The Children’s Hospital of Philadelphia proves Parents can get Paediatric Dermatology Diagnoses without the need for Office Visits in Most Cases if we let them just share Cameraphone photos

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“Using smartphone cameras, parents can reliably take high-quality photographs of their child’s skin condition to send to a dermatologist for diagnosis. This finding suggests that direct-to-patient dermatology can accurately provide pediatric dermatology care.

“Advances in smartphone photography, both in quality and image transmission, may improve access to care via direct parent-to-provider telemedicine,” said Patrick McMahon, MD, pediatric dermatologist at CHOP and senior author of the study. “Our study shows that, for the majority of cases, parents can take photographs of sufficient quality to allow for accurate teledermatology diagnoses in pediatric skin conditions. This is important because pediatric dermatologists are in short supply, with fewer than 300 board-certified physicians serving the nation’s 75 million children.”

Forty patient families participated in the study between March and September 2016. The study team provided photography instruction sheets to 20 families, while the other 20 received no instructions. The sample represented a wide range of ages, ethnicities, and socioeconomic backgrounds, as well as both genders equally. The majority of parents used an Apple iPhone, with the rest using an Android phone.

The researchers compared diagnoses made during in-person examinations with photograph-based diagnoses made by a separate clinician. Overall, of the 87 images submitted, the researchers found that 83 percent of the time, the photograph-based diagnosis agreed with the in-person diagnosis. Only three images did not permit a conclusive remote diagnosis, owing to poor photographic quality. Among the photographs considered high-quality enough to make a diagnosis (37 families), there was an 89 percent agreement in diagnoses.

McMahon noted that skin complaints represent 10 to 30 percent of all 200 million pediatric office visits each year, adding, “While many children’s skin conditions can be handled without input from a pediatric dermatologist, the national shortage of specialists is a known barrier to accessing care. Our findings suggest that telemedicine could improve access for patient families who have geographic, scheduling or financial limitations, as well as reducing wait times.” Media Contact: Joey McCool Ryan, 267-426-6070

mHealth Insights

It’s great to be able to share this news as there have been so many really low quality research efforts in this area over the years..

At the GP Continuing Professional Development (CPD) courses that I attend there’s typically a Dermatology Consultant giving a presentation where they will be giving brief clinical histories and showing images on a powerpoint slide show while polling the audience with a multiple choice set of answers to which the delegates must raise their hands. In most cases the GPs were completely wrong (eg. with only a small minority picking the correct answer) and the Consultant Dermatologists end up joking with them about how bad they are. It has me convinced that we should never leave the responsibility for diagnosis with a busy GP who doesn’t have a special interest in Dermatology when those pictures and a medical history (shared via a clinically validated medical history taking online questionnaire) could be now so easily supplied by Parents/Carers without the need for an office visit or the expensive/time consuming administrative mechanisms (of making an appointment with a GP, going to the GP, getting referred to the Practice Nurse to have a few pictures taken, getting the GP to enter a bit of history into a referral letter, waiting for the Consultant dermatologist’s secretary to receive/read the letter and schedule an appointment, the Patient then to make the appointment and get an accurate diagnosis and treatment plan – all the while worrying about the condition and possibly even experiencing symptoms getting worse).

In 2018 NHS GPs will see more than 13 million Patients reporting with skin problems and more than 750,000 will be referred on to see a dermatologist. Why can’t the NHS just enable Patients/Carers to just reach into their pockets and communicate with the tools of our time?

Related post: Perhaps it’s time we stopped saying ‘go and get help’?

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mHealth guide to the 2017 World Diabetes Congress #IDF2017

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The next biannual congress of the International Diabetes Federation will be held in Abu Dhabi, UAE, on 4-8 December 2017 and will feature more than 200 speakers and representations from 230 national diabetes associations. Register now.

At the last congress (in Vancouver in 2015) I was hired by the IDF to develop and provide a diabetes module of the mHealth for Healthcare Professionals course and I find it amazing that this freely shared video recording is the only content from the entire 200+ hours of conference proceedings that there is any record of because despite the IDF’s claimed ambitions (eg. to embed mHealth and make it a compulsory part of quality care for people with diabetes) has a bizarre outdated approach to sharing.

The organisers were so out of touch in 2015 that they were starting conference sessions by showing a slide that reminded delegates not to take or share images/videos.

They were even publicly telling off delegates who they discovered sharing content with the event’s #WDC2015 hashtag on Twitter. Worse still some of these delegates weren’t tough media hacks or experienced clinicians but Patients who they generously given up their week and been sponsored to fly around the world to attend the congress!

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I find it quite amazing that in 2017 a congress of such high profile is still not live streamed and that the media guidelines are still so incredibly outdated:

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The only sense I can make of it is that the federation feels it might lose control of the conversations but it’s really bizarre because the #IDF2017 hashtag is really prominently posted on the homepage etc:

George B Shaw Apples and Ideas

The conference website is also really poorly designed and the “IDF Congress Profile” tool that’s supposed to help you plan your congress experience is next to useless.

