Join the “Do healthcare systems need their own app stores or could they achieve more by committing to training” #mHealthTV Hangout at 1am (London) on Monday 1 May 2017


Following last weeks fun #mHealthTV Hangout (click here for the video and transcript) organised by John Bennett MD at we’re going to be hosting this weeks event on the topics that are discussed in this blog post about NHS England’s plans to continue pursuing the concept of having their own App Store.

Already confirmed to join us for the Hangout will be John Bennett MD in Miami (Florida) and Yuki Byambasuren MD in Queensland (Australia).

Refresh this blog post at the scheduled time and you will be able to watch the livestream video, ask questions and view the transcript (useful if you want to follow along in another language.

Note: if you have ideas or suggestions for a mHealthTV hangout or would like to join us for the discussion or sponsor one please get in touch via the comments below.

Draft Transcript/Links:

Dr John Bennett: Good evening this is Dr. John Bennett televising from Miami for mHealthTV or the mHealthStudio with David Doherty leading he did last week he’s doing it this week he’s a mHealth expert from Europe, we are also lucky to have Yuki Byambasuren MD a Doctor from Queensland Australia’s Bond University. Let’s do the introductions. First Yuki can you just tell us a little bit about yourself before we turn over to David.

Yuki Byambasuren, MD: Hi everyone and welcome thank you thank you John I’m a Doctor from Mongolia I’m currently doing a PhD degree at Bond University in the Centre for research in evidence-based practice. My project subject is smartphone health apps and their effectiveness and their potential to be used in a primary care settings

