President Trump talks up the TeleHealth opportunity at White House Department of Veterans Affairs Event

mHealth Insights

Visually this is all just ridiculous: Wearing white coats while video calling (CHECK), carrying a stethoscope (CHECK), reading from technology from ancient Egypt (CHECK), windows 95 user interface (CHECK), claims that it is affordable to deploy at scale the precise telehealth kit used onboard the Presidents $400Million modified Jumbo Jet (CHECK), etc.

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President Trump: “Today, I’m pleased to announce another historic breakthrough that will expand VA services to many more patients and veterans. We will do this through telehealth services. It’s what it’s called — telehealth services. We’re expanding the ability of veterans to connect with their VA healthcare team from anywhere using mobile application on the veteran’s own phone or the veteran’s own computer”

I think we should be mindful about the terms that are being used to describe how we are modernising the 2000 year old model of healthcare. TeleHealth means “remote health” (‘tele’ is a Greek derived word-forming element meaning “far/far off/at a distance”) and surely we can all easily see that this isn’t what veteran’s are going to be getting here.

Being ‘far away’ or ‘distant’ is the last thing a Patient will feel when informed healthcare advice that they can trust is for the first time accessible 24×7 by just reaching into their pocket and Facetime video calling their Nurse or Doctor.

With your access to the internet and my medical degree can you imagine what we could achieve

President Trump: “This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health, which is a bigger and bigger request – and also in suicide prevention. It will make a tremendous difference for the veterans in rural locations in particular”

President Trump: “We’re launching the mobile app that will allow VA patients to schedule and change their appointments at VA facilities using their smartphones. So, this is something they were never able to do. Technology has given us this advantage, but, unfortunately, we have not taken advantage of that until now. We’re working tirelessly to keep our promises to our great veterans. Very important”

I think it’s time to be a lot more ambitious and to use our imagination. In 2017 Veterans shouldn’t have to need to download an app to a smartphone to do something as simple as booking an appointment. Surely it’s obvious that making an appointment for an office visit is not really taking advantage of the connected super computers that we all now carry in our pockets eg. in 2013 I reported here about how a 92 year old in the UK was frustrated that her Practice Nurse didn’t use Facetime.

Tim OReilly Quote

Secretary Shulkin: “What we’re announcing today is a big deal for veterans. It’s really going to expand access for veterans in a way we haven’t done before. And, as you may know, VA already has the largest telehealth program in the country. Last year we had 700,000 veterans who got telehealth services through the VA, and we actually can do this for 50 different specialties”

I think the VA shouldn’t be so ready to clap themselves on the back as 700,000 may seem like a large number but it’s still means that less than 4% of veterans are using the VA’s telehealth services (there are 18.3Million Veterans in the USA).

Secretary Shulkin: “what we’re announcing today dramatically expands our current capabilities. Mr. President, by working with the Office of American Innovation and the Department of Justice, we’re going to be issuing a regulation that allows our VA providers to provide telehealth services from anywhere in the country to veterans anywhere in the country, whether it’s in their homes or any location. We call it “anywhere to anywhere” VA healthcare. That’s a big deal”

It surprises me that this is only now happening as Doctors I’ve talked to who work for the US army have told me they’ve been doing this for years eg. the USArmy’s Consultant Ophthalmologists who produced video tutorials to train GPs how to record and share good quality eye exams with their smartphones.

Secretary Shulkin: “…you talked about mental health and suicide prevention; this is one of those areas that we can really use that expertise. And today’s announcement is going to allow us to do that. What we’re going to be rolling out nationally with a rollout across the country is what’s called VA Video Connect. VA Video Connect allows VA providers to use mobile devices to connect with veterans on their mobile devices or their home computers. That’s a big deal”

I don’t think this initiative will achieve the desired outcomes. Enabling video call access to professionals won’t start to properly dent the suicide statistics because Veterans find it challenging enough to share information in face to face office encounters. The VA urgently needs to understand that quick convenient video chats don’t substitute for a Doctor Consultation because the “The biggest “disruption” in healthcare is honest, direct, accessible communication” (2012) and we know that we’re more honest with our phones than our Doctors.