To make it a bit easier I’ve compiled the following mHealth Guide that you may find useful if you’re going (or looking to conduct research and follow along via the limited ‘unauthorised’ social media sharing). If you’ve seen anything I’ve missed please let us know in the comments thread and I’ll update the listing.

Tuesday 5th December 2017

13:15 – 14:45, ICC 4
Community approaches to diabetes care. Mobile diabetes clinic: experience in Palestine
Ahmad Abu Al-Halaweh, Director of the Diabetes Care Centre, Augusta Victoria Hospital (Palestine)

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13:15 – 14:45, Hall 11
Digital health and modern technologies: Integrating digital health with peer and family support in disadvantaged groups
John D. Piette PhD, Professor of Health Behavior & Health Education & Centre for Managing Chronic Disease, School of Public Health at the University of Michigan

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New technologies in diabetes management
Ibrahim Saleh Al-Busaidi, Oman Diabetes Society, Sultanate of Oman.

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Opportunities for diabetes prevention and care through modern technologies: B he@lthy B mobile in India and Senegal
Dr Line Kleinebreil, Consultant, WHO (Switzerland)
Dr Subhash S. Pujari MD, M .D (Medicine), Associate Professor of Medicine, DM Waynad Institute of Medical Sciences (India)
H. Eskandari, ITU/BHealthyBMobile (Switzerland)
Lamine Gueye, Faculté de Médecine de Dakar, Université Cheikh Anta Diop, Dakar (Senegal)
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Opportunities for diabetes prevention and care through modern technologies: B he@lthy B mobile in India and Senegal
Prof A Ramachandran, India Diabetes Research Foundation & Dr. A.Ramachandran’s Diabetes Hospitals (India)
Pankaj Joshi, Director at Diabetes Care Centre & WHO Country Office for India (South Africa)
Dr Fikru Tesfaye Tullu, Acting Coordinator Health Programs, WHO India
R. Kumar, Ministry of Health and Family Welfare (MoHFW), Govt of India.

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15:15 – 16:45, ICC 4
Peer support: applications and approaches. Peer support in China
Zilin Sun, Professor of Endocrinology, Southeast University Medical School, Nanjing (China)

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16:00 – 16:45, Conference Hall B
Diabetes tools and apps – What’s new, what works, and what do patients really want?
Adam Brown, head of diabetes technology & digital health, Close Concerns

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Wednesday 6th December 2017

13:45 – 14:15, ICC 1
eHealth solutions for diabetes: Hype or hope?
Cornelis Tack, Prof of Internal Medicine, Radboud University Medical Centre (The Netherlands)

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Is there a Doctor in my pocket?

is there a Doctor in my pocket

11 years after we launched 3G Doctor Natasha Loder, the Economist’s Healthcare Correspondent, writes that “we are on the verge of a transformation in health care that will render visiting the doctor a thing of the past. I think it’s clear that ‘go and get help’ doesn’t make sense to the Born Mobile generation but it’s misleading to think anyone wants to make the visiting the Doctor a thing of the past (evolving beyond the 2,000 year old office-visit-only model and only visiting the Doctor when it’s required and the Doctor already knows about us is something very different).

mHealth Insights

“Large investments have been driving this change. Last year, equity funding to private digital-health startups grew for the seventh consecutive year and reached $6.1bn. A good proportion of that sum has been directed towards products that target consumers via their mobile phones. The early offerings were apps that would help people find doctors and schedule appointments; but, more recently, apps such as Teladoc in America, Babylon Health in Britain and Min Doktor in Sweden have started to offer access directly to qualified doctors or therapists on a mobile phone”

It’s interesting to compare the Economist’s Healthcare Correspondent views with their Digital Editor’s views on the impact that mobile tech is bring to bear on the healthcare industry. I imagine you’d develop this view of the world as the Healthcare correspondent as most of the public relations people and press releases reaching you would originate from businesses that committed dedicated resources because they’re really keen to bring in their next round of venture debt and will use ‘breaking news’ claims to grab attention but I don’t think it’s accurate to suggest that it’s large investments that are moving the market. It should be obvious that the BornMobile generation getting frustrated with the outdated 2,000 year old office-visit-only model of care (and have social media connections that empower them to vote with their feet for services that are marketed to their needs) rather than the ‘large investments’ that are being made into startups that’s moving the needle as even ‘$6.1Billion invested in digital health startups last year‘ is still less than 0.2% of the $3.5T US Healthcare budget (we’re not even talking tip of the iceberg investment levels here).

Claiming it’s all a new development is obviously a helpful way to keep reader interest but it’s not factual and claims that early offerings were apps is also dismissing the reality that mHealth applications were already widespread even before Apple launched their App Store in July 2008.