Dr John Bennett: welcome you’re the first person I ever met from Mongolia. okay very good okay David welcome could you tell about yourself David and what you do and then take off with the discussion?
David Doherty: (1:15) yes I’m David Doherty I’m a co-founder of a company called 3G Doctor and the discussion this week is going to be around a slightly contentious issue that’s happened here with NHS England who are backing the creation of their own App Store. So literally they’ve had 4 years been trying to create an app store and so far they’ve managed to only produce one approved app on their store but officially they say the library now is really going to get some legs to start growing and this is happening while you know the political domain over here is being dominated by conversations about brexit, breaking up from Europe so there’s a whole lot of funny stuff going on that’s impacting the mobile health care market and I write a blog called mHealth Insight where I talk about things that are happening and obviously the NHS with its huge budgets often does quite exciting things that are worth reporting on but this thing I thought was one of those stories that just didn’t make sense to me so I wrote the blog and the title was I know a 10 year old with a better grasp of how app stores work than NHS England I invited the two people who were mentioned in the story one of whom happened to be a Twitter follower of mine to join in on this discussion but haven’t had a reply yet. But literally it didn’t make sense to me so I tweeted about it wrote my normal mHealth Insights blog as I thought there are some lessons to be learnt from this and my suggestions for what should be done and then on Twitter this was picked up by Yuki who commented that ‘app stores don’t aim to provide what’s best for patients they’re gatekeepers and the NHS is at least trying to provide some safe apps why are you blaming them. And so that’s where this discussion starts because I think there isn’t enough understanding of the technical elements that are at play here. It’s not good enough to go and make things that sound good when you’re dealing with patients and you’re diverting attentions and interests of people away from mobile healthcare you’ve got to really
understand what’s going on technically in the market and so there was a little bit od debate on that discussion between myself and Yuki I thought you know why don’t we bring this into this week’s mHealthTV hang out because this is the type of thing that you know probably doesn’t work very well with the 160 character limits of Twitter and it’s great that Yuki said ok let’s do that.
Dr John Bennett: Yuki you now have your chance, Dave is live on the screen right?
Yuki Byambasuren, MD: yes Oh Twitter and debating things on Twitter is so hard especially as English is not my first language it’s like the third so I type and delete and retype and try to find the shortest word, it’s a great exercise for my English. So yes look you know how app store works you know at the latest count they have something like 200,000 apps under the health and fitness and medical categories which are the two categories in the app stores that pertain to health. I’m in all the app stores including you know an iOS Android you know Google Play and even the
smaller ones it’s the data from research2guidance a germany-based company on health statistics and market analysis so but however you know very small percentage of those apps will be genuinely health related interventional type apps and you know majority of it is just you know educational apps providing information or you know medication reminders or appointment making you know that kind of apps I believe however small percentage the interventional apps there are I believe that they need to be tested by fair trials like randomized control trials to show their full effectiveness and the reason I believe that the NHS wasn’t able to approve more than one apps in four years is actually telling sign that there’s a lack of well tested and proven effective apps it’s not so much of an you know incompetence on NHS Digital side I believe it’s reflective of the evidence you know level that’s out there so and Dave you said you provide training to medical professionals I understand, and you said you give them you know apps that work and you also provide them how to evaluate to teach them how to evaluate apps and
things and I’m very interested to know about your you know training or workshopc  can you tell me more about it
David Doherty: yeah so what we have is really challenging. you know it looks like it’s just this big minefield of all these apps and we’re just going to get a deluged with  250,000 apps, I mean how is anyone going to be able to find value in that? but it’s not
really like that that’s a that’s a situation which is being propelled by researchers who want you to buy their research and think that by telling you it is immensely complex they’ll achieve that. Do you use that store at all? Do you use healthcare apps with your Patients?
Yuki Byambasuren, MD: well because since I’m doing research in this field I just you know I download every app that claims to do you know something and every app that gets a you know the best app Awards from you know anywhere and try to test it out myself and I also do a literature search on you know trials that they’re testing apps and in order to find you know really good effective ones that are tested and so my phone is like you know full of apps it’s got probably about 200 apps and you know the quality is varying and literature also reflects that and for example you know review of all let’s say depression apps you know they’ve looked through very enduring very much detail you know apps and 300 apps and they ended up concluding basically there was none that was evidence-based and proven safe and you know ticking all the boxes and that worries me and I believe that’s a you know practical problem that we really need to address before we go on talking about how to mass implement it and you know widely disseminate it and things like that that’s that’s kind of my opinion so
David Doherty: okay so as a primary care doctor have you ever prescribed an app to a patient?
Yuki Byambasuren, MD:  no I’m not practicing here in Australia so I haven’t done that no
David Doherty: have you ever prescribed or  referred a patient to a website
Yuki Byambasuren, MD: yes I believe so when I was practicing back in Mongolia I used to keep Patients who speaks and understands English some websites like the Cochrane Collaboration website for the patients so it’s a you know all the evidence is translated into a layperson language and it’s easy to understand for patients and yeah I did refer to patient I referred my patients who are you know interested in knowing more about their conditions and interventions plus you know with good health literacy I directed them there yep
David Doherty: okay from the Cochrane Library that sounds really good, but was anything that you recommended Patient generated? you know like a patient community have you ever referred to a website like that?
Yuki Byambasuren, MD: um no. um at that time that was there was actually uh quite a few years ago and um at that time I wasn’t aware of uh you know a good forums patient forum as such and you know now there are many more of them um but no I didn’t use those forums.
David Doherty: Ok I work with doctors who do that on an every patient basis.
Dr John Bennett: You mean like
David Doherty: no. Every Patient these Doctors meet they refer to online content. Every single patient they meet that’s one of the primary objectives when we video consult with people at 3G Doctor. so we
are trying all the time to find you
content, videos, youtube videos, patient forums, patient discussion groups, research papers. that’s the one of the reasons why we have video calls with patients, it’s the reason why patients consult with us is because often they have found information on the internet that is challenging and want to discuss it. and we give them websites and things like that.
Dr John Bennett: (10:30) so therefore so you prescribe you prescribe videos also as well as medication obviously but videos you prescribe
David Doherty: yeah it’s really easy. okay so with our service we use a questionnaire that takes from the patient their history and obviously there’s lots of information revealed in that, things like BMI, and because it’s very easy to provide information personalized to patients once they’ve given you lots of information and because we have resources we can look to we can give patients things to help with those issues that they have brought up and I think it’s in that that we’ve come to the understanding that this idea that the NHS have an app store and being an arbitrator of what’s good or not is just not feasible, one technically, but two because obviously they don’t have sufficient understanding to be able to be that in place. The NHS seems like it’s a single organization it’s made up of almost 10,000 different companies many of them private many different operators in different regions with different budgets and different focuses and targets and what they’re trying to achieve. NHS England saying it’s going to create an app store is actually bringing a sort of administrative hurdle so if you think that you’re going to fix the issues with there being 250,000 apps to sift through. When you’re recommending apps to Patients you realise that all apps actually have a rating, so as soon as you see an app there’s a rating on it. So first of all you could not install apps from a NHS Appstore unless you are going to jailbreak your iPhone because an iPhone only allows you install apps from the Apple App Store. I think this shows a fundamental lack of understanding of the technical element at play here, the NHS may recommend an app to a Patient but then they will have to go over to the actual official app store where the Patient will be able to see other apps that are similar along with the customer feedback and ratings. Although it may be an uncomfortable place for us to be because this isn’t like the Cochrane Library accrediting everything we have, but we have to work with this even if it’s challenging but it gives rise to the opportunity to  give weight to the opinions of people that we respect in our profession,  but if you look at the NHS for example in the four years where it’s trying to make this App Store concept work we’ve seen mobile apps go to absolutely mainstream use by clinicians so I could point you to the BNF, in that last four years the BNF has been made free of charge to NHS Staff, the BNF is the British National formulary it’s an app that’s basically replaces a printed book that Doctors carry around and use to look up formulas before they prescribe a drug because it gives you all the up-to-date information. Now you can have your prescribing Bible on your phone or your iPad and there’s lots of advantages particularly as it’s now made free of charge to all doctors in the UK. Yet that’s not yet an accredited act by this app store so they’ve been very slow to on board things which already in massive mainstream use. Equally innovations are coming so quick that they haven’t even been able to respond to things like the Alivecor, the ECG you’re familiar with. Alivecor has produced an app that is now in such mainstream use screening patients in GP clinics yet NHS App Store hasn’t given it any recognition. Now compare that to the actual Apple AppStore where I can read personal reviews many clinicians have posted personal reviews, I think I posted our first review of the Alivecor ECG on the mHealth Insight blog about seven years ago so if the NHS is that slow at approving things aren’t they only going to really harm innovation and aren’t there many more much bigger opportunities for them to do good? you know for example as a primary care Doctor you’d probably be aware of the Royal College of GPs?
Yuki Byambasuren, MD: yes we have our my own Australian College of GPs here in Australia
David Doherty: Yes they actually work with a mobile operator I know but it’s been a funny relationship and it didn’t work very well. In the UK the Royal College of GPs have a membership exam and in that membership exam you automatically fail if you bring a mobile phone in with you. Now I’ve been calling for years to try and have the RCGP realise that a Doctor will not work a day in their life without a mobile phone and their response is that they don’t
understand what’s happening here because too many people are telling them the NHS
needs an app store that this is the way we discern quality when what we need to
realize is that every patient in the waiting is using a  smartphone, every doctor has
a smartphone and the minimum performance of the smartphone a doctor’s going to be using in primary care is going to be something equivalent to the latest iPhone 7 or iPhone 8. so you have to realise that’s what you’re going to be using for the rest of
your career why would you possibly want to examine and test that doctor when they are not using that tool? What we should be saying is as part of your exam I would like to see you manage a Patient who’s presenting problem is information they read on the Internet and I would like to see you using your phone or an iPad to actually manage that Patient better and we should be examining and training and testing that scenario not the scenario where I’m working against the clock to work it all out in my head because
when I went to school that’s how we used to do math exams, you know all my writings and my workings would all be in the margin but now we let children use
calculators but it’s not that those children are doing easy maths they’re doing far more complex problems with bigger calculus and bigger algebraic equations. In the same way we’ve got to let GPs use the tools of our time and we’re not going to stop talking about completely unfeasible technical barriers which can get in the way of that as Doctors are in a prime position to actually evaluate apps. Many of them have got family friends and have got their own medical conditions and they manage them with apps and so they have personal lived experiences of apps and they should be sharing those with Patients but also they should be sharing them with their colleagues you know if I find I’m sitting in a GP CPD meeting and there’s a Consultant Hematologist giving a talk and he recommends I use this app and I’m not saying here to just completely blindly follow everything you’re told but you’ve done that for decades with text books you know people have recommended text books and we’ve taken them on board things recommended in
medical papers so why is it that apps are so different? I’ve never had a textbook that automatically came with the ability for me to write on its public website that every other reader would see before they bought it what I thought about it and that’s a very powerful thing that the app stores offer. We have  this centralized place where if this app does something I don’t like or don’t approve of I can write that there and that’s what we got to be championing. The NHS should be championing this too. They should be saying we’ve got hundreds of thousands of healthcare professionals who could actually be adding value to the App Stores and that is where the value comes from,  when we go and we say it’s not our property but we can add value to it.
Dr John Bennett: you know David one interesting thing from talking to Yuki briefly the other day is that she actually goes to Patients, correct Yuki?, and asks them what apps they used cool
Yuki Byambasuren, MD:  yes that’s going to be my next study I’m going to interview GPs and their patients right in their waiting rooms if they you know already use apps and how did they find them how did they know that you know that good app and um also I wanted to explore what are the practical barriers and facilitators of you know prescribing apps in the real practice and I would also very interested to hear from David about you know you must have approached hundreds of you know thousands of Doctors to you know to for your services 3G Doctor platform in what kind of those who did not want to join or what kind of
barriers they you know did they cite and
what was your experience in that field
well I’ll share a post a few does a post
like an article I wrote for mobile
health news in 2009 and it was talking
about people saying you know these apps
aren’t gonna work you know it’s never
going to work these non feasible
prospect that we’re gonna have apps of
work what people are wearing current on
was the fact that SMS is a mobile health
care app SMS is used very commonly as a
emergency notification in the UK
hundreds of thousands of people are
registered to use SMS because they have
disabilities so for example they may be
deaf so they can’t use a normal
telephone to call emergency services and
those patients can register just with
the emergency 909 where emergency help
like telephone service to use it with
SMS so we have to be really appreciated
that many other technologies and that
where I saw this first was when I was
doing an early working mobile healthcare
I went into a clinic and I saw that you
know they said patients don’t want to
use their mobile phones for healthcare
so I did a poll of patients who were on
the pill and whether they had alarm
function calendar functions set up on
their mobile phone as reminders and they
all had that but an onlooker would say
none of them used mobile health care
apps they were actually using the
calendar and the alarm functions of
their very basic very cheap Nokia
we wouldn’t even think that was a phone
anymore that’s so old and undone but
actually very early days people were
using these tools
a reminder to take their pill in the
morning and this is this is quite common
and now patients don’t see the
distinction so patients will be using
you know absolute on patients use the
photos they uploaded to Facebook as
visual reminders of how their weights
changing or well changed or how their
helps to Tyrion so we’ve got to realize
that a lot of the content is inter
mixing you know it doesn’t have to sort
of belong in this very controlled
healthcare environment you know if you
show me your facebook pictures I can
often get a really good impression of
your order and psychologists will be
doing that with their patients here in
the UK and you know we’ll have the
patient show them their profile their
Facebook profile of what they’re
updating the comments they make on a lot
of people’s posts this is medical
content when you have the skills and
talent to read it and that’s where I
think we have to start realizing the
opportunity is you know calling an
emergency services on a mobile phone is
technically very different from a
I can do it with the patient in front of
me and we had the first problem with
this in the UK when in about 2002 they
started getting completely inundated on
emergency call lines because Nokia have
made a phone that if you sort of rubbed
everything in your pocket the phone
would actually automatically ring
emergency services so again sort 20:40
fires and calls a day that they had to
go just silent corners the salon is an
awful lot of Technology there’s actually
in the back end trying to thickness
things like very specific location
coming through their call records on
that phone stuff like that it’s now
being shared and it’s really good for
patients because we have to be able to
manage you know major incidents and
things like that
and where people will be calling in
reporting things like road accidents you
know if you’re going on the motorway so
we have to
sometimes go down from this very
high-level thing that they’re
downloading and out and then realize
that actually mobile health care apps
often native functionality of the phones
you already have so we don’t have to
download them the phone sort does them
and a reason it does them is that mobile
companies have seen two successful apps
and then they’ve made of native features
of their phone and so there for example
obviously Apple healthcare is a really
classic example of that we’ve seen a
range of apps that people might use and
now these are sort of native apps that
just you get the phone out of the box
and it’s all sort of working there but
if you think about it you know ten
thousand people are going around the m25
and there’s a major pileup what actually
happens is the cellular networks
actually talk to the people who ring up
so it will say things like a lorry is
jackknifed on the eastbound carriageway
of the m25 between Junction eight and
nine if you’re calling to report that we
have already been noted thank you for
your call if there is extended
circumstances you’d like to share with
us if you can share of us or your
calling about a different thing please
hold the line that immediately filters
all the people who would be driving by
press the button try and ring emergency
services and it actually helps them stop
them just getting completely on datum
helps them do the job so very critical
Public Safety things I can explain in
that way and so sometimes it’s not all
about an app you download and similarly
obviously every phones caught now an app
that is a browser and so they can access
websites so we also have to look at that
being an atom
similarly the YouTube app you know that
I can send now patients a link that
literally opens up a video on their
phone so if I’ve got a patient with me
this is something that doctors aren’t
being trained enough to do I feel if
you’ve got a patient with me and I want
to explain con something quite a
difficult it can be really challenging
to do that inside two five ten minutes
do you normally have with your patient
and so giving the patient
in on their phone and saying watch that
and make another appointment with me if
it doesn’t help that can be really
useful because although the patient
could have gone and found that content
on their own they don’t know where to
they don’t know what sort of resources
to trust and so for example if I was
talking to a patient I want to explain
something and I could say yes my you
know a doctor I know professor John
Bachman and the Mayo Clinic produced a
professor of primary care produced an
amazing talk on that he’ll watch this
video really that’s actually better for
that patient let me spending 20 minutes
talking to basemen because the basically
one watch it in their own time pausing
whenever they want rewind when they
don’t understand bits look up bits that
are mentioned in it which they don’t get
there do that when we’re having a
one-to-one so sometimes when we look at
their health apps there’s things like
sending a patient a text message the
links to a video that will open on their
phone they can play and watch it
we’re opening something very rich we
don’t need to start saying is that
approved binding NHS we need to let
people be you know much more free just
like you are with handing out things
like leaflets to patients in your clinic
we’ve got to realize it’s not completely
different from that if that makes sense
does it yeah yes absolutely I mean
there’s no argument how incredible our
smartphones are you know as tools and
how much it’s been changing our lives in
every aspect I mean that’s just it’s one
of the most incredible you know pieces
of technology ever and in in Australia
on the Royal Australian College of GPs
we have a tool for GPS called handy
handbook of non-drug interventions
you’re short for um and for that and it
provides GPS with non-drug intervention
tools such as you know um people your
therapy for depression or you know apps
for smoking cessation and things like
that and and we always are looking for
evidence-based you know tools to provide
GPS as an alternative for pharmaceutical
interventions and I want to also go back
to your previous answer
you mentioned you wrote about a live
course seven years ago and you know
still you know no uptake or you know
take is very low and actually the
average average ah your duration between
a discovery and the practical
application is you know evaluated to be
seven and a half years in medicine I
mean that is long time and our Center
central research and evidence-based
practice we worked we recognize it as an
utter waste of you know resources and
it’s just way too long and by the time
it’s seven years if new discovery is
implemented the next you discover is
already out you know and so we’re really
lagging behind in in many areas and so
one of the things we do is to close an
evidence practice gap meaning that to
get the evidence as quick as possible to
the GPS directly like a bottom of a
bottom-up approach and it’s it’s quite
possible in Australia actually we’re
lucky here because the Australian
primary care system is you know you’re
very much independent it’s it’s
manageable plastic practices are you
know very independent and if you
directly approach the GPS in a certain
practice and work with them conducting
journal clubs and or a no evidence
workshops they do you know adopt it very
very quickly and and start implementing
it directly and as one of the things we
do and so you mentioned also about that
BNF act like we call here means you know
to be a the you know encyclopedia of all
all drugs and things um there are of
course you know many great acts and
tools for aim the doctors medical
students that are really you know making
their lives easier
but I thought we were talking about more
patient facing apps and um so you
mentioned you know App Store ratings is
you know a great way to go by choosing
you know what’s best I’ll give you one
example of alpha and that you know
MyFitnessPal it’s just been one of the
you know the highest rating apps it’s
been the longest time around you know
it’s been around for 10 15 years however
when it was tested in in our city when
doctors prescribed you know suggested a
My Fitness Pal for people wanting to
lose weight and said okay you know go
and you know do this record your food to
exercise blah blah blah and they gave a
they told the control group just you
know use whatever methods you want to
use to lose weight and and then they
measured their weight loss in you know
it one month after the prescription in
its six months they also had any insight
into their views of the ABS because they
were working with the creators of the
app so the creators of the app were able
to get the actual login plugging numbers
of the patients you know how many times
they were logging in and um you know as
opposed to the patient reporting oh I
use it everyday you know what I mean so
they had a hard data and what’s
interesting is that after what basically
it one month after being prescribed that
app the log in was zero it went down
like like basically zero and and then it
picked up a little bit um
about 10% before the six months um um
check check in and so that shows that
when left alone on to their own devices
with with apps you know it’s patience
you know easily bought since there are
abundance of apps they’re just you know
use it for a while if they don’t like it
they delete it and download the next
thing and um that’s not the most um it
took the best way to go about things
sure there’s an abundance of it however
if there was a effectively tested act
that’s you know proven to work that
incorporates lots of behavior change
you know Theory elements then it you
know maybe the adherence to the app
usage therefore the weight loss roofing
you know could be much better so in six
months none of the intervention the app
taste ad group and the control group
lost any weight basically there was
hardly any weight loss and so so that
shows that I prescribed being cannot
just solve everything on its own you
know just an app itself it has to be
with a frequent follow-up and check in
either a nurse practitioner or our GP
back again plus perhaps some people
would prefer you know like a a peer
support group you know either a Facebook
group or Twitter or what-have-you and uh
you know I think that would increase the
adherence and benefit of using an app
actually so without having to establish
these things if we just tell the
patients to you know go you know or or
ill here’s here’s in at five five star
rated ad and you know that it’s not
tested by any studies then it’s you know
that is also you know creating waste of
resources you know and if if there’s a
an entity like you know NHS or or
anything you know I’m kind of providing
a doing it please the basic vetting of
the ads and eliminate the the ones that
are not worthy of of the time and you
know an adherence and investment in
either partner from the doctors and
patients aside then I think it’s a good
thing um FDA announced that they will
only basically check apps that are um
like a medical device you know you know
the glucose monitoring and and you know
an insulin dose calculating and that
kind of things that are have that could
have a huge implications if gone wrong
and I mean I certainly understand that
it you know two hundred thousand other
things to and to look at as well nobody
can do that and in Australia there
hasn’t been any organized and
orchestrated effort to evaluate you know
or or provide safe apps in in
large-scale at all only the national
organizations like Black Dog instituted
mental health initiatives I’m sorry and
beyondblue and reach out with youth
mental health organization as well and
they provide a few apps that are being
you know proving kind of safe
so in sorry will let me back up to a
level of you know evidence that’s
required for apps
I think you know for pill reminding apps
and you know things like that it’s you
don’t really need like a really high
level you know evidence to show that
they work we all know that bill
reminders working because you know we’ve
been using our calendar apps right and
however on things like you know that
apps that are promising to change your
weight your mood and your you know
affecting your glucose level in your
blood this should be scrutinized a
little bit better more than you know
just a reminder app and I think you’re
trying to do too much I think this
doesn’t make sense because you’re just
trying to rush too quick to do certain
things you’re trying to be a judge of
apps so one of the things I’ve said
about a live chord is a live court
hasn’t actually had a long time to get
market there’s never been an ECG machine
it’s the fastest selling is missing the
world’s ever seen
it’s the world’s easiest to use the
world’s lowest cost ECG machine but it’s
also the fastest ever adopted ECG
machine I’ve been using ECG machines
over 20 years okay so my experience of
ECG machines and all about them so
immediately when I heard about this
kinda internet with this device and I
video called him like we’re doing now
and he showed me how it worked I
immediately knew that this was
technology which was going to be very
very disruptive so I wrote about it what
I’m saying is the NHS app store that
approves apps has never mentioned it has
never approved it and it’s already in
use at last count one in five GPS an
island is using an alive quad today this
is incredible innovation like this as
the rate of adoption has never been seen
like it now will back out of that okay
the appreciation of that is not going to
be done by some civil servants working
for NHS England because if they could do
that if they could tell which apps are
going to be the big hits with and they
could proactively go and find them they
would have proved a lot more than just
one in four years but also
they might as well be working as a VC
because I can get them as much
investment as they want if they think
they can understand things like a live
cause before the mass market does so you
just don’t have that talent proficiency
what also seems to be happening where
you’re picking Fitness Pal now I know
Fitness Pal very well one of the things
you’re doing is you’re trying okay a
doctor level to be like a Silicon Valley
VC and say make the bet on whether this
is good or not okay that’s not how it
works if that’s a really complicated
thing to do is this app going to be good
for patients one it’s not designed for
patients it’s designed for consumers you
want a fitness product twice call
fitness pal if you want to then go and
apply your version of how to test
randomized control trial to add up to an
app that was built for a completely
different purpose guess what you are
going to fail
make no dance about it but that doesn’t
mean the app is a failure it’s just your
version of using the app what’s
incredible is I saw these fitness
devices coming out these wrist-worn
devices when in Japan that technology
was native nearly Ted ten years ago on
what was called the rack of Raccoon
phones in Japan rocki rocki phone meant
a simple phone and it was used their
seniors would happen and these were
smart phones but they had very
easy-to-use features and they had a
Fitness pedometer right it was a little
man running man you’d see a little
symbol of war that was used widely by
doctors 10 years ago they didn’t have to
go and put wristbands on senior citizens
in Japan because they already had the
phone doing that so when the Japanese
saw the American mark again Fitness ah
they’ll they’ll come back to realize
Nick just carry their mobile phone so
