Join us in Harley Street to watch the Exponential Medicine Livestream #xMed

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Tomorrow in San Diego the doors (and free livestream) open for the sold out Singularity University’s annual Exponential Medicine event. This is an incredible event that we’ve been fortunate to participate in but if you’ve never heard about it the quickest way to catch up and get inspired might be by watching the TedXMaastricht “Medicine’s future: there’s an app for that” talk given by the founder Dr Daniel Kraft MD.

I was booked to be in San Diego again but schedules here just wouldn’t permit it and I’ve had to cancel which leaves me really disappointed to be missing the event. Thankfully #XMed has an excellent Livestream so I’ll be definitely trying to watch as many of the presentations as I can.

Speakers include:

Shafi Ahmed, PhD, FRCS, Co-founder, Virtual Medics & Medical Realities
Jordan Amadio, MD MBA, Co-Founder/Partner, NeuroLaunch & Resident Physician in Neurosurgery, Emory University
Mark Bonyhadi, Head of Research, Academic Affairs, Juno Therapeutics, Inc.
Nicole Bradford, Lab Executive Director & Lab Co-Founder, Transformative Technology Labs at Sofia University
Jennifer Brea, CEO/Founder, Shella Films
Jeffrey Brewer, CEO, Bigfoot Biomedical
John S. Brownstein, PhD, Chief Innovation Officer, Boston Children’ Hospital & Professor, Harvard Medical School
Brad Burge, Director of Strategic Communications, MAPS
Shawna Butler RN MBA, Partnerships, Singularity University
Divya Chander MD PhD, Anesthesiologist/Neuroscientist, Stanford University
Asif Dhar,Principal, Deloitte Consulting LLP
Peter Diamandis, MD, Founder, XPRIZE, Singularity University
A. Dara Dotz, Principle Designer and Co-Founder, Field Ready
David Ewing Duncan, Co-founder & CEO, Arc
Ken Dychtwald, PhD, Founder and CEO, AgeWave
Lucien Engelem, Founding Director of REshape Center, Radboud University Medical Center/SUNL
Frank Fitzpatrick, Founder/CEO & Consultant, EarthTones
Brian Forde, Former Technology Advisor to the White House & Congressional Candidate
Yan Fossat, Principal Investigator, Labs for Klick Health
1eMichael J. Gelb, Pioneer in Creative Thinking and Innovation Leadership
Alan Greene, MD, FAAP, Founder, Lead, Private Medical
Rafael Grossmann, MD FACS, General, Trauma, Advanced Laparoscopic and Robotic Surgeon
Moira Gunn, PhD, Host, NPR’s Biotech Nation
Eyal Gura, MBA, Co-Founder and Chairmanm, Zebra Medical Vision Ltd
Nadine Hachach-Haram, NHS Clinical Entrepreneur Fellow & Founder, Proxime
Robert Hariri, MD, PhD, CEO & Founder, Celularity
Will Henshall, Founder & CEO, focus@will (Neuroscience Music Productivity Tools)
Stephen Hunt MD PhD, Interventional Radiologist, University of Pennsylvania
Shanon Jaccard MBA, CEO & Co-Founder, Ballast Health
Neil Jacobstein, Chair of Artificial Intelligence & Robotics, Singularity University
Naveen Jain, Founder & CEO, Viome
Milind Kamkolkar, Global Head, Next Gen Analytics
Hans Keirstead PhD, Stem Cell Biologist, Candidate for US Congress
Iya Khalil PhD, Chief Commercial Officer and Co-Founder, GNS Healthcare
Rob Knight PhD, Professor, Pediatrics and Computer Science & Engineering at University of California San Diego
Andy Kogelnik MD PhD, Director, Open Medicine Institute
Marc Koska, Inventor of the the K1 syringe
