrained because it’s not going to do your health any good and you’re clearly more aware of the WTF! opportunities to transform your practice than your peers and if you’re reading this obscure blog post you’ve got a far better chance of adapting to the future than other Clinicians – never mind the insurers and pharma companies that are ignoring the elephant in the room.

“It’s not hard to envision how such a system might work. Take, for instance, a patient with an acute condition that may not require laboratory tests, such as a urinary tract infection or pharyngitis. Simple pathways already exist for deciding when empirical therapy is appropriate and when a watch-and-wait approach is reasonable.4 The question is whether that watching and waiting can require less of the patient’s and clinician’s time”

Theory is great but in my experience instead of envisioning potential scenarios it’s better to go and find Clinicians (like GP Dr Rupert Bankart) who have made the change and are working smarter so that they can go home on time.

“Today, these clinical issues are often handled over the phone or by email, but in the future, care management could resemble an information-technology ticket system inside an advanced corporation. A patient could open an app, file a “need,” answer a few tailored questions, and receive immediate guidance. The case would be “closed” only when the patient’s need was resolved — which would be an improvement on the traditional model of care. The provider system would be rewarded for solving the problem, not simply documenting activity”

Sounds like the work Dr John Bachman MD, Professor of Primary Care at the Mayo Clinic, was doing that inspired us to launch 3G Doctor way back in November 2006. An incredible Doctor:

“This approach could be extended to acute care when a specimen is needed (e.g., a throat swab in a patient with possible streptococcal pharyngitis). After answering questions in the app, the patient would be guided to the nearest collection center. Antibiotics could be prescribed by the clinician when necessary, with additional follow-up arranged only if the patient needed or requested it. Some provider systems are already moving in this direction. Providence–St. Joseph Health’s Express Care system, now deployed in 33 clinics in four states, allows patients to participate in virtual visits using their phone, tablet, or computer. Patients can schedule visits at any site for in-person evaluations or laboratory testing. If they want to be seen face-to-face but can’t make it to a clinic, a clinician will come to their home or workplace. Patients can also use apps to manage their conditions and symptoms”

Why not? All sounds logical. You just got to first move beyond the idea of trying to do everything with an office visit and it should be obvious that to do that at scale we need to modernise medical education.

“Patients with chronic health needs stand to benefit dramatically from this type of system redesign. Their health systems’ digital interfaces might have an “ongoing needs” section. Here, patients could toggle on and off the shipping of medicines and view insights on various measures that their smartphone might pick up (e.g., data on total hours spent in high-allergen zones for a patient with asthma). A case manager or coach could schedule a quick video check-in, when needed, to ensure that the patient’s condition was being well managed, determine what barriers might be limiting treatment success, and decide whether any adjustments to the medication regimen or care plan were required. At Omada Health, where one of us is the chief executive officer, online tools are used in conjunction with professional health coaches to deliver intensive behavioral counseling for people at high risk for obesity-related disease”

The problem with this is again all about money. The International Diabetes Federation called for mHealth to be an embedded compulsory part of quality diabetes care years ago but the recent IDF World Diabetes Congress proved that it’s all little more than lip service because all the money being made is from inefficient and ineffective care because it leads to more sales eg. why would the industry want to help give away low cost hyper competitive apps that help reduce the need for expensive profitable diabetes care? I personally became so frustrated with this nonsense I went and produced a Veterinary Tech Conference.

“For patients with the most health care needs — the 5% that account for 50% of costs — an “in-person as last resort” system should aim to bring as much of the necessary care and social support into the patient’s home as possible. Automated medication dispensers could be outfitted and refilled during visits from care teams. Web and mobile apps could allow families to stay informed about the patient’s care. Patient data could be integrated with the systems of the latest generation of home health aide organizations, such as Honor, a company oriented toward helping patients live independently at home. Such systems would need to be easy to use; the burden would be on the provider to design an intuitive solution that aligned with the patient’s needs and technical abilities”

Sadly payers aren’t welcoming this type of innovation (eg. a giant Pharmacy Retailer that led these changes was hit with serious fraud charges because they drew down the incentives offered to them to make the change and so they’ve now just gone back to providing the profitable old outdated working practices) so it probably needs a shift like that being proposed by Apple CEO Tim Cook (where services aren’t designed to just get reimbursement).

