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 healthmail.ie) and from one glance at the Clinics website it’s clear paper based records are still being used there.

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

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

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

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

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

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

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

 

Key takeaway:

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

 

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

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

 

 

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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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The time to innovate with mHealth is now

I often hear some version of the phrase “Yeah but you don’t understand it’s so complicated we just can’t do that” from medics when they try to justify their reasons for not moving beyond the office visit only model and it really bugs me because the vacuum left by their inactivity is enabling a growing number of convenient health services that are operated by businesses that are much more about making profits than providing care.

This week I read a couple of news items that I think will help Rural Community Pharmacists and GPs realise the need to make the change before things get a lot worse for them personally:

Rural Community Pharmacists:

Political leaders don’t understand what you do and are so deluded they actually think you can be replaced with an App:

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The global Pharmacy giants that the politicians are hoping will deliver them this rosy future (and who have already made billions from sales through their mHealth apps) are doing plenty of things that would concern Patients/Carers eg. Walgreens (parent company of Boots) fell hook line and sinker for Theranos (backing it with their reputation and a $140 Million investment) and the boss at Lloyds Pharmacy (owned by McKesson) has paid the online retail giant Amazon to put a recording device in the companies HQ boardroom

GPs:

This week I read in the Australian Doctor that Dr Aifric Boylan (an Irish Locum GP who felt forced to emigrate to Australia after feeling “very uncertain about my future career security” and “mentally exhausted by the burden of debt which we saw little prospect of ever repaying”) has started an online service that offers to remotely provide one of the most complex and valuable roles a Family Doctor offers (direct referrals to a range of specialists).

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We live in times of great change and there’s clearly a need to urgently modernise medical education and ensure that the GP career is viable as an unfortunate side effect is that medics will approach innovative ways of doing their job only once they’re financially vulnerable and more vulnerable to being pressurised to nickel and dime things in ways that might be very profitable despite being obviously “controversial and confronting” and possibly dangerous for Patients.

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The end of Smartphone innovation or is it?

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I think this The End of Smartphone Innovation post by Benedict Evans will confuse lots of people as to the opportunity we still have in Mobile. (HatTip: @Bart)

mHealth Insight

I think the key thing to understand is that Augmented Reality (AR) is the next (8th) mass media and you can do lots of it on the 7th Mass Media. Tomi Ahonen was the first to think up and explain this:

Once you appreciate AR as the next mass media it becomes quite obvious that smartphone innovation isn’t going to end just as innovation in PCs didn’t end back in 1995 when I got my first Mobile phone or innovation in TVs didn’t end when the Internet was invented – as presumably if it had your TV would still look like this natty Sony CRT one from 1989:

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So what do I think will happen?

Every year analysts will get headlines by predicting the end of a period innovation in smartphones.

Every economically viable adult on the planet is getting a smartphone and mobile technology is getting increasingly embedded into devices that we all use.

We’re going to do lots of AR with our Smartphones and SIRI/GoogleNow enabled hearing aides that we will look back at and think ‘how did I ever live without that?’.

Airpods

AR will arrive and it will totally transform the concept of privacy. Everyone you ever meet will be able to identify you and do things that will make you feel very uncomfortable such as detect/diagnose things about your health. It will make the idea of going to visit a Doctor who is a stranger unthinkable.

If you want to prosper in this future you need to start exercising your imagination so go out and invest in your future today by treating yourself to the latest Smartphone and hand up your old one to someone who hasn’t got one yet because most of us aren’t using even 10% of the potential of the smartphones that are already in our pockets (many of us aren’t even being allowed to!) something that became clear to my colleague five years ago when together we watched this amazing guy in an Apple store repair a SpaceX engineers iPhone (watch this video of Joseph Danowsky showing David Pogue how he uses his iPhone to get the idea and imagine what happens when the sound is reaching the user via a comfortable silicon device that’s invisibly lodged in the ear)…

Blind Apple Store Salesman fixing a technical problem for a Space X Engineer

Related Posts:

Does Tim Cook have plans to define this decade by making “iPhone” synonymous with “mHealth”? (March 2015)

Apple CEO thinks mHealth revenues will dwarf the $Trillion Smartphone market (August 2016)

Communities Dominate Brands: Augmented Reality Reached 3 Billion Dollars in Annual Revenues, Powered by Pokemon Go,  Augmented Reality will be the next mass media. (@TomiAhonen March 2017)

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Scam Block: a neat Mobile Operator innovation from T-Mobile that will help Patients

SCAM BLOCK WITH AI DATA GATHERING

The mobile operators and their trade organisation have proved themselves to be spectacularly clueless when it comes to understanding the big mHealth opportunities but I think this caller ID checking Scam Block service introduced by T-Mobile is a very positive move.

It’s in no way going to prevent all attempts (eg. concerted manual efforts to scam specific Patients who identify themselves through online review sites etc are probably not going to be effected as they’re done on an individual basis rather than by robocallers) but Patients are very vulnerable as so many EHR databases (containing telephone numbers) have been hacked and there’s enormous scope for tech like this to be expanded to also end fraudulent practices like caller ID spoofing.

For a start wouldn’t it be great if the customer could with a simple swipe redirect the call to a roboanswer service run by T-Mobile to collect intelligence on scams and waste scammer time.

T-Mobile Introduces New Network Technology to Protect Customers from Phone Scams

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Mobile updates to the 4ooo year history of Medicine

2001 BC Here, eat this root.
1000 AD That root is heathen. Here, say this prayer.
1850 AD That prayer is superstition. Here, drink this potion.
1920 AD That potion is snake oil. Here, swallow this pill.
1945 AD That pill is ineffective. Here, take this penicillin.
1955 AD Oops… bugs mutated. Here, take this tetracycline.
1960-1999 AD 39 more “oops”… Here, take this more powerful antibiotic.
2000 AD The bugs have won! Here, eat this root.
2010 AD Call or SMS. Failing that Google It.
2020 AD Let your iPhone take care of it.

The History of Medicine. HatTip: @DrAliLynTan

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