“The most sought-after services are for sexual health and women’s health. Women, unsurprisingly, want repeat prescriptions for contraceptives without having to take the morning off to visit the doctor. But the number of people using remote medicine for other reasons is growing at a fair clip. Kaiser Permanente, a large health-care organisation in America, says that, for the first time in 2016, more than half of the interactions between patients and their doctors were virtual (by video-conference or text messages)”

I think this is a misinterpretation of what’s happening. Yes there is a huge demand for prescriptions but it’s not like that’s a new phenomenon eg. Google was practically seed funded by ‘rogue’ Pharmacy adverts, Walgreens reported in 2014 that they were generating over $375M a month from their smartphone app with Rx ordering services, etc.

Claiming that ‘more than half of the interactions between patients and their doctors were virtual (by video-conference or text messages)’ at Kaiser Permanente looks like a very unreliable statistic because it’s mixing video consults and SMS. I’m a big cheerleader of KPs groundbreaking work – they were the first major healthcare organisation to go Mobile First – but just last week at Exponential Medicine in San Diego John Mattison (the Chief Medical Information Officer and Assistant Medical Director for Kaiser Permanente) said that they provide just 2,000 visits per month (although he expects it to grow ten fold by 2018) (so at most no more than some 0.2% of their 10.2 million health plan members will video consult with their Doctors in 2017). The definition of an interaction is where the grey area probably exists but we should be careful (in his presentation John Mattison made it clear that KP found video consults very challenging) eg. if a hospital sends 2 SMS appointment reminders to Patients (which is clearly what they should be doing – since 2011!), the first when the appointment is made and another 24/48 hours before the time) would that mean they can now legitimately claim that 66% of the interactions between their Doctors and Patients are now ‘virtual’? (Note: there’s nothing virtual about remotely consulting with a Patient).

“Britain’s Babylon Health, based in Kensington in London, is particularly ambitious. At its offices, fake greenery and flowering plants proliferate in a largely unsuccessful attempt to evoke the Hanging Gardens of Babylon. Its app answers medical queries, provides access to doctors and offers users a dashboard of their health stats drawn from the phone or supplemental devices. These data can be supplemented with results from at-home blood-testing kits that one can order via the app. These take readings of liver and kidney function, vitamin levels, bone density and cholesterol. I tried the thyroid test and drew blood with a special device that punches a tiny hole with surprisingly little pain. Then I posted the sample to Babylon. The results (all OK) popped up in the app a day later. If Babylon recommends an appointment with a doctor, it can provide one via video-conferencing almost immediately for £25 ($32). As with many other doctor-on-demand services, it is possible to share notes, or even a video from a consultation, with your regular doctor”

Not sure what this is about but for years there has been self/home testing devices called ThyroScreen sold in the UK (produced by Personal Diagnostics) that you don’t need to send to anyone to get the result in seconds.

“One of the most exciting aspects of digital health is the capacity of mobile phones to gather information as well as deliver it. They can collect data from their own sensors and screens, as well as associated devices such as watches, headbands and the growing constellation of add-ons. Increasingly, such devices are clinically validated and medically useful. Last year the US Food and Drug Administration (FDA) approved 36 connected health apps and devices. Sensimed has produced a smart contact lens that helps physicians track the progression of glaucoma in patients. Quell, which can be controlled with your smartphone, is a wearable leg band that uses nerve stimulation to treat chronic pain. Wing, a connected spirometer (a device you breathe into that measures lung function), helps asthmatics to manage their condition. Remarkably there are now portable devices that measure electrical activity in the heart and brain, and even take pictures of your insides with an ultrasound”

I am in 100% agreement with Natasha Loder here. The last decade has been marked by the convergence of nearly everything electronic to our smartphones and now we’re seeing things that would’ve been unthinkable only a short time ago following the same pattern eg. mHealth tech that is so easy to use that it’s indistinguishable from magiceven your bed is now converging with your smartphone, the big medical device brands are now fearful that Apple is getting to decide if they win or lose, etc.

For more of these and to connect with 900+ entrepreneurs who developed many of them check out the Linkedin mHealth networking group introductions thread.

“In this way, the moderately useful app of today could eventually become a life-saver. For example, clip-on infant monitoring devices – which allow parents to track a baby’s heart rate and oxygen on their phone – might conceivably pick up evidence that would enable doctors to prevent cot deaths”Already happening and non-invasively! eg. I was sleeping with my own mobile embedded device from Biancamed (acquired by ResMed) that was being used to non-invasively monitor at risk babies in cots 5+ years ago (in 2017 it’s probably now used by more horses than infants but that’s another story altogether!).Samsung GTab MyHomeHealthHub“The commercial promise is so large that Google, Amazon and Apple have all been testing the waters of digital health. Amazon’s virtual assistant Alexa looks promising as a channel for diagnosis and advice for patients. Apple seems to be interested in enabling its wristwatch to monitor glucose levels. Google, through its life-sciences arm Verily, is developing both a glucose-monitoring contact lens and a watch designed to gather health-related data”I think it’s fair to say we’re past the testing the waters stage when senior management at Apple (the world’s most valuable company) has made it explicitly clear that they’re going all in on healthcare.