what happened is a lot of hike was done
there in sales now if I was running one
of these randomized control university
programs probably I would have tested
the Fitbit in all out one should have
realized is actually that technology is
already in the mobile phone
and we carry the mobile phone with us we
don’t have to charge an extra device and
actually if I was doing the fitness for
you and you came to me someone
understands a little bit more about how
mobile healthcare works I would say
don’t bother with fitness pal just go
and look at the native pedometer
Apple puts on health care because what
you’ll find is you know that drop-off
that doesn’t exist so with the one where
they show maybe you probably seen on the
Apple watch which shows the thing you
don’t have to do anything it just does
this in the back Samsung had put this on
some of their Galaxy devices under their
self brand you know that that doesn’t
have the fall off because it’s just
native worked in the background and what
you’ll find and this is the reason why
health care organizations
shouldn’t try and build app stores
because I actually what’s happening
within the app stores at Android with
Google Play and with Apple iOS is the
most expensive piece of real estate is
in your pocket the little AMOLED screen
in your pocket on your phone and what
Apple have is they have all that
feedback from what’s going on when you
use apps and from that feedback Apple
develop their phones so if for example
you get a phone out of a box and you
authorize Apple to take that data from
it which most people do what then
happens is Apple see what you actually
do at your phone an Apple phone that
when when you spend 10% of your time
using the camera function they spend 20%
of their R&D on camera technology’s
photo imaging technologies when you
spend 20 percent on the pedometer
they’ll spend that much on it but also
they will see who it Fitness Pal who at
who were added as my coach has made the
best most compelling app for fitness and
they will make that an 80 feature so
sometimes you hit these squabbles where
because apple’s copied my idea and made
this native or google’s bought us and
made us native part of the android
network that’s what’s actually going on
here and
so they’re ahead of us because they’ve
got the data and because they know the
market much better so us trying to go oh
I’ll pick an app and I’ll draw the
randomized control trial and hope that I
find something Apple’s already got that
data Apple already knows that that app
gets downloaded and it never gets used
or Apple already knew knows that gets
downloaded and loads of patients start
actively using it and it knows that for
diabetes Pal world’s number one diabetes
at you know for diabetics it knows this
data so where we should be doing this
stuff and saying look how as the NHS can
we help Apple how can we work with Apple
to actually put an accreditation within
the Apple Store how can we teach doctors
who recommend apps to one have social
media profiles and two to actively rate
their views of out on the Apple Store
you know I don’t hate you today but you
know in reality in Australia or England
or Ireland don’t talk to generally
recommend apps not necessarily approved
by the NIH or the Health Organization in
England or Australia they recommend apps
that they personally have found that are
good isn’t that how in reality how it
works today acne will happen if early
life goal so people like Eric Topol dr.
Eric Topol in in San Diego went on the
Kolbert show and pulled out this device
and actually blew everyone’s mind and
every cardiologist knew by the next the
next morning that was an ECG phone that
could go on your iPhone because every
patient going to them said Ivor bought
it on Amazon or went to the doctor said
hey does that work doctor so this is the
speed of innovation which we can count
on and so yes this is how it should work
we shouldn’t be waiting for an NHS which
takes four years to approve one app
there are much more nimble ways we
you make this ball roll that’s what I’m
encouraging and if we train the
collisions at heart this how to
recognize apps how to have a social
media profile how to put ratings on app
stores how to write reviews themselves
of apps in their field of specialty
that’s where the value comes because you
know if you’re a GP and you specialize
in dermatology and you write you know
what you think of apps and doctors who
use apps and how you can use it we can
learn far more from that than hoping
that the NHS will just approve gold
standard n CT properly approved and and
reality is that can’t even work because
the apps all really changed by the time
the randomized controlled finished
because every day the app developer gets
a list of feedback from patients using
it so it’s a moot you’re trying to say
you know we’ve got a rolling ball where
is it and well it was there and we
approved it but it was there but it’s
now over there and that’s the big
challenge of apps what we’ve got to do
that is have clinicians get on board
these companies invest in these
companies work with these companies
become advisors to these companies all
that comes from training them on mobile
health care you find an app and it’s
brilliant exactly what you want the
patient go and get yourself on the board
of that company that’s the type of
innovation we should be looking in the
NHS within inclinations we shouldn’t be
looking for them to tell us from on high
yes-no on everything reserves we ever do
right I agree with you about on you know
teaching doctors and future doctors
about you know use of technology use of
social media for their purposes and you
know plus apps and I want to go back to
you know again you know I’m medical apps
little eye medical apps
it’s an American doctors to to doctors
we started but you know any any doctor
can add a curation of apps there and
they do provide you know the latest
released medical apps both for patients
and doctors and they do write a review
on it
and there are actually some apps to help
doctors to prescribe apps like for
example at rx you know like the RX of
prescription sign and rx universe
however they wrote a review on rx
universe and they said oh you know
202,000 apps have been prescribed on it
and everything and I got on it I
downloaded it and got inside it and it
included um only handful apps that I’ve
never even heard of and the app itself
the rx
universe that looked really I mean
really wasn’t up to a standard of you
know any apps that anybody would like to
use and so they did
sterling review on again which makes me
wonder you know if if they are really
unbiased and you know not just kind of
promoting an app that they thought I
don’t know somebody had a deleverage on
so such kind of things an expert opinion
the fail ability of expert opinion is
that it can vary and differ so widely
that we cannot you know reliably uh you
use and trust and use one single inner
experts opinion that’s why
evidence-based medicine basically came
to be so that nobody can argue on the
quality of things if we you know agree
on it if it’s shown without any bias
without any with it with a high quality
trial then it’s it’s nobody can deny it
and or in or change it or twist it so
that’s the whole point of you know
evidence-based medicine and I believe
that apps as a medical intervention if
they taught themselves as in a medical
or health-related
intervention they need to be tasted just
like any other intervention that promise
to change your you know health and and
disease improve your disease and in the
meantime whilst we read with you about
the importance of teaching doctors how
to evaluate apps because the apps
landscape is constantly changing you
know add longevity is a huge problem
even the good app sometimes they just
disappear you know due to variety of
reasons of funding or otherwise plus
two apps are being born you know every
every minute most of the apps have also
a problem of being designed by a young
hip you know it take he who has a
healthy privilege but I what I like to
call that he doesn’t even know that he
has because he’s never lived with
chronic conditions more than one which
our aging population has a problem of
and so we need involvement of both those
patients and the specialists involvement
in creation of the app itself rather
than just you know going to an app store
and trial and error fine try to find a
good at by trial and error you know
downloading using it not liking it or
what have you so you know so it right
now we both need a library of safe apps
in face of utter lack of you know
evidence in effectiveness trials I’m you
know we can I suppose go to the
secondary level evidence and so you know
patients both patients and doctors do
need now a list of save apps to start
with to be going on it and plus they
need the beneficent feeling for
everything and teach them how to fish
and I’ll never go hungry so you know
it’s kind of similar lines I like to use
this analogy so um so you told me and
you teach doctors how to evaluate apps
you know the fishing lesson knowing
about it and what kind of frameworks do
you use I know of only three or four um
you know frameworks that evaluate apps
one is a Mars mobile app rating scale
and the other is in light it’s for all
health interventions including M health
interventions however these two
frameworks each has 20 odd domains with
each you know four to five little small
questions underneath so altogether it’s
you know 50 60 questions and answers
with nobody has time for you to go
through on the only one single app and
American Psychiatric Association in
January was
you know pioneered to release an ad
valuation guideline to for psychiatrists
and doctors as well in general it has
five domains and it’s a little bit more
usable compared to the the other two I
mentioned however still its design and
and model is you know I I don’t agree
with it with it because it’s a it’s a
pyramid model which means the the next
next level is filled up on the previous
level and in their design evidence is
tracked third after you know data safety
and risk and security issues plus
basically generic information and you
know I think that it should be more of a
network model where all those important
components that make a good app should
be on an even playing field you know
with interacting with each other um you
know equal take an equally seriously and
so yeah can you tell me more about the
evaluation teachings that you give to
medical professionals yeah I think again
you’re running really far you’re going
too fast for the understanding you’ve
got so what we’ve got here is the NHS
England is not some impartial
organisation it’s not an impartial
arbitrator of what’s good or bad okay
most patients who get care from the NHS
England can’t access their own medical
records the NHS has given Google
millions of patients records those
patients themselves can’t access those
records they never gave consent for an
advertising company in Silicon Valley to
get their medical records so it is far
from being an independent impartial
arbitrator you’d be better asking your
GP in terms of is this good for me or
not secondly you’ll probably find
something really useful in August 2015 I
wrote about actually this is related to
a live go again I wrote about new mi
bees which are thing from the National
Institute of Clinical Excellence and
that’s the found
because it appraises the clinical
significance so it basically talks about
the potential that the naps have to add
value in a clinical setting and alivecor
actually got it MIB
from the National Institute clinical
excellence in back in August 2015
so even though a live core had got a you
know it been seen on us TV every channel
it opened the Consumer Electronics Show
we’ve been used on mainstage by the CEO
of cork on OK cubes even though the
whole tech industry had seen it you know
all the big tech titles diet major
magazines have done it it still wasn’t
recognized by NHS England AppStore
approval but it had already had a
National Institute of Clinical
Excellence it might be written all about
it giving independent impartial advice
to clinicians so they feel more
confident opting and prescribing mobile
health care apps so there are tools for
that that actually are coming from that
what’s the clinical significance how can
we do that so we shouldn’t go and you
know run to you know try and get very
invested interest organizations to be
our impartial independent arbitrator
what’s good that makes sense yeah I do
um you hit on one thing there and Dave
you said NHS is not impartial and the
only way to get impartial and unbiased
evidence is by testing the interventions
so NHS I’m sure that they were you know
would have been looking for apps that
have been you know unbiased impartial II
tasted and they couldn’t find any more
than one in four years and I don’t know
if they’ve been looking for all the for
years if it goes down in but we’re not
the old yeah that’s because they don’t
they’re not capable of looking because
clearly there are apps out there which
are having massive significance which
are finding patients who got atrial
you know undetectable symptomless people
aren’t even aware they’ve got them it’s
picking up this and it’s helping them
prevent strokes so we know for a fact
the top cardiologists the atrial
fibrillation Association screen patients
at their function days so it’s not
they’re not looking they aren’t capable
of doing this they’ve spent four years
now I’m going to do this I’m only
picking one example I can tell you
before of mobile health care apps in
fact go on to the M health group on
LinkedIn you’ll see a thousand
introductions from most eMobile
healthcare developers we facts that are
brilliant and are making a massive
difference so we’ve got to be careful
that we don’t give the stick to say
what’s good or bad to an organization
which doesn’t really understand isn’t
impartial and hasn’t you know isn’t
doing very basic steps itself like where
where is NHS is training the NHS England
training program for people to use their
mobile phones safely and securely where
is where can doctors log on see patient
records where can patients log on these
are very fundamental things this is this
thing of running up million mile an hour
you forget these very fundamental things
I believe every patient in the UK should
be able to log on and see on their
mobile phone screen their medical
records until that’s achieved don’t go
telling me how you judge everyone else
to get me does that make sense yeah
absolutely I agree with you in terms of
patients owning their medical data and
you know genetic material and everything
has to do with their body and and their
health it’s it’s the same thing as well
you know a big issue in America as well
as in the doctor area couple talks about
you know patients owning their own you
know data and medical information I
think I’m seeing as it’s not happening
anywhere again you know same in
Australia as well you know we had have a
electronic medical record you know for
everyone and it was an opt-in opt-in
system but it never took off sadly and
then now they’re trying to try an
opt-out approach I
so so you reckon the NHS digital you
know the agency or department that’s
called an edge is digital that’s
responsible for the NHS you know apps
library and whatever is incapable of
finding the people who are aware of the
field and you know with the right
knowledge and capability well it’s been
going is proven that yeah they do you
recommend like the cardiology
Association of the day recommend here
the top 10 cardiology apps spot on
follow that’s what the NHS should be
doing in exchange should be going how
can we help the you know the for example
the Rd the British cardiology society to
produce its app how can we help the
atrial fibrillation Association produce
an app that we can any doors you know
that’s a much better it’s a different
use of the same budget it gets much
better result you know American Health
says you I mean Heart Association
whatever this specialized physician
groups there are also in organization
like you know a large organization and
what makes you think that those kind of
specialty colleges or organizations have
people with capacity to you know look
for find and curate and evaluate you
know medical or health apps when NH
cases so if I’m a cardiologist you know
in the Irish cardiology society that’s
what they do so the Irish cardiology
Society had me speaker there and I’ll
symposium four years ago and I demoed an
alive go and gave everyone any audience
of their life core so thinking and you
make sure that there can be in they can
be impartial like a you know specialize
our invasion we know with it from
experience with big pharmaceutical
companies you know doctors and
specialists having to stay impartial
independent from all you know outside
influence industry employees is the
massive massive problem and what if for
example one cardiologist is affiliated
with the you know let’s say in
you some you know in intervention in the
counter gask Euler health and you know
he’s got a vested interest in it and
he’s got a conflict of interest right
there and you know what I mean like how
do you prevent such kind of influence
and bias and I mean it’s knee ‘king into
into their opinions as an artist so
actually so what you’re looking at is a
hierarchy of where influence and control
and stuff like that been going on so if
you go into a speciality okay so you go
to something like atrial fibrillation
Association there’ll be some dude like
me who’s got it in their family and they
will go out and they will write on blogs
and stuff about patients this is the
thing this is what we need to do and
then the cardiologists we work with as a
people with this condition will then
regardless of how much peer pressure
they have how much money finances the
drug companies given they’ll have to
start adopting this because patients
will be using it like what happened with
a live course so in that situation it’s
a much smaller challenge than going to
the NHS England and saying hey what
about is to get me NHS England’s got to
cover every single medical special every
single thing so the amount of people are
trying to pull in for their attention
it’s just colossal whereas if you’re in
your sub-speciality then you’ve got an
opportunity to actually influence that
and where the yel HS can work is it can
say yes we’ve got these charities and
these you know speciality interest
groups and Royal College of GPs and
we’re going to work with them
where’s the RC GP zaps and you know
concrete some of them got really Gramps
coming out and that’s that’s a great
thing that’s not been done on NHS
England you know the Royal College of
gynecology and obstetricians and
gynecologists they’ve done I think ten
apps they’re not approved by NHS England
it’s that bizarre so they obviously so
know how to do this thing and what I’m
saying is the specialities they have a
vested interest because you know people
are looking on App Store’s for apps
by their treatment so you recommend the
various specialties recommend certain
number of apps for their specialty yeah
yeah the NHS gets behind it
and if the NHS has to pay these people
they don’t collaborate co-invest to
create apps parties their speciality
organizations believe patients and
clinicians need then what a good use of
their resources much better than trying
to create app store because that’s what
Apple and Google do yeah it doesn’t look
like it’s worth you know Dave and Yuki
have you heard of a company called
haptic haptic yet yes
yeah and they prescribed at how are they
doing I haven’t heard too much from them
have you either you heard when they
closed down yeah well I remember that
they’re big Dremel tables was the
prescription of of apps remember that
Yuki yes so I guess I guess that concept
didn’t fly Dave it didn’t they actually
been our business yeah yeah it didn’t
fly prescribing and write big we had to
close down yeah so what they say to
accompany me to makes an app is they say
you pay us and we put you on the board
so it’s another thing we have to do so
you know if you’re looking at accelerate
the market don’t create Ministry of
hurdles all NHS England in creating an
app store that technically isn’t even
all they’re doing is making a technical
diversion everyone to waste their time
and resources on that’s what I picked up
on my blog that’s my belief that’s what
I think is going on I might be proven
wrong they might in the next four years
due to apps and a booth them but I don’t
think that’s gonna make it even solid as
much progress whereas very very
efficient but um you know NHS they do
provide a list of safe apps you know
mental health apps and um you know
exercising or what-have-you but they I
think that approval the Dave is talking
about it’s in utter and
absolute kind of endorsing basis and
peace ad to work it’s been tested and
proven but but they do provide list of
apps now you go into the website and you
know go on to find NHS Choices then you
know you will see apps and even before
they close down for a while they did
provide um you know a list of apps for
patients and I I would still kind of you
know go for that kind of a nationally
recognized organization sources then
blindly trusting the AppStore evaluation
now that aside um we’re not going to
solve any chest problems today however
um let me go back to head TIGI can be
the reason that have to close down was
that somebody found just found that the
server they were storing some of their
patient information were on faith and um
there are other other similar
initiatives and like at prescription at
our X and our X Universe and the eye
medical apps they’re there all of their
intentions is to provide doctors with
list of apps that they can suggest to
their patients however it’s been stunted
because of the lack of the evidence
those people um you know because you
know in especially in America the
doctors are highly aware of a medical
legal consequences right so for example
in um since AEDPA wasn’t taking the lead
in orbit I mean varying medical health
apps that are safe and you know deem it
safe or unsafe um other organizations
picked up the vitally like for example
Federal Trade Commission I’m fine so far
about handful of apps for
unsubstantiated claims for example in
Europe my baby beets promised to turn
your iPhone microphones you know you put
it on your pregnant belly and you can
hear your baby’s things I mean and also
um the was the other apps um in lots of
acne treatment that they promise your
your phone lights going to cure your
acne and plus measurement of heart rates
and things you know some apps have been
totally crazy you look you’ve won I’ve
actually said my cardio I believe a
cardio we
two eyes if you hold after your exercise
you hold your phone and the cam
front-facing camera is gonna detect the
heart rate I mean that I mean anybody we
can say it’s it’s it’s Villani but you
know patients believed in it they had
hundreds and millions of downloads and
uses so so federal help I am actually
not argument okay okay you’re confusing
so many things here okay we’re getting
down to the peanuts of a haptic failed
not for the reasons you believe haptic
failed yes that was exposed but what
they exposed was there was no technical
feasibility it didn’t make sense just
like this NHS digital apps library
doesn’t make sense
because if I go on the thing and I see
on the apps on the digital apps library
or I see on the haptic I press the
button I want to download it I have to
be sent over to the App Store so the NHS
might say it’s digital apps library says
this is a five star certified brilliant
app I go over the App Store and it says
is zero rated it’s got negative feedback
from five customers they also reasons
why it’s rubbish and it also says next
to it other apps I could download
because that’s how the App Store works
yeah well App Store works so that you
can never make a difference to
understand if someone sees a certified
app and they go on the App Store it says
it’s rubbish use this one but we also
know that the internet comments
especially negative comments your
commentators have you know
self-selection bias and very very
comment what if the common what if the
comment is by username Eric Topol
and I can Google Eric Topol
and that app and it says why he
recommends the other app and that is
exactly the flaw of going into the App
Store and trying to choose apps or
that’s not floor that’s the design
that’s what’s brilliant about it Eric
every NHS gep can have a social media
profile at no cost early they can have a
social media profile and they can rain
apps the patients will go to and trust
that nobody has time to curate even ten
apps no doctor
as Eric Topol is not going to do that
that is not a solution bullet Eric Topol
has approved more than 10 apps Eric
Topol has endorsed far more than 10
items and those work are usually dr.
facing apps for for new medical
professionals rather than forfeiting
their big couple couple for patients but
but again you know how are you going to
find that couple of apps from two
hundred thousand apps because you can
write the beginning I said you’re
looking at the wrong problem most of
these apps you say to two hundred
thousand they’re just cookie cutter ones
their kids play around there’s a low
barrier to entry it’s not even like
printing a leaflet it’s piece of cake
the bacon app and put it on an app store
but they’ll even get really nice and
card lock google that haven’t got
endorsements by doctors this is what the
NHS should be doing it should be getting
the good abs endorsed and recommended by
doctors then we have a result then we
have something that goes on when you
talk about and perhaps it failed until
you can do that bit the bit to do that
is to actually educate trained doctors
only I’m not in other initiatives like
hectic that has a you know proving safe
servers and and you know data safety and
everything if they can do that let them
and let them live on the thing don’t get
government money and wasted on something
that is completely unproven and you’ve
already spent four years proving you are
incapable of doing it okay um so we’ve
been talking a lot about in NHS problems
and um I’d rather talk about you know
how in general any we can improve this
situation that what can work in any
country regardless of the national
health care system so you know a
recommended tiny about your app
evaluation tools like for example give
me the base in the most you know the big
categories for example you go through I
let you as a clinician
learn how to build your own social media
presence upload videos to YouTube
telling people about you and why they
should shops
okay you start to get their own set of
apps that they recommend or based on
their own experience yep and share with
and every time you go and give a talk
recommend out to your colleague okay so
it’s obvious that yogi it’s not
evidence-based but it’s preference that
the physician learns is that right Dave
so yeah it’s based on their experience
based on the eyes
it’s just season practical to me yogi
that every app needs to be evident based
I mean these apps I don’t think they
have the money to put it through trials
etc how do you propose evidence base to
be how do you propose an app to pass
approval to be evidence-based how do you
propose to do that right I don’t have a
solution that you know I’m actually
offering here I have been seeing from
the searches in the literature that many
medical initiatives I was and so my
first project was to locate the you know
evidence on the effectiveness of apps
and I did not find many and it was a
kind of a shocking and a disappointing
result however in the process I found
that many medical institutions Brunner
reputable institutions and universities
and medical centers around the world
have been working to create absinthe and
they’re doing it the right way by first
pilot tasting it with patients involving
patients and getting their feedback
improving improving their prototype and
your testing in a larger cohort and
improving it effective before they can
you know endorse and advise and put it
on on an app store however in that
process we are also finding that at
creation and especially effective at
creation is not that easy
for example group of you know if there’s
an renewing health initiative in Europe
going on and they are working on bipolar
disorder apps for example and you know
it’s a huge team of both technology know
tic and techie people plus psychiatrists
and psychologists and you know every day
every element you know from all the the
multi-faceted intervention would need
they had it in the team how in they
created an app tasted it all on on
patients and they found it was actually
making bipolar disorder patient symptoms
worse and
I mean you know that’s that’s how we
learn we do not learn by just trying out
apps from the app store and then you
know and not liking it in and going for
the next one next one which you know
created by um some kid somewhere good
okay I think you could keep giving me
anecdotes all night we started from this
thing the NHS is claimed to have an
envision where they will host leading
health care apps so they are accessible
trusted by the public I have put the
case tonight that there is no way the
team who spent four years managing to
prove one app and approved 21 others as
safe to use although they haven’t been
certified whatever that means that that
team is incapable of achieving that
I’m sure the test of time will prove I
am right but I wish you very best in
that your hopes that the NHS is going to
achieve that and it’s going to become
some independent impartial arbitrator
apps that we all look to but I’m
recommending my followers like I
recommend doctors who support and
endorse apps to patients be on the right
side make a judgment call be out there
with your judgment because we wait
another four years for another app and
another twenty one apps to get that sort
of safe to use although they haven’t
been certified kite mark whatever that
means no patient will get access these
tools no clinician will start using the
most advanced tool in the world that’s
in the palm of their hand we cannot wait
an organization that doesn’t know how to
do this to deliver us what I think we
all want David I I wasn’t I was actually
giving you some evidence not anecdote
let me give you another one for you know
this act called glucose buddy it’s cheap
and it’s relatively simple and it was
freely available to everyone it still is
and a team of Australian researchers
tested it just simple prescribed the app
to diabetic patients and the control
group was continued as usual what
they’ve been using follow up with their
doctors every
three months or six months but the other
people and they were using the paper
diary you know how this absolutely
replacing paper diary in in monitoring
the glucose and stuff and in after nine
months they um the ad group click elated
hemoglobin level was reduced by almost
1.2 percent which is which is even
better than a diabetic drug reduction if
you’re diabetic dragon next on average
is 0.05
I mean 0.5% so this is a great example
of a simple add freely available that
can you know impact people’s lives even
better than a pharmaceutical
intervention and this can be done easily
if not about um all these all those acts
that are created by you know
non-professional people non-medical
professional people can kind of like
basically survive it out in the App
Store I mean they will hopefully fall
out however in the process I just
worried that they can you know actually
harm some patients you know the patients
just you know trying it out and if the
advice and the insulin calculation or
that you know those bad response
calculations were not based on in a
sound evidence then it could actually
harm patients and that’s just um you
know one of the things that I hope that
we should all aim to prevent by you know
approving and evaluating apps properly
and so basically that’s my bottom line
message that apps that promise to
influence your health and you know
behaviors change your behaviors then it
should be tested and proven effective
otherwise we’ll all be wasting our money
and time and efforts on on things that
are unproven okay you know I think in a
perfect world it would be great if every
app could be evidence tested but I think
it’s kind of impractical to have an app
evidence base to have a study done it’s
a whole level of bureaucracy and delay
of time I think a doctor’s
recommendation from based on his
experience should be sufficient but
that’s my view anyway so I’d like to
like to thank you both both you guys
from coming out I know Yuki you’re
looking forward to a hallo
eh over there in Australia it’s Labor
Day right yes okay and Dave are you Dave
you just finished a concert you’re
probably probably wiped out yeah but
also I’m looking forward to them the NHS
England certifying internet medicine
calm okay there we and I yeah I’m uh I’m
waiting for the phone to ring right now
it could be today well thank you both
very much
okay thank you very much and I’ll send
you the link so you can use it thank you
very much you you keep early you both
have a good day a good night thank you
John thank you David bye good night
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I know a 10 year old with a better grasp of how app stores work than NHS England

