Irish Times: New service to allow GPs to treat patients via smartphones

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At the NAGP’s Primary Care Partnership Conference in Dublin a new service called GP Online has been launched to enable Irish GPs to consult with their Patients via an app and Paul Cullen at the Irish Times got the scoop on this new service being funded by NAGP members.

mHealth Insight

“The first tele-medicine service that allows patients be treated by their GPs using a smartphone is to be launched on Friday”

It can’t be stressed enough mHealth startups need to be careful not to exaggerate or make up fake facts to get headlines because the currencies of anyone who wants to make change happen right now are attention and trust eg. rural GPs in Ireland have for years been routinely giving their mobile number to Patients and most Patients in Ireland have had a smartphone for years.

“GPs hold about 24 million consultations a year, of which 7 million are with private patients. Mr Callaly believes up to one million private consultations could move online in the initial phase”

It’s not at all clear how this gets around HSE requirements of GMS registered Doctors to treat their private and public Patients without preference. It seems that if GPs being paid by the HSE are offering this service to ONLY their Private Patients they’re going to get in a lot of trouble with the GMS (who can easily hold back their payments pending review of their practice) and it’s going to confuse the hell out of Patients (eg. what happens when you hit your 70th birthday and consults with your GP become free but you lose your entitlement to mobile access to your GP?, etc).

“The service operates via an Apple or Android app and can be used on a smartphone, tablet or laptop computer”

 

I’m not sure why the app is being bothered with. Wouldn’t Patients be better off  with a just a website and then using Facetime, Skype or a 3G Video Call to answer when the Doctor calls rather than an app?

In 2017 Facetime/Skype/3G Calls are much more usable and better designed than the Irish Times photo suggests this app makes the video connection which is actually quite similar to the 3G Video call user experience that was available nearly ten years ago (for proof check out this video call between 3G Doctor and Qualcomm’s VP Don Jones in 2009):

Don Jones VP Qualcomm Consulting with 3G Doctor's Dr F Kavanagh MRCGP

“The GPs can provide online treatment for “anything that doesn’t require a physical examination”, he said. Most of the initial demand is expected to come from patients requiring repeat prescriptions or those unable to leave home or work for a face-to-face appointment”

I think the major challenge with this approach is that Patients don’t know if they need a physical exam and nor do the Doctors have any idea until the Patient has shared some history with them about their concerns.

This is why I’ve been advocating for 10+ years for online Doctor consulting services to copy the approach we have taken at 3G Doctor (launched in 2006) and combine mobile video consultations with clinically validated online medical history taking tools.

 

I also wonder how the MedicoLegal Insurers and the HSE will react to GPs signing repeat prescriptions for private Patients via a mobile app. The way the HSE essentially closed down one of the world’s most biggest pharmaceutical companies when they tried to innovate in this area by accusing them of fraud (note: the legal defence team required to defend a case like this would probably bankrupt most Irish GPs) doesn’t bode well for Doctors who might not meet with or document a proper history on a Patient for over a year (eg. as can happen when you’re ordering 6month repeat prescriptions etc).

I think there’s also the question of the value of going to the hassle of downloading and opening an app to get a video connection for something like a repeat prescription when it’s your own GP calling you (something I learnt a lot about from the innovative Dr Tony Stern who in 2009 was seeing most of his GP consults to his registered NHS Patients over the plain old telephone). Outside of skin care the appearance of a Patient doesn’t really come into it for most repeat prescriptions.

“The National Association of GPs, whose members are funding the initiative, predicts that up to 100 family doctors will be offering video consultations by the end of the year…   …Doctors who opt to provide the service will pay €35 a month for the connection and set their own fee levels for patients”

It sounds like easy money and GP Online must have an incredible sales team to manage to sell this to the NAGP (the latest issue of the ICGP’s member magazine is practically dedicated to making the case that mobile video consults are dangerous/useless) but I don’t think there’s actually a viable business model in this for the app developer eg. why would Irish GPs want to pay £35/month to video call Patients when they could just call their Mobile number (and make a check to see if the Patent can accept a FaceTime/3G Call first)?

