I thought it might be interesting to share a few of my thoughts on this article by Charlie Cooper, the Independent’s Health Reporter (HatTip: Ben Heubl, Digital Health Innovation Activist, Advocate & Journalist in the mHealth group on Linkedin).
”Imagine if your doctor was as easy to contact as your Facebook friends – and you could Skype them whenever you liked to talk about your health concerns”
I think there’s a fundamental misunderstanding being made here that’s almost funny. When would a Family Doctor be working (and hence insured) and available for Skype video consulting in the same way that someone’s friends would be available for a chat? Would they do this with a Patient in the consultation room in front of them or would they just let those in the waiting room wait a little longer?
”For anyone waiting to see their GP in today’s cash-strapped NHS, and with doctors already working at full tilt to provide the universal healthcare we all depend upon, it seems like the realm of science fiction”
I think it’s clear even the author realises a NHS future that “could see you Facebook your doctor” wouldn’t even be able to happen without a step change in how we practice medicine. Clearly if there was going to be 100 times more funding going to GP’s it would attract new Doctors and they could afford to shrink down their lists so that they could conceivably be logged into Facebook waiting for Patients to message them but the reality in today’s NHS is that the “Family Doctor is on the brink of extinction“.
”But telehealth, bringing care into the patient’s home, is now one of the buzzwords of the modern NHS. In a population where more and more people, often the elderly, have long-term health problems such as heart disease, obesity, breathing problems or diabetes, the greater part of a doctor’s work can be done in the home, advocates of telehealth say”
Telehealth might be a buzzword but thinking we can ignore the reality that the 3000 year old model of reactive in person healthcare is going to enable us to effectively manage chronic disease is daft.
”In the internet age, the best way to do that, is to have a doctor on a computer, signed in to a network of patients in the same way we are connected to our Facebook friends and Twitter followers”
I think it’s clear we no longer really live in the internet age (we just lived through a decade defined by Nokia and mobile – the newer mass media that is as different from the Internet as the Internet was from the TV) but to anyone who has the first idea what a Family Doctor does it will be obvious that this idea for progress is very flawed. Imagine any other industry innovated with the internet in the same way. We’d have personal sales reps at Ryanair friending us on Facebook so they can make our holiday bookings, our solicitor would be sitting somewhere right now twiddling her thumbs while ‘signed into a network list of all her clients?’ that can also be seen by all her competitors, etc.
For the sake of discussion let’s side step the issue of whether every qualified and experienced practicing Family Doctor would be content or satisfied retiring their vast in-office skill-sets and experience to move to a model where they provide their Patients with 24×7 chat on Facebook.
I’m not sure it would ever be possible to do the same with the regulations that impact on Doctors (to protect the safety and interests of their Patients) and the responsibility they have for the advice and privacy they provide to Patients. The idea of sharing all this with an advertiser funded network and making Family Doctor’s available at all times is totally unworkable.
Yes we need to move to a platform that is online but it’s critical it’s secure and a place where the Patient understands it might not be their Family Doctor that they’re communicating with at 3am on Sunday morning but another Doctor who has access to their detailed Medical Records and can manage their questions and provide a comprehensive written report to the Patient that is recorded to the Medical Record in a way that it productively contributes to the workflow of the team that cares for that individual Patient.
”In the British Medical Journal today, researchers from the Netherlands have reported on the success of a scheme which is being hailed as a trailblazer for the era of telehealth. ParkinsonNet is a dedicated website which links Dutch Parkinson’s disease sufferers with doctors and nurses who specialise in their disease. It acts, in effect, like Facebook for Parkinson’s patients. The professionals communicate and collaborate on the website, where patients can also find information about treatment, about the professionals themselves and what they do and can also, if they want, request an at-home consultation via video link in their homes”
I think there’s a fundamental misunderstanding being made here. This is more like Kaiser Permanente’s Health Connect as there is no freemium advert funded business model eg. the ParkinsonNet website appears to have been funded by the Radboud University Nijmegen Medical Centre.
”Evidence presented by the researchers, from the Radboud University Medical Centre, suggests that the website “empowers patients, improves the quality of care, shifts care away from institutions and into the community and lowers healthcare costs.””
I think a really powerful disruption is happening as this shift is now being driven by mHealth companies eg. Telcare who’ve developed the #1 app for Diabetics and fund it being free to Patients because it works to engage customers with their brand and market their service (Note: you don’t need a Telcare device to use Diabetes Pal).
