Last month the José de Mello Health Group generously brought me over to present a keynote talk at their annual Healthcare Conference held at the Estoril Congress Centre (on the beautiful Estoril Coast 24km from the Portuguese capital Lisbon).
Conferências Saúde CUF 2013 was the 16th annual conference produced by José de Mello Saúde to discuss important issues in clinical practice and healthcare provision with the aim of presenting the major trends in healthcare and the impact that they’re having from clinical, social, ethical and organizational perspectives.
For 2013 José de Mello Saúde decided to focus on Mobile Health as part of a strategic initiative under way at the group and to extend the scope of the meeting by making it open to Patients and the general public.
Objectives of the event:
> Raise awareness for the new opportunities and challenges that mobile technologies represent for the health sector, for the changes in the way of working, etc.
> Discuss the need for an ethical and legal framework that allows security and confidentiality for users;
> Create awareness among health care professionals to the transformations in the relationship between health professionals and in their relation with users;
> Display the new mobile health technologies and applications that are emerging;
> Foster synergies and build partnerships.
Event partners included:
> Cisco, the world’s leading networking company that is now focused on enabling the Internet of Everything who demoed a range of Video technologies including the ruggedised “VX Tactical” and a Video Conferencing COW:
> Portugal Telecom, Portugal’s leading fixed-line and Mobile network provider and their IT Services division PT Prime who together showcased their new box van “Mobile Clinics” that connected over their cellular network to provide video conferencing to a remote clinic to support in-the-field onsite health screening services for large employers:
Note: The idea that these box van “Mobile Clinics” deliver “Mobile Health” is another good reason for us to refer to Healthcare that leverages “Mobile” (the newest mass media) as “mHealth” and not Mobile Health to avoid potential for confusion.
Call for Papers:
José de Mello Saúde promoted a Call For Papers contest on the theme of mHealth and here’s a deck featuring snap shots that I took of the posters on display:
AWAITING SLIDES TO BE UPLOADED
The organisers asked me to focus on the following 5 topics order for my presentation:
> The main technologies and applications that have emerged throughout the past years
> How these new technologies are shaping health care provision
> Main benefits and risks for organizations, health professionals and
> Why it is important that organizations develop an integrated digital
> The case of 3G Doctor – Why and how it was created, what were the challenges, opportunities and barriers faced, which are the main results and benefits for users and doctors and what are the plans for the future
My talk was video recorded but it’s not posted online yet (if you would like a copy perhaps to show at your University etc please make a request in the comments below and I’ll see what I can do to get it to you) but I thought it might be a good idea to quickly share the transcript (thanks to Nuance’s Dragon Speech Recognition Software) and add in some URL’s to help readers dive into topics I touched on in the talk.
Thank you very much to the organisers for putting on this event and we’re very grateful to the sponsors for being involved in something like this – for the first time you’re providing Patients and the Public with access to the processes of innovation (at the Jose de Mello Hospital Group) so a big congratulations on that.
Now I’m from Ireland so I’m obligated to start every talk with a joke so here goes: I recently watched a movie called ‘The Man of Steel’ – the new Superman movie – before I chaired the Going Mobile Summit in Dublin and it was interesting because it made it clear that we didn’t need this event because we’ve already all ‘gone mobile’.