Even the Doctor (Dr Andrew London of the Aylesbury Clinic in Tallaght) who is involved in this pilot and is mentioned/pictured in this Irish Times article appears to be running his entire practices online communications with a just gmail account (and the HSE have wasted lots of energy and money with the ICGP and mobile operator o2/Three Ireland giving GPs a free secure alternative to these advertiser funded email accounts – see healthmail.ie) and from one glance at the Clinics website it’s clear paper based records are still being used there.

Maybe it’s just me but buying online consults from a GP who in 2017 still runs a practice on paper based records would feel a bit like buying my broadband internet from my coal  delivery man…

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“As the technology develops, it is expected that basic medical checks, such as blood pressure, pulse and blood sugar levels, will be carried out online”

It surprises me that this isn’t the primary focus of the service as in 2017 there can’t be a single rural Irish GP who hasn’t been woken out of bed when on call because of a reading on a Patients blood pressure monitor or glucometer (something that is exponentially on the increase as Mobile is cannibalising everything).

I think as soon as you start giving Patients access to their medical records, online tools to share their concerns and getting their medical devices properly connected the need to see a particular GP when a need arises becomes less critical. Perhaps it’s just the legacy group thinking (that your GP and your Medical Records are always bundled together) that has ensured the developers here have failed to appreciate this.

NOTE: Four years ago at 3G Doctor we started offering to consult with Patients who recorded ECGs on the world’s first made for mobile ECG machine and it taught us that this market is materialising incredibly quickly eg. in the most recent ICGP webinar for GPs a poll revealed that as many as 1 in 5 GPs in Ireland are now themselves using an Alivecor which is interesting to compare to the situation in 2011 when a Patient felt they were being told off for presenting with the ECG reading from my Alivecor to their GP..

“This is the first service to allow patients talk to their own GP from the comfort of their home or office. “The advantage is that patients are talking to the doctor who is familiar with their medical history and has all their records to hand,” GP online chief executive Aiden Callaly said”

The other side of the coin is that this initiative could make GPs appear to be have money grabbing motivations because this is being made available only to Private Patients who can’t access their healthcare records online and a key differentiator between this and other services is the gatekeeper role that these GPs are taking to their Patients electronic medical records eg. if the Patient had their own access to their own medical history they could share that with another Doctor of their choice or perhaps do some useful online research and avoid the need for a Doctor chat altogether (or have a much more interesting/useful consultation after they’ve done some medical record assisted research of their own).

 

Key takeaway:

I’m enthusiastic about GPs signing up for this new service as it’s much better than blaming Patients for not fitting with your view of the world but I think the NAGP would get much better outcomes by shifting it’s focus to educating members (about the opportunities mobile offers to transform their service from today’s completely outdated office visit only model of GP care) and the Public (about the disadvantages of Patients video calling multinational insurance companies and sharing their private personal info with advertisers instead of trying to develop a relationship with a Family Doctor) because the reality is the huge online ad budgets of big insurances and VC debt funded data trading companies will always enable them to reach Patients who are looking for services like GP Online anyway:

 

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In my opinion the Patients a HSE GP has who need a service like this the most are their Public Patients and Carers (eg. the Parent of a child or the Son/Daughter who looks after your 90 year old Patient) for whom this service will never reach (because in Ireland GP Care is free for under 6s and over 70s).

It is not viable for Irish GPs to give up 30 minutes of their time in exchange for 30 seconds of their Patients time so if you are an Irish GP serious about offering a mobile first practice please get in touch as I’d like to invite you to take the mHealth course I developed (free of charge) and show you a system that you can use today that has been proven to let your Patients access their records and share their medical concerns with you using their mobile.

*** UPDATE 21 May 2017 ***

At the NAGP annual conference this weekend the GPOnline service was demoed on what looked like a Windows XP laptop accessorised with a cheap USB webcam which I thought was a bit of an oversight in light of how WannaCry malware attacks on healthcare facilities has dominated the headlines over the last week:

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