While I agree with Natasha Loder that we are on the verge of a transformation in health care (that is arising from healthcare increasingly becoming a mobile experience) I hope it will not “render visiting the doctor a thing of the past” but will enable our relationships with Healthcare Professionals to evolve beyond today’s outdated office-visit-only models.

What were your thoughts on reading the article?

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The doctor will see you now: NHS starts outsourcing mobile video consultations

THe doctor will see you now The Times 6 November 2017

The Times has an interesting story today about how NHS clinics in London are outsourcing mobile video consulting service to an xcludarly stage startup called Babylon Health than has already received $85,000,000 in Venture Capital funding:

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The startup is putting the raised money into some big budget outdoor marketing campaign on the London Underground:

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…and on huge road-side electronic billboards:

Babylon indigestion advertbabylon-hangover-did you mean liver disease

The news seems to have really hit a nerve with the RCGP leadership and there’s already a press release on the RCGP website:

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GPs have been quick to point out that the NHS GP practices working with the ‘startup’ are going to be able to cherry pick the younger/healthy Patients of neighbouring practices and it’s going to make them increasingly unviable if they continue to only offer an office visit only service (which they don’t have to as there are plenty of proven ways they can safely innovate beyond this 2,000 year old model without having to outsource to a startup with huge VC debts):

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I think the RCGP is fighting the wrong fight here because there are plenty of things that are more fundamentally nonsensical that NHS funds are wasted on (eg. NHS England pays for free WiFi to be installed in Chip Shops in the hope that customers will use it to learn about how to live healthier lives!) and it’s clear this isn’t a sustainable business in the UK (even the ~$T Google couldn’t afford to sustain their free* doctor video call service and BabylonHealth pretty much acknowledge this in their T&Cs which practically exclude anyone who isn’t healthy (eg. those with health conditions and all sexually active women!) probably because the NHS GPs are only paying them <£50 a year of the £151 per year that the NHS GP Practice will be paid for every new Patient they get to register with them:

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The RCGP has obviously struggled to keep up with the breadth of opportunities that mHealth offers to their members (eg. their Video Consultation Skills Course wasn’t live streamed or even video recorded and was run by a medic who doesn’t offer his Patients video consults and their 2020 Vision for General Practice was outdated by the time it even went to print) but really in 2017 it’s futile to argue online with anyone that is trying to make accessing Doctor care more convenient (like it or not we live in a time when convenience is now a quality measure that is used by Patients) when most RCGP members tolerate a situation in which their services are already outsourced to daft non-evidence based political schemes like NHS Re-Direct/111 etc and for years Patients (some aged 93!) haven’t been able to understand why they can’t use the tools of our time with their NHS GP.

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I think the RCGP are in a losing position here because they’re arguing against this for the wrong reasons as there’s plenty of things that already make GP care access fragmented (eg. Patients who can/are able to line up outside a GP clinic to get an appointment in the morning get better access than those who can’t, Patients who are prepared to exaggerate symptoms will get to navigate the receptionist gatekeeper whereas those more honest will have their greater needs more easily dismissed, etc).

My advice to the RCGP would be to:

> Get your own house in order.

Develop and provide a mHealth for GPs course to all members, we can produce that for you with the Healthcare Informatics Society or watch some of the modules we’ve video recorded for organisations like the International Diabetes Federation and get inspired to make your own.

Make it mandatory for GPs to bring smartphones into their membership exam (currently the presence of a mobile would lead to an automatic fail) and test them on their use of it with Patients who have record access and understanding and have been able to use clinically validated tools that enable them to share their medical history prior to the consultation starting and get a written consult report at the end.

> The reality is Patients know, understand and trust their GP and while a sustainable financial model is fundamental to providing an invaluable ongoing GP service the RCGP must stop focusing on things that might harm the revenues of GPs and start making a big deal about the things that could potentially harm their Patients.

Instead of talking about the harm caused to the practices that will be made unsustainable if this service enables a neighbouring “BabylonHealth Partner” clinic to poach their healthiest/easiest to manage Patients, instead make recommendations to members about how they should be conducting themselves and to the NHS to reform the payment mechanisms (NHS GPs are mostly funded based on the number of Patients on their list rather than the quality of the work they do) and talk to Patients about the harm that the NHS is putting them in the way of by outsourcing consultations to symptom checkers that aren’t yet clinically validated and could clearly be very dangerous…

…and recorded video consultations that are run by private startups with complex T&Cs and Privacy Policies and huge venture capital debt that they need to recover (note: most VC backed companies fail and when they do the private personal data they have collected doing their business will be transferred to another company who may try and reuse it to recover their debts).