To be fair the movie was spoiled because it was so unrealistic. The first thing was apparently there were still jobs in journalism, and the second was that Clark Kent had to spend the first half hour of the movie just looking for a telephone box to get changed in because he couldn’t find one anywhere…
So some people think I’m a bit weird because I just think about Mobile and Healthcare in my work and my first memory in life was the sound of telecoms in healthcare. My little brother was ill and I went to Great Ormond Street Hospital in London and I saw my mother being handed coins for the first time and I realised where these coins came from. They came from the Clinicians that were talking to her by the bedside and those clinicians made a very distinctive sound (to me as a 4 year old) because they jingled. They jingled because they had very deep pockets in their white lab coats and in the bottom of that pocket were coins that they would proffer to Parents when they were giving them bad news. So more coins more bad news sort of thing. And the amazing thing was that I realised in the worlds best hospital the most expensive and the most powerful technology you had access to cost only ten pence and it was at the bottom of the corridor. It was in a little mushroom thing that I presumed was some sort of teleporter – but literally take a picture of yourself with a telephone because your grandchildren will not believe when they grow up that telephones had strings on them and were tied to walls. So you can imagine this telephone enabled you to call the Professor at the Mayo Clinic with this thing. The MRI Scanner which hadn’t really materialised by then – they were still using CT Scanners – wasn’t connected but you could pick that phone up and call anyone in the world and the power of that was immediately obvious to me.
Fast forward some years and that experience had inspired to look into medicine and in 1995 I was at Medical School and I had a mobile phone.
I didn’t have the means or an actual need to have a mobile phone but I’d convinced another brother of mine who was a Veterinarian that there was a need to have a mobile phone for his work as an on-call out-of-hours Vet. Instead of running back to the answer machine I told him it would be cost effective for him to buy a mobile phone. At the time he could see no social reason to have a mobile phone so unless he was working he didn’t want to see the phone and that meant I could go around with this fancy mobile phone and just to help you realise how far back we’re looking here if you look very closely it actually said on that phone that it was a ‘Cellular Telephone’ in case anyone got confused and didn’t know what I was holding – people would actually ask me “what is that?”.
So what is ‘mHealth’? Well today a lot of this is already just take for granted for example we just use our mobile phones to call emergency services but 10 years ago Nokia built a phone on which if you held the button depressed for too long it would ring emergency 999 services in the UK and every emergency call handling service got completely flooded (with callers who had accidentally dialled the service) so they started building in caller ID and introducing some screening technologies that are now commonplace. To understand (mHealth) think of it as the leverage of Mobile – the newest mass media – for health.
Understanding mobile not as a phone, not as a network and not as a technology we own or is in our pocket, but as a mass media is fundamental to seeing a lot of the opportunities. If we look back at some of the older mass medias it’s easy to see that each one has been unique and distinct from the ones that went before it. So whether it was Print, Recordings (with the gramaphone), Radio, the Cinema… but every time one of these new mass medias came along (people) tried to simply do what they had been doing with the old mass media with the new one.
A lot of what we are seeing being done with the mobile today is like trying to be a mini-internet in our pocket. A good example of this is with the first cinema advert where they actually showed an image of the newspaper clip on the screen and they played the radio advert through the speakers. It was actually for a tobacco company. That’s how they thought (at the time) how you would use this new media, it was (as though it was) just a big newspaper and you could broadcast a radio advert at the same time. They didn’t appreciate that moving images and sounds could come around the customer and that they found themselves in a dedicated environment with a big curtain in front of them – and that’s where we are today with mobile. We’re just beginning to see people leveraging the unique assets that this new mass media has and already eight of these have been identified (click here for a mHealth example of how each can be used).
These include that the mobile is permanently carried, that it’s a personal device that we don’t share, these have huge applications for healthcare: I remember handing VHS cassettes and DVDs to Patients and hoping that they would go home and put it on in the front room of their family homes and for many health needs that just didn’t work. The mobile is always on so we can always call our Patient enabling them take to bed yet still be reachable. Mobile has a built in payment channel making it amazingly capable as a means for delivering content. Mobile is there at the creative point of impulse, there when you want to take your blood pressure reading, there when you want to record how you’re feeling, these are unique opportunities we never had with other mass media, the PC was never so readily accessible. Mobile can also offer augmented reality like you can see with the Google Glasses but you can actually do a lot of this already with a mobile phone, so here in Lisbon I can point my mobile phone at some (Portuguese) text and it will actually translate it for me – if you would like a demo of that please ask me afterwards.