Ultimately I have a bug bear with the title of this article: “In-Person Health Care as Option B”. Perhaps I’m old fashioned but ‘in-person’ to me means ‘with the personal presence or action of the individual specified’ and in the last 24 hours I’ve personally had in-person video calls with people I know (one of whom I’ve never met in ‘real life’) in 3 different continents. Maybe the authors don’t use tech like I do but there’s no way anyone could watch me having these video calls and say that the participants weren’t “in-person”. Medical advice that is not in-person is simply not taking advantage of the tech we all have in our pockets.

I have had the mobile number of an incredibly talented Trauma Surgeon on the mobile phone(s) I have permanently carried for the last 23 years so perhaps I now just think like the Born Mobile generation and can’t think why others don’t want the same sort of access to in-person (albeit remote) help.

I know we beat it out of Medical Graduates but don’t we all want our Mothers to have an Option A where they have the mobile number of the Doctor who knows them in their phone? With systems that are well designed we can trust Patients and Carers to not bother their Doctor with simple things they can solve for themselves by calling a friend or loading a website (or using a clinically validated questionnaire when it’s something detailed/complex that they need help with) but don’t we all sense the value of having Option A being “a caring Clinician who knows us no more than a button press away”?

The 3G Doctor Can See You Now

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Taking care of hundreds of kids in the world’s leading children’s Hospitals: There’s an App for that!

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“An app designed by Great Ormond Street Hospital staff that replaces the traditional clipboard at the end of patients’ beds has saved thousands of nursing hours and been hailed as a pioneering use of technology.

Developed by GOSH clinical site practitioner and nurse Sarah Newcombe, the app enables staff to enter the vital signs of up to 350 patients using handheld devices rather than with pen and paper.

The system generates automatic alerts to relevant specialist teams at the hospital if patients show signs of deterioration.

It also enables staff to communicate directly with each other, and crucially they do not need to leave the bedside if they require help with acutely ill patients”

Patient app ‘saves thousands of nursing hours’, Paul Kelso, Health Correspondent, SkyNews.

I’ve reached out to a Clinician I know well who works at GOSH and look forward to getting a demo of the iPhone/iPad app in the next few weeks (and hopefully being allowed to share my thoughts with the team there, here on the mHealth Insight blog and in an update to the mHealth for Healthcare Professionals course that I produce for the Healthcare Informatics Society).

It’ll be interesting to see where this can go next as there’s now the potential to add a lot of additional easy to use sensors and for GOSH to develop remote monitoring services (eg. sending children home with mHealth tech and apps) that Children and Carers around the world can benefit from.

Related posts:

Has your hospital replaced error prone paper based observation systems (Oct 2014).

It’s interesting to compare GOSH’s in house development approach to that of The Royal Free (a neighbouring NHS Hospital) who traded (without consent) the electronic healthcare records of millions of Patients with Google (the world’s biggest seller of personal information) in exchange for a free app for renal monitoring (March 2017).

How would Dr Joseph Bell of the Edinburgh Royal Infirmary inspire his students if he was teaching students today (Sept 2011).

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NBC News: How smartphones could become our guardian angels

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A fascinating article by Edd Gent: How smartphones could become our guardian angels (2 Jan 2018).

mHealth Insights

“Data collected by your device could soon spot health problems before you do”

Soon? We’re already ignoring the data eg. Samsung’s smart scroll app has probably scanned more than 100 million retinas, the photos app on every iPhone knows exactly how many selfies users are taking but few Doctors ever discover this information, etc.

“Smartphones can be literal lifesavers, but they’ve also been linked to health problems including depression and sleep disruption”

Okay I wrote this in 2009 but it still surprises me that so many people think we’re still weighing up the pros and cons of mobiles. Surely in 2018 the balance has well and truly swung towards everyone recognising that mobiles have made a huge positive contribution to our health and well-being?