Related posts:

Can a quick phone call substitute for a Doctor visit? (December 2016)

Technology will never replace Doctors but they must embrace it(January, 2016)

Google is now giving away free Video Chats with Doctors to citizens searching for health info (October 2014)

Update 7 November 2017: 

Plenty of common-sense coming from GPs over at Pulse – I wonder if the RCGP will actually do anything?:

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Update 12 November 2017: 

Harry Longman of GPAccess has an interesting take on what’s happening in his regular newsletter/blog:

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As does Dr Phillip Hammond in his Private Eye article (from 24 October):

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Peter Blackburn in the BMA puts forward the argument that the ‘doctor leaders have said’ that this “smartphone GP service would divert patients away from doctors who know them – and could risk quality and continuity of care” which I don’t think is valid when you appreciate the access to a GP that knows them that young healthy Patients (the only ones eligible for the GPatHeand service) in a city like London have:

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Update 15 November 2017: 

Interesting to see the views of NHS GPs as they get a chance to read the small print, I wonder if they’ll share their concerns about how their colleagues are sharing video recordings of their consultations with the GMC? I wonder how big/successful a class action would be against the GPatHand Partners if the Patients who used the service became aware that their NHS GP had outsourced their private GP consults and the video recordings of these were now the property of a Liquidator? Perhaps that’s the business model (free consult for now and you only pay us if you want to stop someone else owning the video recording)?

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Update 16 November 2017: 

Dr Margaret McCartney has got a response to her “General practice can’t just exclude sick people” article in the BMJ from Dr Mobasher Butt, Partner at GP at Hand, and I think it pretty much proves that you’re trying to split hairs if the big issue you see here is that a few NHS GPs are doing something that excludes large groups of Patients as it’s reasonable to say ‘yes in an ideal world we would offer this to all Patients but NHS GPs aren’t implementing the available proven technology that some of their colleagues are already using and Patients expect convenience so we have to start somewhere’. Yes it’s clearly unfair to offer citizens with iPhones better access than those who don’t have one but the reality is there are probably bigger disparities in the NHS and this is pretty much insignificant when you weigh up the reality that this service is not actually going to make or lose a few NHS GPs in London a lot of money and the additional costs are in all likelihood just going to be paid for out of the £85Million that venture investors have already sunk into this startup (this is a common ‘land grab’ technique with VC debt funded mobile apps eg. look at the impact Uber has had on the Taxi business in cities like London and appreciate that although revenues have grown to $20B in 2016 it lost $2.6B but new investors are still clamouring to get in on the next $10B round!).

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I think Dr Margaret McCartney would’ve made a much more powerful argument against the unacceptable design of this new service if her discussion had focused on what happens if/when the GPatHand/Babylon Health company runs out of money or decides it can’t make money from the NHS and ceases to offer the service. Do the Patients all have to move back to their old GP? Do the old GP clinics have to accept them back? What happens to the video recordings of private Doctor consultations that the private company now claims to ‘own’ because a NHS Patient who wanted convenient access to a NHS GP has accepted T&Cs presented by a private company that was using the NHS logo/branding? What might be the long term negative repercussions of a company that owes £85Million to Venture Capital investors and claims to ‘own’ information relating to NHS Patients? What rights do NHS Patients have to access and own their own copy of this information if the NHS partnership ceases to exist? Does the existence of this new NHS service mean that the gates are open for NHS GPs to now start making £billions by misusing the Electronic Patient Records they have to market/sell private services to Patients or even sell Patients information onto third party organisations without having to do anything more than having Patients agree to some detailed T&Cs before they’re allowed to access NHS services?

Surely these are the bigger issues for Patients and GPs?

Perhaps it’s the use of eye catching adverts and terms like ‘digital health’ and “AI” (artificial intelligence) that has the NHS GPs bamboozled by the major challenges that this new approach presents after all the RCGP vision for the 2022 struggles to see beyond booking clinic appointments online. Perhaps it’s the naming of the service “GPatHand” and “Babylon”?

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…and the way the one company seems to be offering a NHS branded service that is planning to market and sell it’s private sector services to the NHS Patients that move clinic and download the app:

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Take away all the complexity and the proposition being offered to NHS Patients here seems a bit ridiculous eg. can you imagine if a NHS GP received a request from a Patient to move to the ‘GPatHand’ practice and the GP simply messaged the Patient explaining that they’d recently borrowed tens of millions from a venture capital investor and that they now have their NHS GP’s personal mobile number, Facetime ID and email address and from now on they can message them at anytime requesting a Facetime call back with the little caveat that before the Patient is able to have this new service they have to agree to T&Cs similar to the ones that GPatHand are using which enable the existing NHS GP to sell their medical record information and video recordings of any consults they have to third parties?

