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 It should be obvious that the BornMobile generation getting frustrated with the outdated 2,000 year old office-visit-only model of care (and have social media connections that empower them to vote with their feet for services that are marketed to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?

About David Doherty
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