Mobile also has it’s own trillion dollar industry, making it the newest trillion dollar industry. This is very important because it means a lot of talent from other indutries are working to advance the user experience. More than 6 billion people already have a mobile subscription – we’ve just reached the ‘Mobile Moment’ where the number of mobile subscriptions has over taken the total population of this planet and this all literally happened in a little more than 15 years and healthcare has actually been key to its adoption.
So if you looked at why people initially bought mobile phones it was Doctors with pagers, which later got updated into the cellphone networks we use today. For mums the advantage of mobile were obvious because as a carer you could always be reachable and easily call for assistance say for example on your way to visit your elderly Parents etc.
What we’ve also just lived through – and this shows how difficult it is to keep up with this rapid rate of change – is a decade that we’ll all soon realise was the Nokia Decade. Nokia is a brand that became bigger than Coca-Cola, behind ‘Snake’ – the worlds most popular electronic game – I mean who hasn’t played that?
Now this brand is obviously dying but that just highlights the scale and rapid unforgiving growth with which this mega industry moves. Convergence to mobile has been key to all this, all of these consumer technologies have actually already converged to the mobile phone whether they be iPods, or Cameras, or Gaming Devices, Alarm Clocks, Pagers, you can hardly think of a consumer electronic device that hasn’t already converged to what we call the ‘Cannibal of Cannibals’ – the mobile phone with it’s mega industry dynamics ready to suck up anything that comes in it’s way that it can converge with.
It’s important to realise that a lot of this isn’t Smartphones and Apps – the key thing here is that it’s now redesigning healthcare right from the roots up.
A Patient receiving a SMS reminder for their Doctor appointment or being able to say they can’t make the appointment via SMS represent huge opportunities for us to redesign how we access care and the biggest opportunity I feel we have today right now to control future healthcare costs is to teach seniors to use SMS.
It is fundamental because when everyone uses Mobile services as they do in markets like Japan, the world’s most senior market and the market that has led the rush to adopt Smartphones, this can be of invaluable help (in the delivery of healthcare). When the Tsunami hit Japan voice networks were turned off and reallocated for the coordination of the emergency response effort. Mobile Data services could be used by geriatric Patients because +80% of Japanese senior citizens use mobile data services (already), so can you imagine the opportunity for these individuals to stay connected while the voice networks were used for these more dedicated emergency roles? So I think that should be the key take away for anyone no matter where you come from in Healthcare teaching your Patients to use mobile, help them appreciate why they might want to use a mobile, why to leave it on so that they can appreciate ‘reachability’.
Now Convergence is redesigning healthcare and after my talk I’ll be here and please come up and ask me for a demonstration of anything I’ve brought to show you here. This tablet stores a copy of all my medical text and reference books. All searchable by just entering a single keyword. I describe this (to my fellow digital immigrants) as though it’s a wriggly worm that can just burrow through a whole library looking up all the times that keyword is used and I can use that in a consulting environment for example if I need help to explain something to a Patient or I need a picture, instead of relying on posters to be on the wall I can just look to this tool and share it with my Patient. It also means I’ve always got to hand up to date reference materials so I’m never reliant on that old dog eared book with last years prescription guidelines. For Hospitals who are supplying mobile text and reference book content to their employees they’re finding that their library budgets can be much more effectively used, for example Medical Schools now have the simple ability to pull the textbooks back from someone it’s loaned to, the books can never get dog eared or lost, and it also helps them allocate resources better as they know how much the books are being used and referred to. What it also helps them know is whether the books are out of date and no longer do clinicians have the excuse that they had to recall something from the top of their head because the library is closed or difficult to access.
Videos provide a phenomenal opportunity to provide content to Patients to help them understand things and to help Doctors explain things.