Daniel Kraft MD, Faculty Chair for Medicine, Singularity University, Founder & Chair, Exponential Medicine
Jack Kreindler MD, Founder & Director, The Centre for Health and Human Performance
Ray Kurzweil, Co-founder & Chancellor, Singularity University
Margaret Laws, CEO, Hope Labs
Josh Lee, Principle, Deloitte Monitor
Amir Lerman MD, Faculty, Mayo Clinic
John Mattison MD, Chief Medical Information Officer, Kaiser Permanente
Raymond McCauley, Chair Digital Biology & Founding Faculty, Singularity University
David Metcalf PhD, Researcher for the Institute for Simulation and Training, University of Central Florida & President, Moving Knowledge
Jamie Metzl, Senior Fellow, Atlantic Council & Author, Genesis Code
Mark Michalski, Executive Director, MGH & BWH Center for Clinical Data Science
Catherine Mohr, MD, Vice President of Strategy, Intuitive Surgical
Catherine Mohr, MD, Vice President of Strategy, Intuitive Surgical
John Nosta, Digital Health Maven, NostaLab
Bakul Patel, MBA, Associate Director of Digital Health, Food and Drug Administration/Center for Devices and Radiological Health
Nico Preston, Data Scientist & Disease Ecologist
Sonia Ramamoorthy MD, FACS, FASCRS, Professor of Surgery Chief, Division of Colon and Rectal Surgery Vice- Chair of Surgical Quality Rebecca and John Moores Cancer Centre, University of California, San Diego Health System
Jeffrey D. Rediger, MD, MDiv, Faculty, Harvard Medical School Medical Director, McLean Southeast Hospital Adult Psychiatric Program
Roman Reed, President, Roman Reed Foundation Patient Advocate
Kate Rosenbluth PhD, CEO, Cala Health
Chad Ruffin MD, Ear surgeon/Research Fellow at Indiana University, Cochlear implant recipient, CEO of RuffLab Technologies
Lee M. Sanders MD MPH, Associate Professor of Pediatrics, Stanford
Darshak Sanghavi MD, Chief Medical Officer, OptumLabs
Leslie Saxon MD, Founder & Executive Director, USC Center for Body Computing
Michael Seres, Patient Voice/Ambassador for the NHS Founder, 11Health
Jordan Shlain MD, Founder, Private Medical & Founder/Chairman, HealthLoop
Rasu Shrestha MD MBA, Chief Innovation Officer, UPMC Executive Vice President, UPMC Enterprises
Ralph Simon FRSA, Chairman & CEO, Mobilium Global Limited
Larry Smarr PhD, Director, Calit2 at UC San Diego
Brennan Spiegel MD, VR in Healthcare Pioneer Director, Health Services Research in Academic Affairs and Clinical Transformation at Cedars-Sinai
Steven Steinhubl MD, Director, Digital Medicine, Scripps Translational Science Institute
Kevin R. Stone MD, Orthopaedic Surgeon, The Stone Clinic
Jeroen Tas, Executive Vice President, Philips
Charity Sunshine Tillemann-Dick, Soprano, Double-Lung Transplant Recipient
Shoshana Ungerleider MD, Founder, Ungerleider Palliative Care Education Fund
Carin Watson, EVP Learning & Innovation, Interim VP of Marketing, Singularity University
Will Weisman, Executive Director, Conferences, Singularity University
Richard Wender MD, Chief Cancer Control Officer, American Cancer Society
John Werner, Vice President, Meta, Augmented Reality Technology
Jamie Wheal, Executive Director, Flow Genome Project
Gloria Wilder MD MPH, CEO, Core Health & VP, Innovation and Preventive Health, Centene Corporation
Vonda Wright MD, Orthopaedic Surgeon, UPMC/University of Pittsburgh Schools of the Health Sciences
Anna Young, Co-Founder & Health Maker at Pop Up Labs
Alex Zhavoronkov PhD, Co-founder & CEO, Insilico Medicine