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“After four years of wrangling, the UK’s National Health Service has unveiled its library of certified mobile health apps – containing only one approved app. The NHS Digital Apps Library is designed to showcase mobile health tools that are certified by the NHS, while a companion site, the Mobile Health space, will be a resource for mHealth developers looking for NHS guidelines and projects. Unveiled on April 10 in what officials are calling a beta test, the library features one approved app, myCOPD, along with two apps addressing mental health issues, Cove and Chill Panda, that are still being tested. Another 21 apps are listed on the site as “safe to use,” though they haven’t yet been certified. “Our vision is for NHS.UK to host leading healthcare apps so they are accessible and trusted by the public,” Juliet Bauer, director of digital experience at NHS England, and Rachel Murphy, delivery director at NHS Digital, said in an accompanying blog. “The new digital tools pages on NHS.UK have been designed to showcase a selected number of apps while we test our thinking. Each tool has been through an assessment and is safe to use.”

It seems NHS England has a bottomless pit of resources to chuck at half baked ideas for how Patients might want to use their mobiles but the reality is their vision is unworkable because they don’t understand how mobile platforms work.

Because of their global business models the companies that own the 2 major smartphone operating system platforms (Apple/iOS and Google/Android) don’t allow third parties to host apps for download to their devices. Even if NHS England managed to get a basic app review site up and running (something they clearly find very challenging) it’s not going to add up to much more than a hill of beans eg. Patients/Carers who will read about apps on their NHS Digital Apps Library when then have to venture over to the AppStore/GooglePlay to download the app and there they will again be faced with well designed consumer ratings and suggestions for other similar apps.

There is too much waste already in the NHS on pointless, poorly conceived and potentially dangerous apps and I cannot see how the NHS will do anything with this outdated ‘vision’ other than continue to waste limited resources and divert attention away from the productive efforts there are to educate staff and Patients on the opportunity to use mobile to improve the quality and effectiveness of care delivery.

I feel the NHS would get a lot more return on investment if it committed to education and rolling out the mHealth course we developed to staff. Failing that I don’t see why they don’t set their ambitions a bit lower and rip off our course and roll out their own version to staff because it’s a lot easier than trying to make a cheap knock off rival to the global smartphone app stores.

Related posts:

Watch video of Bob Gann, Director of Widening Digital Participation at NHS England, explaining why the NHS is paying for deep fried chip shops to give free WiFi to customers in the hope that they’ll use it to become more healthy (Feb 2016)

How should we achieve Martha Lane Fox’s 4 key recommendations to the National Information Board? (Dec 2015).