S Health is a fantastic development from Samsung. The new Samsung Galaxy S4 has already sold 10 million units (NOW 20 MILLION!) and it’s unique in that it’s brought smartphone based mobile healthcare applications native on a globally retailed mobile. S Health bundles a pedometer (a useful barometer for activity levels that has already become very popular in Japan where Doctors can with one glance get an appreciation of a Patients activity trends), temperature and humidity – can you imagine how this could be used to help us manage the healthcare needs of individuals when there’s a heatwave? An enormous opportunity for Mobile Operators to be involved in providing care!
Sleep by Motion X is the number one Healthcare Application on iOS (Apple). Developed by the guy who invented the CameraPhone this app quite simply monitors your sleep. Can you imagine the opportunity technology like this provides us with to monitor Patients who are being prescribed new medications that we otherwise wouldn’t know are disrupting their sleep?
(The giant US Retail Pharmacy) Wallgreens found in the first 18 months with a dedicated mobile strategy that they made more money than in the last decade with Wallgreens.com. A phenomenal step change that means if you’re talking to anyone in the Pharmaceutical industry they’ve already had their industry disrupted (by mobile) and if they stay behind the curve on mobile they’re going to be left behind very soon.
Smart Stay is a fantastic feature of the Samsung Galaxy S4 that really highlights the disruptive potential of Smartphones with ever faster processors. This phone can now look for the pupils of your eyes and it’s using that information today to save battery resources because if you’re not looking at the screen it will dim the screen. If you’ve ever seen a Doctor provide a neurological exam it’s quite obvious that tracking the eyes is a key component of this and although it’s being done by the smartphone to extend battery life it’s not hard to see how this will trigger innovation.
The Withings BodyScale is a device sold around the world in Apple Stores. It’s a weigh scale that’s connected to your Patients mobile phone.
Withings also produce a Blood Pressure cuff that simply clips on your arm, plugs into your Smartphone. Simple. Very little training needed and your Patients have now got their BP accurately tracked. (Click here to read a debate about hype associated with these mobile connected monitors).
The Alivecor ECG is something that must be demonstrated because it’s one of those unbelievable things that we’re seeing with mHealth. This is a smartphone case with two electrodes. I simply clip it onto a Smartphone and I can now record clinical grade ECGs. Simple to use, just click the button to open the app and you’re now looking at my single lead ECG – I’m 91 there because I’m up on stage here but you can also see things like irregularities. I can also apply this to my clothed chest and you can see how amazing this is… (click here to read notes on my experiences with this device and click here to order your Alivecor today)
What this can also do is read information from an implanted medical device. I can hold it in my hand and have an assistant place a small therapeutic magnet on my chest over the implanted device and the Alivecor will tell me if it’s switched on, if it’s leads are intact, the remaining battery life. Now if I was a betting man I’d take a bet that everyone in here knows the battery life remaining in their mobile phone BUT did you know nobody with an implanted cardiac device here would know the battery level or it’s switched on/off status. Phenomenal step change in my opinion…
Mobile is also converging to everything else. So everything that should be connected will be inside the next decade. This smoke alarm is a good example. You can put your Portugal Telecom SIM card into this device and anytime that device triggers the alert signal can be provided to whoever you want so it might be the local fire service, your next door neighbour, if you’re blind or death it might go to your senior phone which can wake you with a 100 Db alarm. It’s interesting to note that a lot of seniors have actually lost their hearing in the range that smoke alarms signal at.
The Telcare Mobile Connected Blood Glucose monitor is amazing for anyone that works with diabetic Patients. Obviously it’s key that we record blood sugar accurately but what this device does is removes the need for Patients to journal their readings. Just replace your normal meter with this device and a carer, parent or diabetes nurse can immediately see your results on their smartphone. Not only does the device remind Patients to test but smart parents are already using this information to directly incentivise and reward their children for regular testing – for example with credits that they can use in their favorite mobile games…
The ‘Everything’ that should be connected obviously extends to medical records and Microsoft’s HealthVault is very exciting that I’d encourage you to check it out.
