The future of doctors

The Economist this week has an important leader and report on the future of work that has key implications for technology adoption by clinicians.  It is well worth reading in full. For those who cannot, the very basic issue raised is that technology is again replacing labour with capital. In the past this has always resulted in higher value jobs being created. This time though, there are many suggesting that it might just be different: some people will run out of road.

The Economist article does not go into the detail of many individual professions, however the description of the types of work most suited to this next wave of automation does cover much of the field of medicine (as, coincidentally I argued recently in my predictions for 2014). A particularly relevant section in the article is:

The machines are not just cleverer, they also have access to far more data. The combination of big data and smart machines will take over some occupations wholesale;

…which supports my contention:

And just think too, what correlations a single system overseeing the treatment of tens of thousands of people, with access to regular vital signs and other information on progress for each one of them, might be able to spot to enable it to improve patient care, that elude the best of GPs treating far fewer. Doubtless increasing genomic analysis & knowledge will enhance this too. –

So how should doctors react? Clearly one view, which seems still to be the minority approach (and that Telehealth & Telecare Aware is really all about trying to encourage) is to use existing technology, like telehealth and mHealth, to improve healthcare and reduce its cost. Automation is expensive so investors will look for those professions where the expected returns are highest; with this approach, the greatest benefits from automation will lie in other professions, so the greatest impact of automation on the medical profession will be delayed.

The alternative, which still seems to be the majority view, is to argue for the continuation of current practice and ignore the benefits of technology (and ignore the evidence that demographic changes will mean that the ratio of careworkers to those requiring care will render the current system infeasible anyway). That way will keep the cost of care relatively high and promote a crisis in the delivery of healthcare relatively soon, making early profound medical automation particularly attractive.

Of the two, from a patient point of view, earlier rapid automation looks superficially attractive although the chaos of rapid change will likely create many challenges that make it less attractive – let’s hope that the leaders in the medical profession, and those who appoint them, read the Economist this week and recognise the benefits to them (as well as to patients) of early technology adoption.

Rock Health opens new HQ to wonder, sums up 2013

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/RockHealth_Photo©BruceDamonte_02.jpg” thumb_width=”175″ /]As seems to be the way in the West Coast Digital Health scene, the opening of accelerator/funder Rock Health’s new HQ in the Mission Bay district of San Francisco gained more heavy-breathing hype than its mostly positive 2013 digital health investment report. The soireé during last week’s JP Morgan Healthcare Conference, glowingly reported in Xconomy with plenty of pics of the achingly trendy interior design and Health Digerati/D3Hers (Digital Health Hypester/Hipster Horde) at play also was a demo of a different type–how insular interests interlock and circle in Fog City. Star guest San Francisco Mayor Ed Lee spearheaded the remaking of the district into a life sciences/tech center; the Xconomy-moderated panel discussion paired him with Rock Health founder/CEO Halle Tecco and Alexandria Real Estate CEO Joel Marcus;  Alexandria underwrites Xconomy and has a huge investment in life sciences real estate; the new Rock Health HQ is on the ground floor of an Alexandria-owned building. Of course Mission Bay is now hyped as the ‘US Digital Health Hub’ for all those Rock Health-accelerated, funded startups. It does give one pause: how much of this is substance, or is it the peak of style before tipping into The Trough of Disillusionment? The tartest takedown on this is courtesy of Neil Versel’s Meaningful HIT News column. Pointed pokes abound: at Silicon Valley for its health tech failures (Google Health among them), the odd duplications (Google-funded telemedicine provider Doctor On Demand sounds like American Well, Ameridoc, etc.) and the even odder lack of considering integration with payer/provider systems and workflows.  Keep wasting your money, Silicon Valley venture capitalists (Note to Neil: the circular swings seem to be a feature of Alexandria’s properties–they’re present at Alexandria Center NYC too. Image © Bruce Damonte/Studios Architecture)

With that aside, the highlights of the Rock Health Digital Health Funding Year In Review were generally positive, but some of them, looked at critically, weren’t, even when depicted in attractive charts and graphs: (more…)

Certifying medical apps (contd.)