”Patients also appreciated being linked to genuine experts on their condition, rather than having to visit generalists and endure referrals and lengthy waits to see a specialist. The researchers concluded that the model could be used just as successfully by patients with other long-term conditions like diabetes and breathing problems”
Absolutely. It’s critical that we all appreciate that we have failed if we think we need to use office based consultations to manage all healthcare problems. This is why we think the NHS should focus on mHealth efforts to address Diabetes care as it is the Chronic Disease that involves the largest amount of already committed resources, is probably the easiest chronic disease to manage (in contrast to Parkinsons most diabetes care is still self managed), has massive care quality variations across the UK (you’re nearly 2 and a half times more likely to have an amputation if you’re a diabetes Patient being cared for in Somerset than if you were an NHS Patient living in London), etc.
”But it’s the cost benefits which may be of most interest to NHS bosses. The health service in England is under intense financial pressure and facing a £30bn funding gap by 2030 and its managers. The NHS in Scotland and Wales are also eager to save money. A patient with a long-term problem coming to a hospital for something routine is a waste of time for them and a waste of money for the hospital – so the more that can be done in the home, the better, experts say”
Except that in the topsy turvy world of NHS funding if the Hospital doesn’t see a Patient (because for example the Patient community using the free Diabetes Pal app has been able to better manage their diet and avoid an admission) they don’t get paid any money. Until something radical is done (to reward Hospitals for preventing admissions or penalise them for avoidable admissions) it’s unlikely that they will be incentivised to become proponents of this alternative lower cost preventative health approach (in the same way that the PremierInn hotel chain won’t be encouraging potential customers to try AirBnB anytime soon!).
”The Dutch researchers estimated that ParkinsonNet has saved up to 20m euros: a small amount in the context of the NHS’ budget, which exceeds £100bn. However, Parkinson’s is just one of the less common long-term conditions. If the millions of patients who suffered from diabetes, had a heart condition, or breathing problem could be cared for in the same way the savings could be, in theory, enormous”
That’s why the government and the NHS should prioritise mHealth efforts that have been proven to intelligently use data to lower the costs and improve the effectiveness of diabetes care. We have much more ability to self manage Diabetes than a condition like Parkinsons and the lessons and inspiration for a change in practice that would be generated by the NHS reforming diabetes care through the intelligent use of data will be key to convincing other healthcare budget holders that this approach is workable and not just some ‘potential could happen’ picture being painted by technologists in Powerpoint decks.
“Dr Martin McShane, NHS England director for long-term conditions… …“I think this is a really exciting time,” he said. “The problem is we’re almost being out-paced by mobile technology. There are also questions about how we ensure the right governance of these schemes – clear quality standards need to be maintained… But do we want to move to a National Health Service rather than a national hospital service? The answer is yes.””
I think this underlines the importance that the NHS commits to teaching healthcare professionals about mHealth – click here for details on the certified course that I developed for the Healthcare Informatics Society.
”In Scotland, a dedicated Centre for Telehealth and Telecare has been set up, with “patient-centred, at home care” a key part of the country’s plans to “transform” the NHS by 2020. The country is beginning to move beyond “pilots” to “large scale” uses of remote consultations with doctors and therapists, he said. “It’s not about replacing face to face care with technology,” said Professor George Crooks, medical director of NHS 24, who has overall responsibility for the project. “Technology can make face-to-face care more accessible: such as accessing specialist opinion remotely from remote rural or island communities”
Since launching 3G Doctor in 2006 we’ve heard lots of calls from Patients and Carers asking why they can’t video call the NHS. Talking about it is the easy part but Roy Lilley’s 94 year old mum is still waiting…
“We will use it but only where it is safe, effective and, most importantly, appropriate to do so…but people use technology to run their day-to-day life – and they now expect to be able to use their tablet, smartphone or computer as a way to access their health and care services”
I never understand why so many people talk about how we’ll only do this when it’s ‘safe’ as though registered Family Doctor’s are some risk prone group. After working as a GP for 22 years surely George knows that the real issue is whether or not any technology we introduce is enhancing the doctor-patient relationship.
Safety is a distraction as we move to digital interactions because if a registered NHS Doctor decides to practice unsafely they’ll be suspended from practicing by the GMC and this will be helped greatly because the Patient will be able to easily share a detailed account of the unsafe care that they were provided with.
There’s plenty of evidence that shows it’s much more effective and appropriate to let Patients communicate with you online before having to come and wait in your office. Click here to read about Dr Amir Hannan’s efforts to make this happen in his NHS GP practices.
What are your thoughts? In the future do you think we will see NHS Patients connecting with their Family Doctor on Facebook and what effect do you think that would have on the Doctor-Patient relationship?