Click here for the full programme.

I’ll working in central London most of this week and the time difference means the event (which starts at 830am) will be running from 4.30pm so it’s a great opportunity to get together after the working day. If you’re a Patient or Clinician working in the area why don’t you join me and some colleagues to watch it together and depending on numbers we can order in some food etc? An innovative clinic in London’s Harley Street with a big screen room has offered to host the gathering but we’ll have to find a bigger room (perhaps at the RSM or BMA) if we get more registering so RSVP as soon as you can:

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mHealth: Is Mobile Technology Right for Your Clinical Trial?

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I just read this April 2016 dated article by April Schultz, Content Marketing Manager at Forte (a company that offers software products and an array of services to help organizations conduct research), and found it very interesting as it’s trying to make the case that ‘mobile health should not be used for every clinical trial‘.

I think in 2017 when everyone working in the Clinical Trial industry is walking around with a supercomputer in their pocket we should have arrived at realising that every clinical trial would benefit from mobile first design (watch this presentation I gave in 2015 on How Mobile First Clinical Trials & Ratings will transform the $100B Clinical Research Industry to appreciate what this means).

mHealth Insights

“With the development of exciting new digital technologies, the clinical research industry now has the tools to make clinical trials more patient-centric than ever before. In particular, the emergence of wearable and mobile health technologies have the potential to greatly advance patient-centricity in clinical trials through real-time data collection and participant engagement”

This is a long held bugbear of mine (eg. in 2009 I wrote about how successful mHealth applications are already here) but I can’t for the life of me understand why people talk about mHealth as something new. There’s nothing I’ve worn (carried with me at all times) more than my mobile phone since I first got one in 1995.

Why do people think we’re talking about a ‘potential’ opportunity. Visit Apple’s ResearchKit website and watch some of the videos they’ve produced and you’ll soon put these outdated notions to rest:

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Yes most clinical trials are complete dinosaurs (eg. 99% of data is still collected within the four walls of a clinical research facility building) but it should be obvious that participant engagement in clinical trials is no longer something that the Clinical Research Organisations are very good at or have a monopoly on eg. check out how companies like FullPower have supported millions of their customers to share millions of nights of sleep data to not do something as simple as measure the value of a single drug but to build the Sleeptracker Artificial Intelligence Engine that is today improving the sleep for Ms. and Mr. Everyone via actionable personal insights into small adaptations that can improve sleep. In 2017 the Clinical Trial industry is being leap frogged by innovators who have adopted mobile first strategies and it’s no longer fair for companies to suggest it’s ’emerging tech’ with unproven ‘potential’ just because they’re not doing it yet…

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“However, it’s important to make objective decisions about the use of mobile technology to maintain a truly patient-centric trial design. As exciting as mobile health is, some technologies may impede the patient-centricity of a trial, making participation more difficult for some individuals”

This seems to be a crafty way to use social media to add legitimacy to a claim (I thought the embedded link would take me to somewhere that discussed why mHealth impedes the Patient-centricity of a clinical trial) but it’s just a means of promoting a very outdated position that Forte are taking (probably to protect their business interests and stop clients dropping subscriptions to their software and moving business to Apple ResearchKit partners):

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A year on and I suppose it’s positive that only one twitter user has supported the companies position:

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“Why mobile health should not be used for every clinical trial. As described above, mobile health has a lot of potential in the clinical research space and could make the clinical trial experience much more patient-centric. However, these technologies may not be appropriate tools for every trial. It’s essential to be sure you’re using tools that enhance the patient experience and ensure data integrity. For some patient populations, mobile health could prove detrimental. When determining whether mobile health is appropriate for your clinical trial, evaluate and characterize your participant population and their relationship with digital technology. Also take into account the feasibility of a mobile health study and assess whether you have the necessary resources to provide the best participant experience. Answer these key questions when considering mobile health for your study:

What is the age range of my participant population? While younger generations are very adept with technology, seniors may struggle to use mobile health applications or devices. Using mobile health for an older demographic may require research staff to provide extra training. Such trial design could also inconvenience an older patient population as it may require them to perform atypical tasks and significantly alter the way they function throughout the day.”

I think this conclusion is reached because of a couple of common misconceptions about older people being resistant to using tech and mHealth being just about smartphone apps. I think it’s important to note that there’s no reason not to think of mHealth as also including the opportunities we have to embed mobile connectivity into sensory devices that seniors already use to manage their health.

“Do the majority of my participants have smartphones? The demographics of your participant population, including age, financial status, location, as well as a variety of other factors, could influence whether they have access to a smartphone. If some of your participants don’t have smartphones, will you provide them the necessary technology? This could prove logistically difficult and limit the amount of eligible study participants in your target population.”

This position stuns me because everytime I see a rep from a drug company they’re wielding the latest tech from Apple iPads to iPhones and even Apple Watch yet when it comes to the Patients who make their clinical research possible the idea of gifting an inexpensive smartphone is just out of the question a step too far. Time to get your priorities right and at the bare minimum stop telling us it’s preposterous for you to think about investing this much in your trial participants (most trials today cost in excess of $100k per Patient so relatively the gifted mobile is insignificant).

I think it’s an endemic issue with the current design of the clinical trial industry as you would think it’s obvious that the pharma brands should just reinvest the money they save on the use of clinical research facilities and reimbursing all the travel etc but it doesn’t typically work like that because most clinical trials are still outsourced (usually to the CRO that bids the lowest price) and aren’t branded by the drug company that pays for them (this is another important reason why Apple ResearchKit ratings are going to completely disrupt today’s conventional outdated way of doing things).