No sooner had I given my keyboard the final tap to publish the conclusions of my work yesterday on medical apps than the first item hit my inbox that suggest that certification is a flawed proposition.

The suggestion of this iMedicalApps article is that the Happtique saga has shown certification to be impossible. Instead it is suggested that people make up their own minds based on peer review on sites (you’ve guessed it) such as theirs, and a greater understanding of apps.  The key paragraph for me is (more…)

Net neutrality’s end and effect on telehealth (US)

With its recent decision in ending ‘net neutrality’ as directed in the FCC‘s 2010 Open Internet Order, the (Washington) DC Circuit Court of Appeals has changed the playing field for mHealth. The FCC regulation treated internet service providers (ISPs) like telecommunications companies by enforcing telecom ‘common carriage’ requirements that prevented ISPs from blocking or discriminating against types or providers of internet traffic. The current situation is now a double-edged sword for the ISPs: on one edge, ISPs such as Verizon, Comcast or Charter won, because they now can charge fees to, slow down or demand revenue sharing of high-demand content originators (Netflix) which also use a lot of bandwidth; the other edge is that the court affirmed that the FCC regulates the relationship between the two.

The meaning for mHealth? The amount of health data carried over the internet is growing exponentially and dependent on speed. If internet carriage can be held up for small providers to make way for high-paying content, it can and will change the revenue model for mHealth. From clinicians to fitness buffs, everyone wants their data right now. It may impact lower-income people and home health which uses internet tracking for healthcare. But it may also have a stimulative effect on ISPs–more bandwidth and speed means more revenue. How does this compare to UK/Europe/Asia/Oceania regulation? What do you see as the outcome?

More here: mHealth after net neutrality: Innovation drain or gain? (GovernmentHealthIT)Three Dangers of Losing Net Neutrality That Nobody’s Talking About (Wired)Net Neutrality is Dead! Long Live Net Neutrality! (Wall Street Journal)  And an advocate of Congress getting involved (!) is Greg Slabodkin in FierceMobileHealthcareHat tip to Editor Charles Lowe for pointing out the potential effect on mHealth.

‘Candy Crushing’ stroke rehab

A development that deserves more attention is the use of ‘gamification’ in rehab. In one program, it’s using a combination of incentives, brain stimulation and robotics. The popular Candy Crush Saga game uses a moving candy target, rewards (to higher levels) and reduced reaction times at the harder levels. The Manhasset, New York-based Feinstein Institute for Medical Research at North Shore-LIJ Health System is testing this notion with rehab for paralyzed limbs. Instead of concentrating on training other limbs to compensate for the paralyzed ones, the Non-Invasive Stroke Recovery Lab program focuses on gaining more movement in the affected limbs. Using robots to move the limb at first, then sensing when the patient is moving them on their own, they gradually train the brain to move the limb for whatever motion can be achieved. Therapists use these programs with patients to gain the “just-right” amount of challenge to maintain motivation and attention. According to their website, several programs are being tested using devices for the wrist, shoulder-elbow, hand and an anti-gravity one for the shoulder. A fifth one is in early development to improve gait post-stroke. Also in test is coupling this with trans-cranial direct current stimulation. mHealthNews. Feinstein Institute and researcher (Bruce Volpe) website.

Drug manufacturer Pfizer is also testing gamification for a different sort of rehabilitation–using Evo Challenge from Akili Interactive Labs in determining the status of and improving the abilities of those with cognitive impairments, Alzheimer’s disease (with and without amyloid in the brain) and ADHD. The game, which involves navigation around obstacles and rewards, is designed to improve the impaired processing of cognitive interference, a/k/a distractions. MedCityNews

Are health apps ‘discriminating’ against developing countries?