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Join us in Harley Street to watch the Exponential Medicine Livestream #xMed

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Tomorrow in San Diego the doors (and free livestream) open for the sold out Singularity University’s annual Exponential Medicine event. This is an incredible event that we’ve been fortunate to participate in but if you’ve never heard about it the quickest way to catch up and get inspired might be by watching the TedXMaastricht “Medicine’s future: there’s an app for that” talk given by the founder Dr Daniel Kraft MD.

I was booked to be in San Diego again but schedules here just wouldn’t permit it and I’ve had to cancel which leaves me really disappointed to be missing the event. Thankfully #XMed has an excellent Livestream so I’ll be definitely trying to watch as many of the presentations as I can.

Speakers include:

Shafi Ahmed, PhD, FRCS, Co-founder, Virtual Medics & Medical Realities
Jordan Amadio, MD MBA, Co-Founder/Partner, NeuroLaunch & Resident Physician in Neurosurgery, Emory University
Mark Bonyhadi, Head of Research, Academic Affairs, Juno Therapeutics, Inc.
Nicole Bradford, Lab Executive Director & Lab Co-Founder, Transformative Technology Labs at Sofia University
Jennifer Brea, CEO/Founder, Shella Films
Jeffrey Brewer, CEO, Bigfoot Biomedical
John S. Brownstein, PhD, Chief Innovation Officer, Boston Children’ Hospital & Professor, Harvard Medical School
Brad Burge, Director of Strategic Communications, MAPS
Shawna Butler RN MBA, Partnerships, Singularity University
Divya Chander MD PhD, Anesthesiologist/Neuroscientist, Stanford University
Asif Dhar,Principal, Deloitte Consulting LLP
Peter Diamandis, MD, Founder, XPRIZE, Singularity University
A. Dara Dotz, Principle Designer and Co-Founder, Field Ready
David Ewing Duncan, Co-founder & CEO, Arc
Ken Dychtwald, PhD, Founder and CEO, AgeWave
Lucien Engelem, Founding Director of REshape Center, Radboud University Medical Center/SUNL
Frank Fitzpatrick, Founder/CEO & Consultant, EarthTones
Brian Forde, Former Technology Advisor to the White House & Congressional Candidate
Yan Fossat, Principal Investigator, Labs for Klick Health
1eMichael J. Gelb, Pioneer in Creative Thinking and Innovation Leadership
Alan Greene, MD, FAAP, Founder, Lead, Private Medical
Rafael Grossmann, MD FACS, General, Trauma, Advanced Laparoscopic and Robotic Surgeon
Moira Gunn, PhD, Host, NPR’s Biotech Nation
Eyal Gura, MBA, Co-Founder and Chairmanm, Zebra Medical Vision Ltd
Nadine Hachach-Haram, NHS Clinical Entrepreneur Fellow & Founder, Proxime
Robert Hariri, MD, PhD, CEO & Founder, Celularity
Will Henshall, Founder & CEO, focus@will (Neuroscience Music Productivity Tools)
Stephen Hunt MD PhD, Interventional Radiologist, University of Pennsylvania
Shanon Jaccard MBA, CEO & Co-Founder, Ballast Health
Neil Jacobstein, Chair of Artificial Intelligence & Robotics, Singularity University
Naveen Jain, Founder & CEO, Viome
Milind Kamkolkar, Global Head, Next Gen Analytics
Hans Keirstead PhD, Stem Cell Biologist, Candidate for US Congress
Iya Khalil PhD, Chief Commercial Officer and Co-Founder, GNS Healthcare
Rob Knight PhD, Professor, Pediatrics and Computer Science & Engineering at University of California San Diego
Andy Kogelnik MD PhD, Director, Open Medicine Institute
Marc Koska, Inventor of the the K1 syringe
Daniel Kraft MD, Faculty Chair for Medicine, Singularity University, Founder & Chair, Exponential Medicine
Jack Kreindler MD, Founder & Director, The Centre for Health and Human Performance
Ray Kurzweil, Co-founder & Chancellor, Singularity University
Margaret Laws, CEO, Hope Labs
Josh Lee, Principle, Deloitte Monitor
Amir Lerman MD, Faculty, Mayo Clinic
John Mattison MD, Chief Medical Information Officer, Kaiser Permanente
Raymond McCauley, Chair Digital Biology & Founding Faculty, Singularity University
David Metcalf PhD, Researcher for the Institute for Simulation and Training, University of Central Florida & President, Moving Knowledge
Jamie Metzl, Senior Fellow, Atlantic Council & Author, Genesis Code
Mark Michalski, Executive Director, MGH & BWH Center for Clinical Data Science
Catherine Mohr, MD, Vice President of Strategy, Intuitive Surgical
Catherine Mohr, MD, Vice President of Strategy, Intuitive Surgical
John Nosta, Digital Health Maven, NostaLab
Bakul Patel, MBA, Associate Director of Digital Health, Food and Drug Administration/Center for Devices and Radiological Health
Nico Preston, Data Scientist & Disease Ecologist
Sonia Ramamoorthy MD, FACS, FASCRS, Professor of Surgery Chief, Division of Colon and Rectal Surgery Vice- Chair of Surgical Quality Rebecca and John Moores Cancer Centre, University of California, San Diego Health System
Jeffrey D. Rediger, MD, MDiv, Faculty, Harvard Medical School Medical Director, McLean Southeast Hospital Adult Psychiatric Program
Roman Reed, President, Roman Reed Foundation Patient Advocate
Kate Rosenbluth PhD, CEO, Cala Health
Chad Ruffin MD, Ear surgeon/Research Fellow at Indiana University, Cochlear implant recipient, CEO of RuffLab Technologies
Lee M. Sanders MD MPH, Associate Professor of Pediatrics, Stanford
Darshak Sanghavi MD, Chief Medical Officer, OptumLabs
Leslie Saxon MD, Founder & Executive Director, USC Center for Body Computing
Michael Seres, Patient Voice/Ambassador for the NHS Founder, 11Health
Jordan Shlain MD, Founder, Private Medical & Founder/Chairman, HealthLoop
Rasu Shrestha MD MBA, Chief Innovation Officer, UPMC Executive Vice President, UPMC Enterprises
Ralph Simon FRSA, Chairman & CEO, Mobilium Global Limited
Larry Smarr PhD, Director, Calit2 at UC San Diego
Brennan Spiegel MD, VR in Healthcare Pioneer Director, Health Services Research in Academic Affairs and Clinical Transformation at Cedars-Sinai
Steven Steinhubl MD, Director, Digital Medicine, Scripps Translational Science Institute
Kevin R. Stone MD, Orthopaedic Surgeon, The Stone Clinic
Jeroen Tas, Executive Vice President, Philips
Charity Sunshine Tillemann-Dick, Soprano, Double-Lung Transplant Recipient
Shoshana Ungerleider MD, Founder, Ungerleider Palliative Care Education Fund
Carin Watson, EVP Learning & Innovation, Interim VP of Marketing, Singularity University
Will Weisman, Executive Director, Conferences, Singularity University
Richard Wender MD, Chief Cancer Control Officer, American Cancer Society
John Werner, Vice President, Meta, Augmented Reality Technology
Jamie Wheal, Executive Director, Flow Genome Project
Gloria Wilder MD MPH, CEO, Core Health & VP, Innovation and Preventive Health, Centene Corporation
Vonda Wright MD, Orthopaedic Surgeon, UPMC/University of Pittsburgh Schools of the Health Sciences
Anna Young, Co-Founder & Health Maker at Pop Up Labs
Alex Zhavoronkov PhD, Co-founder & CEO, Insilico Medicine