How would the Born Mobile generation redesign that Patient Care Experience? (Sept 2015).


An interesting discussion on Twitter:

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Cancer Research UK: GPs are failing thousands of Cancer Patients

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The Royal College of General Practitioners hasn’t taken too kindly to the headline media attention generated by a Cancer Research UK funded paper published in the college’s official BJGP publication.

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mHealth Insights

I think it’s  fascinating that this paper has come just weeks since Cancer Research UK was fined by the Office of the Information Commissioner for researching and paying for data on their donors in efforts to get more money from them and their loved ones and don’t think either organisation comes out well from the finger pointing going on here.

Wouldn’t we get better outcomes if Cancer Research UK had the smart data analysts they have working on fundraising working to help Patients with the challenges of collecting and sharing of symptom information with their GPs, and shouldn’t we expect the RCGP to be doing more than just calling for new and improved diagnostic tools when we know that they don’t teach/encourage GPs to use mobile phones during consultations (and even ban their use in the membership exam) and in 2017 are promoting websites to Parents and printed toolkits to busy GPs in the hope that this will help the NHS pick up on extremely rare brain tumours in children (rather than getting behind ways that have been proven by NHS GPs to improve Patient access and help Patients share info about their symptoms).

Related Posts:

The HeadSmartUK campaign calls on GPs to suspect brain tumour in any child presenting with a range of non-specific & vague symptoms (Jan 2017)

Our failure to make Doctors accessible is reducing the effectiveness of cancer treatments and killing Patients (Feb 2014)

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Join the “Mobile Health: What it is today?” Hangout at 7pm on Saturday 22 April 2017

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Tomorrow at 2pm in Miami (7pm London/Dublin) I’ll be joining Dr John Bennett MD and three students on a Google Hangout in the mHealth Studio (a new initiative from

Refresh this blog post at the scheduled time and you will be able to watch the livestream video and ask questions.

Transcript(ideal to use with Google Translate)/Links:

Dr John Bennett: Good afternoon this is Dr John Bennett broadcasting from sunny Miami today at in the mHealth studio we have the honour of having David Doherty of 3G Doctor. I’ve been following him for a couple years now on and we’re going to have a kind of free form discussion. First we’ll introduce students before we turn things over to Dave. Hello Dianna! could you please describe what you do etc.

Dianna Medina: I’m currently in a master’s program at Larkin University here in Miami studying biomedical sciences and looking forward to taking my MCATs pretty soon and going into medical school.

Dr John Bennett: You’re welcome Dianna, welcome Mailenys Fuentes

Mailenys Fuentes: Well I’m also going to Larkin University studying a masters in biomedical sciences and studying for the mcat and I’m very glad to be here.

Dr John Bennett: okay Ehsan how are you from Ireland?

Ehsan Ghaffari: hi there i’m Ehsan from trinity College a third year med student and it’s a pleasure to meet you.

Dr John Bennett: yeah in the backyard of David almost and Marco

Marco Callo: good afternoon my name is Marko Antonio and I’m from Bolivia and dr. I’m glad to be here thanks for invitation yeah

Dr John Bennett: Marco is a frequent participant in our shows here and the main man Simon how are you doing Simon?

Simon R Downes PhD: I fine thank you it’s 3am here Tokyo it’s an honor to be here I’m a medical student in Japan and looking forward to the presentation thank you

Dr John Bennett: Good day David how are you doing?

David Doherty: good morning, good afternoon and good evening from us here in Dublin

Dr John Bennett: yeah with every way welcome David. I’ve been telling the panelists before we started I’ve been following you for years on your blog and that you’re a very honest reporter of what’s going on if you don’t like something you say. can you please describe your career how you got started in mhealth etc and your background?

David Doherty: yeah my first experience in life that I remember was actually using telephones in healthcare. I was in a sick children’s hospital with a brother of mine and I noticed that the Doctors made a noise that sounded as they came down the corridor and the reason they made a noise is that they had money in the bottom of the big deep white jacket pockets and I noticed when they told news to parents they would proffer those coins to the parent and it was when my mother was given these coins I was particularly interested because I thought it was money for the sweet shop but we went out of the ward, down the stairs and into the lobby of the hospital and she put them into this incredible machine that was sitting there and it was literally a payphone. but I thought obviously my mom was wasting the money and then I saw that emotional connection that she was having to our home and it was a dawning moment for me that the you know that this hospitals most powerful piece of technology was out there were all the smokers were in the lobby and you know it was letting you access billions of pounds of infrastructure the world over for just 10 pence. You could call the Mayo Clinic on that telephone line and then about 15 years later I enrolled at the Medical School next door to that hospital at UCL in London and I was the only student there with a mobile phone and people used to think why has this crazy kid got a mobile phone? what would you use that for, what a crazy device. And they actually fought i had taken the phone from home and took it with me for the day. They couldn’t believe that with this little digital cell phone I could actually make telephone calls but i actually had no reason to have that phone it was really expensive and I had somehow managed to get it by convincing my brother who was a Veterinary Surgeon, as I was living above a Vet Surgery at the time and helping him and so I got a Mobile to take to college by explaining to him the value of it as an alternative to the pagers and answer machines that were in use back then, You’ll remember those days yourself John, but literally there was me in my Medical School Library which I’ve since gone back and lectured in that had no internet connection and now when you go back there are no books there are just screens on desks. but the incredible step is that I’m still gobsmacked as to how slowly we are to adopt technology. In the UK the Royal College of General Practitioners has got a global reputation for training the best family Doctors in the world yet when you go to your MRCGP (membership) exam you are immediately failed if you actually bring a mobile phone into the exam, yet every single Patient in your waiting room has got a smartphone in their pocket and every Doctor is not going to work a day of their future career without the equivalent of something like an iPhone 7 in their pocket, yet we’re making these people not use this incredible cyborg technology – as Elon Musk calls it we’re already cyborgs whether we accept it or not so why aren’t we letting our Doctors use these superpowers? Part of my mission in starting a company that lets you video call a Doctor was also to help Doctors realize how we can actually use use these superpowers and I’ve developed the first CPD accredited course for doctors to teach them about mobile healthcare and I have provided that to esteemed colleagues at events across the world from the World Diabetes Congress in Vancouver to events in Istanbul Turkey. I’ve literally gone around the world learning from people about how they use mobile technologies in their markets and also sharing the insights that I get from that with other Clinicians because I think it’s time we moved on from stamping stuff on dead trees and started using these incredible technologies that are already the tools of our time. You know it’s nothing groundbreaking anymore so it’s really good timing because not only are we seeing all digital technologies converging to mobile phones but also we’ve seeing this incredible thing where mobile phones are going inside other technologies to power this thing that’s being called the Internet of Things because literally the internet is evolving from something that we manoeuvre around with a cursor or a mouse and click on things to something which is used by things interacting with machines so think of things like embedded glucometers or ECG machines with their own connectivity. Now there’s huge value that can come from these data insights but unless we all start using our mobile phones as Clinicians and letting Patients use their phones with us none of these things will be able to ever realise their potential. So that’s my biggest concern and biggest passion for making sure we all get on board and learn about this fascinating new mass media which is mobile the most misunderstood newest mass media most people just think it’s a device in their pocket providing a little internet and they don’t realize it’s as big a step change as we had with the TV or the printed press with Guttenberg. We’ve got this new mass media it’s very misunderstood at the moment and there’s a huge their wealth of potential that we can get when we understand it and utilize it.

Dr John Bennett: (7:30) you know Dave we’re in kind of a similar situation with hangouts we have a hard time convincing a lot of Doctors just to get on the internet to talk, to talk about whatever subject. some people seem to be afraid of the video screen almost. and I’m sure you start from the very beginning like the iPhone came around what 2007-2008 was that the first year?

David Doherty: no we were launched before that. Actually in Europe we had 3G video calls long before Facetime and back in 2006 as soon as mobile operators launched video calls we had the service live. We launched this at the royal society of medicine in November 2006.

Dr John Bennett: so you’ve been battling the whole way trying to get Physicians to use it?

David Doherty: (8:12) well it’s hard to call it a battle when you look at the adoption that we’ve seen since then. We came at this from the Physician side so my business partners are all GPs who have their own clinical practices built out of bricks and mortar so you know we didn’t have to challenge them. Patients want this, all we had to do was tell Patients we were there, make sure the service was safe and we did a bit of design to the service with 3GDoctor that’s worth filling you in on essentially what happens is the patient goes online completes an interactive medical history questionnaire that was actually developed initially in america by a company called Primetime Medical. The product is called Instant Medical History and it was clinically validated several years ago by Professor John Bachman who’s the Professor of Primary Care at the Mayo Clinic and it provides an incredible opportunity for patients to have their own time giving their history. Literally patients when given a blank email page or a page will write 10 pages or two lines. Patients aren’t always aware what things are relevant but this process also gives them time to consolidate their thoughts and feelings and share things. They can also complete things like depression scalings, you know the stuff that you’d be familiar with Consultant Psychiatrists using, Patients can actually fill this stuff in themselves. I see doctors complaining all the time that patients waste their time but the incredible thing we know is that US Doctors spend over half of their time doing clerical work that we know Patients are interested in doing, that they can do and that they’ve got the tools in their pockets to do it so it’s time we started letting patients give that history. This also provides opportunities for Doctors to not just be some sort of drone asking the same questions of their patients but go straight into really trying to help Patients with their information and so if we twin that with other stuff like a website you’ve seen – I mean seriously in 2017 we still have patients who go to their Doctor and try and share a webpage and the Doctor is like laughing at them thinking this is the most stupid thing that they’re ever going to do, what look up the YouTube video with their Patient. Whereas because our service is completely online and we don’t have the brick and mortar office we don’t have any problem with discussing online content with patients and just that alone is a huge opportunity. Since we started I’ve seen an awful lot of companies start up offering video consults and what they often try and do is the very difficult and dangerous prescribing part of the Doctor role rather than actually trying to help patients with information. With most Patients getting interrupted within 18 seconds of coming in the door and starting to talk to their Doctor, we here have an opportunity for the Patients to give all their history through the interactive questionnaire and then at the end they get free text box that they can use to share websites or any extra information they wish to share and the Doctor gets this in a concise familiar format before they actually do the video call. It means that Patients don’t pick the Doctor but the Doctor gets to pick the Patient. So we have a Doctor who looks at the output from the interactive history and decides which Doctor would be best suited to consulting with that Patient. Some of the things we find that actually aren’t going to be suited to a mobile video consult and what we can do in these instances is instead of charging the Patient for that consultation we can give them a null fee and just advise them to go to their Family Doctor with this printed report as it will make a help their Doctor make sense of their needs. And what the patient finds is that when they go to the Doctor with this letter from their Doctor will see this history printed out for them and realise we’ve done their job for them. It also means we support continuity of care. when we’ve seen a Patient they get access to a written report from us because immediately after the consult our Doctor writes notes and then Patients can just log in and download the PDF or share it. This report details all that was shared via the questions and answers and the info mentioned in the free text box together with the Doctors written report on the bottom of that. This supports continuity of care as when you go to see the next person you don’t have to repeat it all. This is a major problem facing telephone helplines or the insurance paid for video call services where the Patient has to go back to another Doctor and tell them all the things they said on the video or telephone call and that’s really ineffective because most doctors will just cut past a recount of events and just ask their Patient to tell them why they’re presenting and so you might’ve spent half an hour talking to a Doctor over video but because it lacked documentation you still have this complete disconnect and it just doesn’t support continuity of care because you can’t go back and easily review audio or video recordings. We also look to follow up with patients to for example check on how the advice worked out so that we can learn from our experiences and monitor how well we are doing and and that too just wouldn’t be possible if the content we were looking at was a 10 minute recording of a video call so the documentation part is very important. That’s a real key message with with the mobile phone everything’s documented you know every website you’ve been on big tech companies like Google and Facebook are tracking and they have all this data but you know when Patients go to the Doctor they walk in and it’s all new: “who are you? what do you do?” and it’s just quite bizarre that we just don’t have data sharing. One of the first things that’s needed to enable that is that we move care from the old way of doing it it was undocumented and you sort of tried to remember what the doctor said to this fully documented way which also helps the Doctors be concise and also helps them learn from the information that’s being shared but on top of that interactive history you can now add things like the Alivecor ECG readings, data that you can capture with your phone and so more and more increasingly going to see diagnostic stuff with bespoke questionnaires that go into that. so we are working with a paediatrician in London’s Harley Street and he’s probably the most experienced Consultant Paediatrician in Europe – his name is Professor Sam Lingam,  and we’ve taken the questionnaires this guy starting creating in the 1970s. I think it was 1979 he was giving all of his Patients at Great Ormond Street Hospital in London access to their patient notes and another doctor looked at this and thought what is this bizarre doctor doing and so he wrote a paper reporting on what this experimental weird Doctor doing. and today he uses what he found is he had these long queues going out the door of Parents and he just didn’t have the time to sit with every one of them and take a history so he made a very basic questionnaire and it grew into a huge wad of paper that captured all the history info from the Parents and Grandparents. A lot of it was genetic history that today people are thinking they have to run to companies like 23andme for but actually you get most of this information by asking specific questions of parents you know things like how babies were delivered etc and he’s produced all this and we’re putting the questions into the Instant Medical History tool and also developing a service for him so it’s not just really basic stuff what we find we can help with. We can actually manage some of the most complex and difficult to diagnose patients that exist. Patients who in many cases have ding donged around doctors without documentation that when they actually take the time breathe deeply and complete their questionnaire they can give the best history they have ever given.