“Is real-time data truly necessary for the benefit of my study? The potential of mobile health and real-time data is exciting and it’s tempting to take advantage of the technology regardless of whether your study will truly benefit from its use. Critically evaluate whether the costs of using mobile health (such as those listed above) are worth the benefits of real-time data. If the benefits fall short, it may be best to opt-out of mobile health and design a trial better suited to the needs of your study and participants.”

This is a typical mindset view of people I meet who work in the CRO industry. They can’t see any value beyond the tightly defined measurement requirements that they’re being paid to collect in their specific trial. The idea that the big data sets collected during a trial could be reviewed and processed by someone else or at a later time to draw other insights that weren’t perhaps clear when the trial was being quoted for is of no interest because most trials today are run by CROs who are focused on cost. Most trials today in Europe fail because they don’t recruit any/enough Patients or because the CRO tried to run them on too tight a shoestring.

“While mobile health technology could revolutionize how the clinical research industry conducts clinical trials, patient-centricity relies on the industry’s focus on building a positive participant experience. Regardless of whether mobile health is incorporated into study design, it’s essential to design each trial with the participant’s best interests in mind”

It’s no surprise that Mobile companies like Apple and Google are wiping the floor with brands in the CRO industry because they are so clearly out of touch with the business they’re in. How could a Mobile First approach not achieve a more ‘positive participant experience’ to what we have today where most Patients don’t know that clinical trial opportunities exist, aren’t being recommended to them by Carers, can’t find reviews of clinical trial experiences, etc, etc.

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Apple senior management have made it clear: they’re going all in on Healthcare

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Thanks to some great reporting by Christina Farr at CNBC it couldn’t be any clearer: Apple’s COO Jeff Williams can’t think of ‘anything more significant’ than to change the way health is delivered.

Add the CEO Tim Cook’s views on how the mobile health revenues will dwarf the $1.8Trillion mobile market and anyone with Apple shares is now investing in the most exciting ever healthcare venture…

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Is Apple going to buy Primary Care Clinics or have Reporters taken the bait?

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CNBC’s Chrissy Farr reports that Apple has explored buying a “medical-clinic start-up as part of a bigger push into health care” and while I think it would makes a whole lot of sense for Apple to own the company that provides the on-site medical clinic’s for their own staff and it’s clearly going to need to hire some smart people with sector experience to realise it’s goals (and even a ‘startup’ that has already raised +$100 Million is inexpensive when you have Apple’s $250 Billion cash reserves) I can’t see this being a positive strategic move for the brand that thinks it’s mHealth revenues will dwarf the $trillion smartphone market and appreciates the enormous opportunities that emerge when you don’t care about reimbursement.

I still hold out hope that Apple is going to completely side step the insurance reimbursed primary care model as that’s what’s fundamentally undermining the US healthcare system and give customers something that’s not fixated on the age old but now definitely broken office-visit-only model. If you’re not living in the US or don’t understand why having insurance that covers primary care services imagine your car insurance was sold in a way that included things like car washes, replacement tyres, oil changes, stone chip repairs, and fuel.

Checking out the Crossover Health website and while it seems the clinic design is very inline with that of an Apple Retail Store it’s a little surprising to see acupuncture treatments prominently featured on the homepage and surely if the company was trying for an exit to Apple we wouldn’t be seeing the clinicians(?) there using Microsoft Surface tablets…

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mHealth guide to the International Association for Youth Mental Health annual conference in Dublin #IAYMH2017

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The Conference brings together leaders from around the world who are dedicated to creating positive change in youth mental health. At the core of that change is young people. Through youth engagement at every possible level, IAYMH is working towards making sure that the Conference empowers young people to make a difference. This will be the 4th IAYMH Conference to take place and we are seeing more and more young people who are eager to share their learning, enrich their understanding and contribute to the positive moves being made in youth mental health

Event Agenda (PDF)

It’s rare to meet a young person without their own mobile phone so I hope we’re soon going to move beyond the idea of telling people to “go and get help” and completely redesign the outdated mental healthcare services that we subject Patients and Carers to.