Click here for the full programme.

I’ll working in central London most of this week and the time difference means the event (which starts at 830am) will be running from 4.30pm so it’s a great opportunity to get together after the working day. If you’re a Patient or Clinician working in the area why don’t you join me and some colleagues to watch it together and depending on numbers we can order in some food etc? An innovative clinic in London’s Harley Street with a big screen room has offered to host the gathering but we’ll have to find a bigger room (perhaps at the RSM or BMA) if we get more registering so RSVP as soon as you can:

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mHealth: Is Mobile Technology Right for Your Clinical Trial?

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I just read this April 2016 dated article by April Schultz, Content Marketing Manager at Forte (a company that offers software products and an array of services to help organizations conduct research), and found it very interesting as it’s trying to make the case that ‘mobile health should not be used for every clinical trial‘.

I think in 2017 when everyone working in the Clinical Trial industry is walking around with a supercomputer in their pocket we should have arrived at realising that every clinical trial would benefit from mobile first design (watch this presentation I gave in 2015 on How Mobile First Clinical Trials & Ratings will transform the $100B Clinical Research Industry to appreciate what this means).

mHealth Insights

“With the development of exciting new digital technologies, the clinical research industry now has the tools to make clinical trials more patient-centric than ever before. In particular, the emergence of wearable and mobile health technologies have the potential to greatly advance patient-centricity in clinical trials through real-time data collection and participant engagement”

This is a long held bugbear of mine (eg. in 2009 I wrote about how successful mHealth applications are already here) but I can’t for the life of me understand why people talk about mHealth as something new. There’s nothing I’ve worn (carried with me at all times) more than my mobile phone since I first got one in 1995.