Dr John Bennett: (15:30) it seems probably no accident that Google’s seems to have access to a lot of NHS Patient records, is that correct?

David Doherty: I think we’re going to find that the NHS has given it all and we will probably find out in the future.

Dr John Bennett: yeah it’s funny Google seem to be making more headway in England with access to patient records than they are in America

David Doherty: yes but it’s quite contentious and there’s been a great paper published by a really smart lawyer who’s working at Cambridge University that reports on how Deepmind – they call it Deepmind but it’s owned by Google so it’s the AI part of Google -went into the Royal Free Hospital Trust to produce a very small app for Patients who are on dialysis but it turned out months down the line that someone found out through a  freedom of information access request that actually they had been given access to Patient records going back 6 years and going forward ten years which is just literally half of all Patients in North London who have ever been in that trust despite the very small requirement for record access to produce the app. It appears that the rules don’t seem to apply to Google, you know the sort of things that they stop Clinicians like you John doing because of Patient Privacy issues, well these don’t seem to apply to Google. Possibly no one is big or brave enough to actually take on Google because like a lot of major tech companies their senior management appear to have a swinging door that let’s them move in and out of powerful PR jobs in government. So there are big issues but maybe there’s an upside because there’s certainly no value in squirrelling away all these records like the NHS has been doing for years. They’re still posting records through the postal system on CDs and stuff so that’s also not good you know. I think we should really welcome some of these tech companies but we should be careful to make sure that they’re very transparent and they should apologize when they make mistakes like this because clearly those millions of Patients who went into that Trust never gave consent for a company that sells advertising for a business to get their medical records and there’s privatization of the NHS really coming in that is going to confer huge value to companies like Google because as you know the insurers will pay for this information all day.

Dr John Bennett: yeah well going back to your the percentage of physician time spent on clerical tasks just today I saw a statistic that says exactly you said, in the uSA Doctors say that they spend 50% of their time doing clerical work. Would you say that percentage is a little better with your GP service?

David Doherty: I think what we’ve got to do is realize that the most underutilized resource in the whole healthcare industry is the Patient. They’ve got the capacity they’ve got the interest in getting this information correct. You know whenever they reveal Patient records to Patient’s the first thing is they find things are completely wrong, oh that wasn’t me, what are you talking about, this isn’t information about me, etc. I mean can you imagine if people’s bank accounts were being run in such a way that only the bank manager could ever look at your account statement and see what’s going on. We’d all be broke on the road you know so yeah we’ve just got to move beyond the status quo and there’s been some really good pioneers in the UK for example the fabulous Dr Amir Hannan, everyone should follow this GP and support him because he’s doing groundbreaking work since he took over the surgery that had been previously run by Dr Harold Shipman – the Doctor who was struck off and convicted of killing a lot of his Patients and he really got away of it because there wasn’t visibility of healthcare records. he was killing a lot of elderly patients and getting away with it as their children couldn’t really see what was going on with medications being prescribed. So when Dr Hannan went into that practice as their new GP  obviously there was this huge lack of trust with the doctor so he came in and literally opened up the medical records to his Patients as these are yours. I think it’s sad that you needed a really harrowing situations like this that you have to just stop trying to keep going on the way you have been but actually the way he’s been practicing is interesting because he also used Instant Medical History with his Patients because you find that as soon as Patients can see their medical records immediately they want to talk about them and they have questions. As a smart Doctor letting Patients communicate with you enables you to provide more value because you can both see all the stuff that was done before and you can see why the patient’s got these concerns. Literally our job has got to evolve into being more about guiding Patients towards better information as it’s no longer good enough just to complain that Patients are looking up the wrong things on the internet. The opportunity here is to be more like the librarian and sign post Patients to good resources and knowing what resources will be useful comes from experience and having the medical records and letting Patients share with you their presenting concerns. We’ve actually had patients use our service that we just needed to point to a YouTube video and when I’ve shown this the doctors they were surprised that we didn’t call the patient but just asked them to check out a video and then decide if they  still wanted a video consult. Doctors are just amazed at this and it’s clear this is a huge unmet training opportunity. Medical schools aren’t teaching future doctors how to share content with Patients and many of the older Doctors and Tutors are scratching their head and will say to me but you know these Patients could just look this up on YouTube themselves anyway but the difference between something given by you is similar to the value of buying drugs on the internet and being prescribed a medicine by a Doctor. This is the thing with digital content so we have to teach this, bake it right into how we teach medical students and the sad thing is I go to medical students they and they are sitting in their Anatomy room looking at dumb pieces of printed paper just like I did over 20 years ago and its  a disgrace but one of the things i find is that there was a population of girls who all had iPads and iPad mini’s and they all had 3D4Medical all downloaded and I went up and I talked to them and I found they had all bought these themselves and there hadn’t been encouragement from the lecturers, I mean you cannot be a Professor of Anatomy and be thinking that somehow teaching people with printed pieces of paper is a 2017 thing to do. Children are growing up today thinking nothing of pressing a few buttons on this thing here and getting a car come and pick them up, or a food delivery or next day delivery of an ECG machine they can stick on the back of their phone. It’s a different world and we all have to live in that world because we’re supposed to care for Patients in that world.

Dr John Bennett: so generally medicines is kind of slow in acceptance of the digital world you feel?

David Doherty: a little bit slow but you know there’s there’s elements where it’s really flying, One of the other things I’m working on because I have some experience of Veterinary Medicine where they had electronic healthcare records 15 years ago. I noticed recetnly the CEO of the MacMillan Cancer Trust found  her child who had a serious medical condition and was being seen by number of hospitals but had no access to medical records, and the two different NHS hospitals treating her themselves couldn’t access one anothers electronic healthcare records. And then she phoned up the out of hours Vet – and I know the person who installed this electronic healthcare record over ten years ago, and she was surprised how her little puppy dog had fully electronic records accessible from anywhere on an iPad. So we can learn from other medical practices and I gave a lecture recently at the Royal Veterinary College in London talking about how we should have One Medicine as you know half of this problem we have with antibiotics is an animal problem – anyway we can learn lots from looking at the bigger picture and  I’m learning why Vets have been able to innovate in ways Physicians can’t. I normally find that the veterinary/human medicine difference provides a perfect sniff test of if something’s valuable or irrelevant and exists just because of a political reason, as you know there are a lot of  EHR conferences you could actually spend literally about nine ten months a year touring around these big EHR events but they don’t have that in veterinary medicine at all. Vets would laugh at a lot of the things that the human medicine doctors are doing and so we can learn from that, there are differences clearly, but we have to realize that the reason why is often  political and the big data companies are doing other things with the data relating to humans. we have to stop that you know and mHealth is how we’re going to make a lot of these very opaque company operations like within the pharmaceutical industry clear, this is the big opportunity Doctors have to help clean up their industry and really add value to what they are offering and start working more directly with Patients and taking out some of the powerful middlemen because the time Doctors waste on clerical duties is all too often serving some insurance corporation and not the Patient. Physicians need to stop serving other masters and get right back to their Patients. That’s really what we try to do at 3G Doctor as there’s no insurance company involved it’s just you the Patient with an independent impartial doctor and we really try to style it more like you’re accessing the advice of an uncle or auntie who’s a Doctor and how they would talk to you. So say you know you might meet your Uncle at a dinner party at Christmas or something you say hey uncle Chris I’ve got this issue with XYZ, uncle Chris doesn’t pull out drugs from his pocket, uncle Chris doesn’t sell you something, uncle Chris might give you a note and say go to your doctor and say this and this. And when you go to your Doctor you say your uncle Chris is a neurologist in Cambridge and he told you to bring this up. That’s the sort of thing we want to be doing, we don’t want to replace your family doctor as we know that that’s the best place for you to get care but so many young people particularly have lost that relationship and so many older people can’t connect to their busy GP. We’ve had a patient who had a parent who had a stroke and they’ve called their GP to talk about their Parents care and the GP has told them that because of privacy issues they can’t talk about this other Patients care and they’ve said what do you want me to do, bring my mum who you know has had a stroke in here with me? and they are told well that’s what has to happen. It should be obvious we just have a completely bizarre thing going on here whereas with us if they want to talk about something like their mom who has had a stroke it’s simple as just sharing this is her age this is what’s happening and they can do that over a video call with her present if need be. This is another big advantage of  going on information that the Patient shares with us. Isn’t it a really weird thing that we’ve let this a big clerical job also disrupt our ability to actually care for people which is even more concerning than just being a waste of half of our time.

Dr John Bennett: okay david let’s see it the students have any questions or comments.

Simon R Downes PhD: I have a question… …thank you very much is very interesting to hear and i’m happy to hear about the company called  interoperability and that one of the hangouts we’ve had is the difficulty particularly in the USA where the computer systems cannot talk with each other. I would like to see this change as it would be wonderful to be able to do this. another thing i was thinking about is that you are using video i was working for a company for a couple years where as a psychologist I was using text only to communicate with clients and the idea of bringing video came up but we never got to that point and I was wondering firstly do you have a text-based system if for example for people in remote areas that may not have video capability and well who is able to use video. thank you.

David Doherty: yes a great point. text is obviously the way people prefer to share information and with the service that actually comes through in the preconsult care that we provide through the questionnaire, so when you go on the questionnaire it asks about how you’re feeling, have you suffered from depression, how long you have felt depressed for and all those routine questions which would send any sane Doctor in need of care themselves if they had to spend the day asking them. Because the history is taken from the patient before the consult starts we’ve a new starting point. In terms of access to video calls almost 98% of the UK and Irish population have this and all of our Doctors are General Medical Council or Irish Medical Council registered and as part of the Insurance conditions we only provide care for Patients in the UK and Ireland. If for any reason a Patient can’t access video we of course can always fall back to a voice call because Patients register for our service using their mobile phone number so we text them before we call and then we call you on your number and if you can accept a video call then you’re fine if. If you’re in a rural area that doesn’t have 3G coverage you might have Wi-Fi in which case you can choose to have a FaceTime call even though mobile reception is poor.

Simon R Downes PhD: this wonderful I mean just throwing one more thing I mean I live in Tokyo and we have something come out last year called Pocket Doctor and that’s a video-based a similar system I think I’m if I’m catching you right but what we’re finding is that the younger people are there on to it but people who are maybe they’ve even into their both 40s 50s are a little bit behind in the technology. How can we train them to be ready to use this and to accept it in Japan where they’re very afraid of privacy and maybe how they look on the phone perhaps even. How do you prepare the patients for the experience

David Doherty: yeah like I say innovation happens very differently in different countries and we’ve had in Japan incredible things happen where for example you will know as this is five year old data but more than 80% of old age pensioners in Japan today have used mobile data services. so they are in ways more ready because as you know they’ll play CartRider with their grandkids like the South Koreans. But in some markets mHealth is completely illegal so when you sit there wondering how are Samsung and LG  completely missing out on the opportunity to innovate and apply tech in the healthcare space it’s because it’s literally illegal in their home countries, so when their executives come over and they see people doing it here they go we could do that maybe as like a research project in a hospital but we couldn’t do that with ‘real’ Patients and so in these markets this still looks like a really experimental approach because of their mindset because like you say the legislation and privacy issues are restricting things. I once got to see details on LG’s big failed rollout of a telemedicine project and they had Patients who all had 50 inch TVs in their homes set up with webcams to let them video call their GP around the cornerand they showed me all the data on why this approach failed and yet they couldn’t identify the reasons. The first thing I asked was what healthcare content did they put on the TV and they’re like oh it wasn’t about content and I was like well what were you expecting them to discuss? And so it’s this type of disconnect that’s going on, if you don’t have content to discuss with the remote Medic and you don’t have access to your medical records none of these meetings will be very valuable and you might as well just go around the corner and walk into your GPs clinic – and in South Korea they have also got a very high GP per head of population ratio so it’s actually quite easy to go around and see the GP you know. In our case sometimes Patients don’t have an accessible GP, or they’re not registered with a GP, or they’re bed bound so they can’t get to the GP but it’s clear that every country seems to have its own unique little reasons why this hasn’t taken off. From Korea and Japan the powerhouses for mobile tech outdated legislation has just stopped innovation in its tracks. In Russia they’ve just recently passed a telemedicine bill and for the first time it has become legal and I’m over there next week trying to learn about what needs to be done. Japan’s really interesting because they have prioritized the responsibility society has to seniors but for some reason this disconnect still exists so clearly we have to learn from how others are innovating. One of the things we’re seeing in England is a much slower adoption of mobile by senior citizens so I’ve written a blog post about ‘how to teach your senior to use text messaging’ because we don’t have those things you have in Japan – in japan you have the Raku Raku phones and you can go in a phone shop and there’s a 70 year old there to help you, but when you tell this to a Doctor in the UK or Ireland their jaw would drop because they’ve only ever seen spotty young people working in phone shops. Things can be completely different in different markets but there are huge opportunities to learn from one another which is something I really try to do with the blog and with the LinkedIn mHealth group that now has 8,000 members from all over the world. I get to see what companies like NTTDocomo are doing and it just baffles me because they’re trying to innovate in the face of outdated legislation. Samsung for example even have their own hospitals but they’re just completely missing the opportunity to lead this market.

Dr John Bennett: (33:55) we’ve had a really hard time getting doctors on to do hangouts Dave, we haven’t had one Korean Doctor and we’ve tried to get Japanese neurosurgeons but so far no success. it’ll take time I think in those countries but Simon you say it’s because the culturally the Oriental people don’t like to get in front of a camera?