The ‘discrimination’ noted here comes from a study published this month in the Journal of Medical Internet Research’s mHealth and uHealth (JMIR), which attempts to cross-reference ‘high-income country’ and ‘low- and middle-income countries’ diseases with the number of apps available for those diseases. The count is based on a review of literature and apps stores. Unfortunately the study, as reported in FierceMobileHealthcare, sounds quite broad-brush. In general, they assert, there are more apps for high-income country diseases such as dementia and ischemic heart disease. Apps for low-income country diseases, such as lower respiratory diseases and malaria, are fewer. Exceptions are apps for HIV/AIDS, which disproportionately affects low income countries but are abundant, and the dearth of apps for  trachea, bronchus and lung cancers prevalent in high and middle-income countries. No mention of whether certain diseases are more effectively controlled by app usage than others, though. JMIR study.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/screen-shot-2014-01-10-at-3-00-24-am.png” thumb_width=”150″ /]Better than a ‘malaria app’ would be eradication, and a step towards this is rapid, accurate and inexpensive analysis of this increasingly drug-resistant disease. A Newcastle, UK company, QuantuMDx, founded by molecular biologist Jonathan O’Halloran, will be crowdfunding a miniature malaria blood testing device called Q-POC, which takes a blood sample; through DNA sequencing provides a malaria diagnosis and screens for drug resistance in a record 15 minutes, without running water or stable electricity. The crowdfunding on Indiegogo starting 12 February is to fund the device through clinical trials. Eventual markets are Brazil, India and Africa, then to extend the technology to TB, STDs and cardiovascular disease. MedCityNews

Council funded care receivers cut by 1/3, half a million lose service

With the Government’s Care Bill currently working its way through the UK parliament, a discussion paper has been published showing that over the past five years the Councils have reduced the number of people with “moderate needs” receiving Council funded care by one third. [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/Infirm-person.jpg” thumb_width=”150″ /]The paper, produced by the Personal Social Services Research Unit at the University of Kent and the London School of Economics, paints a dire picture of how budget cuts have squeezed Councils into cutting the number of people eligible for care.

Fair Access to Care Services guidelines were introduced in the UK in 2003 in an attempt to provide a common framework for eligibility for state funded care services (more…)

Your Tuesday robot fix

Our first ‘robot fix’ for 2014 is a triple from Armed With Science (US Department of Defense):

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/scr_schaft.jpg” thumb_width=”150″ /]The DARPA Robotics Challenge Trials 2013, held 20-21 December in warm Homestead, Florida, turned out to be an early Christmas present for eight finalists out of 16 competitors. The top by far was the Robot S-One (left) from SCHAFT Inc. The remaining finalist developers in order were : Florida Institute for Human & Machine Cognition, Carnegie Mellon University + National Robotics Engineering Center, Massachusetts Institute of Technology + Computer Science and Artificial Intelligence Laboratory, NASA Jet Propulsion Laboratory, TRACLabs Inc., Worcester Polytechnic Institute and Lockheed Martin Advanced Technology Labs. They will divide $8 million in funding to prepare for the final DARPA competition for a $2 million award at end of this year. Article. Previously in TTA: DARPA field competition

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/TALOS_Future_Army_Soldier_Display_Wide-600X350-526×350.jpg” thumb_width=”150″ /]The TALOS is an outgrowth of both exoskeleton research and body armor, in development by the US Special Operations Command. “The goal is to provide operators lighter, more efficient full-body ballistics protection and super-human strength.” The suit has antennae and computers to provide enhanced situational awareness; cooled and heated; replete with sensors to monitor heart rate, temperature and body position–and may be able to deliver oxygen and hemorrhage controls. Research on this may also advance assistive exoskeletons for the disabled or prosthetics. Socom Leads Development of ‘Iron Man’ Suit

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/Overrun-by-Robots1-183×108.jpg” thumb_width=”150″ /]’Start ’em young!’ could be the rallying cry of the 2014 VEX All-American Robotics Competition. Sponsored by the US Army and the Robotics Education Competition Foundation, the competition is designed to stimulate STEM (science, technology, engineering, math) education prior to university. This article is about a high school and middle school competition in Texas. Overrun by Robots and STEM Powered by Robotics

Driving up medical app usage in the UK – part III: conclusions

This series of posts covers some work I have been doing over the past three months: attempting to answer the question of how best to improve the perception by clinicians and patients of the efficacy of health-related apps. This work has been done for the i-Focus project, part of the Technology Strategy Board’s dallas programme.