Why do people think we’re talking about a ‘potential’ opportunity. Visit Apple’s ResearchKit website and watch some of the videos they’ve produced and you’ll soon put these outdated notions to rest:

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Yes most clinical trials are complete dinosaurs (eg. 99% of data is still collected within the four walls of a clinical research facility building) but it should be obvious that participant engagement in clinical trials is no longer something that the Clinical Research Organisations are very good at or have a monopoly on eg. check out how companies like FullPower have supported millions of their customers to share millions of nights of sleep data to not do something as simple as measure the value of a single drug but to build the Sleeptracker Artificial Intelligence Engine that is today improving the sleep for Ms. and Mr. Everyone via actionable personal insights into small adaptations that can improve sleep. In 2017 the Clinical Trial industry is being leap frogged by innovators who have adopted mobile first strategies and it’s no longer fair for companies to suggest it’s ’emerging tech’ with unproven ‘potential’ just because they’re not doing it yet…

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“However, it’s important to make objective decisions about the use of mobile technology to maintain a truly patient-centric trial design. As exciting as mobile health is, some technologies may impede the patient-centricity of a trial, making participation more difficult for some individuals”

This seems to be a crafty way to use social media to add legitimacy to a claim (I thought the embedded link would take me to somewhere that discussed why mHealth impedes the Patient-centricity of a clinical trial) but it’s just a means of promoting a very outdated position that Forte are taking (probably to protect their business interests and stop clients dropping subscriptions to their software and moving business to Apple ResearchKit partners):

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A year on and I suppose it’s positive that only one twitter user has supported the companies position:

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“Why mobile health should not be used for every clinical trial. As described above, mobile health has a lot of potential in the clinical research space and could make the clinical trial experience much more patient-centric. However, these technologies may not be appropriate tools for every trial. It’s essential to be sure you’re using tools that enhance the patient experience and ensure data integrity. For some patient populations, mobile health could prove detrimental. When determining whether mobile health is appropriate for your clinical trial, evaluate and characterize your participant population and their relationship with digital technology. Also take into account the feasibility of a mobile health study and assess whether you have the necessary resources to provide the best participant experience. Answer these key questions when considering mobile health for your study:

What is the age range of my participant population? While younger generations are very adept with technology, seniors may struggle to use mobile health applications or devices. Using mobile health for an older demographic may require research staff to provide extra training. Such trial design could also inconvenience an older patient population as it may require them to perform atypical tasks and significantly alter the way they function throughout the day.”

I think this conclusion is reached because of a couple of common misconceptions about older people being resistant to using tech and mHealth being just about smartphone apps. I think it’s important to note that there’s no reason not to think of mHealth as also including the opportunities we have to embed mobile connectivity into sensory devices that seniors already use to manage their health.

“Do the majority of my participants have smartphones? The demographics of your participant population, including age, financial status, location, as well as a variety of other factors, could influence whether they have access to a smartphone. If some of your participants don’t have smartphones, will you provide them the necessary technology? This could prove logistically difficult and limit the amount of eligible study participants in your target population.”

This position stuns me because everytime I see a rep from a drug company they’re wielding the latest tech from Apple iPads to iPhones and even Apple Watch yet when it comes to the Patients who make their clinical research possible the idea of gifting an inexpensive smartphone is just out of the question a step too far. Time to get your priorities right and at the bare minimum stop telling us it’s preposterous for you to think about investing this much in your trial participants (most trials today cost in excess of $100k per Patient so relatively the gifted mobile is insignificant).

I think it’s an endemic issue with the current design of the clinical trial industry as you would think it’s obvious that the pharma brands should just reinvest the money they save on the use of clinical research facilities and reimbursing all the travel etc but it doesn’t typically work like that because most clinical trials are still outsourced (usually to the CRO that bids the lowest price) and aren’t branded by the drug company that pays for them (this is another important reason why Apple ResearchKit ratings are going to completely disrupt today’s conventional outdated way of doing things).

“Is real-time data truly necessary for the benefit of my study? The potential of mobile health and real-time data is exciting and it’s tempting to take advantage of the technology regardless of whether your study will truly benefit from its use. Critically evaluate whether the costs of using mobile health (such as those listed above) are worth the benefits of real-time data. If the benefits fall short, it may be best to opt-out of mobile health and design a trial better suited to the needs of your study and participants.”

This is a typical mindset view of people I meet who work in the CRO industry. They can’t see any value beyond the tightly defined measurement requirements that they’re being paid to collect in their specific trial. The idea that the big data sets collected during a trial could be reviewed and processed by someone else or at a later time to draw other insights that weren’t perhaps clear when the trial was being quoted for is of no interest because most trials today are run by CROs who are focused on cost. Most trials today in Europe fail because they don’t recruit any/enough Patients or because the CRO tried to run them on too tight a shoestring.

“While mobile health technology could revolutionize how the clinical research industry conducts clinical trials, patient-centricity relies on the industry’s focus on building a positive participant experience. Regardless of whether mobile health is incorporated into study design, it’s essential to design each trial with the participant’s best interests in mind”

It’s no surprise that Mobile companies like Apple and Google are wiping the floor with brands in the CRO industry because they are so clearly out of touch with the business they’re in. How could a Mobile First approach not achieve a more ‘positive participant experience’ to what we have today where most Patients don’t know that clinical trial opportunities exist, aren’t being recommended to them by Carers, can’t find reviews of clinical trial experiences, etc, etc.

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