“They’re a very good proxy for capturing how we interact with our environment and other people,” Dr. John Torous, co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center in Boston, says of smartphones. “Things like how active people are, how much people are sleeping, how far people are traveling each day. That basic health information is important across anything from just general wellness to heart conditions to mental health conditions to diabetes.”

I think society is gradually realising that most Doctors today are having little more than encounters with strangers so it doesn’t surprise me that Dr Torous thinks mobiles can only manage to provide a ‘very good proxy’. Aren’t we all now aware that we’re probably being more honest with our mobiles than even ourselves?

As a side note I don’t blame medics for holding their traditional views (even in the world’s best medical schools the students of tomorrow still aren’t getting proper training to use these incredibly powerful always carried supercomputers) but find it’s an eye opener when they get to appreciate the spyware that is already loaded on millions of smartphones:

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“Researchers at the University of Michigan have built a smartphone app that monitors the voices of bipolar disorder patients to detect mood swings. Loud or rapid speech can be indicative of mania, while long pauses between utterances can suggest depression. The Michigan researchers hope the app will eventually be able to predict mood swings and then notify the user and his/her doctors that an episode may be imminent.”

I think this really highlights the need for Patients and their Carers to be in much more control of data as the reality is speech monitoring tech like this is not yet being used for medical value but is already being used at scale by others eg. to get an idea look to China where huge volumes of  personal mobile data is being mined by financial services companies to make millions of credit decisions.

It shouldn’t be hard to imagine that there are unscrupulous advertisers taking advantage of data that indicates mood swings to push more credit at vulnerable customers at the optimum time but I think most people who will ever read this are probably far too decent to even begin imagining what gambling, drug selling and outright scam websites are already busy with.

“Academic researchers aren’t the only ones looking for ways to harness smartphone data for better health. Mindstrong, a startup in Palo Alto, California, is testing an app that collects location, activity, and social interaction data as well as keyboard use and even word choice. The hope is that the app will be able to help detect various mental illnesses; unusually slow typing or misspellings could indicate cognitive impairment, while certain language patterns — frequent use of the word “I,” for instance — might mean depression”

Isn’t it becoming obvious that Facebook already knows this type of information and is selling it to advertisers?

“Chicago-based Triggr Health is already selling an addiction recovery app that it says can tell when users are likely to relapse. It relies on smartphone data as well as drug use history and other personal information. When the app spots a potential relapse, a member of the company’s chat support team steps in to offer advice or alert the individual’s real-world care team”

I think it’s interesting to note that already with all your location data a lot of mobile apps already know more than the Trigger Health app will ever know eg. they know when you’re visiting a pharmacy or a neighbourhood where drugs are being traded.

“NOT READY FOR PRIME TIME? For all the promise of smartphone health data, there’s scant evidence proving its effectiveness in the real world. Then there’s the matter of privacy. “People may be surprised to find that personal data entered into a mental health app is forever out of their control,” says Torous”

I sense I might be in a growing minority but I’d much prefer the situation where information that I gave to an app that I wrongly entrusted is misused than information about me that I can never access in the first place is being traded by healthcare organsations that I pay for via taxation with data trading corporations  I never even know about.

“Reliability is another concern. Little says insufficiently tested services could wind up diagnosing people with problems they don’t have. That could cause needless distress and waste doctors’ time. “Human behavior is infinitely complex,” Little says. “Trying to measure a hand tremor from a smartphone is great until you realize someone’s using a lawnmower.”

I think this basic issue is overcome when we just realise we need to combine mHealth sensor data with clinically validated medical history taking questionnaires and then using that data to tweak the algorithms so that when hand tremors are detected in future the microphone & gyro turn on to discount the finding if there is also a vibrating engine detected.

“RUNNING IN THE BACKGROUND. At present, Little says the most reliable disease monitoring systems involve the use of so-called “structured” tests, in which people carrying smartphones perform certain specific tasks. For instance, researchers might ask an individual to walk 20 steps to generate movement data, which is then analyzed — or to repeat a specific sentence so the same can be done with voice data”

I’d disagree with this conclusion but perhaps it’s my familiarity with the use of sleep monitoring apps like SleepTracker.