Part I briefly summarised the EU regulations covering health-related apps. The point was made that any health-related app must comply with data protection and consumer protection requirements, irrespective of whether the risk level is sufficient for it to be classified as a ‘medical device’. Where an app is classified as a ‘medical device’ it also has to be classified so that the appropriate adjudication work can be determined for it to receive a CE mark (Class I, lowest risk, requires least investigation; Class III, highest risk, requires greatest investigation).

Part II summarised the principal findings from discussions with a very wide range of potential stakeholders, from patients to consultants, and from individual app developers to chief executives of app curation companies.  The key findings were:

  • There is currently little academically-endorsed evidence of medical app efficacy, though much anecdotal evidence;
  • There are too many bogus apps around;
  • There are safety worries – for example where clinicians are using unregulated apps to manage medication dosage;
  • The process for obtaining certification is unclear;
  • Some app developers are ignoring data privacy legislation;
  • The business model for achieving sales via the NHS is not well understood.

In addition, a theme running through both posts is that there is an international dimension to this issue, with some countries, notably the US, well advanced in certain aspects.

From these findings, four key conclusions emerge: (more…)

Google Contact Lens for diabetics in development

Breaking news

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”130″ /][grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/01/Hand-holding-zoomed-in.jpg” thumb_width=”150″ /]It’s unusual that a smart contact lens that measures blood glucose makes lead worldwide news while it is still in clinical studies, but when it is from Google, The Gimlet Eye wants to be the first to try it.

Google’s blog and a single interview they granted to the Associated Press have confirmed the earlier rumor on a blood glucose-measuring contact that first appeared last Friday [TTA 10 January; item from FierceMedicalDevices in the 4th paragraph, Google’s meeting with FDA on a powered contact lens]. The AP article also confirmed its genesis in University of Washington/NSF research. The Google lens under development might have tiny LED lights that visually advise the wearer on their glucose levels, as well as transmit the information via a wireless chip. Last week’s speculation was on a Google Glass-like display à la iOptik.

Research specifically directed towards continual monitoring of the blood glucose in tears has been ongoing and other companies have developed powered lenses. A key question is the equivalence and accuracy of monitoring tears versus blood. (more…)

Royal Society of Medicine events that should appeal

This year the RSM kicks off with Recent developments in digital health on 27th February, in association with the Royal Academy of Engineering. This event aims to update attendees on all the latest advances in the field of digital health that will affect care delivery. Perhaps the highlight of the day will be the demonstration of a smartphone that, on its own, can measure a person’s systolic and diastolic blood pressures, pulse, blood oxygen saturation, respiration and temperature – as this is a facility that will appear on the next generation of smartphones, the discussion on how app developers and the medical profession will respond will be particularly interesting. In addition there will be presentations by leading thinkers in the field on topics like big data, mHealth, medical apps, point-of-care-testing, genomic technology, evidence gathering and NHS England’s digital priorities.

Another event, that sold out early last year, is our medical apps day, this year on 10th April, entitled  (more…)

2013 fitness tracker sales…and a personal experience

As someone who has been wearing a Jawbone UP for some five months, I was interested to read that Mobihealthnews reports on a (pay-walled) survey that shows Fitbit, Jawbone and Nike as sharing 97% of the activity tracker market in 2013 present, the split being 68%, 19% & 10%, respectively (the rest 3%).

At the same time that news agency, along with others, reports on the rash apparently created by the recently-introduced Fitbit Force on some people. Closer to home, I have had cause to scrutinise (more…)

Upcoming CUHTec courses in March (UK)

There are two upcoming CUHTec courses in March on Learning Disability Services and Digital and Mobile Telecare. These strategy courses are for commissioners, service development managers, trainers and others with responsibility for telecare and AT service planning and delivery.

  • CUHTec telecare strategy course: Learning Disability Services. Culture Lab, University of Newcastle, Thursday 20 March 2014
  • CUHTec telecare strategy course: Moving to digital and mobile telecare. Culture Lab, University of Newcastle, Friday 21 March 2014

To find out more and to book a place please visit CUHTec’s website. Thanks to reader Prof. Andrew Monk, director of The Centre for Usable Home Technology (CUHTec), for the update.