Simon R Downes PhD: um it’s that and also yes privacy issues they’re very afraid. I can’t get doctors on Skype or even individuals they feel very worried about privacy issues in Japan it’s all very interesting but it is changing so I expect we’re going to be seeing acceptance and there’s this new laws passed for remote care of people in the country so they will be able to communicate with a company called Cure.Ly and we were trying to make some headway but it was all ready but it just didn’t get the take up.

Dr John Bennett: Any one else have any questions or comments?

Ehsan Ghaffari: I do first of all David thank you so much I love the talk i love you the great field that you’re interested in. i love it too.  I’ve got three questions if you can answer quickly. The first question is so you mentioned really interesting point that the Patients don’t pick the doctors on your platform how do the doctors choose what Patients they can you know offer consultations to on your platform?

David Doherty: (35:36) so that is done on an individual basis, what we find today with triage is that healthcare organizations typically have the least experienced person trying to do it so for example when you ring up the NHS’s 111 telephone service they literally have a school leaver who’s reading a script off a screen and actually that’s where you should have your most experienced. so it might seem completely counterintuitive but if you gave a medical history to someone like John he could look at it in seconds and say that’s what we need to do with that Patient, that’s the type of Doctor that would be able to clear that up. In our case our first priority is which doctor we’ve got available for the Patient you know we have to be realistic about who’s available to make the call and the second thing is we get a very good feel for it you know. Some people will want to talk about something emotional so then it’s about which doctor is available who’s really emotive whereas if we’ve got someone who’s got done a lot of research who’s got the best internet research skills. That’s actually a big challenge and and is a skill we struggle to find in doctors when recruiting. We have to do more to develop these skills within doctors but also find ones who’ve got an actual interest in doing this, the reason I just fell at the feet of one Doctor colleague was because he had a sign in his waiting room which said that there was a weekly prize awarded for the patient who brought the most interesting research from the Internet to their appointment. Cool right? Well that is just the type of Doctor who needs to be providing this service. so if a patient for example wanted to discuss issues debated in a protracted argument on MumsNet, a website in which young mums discuss issues, this Doctor would be an ideal one to chuck in on that because there are all these opinions and some of them will be related to sales materials produced by commercial companies so a savvy doctors who has been around a while and heard all the sales pitches can and they are perfectly placed to get to the bottom of this stuff really quickly and help explain things to Patients. The direction of the consultation really depends on the out put of the Instant Medical History questionnaire that the Patient completes and that really is the best way of working with Patients but you know sometimes the Patient could be directed directly to their family doctor with the information but as you know some of us don’t have one so in that case the Doctor can really work with them to ensure that the next step they take is the right one.

Ehsan Ghaffari: (37:30) so the Doctors on your platform will pick the Patient’s they want to treat or do they get one at random to look at?

David Doherty: so we’ll have a doctor always on you call to screen the outputs of the Instant Medical History questionnaires as they are received and they in turn decide who is best placed to consult with that particular Patient. This decision is made based on who’s available so for example if tonight you were a Doctor working for us in Dublin and you’re available and let’s say a Patient shares information relating to something basic like for example blood in his urine, if we’re sure you can handle that you’re assigned that Patient and you can get on with it. Alternatively if we see a medical history that’s more challenging and this happens a lot because the questionnaires are interactive so Patients will often start with a keyword and then end up answering questions that might reveal a completely different issue for example something really really sensitive but non-urgent, in this case we might think one particular Doctor is a bit more emotive and so we’ll just ask the Patient if they mind if we call them in a hour when for example Dr. Kavanagh is going to be available and we think she’d be really suited to helping you as this Doctor specialises in this area. So we schedule you to see that particular Doctor because you know once you’ve done a few Patients with similar issues you can get really good because you’re learning all the time. Because Doctors typically get very little experience helping Patients who have done internet research which is mostly what we do, we find Doctors will quickly get more talented at covering certain topics. I think Doctors should really be encouraged to work on things they like doing, so often I see the morale in Doctors is so low and it’s quite obvious why if you think about it for example we’ve got Doctors who are new mothers are we’re dragging them back out to work in hectic 12 hour hospital shifts from which they’re spending 2 hours travelling time, it’s just ridiculous that we’re force fitting these talented professionals into this rigid job
structure because we can’t be imaginative. I mean do you know there are 4 million homeworkers in the UK and Ireland? So why are there no home working Doctor career opportunities offered to graduates there at Trinity?

Ehsan Ghaffari: silly isn’t?

David Doherty: (40:20) crazy, I mean look there’s all of us here talking away from different continents but there’s not a Doctor in the country who hasn’t got a smartphone in their pocket who could be working with Patients like this but no one’s ever talked to them about this opportunity so we have them leaving the career in droves instead of trying out the opportunity to be home working Doctors. I keep saying that we should have mHealth units in medical schools helping students appreciate that they can work from home as a career because medics can now have careers working from a veranda in Australia caring for Patients in the UK late at night. We need to have people talking up careers where Medics can put their feet up and be a big deal online you know ‘I’m gonna have the best reviews on trip advisor as I’m brilliant at this’, ‘i’m going to raise my family and i’m going to have this fantastic life and i’m going to really add value to patients who were struggling with stuff’ but instead what we have are Doctors writing in broadsheet newspapers about how they schedule a suicidal Patient for a consult at nine o’clock in the morning and then complain that the patient was minutes late. I mean why would anyone schedule a Patient who was suicidal and in this case the reason for the patient feeling suicidal was given as being eviction from her flat for non-payment of rent, is it any surprise that this Patient has money concerns after we’ve made them wait all weekend worrying about their life and expected them to take of work on Monday to come into the clinic. This must seem a bizarre world for those who think everything
must be managed with an office visit. Of course we’ve had 2000 years learning how to perfect the office visit only model but the mobile phone provides us with the opportunity to make a step change so that’s why I want to share everything we do widely. You know initially when I started this business my Doctor colleagues would say to me ‘oh David you’re going to give all your ideas away’ but now it’s becoming obvious giving ideas away creates value for example it’s how we market our company, it helps me to find and work with interesting people like John and the viewers of this hangout get value and so are inclined to want to trust and work with us too. If you’ve got valuable ideas my recommendation is to start give start giving them away. We’ve just heard from Simon there that a company in Japan has just started out doing what we launched 10 years ago people. We were told we were mad doing this and that no Patient would ever want to Video Consult with a Doctor and that we’d never have been able to recruit a single GP but sharing our journey and experience has been the root to building trust and recruiting talent and making money so that it remains a profitable venture that we can reinvest in. In the future most of the work Doctors do with Patients today will be done remotely so it’s important to realise we need to start becoming experienced at this.

Dr John Bennett: (43:00) a you have a training program correct? for healthcare professionals who want to learn about mHealth?

David Doherty: yes. I produced that for the health informatics society here in Dublin. They are also a part of the Irish Computer Society and it’s a really progressive organization that produces the European Computer Driver License which is a course for people to learn how to use IT proficiently and about 20 million European citizens have already done it. When they saw what we’re doing they realised that there was a need for a course to teach people how to start using mobile because there are loads of IT companies going into healthcare organisations selling expensive mHealth projects and promising to train staff on how to use it and what actually happens is that the IT firms presume that they are being paid to merely train the staff to use their app and not on how to use the technology and literally mobile phones have been invented and deployed so quickly it’s caught people out. Imagine if an ambulance or a helicopter was invented in the last five years and we were just giving staff keys to go off and pick up Patients? You know we don’t do any tests to see whether staff are competent in the use of this technology and we keep seeing medics getting in trouble because they were breaching policy by using apps like Whatsapp to share a medical information like a picture of an x-ray with colleagues. They did a survey in the UK on why so many Hospital Doctors were using whatsapp and it revealed it was because the corporate IT systems were so slow, buggy and expensive and just hard to use and unconnected they were using whatsapp for sharing private medical information. Hospitals think they need to punish staff and clamp down on this but actually they need to train staff better because there’s so much potential in what is clearly the most powerful tool we’ve all ever put in our hand. The upside of training is that you get much more value from mobiles and we’ve now developed modules of the course with bespoke focuses, for example on cardiology at the Irish Cardiac Society, for diabetes at the World Diabetes Congress.

Dr John Bennett: I think you’re doing such great work there

David Doherty: Thank and that’s why I’m so keen to help you with the mHealth Studio because I went to the World Diabetes Congress, a biannual event and the biggest event in the world diabetes industry and ran by the International Diabetes Federation in Vancouver and they sponsored Patients to fly in from all over the world on bursaries but when the Patient’s got there and started tweeting photos of presenters slides they were told off by the organizers publicly. Can you imagine what an insult that would be had you flown from Brisbane to Vancouver as you wanted to share info to help all the other diabetic patients and you’re like wow why are they’re angry at me for doing this? They’re getting a slap in the face for doing that because these scientific communities live in the past and don’t want to enable free sharing of information. To get a sense of how outdated this approach is consider that the only hour of content at that entire world diabetes congress was the hour I recorded and put on youtube. I just find that amazing, I mean has no one else working in Diabetes care got anything they want to share with people? Do we not see that we shouldn’t be doing the same conference every two years. Sharing let’s us say that’s been said that’s been done let’s move forward. You can’t keep saying the same thing every year if you make sharing the default because you could just watch last years lectures. We need to share to build the collective intelligence and move everyone on and I think that’s what you’re in a really unique place to do with these internet medicine hangouts.

Dr John Bennett: you know I’m glad you feel that way Dave. You know I couldn’t understand when I was talking to a group of physicians & phd’s on the internet saying you just take a smartphone to a conference and interview people and they looked at me
like I was crazy. This just takes a minute because you have an excellent camera and a  means of communication from a conference – a place where other people would like to be. There’s nothing to stop you talking directly to the guy that just presented but what’s the huge change in mindset is needed before people do that?

David Doherty: (47:46) I find it’s been taken out of them during their training. You know if I sit you at a desk and I make you copy stuff out of books and learn it you. If I need you to memorize the content of books to do exams I’ve began taking out of you the ability you have to excel in an environment where all that information is stored on your phone. Today all that information in our medical school textbooks isn’t just on our phones it’s also in our Patients pocket on their phones too. I often ask Doctors if they have ever been googled by a Patient and some still think this isn’t happening. Go out in their waiting rooms and their Patients are on Goolge reading and writing reviews about them but the Doctors just don’t know how to find this so I show them on Facebook or wherever. A big opportunity lies in playing to a Doctors ego. We got involved in a really cool project called Harley Street TV about 8 years ago and found this really bizarre way to get really successful Doctors interested was to show them what happens when a Patient Googles their name. When you do this you often get an add for a rival clinician around the corner who are running Google adwords and the Clinician would normally say he’s going to sue them how dare they. Then you keep going down and you’re soon on page 5 and it’s all just rubbish out of date stuff about him and old hospitals he worked at before. Then we’d show how it can look for a colleague who was already working with us and the first thing you’d be greeted by was a lovely YouTube video on specific area of his expertise. Something else we learnt was that these medics weren’t primarily motivated by the impression it would make on Patients but rather that it had on their children or their childrens friends from school because googling what your friends parents do is now a common thing nowadays. Medics want to be proud of how they look on the internet so if I was you John I would just be saying look this is what comes up when I Google you but if you join us on and record an interview that’s going to be the first thing anyone sees plus you can put a link to that on your Twitter account and you’re good to go, how could they say no to that? No one wants to look bad. and you know sometimes you’ve got to play to people’s ego to make them want to do it but the young ones we need to go and actually train them on the opportunities to share, it’s all about training.

Dr John Bennett: (50:10) well I think the students can probably answer this one, I mean I wish I was a student again because you must get taught from day one how to do things digitally is that correct? I mean first it’s a little different as all of you grew up with computers unlike me and you’re all very adept at Facebook etc etc but was it an easy transition for students to get into the digitalization of medicine?

Ehsan Ghaffari: for me like once you start getting into the internet young so like I just started through YouTube and Facebook and then automatically because those two platforms become a part of your daily life anything else would be so much so much easier to adapt to whereas I feel the older people when they come in they’re not bound
by Facebook or etc so they’re just like basically lost, they don’t have their own little home on the internet whereas like we’ve already have our own niche where we constantly have visited you know clicked the notification button every day and the internet sort of becomes home for you you know it becomes second nature and everything else is easier to learn. In terms of college we only had one project in three years so we’ve had one this year where they told us to do a study or an essay about health behavior changing apps and how useful they are etc which I did about some Chinese app which measures everything. It’s called iCare Health, by holding one finger behind the camera one finger in front it measures your blood pressure, your blood lipids, gives you your heart rate, your SATs your cell oxygen saturation and then you can like you can self monitor so it provides it puts it into a graph and you can monitor over time and then it gives you little ways on how to improve on each of them and it tells you if your results are normal or not but then when you come to use the coins which you get for measuring the shops in Chinese so you can’t really use the coins or anything but pretty awesome, just one essay.

Dr John Bennett: (53:20) Diane you’re being quiet today, you don’t have to say anything but do you have any comments or questions for David?

Dianna Medina: oh I just wanted to say a little bit about the topic that you just mentioned. It’s a little bit difficult kind of growing up in the internet world and having Google right there you always want to google search anything for a project or before you start actually finding resources or journals for references for any kind of paper and it’s difficult growing up in that and then trying to go to school and everything is like out of the book or out of this really old textbook or having to just search and get all your information from there as opposed to utilizing the new tech and the new apps that we have available in medicine. So I kind of feel like education is definitely a little bit behind in that sense where they’re trying to teach us the old way but we are learning in a totally different ways.