Secretary Shulkin: “And there’s one more thing, Mr. President. We’re going to be announcing a new technology called the Veterans Appointment Request. And what that is, is it’s allowing the veteran, on their smartphone, to be able to schedule their appointments directly with VA providers, or to change their appointments, or cancel their appointments with VA providers. Now, today, this is available in all 18 of our regions across the country. And we’ve already booked more than 4,000 appointments from veterans directly from their smartphones so that they can schedule their own appointments. But now we’re announcing the national rollout of this”

I’m stunned at this. I know small GP clinics in the UK and Ireland that have been doing this for 7+ years and have provided more mobile appointment bookings than the entire VA. Talk about the future being here already but just not evenly distributed!

Secretary Shulkin: “Now, let me show you how this works, Mr. President. If we come over here — we use technology in a way that’s pretty incredible. In fact, Mr. President, I’m one of those doctors. I practice right here in Washington to my clinic in Grants Pass, Oregon. And I want to say hello to our veteran today. Mr. Amescua, how are you? Mr. Amescua is a veteran. He served in the Coast Guard for 26 years. He was a helicopter rescue swimmer and served the country. And here we are in Oregon. And this is our great team — Peggy and Denise and Terry. And, Peggy, would you mind — I understand there might be some area of concern on Mr. Amescua’s skin. Can we take a look at that, please? Team Member: Yes, sir. Dr. Shulkin, this is the area that is of concern. Secretary Shulkin: Okay. So, as we focus in on that, you can see, Mr. President, I can take a look at that area and if I have any concern about it we can send this to a specialist or we can take a look at it”

What an incredibly inefficient process. The VA should cut the waste and consult the Born Mobile Generation to redesign this Patient Care Experience.

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Secretary Shulkin: “Mr. President, if you walk over here, this is actually the new doctor’s bag – the doctor’s bag of the future. And you may actually recognize this because this is the doctor’s bag that travels with you when you go on Air Force One. And so we have Dr. Ronny Jackson, your doctor here that usually takes care of you, Dr. Jackson. And we now are able to bring this doctor’s bag into the home of our veterans. Our nurse practitioners, our technicians are able to use this type of technology now – the same technology available to the President of the United States. And that’s the way it should be, because our veterans deserve that type of technology”

The first thing I’m thinking is that this aluminium encased laptop must cost a bomb but seriously how many nurse practitioners are going to put out their backs in the next year if they are having to lug that in and out of their trunk and into every Patients home?

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Couldn’t they achieve the same with an iPhone/iPad and some smartphone medical accessories?

Secretary Shulkin: “Now, I’m going to show you just one or two other things. Dr. Neil Evans over here, one of our doctors, is going to show you VA Video Connect that I talked about. So here we are in Grants Pass, Oregon. Hi, Mr. Amescua, how are you? Can you raise your hand? Good. So, here we are in Grants Pass, Oregon on our mobile device, and this is how we can use VA Video Connect. But watch this, Mr. President. If we need to bring in a specialist from anywhere
in the country into Grants Pass, Oregon, we can”

I can’t see why the President of the United States is supposed to be impressed by a video conference call? He’s probably been using it at least once a week for the last 10 years (eg. when being interviewed on the TV news channels).

Secretary Shulkin: “Dr. Watts is a specialist – an internal medicine specialist in Cleveland, Oregon, and she is now connected in with Mr. Amescua in Grants Pass, Oregon. So, we can get the expertise from anywhere in the country immediately. The VA is able to do this right now. So, thank you very much. And so, Mr. President, this is how we’re expanding access. This is how we’re bringing the very best technology available in the country. And really thanks to your help in cutting through the regulation, the Office of American Innovation, we’re able to expand that success dramatically today and to roll this out”

I think it’s clear that the terrible design of this synchronous system will have no chance of expanding access to expertise. By utilising staff and Patients so efficiently it will waste resources and ultimately limit access to expertise.

Look how many staff members are being used here to bounce around what is a straightforward bit of dermatological history and a picture that Mr Amescua could probably have taken on his own using nothing more than his mobile during the month that he probably waited to get that video consultation in the clinic:

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