It doesn’t appear that the event is being video recorded/livestreamed so here are the sessions that I’ll try and follow up on:

Co-creating a mobile youth outreach service
Trish Kane, Brisbane North
Primary Health Network, Australia

Mobile apps as data collection tools in youth mental health: an ecological momentary assessment study
Rachel Kenny, University College Dublin, Ireland

Effectiveness of a mobile app interven- tion in adolescents with first episode psychosis
Teresa Sanchez-Gutierrez, Facultad de Ciencias de la Salud. Universidad Internacional de La Rioja (UNIR), Spain

How do you tune your mood?”Using music and technology in and beyond therapy
Carmen Cheong-Clinch,
Project Tune your Mood, Australia

Gaming against stigma: a qualitative study of mental illness messages in video games
Manuela Ferrari, Douglas Mental Health University Institute, Canada

Using new and emerging technologies to design and develop an online clinical shared decision making tool for personalised mental health care
Elizabeth Scott, Brain and Mind Centre, University of Sydney, Australia

Digital media & youth mental health: youth, parent, and service provider perspectives
Brandi Bell, University of Prince Edward Island, Canada

Youth mental health services in 2025 and beyond: developing the scaffolding for services of the future
Sarah Cullinan (Ireland) and Liz Burgat (Australia).

Technology: how can we harness it to improve young people’s wellbeing?
Derek Chambers (Ireland) and Sophie Potter (Australia)

How digital technology removes stigma, increases access and improves outcomes for young people seeking mental health support
Aaron Sefi, XenZone, UK

Co-creating a mobile youth outreach service
Trish Kane, Brisbane North Primary Health Network, Australia

CAMHS Communications Project
Ian Power, Executive Director of SpunOut

Development and valida- tion of MyLifeTracker: A rou- tine mental health outcome measure for young people aged 12 to 25 years
Benjamin Kwan, University of Canberra, Australia

“What is the point of life?”: An interpretative phenomenological analysis of suicide in young men with first-episode psychosis
Ruchika Gajwani, University of Glasgow, UK

I share therefore I am, an exploration of online self-disclosure on Facebook
Colman Noctor, St Patrick’s Mental Health Services and Trinity College Dublin, Ireland

A meaningful conversation: explaining youth mental health to intelligent machines so that they can explain it back (better) to us
Matthew Hamilton, Orygen, Australia

Talk or text? Patterns and challenges associated with face- to-face and electronic communication in youth at-risk for and in the first episode of psychosis
Christopher Bowie, Queen’s University, Canada

General practitioners’clinical expertise in managing suicidal young people: implications for continued education
Maria Michail, University of Nottingham, UK

Raising the bar for youth suicide prevention
Vivienne Browne, Orygen, Australia

‘If I could see on a piece of paper options for treatment that would just be insane’: shared decision making in youth mental health
Magenta Simmons, Orygen, Australia

Exploring mental health and technology use among hard to reach groups of young people
Roisin Doolan, ReachOut Ireland

Using virtual worlds to deliver therapy in psychosis
Andrew Thompson, Univer- sity of Warwick, UK

ADHD: is there an app for that?
David Hogan, University College Dublin, Ireland

Project Synergy: providing the right care, at the right place, first time, every time
Ian Hickie, University of Sydney, Australia

Can social media play a positive role for young adults with eating disorders? an investigation of the mixed impact of social media use
Anna -Sophia Warren, King’s College London, UK

Emerging trends in technology for young people’s mental health and wellbeing
Mario Alvarez

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“Apple Watch is the most used heart rate monitor in the world”

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Apple Special Event, September 2017.

The new devices are great but I think the biggest development at Apple in 2017 will remain the “Today at Apple we’re going to be learning about…” and the renaming of the retail stores as ‘town squares’ is going to be key to communicating this. Recognition of where Apple is already with regard to biomonitoring makes it obvious why Tim Cook is so certain about the need to move beyond today’s insurance/reimbursement model (today’s insurance model won’t make any sense when insurers can via Apple access the 24×7 health information emanating from your entire family).

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When I shared my 2009 prediction that we were about to enter a decade that would be defined by the convergence of healthcare to mobile (‘we’ll drop the Health in mHealth not the m’) most thought I was crazy (healthcare is a conservative industry and change happens but takes decades to actually happen) but today the world’s biggest cardiology firms are having crisis meetings because the most used heart monitor in the world is an inexpensive mobile connected, waterproof wearable device sold in an Apple retail store and the easiest to use and most inexpensive clinical grade ECG machine works with an iPhone/iPad/Watch and can be ordered now by pressing a few buttons on your phone and Amazon will deliver it to you tomorrow.

Related posts:

Apple is getting to decide which Medical Device brands Win or Lose…

Will established medical device manufacturers become more than iPhone accessory brands before the mHealth decade is out?

How would the Born Mobile generation redesign that Patient Care Experience?

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

mHealth Insights

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

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

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

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

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

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

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

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

Tim OReilly Quote

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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