Dr John Bennett: wow so that just still occurs.

David Doherty: through the mHealth network that I’ve built up I get to learn some really interesting things for example students who are on the iPad project in some medical schools in the US that have completely thrown out not just the books but all printed content and the students there have written to me saying ‘hey David I really like your blog’ and when I’ve asked to look at their apps they’ve given me passwords to log inand check out what these students are doing and when I showed this to a student over here they think I’m like some man from the future because they don’t know how I’ve got all this stuff in the iPad and they want it because it’s obvious it makes studying so much easier. UCIrvine published a paper that showed if you were one of the students that was given the iPad that year you scored 26% higher. On my blog I wrote how if anyone now fails in a US medical school that hasn’t yet got on the iPad project you could probably take your school to court and win damages because it could be argued that they are failing you as long as you’re within 26% of the pass mark because rival medical schools have proven that the students perform better, and I think the reason they perform better is because you know when I’m going along with my histology book on the bus it’s hard to be getting it out in front of people and stuff like that but I can do the quizzes and all of that on the iPad app and so it’s much easier to fit this with your lifestyle and not break your back carrying every book around but also use five-minute opportunities to deep dive into a subject and do some research but also apps are better than books. Something I’ve noticed here in the UK and Ireland is that there’s such competition for medical school places that the students are really academic types. I often ask audiences to get their phones out and then ask for them to get their other phone out but medical students don’t typically have a second phone and they don’t seem to prioritise having the latest smartphones. These Medical Students are all playing grade 8 violin but they’re not into tech and I actually think we’ve got an endemic problem that we need to overcome as we know they’re never going to do surgery with just low tech scalpels so we’ve got to have to modernise. My anatomy lecturer told us to go and get a Nintendo Game Boy and that was back in the 1990’s in London and I really think Medical Students should be using smartphones in their exams. Remember calculators being banned from maths exams? Just as Math exams aren’t easier now that they have calculators because the questions are now more complex and of course these graduates use these tools to engineer better bridges etc because they trained with tech. We need to think like this in medicine which is why I picked up at the beginning that we have General Practitioners literally being failed if they bring a mobile phone into the membership exam. When or where in their career is a GP ever going to be without a mobile phone when working? If a Doctor ever practices medicine on the moon they’ll have a mobile so why are we telling them they can’t use this tool? Isn’t this part of the problem facing Patients who want to discuss youtube videos or something they heard John discussing at Larkin Community Hospital on an internet hangout. It just doesn’t make sense to be going to a doctor who’s sitting there with paper binders and an EHR that no one else can look at…

Dr John Bennett: (58:32) you know I thought it’d be a done deal David when they come out with that study you mentioned at UC Irvine were students were doing 26% better in their exams than compared with their associates who were traditionally trained I thought it’d be a slam dunk were all schools would go oh wow let’s all get iPads deployed. But as far as medical education it sounds like it hasn’t seemed to have occurred.

David Doherty: yeah ten years ago a good friend of mine Dr Henrik Andersonn from Sweden started a company and they produced this product called iDoc that was rolled out by the Welsh Deanery to every student with a mobile operator giving all the students free iPhones and before that they had bought these weird Microsoft PDA things so
that was really early on but they just kept picking the wrong platforms so every year you’d think this the future of Medical Education but they kept choosing to buy these unsupported Microsoft devices and burning themselves as the operating systems changed and the old ones would no longer be supported. Whereas these US Medical Schools have started with the iPad and the community of developers that Apple has inspired means that now the skills of the most talented developers in the world can now be reapplied to educational content. If you ever get the chance to check out the apps these students are using there are groundbreaking details that will blow you away. Are any of the students using any of 3D4Medical’s apps? Hands up? No one? Well you should, they do all these amazing Anatomy apps that allow you to learn through playing multiple choice quizzes. It even lets you share your scores with colleagues on Facebook groups and the Medical Schools are now able to mark students based on how their study group performs. It amazes me that medical schools are still training students to be individual performers because we know the job is about working as a part of a team. Because the iPad scores are all connected the administrative hurdle for lecturers to teach in this way has disappeared so students are now incentivised to pick up on when members of their team need a bit of extra help because individual scores impact on team performance, once students are rewarded for working as part of teams it just becomes natural to do things like Hangouts. The iPad enables medical students to be trained to work in teams and considering that’s what their career is going to be all about it should be a done deal you know but some of them say they’ve got reservations about buying iPads because they think they’re expensive or that the students will be playing games but seriously if you’re at Medical School your motivation isn’t to play computer games is it?

Dr John Bennett: I don’t think so no I don’t think so. Well David I won’t keep you too long
as you’ve spent a lot of time I really appreciate you coming out and also to all the students but could we get a view of the Kerry countryside?

David Doherty: okay okay did you get that?

Dr John Bennett: Wow that’s beautiful South Western Ireland there. Well I hope we can do a lot more of these David and thanks again for all the students. Now I’ll finish the televised part and then we can just chat so thank you very much.

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Let’s meet at the Russian mHealth Congress, 28 April 2017

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Finalising last minute plans for a trip to the Russian mHealth Congress being held on the 28th April 2017 at the Hotel Mercure Paveletskaya.

It’s an exciting time for mHealth as although Russia is very clearly another early adopter of Mobile the country has suffered like South Korea from outdated legislation preventing mHealth innovations so I’m hoping to learn lots about the opportunity to take mHealth innovations to Russian Carers/Patients and learn from how the Russians are approaching mHealth now that the government telemedicine bill has passed.

The event is being organised by Smile Expo and will comprise a range of presentations and talks on topics including: The newest Russian mHealth opportunities,  Investments in mHealth technologies,  Are we on the brink of technological singularity and what does it mean in terms of mHealth?,  Is our consciousness ready for the technological capabilities?,  Collaboration between the government and private companies while implementing telemedicine in Russia,  Application of modern digital technologies and Internet as a part of clinics group operation,  Personal remote patient monitoring with and without gadgets,  mHealth tools application in the complex of services of personal health manager,  Business approach to Health Management: new opportunities for staff efficiency improvement,  Data from gadgets and applications as biomarkers for early diagnosis of diseases,  Mobile technologies in stress management.

Speakers will include:

Aleksey Alekseev, Neurologist & General Director, Med-YurKonsalt LLC
Leonid Bugaev, Founder & CEO, Nordic Agency AB
Aleksey Danilov, Doctor of Medical Science, professor at I.M. Sechenov First Moscow State Medical University, director at Institute for interdisciplinary medicine
Svetlana Fominykh, Public Speaking Coach
Alexey Grinenko, Investment Manager, IIDF
Gayane Harutyunyan, Lead Architect, IBM Client Center
Irina Kargalskaya, Co-Chairman of the Patient-Centered Telemedicine Committee, Russian Patients Association
Roman Kataev, Product Director, GetDoctor
Airat Khanov MD, Academic and CEO, Telemedsoft LLC
Oleg Korzinov, CEO, KSI Ventures and Exec Director, Northern Biopharmaceutical cluster
Prof Petr Kuznetsov MD, Professor at National Research University and VP, National Association of Medical Informatics.
Alexander Lazarev, Managing Partner, Maxfield Capital
Georgiy Lebedev, Chairman, Internet+Medicine Committee at Internet Development Institute
Alexander Penkov, Manager, ONETRAK University
Eduard Segal, Head of Business Development and Innovations, PJSC MTS
Viacheslav Semenchuk, Surgeon & Development Director, ADITIM
Igor Shaderkin, Head, Research Institute of Urology and Interventional Radiology (branch of the Ministry of Health of Russia)
Evgeniya Smorodnikova, Co-founder, Welltory
Andrei Tsoi, Senior Editor,
Anton Vladzimirsky MD, Deputy Director General for Innovations, Medstrakh (Medical Insurer)
Denis Yudchitz, Chief director at Mobile Medical Technologies Ltd and CEO/co-Founder, “Pediatrician 24/7” and “Online Doctor”.
Ruslan Zaydullin, CEO and co-founder, DOC+
Boris Zingerman, IT department manager, Hematology Research Centre

Let’s meet in Moscow?

Things are a bit last minute (we might even end up presenting an intro to the mHealth course we developed) but it would be great to check out healthcare services while there (at present it looks I’ll be in Moscow for an extra day) so get in touch via the comments if you know of anything I should check out on my visit.

Click here to register (tickets are available from just 10,000Rub/€167).

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Did the Smartphone win the Qualcomm Tricorder XPrize?

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Analysts may be talking up the end of Smartphone innovation but check out the Smartphone Medical and the profiles of the 2 winners of Qualcomm’s Tricorder X Prize and I think it’s clear Mobile is cannibalising the world eating up everything and that now even includes future medical devices that we haven’t even yet dreamed of!


mHealth Insights

I’m not surprised and think it’s a positive omen for mHealth innovators that the winners of the competition both ended up being variants on the smartphone physical.

It’s been fascinating to follow this X Prize competition as it took a bold direction change etc especially as a few of the teams that were attempting to win it had asked me for help. I know of no more efficient way to get affluent researchers to commit themselves to finding a solution but I think the financial model could be better designed (eg. 300 teams paid in $25,000 entry fees to join the competition – generating $7.5 million before it even started) to encourage ideas/attempts from less well funded competitors. Imagine if 7000 entry bids had come in?

The winner profiles are very interesting to read up on and the organisers have made some cool video content that will hopefully inspire medical device developers to think like the Born Mobile generation eg. Final Frontier Medical Devices:

and Dynamic BioMarkers Group (who look likely to try and commercialise this with the HTC smartphone brand):

Related Posts:
What’s The Future (WTF?) & how is your imagination failing you? (Jan 2017)

Can you imagine a world where we have Tricorders but you still have to go & sit next to your Doctor? (March 2013)

Nokia joins Qualcomm in search of the Tricorder (May 2012)

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Cancer Charities: experts in personal data sharing just not yet in ways that help us better understand Cancer Care

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Are Airports more interested in your medical history than your GP?

“It has different tools and sensors: iris scanners, finger prints, facial recognition. It has video cameras and microphones, and eye trackers to measure pupil size and how that might change during the course of an interview. We also have floor sensors to judge how people are standing. It really is a myriad of sensors…   …we hope the passenger experience will be convenient and quick. Rather than having to waiting in large queues to get to border security officers, we envisage there will be a bank of AVATARs that can be used to self-screen by scanning your passport. It pulls up your information and the system knows what questions are pertinent based on your status, visa, country of origin of travel, and so on…  …you can get though the process faster, as the majority of the questions usually asked by a border official have been asked by the kiosk. The human component is filling in the blanks, or what the AVATAR suggests needs following up…   …when asked about drugs, for example, it might notice a pattern that someone is answering with more ager or uncertainty. It is essentially looking at the behaviour that might imply there should be further investigation…   AVATAR is an interviewer, actively listening. A lie detector evokes images of a polygraph We’re almost opposite to that… AVATAR is meant to gather more information for the decision makers”

April 2017 Issue 22, Airport Industry Review

I find it fascinating to read about how airports are trialling sensory kiosk technology to analyse health data while travellers complete interactive questionnaires as so little development has been made in the use of such tech in the healthcare industry despite the abundance of evidence going back decades:

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Can you imagine the situation where medical discoveries will be revealed to border officials and perhaps not to Patients?

It’s interesting to compare this to the situation we have in modern office visit only Doctor practices where Patients turn up and the time pressured Doctor is left having to guess what’s up and even complaining that Patients are wasting their time (when we know the availability of simple Q&As on their mobile could’ve let Patients self manage most of these health concerns and will help Patients share more honestly especially when it involves very sensitive concerns).

The office only visit model of Primary Care

It also confirms to me one other way that Digital Health will increasingly grow to be distinct from mHealth in that it will be something that will be seen to be done to Patients (rather than with them) and out of their control (it’s positive to note that Apple has strategically recognised the threat of this major issue).

Related posts:

Perhaps GPs are just too fatigued for innovation that has been clinically validated?

Videos from the Royal Aeronautical Society’s Mental Health & Well-Being Conference

Philippe Kahn shares his thoughts on Wearables

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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 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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Can you really build an AI Virtual GP for £250,000?

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In the world of #DigitalHealth it seems it’s not possible to make unsubstantiated project claims that are big enough but this one is just ridiculous and undermines the quality of the publications/websites that are giving it airtime (so I won’t link to the actual article as that just fuels the insanity).

To put the ambitions of this project in perspective the Stowhealth GP Practice is likely to have at least one GP who is earning £250,000/year and all of the conditions it’s focused on helping Patients with are things GPs should be encouraging them to manage on their own (eg. here are NHS videos that already exist to help Patients self manage colds/flu (from 2008), coughs (from 2009) and hay fever (from 2008)) yet they don’t yet offer online access to anything more than summary care records and an appointment booking facility (via their EHR provider TPP).

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I find this is about as headline baiting as Ryanair’s Michael O’Leary holding a press meeting on April the 1st and saying he’s going to build a virtual self flying plane with a budget of €80,000 that will be focused on not taking customers on journeys (the artificial intelligence will be used to determine which passengers might be gullible enough to fall for it).

Note: We’ve been using history taking technologies at 3G Doctor for 10+ years and the first thing you need to know is that this is something that is incredibly complex and requires experience to build (which is why we work with the world’s experts in this area) and the NHS ReDirect & 111 services wasted >£100 Million a year proving that triaging isn’t the easy bit where you want to be cheap and try and cut corners.

Related Post: The Evidence is in: AskMyGP is helping NHS GPs work at the top of their licence

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