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Samsung to launch a mobile app connected inspirometer at the Digital Health Summit at the Consumer Electronic Show

“GoBreath is a recovery solution for people who have experienced lung damage and suffer from postoperative pulmonary complications after general anesthesia. Patients commonly need to exercise deep breathing for faster recovery, with one of the conventional methods through use of an inspirometer. However, deep breathing becomes challenging for patients who have undergone surgery due to lung pain. A doctor at Samsung Medical Center came up with the concept of GoBreath, which helped his patients recover faster, and consists of a portable device and mobile app that can teach patients basic techniques such as inspiration, coughing or deep breathing. Patients can refer to exercise guidelines and check how well their lungs have recovered through the app. GoBreath even offers a web and cloud service for doctors to help them monitor their patients’ recovery progress as well as provide reminders to practice”

Samsung CLab to reveal creative new projects at CES 2018

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mHealth Insights

Apple completely ignores the Consumer Electronics Show in Las Vegas but it never fails to bring out the very worst in Healthcare concepts from the world’s biggest mobile brand (remember the Samsung Welt Belt from previous years?). Still the concepts the world’s biggest mobile brand (they are set to ship 320 million smartphones & 40 million feature phones in 2018) are backing for 2017 look particularly bad.

It’s no secret that Samsung has long struggled with the media at product launches (e.g “Samsung weird”) but the very poor track record of Samsung Health (eg. the now pretty much scrapped S Health from 2013 and later “Voice of the Body” health monitoring wearable) is greatly undermining trust in fans of the brand. Once again the copy being used seems to have been created by pasting some Korean text into Google Translate and I feel it looks set to humiliate the visionary new CEO DJ Koh in front of the worlds media especially as there are statements in the intro video (like “a lung works in the same way as a balloon“) that are going to come across as rather condescending to anyone who has even a basic understanding of the respiratory system (eg. the medics that the media will ask about this new product before they publish their reports on it).

Public appeal to DJ Koh: please drop whoever is supplying you with these daft concepts and partner or aqui-hire a brand like PN Medical who understand the opportunity to do more than just breathing in and out and coughing and the potential for mobile phones to create engagement and feedback mechanisms.

UPDATED: 10 Jan 2018

It was interesting to see that the GoBreath device prototype featured it’s own screen (I’m very surprised the world’s biggest mobile device and screen manufacturer didn’t have the imagination to see the opportunity to port this information to one of the devices it has in the hands of nearly a billion customers) and didn’t try to do any more than digitalise an analogue inspirometer. Media coverage was thin on the ground and even in the positive tech press the point was missed eg. “makes fixing your lung capacity fun”:

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“If you have issues with breathing after chest trauma, surgery or anesthesia, then there are breathing exercises designed to help. Normally, your ability to breathe is calculated by using a spirometer, which isn’t that interactive — or accurate. That’s what prompted a team of Korean designers to begin working on GoBreath, a digital spirometer that tries to make breathing exercises fun. It’s another one of Samsung’s C-Lab projects to try and spin out neat product ideas from the Korean behemoth.

The small white device connects to a smartphone over Bluetooth, and then you breathe into it in the normal way. But on screen, rather than a dull metric of how well you’re doing or a figure of your peak flow, the data are represented visually. For respiration, you need to follow a dot running along a graph, Flappy Bird-style, while coughing requires you to cough loud enough to shake the leaves from a cartoon tree.

Right now, it’s just a demonstration, and the team doesn’t — yet — have a clear road to turning this device into a product. But you never know, in a couple of years, we may see Samsung-branded digital spirometers in use to help folks with damaged lungs get back on their feet”

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Manufacturers of children’s toys now are more progressive than the Institutions that are training & examining Doctors

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Yet still organisations like the RCGP will automatically fail a Doctor taking the membership exam for having a Mobile on their person

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