Augmented Reality is also something exciting and we’ve all seen the Google Glasses but the thing that baffles me most about this is that we’re still doing so little with the augmented reality opportunity we already have with mobile.
The Plantronic Voyager Legend is a bluetooth connected device that I use to control a range of things from my phone to my computer. It’s phenomenal what can be deduced from processing sounds and the opportunity for natural language to be transcribed using technologies like SIRI which is powered by Nuance.
We’re arriving at a day when we will be using natural language to converse with our mobile phones, arranging a Video Consultation with a Doctor in the same way that today you can use SIRI to locate a store and place an order at Starbucks…
So I’m now going to tell you about 3G Doctor, a service I developed with colleagues from my appreciation of the opportunity in 3G Video Calling technology to put Doctors in the hands and pockets of Patients.
3G Doctor offers documented Mobile Video Consultations with registered Doctors (in the UK and Ireland for regulatory reasons). Available 24×7 so anytime you’d like to use it for non emergency needs and it costs only £35 – an one off all inclusive fee.
It’s bundled like a mobile service so you simply register on the secure 3GDoctor.com website that’s optimised for mobile so if you go on a mobile phone you’ll see it’s different to the PC version.
Then top up your account with £35 using a wide range of electronic forms of payment.
You can also share with us your HealthVault record or any other online accessible Healthcare Record then you can share your concerns before you meet with the Doctor by completing an interactive Medical History Questionnaire.
This is a technology we took over from the USA and adapted to mobile. It’s been clinically validated at the Mayo Clinic but in essence what it does is immortalises the best history taking skills of the worlds’ best Doctors and packages that as a mobile experience. This is the bit where we’re putting the SIRI technology to work to make this Q&A something you can just talk to which to me will be an incredible achievement for the mobile industry in terms of we will have created the ability (for a mobile) to take a history from a Patient. When you appreciate how long we spend at Medical School trying to learn how to do that it becomes obvious how disruptive this is going to be and how empowering for Patients this will be as ensures their needs will be not only heard but clearly documented.
What we also enable is for Patients to share other aditional information that they feel is important and that might include photos or websites, YouTube videos that they’ve watched. If you’ve ever tried to share a YouTube video with your Doctor you’ll realise how difficult that can be but with 3G Doctor we don’t just serve that need but we also try to provide Patients with at least one or two links to videos as part of the documentation they take away from the consultation.
A Doctor then reviews the information that you’ve shared with them and conducts any additional research that they need to do before video calling you back to consult on your problem.
The video consultation itself normally lasts no more than about 10 minutes and afterwards you can simply login to the secure website from where you can view, download and print the comprehensive written consultation report.
This report contains all the information you shared, the advice and information the Doctor gave including an action plan as to what to do next.
The great thing about this is it now means you don’t have to repeat everything you say over and over and this is one of the key lessons you’re going to take away here. This documentation includes an action plan that ensures the next move you make is the right one and that’s what we’re selling the Documented Advice of Registered Doctors.
This is not a replacement for the family Doctor where the best care can be recieved. But if you’ve moved away from home or aren’t registered with a family Doctor or don’t feel you want to present to your Doctor about an issue then you can use a service like ours.
We’re definitely not selling prescriptions but many of the action plans we provide do recommend Patients to go and get medications that are available over the counter.
Following the consultation Patients get the opportunity to provide feedback to us on their experience.
So I’d like to now ask you to put up your hands if you think you have a good Doctor…
Does anybody here have a good Doctor?
…excellent can you tell me why you think your Doctor is good please?
‘because he knows me’
‘because he looks me in the eye’
The funny thing is every time I ask this question I never have a reply that is actually a good way of judging whether your Doctor is a good Doctor. Your Doctor probably is a good Doctor because he hasn’t been struck off, he’s still working with Patients, You’ve not had a problem with him, but none of this actually means he’s actually a good Doctor and this is a big challenge that Doctors face because we’ve devised a system in which malpractice is the process we use to protect Patients.
So you know when you’re looking in the eyes of someone who’s still got their job and therefore hasn’t been sued for malpractice – well he must be good because he hasn’t been sued and therefore you’ll be safe with this Doctor. Now whilst that does actually work to an extent as we move forward what we’re finding is the best way to measure effectiveness is by introducing documentation.
If you look to the aviation industry we find that’s really key to what’s driven safety. Documenting what’s happening and then following checklists to ensure it is done. What we have with Healthcare is a system that is largely undocumented. The value of that documentation and getting history inforamtion from the Patient is really key to solving one of the really big problems that Patients have: That their Doctors don’t listen to them.
But what happens when you start with a read/write approach to Electronic Healthcare Records? We’ve started with EHRs that belong to the government or the healthcare provider but what if belonged to the Patient and they actually helped read, write and reviewed it?
Patient expectations are changing. This has to happen. If we look here to how Patients are spending their time in the clinic we see they’re reading out of date magazines, filling in the same old paper form that they completed on their last visit.
If we look at what they’re doing after the consultations: half of them are worried and uncertain the rest are Googling the wrong things and a small proportion of them are asking other people and trying to recall what was actually said in the consult room.
To help you see the mess we’re in can you imagine another industry that was as undocumented as healthcare? Let’s imagine fueling your car was a completely undocumented process.
So here’s my fuel gauge but it doesn’t work because that’s documentation:
I’m now driving a car and I have no idea how much fuel is onboard. It’s already feeling quite crazy I mean how would I know when I needed to fill up?
Luckily there’s a roadside garage with Petrol being sold. But there’s no prices because that of course would again be documentation…
So I’ll pull in there as I’ll probably need petrol. But when I approach the pumps it’s obvious that there’s no octane level, nor is there any pricing information or volume gauges.
Imagine then going into the store to pay and I’m told that I’ll find out how much it costs when I recieve my credit card statement in three months time?
Can you imagine how we’d use a product that was sold to us like that?
We’d be really sparing of this product. The idea of going for a leisurely drive on a Sunday would be the stuff nightmares were made of. We’d be sharing lifts everywhere. Commuting to work wouldn’t be feasible as we couldn’t cope unless we worked near to where we lived. Everything would be very different if we had a product that was undocumented but sadly that’s what’s really happening in healthcare today and that’s the key lesson to take away here.
If we look to how undocumented care is not engaging Patients it becomes obvious why they find it so easy to engage with things that do offer documentation. So Doctors might worry about their Patients because they look on the internet and read marketing materials from drug companies and quacks and they wonder why Patients are engaging with this but they’re not as quick to look at themselves and the way they are failing the Patients they care for because they don’t offer a documented experience.
So really mHealth is a gamechanger because it supports the documentation of care. This is going to be a step change that we will soon all appreciate will redesign the healthcare experience.
At 3G Doctor we’ve started in a little way with Patients who want to talk about a concern they have about some information and we make it easy for them to do the right thing first time. Some Doctors actually ask us ‘what do Patients want to talk about?’ and many Patients will say to us how can Doctors not see that this is exactly what I want to talk about. But what we’re not doing is just referring onto Doctors we’re saying to Doctors: This Patient has talked with us about this problem, here’s a record of what they shared with us and the advice we’ve given them, now you can get stuck in doing the really high quality bit which is where you care for that Patient and provide them with the appropriate help that they need.
Discussion of some disruptive mHealth tech/services (the Firetext Mobile Connected Smoke Alarm, SenCit Mobile Connected Care Monitor, Doro EasyPhones with programmable ‘ICE’ and SOS button, Telcare Mobile Connected Glucometer, Bluetooth Tracked Medication Dispenser, etc) followed by Q&A with audience.
Thank you to the Jose de Mello Hospital Group for sponsoring our involvement in the meeting and for the event sponsors CISCO and Portugal Telecom. If you would like us to present to or host a workshop at your organisation please complete this enquiry form.